Ch 28
The nurse is assessing a pregnant client who is a chronic smoker and lives in a high altitude area. Which pregnancy-related risk may be high in the client? 1 Placental previa 2 Molar pregnancy 3 Abruptio placenta 4 Ectopic pregnancy
Placental previa Pregnant women who live at high altitudes or are smokers have lower blood oxygenation. A decrease in the uteroplacental oxygenation leads to an increase in the placental surface area. Therefore, the client is more likely to have placenta previa. Molar pregnancy is more common in pregnant women who have had a prior molar pregnancy and those who are in their early teens or older than 40 years of age. Pregnant clients with hypertension may have a high risk of having abruptio placenta. Clients with tubal infection or damage are at risk of having ectopic pregnancies.
The quantitative human chorionic gonadotropin (β-hCG) levels are high in a client who is on methotrexate therapy for dissolving abdominal pregnancy. Which instruction does the nurse give to this client? Correct 1 "Avoid sexual activity." 2 "Avoid becoming pregnant again." 3 "Avoid feeling sad and low." 4 "Take folic acid without fail."
"Avoid sexual activity." High β-hCG levels indicate that the abdominal pregnancy is not yet dissolved. Therefore the nurse advises the client to avoid sexual activity until the β-hCG levels drop and the pregnancy is dissolved completely. If the client engages in vaginal intercourse, the pelvic pressure may rupture the mass and cause pain. Abdominal pregnancy increases the chances of infertility or recurrent ectopic pregnancy in clients. However, the nurse need not instruct the client to avoid further pregnancy, because it may increase the feelings of sadness and guilt in the client. The nurse encourages the client to share feelings of guilt or sadness related to pregnancy loss. Folic acid is contraindicated with methotrexate therapy, because it may exacerbate ectopic rupture
Which statement by the nursing student about the management of molar pregnancy indicates effective learning? 1 "Methotrexate therapy is prescribed to abort molar pregnancy." 2 "Expectant management is initiated as per the amount of bleeding." 3 "Suction curettage is the safest way of terminating molar pregnancy." 4 "Induction of labor with oxytocic agents is one of the treatment options."
"Suction curettage is the safest way of terminating molar pregnancy." In molar pregnancy the avascular transparent vesicles in the uterus may cause uterine distention. Therefore suction curettage is used for rapid and effective evacuation of the hydatidiform mole. Methotrexate therapy is prescribed to dissolve an ectopic pregnancy. Expectant management is initiated in case of a normal fetus, not in the case of a molar pregnancy. Induction of labor with oxytocic agents is not a safe method, because it has a risk of embolization of trophoblastic tissue.
The nurse is working in an obstetric ward. Which client in the ward is at the highest risk of developing hydatidiform mole? 1 A client with hypothyroidism 2 A client with diabetes mellitus 3 A client with lupus erythematosus 4 A client with prior molar pregnancy
A client with prior molar pregnancy Hydatidiform mole is a benign proliferative growth of the placental trophoblast. In this condition the chorionic villi develop into edematous or avascular transparent vesicles, which hang in a grapelike cluster. A client with prior molar pregnancy is at a higher risk of developing hydatidiform mole. The presence of growing tissue in a molar pregnancy increases the risk of hydatidiform mole. Clients with hypothyroidism, diabetes mellitus, and lupus erythematosus are not at a higher risk of developing hydatidiform mole.
Which pregnant patient is a likely candidate for expectant management? 1 A molar pregnancy that has a risk for vaginal bleeding 2 A patient who is 32 6⁄7 weeks of gestation, who is likely to deliver soon 3 A patient diagnosed with preeclampsia who is on an antihypertensive medication 4 A patient with a threatened miscarriage that has no bleeding or infection
A patient with a threatened miscarriage that has no bleeding or infection If bleeding and infection does not occur after a threatened miscarriage, then the patient is managed expectantly to continue the pregnancy successfully. Molar pregnancy is terminated as soon as it is identified and hence there is no need for expectant management. A patient with 32 6⁄7 weeks of gestation who is likely to deliver soon does not need to be managed expectantly. A patient with preeclampsia who is on an antihypertensive medication does not need expectant management as the condition can be managed at home.
The nurse finds that a client in labor has developed spontaneous bruises over the skin. The fetal heart activity monitor indicates late decelerations in the fetal heart rate (FHR). What is the best intervention to prevent fetal complications, if the nurse suspects disseminated intravascular coagulation (DIC) in the client? 1 Assisting the client to supine position 2 Increasing the rate of oxytocin intravenous (IV) infusion 3 Administering oxygen through a face mask 4 Administering intravenous (IV) fluids to the client
Administering oxygen through a face mask DIC may be caused secondary to placental abruption, which may result in late deceleration of the FHR. Late deceleration is due to decreased blood flow and oxygen to the fetus during the uterine contractions (UCs). Therefore, an oxygen mask is applied to the client. A side-lying tilt would provide proper blood flow by decreasing the pressure on the uterus. Hence, the client should be assisted to a side-lying position and not to a supine position. An IV oxytocin infusion is given to increase the UCs during labor, but it is discontinued when a late deceleration is noted. IV fluids are administered to the client to promote fluid balance, but it may not directly help in improving the fetal heart rate.
In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? 1 Administration of blood 2 Preparation of the woman for invasive hemodynamic monitoring 3 Restriction of intravascular fluids 4 Administration of steroids
Administration of blood Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding. Management of DIC includes volume replacement, not volume restriction. Steroids are not indicated for the management of DIC.
Which nursing interventions are implemented while caring for a pregnant client with disseminated intravascular coagulation? Select all that apply. 1 Assess for signs of bleeding. 2 Monitor urinary output. 3 Initiate electronic fetal monitoring. 4 Administer prescribed oxygen. 5 Provide suctioning once a day.
Assess for signs of bleeding. Monitor urinary output. Initiate electronic fetal monitoring. Administer prescribed oxygen. DIC causes extensive external bleeding due to the destruction of clotting factors. Therefore, the nurse needs to assess the client for signs of bleeding, rapid replacement of blood products, and clotting factors. DIC also causes renal failure, so the nurse needs to monitor urinary output in the client as well. Urinary output needs to be more than 30 ml/ hr. Continuous electronic fetal monitoring is necessary to assess if the fetus has sufficient oxygenation. The nurse needs to administer the prescribed oxygen through a nonrebreather facemask to maintain adequate fetal oxygenation. Suctioning is necessary in patients when the airway is obstructed, for instance, after a convulsion.
The nurse is caring for a pregnant client who has a history of second trimester loss and preterm birth. After reviewing the ultrasound reports, the nurse finds that the client has a cervix less than 30 mm. What treatment strategy should be included in the treatment plan? 1 Cerclage insertion 2 Cesarean delivery 3 Corticosteroid therapy 4 Methotrexate (MTX) therapy
Cerclage insertion client who has a history of second trimester loss and preterm delivery has a risk of premature cervical opening called cervical insufficiency. Cerclage insertion decreases preterm birth through a cervical suture placed surgically to tie the cervix and keep it closed. It is not necessary for a client with cervical insufficiency to have a cesarean delivery. If the client has proper treatment with cerclage or progesterone, it is possible for the client to have a vaginal delivery. Corticosteroid therapy is given to the client at risk of having a preterm delivery to accelerate fetal lung maturity. MTX therapy is used to treat ectopic pregnancy.
Which of the following presentations is associated with early pregnancy loss occurring in less than 12 weeks gestation? Select all that apply.
Chromosomal abnormalities Antiphospholipid syndrome Hypothyroidism Fifty percent of early pregnancy losses result from genetic abnormalities. Antiphospholipid syndrome is associated with early pregnancy loss. Hypothyroidism is associated with early pregnancy loss. Infection is not a likely source of early pregnancy loss. Cystitis in not associated with early pregnancy loss. Caffeine use is associated with second-trimester losses because of maternal behavior.
What are the possible causes of miscarriage during early pregnancy? Select all that apply. 1 Premature dilation of cervix 2 Chromosomal abnormalities 3 Endocrine imbalance 4 Hypothyroidism 5 Antiphospholipid antibodies
Chromosomal abnormalities Endocrine imbalance Hypothyroidism Antiphospholipid antibodies Chromosomal abnormalities account for 50% of all early pregnancy losses. Endocrine imbalance is caused by luteal phase defects, hypothyroidism, and diabetes mellitus in pregnant patients and results in miscarriage. Antiphospholipid antibodies also increase the chances of miscarriage in pregnant patients. Premature dilation of the cervix may cause a second-trimester loss, and is usually seen in patients between 12 and 20 weeks of gestation.
A client reports mild vaginal bleeding, pain, and cramping in her lower abdomen at 6 weeks of gestation. Upon performing a pelvic examination, the nurse finds that the client's cervical os is closed. What is the priority intervention in this condition? 1 Administer intravenous fluids to the client. 2 Administer methylcarboprost tromethamine (Hemabate) to the client. 3 Determine the client's human chorionic gonadotropin and progesterone levels. 4 Prompt termination of pregnancy in the patient by dilation and curettage method.
Determine the client's human chorionic gonadotropin and progesterone levels. Mild vaginal bleeding, pain in the lower abdomen, and mild uterine cramps with a closed cervical os are the symptoms of threatened miscarriage. Therefore, the nurse should determine the human chorionic gonadotropin and progesterone levels in the client to find whether the fetus is alive in the uterus. The nurse should administer intravenous fluids if the client has severe bleeding. The nurse should administer methylcarboprost tromethamine (Hemabate) to prevent excessive bleeding after miscarriage. In this case, the client does not have a complete miscarriage or excessive bleeding; therefore, the nurse would not administer this medication to the client. Dilation and curettage is a surgical method to terminate a pregnancy. It is performed on a client with inevitable miscarriage, but not threatened miscarriage.
A nurse is examining a client who has been admitted for possible ectopic pregnancy who is approximately 8 weeks pregnant. Which finding would be a priority concern? 1 No FHT heard via Doppler 2 Scant vaginal bleeding noted on peri pad 3 Ecchymosis noted around umbilicus 4 Blood pressure 100/80
Ecchymosis noted around umbilicus Ecchymosis around the umbilicus indicates Cullen's sign, which could represent a ruptured intrabdominal ectopic pregnancy. Because the client is most likely in the early stages of pregnancy, FHT would not be able to be auscultated at this time. Scant vaginal bleeding would not be a priority concern but should still be monitored by the nurse.
What does the nurse administer to a client if there is excessive bleeding after suction curettage? 1 Nifedipine (Procardia) 2 Methyldopa (Aldomet) 3 Hydralazine (Apresoline) 4 Ergonovine (Methergine)
Ergonovine (Methergine) Ergonovine (Methergine) is an ergot product, which is administered to contract the uterus when there is excessive bleeding after suction curettage. Nifedipine (Procardia) is prescribed for gestational hypertension or severe preeclampsia. Methyldopa (Aldomet) is an antihypertensive medication indicated for pregnant clients with hypertension. Hydralazine (Apresoline) is also an antihypertensive medication used for treating hypertension intrapartum.
A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, she is at the greatest risk for what problem? 1 Hemorrhage 2 Infection 3 Urinary retention 4 Thrombophlebitis
Hemorrhage Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta.
The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman indicates a correct understanding of the discharge instructions? 1 "I will not experience mood swings, because I was only at 10 weeks of gestation." 2 "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." 3 "I should eat foods that are high in iron and protein to help my body heal." 4 "I should expect the bleeding to be heavy and bright red for at least 1 week."
I should eat foods that are high in iron and protein to help my body heal." A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. After a miscarriage a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped, and pregnancy should be avoided for 2 months. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider.
The nurse is preparing a client for abortion. Which medicine is administered to the client after the evacuation of the uterus to prevent hemorrhage? 1 Oxytocin (Pitocin) 2 Misoprostol (Cytotec) 3 Vitamin K (Aqua-Mephyton) 4 Magnesium sulfate (Sulfamag)
Oxytocin (Pitocin) Oxytocin (Pitocin) is administered to the client to prevent hemorrhage after evacuation of the uterus. It prevents hemorrhage by causing contractions of the uterus. Misoprostol (Cytotec) is used to complete a missed miscarriage within 7 days. It helps by expelling the products of conception from the uterus. Vitamin K (Aqua-Mephyton) is used for the treatment of disseminated intravascular coagulation (DIC). Magnesium sulfate (Sulfamag) is used for tocolysis to suppress uterine contractions.
A woman at 37 weeks of gestation is admitted with a placental abruption after a motor vehicle accident. Which assessment data are most indicative of her condition worsening? 1 P 112, R 32, BP 108/60; FHR 166-178 2 P 98, R 22, BP 110/74; FHR 150-162 3 P 88, R 20, BP 114/70; FHR 140-158 4 P 80, R 18, BP 120/78; FHR 138-150
P 112, R 32, BP 108/60; FHR 166-178 Bleeding, which impacts the mother's well-being as well as that of her fetus, is the most dangerous problem. The decreasing blood volume would cause increases in pulse and respirations and a decrease in blood pressure. The fetus often responds to decreased oxygenation as a result of bleeding, causing a decrease in perfusion. This causes the fetus' heart rate to increase above the normal range of 120-160 beats per minute. The other options have measurements that are in the "normal" range and would not reflect a deterioration of the patient's physical status.
The nurse is assessing a pregnant client at 6 weeks of gestation. Upon reviewing the client's medical history, the nurse finds that the client had undergone a large cone biopsy. Which treatment strategy does the nurse expect to be most beneficial to prevent miscarriage in the client? 1 Administering misoprostol (Cytotec) orally for 7 days 2 Performing abdominal cerclage at 11 weeks of gestation 3 Placing a rescue cerclage in the cervix at 23 weeks of gestation 4 Administering ergonovine (Methergine) during the 3rd trimester
Performing abdominal cerclage at 11 weeks of gestation A client who has undergone a large cone biopsy may be at risk of miscarriage due to the presence of an extremely short cervix. Therefore, the primary health care provider would perform an abdominal cerclage at 11 or 13 weeks of gestation in order to prevent the opening of the cervical os. Misoprostol (Cytotec) is a prostaglandin analogue that induces miscarriage. Therefore, misoprostol (Cytotec) does not help to prevent miscarriage in the patient. Ergonovine (Methergine) causes uterine contractions and helps prevent excessive bleeding, but it does not prevent miscarriage. A rescue cerclage cannot be performed in a client who has undergone a large cone biopsy, because the client has a short cervix.
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of what condition? 1 Eclamptic seizure 2 Rupture of the uterus 3 Placenta previa 4 Placental abruption
Placental abruption Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding.
The nurse is caring for a client who is 35 weeks pregnant, and reports moderate vaginal bleeding. The ultrasonographic reports indicate abruptio placentae. Which immediate interventions should the nurse provide? 1 Determine hemoglobin value. 2 Prepare the client for delivery. 3 Determine blood and fluid volume. 4 Provide oxygen therapy
Prepare the client for delivery. The nurse should immediately prepare the client for delivery because the client is near the end of gestation and has moderate bleeding. The client's hemoglobin and hematocrit values should be determined to monitor the bleeding. However, this intervention can be performed after the client is admitted for delivery. The nurse should assess the blood and fluid volume by inserting a catheter during delivery to determine if blood transfusion is necessary. Oxygen therapy may be given if the client has difficulty in breathing.
Which is an important nursing intervention when a client has an incomplete miscarriage with heavy bleeding? 1 Initiate expectant management at once. 2 Prepare the client for dilation and curettage. 3 Administer the prescribed oxytocin (Pitocin). 4 Obtain a prescription for ergonovine (Methergine
Prepare the client for dilation and curettage In the case of an incomplete miscarriage, sometimes there is heavy bleeding and excessive cramping and some part of fetal tissue remains in the uterus. Therefore the nurse needs to prepare the client for dilation and curettage for the removal of the fetal tissue. Expectant management is initiated if the pregnancy continues after a threatened miscarriage. Oxytocin (Pitocin) is administered to prevent hemorrhage after evacuation of the uterus. Ergonovine (Methergine) is administered to contract the uterus.
Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach? 1 Prepare the woman for a dilation and curettage (D&C). 2 Place the woman on bed rest for at least 1 week and reevaluate. 3 Prepare the woman for an ultrasound and blood work. 4 Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.
Prepare the woman for an ultrasound and blood work. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. D&C is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Telling the woman that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.
Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? 1 Prepare the woman for a dilation and curettage (D&C). 2 Place the woman on bed rest for at least 1 week and reevaluate. 3 Prepare the woman for an ultrasound and bloodwork. 4 Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.
Prepare the woman for an ultrasound and bloodwork Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. D&C is not considered until signs of the progress to inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.
A nurse is evaluating several obstetrical clients for their risk for cervical insufficiency. Which client would be considered most at risk? 1 Primipara 2 Grand multipara who has previously had all vaginal deliveries without a problem 3 Primipara who has a cervical cone biopsy performed for cervical dysplasia prior to the pregnancy. 4 Multipara who had her previous delivery via C section due to cephalopelvic disproportion (CPD).
Primipara who has a cervical cone biopsy performed for cervical dysplasia prior to the pregnancy A client who has had previous surgical interventions (such as a cone biopsy) is at greater risk for cervical insufficiency. There is no indication that a primipara is at risk for cervical insufficiency. A grand multipara who has previously had vaginal deliveries without incident is not necessarily at an increased risk for cervical insufficiency. A multipara who has delivered via C section as a result of CPD would not necessarily be at an increased risk, because the issue involves pelvic adequacy as determined by pelvic measurements in relationship to the fetus.
A pregnant client in the first trimester reports spotting of blood with the cervical os closed and mild uterine cramping. What else does the nurse need to assess? Select all that apply. 1 Progesterone levels 2 Transvaginal ultrasounds 3 Human chorionic gonadotropin (hCG) measurement 4 Blood pressure 5 Kleihauer-Betke (KB) test reports
Progesterone levels Transvaginal ultrasounds Human chorionic gonadotropin (hCG) measurement The spotting of blood with the cervical os closed and mild uterine cramping in the first trimester indicate a threatened miscarriage. Therefore the nurse needs to assess progesterone levels, transvaginal ultrasounds, and measurement of hCG to determine if the fetus is alive and within the uterus. BP measurements do not help determine the fetal status. KB assay is prescribed to identify fetal-to-maternal bleeding, usually after a trauma.
The primary health care provider prescribes methotrexate (MTX) to treat ectopic pregnancy in a client. The nurse instructs the client to avoid taking any analgesic stronger than acetaminophen (Tylenol). What could be the reason for giving this instruction? 1 MTX has an interaction with other analgesics. 2 Stronger analgesics can mask symptoms of the tubal rupture. 3 Other analgesics may cause liver function impairment in the client. 4 Other analgesics may cause renal function impairment in the client.
Stronger analgesics can mask symptoms of the tubal rupture. Methotrexate (MTX) is an antimetabolite and folic acid antagonist. The medication can destroy rapidly dividing cells. The therapy helps avoid surgery and is a safe and effective option. Strong analgesics can mask symptoms of tubal rupture. Therefore, the nurse instructs the client to avoid taking any analgesic stronger than acetaminophen (Tylenol). Methotrexate (MTX) does not have an interaction with other analgesics. Analgesics do not interact with methotrexate (MTX) to cause liver or renal dysfunction.
The nurse is assessing a client who is 18 weeks pregnant. The client reports heavy bleeding, infection, and excessive cramping. Which treatment strategy should be included in the treatment plan? 1 Suction curettage 2 McDonald technique 3 Administration of methotrexate (MTX) 4 Administration of misoprostol (Cytotec)
Suction curettage Heavy bleeding, infection, and excessive cramping are signs and symptoms of miscarriage. In this situation, fetal or placental tissue must be removed from the uterus by suction curettage. McDonald technique is used in case of cervical insufficiency. In this technique, suture is placed around the cervix beneath the mucosa to constrict the internal os of the cervix. MTX is used in the treatment of ectopic pregnancy. Misoprostol (Cytotec) is prostaglandin drug. If bleeding and infection are absent, then misoprostol (Cytotec) is used for miscarriage.
A client reports painless, bright-red vaginal bleeding during the second trimester of pregnancy. Upon assessment, the nurse finds that the client's urine output has decreased, the fundal height has increased, and the uterus is nontender with normal tone. What does the nurse interpret from these findings? 1 The client has placenta previa. 2 The client has ectopic pregnancy. 3 The client has hydatidiform mole. 4 The client has normal development.
The client has placenta previa. Placenta previa is an obstetric complication in which the placenta is implanted partially or completely in the lower uterine segment (near to or covering the cervix). Painless, bright-red vaginal bleeding takes place during the second trimester. Decreased urine output, greater-than-expected fundal height, and a nontender uterus with normal tone are signs of placenta previa. In ectopic pregnancy the fertilized ovum is implanted outside the uterine cavity. Hydatidiform mole is a benign proliferative growth of the placental trophoblast in which the chorionic villi develop into cystic vesicles that hang in a grapelike cluster. Decreased urine output is a complication seen in clients with diffused intravascular coagulopathy (DIC).
The nurse is caring for a client who reports abdominal pain and abnormal vaginal bleeding after the menstrual cycle. The nurse tells the client, "You should not consume foods rich in folic acid, and you should stay indoors." What is the reason for these instructions? 1 The client is taking oxytocin (Pitocin). 2 The client is taking methotrexate (MTX). 3 The client is taking misoprostol (Cytotec). 4 The client is taking ergonovine (Methergine).
The client is taking methotrexate (MTX). Abdominal pain and abnormal vaginal bleeding after the menstrual cycle indicate that the client has ectopic pregnancy. MTX therapy is used in the treatment of ectopic pregnancy. Folic-rich, gas-forming foods and sun exposure decreas the effectiveness of MTX. These factors do not affect the effectiveness of oxytocin (Pitocin), misoprostol (Cytotec), and ergonovine (Methergine). Hence, the client does not need to avoid folic-rich, gas-forming foods, or sun exposure, while taking oxytocin (Pitocin), misoprostol (Cytotec), and ergonovine (Methergine).
A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion?
Threatened A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion presents with heavy bleeding, mild to severe cramping, and cervical dilation. An inevitable abortion presents with the same symptomatology as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation. A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.
A pregnant client with chronic hypertension is at risk for placental abruption. Which symptoms of abruption does the nurse instruct the client to be alert for? Select all that apply. 1 Weight loss 2 Abdominal pain 3 Vaginal bleeding 4 Shortness of breath 5 Uterine tenderness
Abdominal pain Vaginal bleeding Uterine tenderness The nurse instructs the pregnant client to be alert for abdominal pain, vaginal bleeding, and uterine tenderness, because they indicate placental abruption. Weight loss indicates fluid and electrolyte loss, not placental abruption. Shortness of breath indicates inadequate oxygen, which is usually seen in a client who is having cardiac arrest.
The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is what? 1 Bleeding 2 Intense abdominal pain 3 Uterine activity 4 Cramping
Intense abdominal pain Pain is absent with placenta previa but may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity may be present with both placental conditions. Cramping is a form of uterine activity that may be present in both placental conditions.
A pregnant client has preterm labor. Which medication would be helpful in preventing preterm labor in the client? 1 Oxytocin (Pitocin) 2 Methotrexate (MTX) 3 Misoprostol (Cytotec) 4 Magnesium sulfate (Sulfamag)
Magnesium sulfate (Sulfamag) Magnesium sulfate (Sulfamag) is a tocolytic agent used to slow down uterine contractions. Oxytocin (Pitocin) is used to prevent uterine hemorrhage. MTX is used for the treatment of ectopic pregnancy. Misoprostol (Cytotec) is used to expel the products of conception completely after a miscarriage.
The ultrasound report of a 12-week pregnant woman shows snowstorm pattern. Upon further examination, the nurse finds elevated human chorionic gonadotropin (hCG) levels and dark brown vaginal discharge. What complication does the nurse expect in the client? 1 Hemorrhage 2 Hypertension 3 Hyperglycemia 4 Molar pregnancy
Molar pregnancy Snowstorm pattern in the ultrasound, elevated hCG, and dark brown vaginal discharge indicate that the client has a hydatidiform mole. The risk of hemorrhage is predominant in a client with placenta previa. The blood pressure of the client is not affected by the hydatidiform mole. Therefore, the client would not be at a risk of hypertension. a hydatidiform mole does not alter the blood glucose levels. Therefore, the client would not necessarily have hyperglycemia.
Which clinical reports does the nurse evaluate to identify ectopic pregnancy in a client? Select all that apply. 1 Quantitative human chorionic gonadotropin (β-hCG) levels 2 Transvaginal ultrasound 3 Progesterone level 4 Thyroid test reports 5 Kleihauer-Betke (KB) test
Quantitative human chorionic gonadotropin (β-hCG) levels Transvaginal ultrasound Progesterone level An ectopic pregnancy is indicated when β-hCG levels are greater than 1500 milli-international units/ml, but no intrauterine pregnancy is seen on the transvaginal ultrasound. A transvaginal ultrasound is repeated to verify if the pregnancy is inside the uterus. A progesterone level less than 5 ng/ml indicates ectopic pregnancy. Thyroid test reports need to be evaluated in case the patient has hyperemesis gravidarum, because hyperthyroidism is associated with this disorder. The KB test is used to determine transplacental hemorrhage.
A pregnant client reports painless vaginal bleeding at 22 weeks of gestation. The client's ultrasonographic reports reveal a normally implanted placenta. What examination does the nurse perform immediately in the client? 1 Non-stress test (NST) 2 Speculum examination 3 Biophysical profile (BPP) 4 Kleihauer-Betke (KB) test
Speculum examination If the client has a normally implanted placenta, then a speculum examination should be performed immediately to rule out local causes of bleeding. NST and BPP are performed every 2 to 3 weeks for fetal surveillance. A KB test is performed to determine the presence of transplacental hemorrhage.
pregnant client is diagnosed with succenturiate placenta. What should the nurse understand about the client's condition? 1 The placenta separates prematurely from the uterus. 2 The placenta is implanted in the lower uterine segment. 3 The placental trophoblasts have undergone proliferative growth. 4 The placenta is divided into more lobes, rather than a single lobe.
The placenta is divided into more lobes, rather than a single lobe. When the placenta is divided into two or more lobes, rather than as a single mass, it is called a succenturiate placenta. Premature separation of the placenta from the uterus is called abruptio placentae. A placenta implanted in the lower uterine segment is known as placenta previa. Benign proliferative growth of the placental trophoblast is known as molar pregnancy.
What dietary instructions does the nurse give a client who has experienced miscarriage? 1 "Increase folic acid and zinc in your diet." 2 "Eat foods that are high in iron and protein." 3 "Restrict fluid intake to 125 milliliters per hour." 4 "Reduce dietary fat intake by 40 to 50 grams per day."
"Eat foods that are high in iron and protein." The nurse advises the client to eat foods that are high in iron and protein to help in tissue repair and red blood cell (RBC) replacement. Folic acid and zinc are more helpful in maintaining a pregnancy and are not needed after a miscarriage. Fluid intake is restricted in clients who are at risk for pulmonary edema. Dietary fat is reduced if the client has cholecystitis or cholelithiasis, because it may worsen epigastric pain.
A pregnant client is diagnosed with abruptio placentae. What signs and symptoms would the nurse find in the client? Select all that apply. 1 Hypoglycemia 2 Abdominal pain 3 Vaginal bleeding 4 Delayed menses 5 Uterine tenderness
Abdominal pain Vaginal bleeding Uterine tenderness Premature separation of the placenta from the uterus is called as abruptio placentae. Vaginal bleeding, abdominal pain, and uterine tenderness are signs and symptoms of abruptio placentae. Abruptio placentae does not affect blood glucose level; therefore, it does not cause hypoglycemia. Delayed menses is a sign of an ectopic pregnancy.
The nurse correctly explains to the nursing student that the majority of ectopic pregnancies are located where? 1 Uterine fundus 2 Cervical os 3 Ampulla 4 Fimbriae
Ampulla The majority of ectopic pregnancies, approximately 80 percent, are located in the ampulla, or the largest portion of the tube. A pregnancy within the uterus would be considered a normal pregnancy. Implantation of the pregnancy at the cervical os would be a significant abnormality.
A pregnant client is treated with prostaglandins after a miscarriage. What side effects of prostaglandins will the nurse monitor in the patient? Select all that apply. 1 Diarrhea 2 Vomiting 3 Skin rashes 4 Blurred vision 5 Yellow-colored sputum
Diarrhea Vomiting Prostaglandins help expel the products of conception completely. Diarrhea and vomiting are side effects of prostaglandins. Prostaglandins do not affect skin integrity; therefore, they do not cause skin rashes. Prostaglandins do not affect vision; therefore, they do not cause blurred vision. Yellow-colored sputum is not a side effect of prostaglandins. Yellow-colored sputum is a sign of infection.
Which condition is characterized by implantation of fertilized ovum outside the uterine cavity? 1 Placenta previa 2 Molar pregnancy 3 Ectopic pregnancy 4 Cervical insufficiency
Ectopic pregnancy Ectopic pregnancy is a condition in which the fertilized ovum is implanted outside the uterine cavity. Placenta previa is a condition in which the placenta is implanted in the lower uterine segment. Molar pregnancy is a benign proliferative growth of the placental trophoblast. In this condition, the chorionic villi develop into cystic and avascular transparent vesicles that hang in a grapelike cluster. Cervical insufficiency is characterized by passive and painless dilation of the cervix. It may lead to recurrent preterm birth during the second trimester in the absence of other causes.
Upon reviewing the ultrasonography reports of a pregnant client, the nurse finds that the placenta is at a distance of 2.5 cm from the internal cervical os. What complication is likely if the client has a vaginal delivery? 1 Hemorrhage 2 Hyperthyroidism 3 Thrombocytopenia 4 Hypofibrinogenemia
Hemorrhage A placenta implanted in the lower uterine segment 2.5 cm from the internal cervical os indicates that the client has marginal placenta previa. In placenta previa, disruption of placental blood vessels occurs with stretching and thinning of the lower uterine segment, which results in bleeding. Therefore, the major maternal complication associated with placenta previa is hemorrhage. Hyperthyroidism is one of the serious complications of hydatidiform mole. Thrombocytopenia and hypofibrinogenemia are complications of abruptio placentae.
Which test is used to determine the presence of fetal-to-maternal bleeding in a pregnant patient? 1 D-dimer test 2 Non-stress test (NST) 3 Kleihauer-Betke (KB) test 4 Biophysical profile (BPP) test
Kleihauer-Betke (KB) test The KB test is used to determine the presence of fetal-to-maternal bleeding or transplacental hemorrhage. The D-dimer test is used to diagnose blood disorders, such as disseminated intravascular coagulation (DIC). The NST and BPP tests are used to determine fetal surveillance.
During the assessment of a pregnant client, the nurse finds that the client has cramps, closed cervical os without any tissue perforation, and absence of uterine bleeding. The client's ultrasonic report reveals that the fetal growth is less than expected per the gestational period, and absence of fetal heartbeat. Which drug would be added to the client's prescription? 1 Ampicillin (Amcill) 2 Methotrexate (MTX) 3 Misoprostol (Cytotec) 4 Ergonovine (Methergine)
Misoprostol (Cytotec) Cramps, a closed cervical os without any tissue perforation, absence of uterine bleeding, and fetal growth inappropriate to the gestational age and no fetal heartbeat indicate miscarriage. A miscarriage with no bleeding and infection should be treated conservatively. Misoprostol (Cytotec) is a prostaglandin drug that is administered either orally or vaginally to complete the miscarriage within 7 days. Ampicillin (Amcill) is an antibiotic used to treat infection. MTX is used to treat ectopic pregnancy. Ergonovine (Methergine) is used for uterine contractions.
