Midterms Rationalization
Before giving a repeat dose of magnesium sulfate to a pre-eclamptic patient, the nurse should assess the patient's condition. Which of the following conditions will require the nurse to temporarily suspend a repeat dose of magnesium sulfate? A.100 cc. urine output in 4 hours B.Knee jerk reflex is (+)2 C.Serum magnesium level is 10mEg/L. D.Respiratory rate of 16/min
A. 100 cc. urine output in 4 hours The minimum urine output expected for a repeat dose of MgSO4 is 30 cc/hr. If in 4 hours the urine output is only 100 cc this is low and can lead to poor excretion of Magnesium with a possible cumulative effect, which can be dangerous to the mother.
A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? A. Activity limited to bedrest. B. Platelet infusion C. Immediate cesarean delivery D. Labor induction with oxytocin
A. Activity limited to bedrest. Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client's bleeding.
24.When developing a plan of care for a client newly diagnosed with gestational diabetes, which of the following instructions would be the priority? A.Dietary intake B.Medication C.Exercise D.Glucose monitoring
A. Dietary Intake Although all of the choices are important in the management of diabetes, diet therapy is the mainstay of the treatment plan and should always be the priority. The goal of dietary therapy is to avoid single large meals and foods with a large percentage of simple carbohydrates.
38.Upon assessment, the nurse found the following: fundus at 2 fingerbreadths above the umbilicus, last menstrual period (LMP) 5 months ago, fetal heartbeat (FHB) not appreciated. Which of the following is the most possible diagnosis of this condition? A.Hydatidiform mole B.Missed abortion C.Pelvic inflammatory disease D.Ectopic pregnancy
A. Hydatidiform mole Hydatidiform mole begins as a pregnancy but early in the development of the embryo degeneration occurs. The proliferation of the vesicle-like substances is rapid causing the uterus to enlarge bigger than the expected size based on ages of gestation (AOG). In the situation given, the pregnancy is only 5 months but the size of the uterus is already above the umbilicus which is compatible with 7 months AOG. Also, no fetal heartbeat is appreciated because the pregnancy degenerated thus there is no appreciable fetal heartbeat.
Which of the following best describes preterm labor? A.Labor that begins after 20 weeks gestation and before 37 weeks gestation. B.Labor that begins after 15 weeks gestation and before 37 weeks gestation C.Labor that begins after 24 weeks gestation and before 28 weeks gestation. D.Labor that begins after 28 weeks gestation and before 40 weeks gestation.
A. Labor that begins after 20 weeks gestation and before 37 weeks gestation.
Which of the following factors would the nurse suspect as predisposing a client to placenta previa? A.Multiple gestation B.Uterine anomalies C.Abdominal trauma D.Renal or vascular disease
A. Multiple gestation Placenta previa is more common in older and multiparous women. The reason is not clear but it may be associated with the aging of the vasculature of the uterus. This causes placental hypertrophy and enlargement which increases the likelihood of the placenta encroaching on lower segment.
The post-term neonate with meconium-stained amniotic fluid needs care designed to especially monitor for which of the following? A.Respiratory problems B.Gastrointestinal problems C.Integumentary problems D.Elimination problems
A. Respiratory problems Intrauterine anoxia may cause relaxation of the anal sphincter and emptying of meconium into the amniotic fluid. At birth some of the meconium fluid may be aspirated, causing mechanical obstruction or chemical pneumonitis.
The main reason for an expected increased need for iron in pregnancy is: A.The mother may have physiologic anemia due to the increased need for red blood cell mass as well as the fetal requires about 350-400 mg of iron to grow. B.The mother may suffer anemia because of poor appetite. C. The fetus has an increased need for RBC which the mother must supply. D. The mother may have a problem with digestion because of pica.
A. The mother may have physiologic anemia due to the increased need for red blood cell mass as well as the fetal requires about 350-400 mg of iron to grow. About 400 mg of iron is needed by the mother in order to produce more RBC mass to be able to provide the needed increase in blood supply for the fetus. Also, about 350-400 mg of iron is needed for the normal growth of the fetus. Thus, about 750-800 mg iron supplementation is needed by the mother to meet this additional requirement.
Because cervical effacement and dilation are not progressing in a patient in labor, the doctor orders I.V. administration of oxytocin (Pitocin). Why should the nurse monitor the patient's fluid intake and output closely during oxytocin administration? A. Oxytocin causes water intoxication. B. Oxytocin causes excessive thirst. C. Oxytocin is toxic to the kidneys. D. Oxytocin has a diuretic effect.
Answer: A. Oxytocin causes water intoxication The nurse should monitor fluid intake and output because prolonged oxytocin infusion may cause severe water intoxication, leading to seizures, coma, and death. In addition, oxytocin may cause water intoxication via an antidiuretic hormone-like activity when administered in excessive doses with electrolyte-free solution
A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? Select all that apply. A. The fetal alarm signal is reached when there are no fetal movements noted for 5 hours. B.The patient can monitor fetal activity once daily for a 60-minute period and note activity. C. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. D. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fatal movements are noted
Answer: B,C,D The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours. Fetal movement is one show of a baby's health in the womb. Each woman should learn the normal pattern and number of movements for her own baby A change in the normal pattern or number of fetal movements may mean the baby is under stress. And it's not normal for a baby to stop moving with the start of labor
A pregnant patient asks the nurse if she can take castor oil for her constipation. How should the nurse respond? A."Yes, it produces no adverse effect." B."No, it can initiate premature uterine contractions." C."No, it can promote sodium retention." D."No, it can lead to increased absorption of fat-soluble vitamins."
Answer: B. "No, it can initiate premature uterine contractions." Castor oil can initiate premature uterine contractions in pregnant women. It also can produce other adverse effects, but it does not promote sodium retention.
A patient in her 14th week of pregnancy has presented with abdominal cramping and vaginal bleeding for the past 8 hours. She has passed several clots. What is the primary nursing diagnosis for this patient? A.Knowledge deficit B.Fluid Volume Deficit C.Anticipatory grieving D.Pain
Answer: B.Fluid Volume Deficit If bleeding and clots are excessive, this patient may become hypovolemic. Pad count should be instituted. Blood volume expands during pregnancy, and a considerable portion of the weight of a pregnant woman is retained water.
To prevent preterm labor from progressing, drugs are usually prescribed to halt the labor. The drugs commonly given are: A.Magnesium sulfate and terbutaline B.Prostaglandin and oxytocin C.Progesterone and estrogen D.Dexamethasone and prostaglandin
B. .Prostaglandin and oxytocin In imminent abortion, the pregnancy will definitely be terminated because the cervix is already open unlike in threatened abortion where the cervix is still closed.
When evaluating a client's knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse in charge that the client understands the information given to her? A."I'll report increased frequency of urination." B."If I have blurred or double vision, I should call the clinic immediately." C."If I feel tired after resting, I should report it immediately." D."Nausea should be reported immediately."
B. B."If I have blurred or double vision, I should call the clinic immediately." Blurred or double vision may indicate hypertension or preeclampsia and should be reported immediately. It can affect the visual pathways, from the anterior segment to the visual cortex.
Which of the following would the nurse assess in a client experiencing abruptio placenta. A.Bright red, painless vaginal bleeding B.Concealed or external dark red bleeding C.Palpable fetal outline D.Soft and nontender abdomen
B. Bright red, painless vaginal bleeding A client with abruptio placentae may exhibit concealed or dark red bleeding, possibly reporting sudden intense localized uterine pain. The uterus is typically firm to board-like, and the fetal presenting part may be engaged.
Smoking is contraindicated in pregnancy because: A. Nicotine causes vasodilation of the mother's blood vessels. B. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus. C. The smoke will make the fetus, and the mother feels dizzy. D. Nicotine will cause vasoconstriction of the fetal blood vessels.
B. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus.
18.Which of the following would the nurse identify as a classic sign of PIH? A.Edema of the feet and ankles B.Edema of the hands and face C.Weight gain of 1 lb/week D.Early morning headache
B. Edema of the hands and face Aggressive volume resuscitation may lead to pulmonary edema, which is a common cause of maternal morbidity and mortality. Pulmonary edema occurs most frequently 48-72 hours postpartum, probably due to mobilization of extravascular fluid. Because volume expansion has no demonstrated benefit, patients should be fluid restricted when possible, at least until the period of postpartum diuresis.
A client 12 weeks' pregnant came to the emergency department with abdominal cramping and moderate vaginal bleeding. Speculum examination reveals 2 to 3 cm cervical dilation. The nurse would document these findings as which of the following? A.Threatened abortion B. Imminent abortion C.Complete abortion D.Missed abortion
B. Imminent abortion Cramping and vaginal bleeding coupled with cervical dilation signify that termination of the pregnancy is inevitable and cannot be prevented. Thus, the nurse would document an imminent abortion.
26.Which of the following would be the priority nursing diagnosis for a client with an ectopic pregnancy? A. Risk for infection A.Pain B.Knowledge Deficit C.Anticipatory Grieving
B. Knowledge Deficit For the client with an ectopic pregnancy, lower abdominal pain, usually unilateral, is the primary symptom. Thus, pain is the priority.
34.Which of the following signs will require a mother to seek immediate medical attention? A.When the first fetal movement is felt. B.No metal movement is felt on the 6th month. C.Mild uterine contraction. D.Slight dyspnea on the last month of gestation.
B. No metal movement is felt on the 6th month. Fetal movement is usually felt by the mother during 4.5 - 5 months. If the pregnancy is already in its 6th month and no fetal movement is felt, the pregnancy is not normal either the fetus is already dead intra-uterine or it is an H-mole.
Which of the following signs and symptoms will most likely make the nurse suspect that the patient has hydatidiform mole? A.Slight bleeding B.Passage of clear vesicular mass per vagina C.Absence of fetal heartbeat D.Enlargement of the uterus
B. Passage of clear vesicular mass per vagina Hydatidiform mole (H-mole) is characterized by the degeneration of the chorionic villi wherein the villi becomes vesicle-like. These vesicle-like substances when expelled per vagina and is a definite sign that the woman has H-mole.
Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta? A.Excessive vaginal bleeding B.Rigid, board-like abdomen C.Tetanic uterine contractions D.Premature rupture of membranes
B. Rigid, board-like abdomen The most common assessment finding in a client with abruption placenta is: - rigid or boardlike abdomen - sharp stabbing Pain - sensation high in the uterine fundus with the initial separation
A client with severe preeclampsia is admitted with BP 160/110, proteinuria, and severe pitting edema. Which of the following would be most important to include in the client's plan of care? A.Daily weights B.Seizure precautions C.Right lateral positioning D.Stress reduction
B. Seizure Precautions Women hospitalized with severe preeclampsia need decreased CNS stimulation to prevent a seizure. Seizure precautions provide environmental safety should a seizure occur.
It is (usually) defined as a fetus of more than 20 to 24 weeks of gestation or one that weighs at least 500 grams • A. AOG • B. Viable fetus • C. Vailability • D. Normal Birth Weight
B. Viable fetus
16.Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester? A.Dysuria B.Frequency C.Incontinence D.Burning
B.Frequency Pressure and irritation of the bladder by the growing uterus during the first trimester is responsible for causing urinary frequency.
10.A client makes a routine visit to the prenatal clinic. Although she is 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Charles diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: A.An empty gestational sac. B.Grapelike clusters. C.A severely malformed fetus. D.An extrauterine pregnancy.
B.Grapelike clusters. In a client with gestational trophoblastic disease, an ultrasound performed after the 3rd month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually, no embryo (and therefore no fetus) is present because it has been absorbed.
A nurse is preparing to administer prophylactic eye ointment to a newborn to prevent opthalmia neonatorum. Which of the following medications should the nurse anticipate administering? A.Ofloxacin B.Nystatin C.Erythromycin D.Ceftriaxone
C. Erythromycin
32.The amniotic fluid of a client has a greenish tint. The nurse interprets this to be the result of which of the following? A.Lanugo B.Hydramnios C.Meconium D.Vernix
C. Meconium The greenish tint is due to the presence of meconium. Meconium is a thick, green, tar-like substance that lines the baby's intestines during pregnancy. Typically this substance is not released in the baby's bowel movements until after birth. However, sometimes a baby will have a bowel movement prior to birth, excreting the meconium into the amniotic fluid.
19. In which of the following types of spontaneous abortions would the nurse assess dark brown vaginal discharge and a negative pregnancy test? A.Threatened B.Imminent C.Missed D.Incomplete
C. Missed In a missed abortion, there is early fetal intrauterine death, and products of conception are not expelled. The cervix remains closed; there may be a dark brown vaginal discharge, negative pregnancy test, and cessation of uterine growth and breast tenderness.
Which of the following is TRUE in Rh incompatibility? A. The condition can occur if the mother is Rh(+) and the fetus is Rh(-). B. Every pregnancy of an Rh(-) mother will result in erythroblastosis fetalis. C. On the first pregnancy of the Rh(-) mother, the fetus will not be affected. D. RhoGam is given only during the first pregnancy to prevent incompatibility.
C. On the first pregnancy of the Rh(-) mother, the fetus will not be affected. On the first pregnancy, the mother still has no contact with Rh(+) blood thus it has not antibodies against Rh(+). After the first pregnancy, even if terminated into an abortion, there is already the possibility of mixing of maternal and fetal blood so this can trigger the maternal blood to produce antibodies against Rh(+) blood. The fetus takes its blood type usually from the father.
When a pregnant woman goes into a convulsive seizure, the MOST immediate action of the nurse to ensure the safety of the patient is: A.Apply restraint so that the patient will not fall out of bed. B.Put a mouth gag so that the patient will not bite her tongue and the tongue will not fall back. C.Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration. D.Check if the woman is also having precipitate labor.
C. Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration. Positioning the mother on her side will allow the secretions that may accumulate in her mouth to drain by gravity thus preventing aspiration pneumonia.
In placenta previa marginalis, the placenta is found at the: A.Internal cervical os partly covering the opening. B.External cervical os slightly covering the opening. C.Lower segment of the uterus with the edges near the internal cervical os. D.Lower portion of the uterus completely covering the cervix.
C.Lower segment of the uterus with the edges near the internal cervical os. Placenta marginalis is a type of placenta previa wherein the placenta is implanted at the lower segment of the uterus thus the edges of the placenta are touching the internal cervical opening/os. The normal site of placental implantation is the upper portion of the uterus.
A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms? A.Proteinuria, headaches, vaginal bleeding B.Headaches, double vision, vaginal bleeding C.Proteinuria, headaches, double vision D.Proteinuria, double vision, uterine contractions
C.Proteinuria, headaches, double vision A patient with pregnancy-induced hypertension complains of a headache, double vision, and sudden weight gain. A urine specimen reveals proteinuria.
Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy? A.Large for gestational age (LGA) fetus B.Hemorrhage C.Small for gestational age (SGA) baby D.Erythroblastosis fetalis
C.Small for gestational age (SGA) baby Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus.
Which of the following would be the nurse's most appropriate response to a client who asks why she must have a cesarean delivery if she has a complete placenta previa? A."You will have to ask your physician when he returns." B."You need a cesarean to prevent hemorrhage." C."The placenta is covering most of your cervix." D."The placenta is covering the opening of the uterus and blocking your baby."
D. "The placenta is covering the opening of the uterus and blocking your baby." A complete placenta previa occurs when the placenta covers the opening of the uterus, thus blocking the passageway for the baby. This response explains what a complete previa is and the reason the baby cannot come out except by cesarean delivery.
Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage? A. Placenta previa B. Ectopic pregnancy C. Incompetent cervix D. Abruptio placenta
D. Abruptio placenta Abruptio placenta is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage.
Which of the following danger signs should be reported promptly during the antepartum period? Constipation Breast tenderness Nasal stuffiness Leaking amniotic fluid
D. Leaking amniotic fluid Danger signs that require prompt reporting leaking of amniotic fluid, vaginal bleeding, blurred vision, rapid weight gain, and elevated blood pressure.
A client with eclampsia begins to experience a seizure. Which of the following would the nurse in charge do first? A.Pad the side rails. B.Place a pillow under the left buttock. C.Insert a padded tongue blade into the mouth. D. Maintain a patent airway.
D. Maintain a patent airway The priority for the pregnant client having a seizure is to maintain a patent airway to ensure adequate oxygenation to the mother and the fetus. Additionally, oxygen may be administered by face mask to prevent fetal hypoxia.
5.A female adult patient is taking a progestin-only oral contraceptive or mini pill. Progestin use may increase the patient's risk for: A. Endometriosis B. Female hypogonadism C. Premenstrual syndrome D. Tubal or ectopic pregnancy
D. Tubal or ectopic pregnancy Women taking the mini pill have a higher incidence of tubal and ectopic pregnancies, possibly because progestin slows ovum transport through the fallopian tubes.
A multigravida at 38 weeks' gestation is admitted with painless, bright red bleeding and mild contractions every 7 to 10 minutes. Which of the following assessments should be avoided? A.Maternal vital sign B.Fetal heart rate C.Contraction monitoring D.Cervical dilation
D.Cervical dilation The signs indicate placenta previa and vaginal exam to determine cervical dilation would not be done because it could cause hemorrhage.
