Ch 19: Nursing Management of Pregnancy at Risk

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? a. prevent maternal D antibody formation. b. promote maternal D antibody formation. c. stimulate maternal D immune antigens. d. prevent fetal Rh blood formation.

a. prevent maternal D antibody formation.

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

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)?

strong abdominal cramping

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

b. Assess the client's vital signs.

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? a. An ultrasound will be done to reassess the correctness of gestational dates. b. Lab work will be drawn to rule out acid-base imbalances. c. Encourage rest and increased fluids d. Morning sickness is common in pregnancy

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

The nurse is comforting and listening to a young couple who just suffered a spontaneous abortion (miscarriage). When asked why this happened, which reason should the nurse share as a common cause?

chromosomal abnormality

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? a. dextrose 5% and water b. albumin c. 0.45% sodium chloride d. normal saline

d. normal saline

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

d. preterm rupture of membranes followed by preterm birth

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?

diminished reflexes

During pregnancy a woman's blood volume increases to accommodate the growing fetus to the point that vital signs may remain within normal range without showing signs of shock until the woman has lost what percentage of her blood volume? a. 40% b. 50% c. 20% d. 30%

a. 40%

A nurse is preparing a nursing care plan for a client who is admitted at 22 weeks' gestation with advanced cervical dilation (dilatation) to 5 cm, cervical insufficiency, and a visible amniotic sac at the cervical opening. Which primary goal should the nurse prioritize at this point? a. Bed rest to maintain pregnancy as long as possible b. Education on causes of cervical insufficiency for the future c. Notification of social support for loss of pregnancy d. Give birth vaginally

a. Bed rest to maintain pregnancy as long as possible

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

a. assessing the amount and color of the bleeding

A high-risk pregnant client is determined to have gestational hypertension. The nurse suspects that the client has developed preeclampsia with severe features based on which finding? a. blurred vision b. blood pressure of 150/100 mm Hg c. proteinuria of 300 mg per 24 hours d. mild facial edema

a. blurred vision

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?

amniocentesis

A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that:

as long as she receives Rho(D) immune globulin, there is no limit

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

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

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. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best? a. "I know that it is sad but the pregnancy must be terminated to save your life." b. "The choice is up to you but the health care provider is recommending an abortion." c. "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." d. "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out."

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

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? a. Attach EFM. b. Establish IV access. c. Rule out shock. d. Rule out pregnancy.

c. Rule out shock.

A nurse is assessing a pregnant client for the possibility of preexisting conditions that could lead to complications during pregnancy. The nurse suspects that the woman is at risk for hydramnios based on which preexisting condition? a. late maternal age b. hypertension c. diabetes d. isoimmunization

c. diabetes

What would be the physiologic basis for a placenta previa? a. a placenta with multiple lobes b. a loose placental implantation c. low placental implantation d. a uterus with a midseptum

c. low placental implantation

Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? a. ondansetron b. oxytocin c. methotrexate d. promethazine

c. methotrexate

A woman at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination would lead to a diagnosis of placental abruption (abruptio placentae)? a. Sonogram shows the placenta covering the cervical os b. Uterus is soft between contractions c. Fetus is in a breech position d. Onset of vaginal bleeding was sudden and painful

d. Onset of vaginal bleeding was sudden and painful

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination, there is an elevated human chorionic gonadotropin (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 condition? a. ectopic pregnancy b. placenta previa c. placental abruption (abruption placentae) d. gestational trophoblastic disease

d. gestational trophoblastic disease

A client has been admitted with placental abruption (abruptio placentae). She has lost 1,200 ml of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? a. grade 1 b. grade 3 c. grade 4 d. grade 2

d. grade 2

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome?

hemolysis, elevated liver enzymes, low platelet count

A nursing instructor identifies which factor as increasing the chances of infection when coupled with prolonged labor?

premature rupture of membranes

A pregnant client with hyperemesis gravidarum needs advice on how to minimize nausea and vomiting. Which instruction should the nurse give this client?

Eat small, frequent meals throughout the day.

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? a. fetal distress related to hypoxia b. central nervous system (CNS) involvement c. infection d. cord compression

a. fetal distress related to hypoxia

A nurse is providing care to a multiparous client. The client has a history of cesarean births. The nurse anticipates the need to closely monitor the client for which condition? a. placenta accreta b. placental abruption (abruptio placentae) c. oligohydramnios d. preeclampsia

a. placenta accreta

A woman has presented to the emergency department with symptoms that suggest an ectopic pregnancy. Which finding would lead the nurse to suspect that the fallopian tube has ruptured? a. referred shoulder pain b. nausea c. breast tenderness d. vaginal spotting

a. referred shoulder pain

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? a. respiratory rate b. hemoglobin c. ability to sleep d. urine protein

a. respiratory rate

The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client? a. Sweating b. Tachycardia c. Gastrointestinal bleeding d. Halos around lights

b. Tachycardia

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? a. multiple gestation pregnancy b. use of IUD for contraception c. high number of pregnancies d. use of oral contraceptives

b. use of IUD for contraception

An 18-year-old pregnant client is hospitalized as she recovers from hyperemesis gravidarum. The client reveals she wanted to have an abortion 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? a. Share the information with the client's family. b. Encourage the client to be positive about the situation. c. Contact the health care provider to report the client's feelings. d. Continue to monitor the client's hyperemesis gravidarum.

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

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? a. suppresses the immune response to prevent isoimmunization b. alleviates strong uterine cramping c. ensures passage of all the products of conception d. halts the progression of the abortion

c. ensures passage of all the products of conception