Exam 3

Cytomegalovirus (CMV) is what?

A herpesvirus that can produce the symptoms of prolonged high fever, chills, headache, malaise, extreme fatigue, and an enlarged spleen.

A client has been admitted to the hospital with a diagnosis of severe preeclampsia. Which nursing intervention is the priority? A) Confine the client to bed rest in a darkened room. B) Administer oxygen by face mask. C) Keep the client on her side so that secretions can drain from her mouth. D) Check for vaginal bleeding every 15 minutes.

A) Confine the client to bed rest in a darkened room. With severe preeclampsia, most women are hospitalized so that bed rest can be enforced and a woman can be observed more closely than she can be on home care. The nurse should darken the room if possible because a bright light can also trigger seizures. The other interventions listed pertain to a client who has experienced a seizure and has thus progressed to eclampsia.

The nurse is caring for a pregnant woman is determined to be at high risk for gestational diabetes. The nurse prepares to rescreen this client at which time frame? A) 16 to 20 weeks B) 20 to 24 weeks C) 24 to 28 weeks D) 28 to 32 weeks

C) 24 to 28 weeks A woman identified as high risk for gestational diabetes would undergo rescreening between 24 and 28 weeks, however, some health care providers can choose to conduct this screening earlier.

Complications due to Epilepsy include ___________, ____________, _________, and ______________.

Complications due to epilepsy include preeclampsia, preterm labor, placental abruption

Abdominal trauma may result in _____________________

Placental abruption

TORCH infection stands for

ToxoplasmosisOther = syphillis, varicella, HIVRubellaCytomegalovirusHerpes Simplex

Preeclampsia + seizures =

eclampsia

What does HELLP stand for?

hemolysis, elevated liver enzymes, low platelets

chorioamnionitis

inflammation of the chorion and amnion

AFP (alpha-fetoprotein)

test measured at 16-18 weeks gestation if serum increased indicates neural tube defects.

signs of ectopic pregnancy

unilateral lower quadrant/ pelvic pain, rigid tender abdomen, missed period, bleeding

A client with a multiple gestation has come to a health care facility for a regular antenatal check-up. When educating the client on pregnancy, about which complication should the nurse inform the client? A) Hypotension B) Fetal macrosomia C) Frequent diarrhea D) Placental dysfunction

D) Placental dysfunction The nurse should inform the client that placental dysfunction might occur as a complication of multiple pregnancies. Other complications of multiple pregnancies include preterm labor, hypertension, anemia, cord abnormalities, congenital anomalies, intrauterine growth restriction, and low birth weight. Hypertension, and not hypotension, is seen in multiple pregnancies. Fetal macrosomia is not seen in cases of multiple gestation. Constipation, and not diarrhea, is also seen as a complication of multiple pregnancies. This is due to the decreased functioning of the gastrointestinal system in multiple pregnancy.

The nurse is presenting a class at a local community health center on violence during pregnancy. Which possible complication would the nurse include? A) gestational hypertension B) chorioamnionitis C) placenta previa D) postterm labor

B) chorioamnionitis Women assaulted during pregnancy are at risk for chorioamnionitis, placental abruption, preterm labor, stillbirth, miscarriage, uterine rupture, and injuries to the mother and fetus. Gestational hypertension is not associated with violence during pregnancy.

What is the recommended amount of protein (grams/day) in pregnancy? A) 40 g/d B) 46 g/d C) 50 g/d D) 71 g/d

D) 71 g/d A pregnant woman should consume 71 grams of protein per day.

Antidote for magnesium sulfate

calcium gluconate

The health care provider of a newly pregnant client determines the woman also has mitral stenosis and will need appropriate therapy. Which medication should the nurse prepare to teach this client to provide her with the best possible care? A) heparin B) digoxin C) aspirin D) warfarin

A) Heparin This client has an increased risk for developing blood clots. If an anticoagulant is required, heparin is the drug of choice as it does not cross the placenta barrier. Warfarin crosses the placenta and may have teratogenic effects. Aspirin is not recommended in this situation. If digoxin is not used to prevent blood clots.

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? A) postterm birth B) maternal hypotension C) congenital anomalies D) fetal nonimmune hydrops

C) congenital anomalies Multiple gestation involves two or more fetuses. The perinatal complications associated with multiple pregnancy include preterm birth, maternal hypertension and congenital anomalies. Fetal nonimmune hydrops occurs in the infection of pregnant clients with parvovirus. Postterm birth, maternal hypotension, and fetal nonimmune hydrops are not seen as complications of multiple pregnancy.

The nurse reviews the medication therapy regimen of a pregnant woman with chronic hypertension. Which medication would the nurse most likely expect to find? A) labetalol B) atenolol C) carvidelol D) metoprolol

A) labetalol Although beta-blockers and calcium channel blockers may be prescribed to reduce blood pressure by peripheral dilation to a safe level, it should not be reduced below the threshold that allows for good placenta circulation. Labetalol and nifedipine are typical drugs that may be prescribed.

A primary care provider prescribes oral tocolytic therapy for a woman with preterm labor. The nurse explains to the client about the drugs that may be used. The nurse determines that the client needs additional teaching when she states which drug might be used? A) magnesium sulfate B) nifedipine C) indomethacin D) bethamethasone

A) magnesium sulfate Magnesium sulfate is only given intravenously for preterm labor. Nifedipine and indomethacin are given orally for preterm labor. Betamethasone promotes fetal lung maturity by stimulating surfactant production.

A pregnant client with severe preeclampsia has developed HELLP syndrome. In addition to the observations necessary for preeclampsia, what other nursing intervention is critical for this client? A) observation for bleeding B) maintaining a patent airway C) administration of a tocolytic, if prescribed D) monitoring for infection

A) observation for bleeding Because of the low platelet count associated with this condition, women with HELLP syndrome need extremely close observation for bleeding, in addition to the observations necessary for preeclampsia. Maintaining a patent airway is a critical intervention needed for a client with eclampsia while she is having a seizure. Administration of a tocolytic would be appropriate for halting labor. Monitoring for infection is not a priority intervention in this situation.

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding? A) slight vaginal bleeding B) cervical dilation C) strong abdominal cramping D) passage of fetal tissue

A) slight vaginal bleeding Slight vaginal bleeding early in pregnancy, no cervical dilation, and a closed cervical os are associated with a threatened abortion. Strong abdominal cramping is associated with an inevitable abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.

A woman at 9 weeks' gestation is admitted to the obstetrical unit for hyperemesis gravidarum. Which action should the nurse prioritize immediately? A) Bed rest with bathroom privileges B) Instruct on NPO status C) Establish IV for rehydration D) Administration of antiemetics

B) Instruct on NPO status The initial priority intervention is to explain the NPO status to the client so the vomiting may be brought into control. The next steps will depend on the severity of the hyperemesis gravidarum. Most clients are dehydrated by the time they come to the clinic or hospital for assistance, so establishing an IV line would most likely be the next step. This will also allow for administration of medication to bypass the GI tract. It is also possible the client will be on bedrest with bathroom privileges, but this is not a priority instruction.

The nurse is caring for an intrapartum mother whose fetus has asymmetrical intrauterine growth restriction (IUGR) after the 24th week of gestation. Which nursing action is best? A) Provide emotional support to the mother and support person as the neonate has anomalies. B) Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. C) Anticipate a precipitous delivery since the neonate is small for gestational age. D) Use regular assessment techniques as an uncomplicated delivery is anticipated.

B) Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. The fetus with asymmetrical intrauterine growth restriction is compromised in some manner; thus, regular assessment of the fetal monitor tracings can indicate if the fetus is in distress (a common occurrence). If the fetus is in distress due to the work of birth, be prepared for a cesarean section. A congenital anomaly nor a precipitous delivery is not always present with IUGR. Since there is a complication causing IUGR, a complicated delivery is anticipated.

The nurse is reviewing the plan of care for a pregnant patient experiencing a threatened miscarriage. Which outcome would be appropriate for this patient? A) rest is maintained until all bleeding stops. B) Less than one perineal pad is saturated per hour. C) Bleeding spontaneously stops within 24 to 48 hours. D) Normal coitus is resumed 1 week after the episode.

C) Bleeding spontaneously stops within 24 to 48 hours For a threatened miscarriage, an outcome for care would be that all bleeding would spontaneously stop within 24 to 48 hours. Bed rest is not recommended for a threatened miscarriage because blood will pool in the vagina. Vaginal bleeding that saturates a perineal pad in 1 hour is an emergency and could indicate an incomplete or complete miscarriage. Normal coitus should be withheld for 2 weeks after a threatened miscarriage.

An 18-year-old pregnant client is hospitalized as she recovers from hyperemesis gravidarum. The client reveals she wanted to have an abortion but the cultural background forbids it. She is very unhappy about being pregnant and even expresses a wish for a miscarriage. Which action should the LPN prioritize? A) Reassure the client that her conversation is confidential and encourage her to continue. B) Contact the hospital's psychiatry department to have someone see the client. C) Consult with the RN about offering the client a chance to speak with a psychiatrist. D) Share the information with the physician and the client's family.

C) Consult with the RN about offering the client a chance to speak with a psychiatrist. The client is experiencing a psychological situation that needs intervention by a trained professional in the area of mental health. The hyperemesis gravidarum may worsen her feelings toward the pregnancy and need to be monitored. Encouraging the client to continue to share her feelings would be helpful, but it is not the best option offered. Contacting the hospital's psychiatry department is not within the province of the LPN to act on his or her own. Sharing the information with the physician is appropriate after apprising the RN of the situation, but the scenario described does not indicate that you have the client's permission to share this information with the client's family.

After delivery, a patient is diagnosed with placenta succenturiata. For what procedure should the nurse prepare this patient? A) Lavage of the uterus B) Repair of an episiotomy C) Manual removal of accessory lobes D) Emergency resuscitation of the newborn

C) Manual removal of accessory lobes A placenta succenturiata is a placenta that has one or more accessory lobes connected to the main placenta by blood vessels. This disorder needs to be recognized because the small lobes may be retained in the uterus after birth, leading to severe maternal hemorrhage. Once the remaining lobes are recognized and removed from the uterus manually, the uterus will contract with no adverse maternal effects. Uterine lavage is not a treatment for this disorder. This disorder is not specifically associated with an episiotomy. No fetal abnormality is associated with this disorder.

A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? A) Check deep tendon reflexes. B) Measure fundal height. C) Palpate the fundus, and check fetal heart rate. D) Obtain a voided urine specimen, and determine blood type.

C) Palpate the fundus and check fetal heart rate The classic signs of abruptio placentae are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.

A pregnant client arrives at the clinic for a regular antenatal check-up. Examinations and weight recording reveal a slow fetal weight gain. About which of the following pregnancy-related risks should the nurse alert the client? A) Prolonged labor B) Pre-eclampsia C) Preterm labor D) Uterine infections

C) preterm labor The nurse should alert the client with slowed fetal growth that she may experience a preterm labor. Preterm labor is common among women who show slowed fetal growth. Slowed fetal growth does not predispose the client to a prolonged labor, where the duration of labor is long. Prolonged labor is experienced when there is fetal macrosomia or the size of the fetus is large. A slowed fetal growth also does not predispose the client to pre-eclampsia or uterine infections. Multiparity, multiple gestation, hypertension for 4 years or more, family history of preeclampsia, hypertension in a previous pregnancy, and renal disease are factors that predispose to the development of pre-eclampsia. A ruptured amniotic membrane is a risk factor for the development of uterine infections.

The nurse is concerned that a pregnant patient is experiencing abruptio placentae. What did the nurse assess in this patient? A) Increased blood pressure and oliguria B) Pain in a lower quadrant and increased pulse rate C) Painless vaginal bleeding and a fall in blood pressure D) Sharp fundal pain and discomfort between contractions

D) Sharp fundal pain and discomfort between contractions Abruptio placentae is characterized by a sharp, stabbing pain high in the uterine fundus as the initial separation occurs. Manifestations of abruptio placentae do not include increased blood pressure, oliguria, pain in the lower quadrant, increased pule rate, painless vaginal bleeding, or a fall in blood pressure.

A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor? A) can be used as long as they control serum glucose levels. B) can be taken until the degeneration of the placenta occurs. C) are usually suggested primarily for women who develop gestational diabetes. D) have been shown to be effective and safe in recent short term studies.

D) have been shown to be effective and safe in recent short term studies. Recent studies have examined the use of oral hypoglycemic medications in pregnancy with much success. Several studies have used glyburide with promising results. Many health care providers are using glyburide and metformin as an alternative to insulin therapy because they do not cross the placenta and therefore do not cause fetal/neonatal hypoglycemia. Some oral hypoglycemic medications are considered safe and may be used if nutrition and exercise are not adequate alone. Maternal and newborn outcomes are similar to those seen in women who are treated with insulin. Oral hypoglycemic agents, however, must be further investigated to determine their safety with confidence and provide better treatment options for diabetes in pregnancy. Currently, there is a growing acceptance of glyburide use as a primary therapy for gestational diabetes. Glyburide and metformin have also been found to be safe, effective, and economical for the treatment of gestational diabetes, although neither drug has been approved by the FDA for use in pregnancy.

Which measure would the nurse include in the plan of care for a woman with premature rupture of membranes if her fetus's lungs are mature? A) reduction in physical activity level B) observation for signs of infection C) administration of corticosteroids D) labor induction

D) labor induction With premature rupture of membranes 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.

Biophysical profile (BPP)

uses a real-time ultrasound for visualization of physical and physiological characteristics of a fetus.A test that assess five variables; fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and fetal reaction

A woman in week 16 of her pregnancy calls her primary care provider's office to report that she has experienced abdominal cramping, cervical dilation, vaginal spotting, and the passing of tissue. The nurse instructs the client to bring the passed tissue to the hospital with her. What is the correct rationale for this instruction? A) to determine whether gestational trophoblastic disease is present B) to determine whether infection is present C) to determine whether the fetus is viable D) to determine the stage of development of the fetus

A) to determine whether gestational trophoblastic disease is present Gestational trophoblastic disease is abnormal proliferation and then degeneration of the trophoblastic villi. The embryo fails to develop beyond a primitive start. Abnormal trophoblast cells must be identified because they are associated with choriocarcinoma, a rapidly metastasizing malignancy. This is why it is important for any woman who begins to miscarry at home to bring any clots or tissue passed to the hospital with her. The presence of clear fluid-filled cysts changes the diagnosis from a simple miscarriage to gestational trophoblastic disease. The client is not instructed to bring in passed tissue to determine whether infection is present or the fetus is viable or to determine the stage of development of the fetus.

A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply. A) periods of rest into the workday. B) taking the scheduled warfarin. C) Receive pneumococcal and influenza vaccines. D) Let the physician know if you become short of breath or have a nighttime cough. E) Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus.

A, C, D

The nurse would be alert for possible placental abruption during labor when assessment reveals which finding? A) macrosomia B) gestational hypertension C) gestational diabetes D) low parity

B) gestational hypertension Risk factors for placental abruption include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, domestic violence, and placental pathology. Macrosomia, gestational diabetes, and low parity are not considered risk factors.

Assessment of a pregnant woman reveals oligohydramnios. The nurse would be alert for the development of which condition? A) maternal diabetes B) placental insufficiency C) neural tube defects D) fetal gastrointestinal malformations

B) placental insufficiency A deficiency of amniotic fluid, oligohydramnios, is associated with uteroplacental insufficiency and fetal renal abnormalities. Excess amniotic fluid is associated with maternal diabetes, neural tube defects, and malformations of the gastrointestinal tract and central nervous system.

A nurse is reviewing the medical record of a pregnant client diagnosed with placenta previa. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which type of placenta previa? A) total B) partial C) marginal D) low-lying

D) Low- lying Placenta previa is generally classified according to the degree of coverage or proximity to the internal os, as follows: total placenta previa - the internal cervical os is completely covered by the placenta; partial placenta previa - the internal os is partially covered by the placenta; marginal placenta previa - the placenta is at the margin or edge of the internal os; low-lying placenta previa - the placenta is implanted in the lower uterine segment and is near the internal os but does not reach it.

A young woman presents at the emergency department reporting lower abdominal cramping and spotting at 12 weeks' gestation. The primary care provider performs a pelvic examination and finds that the cervix is closed. What does the care provider suspect is the cause of the cramps and spotting? A) Ectopic pregnancy B) Habitual abortion C) Cervical insufficiency D) Threatened abortion

D) threatened abortion Spontaneous abortion occurs along a continuum: threatened, inevitable, incomplete, complete, missed. The definition of each category is related to whether or not the uterus is emptied, or for how long the products of conception are retained.