Maternity Ch. 28, Hemorrhagic Disorders

Which statement by the student nurse student regarding the management of reduced cervical competence (premature dilation of the cervix) indicates effective learning?

"A prophylactic cerclage is used to constrict the internal os of the cervix."

The quantitative human chorionic gonadotropin (β-hCG) levels are high in a client who is on methotrexate therapy for dissolving an abdominal pregnancy. Which nursing instruction is appropriate for this client?

"Avoid sexual activity."

Which nursing information is appropriate to discuss with a client who has received methotrexate therapy? Select all that apply.

"Avoid vitamins and foods that contain folic acid." "Make sure to close the lid of the toilet and double-flush." "When you resume intercourse, you must use contraception for 3 months."

Which instructions would the nurse give to a client who is prescribed methotrexate therapy for dissolving a tubal pregnancy?

"Discontinue folic acid supplements."

Which dietary instructions would the nurse give a client who has experienced miscarriage?

"Eat foods that are high in iron and protein."

The nurse is teaching care precautions to a pregnant client who underwent cervical cerclage during the second trimester. Which statement by the client indicates the need for further teaching?

"I should consult the obstetrician if I have contractions 20 minutes apart."

The nurse is preparing to discharge a 30-year-old client who experienced a miscarriage at 10 weeks of gestation. Which statement by the client indicates effective learning of the discharge instructions?

"I should eat foods that are high in iron and protein to help my body heal."

Which statement by the student nurse regarding the management of molar pregnancy indicates effective learning?

"Suction curettage is the safest way of terminating molar pregnancy."

Which pregnant client is a likely candidate for expectant management?

A client with a threatened miscarriage that has no bleeding or infection

The nurse working in an obstetric clinic is taking health histories and knows that which client is at the highest risk of developing hydatidiform mole?

A client with prior molar pregnancy

Which signs and symptoms would the nurse find in assessing the client with ectopic pregnancy? Select all that apply.

Abdominal pain Delayed menses Abnormal vaginal bleeding

The nurse instructs the pregnant client with chronic hypertension to be alert for which symptoms of abruption? Select all that apply.

Abdominal pain Vaginal bleeding Uterine tenderness

Which signs and symptoms would the nurse find in assessing the client with abruption placentae? Select all that apply.

Abdominal pain Vaginal bleeding Uterine tenderness

A client in labor has developed spontaneous bruises over the skin, and the fetal heart monitor indicates late decelerations in fetal heart rate (FHR). The nurse suspects disseminated intravascular coagulation (DIC). Which would be the best nursing intervention to prevent fetal complications?

Administering oxygen through a face mask

Which intervention would the nurse anticipate for a client with disseminated intravascular coagulation (DIC)?

Administration of blood

Which nursing interventions are implemented when caring for a pregnant client with disseminated intravascular coagulation (DIC)? Select all that apply.

Assess for signs of bleeding. Monitor urinary output. Initiate electronic fetal monitoring. Administer prescribed oxygen.

After assessing a client, the nurse concludes that the client has a threatened miscarriage. Which signs in the client would be consistent with the diagnosis? Select all that apply.

Blood spotting Closed cervical os Mild uterine cramping

Which nursing instruction is appropriate when discussing self-care after a miscarriage? Select all that apply.

Increase dietary intake of iron. Avoid tub baths for 2 weeks. Notify the health care provider if vaginal discharge has a foul odor.

The nurse is caring for a pregnant client who has a history of second-trimester loss and preterm birth. After reviewing the ultrasound report, the nurse finds that the client has a cervix less than 30 mm. Which treatment strategy would the nurse anticipate in the treatment plan?

Cerclage insertion

Which presentations are associated with early pregnancy loss occurring at less than 12 weeks of gestation? Select all that apply.

Chromosomal abnormalities Antiphospholipid syndrome Hypothyroidism

Which are the possible causes of miscarriage during early pregnancy? Select all that apply.

Chromosomal abnormalities Endocrine imbalance Hypothyroidism Antiphospholipid antibodies

Which sign would the nurse observe in a client with hydatidiform mole?

Dark brown vaginal discharge

A client reports mild vaginal bleeding, pain, and cramping in her lower abdomen at 6 weeks of gestation. On performing a pelvic examination, the nurse finds that the client's cervical os is closed. What is the priority nursing intervention in this case?

Determine the client's human chorionic gonadotropin and progesterone levels.

A client is treated with prostaglandins after a miscarriage. Which side effects of prostaglandins would the nurse monitor in the client? Select all that apply.

Diarrhea Vomiting

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. What is the reason for giving this instruction?

Stronger analgesics can mask symptoms of the tubal rupture.

Which clinical treatment would the nurse anticipate for a client who presents at 9 weeks of gestation stating she has had a blood-soaked peri pad over the past hour and has been cramping, and it is noted on examination that her cervix is dilated?

Dilation and suction curettage

The nurse is examining a client who is approximately 8 weeks pregnant and was admitted for possible ectopic pregnancy. Which would be the priority concern in this case?

Ecchymosis noted around the umbilicus

Which condition is characterized by implantation of fertilized ovum outside the uterine cavity?

Ectopic pregnancy

Which medication would the nurse administer to the client if there is excessive bleeding after suction curettage?

Ergonovine

A client diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, the client is at the greatest risk for which complication?

Hemorrhage

On reviewing the ultrasound report of a pregnant client, the nurse finds that the placenta is at a distance of 2.5 cm from the internal cervical os. Which complication is likely if the client has a vaginal delivery?

Hemorrhage

The nurse explains to the student nurse that the most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is which client condition?

Intense abdominal pain

Which test is used to determine the presence of fetal-to-maternal bleeding in a pregnant client?

Kleihauer-Betke (KB) test

During the assessment of a pregnant client, the nurse finds that the client has cramps, a closed cervical os without tissue perforation, and absence of uterine bleeding. The client's ultrasound report reveals that fetal growth is less than expected per the gestational period, and there is no fetal heartbeat. Which drug would be added to the client's prescription?

Misoprostol

The ultrasound report of a 12-week-pregnant client shows a snowstorm pattern. On further examination, the nurse finds elevated human chorionic gonadotropin (hCG) levels and dark brown vaginal discharge. Which complication would the nurse expect in the client?

Molar pregnancy

The nurse is preparing a client for abortion. Which medicine would the nurse administer to the client after evacuation of the uterus to prevent hemorrhage?

Oxytocin

Which medications would be administered to manage excessive bleeding in a client after a miscarriage? Select all that apply.

Oxytocin Ergonovine

The nurse is assessing a pregnant client at 6 weeks of gestation. On reviewing the client's medical history, the nurse finds that the client had undergone a large cone biopsy. Which treatment strategy would the nurse expect to be most beneficial to prevent miscarriage in the client?

Performing abdominal cerclage at 11 weeks of gestation

A client reports painless, bright red vaginal bleeding during the second trimester of pregnancy. On assessment, the nurse notes decreased urine output, increased fundal height, and a nontender uterus with normal tone. Which client condition would the nurse interpret from these findings?

Placenta previa

A pregnant client after 20 weeks of gestation reports painless bright red vaginal bleeding. On assessment, the nurse finds that the client's vital signs are normal. Which condition would the nurse suspect in the client?

Placenta previa

A client 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. Which client condition would the nurse suspect?

Placental abruption

Which complication would be correlated with the assessment findings in the electronic health record for a labor and delivery client at 39 weeks of gestation?

Placental abruption

Which condition is associated with a high risk for disseminated intravascular coagulation (DIC)?

Placental abruption

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?

Placental previa

The nurse notes signs of threatened abortion (miscarriage) in a client at 8 weeks of gestation. Which management approach is appropriate for this client?

Prepare the client for an ultrasound examination and blood work.

The nurse is caring for a client who is 35 weeks pregnant and reports moderate vaginal bleeding. The ultrasound report indicates abruptio placentae. Which immediate intervention would the nurse provide?

Prepare the client for delivery.

Which nursing intervention is important when a caring for a client who has an incomplete miscarriage with heavy bleeding?

Prepare the client for dilation and curettage.

A nurse is evaluating several obstetric clients for the risk for cervical insufficiency. Which client would be considered most at risk?

Primipara who had a cervical cone biopsy performed for cervical dysplasia before the pregnancy

A pregnant client in the first trimester reports spotting of blood and mild uterine cramping. The nurse notes that the cervical os is closed. Which additional factors would the nurse need to assess in this client? Select all that apply.

Progesterone levels Transvaginal ultrasound examination report Human chorionic gonadotropin (hCG) measurement

Which clinical reports would the nurse evaluate to identify ectopic pregnancy in a client? Select all that apply.

Quantitative human chorionic gonadotropin (β-hCG) levels Transvaginal ultrasound report Progesterone level

A pregnant client reports painless vaginal bleeding at 22 weeks of gestation. The client's ultrasound report reveals a normally implanted placenta. Which intervention would the nurse anticipate the primary health care provider will prescribe for this client?

Speculum examination

The nurse is assessing a client who is 18 weeks pregnant. The client reports heavy bleeding, infection, and excessive cramping. Which treatment strategy would the nurse anticipate in the treatment plan?

Suction curettage

Which maternal risk is associated with placenta previa?

Surgery-related trauma

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?

The client is taking methotrexate.

A client has received methotrexate therapy for an ectopic pregnancy. Which client action would help prevent complications?

The client uses a contraceptive method for 3 months.

A pregnant client is diagnosed with a succenturiate placenta. Which statement is accurate regarding the client's condition?

The placenta is divided into more lobes, rather than a single lobe.

A client 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 client is based on a probable diagnosis of which type of spontaneous abortion?

Threatened

The nurse would prepare the client for which procedure based on the evaluation of the electronic health record?

Transvaginal ultrasonography