Chapter19-Nursing Management of Pregnancy at Risk-Pregnancy

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

Ans: B Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 7 mEq/L are considered therapeutic, whereas levels more than 8 mEq/dL are generally considered toxic.

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the nurse to suspect that the client is having an adverse effect associated with this drug? A) Gastrointestinal bleeding B) Blurred vision C) Tachycardia D) Sweating

Ans: C 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, or sweating. Magnesium sulfate may cause sweating.

Which of the following data on a client's health history would the nurse identify as contributing to the client's risk for an ectopic pregnancy? A) Use of oral contraceptives for 5 years B) Ovarian cyst 2 years ago C) Recurrent pelvic infections D) Heavy, irregular menses

Ans: C In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy.

After teaching a woman who has had an evacuation for a hydatidiform mole (molar pregnancy) about her condition, which of the following statements indicates that the nurse's teaching was successful? A) "I will be sure to avoid getting pregnant for at least 1 year." B) "My intake of iron will have to be closely monitored for 6 months." C) "My blood pressure will continue to be increased for about 6 more months." D) "I won't use my birth control pills for at least a year or two."

Ans: A After evacuation of a hydatidiform mole, long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for 1 year and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow-up after evacuation of a hydatidiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided.

In a woman who is suspected of having a ruptured ectopic pregnancy, the nurse would expect to assess for which of the following as a priority? A) Hemorrhage B) Jaundice C) Edema D) Infection

Ans: A With a ruptured ectopic pregnancy, the woman is at high risk for hemorrhage. Jaundice, edema, and infection are not associated with a ruptured ectopic pregnancy.

While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios based on which of the following? (Select all that apply.) A) History of diabetes B) Complaints of shortness of breath C) Identifiable fetal parts on abdominal palpation D) Difficulty obtaining fetal heart rate E) Fundal height below that for expected gestational age

Ans: A, B, D Factors such as maternal diabetes or multiple gestations place the woman at risk for hydramnios. In addition, there is a discrepancy between fundal height and gestational age, such that a rapid growth of the uterus is noted. Shortness of breath may result from overstretching of the uterus due to the increased amount of amniotic fluid. Often, fetal parts are difficult to palpate and fetal heart rate is difficult to obtain because of the excess fluid present.

A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.) A) Dark red vaginal bleeding B) Insidious onset C) Absence of pain D) Rigid uterus E) Absent fetal heart tones

Ans: A, D, E Feedback: Assessment findings associated with abruption placenta include a sudden onset, with concealed or visible bleeding, dark red bleeding, constant pain or uterine tenderness on palpation, firm to rigid uterine tone, and fetal distress or absent fetal heart tones.

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate? A) "My mother lives next door and can drive me here if necessary." B) "I have a toddler and preschooler at home who need my attention." C) "I know to call my health care provider right away if I start to bleed again." D) "I realize the importance of following the instructions for my care."

Ans: B Having a toddler and preschooler at home needing attention suggest that the woman would have difficulty maintaining bed rest at home. Therefore, expectant management at home may not be appropriate. Expectant management is appropriate if the mother and fetus are both stable, there is no active bleeding, the client has readily available access to reliable transportation, and can comprehend instructions.

A nursing student is reviewing an article about preterm premature rupture of membranes. Which of the following would the student expect to find as factor placing a woman at high risk for this condition? (Select all that apply.) A) High body mass index B) Urinary tract infection C) Low socioeconomic status D) Single gestations E) Smoking

Ans: B, C, E High-risk factors associated with preterm PROM include low socioeconomic status, multiple gestation, low body mass index, tobacco use, preterm labor history, placenta previa, abruptio placenta, urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis.

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which of the following would lead the nurse to suspect that the woman is developing an infection? (Select all that apply.) A) Fetal bradycardia B) Abdominal tenderness C) Elevated maternal pulse rate D) Decreased C-reactive protein levels E) Cloudy malodorous fluid

Ans: B, C, E Possible signs of infection associated with premature rupture of membranes include elevation of maternal temperature and pulse rate, abdominal/uterine tenderness, fetal tachycardia over 160 bpm, elevated white blood cell count and C-reactive protein levels, and cloudy, foul-smelling amniotic fluid.

A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make? A) "Make sure that anything around your waist is quite snug." B) "Try to eat three large meals a day with less snacking." C) "Drink fluids in between meals rather than with meals." D) "Lie down for about an hour after you eat"

Ans: C Suggestions to minimize nausea and vomiting include avoiding tight waistbands to minimize pressure on the abdomen, eating small frequent meals throughout the day, separating fluids from solids by consuming fluids in between meals; and avoiding lying down or reclining for at least 2 hours after eating.

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate? A) "Why are you crying?" B) "Will a pill help your pain?" C) "I'm sorry you lost your baby." D) "A baby still wasn't formed in your uterus."

Ans: C Telling the client that the nurse is sorry for the loss acknowledges the loss to the woman, validates her feelings, and brings the loss into reality. Asking why the client is crying is ineffective at this time. Offering a pill for the pain ignores the client's feelings. Telling the client that the baby wasn't formed is inappropriate and discounts any feelings or beliefs that the client has.

After teaching a group of nursing students about the possible causes of spontaneous abortion, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of first trimester abortions? A) Maternal disease B) Cervical insufficiency C) Fetal genetic abnormalities D) Uterine fibroids

Ans: C The causes of spontaneous abortion are varied and often unknown. The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother. Chromosomal abnormalities are more likely causes in first trimester and maternal disease is more likely in the second trimester. Those occurring during the second trimester are more likely related to maternal conditions, such as cervical insufficiency, congenital or acquired anomaly of the uterine cavity (uterine septum or fibroids), hypothyroidism, diabetes mellitus, chronic nephritis, use of crack cocaine, inherited and acquired thrombophilias, lupus, polycystic ovary syndrome, severe hypertension and acute infection such as rubella virus, cytomegalovirus, herpes simplex virus, bacterial vaginosis, and toxoplasmosis.

The health care provider orders PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which of the following would be most important for the nurse to do? A) Use clean technique to administer the drug. B) Keep the gel cool until ready to use. C) Maintain the client for 1/2 hour after administration. D) Administer intramuscularly into the deltoid area.

Ans: C When PGE2 is ordered, the gel should come to room temperature before administering it. Sterile technique should be used and the client should remain supine for 30 minutes after administration. RhoGAM is administered intramuscularly into the deltoid area.

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

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

A nurse is teaching a pregnant woman with preterm premature rupture of membranes who is about to be discharged home about caring for herself. Which statement by the woman indicates a need for additional teaching? A) "I need to keep a close eye on how active my baby is each day." B) "I need to call my doctor if my temperature increases." C) "It's okay for my husband and me to have sexual intercourse." D) "I can shower but I shouldn't take a tub bath."

Ans: C Feedback: The woman with preterm premature rupture of membranes should monitor her baby's activity by performing fetal kick counts daily, check her temperature and report any increases to the health care provider, not insert anything into her vagina or vaginal area, such as tampons or vaginal intercourse, and avoid sitting in a tub bath.

Which assessment finding would lead the nurse to suspect infection as the cause of a client's PROM? A) Yellow-green fluid B) Blue color on Nitrazine testing C) Ferning D) Foul odor

Ans: D A foul odor of the amniotic fluid indicates infection. Yellow-green fluid would suggest meconium. A blue color on Nitrazine testing and ferning indicate the presence of amniotic fluid.

Which of the following findings on a prenatal visit at 10 weeks might lead the nurse to suspect a hydatidiform mole? A) Complaint of frequent mild nausea B) Blood pressure of 120/84 mm Hg C) History of bright red spotting 6 weeks ago D) Fundal height measurement of 18 cm

Ans: D Findings with a hydatidiform mole may include uterine size larger than expected. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion.

Which of the following findings would the nurse interpret as suggesting a diagnosis of gestational trophoblastic disease? A) Elevated hCG levels, enlarged abdomen, quickening B) Vaginal bleeding, absence of FHR, decreased hPL levels C) Visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen D) Gestational hypertension, hyperemesis gravidarum, absence of FHR

Ans: D Gestational trophoblastic disease may be manifested by early development of preeclampsia (gestational hypertension), severe morning sickness due to high hCG levels, and absence of fetal heart rate or activity. There is no fetus, so quickening and evidence of a fetal skeleton would not be seen. The abdominal enlargement is greater than expected for pregnancy dates, but hCG, not hPL, levels are increased.

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

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

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

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

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse anticipates that the client will receive RhoGAM at which time? A) At 34 weeks' gestation and immediately before discharge B) 24 hours before delivery and 24 hours after delivery C) In the first trimester and within 2 hours of delivery D) At 28 weeks' gestation and again within 72 hours after delivery

Ans: D To prevent isoimmunization, the woman should receive RhoGAM at 28 to 32 weeks gestation and again within 72 hours after delivery.

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

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

After reviewing a client's history, which factor would the nurse identify as placing her at risk for gestational hypertension? A) Mother had gestational hypertension during pregnancy. B) Client has a twin sister. C) Sister-in-law had gestational hypertension. D) This is the client's second pregnancy.

Ans: A A family history of gestational hypertension, such as a mother or sister, is considered a risk factor for the client. Having a twin sister or having a sister-in-law with gestational hypertension would not increase the client's risk. If the client had a history of preeclampsia in her first pregnancy, then she would be at risk in her second pregnancy.

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

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

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

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

A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the client's plan of care? A) Clear liquid diet B) Total parenteral nutrition C) Nothing by mouth D) Administration of labetalol

Ans: C Typically, on admission, the woman with hyperemesis has oral food and fluids withheld for the first 24 to 36 hours to rest the gut and receives parenteral fluids to rehydrate and reduce the symptoms. Once the condition stabilizes, oral intake is gradually increased. Total parenteral nutrition may be used if the client's condition does not improve with several days of bed rest, gut rest, IV fluids, and antiemetics. Labetalol is an antihypertensive agent that may be used to treat gestational hypertension, not hyperemesis.