Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications
A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response? "After a curettage procedure, it is recommended that you give your body some time to build up its stores." "A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." "Since you are at the end of your reproductive years, it is suggested that you don't try to have any more pregnancies." "You may need chemotherapy, so we don't want to risk pregnancy."
"A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." Explanation:
A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response? "After a curettage procedure, it is recommended that you give your body some time to build up its stores." "A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." "Since you are at the end of your reproductive years, it is suggested that you don't try to have any more pregnancies." "You may need chemotherapy, so we don't want to risk pregnancy."
"A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." Explanation:
A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? "Maintain bed rest, and count the number of perineal pads used." "Come to the health care facility if uterine contractions begin." "Continue normal activity, but take the pulse every hour." "Come to the health facility with any vaginal material passed."
"Come to the health facility with any vaginal material passed." 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 the material can be assessed for this.
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? "Your spontaneous bleeding is not work-related." "It is hard to know why a woman bleeds during early pregnancy." "I can understand your need to find an answer to what caused this. Let's talk about this further." "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."
The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement? "If I have changes in my vision, I will lie down and rest." "I will weigh myself every morning after voiding before breakfast." "I will count my baby's movements after each meal." "If I have a severe headache, I'll call the clinic."
"If I have changes in my vision, I will lie down and rest."
A pregnant client with preterm premature rupture of the membranes is being discharged home. A nurse is preparing the client's discharge teaching plan. Which instructions would the nurse include? Select all that apply. "Be sure to perform fetal moverment (kick) counts about once every 3 days." "If you notice your belly starting to tighten, call your health care provider." "Gently massage your breasts at least once each day." "Take tub baths instead of showers." "Check your temperature each day, reporting any increase immediately."
"If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately."
he nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? "I need a cesarean section if I develop this problem." "If I develop this complication, I will have bright red vaginal bleeding," "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." "Since I am over 30, I run a much higher risk of developing this problem."
"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best? "Please come in now for an evaluation by your health care provider." "Lie on your left side and drink lots of water and monitor the bleeding." "If the bleeding lasts more than 24 hours, call us for an appointment." "Bleeding during pregnancy happens for many reasons, some serious and some harmless."
"Please come in now for an evaluation by your health care provider."
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? "Staples are put in the cervix to prevent it from dilating." "The cervix is glued shut so no amniotic fluid can escape." "Purse-string sutures are placed in the cervix to prevent it from dilating." "A cervical cap is placed so no amniotic fluid can escape."
"Purse-string sutures are placed in the cervix to prevent it from dilating." Explanation: The cerclage, or purse string suture, is inserted into the cervix to prevent preterm cervical dilation (dilatation) and pregnancy loss. Staples, glue, or a cervical cap will not prevent the cervix from dilating.
A client experiencing a threatened abortion is concerned about losing the pregnancy and asks what she can do to help save her baby. What is the most appropriate response from the nurse? "Carry on with the activity you engaged in before this happened." "Restrict your physical activity to moderate bed rest." "Strict bed rest is necessary so as not to jeopardize this pregnancy." "There is no research evidence that I can recommend to you."
"Restrict your physical activity to moderate bed rest."
A 16-year-old client was at 12 weeks' gestation when she gave birth to a fetus last week. The client has come to the office for follow-up and, while waiting in an examination room, notices that on the schedule is written her name and "follow-up of spontaneous abortion." The client is upset about what is written on the schedule. How can the nurse best explain this terminology? "Spontaneous abortion is the medical name for a miscarriage." "Abortion is a medical term for any interruption of pregnancy before a fetus is viable." "Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy." "Oh, that just means it was a miscarriage."
"Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy." Explanation:
A nurse is caring for a 37-year-old client who just experienced a spontaneous abortion (miscarriage) in the first trimester. When asked by the client why this happened, which is the best response from the nurse? "The most common reason is the baby was not developing correctly." "Your body's immune system may have thought the baby was a danger." "The baby may not have attached to the uterus in the right way." "Your body may not have produced enough progesterone to sustain the pregnancy."
"The most common reason is the baby was not developing correctly."
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 (D&C). The client looks frightened and confused and states that she does not believe in induced abortion (medical abortion). Which statement by the nurse is best? "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." "I know that it is sad but the pregnancy must be terminated to save your life." "The choice is up to you but the health care provider is recommending an induced abortion (medical abortion). "You have experienced an incomplete abortion (miscarriage) and must have the placenta and any other tissues cleaned out."
"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."
A nurse has been assigned to assess a pregnant client for placental abruption (abruptio placentae). For which classic manifestation of this condition should the nurse assess? painless bright red vaginal bleeding increased fetal movement "knife-like" abdominal pain with vaginal bleeding generalized vasospasm
"knife-like" abdominal pain with vaginal bleeding
A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize? A systolic blood pressure increase of 10 mm Hg Weight gain of 1.2 lb (0.54 kg) during the past 1 week A dipstick value of 2+ for protein Pedal edema
A dipstick value of 2+ for protein
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? Quantitative human chorionic gonadotropin (hCG) test Qualitative human chorionic gonadotropin (hCG) test Pelvic examination Abdominal ultrasound
Abdominal ultrasound
A nurse is caring for a client with hyperemesis gravidarum. Which nursing action is the priority for this client? Administer total parenteral nutrition. Administer an antiemetic. Set up for a percutaneous endoscopic gastrostomy. Administer IV normal saline with vitamins and electrolytes.
Administer IV normal saline with vitamins and electrolytes.
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? Contraction test Nonstress test Biophysical profile Amniocentesis
Amniocentesis
A client with preeclampsia is receiving magnesium sulfate to suppress or control seizures. Which nursing intervention should a nurse perform to determine the effectiveness of therapy? Assess deep tendon reflexes. Monitor intake and output. Assess the client's mucous membrane. Assess the client's skin turgor.
Assess deep tendon reflexes.
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? Maternal smoking Lack of prenatal care Chromosomal abnormality The age of the mother
Chromosomal abnormality Explanation: The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal abnormality. There is nothing that can be done and the mother should feel no fault. The nurse needs to encourage the parents to speak with a health care provider for further information and questions related to genetic testing. Early pregnancy loss is not associated with maternal smoking, lack of prenatal care, or the age of the mother.
A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? Bright red, painless vaginal bleeding Brisk deep tendon reflexes and shoulder pain Dark red, "clumpy" vaginal discharge Painful uterine contractions and nausea
Dark red, "clumpy" vaginal discharge
The nurse is assessing a new client who is being admitted with gestational hypertension. Which nursing diagnosis should the nurse prioritize for this client? Deficient fluid volume related to vasospasm of arteries Decreased reflexes due to medication administration Risk for injury related to fetal distress Imbalanced nutrition related to decreased sodium levels
Deficient fluid volume related to vasospasm of arteries
What special interventions would the nurse implement in a client who is carrying twin fetuses? Schedule non-stress tests (NST) starting at 16 weeks. Demonstrate to the client how to perform fetal movement (kick) counts after 32 weeks. Assist the physician on doing uterine ultrasounds every 2 weeks to monitor fetal size and placental information. Remind the client to monitor her intake since she does not need any more food for a multiple pregnancy than she would ingest for a singleton pregnancy.
Demonstrate to the client how to perform fetal movement (kick) counts after 32 weeks.
A client reports bright red, painless vaginal bleeding at 32 weeks' gestation. A sonogram reveals that the placenta has implanted low in the uterus and is partially covering the cervical os. Which immediate care measure(s) should the nurse initiate? Select all that apply. Place the client on bed rest maintaining the supine position. Determine the time the bleeding began and how much blood has been lost. Obtain baseline vital signs and compare to vital signs previously obtained. Assist the client into stirrups and perform a pelvic examination. Attach external monitoring equipment to record fetal heart sounds and fetal movement (kick) counts.
Determine the time the bleeding began and how much blood has been lost. Obtain baseline vital signs and compare to vital signs previously obtained. Attach external monitoring equipment to record fetal heart sounds and fetal movement (kick) counts.
A client tells that nurse in the doctor's office that her friend developed high blood pressure on her last pregnancy. She is concerned that she will have the same problem. What is the standard of care for preeclampsia? Take a low-dose antihypertensive prophylactically. Have her blood pressure checked at every prenatal visit. Monitor the client for headaches or swelling on the body. Take one aspirin every day.
Have her blood pressure checked at every prenatal visit.
A 24-year-old woman presents with vague abdominal pains, nausea, and vomiting. An urine hCG is positive after the client mentioned that her last menstrual period was 2 months ago. The nurse should prepare the client for which intervention if the transvaginal ultrasound indicates a gestation sac is found in the right lower quadrant? Bed rest for the next 4 weeks Intravenous administration of a tocolytic Immediate surgery Internal uterine monitoring
Immediate surgery Explanation: The client presents with the signs and symptoms of an ectopic pregnancy, which is confirmed by the transvaginal ultrasound. Ectopic pregnancy means an embryo has implanted outside the uterus. Surgery is necessary to remove the growing structure before damage can occur to the woman's internal organs. Bed rest, a tocolytic, and internal uterine monitoring will not correct the situation. The growing structure must be removed surgically
A pregnant woman has been admitted to the hospital due to preeclampsia with severe features. Which measure will be important for the nurse to include in the care plan? Institute and maintain seizure precautions. Institute NPO status. Admit the client to the middle of ICU where she can be constantly monitored. Plan for immediate induction of labor.
Institute and maintain seizure precautions.
The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client? Provide a well-lit room. Keep head of bed slightly elevated. Place the client in a supine position. Keep the suction equipment readily available.
Keep the suction equipment readily available.
The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? Monitor the client's beta-hCG level. Monitor the mass with transvaginal ultrasound. Monitor the client's vital signs and bleeding. Monitor the fetal heart rate (FHR).
Monitor the client's vital signs and bleeding. Explanation: A nurse should closely monitor the client's vital signs and bleeding (peritoneal or vaginal) to identify hypovolemic shock that may occur with tubal rupture. Beta-hCG level is monitored to diagnose an ectopic pregnancy or impending spontaneous abortion (miscarriage). Monitoring the mass with transvaginal ultrasound and determining the size of the mass are done for diagnosing an ectopic pregnancy. Monitoring the FHR does not help to identify hypovolemic shock.
The nurse is caring for an Rh-negative nonimmunized client at 14 weeks' gestation. What information would the nurse provide to the client? Obtain Rho(D) immune globulin at 28 weeks' gestation. Consume a well-balanced, nutritional diet. Avoid sexual activity until after 28 weeks. Undergo periodic transvaginal ultrasounds.
Obtain Rho(D) immune globulin at 28 weeks' gestation. Explanation: The current recommendation is that every Rh-negative nonimmunized woman receives Rho(D) immune globulin at 28 weeks' gestation and again within 72 hours after giving birth. Consuming a well-balanced nutritional diet and avoiding sexual activity until after 28 weeks will not help to prevent complications of blood incompatibility. Transvaginal ultrasound helps to validate the position of the placenta and will not help to prevent complications of blood incompatibility.
A client at 34 weeks' gestation presents to labor and delivery with vaginal bleeding. Which finding from the obstetric examination leads the nurse to anticipate the client is experiencing a placental abruption (abruptio placentae)? Onset of vaginal bleeding was sudden and painful. Fetus is in a breech position. Sonogram shows the placenta covering the cervical os. Uterus is soft between contractions.
Onset of vaginal bleeding was sudden and painful.
A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? Premature separation of the placenta Preterm labor that was undiagnosed Placenta previa obstructing the cervix Possible fetal death or injury
Premature separation of the placenta Explanation: Premature separation of the placenta begins with sharp fundal pain, usually followed by dark red vaginal bleeding. Placenta previa usually produces painless bright red 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 client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal? Decrease blood pressure Decrease protein in urine Prevent maternal seizures Reverse edema
Prevent maternal seizures Explanation: The primary therapy goal for any client with preeclampsia 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 a primary goal of decreasing blood pressure, decreasing protein in the urine, or reversing edema.
A woman at 28 weeks' gestation has been hospitalized with moderate bleeding that is now stabilizing. The nurse performs a routine assessment and notes the client sleeping, lying on the back, and electronic fetal heart rate (FHR) monitor showing gradually increasing baseline with late decelerations. Which action will the nurse perform first? Administer oxygen to the client. Notify the health care provider. Reposition the client to left side. Increase the rate of IV fluids.
Reposition the client to left side.
A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin? STIs amniocentesis molar pregnancy maternal trauma
STIs Explanation: Indications for Rho(D) immune globulin include isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage, molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.
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? Gastrointestinal bleeding Halos around lights Tachycardia Sweating
Tachycardia Explanation: Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision (halos around lights), or sweating. Magnesium sulfate may cause sweating.
The nurse is caring for a client who has remained in stable condition at 37 weeks' gestation. The client's condition suddenly changes. Which assessment change should the nurse prioritize? Vaginal bleeding and no pain Uterine contractions with vaginal mucus Fundal height and fetal heart rate Size and contour of the abdomen
Vaginal bleeding and no pain Placenta previa includes bright red and painless vaginal bleeding, which is different from the dark red bleeding of placental abruption (abruptio placenta) accompanied by severe pain. This differentiates the two conditions. Uterine contractions with vaginal mucus may be indications of the start of labor with the mucus plug being discharged. The fetal heart rate, fundal height, and contour of the abdomen are normal components that are assessed during the labor process.
The nurse is transcribing messages from the answering service. Which phone message should the nurse return first? an 18-year-old, 38-week G2P1 client with intermittent cramping; the client's last blood pressure was 98/50 mm Hg, and proteinuria was 1+ a 25-year-old, 31-week G1P0 client with blood pressure of 100/80 mm Hg and left flank pain; the client's last blood pressure was 100/77 mm Hg and she had no proteinuria a 20-year-old, 31-week G1P0 client with malaise and rhinitis; the client's last blood pressure was 120/80 mm Hg, and she had no proteinuria a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria
a 35-year-old, 21-week G3P2 client with blood pressure of 160/110 mm Hg, blurred vision, and whose last blood pressure was 143/99 mm Hg and urine dipstick showed a +2 proteinuria
The nurse is preparing discharge instructions for several clients after their admission for emergent care of a pregnancy complication. The nurse will stress the importance of frequent and continuous office visits to the client with: a molar pregnancy. an ectopic pregnancy. a complete spontaneous abortion (miscarriage). Rh negative blood.
a molar pregnancy. Explanation: Molar pregnancies can indicate the possibility of developing malignancy. The woman will need close observation and follow-up for a year, every 1 to 2 weeks for hCG levels to detect cancer. A follow-up visit after an ectopic pregnancy or a complete spontaneous abortion (miscarriage) are typically scheduled at 6 weeks, not monthly. A woman who is Rh negative does not need a follow-up visit because of her Rh status, but would be scheduled as per routine postpartum visits.
A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission? performing a vaginal examination to assess the extent of bleeding helping the woman remain ambulatory to reduce bleeding assessing fetal heart tones by use of an external monitor assessing uterine contractions by an internal pressure gauge
assessing fetal heart tones by use of an external monitor
The nurse is required to assess a pregnant client who is reporting vaginal bleeding. Which nursing action is the priority? monitoring uterine contractility assessing signs of shock determining the amount of funneling assessing the amount and color of the bleeding
assessing the amount and color of the bleeding
nurse is caring for a pregnant client who suddenly experiences an eclamptic seizure. The nurse should work diligently to prevent what from happening? muscle rigidity followed by facial twitching rapid respirations during the seizure coma occurring after seizure respiratory failure after seizure
coma occurring after seizure
A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication? postterm birth maternal hypotension congenital anomalies fetal nonimmune hydrops
congenital anomalies
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? diabetes hypertension late maternal age isoimmunization
diabetes Explanation: Approximately 18% of all women with diabetes will develop hydramnios during their pregnancy. Hydramnios occurs in approximately 2% of all pregnancies and is associated with fetal anomalies of development
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 elevated liver enzymes seizures serum magnesium level of 6.5 mEq/L
diminished reflexes
A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP? elevated lipoproteins hemolysis liver enzyme elevation low platelet count
elevated lipoproteins
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? ensures passage of all the products of conception alleviates strong uterine cramping suppresses the immune response to prevent isoimmunization halts the progression of the abortion
ensures passage of all the products of conception
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? ensures passage of all the products of conception alleviates strong uterine cramping suppresses the immune response to prevent isoimmunization halts the progression of the abortion
ensures passage of all the products of conception Explanation: Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rho(D) immune globulin is used to suppress the immune response and prevent isoimmunization. Reference:
A woman at 9 weeks' gestation was unable to control the nausea and vomiting of hyperemesis gravidarum through conservative measures at home. With nausea and vomiting becoming severe, the woman was omitted to the obstetrical unit. Which action should the nurse prioritize? bed rest with bathroom privileges instruct on NPO status establish IV for rehydration administration of antiemetics
establish IV for rehydration
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? cord compression fetal distress related to hypoxia infection central nervous system (CNS) involvement
fetal distress related to hypoxia Explanation: When meconium is present in the amniotic fluid, it typically indicates fetal distress related to hypoxia. Meconium stains the fluid yellow to greenish brown, depending on the amount present. A decreased amount of amniotic fluid reduces the cushioning effect, thereby making cord compression a possibility. A foul odor of amniotic fluid indicates infection. Meconium in the amniotic fluid does not indicate CNS involvement.
A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? firm, rigid uterus on palpation gradual onset of symptoms fetal heart rate within normal range absence of pain
firm, rigid uterus on palpation
A woman at 10 weeks' gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize? report of frequent mild nausea blood pressure of 120/84 mm Hg history of bright red spotting 6 weeks ago fundal height measurement of 18 cm
fundal height measurement of 18 cm
A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? preeclampsia placental abruption (abruptio placentae) placenta previa gestational hypertension
gestational hypertension
The nurse is assessing a client at 12 weeks' gestation at a routine prenatal visit who reports something "does not feel right." Which set of assessment findings should the nurse prioritize? elevated human chorionic gonadotrophin (hCG) levels, enlarged abdomen, quickening vaginal bleeding, increased human placental lactogen (hPL) levels visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen gestational hypertension, hyperemesis gravidarum, absence of fetal heart rate (FHR)
gestational hypertension, hyperemesis gravidarum, absence of fetal heart rate (FHR) Explanation: The early development of gestational hypertension/preeclampsia, hyperemesis gravidarum, and the absence of fetal heart rate (FHR) are suspicious for gestational trophoblastic disease (GTD). The elevated levels of human chorionic gonadotrophin (hCG) lead to severe morning sickness. There is no fetus, so FHR, quickening, and evidence of a fetal skeleton would not be seen. The abdominal enlargement is greater than expected for pregnancy dates, but hCG, not human placental lactogen (hPL), levels are increased. Although the other findings are also concerning, they would be evaluated after the client was evaluated for potential GTD
A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect? placenta previa hyperemesis gravidarum gestational trophoblastic disease pregnancy-induced depression
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? grade 2 grade 1 grade 3 grade 4
grade 2 Explanation: The classifications for placental abruption (abruptio placentae) are: grade 1 (mild) - minimal bleeding (less than 500 ml), 10% to 20% separation, tender uterus, no coagulopathy, signs of shock or fetal distress; grade 2 (moderate) - moderate bleeding (1,000 to 1,500 ml), 20% to 50% separation, continuous abdominal pain, mild shock, normal maternal blood pressure, maternal tachycardia; grade 3 (severe) - absent to moderate bleeding (more than 1,500 ml), more than 50% separation, profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased blood pressure, significant tachycardia, and development of disseminated intravascular coagulopathy. There is no grade 4
A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply. hyperthermia hemolysis elevated liver enzymes leukocytosis low platelet count
hemolysis elevated liver enzymes low platelet count
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? high number of pregnancies multiple gestation pregnancy use of oral contraceptives history of endometriosis
history of endometriosis
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? high number of pregnancies multiple gestation pregnancy use of oral contraceptives history of endometriosis
history of endometriosis Explanation: The nurse needs to complete a full history of the client 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 abortions (elective terminations of pregnancy). Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy.
A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as: hydatidiform mole. ectopic pregnancy. placenta accrete. hydramnios.
hydatidiform mole. Gestational trophoblastic disease comprises a spectrum of neoplastic disorders that originate in the placenta. The two most common types are hydatidiform mole (partial or complete) and choriocarcinoma. Hydatidiform mole is a benign neoplasm of the chorion in which the chorionic villi degenerate and become transparent vesicles containing clear, viscid fluid. Ectopic pregnancy, placenta accreta, and hydramnios fall into different categories of potential pregnancy complications.
A 25-year-old client at 22 weeks' gestation is noted to have proteinuria and dependent edema on her routine prenatal visit. Which additional assessment should the nurse prioritize and convey to the RN or health care provider? initial BP 120/80mm Hg; current BP 130/88 mm Hg initial BP 100/70 mm Hg; current BP 140/90 mm Hg initial BP 140/85 mm Hg; current BP 130/80 mm Hg initial BP 110/60 mm Hg; current BP 112/86 mm Hg
initial BP 100/70 mm Hg; current BP 140/90 mm Hg
Which measure would the nurse include in the plan of care for a woman with prelabor rupture of membranes if her fetus's lungs are mature? reduction in physical activity level observation for signs of infection administration of corticosteroids labor induction
labor induction Explanation: With prelabor rupture of membranes (PROM) in a woman whose fetus has mature lungs, induction of labor is initiated. Reducing physical activity, observing for signs of infection, and giving corticosteroids may be used for the woman with PROM when the fetal lungs are immature.
What would be the physiologic basis for a placenta previa? a loose placental implantation low placental implantation a placenta with multiple lobes a uterus with a midseptum
low placental implantation
Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? oxytocin promethazine ondansetron methotrexate
methotrexate 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 28-year-old primigravida client with type 2 diabetes comes to the health care clinic for a routine first trimester visit reporting frequent episodes of fasting blood glucose levels being lower than normal, but glucose levels after meals being higher than normal. What should the nurse point out that these episodes are most likely related to? tissue sensitivity to insulin increases using too much insulin at this stage of the pregnancy normal response to the pregnancy insulin resistance is starting to decrease
normal response to the pregnancy
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? normal saline dextrose 5% and water 0.45% sodium chloride albumin
normal saline
A nurse is teaching a group of pregnant woman about bleeding that can occur early in pregnancy. The nurse determines that additional teaching is needed when the group identifies which condition as a common cause? placenta previa spontaneous abortion (miscarriage) ectopic pregnancy GTD
placenta previa
A woman at 35 weeks' gestation with severe polyhydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client? preterm rupture of membranes followed by preterm birth development of eclampsia hemorrhaging development of gestational trophoblastic disease
preterm rupture of membranes followed by preterm birth
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? promote maternal D antibody formation. prevent maternal D antibody formation. stimulate maternal D immune antigens. prevent fetal Rh blood formation.
prevent maternal D antibody formation. Explanation: Because Rho(D) immune globulin contains passive antibodies, the solution will prevent the woman from forming long-lasting antibodies which may harm a future fetus. The administration of Rho(D) immune globulin does not promote the formation of maternal D antibodies; it does not stimulate maternal D immune antigens or prevent fetal Rh blood formation.
The nurse is admitting a G3 P2 client at 38 weeks' gestation who arrived reporting painless bleeding from the vagina leading to the diagnosis of placenta previa. When questioned by the client as to what caused this, which most likely factor should the nurse point out in her answer? morbidly obese maternal age more than 30 years living in coastal areas previous cesarean birth
previous cesarean birth
The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours to detect which condition? pulmonary hypertension pulmonary edema pulmonary emboli pulmonary atelectasis
pulmonary edema Explanation: In the hospital, monitor blood pressure at least every 4 hours for mild preeclampsia and more frequently for severe disease. In addition, it is important to auscultate the lungs every 2 hours. Adventitious sounds may indicate developing pulmonary edema.
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? referred shoulder pain vaginal spotting nausea breast tenderness
referred shoulder pain
The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? lung sounds oxygen saturation reflexes magnesium sulfate level
reflexes Explanation: Reflex assessment is part of the standard assessment for clients 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 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? urine protein ability to sleep hemoglobin respiratory rate
respiratory rate Explanation: A therapeutic level of magnesium is 4 to 8 mg/dl (1.65 to 3.29 mmol/L). If magnesium toxicity occurs, one sign in the client will be a decrease in the respiratory rate and a potential respiratory arrest. Respiratory rate will be monitored when on this medication. The client's hemoglobin and ability to sleep are not factors for ongoing assessments for the client on magnesium sulfate. Urinary output is measured hourly on the preeclamptic client receiving magnesium sulfate, but urine protein is not an ongoing assessment.
The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving betamethasone and magnesium sulfate. The nurse recognizes the client is being treated for which condition? gestational hypertension gestational diabetes severe preeclampsia postterm pregnancy
severe preeclampsia
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? premature birth hypertension spontaneous abortion (miscarriage) preterm laborspontaneous abortion (miscarriage)
spontaneous abortion (miscarriage)
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 slight vaginal bleeding closed cervical os no passage of fetal tissue
strong abdominal cramping
A young client gives birth to twin boys who shared the same placenta. For what serious complication should the nurse prepare? twin-to-twin transfusion syndrome (TTTS) hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome toxoplasmosis, others, rubella, cytomegalovirus, and genital herpes (TORCH) infection ABO incompatibility
twin-to-twin transfusion syndrome (TTTS)
A young client gives birth to twin boys who shared the same placenta. For what serious complication should the nurse prepare? twin-to-twin transfusion syndrome (TTTS) hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome toxoplasmosis, others, rubella, cytomegalovirus, and genital herpes (TORCH) infection ABO incompatibility
twin-to-twin transfusion syndrome (TTTS) Explanation: When twins share a placenta, a serious condition called twin-to-twin transfusion syndrome (TTTS) can occur. HELLP syndrome (which stands for hemolysis, elevated liver enzymes, low platelets count) is a hypertensive disorder of pregnancy that occurs most often as a complication of preeclampsia. TORCH infection is a group of infections commonly implicated in congenital anomalies. It stands for toxoplasmosis, others, rubella, cytomegalovirus, and genital herpes. ABO incompatibility is a condition where the newborn's blood type is different from the gestational parent's blood type. If the two blood types mix, the newborn's body may attack the red blood cells and break them down.
A nurse is caring for a pregnant client admitted with mild preeclampsia. Which assessment finding should the nurse prioritize? urine output of less than 15 ml/hr 1+ ankle edema mild hand edema proteinuria of 200 mg/24 hours
urine output of less than 15 ml/hr
