#4 OB EAQ Intrapartum Complications

he nurse is caring for a client who has had a spontaneous abortion. Which complication should the nurse assess this client for? 1. Hemorrhage 2. Dehydration 3. Hypertension 4. Subinvolution

1. Hemorrhage (Hemorrhage may result if placental tissue is retained or uterine atony occurs. There is no indication that the client has been deprived of fluids. Hypotension, not hypertension, may occur with postabortion hemorrhage. Subinvolution is more likely to occur after a full-term birth.)

A pregnant client experiences an episode of painless vaginal bleeding during the last trimester. What does the nurse suspect is the cause of this bleeding? 1. Placenta previa 2. Abruptio placentae 3. Frequent sexual intercourse 4. Excessive alcohol ingestion

Placenta previa (As the lower uterus contracts and dilates, the edge of the low-lying placenta separates from the walls of the uterus, thereby opening placental sinuses and allowing blood to escape. Abruptio placentae is usually accompanied by intense pain. Frequent sexual intercourse is probably not the cause unless placenta previa is present. Alcohol ingestion does not cause painless vaginal bleeding.)

A client being prepared for surgery because of a ruptured tubal pregnancy complains that she feels lightheaded. Her pulse is rapid, and her color is pale. Which condition does the nurse anticipate as a common complication of a ruptured tubal pregnancy? 1. Shock 2. Anxiety 3. Infection 4. Hyperoxygenation

1. Shock (Hemorrhage can result from a ruptured tubal pregnancy, and shock may ensue. Although the client may be very anxious, the signs and symptoms are those of hemorrhagic shock. There is no data, such as fever or a rising white blood cell count, to support the conclusion that the client has an infection. The data does not support a hyperoxygenated state.)

The nurse is assessing a client with worsening preeclampsia. What is the most significant clinical manifestation of severe preeclampsia? 1. Polyuria 2. Vaginal spotting 3. Proteinuria of 3+ 4. Blood pressure of 130/80 mm Hg

3. Proteinuria of 3+ (As preeclampsia worsens, blood pressure and edema increase and degenerative changes of the kidney cause increasing proteinuria (3+). With worsening preeclampsia, oliguria, not polyuria, is expected. Vaginal spotting is not a sign of worsening preeclampsia. A blood pressure of 130/80 mm Hg is within acceptable limits; however, there is insufficient information to determine whether it is increased in this client.)

A nurse teaches the warning signs that should be reported throughout pregnancy. Which statement by the client indicates an understanding of the prenatal instructions? 1. "I'll call the clinic if I have abdominal pain." 2. "Mild, irregular contractions mean that my labor is starting." 3. "I need to call the clinic if my ankles start to swell at night." 4. "A whitish vaginal discharge means that I'm getting an infection."

1. "I'll call the clinic if I have abdominal pain." (Abdominal pain should be reported immediately, because it may indicate abruptio placentae or the epigastric discomfort of severe preeclampsia. Mild, irregular contractions are preparatory (Braxton Hicks) contractions, which are common and are believed to help prepare the uterus for labor. Swelling of the ankles at night is physiologic edema of pregnancy, caused by pressure of the gravid uterus that impedes venous return; it disappears with elevation of the legs. Leukorrhea occurs during pregnancy as a result of increases in the estrogen and progesterone levels, which cause the vaginal discharge to become more alkaline.)

A 16-year-old primigravida at 32 weeks' gestation is admitted to the high-risk unit. Her blood pressure is 170/110 mm Hg and she has 4+ proteinuria. She has gained 50 lb (22.7 kg) during the pregnancy, and her face and extremities are edematous. Which complication is this client experiencing? 1. Eclampsia 2. Severe preeclampsia 3. Chronic hypertension 4. Gestational hypertension

2. Severe preeclampsia (With severe preeclampsia, arteriolar spasms result in hypertension and decreased arterial perfusion of the kidneys. This in turn causes an alteration in the glomeruli, resulting in oliguria and proteinuria, retention of sodium and water, and edema. Eclampsia is characterized by seizures; there is no data to indicate that the client is having or has had seizures. Chronic hypertension is hypertension diagnosed before pregnancy or before 20 weeks' gestation. Hypertension that is first diagnosed during pregnancy that persists beyond the postpartum period is also considered chronic hypertension. Gestational hypertension is hypertension that first occurs during midpregnancy without proteinuria; it is definitively diagnosed when the hypertension resolves 12 weeks after delivery.)

A pregnant client with type 1 diabetes is visiting the prenatal clinic for the first time. The client is at risk for serious complications. What is the most important goal during pregnancy to decrease risk of complications? 1. Monitor and control blood glucose levels. 2. Limit pregnancy weight gain to an average of 25 pounds. 3. Preplan for a cesarean section. 4. Show up for all perinatal office visits.

1. Monitor and control blood glucose levels. (In any prenatal situation, the goal is an optimally healthy mother and newborn. Monitoring to control blood glucose levels is the most important goal to a healthy mother and baby. By controlling a healthy glucose level, other complications are less likely to occur. The mother can best manage glucose levels by controlling weight gain and monitoring levels regularly. A woman who is average weight before getting pregnant can gain 25 to 35 pounds after becoming pregnant. Underweight women can gain 28 to 40 pounds. Overweight women should gain no more than 15 to 25 pounds during pregnancy. Preplanning for a cesarean section is realistic due to the larger than average size of babies delivered by diabetics but is not a risk reducing factor during the pregnancy. Perinatal office visits will help the mother monitor and identify early interventions that can be implemented to maintain blood glucose control. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.)

A 16-year-old primigravida who appears to be at or close to term arrives at the emergency department stating that she is in labor and complaining of pain continuing between contractions. The nurse palpates the abdomen, which is firm and shows no sign of relaxation. What problem does the nurse conclude that the client is experiencing? 1. Placenta previa 2. Precipitous birth 3. Abruptio placentae 4. Breech presentation

3. Abruptio placentae (Rationale: Abruptio placentae indicates premature placental separation; the classic signs are abdominal rigidity, a tetanic uterus, and dark-red bleeding. Placenta previa occurs with a low-lying placenta and is manifested by painless bright-red bleeding. Information on cervical effacement, dilation, and station is required before the nurse can come to this conclusion. Fetal presentation is not related to the client's signs and symptoms.)

A client who is in labor is admitted 30 hours after her membranes ruptured. Which condition is this client at increased risk for? 1. Cord prolapse 2. Placenta previa 3. Chorioamnionitis 4. Abruptio placentae

3. Chorioamnionitis (The risk of developing chorioamnionitis (intra-amniotic infection) is increased with prolonged rupture of the membranes; foul-smelling fluid is a sign of infection. A prolapsed cord usually occurs shortly after the membranes rupture, not a day and a half later. Placenta previa is an abnormally implanted placenta; it is unrelated to ruptured membranes. Premature separation of the placenta is unrelated to ruptured membranes.)

While mopping the kitchen floor, a client at 37 weeks' gestation experiences a sudden sharp pain in her abdomen with a period of fetal hyperactivity. When the client arrives at the prenatal clinic, the nurse examines her and detects fundal tenderness and a small amount of dark-red bleeding. What does the nurse conclude is the probable cause of these clinical manifestations? 1. True labor 2. Placenta previa 3. Partial abruptio placentae 4. Abdominal muscular injury

3. Partial abruptio placentae (Typical manifestations of abruptio placentae are sudden sharp localized pain and small amounts of dark-red bleeding caused by some degree of placental separation. True labor begins with regular contractions, not sharp localized pain. There is no pain with placenta previa, just the presence of bright-red bleeding. There are no data to indicate that the client sustained an injury.)