OB Exam 5

12. When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)? a. 12 to 14 b. 6 to 8 c. 23 to 24 d. After 24

ANS: A A prophylactic cerclage is usually placed at 12 to 14 weeks of gestation. The cerclage is electively removed when the woman reaches 37 weeks of gestation or when her labor begins. Six to 8 weeks of gestation is too early to place the cerclage. Cerclage placement is offered if the cervical length falls to less than 20 to 25 mm before 23 to 24 weeks. Although no consensus has been reached, 24 weeks is used as the upper gestational age limit for cerclage placement. DIF: Cognitive Level: Apply REF: p. 674 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

18. What is the correct definition of a spontaneous termination of a pregnancy (abortion)? a. Pregnancy is less than 20 weeks. b. Fetus weighs less than 1000 g. c. Products of conception are passed intact. d. No evidence exists of intrauterine infection.

ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of the fetus is not considered because some older fetuses may have a low birth weight. A spontaneous abortion may be complete or incomplete and may be caused by many problems, one being intrauterine infection. DIF: Cognitive Level: Remember REF: p. 669 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. The reported incidence of ectopic pregnancy has steadily risen over the past 2 decades. Causes include the increase in sexually transmitted infections (STIs) accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse suspects that a client has early signs of ectopic pregnancy. The nurse should be observing the client for which signs or symptoms? (Select all that apply.) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E A missed period or spotting can be easily mistaken by the client as an early sign of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. As the fallopian tube tears open and the embryo is expelled, the client often exhibits severe pain accompanied by intraabdominal hemorrhage, which may progress to hypovolemic shock with minimal or even no external bleeding. In approximately one half of women, shoulder and neck pain results from irritation of the diaphragm from the hemorrhage. DIF: Cognitive Level: Apply REF: p. 676 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. What do these complications include? (Select all that apply.) a.Atherosclerosis b.Retinopathy c.Intrauterine fetal death (IUFD) d.Nephropathy e.Neuropathy f.Autonomic neuropathy

ANS: A, B, D, E These structural changes will most likely affect a variety of systems, including the heart, eyes, kidneys, and nerves. IUFD (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication.

A nurse is caring for a pregnant client who is being monitored for gestational hypertension. Which assessment finding indicates a worsening of gestational hypertension and the need to notify the healthcare​ provider?

Client complains of blurred vision and a headache

Which of the following is most important for the preeclamptic mother to do while managing at home? A. increase protein in her diet B. reporting any weight loss C. measuring calfs for degree of edema D. maintaining bed rest

D. maintaining bed rest

A postpartum client with preeclampsia voices concerns about avoiding a second pregnancy. What information can the nurse provide​ her?

Information about various forms of contraception

The nurse is caring for a hypertensive pregnant client who is on magnesium sulfate therapy. The nurse finds that the client has drowsiness, slurred speech, and depressed respiration. What medication would help in treating magnesium toxicity?

Intravenous calcium gluconate (Kalcinate)

A nurse providing care for the antepartum woman should understand what about the contraction stress test (CST)?

Is considered negative if no late decelerations are observed with the contractions

What is required for the diagnosis of HELPP syndrome?

LAB TESTS are required to confirm, not just based on clinical presentation.

The nurse is reviewing the chart of multigravid client at 39 weeks' gestation with suspected HELLP syndrome. The nurse should notify the health care provider about which of the following test results?

Lactate dehydrogenase (LDH) greater than 200 U/L (3.34 pkat/L)

The nurse is making a plan of care for a client with severe preeclampsia. Which of the following laboratory values would indicate the client has developed HELLP​ syndrome? ​(Select all that​ apply.)

Low hematocrit low platelets elevated liver enzymes

A patient asks the nurse to describe which factors are included in HELLP syndrome. Which response by the nurse indicates an accurate description of this disorder? Select all that apply. Low platelets Hypertension Low leukocytes Elevated erythrocytes Elevated liver enzymes

Low platelets Elevated liver enzymes

When caring for a patient with gestational hypertension, the nurse notes that after the administration of methyldopa, the patient's blood pressure is 178/96, and also reports headache and blurry vision. The nurse anticipates which order from the patient's primary care provider? Up ad lib Lisinopril Salt-free diet Magnesium sulfate

Magnesium sulfate

A nurse is caring for a pregnant client with preeclampsia. The nurse is at the bedside and notes that the client has now progressed to eclampsia. Which would be the​ nurse's first​ priority?

Maintain an open airway

When teaching a primigravid client with diabetes about common causes of hyperglycemia during pregnancy, which of the following would the nurse include?

Maternal infection

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including what?

Maternal serum alpha-fetoprotein (MSAFP) is a screening tool only; it identifies candidates for more definitive procedures.

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client?

Monitor the client's vital signs and bleeding

A client is undergoing percutaneous umbilical blood sampling (PUBS). What is the best intervention for the nurse to perform after conducting the test?

Monitor the fetal heart rate (FHR).

C

a pregnant woman at 32 wks gestation comes to the ED because she has begun to experience bright red vaginal bleeding. She reports no pain. The admission nurse expects the woman is experiencing: A. abruption placentae B. DIC C. placenta previa D. preterm labor

A

a pregnant woman at 38 wks gestation is diagnosed with marginal placenta previa, she has just given birth to a healthy newborn male. The nurse recognizes that the immediate focus for care of this woman is: A. preventing hemorrhage B. relieving acute pain C. preventing infection D. fostering attachment of the woman with her new son

3

a recurrent miscarriage/abortion is ______ or more spontaneous pregnancy losses before 20 weeks of gestation.

25

a short cervix is < _____ mm or 1" and can be indicative of cervical incompetence.

inevitable

abortion that is often accompanied with ROM and cervical dilation. Passage of products will occur (moderate-heavy bleed)

weekly

after a molar pregnancy, a woman may need __________ HCG levels to rule out cancer.

bed rest

after cerclage, _______ _________ is required for a few days immediately follwing. - avoid intercourse, standing > 90 mins, heavy lifting

no

are prostaglandins recommended for a molar pregnancy?

A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that:

as long as she receives RhoGAM, there is no limit.

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?

assessing fetal heart tones by use of an external monitor

A women in her 3rd trimester presents to the ED with epigastric pain, nausea, vomiting, and jaundice. What would the nurse suspect as treatment? a. IV fluid bolus b. delivery of the baby and placenta c. antihypertensive medication d. blood transfusion

b

An epidural or spinal anesthesia may be contraindicated in the presence of....? a. low hematocrit b. low platelet count c. proteinuria d. low hemoglobin

b

Hypertension that occurs in the second half of pregnancy in a previously normotensive mother accompanied by signs of end organ damage and proteinuria. a. gestational hypertension b. preeclampsia c. chronic hypertension d. eclampsia e. superimposed preeclampsia

b

_______________'s pathological process involves distortion of red blood cells, vasospasm, and impediment of hepatic blood flow. a. Preeclampsia b. HELLP syndrome c. DIC d. Hypertension

b

For a client with preeclampsia, which order would a nurse question? SATA a. low dose aspirin b. high dose aspirin b. methyldopa or labetelol c. magnesium sulfate d. steroids e. lisinopril

b, e

cervical incompetance

passive & painless dilation of the cervix leading to recurrent preterm births during the 2nd trimester. - acquired or congenital

ectopic pregnancy

what do you suspect if a patient has abdominal pain, shoulder pain, and a + pregnancy test?

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?

use of IUD for contraception

mole

what do you suspect if a woman is measuring larger than her gestational age?

stillbirth

what is the major fetal risk in placenta previa?

vaginal exams

what should you NOT do if you suspect placenta previa?

ectopic pregnancy

when the fertilized egg is implanted outside the uterine cavity. Often in fallopian tube.

Which statement by the client indicates an understanding of the teaching regarding the use of magnesium sulfate and corticosteroids for preterm labor?

"The magnesium sulfate is to stop contractions while the corticosteroids increase lung surfactant in my baby so he can breathe better if he is born early."

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. The client looks frightened and confused and states that she does not believe in 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."

A client has just had a cesarean section for a prolapsed cord. In reviewing the client's history, which of the following factors places a client at risk for cord prolapse? Select all that apply.

(1). 2 station (2). Low birth weight infant (3). Rupture of membranes (4) Breech presentation

A client at 28 weeks' gestation presents to the emergency department with a "splitting headache." What actions are indicated by the nurse at this time? Select all that apply.

(1). Assess the client for vision changes or epigastric pain. (2). Obtain a NST. (3). Assess the client's reflexes and presence of a clonus.

The nurse is assessing a multigravid client at 12 weeks' gestation who has been admitted to the emergency department with sharp right-sided abdominal pain and vaginal spotting. Which of the following should the nurse obtain about the client's history? Select all that apply.

(1). History of sexually transmitted infections (2). Number of sexual partners (3). Last menstrual cycle (4). Contraceptive use

The nurse is administering intravenous magnesium sulfate as prescribed for a client at 34 weeks' gestation with severe preeclampsia. Which of the following are desired outcomes of this therapy? Select all that apply.

(1). T 98 (36.7), P72, R14 (2). DTR 2+ (3). Magnesium level = 5.6 mg/dL (2.8 mmol/L)

7. A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for: A. Hemorrhage B. Infection C. Urinary retention D. Thrombophlebitis

*A. Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss.* B. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. C. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. D. There is no greater risk for thrombophlebitis than with a normally implanted placenta.

8. The nurse providing safe intrapartum care needs to understand the physiology behind placental anomalies that can significantly increase the risk for postpartum hemorrhage. Which of the following placental anomalies increases this risk? A. Succenturiate placenta B. Vasa previa C. Battledore insertion D. Placenta previa

*A. In this rare condition the placenta is divided into two or more separate lobes, each with a distinct circulation. During placental expulsion, one of more of the lobes can remain attached to the decidua basalis, preventing uterine contraction and increasing the risk of postpartum hemorrhage.* B. Vasa previa, also known as velamentous insertion of the cord, is a rare anomaly associated with placenta previa and multiple gestation. The cord vessels begin to branch at the membranes and then course onto the placenta. ROM or traction on the cord can tear the vessels causing the fetus to rapidly bleed to death. C. Also known as marginal insertion of the cord, this condition increases the risk of fetal hemorrhage, especially after marginal separation of the placenta. D. With a complete or partial previa, the placenta covers the cervical os. This client is at risk for intrapartum hemorrhage or fetal anemia.

6. In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? A. Administration of blood B. Preparation of the woman for invasive hemodynamic monitoring C. Restriction of intravascular fluids D. Administration of steroids

*A. Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters.* B. Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding. C. Management of DIC includes volume replacement, not volume restriction. D. Steroids are not indicated for the management of DIC.

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. The nurse should assess which specific lab result? BB. Indirect Coombs test CC. Hemoglobin level DD. hCG level EE. Maternal serum alpha-fetoprotein (MSAFP)

*BB. Indirect Coombs test* Rationale: The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for NTDs in pregnancy

A 16-year-old client gave birth to a 12 weeks' gestation 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 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."

What dietary instructions does the nurse give a client who has experienced miscarriage?

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

The nurse determines teaching has been effective when the patient makes which statement about her preeclampsia diagnosis? "My coworkers are coming to visit me later on this afternoon." "I should let you know if my headache gets worse, or I feel my face twitch." "I'm uncomfortable in the bed, so I am going to walk up and down the hallway for a while." "I don't want the hospital meal because my husband is bringing fried chicken and French fries for dinner."

"I should let you know if my headache gets worse, or I feel my face twitch."

When assessing a pregnant female, which of the following patient statements are indicative of preeclampsia? Select all that apply. "I'm seeing spots in my peripheral vision." "I'm having a hard time sleeping through the night." "I have to keep Tylenol nearby all the time because of these frequent headaches." "I haven't been able to wear my wedding band anymore because it's too tight." "I have terrible heartburn that never seems to go away."

"I'm seeing spots in my peripheral vision." "I have to keep Tylenol nearby all the time because of these frequent headaches." "I haven't been able to wear my wedding band anymore because it's too tight." "I have terrible heartburn that never seems to go away."

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test? A. "I will need to have a full bladder for the test to be done accurately." B. "I should have my husband drive me home after the test because I may be nauseous." C. "This test will help to determine if the baby has Down syndrome or a neural tube defect." D. None of the above

*D. None of the above* Rationale: An ultrasound is the test that requires a full bladder. An amniocentesis would be the test that a pregnant woman should be driven home afterward. A maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome. The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements.

What is an indicator for performing a contraction stress test? D. Increased fetal movement and small for gestational age E. Maternal diabetes mellitus and postmaturity F. Adolescent pregnancy and poor prenatal care G. History of preterm labor and intrauterine growth restriction

*E. Maternal diabetes mellitus and postmaturity* Rationale: Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Although adolescent pregnancy and poor prenatal care are risk factors of poor fetal outcomes, they are not indicators for performing a contraction stress test. Intrauterine growth restriction is an indicator; but history of a previous stillbirth, not preterm labor, is the other indicator.

The health care provider has ordered a magnetic resonance imaging (MRI) study to be done on a pregnant patient to evaluate fetal structure and growth. The nurse should include which instructions when preparing the patient for this test? (Select all that apply.) FF. A lead apron must be worn during the test. GG. A full bladder is required prior to the test. HH. An intravenous line must be inserted before the test. II. Jewelry must be removed before the test. JJ. Remain still throughout the test.

*II. Jewelry must be removed before the test.* *JJ. Remain still throughout the test.* Rationale: Magnetic resonance imaging (MRI) is a noninvasive radiologic technique used for obstetric and gynecologic diagnosis. Similar to computed tomography (CT), MRI provides excellent pictures of soft tissue. Unlike CT, ionizing radiation is not used. Therefore vascular structures within the body can be visualized and evaluated without injecting an iodinated contrast medium, thus eliminating any known biologic risk. Similar to sonography, MRI is noninvasive and can provide images in multiple planes, but no interference occurs from skeletal, fatty, or gas-filled structures, and imaging of deep pelvic structures does not require a full bladder. The woman is placed on a table in the supine position and moved into the bore of the main magnet, which is similar in appearance to a CT scanner. Depending on the reason for the study, the procedure may take from 20 to 60 minutes, during which time the woman must be perfectly still except for short respites.

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? H. Biophysical profile I. Amniocentesis J. Maternal serum alpha-fetoprotein (MSAFP) K. Transvaginal ultrasound

*K. Transvaginal ultrasound* Rationale: A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal). An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach.

A nonstress test (NST) is ordered on a pregnant women at 37 weeks gestation. What are the most appropriate teaching points to include when explaining the procedure to the patient? (Select all that apply) KK. After 20 minutes, a nonreactive reading indicates the test is complete. LL. Vibroacoustic stimulation may be used during the test. MM. Drinking orange juice before the test is appropriate. NN. A needle biopsy may be needed to stimulate contractions. OO. Two sensors are placed on the abdomen to measure contractions and fetal heart tones.

*LL. Vibroacoustic stimulation may be used during the test.* *MM. Drinking orange juice before the test is appropriate.* *OO. Two sensors are placed on the abdomen to measure contractions and fetal heart tones.* Rationale: A nonreactive test requires further evaluation. The testing period is often extended, usually for an additional 20 minutes, with the expectation that the fetal sleep state will change and the test will become reactive. During this time vibroacoustic stimulation (see later discussion) may be used to stimulate fetal activity. Vibroacoustic stimulation is often used to stimulate fetal activity if the initial NST result is nonreactive and thus hopefully shortens the time required to complete the test. Care providers sometimes suggest that the woman drink orange juice or be given glucose to increase her blood sugar level and thereby stimulate fetal movements. Although this practice is common, there is no evidence that it increases fetal activity. A needle biopsy is not part of a NST. The FHR is recorded with a Doppler transducer, and a tocodynamometer is applied to detect uterine contractions or fetal movements. The tracing is observed for signs of fetal activity and a concurrent acceleration of FHR.

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST): L. sometimes uses vibroacoustic stimulation. M. is an invasive test; however, contractions are stimulated. N. is considered negative if no late decelerations are observed with the contractions. O. is more effective than nonstress test (NST) if the membranes have already been ruptured.

*N. is considered negative if no late decelerations are observed with the contractions.* Rationale: Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by IV oxytocin but not if by nipple stimulation. No late decelerations indicate a positive CST. CST is contraindicated if the membranes have ruptured.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? P. Doppler blood flow analysis Q. Contraction stress test (CST) R. Amniocentesis S. Daily fetal movement counts

*P. Doppler blood flow analysis* Rationale: Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high-risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: T. chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. U. screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. V. percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. W. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

*W. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.* Rationale: CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for Down syndrome. This is correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.

Prior to the patient undergoing amniocentesis, the most appropriate nursing intervention is to: X. administer RhoD immunoglobulin. Y. administer anticoagulant. Z. send the patient for a computed tomography (CT) scan before the procedure. AA. assure the mother that short-term radiation exposure is not harmful to the fetus.

*X. administer RhoD immunoglobulin.* Rationale: Because of the possibility of fetomaternal hemorrhage, administering RhoD immunoglobulin to the woman who is Rh negative is standard practice after an amniocentesis. Anticoagulants are not administered before amniocentesis as this would increase the risk of bleeding when the needle is inserted transabdominally. A CT is not required before amniocentesis, because the procedure is ultrasound guided. The mother is not exposed to radiation during amniocentesis.

What are the key issues that should be reported to the doctor promptly for a woman with preeclampsia and HELLP syndrome?

- Decrease urine output (UOP) - Increase in BP - Increase in CNS irritability (clonus, H/A, hyperreflexia) - Severe, persistent epigastric pain - Change in lab values - Increase in urine protein

Describe the effect of platelet count for a woman with HELLP syndrome and how it affects her pain management.

- Epidurals not to be given if platelet count <100,000. - Depends on if it's been a drop and mom is stable or if it's an acute drop.

List some of the severe complications associated with complications of preeclampsia.

- IUGR - Liver rupture - Heart failure - Renal failure - Placental abruption - Eclampsia (seizures, coma) - HELLP syndrome - DIC - Pulmonary edema

placenta previa

- painless bright red bleeding - normal vitals until 40% BV loss - uterus is soft, relaxed, non-tender

It is always important to have __________ and _________ at the bedside for safety measures in the room of an preeclamptic patient.

-Suction - O2

ectopic

3 classic signs of _________ pregnancy: 1. ab pain 2. delayed menses 3. abnormal vaginal bleeding

After instructing a multigravid client diagnosed with mild preeclampsia how to keep a record of fetal movement patterns at home, the nurse determines that the teaching has been effective when the client says that she will count the number of times the baby moves during which of the following time spans?

1-hour period each day

The nurse is preparing to teach an antepartum client with GDM the correct method of administering an intermediate-acting insulin, such as neutral protamine Hagedorn (NPH), with a short-acting insulin (regular). In the correct order from 1 through 6, match the step number with the action needed to teach the client self-administration of this combination of insulin. a.Without adding air, withdraw the correct dose of NPH insulin. b.Gently rotate the insulin to mix it, and wipe the stopper. c.Inject air equal to the dose of NPH insulin into the vial, and remove the syringe. d.Inject air equal to the dose of regular insulin into the vial, and withdraw the medication. e.Check the insulin bottles for the expiration date. f.Wash hands. 1. Step 1 2. Step 2 3. Step 3 4. Step 4 5. Step 5 6. Step 6

1. ANS: F DIF: Cognitive Level: Apply REF: p. 694 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: Regular insulin is always drawn up first when combining insulin. Other steps include ensuring that the insulin syringe corresponds to the concentration of insulin that is being used. The bottle should be checked before withdrawing the medication to be certain that it is the appropriate type. 2. ANS: E DIF: Cognitive Level: Apply REF: p. 694 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: Regular insulin is always drawn up first when combining insulin. Other steps include ensuring that the insulin syringe corresponds to the concentration of insulin that is being used. The bottle should be checked before withdrawing the medication to be certain that it is the appropriate type. 3. ANS: B DIF: Cognitive Level: Apply REF: p. 694 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: Regular insulin is always drawn up first when combining insulin. Other steps include ensuring that the insulin syringe corresponds to the concentration of insulin that is being used. The bottle should be checked before withdrawing the medication to be certain that it is the appropriate type. 4. ANS: C DIF: Cognitive Level: Apply REF: p. 694 TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment NOT: Regular insulin is always drawn up first when combining insulin. Other steps include ensuring that the insulin syringe corresponds to the concentration of insulin that is being used. The bottle should be checked before withdrawing the medication to be certain that it is the appropriate type. 5. ANS: D DIF: Cognitive Level: Apply REF: p. 694

During a prenatal visit at 30 weeks of gestation, Angela's blood pressure (BP) was 156/98 mm Hg; it has ranged be- tween 142/92 and 150/90 mm Hg since the 28th week of her pregnancy; her urinalysis indicated a protein level of 21 using a dipstick; her biceps and patellar reflexes are 21.

1. E E. Preeclampsia (mild) without severe features

Susan, a 34-year-old pregnant client, has had a consistently high BP ranging from 148/92 mm Hg to 160/98 mm Hg since she was 28 years old. Her weight gain has followed normal patterns and urinalysis remains normal as well.

3. B B. Chronic hypertension

What is the normal range of amniotic fluid index?

10 to 25 cm

1

10-20% separation is considered grade _____ mild separation. - minimal bleeding - no tenderness - no distress

10. _______________________________ A systolic blood pressure greater than 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg. The elevated values must be present on _______________________________ separate occasions at least __________________________________________ hours apart but within a maximum of a _________________________________ -week period.

10. Hypertension; 2; 4 to 6; 1

11. _______________________________ A protein concentration at or greater than 300 mg/dL in a 24-hour urine collection.

11. Proteinuria

After suction and evacuation of a complete hydatiform mole, the 28-year-old multigravid client asks the nurse when she can become pregnant again. The nurse would advise the client not to become pregnant again for at least which of the following time spans?

12 months

12. _______________________________ Accumulation of fluid in the tissues of the lowest or most dependent parts of the body, where hydrostatic pressure is the greatest. For ambulating women it is first evident in __________________________________________; if the pregnant woman is confined to bed, it occurs in the _________________________________.

12. Dependent edema; ankles; sacrum

13. _______________________________ Onset of seizure activity or coma in the woman diagnosed with preeclampsia, with no history of preexisting pathology that can result in seizure activity.

13. Eclampsia

14. _______________________________ A laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction; it is characterized by _______________________________, elevated _______________________________, and low _______________________________.

14. HELLP syndrome; hemolysis; liver enzymes; platelets

15. _______________________________ Activity in blood vessels that diminishes their diameter, thereby impeding tissue perfusion in all organ systems, increasing peripheral vascular resistance and blood pressure, and increasing endothe- lial cell permeability.

15. Vasospasm

17. When measuring the blood pressure to ensure consistency and to facilitate early detection of blood pressure changes consistent with preeclampsia, the nurse should: A. Place the woman in a sitting position with feet flat on the floor B. Allow the woman to rest for 5 minutes after positioning her before measuring her blood pressure C. Record Korotkoff phase IV (muffled sound) as the diastolic pressure D. Use a proper-sized cuff that covers at least 50% of her upper arm

17. Choice A is correct; the woman should rest for at least 10 minutes after assuming her position and the cuff should cover 80% of the upper arm or be 1.5 times the length of the upper arm; either Korotkoff phase V alone or with phase IV should be used when recording the diastolic pressure. A. Place the woman in a sitting position with feet flat on the floor

18. When caring for a woman with preeclampsia without severe features, it is critical that during assessment the nurse be alert for signs of progress to preeclampsia with severe features. Progress to preeclampsia with severe features is indicated by which of the following assessment findings? A. Serum creatinine 0.9 mg/dL B. Platelet count of 180,000/mm3 C. Positive ankle clonus response with DTRs 41 bilaterally D. Blood pressure of 150/88 and 154/96 mm Hg, 6 hours apart

18. Choice C is correct; with severe preeclampsia the DTRs should be 31 with positive ankle clonus indicating increased cerebral involvement, the BP should be .160/110 mm Hg, with a platelet count of ,100,000/mm3, which reflects thrombocytopenia; serum creatinine would be greater than 1.1 mg/dL. C. Positive ankle clonus response with DTRs 41 bilaterally

19. A woman with preeclampsia is admitted to the hospital and her primary health care provider has ordered that an infusion of magnesium sulfate be started. In implementing this order, the nurse should: (Circle all that apply.) A. Prepare a solution of 20 g of magnesium sulfate in 100 mL of 5% glucose in water B. Monitor maternal vital signs, fetal heart rate (FHR) patterns, and uterine contractions every hour C. Expect the maintenance dose to be approximately 1 to 3 g/hour D. Administer a loading dose of 4 to 6 g over 15 to 30 minutes E. Prepare to administer hydralazine (Apresoline) if signs of magnesium toxicity occur F. Report a respiratory rate of less than 12 breaths/minute to the primary health care provider immediately

19. Choices C, D, and F are correct; a respiratory rate of less than 12 breaths/minute indicates central nervous system (CNS) depression caused by the magnesium sulfate; the solution should be 40 g in 1000 mL of Ringer lactate; assessment should occur every 15 to 30 minutes and the maintenance dose should be 1 to 3 g/hour; calcium gluconate is the antidote for mag- nesium sulfate toxicity. C. Expect the maintenance dose to be approximately 1 to 3 g/hour D. Administer a loading dose of 4 to 6 g over 15 to 30 minutes F. Report a respiratory rate of less than 12 breaths/minute to the primary health care provider immediately

At 37 weeks of gestation, Mary's BP rose from a prepreg- nant baseline of 118/66 mm Hg to 142/88 mm Hg. No other problematic signs and symptoms, including proteinuria, were noted.

2. C C. Gestational hypertension

20. The primary expected outcome for nursing care associated with the administration of magnesium sulfate would be met if which assessment finding is present? A. The woman exhibits a decrease in both systolic and diastolic blood pressure. B. The woman experiences no seizures. C. The woman states that she feels more relaxed and calm. D. The woman urinates more frequently, resulting in a decrease in pathologic edema.

20. Choice B is correct; magnesium sulfate acts as a CNS depressant and is given to prevent seizures. B. The woman experiences no seizures.

21. A woman has been diagnosed with preeclampsia without severe features and will be treated at home. In teaching this woman about her treatment regimen for preeclampsia, the nurse should tell her to: (Circle all that apply.) A. Follow a low-salt diet B. Use a dipstick to check a clean catch specimen of her urine for protein C. Maintain a fluid intake of six to eight 8-ounce glasses of water each day D. Increase the roughage in her diet E. Perform gentle range-of-motion exercises of her upper and lower extremities F. Ask her friends to avoid visiting or calling her because she needs to rest

21. Choices B, C, D, and E are correct; a clean catch midstream urine specimen should be used to assess urine for protein using a dipstick; fluid intake should be six to eight 8-ounce glasses a day along with roughage to prevent constipation; gentle exercise improves circulation and helps to preserve muscle tone and a sense of well-being; no sodium restriction is required except for limiting excessively salty foods; diversional activities, including contact with friends, will decrease boredom and stress. B. Use a dipstick to check a clean catch specimen of her urine for protein C. Maintain a fluid intake of six to eight 8-ounce glasses of water each day D. Increase the roughage in her diet E. Perform gentle range-of-motion exercises of her upper and lower extremities

22. A woman with preeclampsia with severe features is receiving nifedipine (Procardia). She asks the nurse what this medication is for. The nurse should tell her that nifedipine is used to: A. Prevent seizures B. Relieve the headaches she is starting to have C. Decrease her blood pressure D. Reduce the edema in her hands and legs

22. Choice C is correct; nifedipine (Procardia) is a calcium channel blocker used to decrease blood pressure. C. Decrease her blood pressure

23. A woman with preeclampsia gave birth by cesarean section 1 hour ago. She is still receiving a magnesium sulfate infusion at 1 g/hour. A major concern regarding the administration of magnesium sulfate at this time is: A. Increased risk for seizures B. Central nervous system depression C. Hypotension D. Diuresis

23. Choice B is correct; magnesium sulfate is a CNS depressant that potentiates the action of other CNS depressants such as opioid analgesics; it reduces the risk for seizures but is unlikely to cause hypotension; diuresis is a common expected finding in the post- partum period. B. Central nervous system depression

24. Following vaginal birth 2 hours ago a woman with preeclampsia is experiencing a heavy flow as a result of a boggy uterus. It is determined that she will require medication to reduce the amount of blood loss. Which medication would the nurse anticipate administering? A. Methergine (methylergonovine) B. Calcium gluconate C. Pitocin (oxytocin) D. Normodyne (labetalol)

24. Choice C is correct; oxytocin (Pitocin) as an oxytocic medication is safe and effective to use to contract the uterus and reduce blood loss because it will not increase blood pressure as can methylergonovine (Methergine), another oxytocic medication; calcium gluconate is the antidote used for magnesium sulfate toxicity; labetalol (Normodyne) is an antihyperten- sive medication. C. Pitocin (oxytocin)

25. A woman, who is at 35 weeks of gestation with preeclampsia, has a seizure. Immediately after the seizure the nurse's priority action is to: A. Evaluate fetal heart rate and pattern for signs of decreasing variability, late decelerations, or bradycardia B. Assess status of the maternal airway, respiratory effort, and pulse C. Determine if membranes have ruptured and if the amniotic fluid contains meconium D. Prepare to increase the amount of magnesium sulfate being infused from 1 g/hour to 2 g/hour"

25. Choice B is correct; although choices A, C, and D are all appropriate actions, they are not the first priority; remember the ABCs—airway, breathing, circulation—when considering the priority action. B. Assess status of the maternal airway, respiratory effort, and pulse

Which type of ultrasound is the standard medical scan used in pregnancy?

2D

Match the hypertensive disorder with its description. A) Hypertension with proteinuria B) Seizures associated with hypertension C) Elevated blood pressure persisting 10 weeks after delivery D) Development of high blood pressure at 30-weeks gestation 1) Eclampsia 2) Gestational hypertension 3) Preeclampsia 4) Chronic hypertension

3 1 4 2

A primigravid client with severe preeclampsia exhibits hyperactive, very brisk patellar reflexes with two beats of ankle clonus present. The nurse documents the patellar reflexes at which of the following?

4+

At 32 weeks of gestation, Maria—with hypertension since 28 weeks, hyperactive deep tendon reflexes (DTRs) with clonus, and proteinuria of 41—has a convulsion.

4. A A. Eclampsia

Shawna is a primigravida at 28 weeks of gestation. Her BP has risen to 160/110 mm Hg and higher. Proteinuria is at 31. She has been complaining of a headache and states that she needs to wear sunglasses even indoors because light hurts her eyes. She reports that she has been using two pil- lows at night instead of one to breathe more easily when she sleeps.

5. F F. Preeclampsia (severe) with severe features

Dawn has been hypertensive since her 24th week of preg- nancy. Urinalysis indicates a protein content of 31. Further testing reveals a platelet count of 95,000 and elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels; she has begun to experience nausea with some vomiting and epigastric pain.

6. D D. HELLP syndrome

7. _______________________________ Onset of hypertension without proteinuria after the 20th week of pregnancy; it does not persist longer than 12 weeks postpartum, usually resolving during the first postpartum week.

7. Gestational hypertension

8. _______________________________ Hypertension that is present before pregnancy.

8. Chronic hypertension

9. _______________________________ Pregnancy-specific condition in which hypertension develops after 20 weeks of gestation or in the early postpartum period in a previously normotensive woman; the presence of thrombocytope- nia, impaired liver function, newly developed renal insufficiency, pulmonary edema, or new onset cerebral or visual disturbances confirms the diagnosis.

9. Preeclampsia

Which woman has an increased risk of developing preeclampsia? Select all that apply. A 25-year-old woman with liver disease A 26-year-old woman with a BMI of 32 A 34-year-old woman who has breast cancer A 30-year-old woman with a family history of diabetes A 40-year-old multiparous woman pregnant with twins

A 26-year-old woman with a BMI of 32 A 40-year-old multiparous woman pregnant with twins

The nurse understands which finding indicates preeclampsia progressing to eclampsia? Proteinuria Weight gain in the absence of edema Pitting edema in the absence of weight gain A generalized seizure not attributed to other causes

A generalized seizure not attributed to other causes

A

A primigravida at 10 wks gestation reports mild uterine cramping and slight vaginal spotting without passage of tissue. When she's examined, no cervical dilation is noted. The nurse caring for this woman should: A. anticipate that the woman will be sent home w instructions to limit her activity & to avoid stress or orgasm B. prepare the woman for D & C C. notify a grief counselor to assist the woman w the imminent loss of her fetus D. tell the woman that the Dr. will most likely perform a cerclage to help her maintain her pregnancy

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits what?

A respiratory rate of 10 breaths/minute

inevitable

A woman comes to the emergency department and states that she is 12 weeks pregnant and has been having vaginal bleeding. Exam reveals the cervix is 3 cm dilated. Which type of spontaneous abortion is the client experiencing?

C

A woman is admitted through the ED with a medical dx of ruptured ectopic pregnancy. The primary nursing dx at this time is: A. acute pain related to irritation of the peritoneum with blood B. risk for infection RT tissue trauma C. deficient fluid volume RT blood loss associated with rupture of the uterine tube D. anticipatory grieving RT unexpected pregnancy outcome

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be: a. Negative. b. Positive. c. Satisfactory. d. Unsatisfactory.

A ~ Feedback A Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute timeframe. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative. B A positive CST indicates the presence of repetitive later FHR decelerations. C This term is not applicable. D This term is not applicable.

Nurses should be aware that the biophysical profile (BPP): a. Is an accurate indicator of fetal well-being. b. Is a compilation of health risk factors of the mother during the later stages of pregnancy. c. Consists of a Doppler blood flow analysis and an amniotic fluid index. d. Involves an invasive form of ultrasonic examination.

A ~ Feedback A An abnormal BPP score is one indication that labor should be induced. B The BPP evaluates the health of the fetus. C The BPP requires many different measures. D The BPP is a noninvasive procedure.

A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time? a. Ultrasound examination b. Maternal serum alpha-fetoprotein screening (MSAFP) c. Amniocentesis d. Nonstress test (NST)

A ~ Feedback A An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. B It is too early in the pregnancy to perform this test. The MSAFP is performed at 16 to 18 weeks of gestation, followed by amniocentesis if the MSAFP levels are abnormal or if fetal/maternal anomalies are detected. C It is too early in the pregnancy to perform this test. The MSAFP is performed at 16 to 18 weeks of gestation, followed by amniocentesis if the MSAFP levels are abnormal or if fetal/maternal anomalies are detected. D It is too early in the pregnancy to perform this test. An NST is performed to assess fetal well-being in the third trimester.

In comparison to contraction stress tests (CSTs), the nonstress test (NST) for antepartum fetal assessment: a. Has no known contraindications. b. Has fewer false-positive results. c. Is more sensitive in detecting fetal compromise. d. Is slightly more expensive.

A ~ Feedback A The NST is noninvasive, inexpensive, and has no known contraindications. B The NST has a high rate of false-positive results. C The NST is less sensitive than the CST. D The NST is relatively inexpensive.

A woman asks her nurse, "My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?" The best response by the nurse is: a. Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby. b. Your placenta isn't working properly, and your baby is in danger. c. This means that we will need to perform an amniocentesis to detect if you have any placental damage. d. Don't worry about it. Everything is fine.

A ~ Feedback A This is an accurate and appropriate statement. B Although this statement may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the woman. C An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. D This statement is not appropriate and discredits the woman's concerns.

Intrauterine growth restriction is associated with what pregnancy-related risk factors? (SATA) a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension d. Premature rupture of membranes e. Smoking

A, B, C, E ~ Feedback Correct These risk factors are associated with the occurrence of intrauterine growth restriction (IUGR). Incorrect Premature rupture of membranes is associated with preterm labor, not IUGR.

1. A woman 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 woman is based on a probable diagnosis of which type of spontaneous abortion? A. Incomplete B. Inevitable C. Threatened D. Septic

A. A woman with an incomplete abortion presents with heavy bleeding, mild to severe cramping, and cervical dilation. B. An inevitable abortion presents with the same symptomatology as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation. *C. A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. * D. A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.

4. The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: A. Bleeding B. Intense abdominal pain C. Uterine activity D. Cramping

A. Bleeding may be present in varying degrees for both placental conditions. *B. Pain is absent with placenta previa and may be agonizing with abruptio placentae.* C. Uterine activity may be present with both placental conditions. D. Cramping is a form of uterine activity that may be present in both placental conditions.

2. Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? A. Prepare the woman for a dilation and curettage (D&C). B. Place the woman on bed rest for at least 1 week and reevaluate. C. Prepare the woman for an ultrasound and bloodwork. D. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

A. D&C is not considered until signs of the progress to inevitable abortion are noted or the contents are expelled and incomplete. B. Bed rest is recommended for 48 hours initially. *C. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process.* D. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.

5. A woman 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. The nurse suspects the onset of: A. Eclamptic seizure B. Rupture of the uterus C. Placenta previa D. Placental abruption

A. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. B. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. C. Placenta previa presents with bright red, painless vaginal bleeding. *D. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption.*

Which of the following is false regarding magnesium sulfate infusion given to the preeclamptic mom? A. It is administered to control blood pressure B. It is a calcium channel blockers C. It works to decrease CNS irritability D. It helps to prevent eclamptic seizures

A. It is administered to control blood pressure (Not an antihypertensive, it should NOT drastically lower the blood pressure)

The nurse is caring for a client with severe preeclampsia who is showing signs of bleeding and oozing from intravenous sites and who is bruising under the skin. The nurse suspects this is a sign of which clinical manifestation? A. Hemolysis, elevated liver enzymes, low platelet count syndrome (HELLP) B. Chronic hypertensive disease C. Transient hypertension D. Eclampsia

A. Rationale: Pregnant women with severe preeclampsia may develop HELLP syndrome, which has a very poor prognosis. HELLP presents with nausea, vomiting, flu-like symptoms, and bleeding due to liver involvement and platelet aggregation. Eclampsia presents with seizures, blurred vision, and high blood pressure. Chronic and transient hypertension may lead to HELLP syndrome.

The nurse is instructing a client with mild pregnancy-induced hypertension (PIH) who is about to be discharged home. The nurse teaches the client's spouse to call the physician if the client experiences which symptom? A. Fetal movement slows or stops. B. Edema decreases. C. Appetite increases. D. Back pain increases.

A. Rationale: The fetus is affected by PIH due to maternal vasospasms that decrease blood flow and nutrients to the fetus, which may cause the baby to die if PIH worsens. Back pain and increased appetite are not signs of worsening PIH. Edema increases as PIH progresses.

The nurse assesses her pregnant client. Her deep tendon reflexes are 1+. This means A. This is considered a normal response B. She has CNS hyper reactivity present C. She has magnesium toxicity D. She has no response

A. This is considered a normal response 1+ = somewhat diminished reflexes, but still low normal (3+ or 4+ might indicate hyper reactive CNS and risk of seizure activity)

Which of the following is NOT a cellular change that results from poor placental perfusion and hypoxia? A. Vasodilation B. Activation of the coagulation cascade mechanism C. Intravascular fluid redistribution D. Decrease perfusion to organs

A. Vasodilation Causes *vasoconstriction* (vessels constrict which causes higher resistance)

Which parameter is measured to detect neural tube defects in a fetus? A: Acetylcholinesterase B: Phosphatidylglycerol (PG) C: Lecithin-to-sphingomyelin (L/S) ratio D: Surfactant-to-albumin (S/A) ratio

A: Acetylcholinesterase Acetylcholinesterase and amniotic fluid alpha-fetoprotein (AFP) measurement are used to diagnose neural tube defects. The presence of Phosphatidylglycerol (PG) is used in amniocentesis to determine fetal lung maturity. The lecithin-to-sphingomyelin (L/S) ratio is used in amniocentesis to determine fetal lung maturity. The surfactant-to-albumin (S/A) ratio helps determine fetal lung maturity in the TDx FLM assay.

Which are prenatal tests used for diagnosing fetal defects in pregnancy? Select all that apply. A: Amniocentesis B: Polyhydramnios C: Amniotic fluid index (AFI) D: Chorionic villus sampling (CVS) E: Daily fetal movement count (DFMC) F: Percutaneous umbilical blood sampling (PUBS)

A: Amniocentesis D: Chorionic villus sampling (CVS) F: Percutaneous umbilical blood sampling (PUBS) Amniocentesis, PUBS, and CVS are prenatal tests used for diagnosing fetal defects in pregnancy. Polyhydramnios is increased amniotic fluid. AFI is a method in which the vertical depths (in centimeters) of the largest pocket of amniotic fluid in all four quadrants surrounding the maternal umbilicus are totaled. DFMC, the kick count, is frequently used to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation.

A client has elevated nuchal translucency and low maternal serum marker levels. Which abnormality would be likely in the client's newborn? A: Pyelectasis B: Oligohydramnios C: Neural tube defect D: Fetal cardiac disease

A: Pyelectasis is the enlargement of the renal pelvis and is considered a "soft marker" for Down syndrome. Elevated nuchal translucency and low maternal serum marker levels are indicative of pyelectasis. Oligohydramnios is a decrease in amniotic fluid. Elevated nuchal translucency and low maternal serum marker levels do not indicate oligohydramnios. Neural tube defects may be caused by reduced folic acid availability; they cannot be identified by elevated nuchal translucency and low maternal serum marker levels. Elevated nuchal translucency alone indicates an increased risk of fetal cardiac disease and chromosomal abnormalities.

Which tests help detect the presence of Down syndrome in the fetus of a patient in the second trimester of pregnancy? Select all that apply. A: Quad-screen B: Fetal nasal bone assessment C: Triple-marker screen D: Nuchal translucency screening E: Pregnancy-associated placental protein (PAPP-A) measurement

A: Quad-screen C: Triple-marker screen The quad-screen is performed in the second trimester using four different serum markers: maternal serum alpha-fetoprotein (MSAFP), unconjugated estriol, human chorionic gonadotropin (hCG), and inhibin A. Low levels of MSAFP, unconjugated estriol, and inhibin A, and high levels of hCG, indicate Down syndrome. The triple-marker screen is similar to the quad-screen but does not include assessment of inhibin A. The triple-marker screen is performed at 16 to 18 weeks of gestation and consists of three maternal serum markers: MSAFP, unconjugated estriol, and hCG. The fetal nasal bone is assessed in the first trimester of pregnancy. Nuchal translucency would be used in combination with different serum markers to identify Down syndrome. Nuchal translucency is measured in the first trimester of pregnancy. Pregnancy-associated placental protein (PAPP-A) is measured in the first trimester of pregnancy to detect Down syndrome.

Achieving and maintaining euglycemia are the primary goals of medical therapy for the pregnant woman with diabetes. These goals are achieved through a combination of diet, insulin, exercise, and blood glucose monitoring. The target blood glucose levels 1 hour after a meal should be _____________.

ANS: 110 to 129 mg/dl Target levels of blood glucose during pregnancy are lower than nonpregnant values. Accepted fasting levels are between 60 and 99 mg/dl, and 1-hour postmeal levels should be between 110 to 129 mg/dl. Two-hour postmeal levels should be 120 mg/dl or less.

21. What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy? a. Assessing FHR and maternal vital signs b. Performing a venipuncture for hemoglobin and hematocrit levels c. Placing clean disposable pads to collect any drainage d. Monitoring uterine contractions

ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The most important assessment is to check the well-being of both the mother and the fetus. The blood levels can be obtained later. Assessing future bleeding is important; however, the top priority remains mother/fetal well-being. Monitoring uterine contractions is important but not a top priority. DIF: Cognitive Level: Apply REF: p. 681 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

8. The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, "Why is this taking so long?" What is the nurse's most appropriate response? a. "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." b. "I don't know why it is taking so long." c. "The length of labor varies for different women." d. "Your baby is just being stubborn."

ANS: A Because magnesium sulfate is a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate. The nurse should explain to the client the effects of magnesium sulfate on the duration of labor. Although the length of labor varies for different women, the most likely reason this woman's labor is protracted is the tocolytic effects of magnesium sulfate. The behavior of the fetus has no bearing on the length of labor. DIF: Cognitive Level: Apply REF: p. 664 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

11. Which intervention is most important when planning care for a client with severe gestational hypertension? a. Induction of labor is likely, as near term as possible. b. If at home, the woman should be confined to her bed, even with mild gestational hypertension. c. Special diet low in protein and salt should be initiated. d. Vaginal birth is still an option, even in severe cases.

ANS: A By 34 weeks of gestation, the risk of continuing the pregnancy may be considered greater than the risks of a preterm birth. Strict bed rest is controversial for mild cases; some women in the hospital are even allowed to move around. Diet and fluid recommendations are essentially the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe gestational hypertension should expect a cesarean delivery. DIF: Cognitive Level: Apply REF: p. 660 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

22. Which order should the nurse expect for a client admitted with a threatened abortion? a. Bed rest b. Administration of ritodrine IV c. Nothing by mouth (nil per os [NPO]) d. Narcotic analgesia every 3 hours, as needed

ANS: A Decreasing the woman's activity level may alleviate the bleeding and allow the pregnancy to continue. Ritodrine is not the first drug of choice for tocolytic medications. Having the woman placed on NPO is unnecessary. At times, dehydration may produce contractions; therefore, hydration is important. Narcotic analgesia will not decrease the contractions and may mask the severity of the contractions. DIF: Cognitive Level: Understand REF: pp. 671-672 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

17. A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication? a. Hydralazine b. Magnesium sulfate bolus c. Diazepam d. Calcium gluconate

ANS: A Hydralazine is an antihypertensive medication commonly used to treat hypertension in severe preeclampsia. Typically, it is administered for a systolic BP higher than 160 mm Hg or a diastolic BP higher than 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of CNS irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam is sometimes used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity. DIF: Cognitive Level: Analyze REF: p. 665 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

15. Which neonatal complications are associated with hypertension in the mother? a. Intrauterine growth restriction (IUGR) and prematurity b. Seizures and cerebral hemorrhage c. Hepatic or renal dysfunction d. Placental abruption and DIC

ANS: A Neonatal complications are related to placental insufficiency and include IUGR, prematurity, and necrotizing enterocolitis. Seizures and cerebral hemorrhage are maternal complications. Hepatic and renal dysfunction are maternal complications of hypertensive disorders in pregnancy. Placental abruption and DIC are conditions related to maternal morbidity and mortality. DIF: Cognitive Level: Understand REF: p. 667 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition? a.Macrosomia b.Congenital anomalies of the central nervous system c.Preterm birth d.Low birth weight

ANS: A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this fetus.

19. What is the most common medical complication of pregnancy? a. Hypertension b. Hyperemesis gravidarum c. Hemorrhagic complications d. Infections

ANS: A Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women will have nausea and vomiting, but a relatively few will have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common. Infection is a risk factor for preeclampsia. DIF: Cognitive Level: Remember REF: p. 653 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

14. In caring for the woman with DIC, which order should the nurse anticipate? a. Administration of blood b. Preparation of the client for invasive hemodynamic monitoring c. Restriction of intravascular fluids d. Administration of steroids

ANS: A Primary medical management in all cases of DIC involves a correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be initially ordered in a client with DIC because it could contribute to more areas of bleeding. Management of DIC would include volume replacement, not volume restriction. Steroids are not indicated for the management of DIC. DIF: Cognitive Level: Apply REF: pp. 685-686 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

Which statement concerning the complication of maternal diabetes is the most accurate? a.Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b.Hydramnios occurs approximately twice as often in diabetic pregnancies than in nondiabetic pregnancies. c.Infections occur about as often and are considered about as serious in both diabetic and nondiabetic pregnancies. d.Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well-being.

ANS: A Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild-to-moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

9. What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia? a. Risk for injury to mother and fetus, related to central nervous system (CNS) irritability b. Risk for altered gas exchange c. Risk for deficient fluid volume, related to increased sodium retention secondary to the administration of magnesium sulfate d. Risk for increased cardiac output, related to the use of antihypertensive drugs

ANS: A Risk for injury is the most appropriate nursing diagnosis for this client scenario. Gas exchange is more likely to become impaired, attributable to pulmonary edema. A risk for excess, not deficient, fluid volume, related to increased sodium retention, is increased, and a risk for decreased, not increased, cardiac output, related to the use of antihypertensive drugs, also is increased. DIF: Cognitive Level: Apply REF: p. 660 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

9. With regard to hemorrhagic complications that may occur during pregnancy, what information is most accurate? a. An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies. b. Incidences of ectopic pregnancy are declining as a result of improved diagnostic techniques. c. One ectopic pregnancy does not affect a woman's fertility or her likelihood of having a normal pregnancy the next time. d. Gestational trophoblastic neoplasia (GTN) is one of the persistently incurable gynecologic malignancies.

ANS: A Short labors and recurring losses of pregnancy at progressively earlier gestational ages are characteristics of reduced cervical competence. Because diagnostic technology is improving, more ectopic pregnancies are being diagnosed. One ectopic pregnancy places the woman at increased risk for another one. Ectopic pregnancy is a leading cause of infertility. Once invariably fatal, GTN now is the most curable gynecologic malignancy. DIF: Cognitive Level: Understand REF: p. 675 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

13. In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder? a. DIC b. Amniotic fluid embolism (AFE) c. Hemorrhage d. HELLP syndrome

ANS: A The diagnosis of DIC is made according to clinical findings and laboratory markers. A physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman's arm. Excessive bleeding may occur from the site of slight trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage occurs for a variety of reasons in the postpartum client. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. HELLP syndrome is not a clotting disorder, but it may contribute to the clotting disorder DIC. DIF: Cognitive Level: Understand REF: p. 685 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a.Hypoglycemia b.Hypercalcemia c.Hypobilirubinemia d.Hypoinsulinemia

ANS: A The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, thus leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth, and large amounts of bilirubin are released into the neonate's circulation, with resulting hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, hyperinsulinemia develops in the neonate.

2. One of the most important components of the physical assessment of the pregnant client is the determination of BP. Consistency in measurement techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings? (Select all that apply.) a. The client should be seated. b. The client's arm should be placed at the level of the heart. c. An electronic BP device should be used. d. The cuff should cover a minimum of 60% of the upper arm. e. The same arm should be used for every reading.

ANS: A, B, E BP readings are easily affected by maternal position. Ideally, the client should be seated. An alternative position is left lateral recumbent with the arm at the level of the heart. The arm should always be held in a horizontal position at approximately the level of the heart. The same arm should be used at every visit. The manual sphygmomanometer is the most accurate device. If manual and electronic devices are used in the care setting, then the nurse must use caution when interpreting the readings. A proper size cuff should cover at least 80% of the upper arm or be approximately 1.5 times the length of the upper arm. DIF: Cognitive Level: Apply REF: p. 658 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is a thyroid storm, which may occur in response to stress such as infection, birth, or surgery. What are the signs and symptoms of this emergency disorder? (Select all that apply.) a.Fever b.Hypothermia c.Restlessness d.Bradycardia e.Hypertension

ANS: A, C Fever, restlessness, tachycardia, vomiting, hypotension, and stupor are symptoms of a thyroid storm. Fever, not hypothermia; tachycardia, not bradycardia; and hypotension, not hypertension, are symptoms of thyroid storm.

2. Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage? (Select all that apply.) a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Systemic disorders e. Varicella

ANS: A, C, D, E Infections are not a common cause of early miscarriage. At least 50% of pregnancy losses result from chromosomal abnormalities. Endocrine imbalances such as hypothyroidism or diabetes are also possible causes for early pregnancy loss. Other systemic disorders that may contribute to pregnancy loss include lupus and genetic conditions. Although infections are not a common cause of early miscarriage, varicella infection in the first trimester has been associated with pregnancy loss. DIF: Cognitive Level: Remember REF: p. 669 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE 1. Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.) a. Placental abruption b. Placenta previa c. Renal failure d. Cirrhosis e. Maternal and fetal death

ANS: A, C, E The HELLP syndrome is associated with an increased risk for adverse perinatal outcomes, including placental abruption, acute renal failure, subcapsular hepatic hematoma, hepatic rupture, recurrent preeclampsia, preterm birth, and fetal and maternal death. The HELLP syndrome is associated with an increased risk for placental abruption, not placenta previa. It is also associated with an increased risk for hepatic hematoma, not cirrhosis. DIF: Cognitive Level: Analyze REF: p. 658 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE 1. A client who has undergone a D&C for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that her vital signs are stable, that bleeding has been controlled, and that the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, what information should discharge teaching include? (Select all that apply.) a. Iron supplementation b. Resumption of intercourse at 6 weeks postprocedure c. Referral to a support group, if necessary d. Expectation of heavy bleeding for at least 2 weeks e. Emphasizing the need for rest

ANS: A, C, E The woman should be advised to consume a diet high in iron and protein. For many women, iron supplementation also is necessary. The nurse should acknowledge that the client has experienced a loss, however early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest. Nothing should be placed in the vagina for 2 weeks after the procedure, including tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The client should expect a scant, dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur, she should be instructed to contact her health care provider. DIF: Cognitive Level: Apply REF: p. 672 TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

18. The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern? a. Sleepy, sedated affect b. Respiratory rate of 10 breaths per minute c. DTRs of 2 d. Absent ankle clonus

ANS: B A respiratory rate of 10 breaths per minute indicates the client is experiencing respiratory depression from magnesium toxicity. Because magnesium sulfate is a CNS depressant, the client will most likely become sedated when the infusion is initiated. DTRs of 2 and absent ankle clonus are normal findings. DIF: Cognitive Level: Understand REF: p. 664 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time? a.Risk for injury, to the fetus related to birth trauma b.Deficient knowledge, related to diabetic pregnancy management c.Deficient knowledge, related to insulin administration d.Risk for injury, to the mother related to hypoglycemia or hyperglycemia

ANS: B Before a treatment plan is developed or goals for the outcome of care are outlined, this client must come to an understanding of diabetes and the potential effects on her pregnancy. She appears more concerned about changes to her social life than adopting a new self-care regimen. Risk for injury to the fetus related to either placental insufficiency or birth trauma may come later in the pregnancy. At this time, the client is having difficulty acknowledging the adjustments that she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be on insulin. Insulin requirements increase with gestation. The importance of glycemic control must be part of health teaching for this client. However, she has not yet acknowledged that changes to her lifestyle need to be made and may not participate in the plan of care until understanding takes place.

2. A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by the nurse? a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, not getting pregnant at this time is best." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

ANS: B Beta-human chorionic gonadotropin (beta-hCG) hormone levels are drawn for 1 year to ensure that the mole is completely gone. The chance of developing choriocarcinoma after the development of a hydatidiform mole is increased. Therefore, the goal is to achieve a zero human chorionic gonadotropin (hCG) level. If the woman were to become pregnant, then it may obscure the presence of the potentially carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an intrauterine device (IUD) is acceptable. DIF: Cognitive Level: Apply REF: p. 679 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy? a.PKU is a recognized cause of preterm labor. b.The fetus may develop neurologic problems. c.A pregnant woman is more likely to die without strict dietary control. d.Women with PKU are usually mentally handicapped and should not reproduce

ANS: B Children born to women with untreated PKU are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PKU has no effect on labor. Women without dietary control of PKU are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first prenatal visit may be warranted, especially in individuals with a family history of the disorder, with low intelligence of an uncertain cause, or who have given birth to microcephalic infants.

11. Which laboratory marker is indicative of DIC? a. Bleeding time of 10 minutes b. Presence of fibrin split products c. Thrombocytopenia d. Hypofibrinogenemia

ANS: B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. Bleeding time in DIC is normal. Low platelets may occur but are not indicative of DIC because they may be the result from other coagulopathies. Hypofibrinogenemia occurs with DIC. DIF: Cognitive Level: Remember REF: p. 684 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

17. Which maternal condition always necessitates delivery by cesarean birth? a. Marginal placenta previa b. Complete placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In complete placenta previa, the placenta completely covers the cervical os. A cesarean birth is the acceptable method of delivery. The risk of fetal death occurring is due to preterm birth. If the previa is marginal (i.e., 2 cm or greater away from the cervical os), then labor can be attempted. A cesarean birth is not indicated for an ectopic pregnancy. Labor can be safely induced if the eclampsia is under control. DIF: Cognitive Level: Understand REF: p. 681 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

salpingostomy

surgery for ectopic pregnancy to preserve tubal function, incision made over pregnancy site and products are removed.

The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what? a.Corticosteroids to reduce inflammation b.Intravenous (IV) therapy to correct fluid and electrolyte imbalances c.Antiemetic medication, such as pyridoxine, to control nausea and vomiting d.Enteral nutrition to correct nutritional deficits

ANS: B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy to correct fluid and electrolyte imbalances. Corticosteroids have been successfully used to treat refractory hyperemesis gravidarum, but they are not the expected initial treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic medication. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation but is not the initial treatment for this client.

19. What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus? a. Inevitable abortion b. Missed abortion c. Incomplete abortion d. Threatened abortion

ANS: B Missed abortion refers to the retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion, the woman has cramping and bleeding but no cervical dilation. DIF: Cognitive Level: Remember REF: p. 670 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

1. A pregnant woman is being discharged from the hospital after the placement of a cervical cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural care should the nurse emphasize in the discharge teaching? a. Any vaginal discharge should be immediately reported to her health care provider. b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be reported. c. The client will need to make arrangements for care at home, because her activity level will be restricted. d. The client will be scheduled for a cesarean birth.

ANS: B Nursing care should stress the importance of monitoring for the signs and symptoms of preterm labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest is an element of care. However, the woman may stand for periods of up to 90 minutes, which allows her the freedom to see her physician. Home uterine activity monitoring may be used to limit the woman's need for visits and to monitor her status safely at home. The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned. DIF: Cognitive Level: Apply REF: p. 675 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which thyroid disorder is a contraindication for breastfeeding? a.Hyperthyroidism b.PKU c.Hypothyroidism d.Thyroid storm

ANS: B PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine and therefore should elect not to breastfeed. A woman with either hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism and is not a contraindication to breastfeeding.

16. In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio placentae? a. Bleeding b. Intense abdominal pain c. Uterine activity d. Cramping

ANS: B Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity and cramping may be present with both placental conditions. DIF: Cognitive Level: Understand REF: p. 683 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy? a.Frequent episodes of maternal hypoglycemia b.Congenital anomalies in the fetus c.Hydramnios d.Hyperemesis gravidarum

ANS: B Preconception counseling is particularly important since strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risk of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormonal changes and the effects on insulin production and use. Hydramnios occurs approximately 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is observed in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

4. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed? a. Amniocentesis for fetal lung maturity b. Transvaginal ultrasound for placental location c. Contraction stress test (CST) d. Internal fetal monitoring

ANS: B The presence of painless bleeding should always alert the health care team to the possibility of placenta previa, which can be confirmed through ultrasonography. Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus is presumed to have immature lungs at this gestational age, and the mother is given corticosteroids to aid in fetal lung maturity. A CST is not performed at a preterm gestational age. Furthermore, bleeding is a contraindication to a CST. Internal fetal monitoring is also contraindicated in the presence of bleeding. DIF: Cognitive Level: Apply REF: p. 680 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. Which nursing diagnosis is most appropriate for the client at this time? a.Deficient fluid volume b.Imbalanced nutrition: less than body requirements c.Imbalanced nutrition: more than body requirements d.Disturbed sleep pattern

ANS: B This client's clinical cues include weight loss, which supports a nursing diagnosis of "Imbalanced nutrition: less than body requirements." No clinical signs or symptoms support a nursing diagnosis of deficient fluid volume. This client reports weight loss, not weight gain. Although the client reports nervousness, the most appropriate nursing diagnosis, based on the client's other clinical symptoms, is "Imbalanced nutrition: less than body requirements."

In terms of the incidence and classification of diabetes, which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments? a.Type 1 diabetes is most common. b.Type 2 diabetes often goes undiagnosed. c.GDM means that the woman will receive insulin treatment until 6 weeks after birth. d.Type 1 diabetes may become type 2 during pregnancy.

ANS: B Type 2 diabetes often goes undiagnosed because hyperglycemia gradually develops and is often not severe. Type 2, sometimes called adult-onset diabetes, is the most common type of diabetes. GDM refers to any degree of glucose intolerance first recognized during pregnancy; insulin may or may not be needed. People do not go back and forth between type 1 and type 2 diabetes.

5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the ROM. The nurse should suspect the possibility of what condition? a. Placenta previa b. Vasa previa c. Severe abruptio placentae d. Disseminated intravascular coagulation (DIC)

ANS: B Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels thus are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR without other known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa most likely would be ascertained before labor and is considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors. DIF: Cognitive Level: Analyze REF: p. 684 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

Which preexisting factor is known to increase the risk of GDM? a.Underweight before pregnancy b.Maternal age younger than 25 years c.Previous birth of large infant d.Previous diagnosis of type 2 diabetes mellitus

ANS: C A previous birth of a large infant suggests GDM. Obesity (body mass index [BMI] of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years is not generally at risk for GDM. The person with type 2 diabetes mellitus already has diabetes and thus will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

15. A woman arrives at the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? a. Incomplete b. Inevitable c. Threatened d. Septic

ANS: C A woman with a threatened abortion has spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would have heavy bleeding, mild-to-severe cramping, and cervical dilation. An inevitable abortion demonstrates the same symptoms as an incomplete abortion: heavy bleeding, mild-to-severe cramping, and cervical dilation. A woman with a septic abortion has malodorous bleeding and typically a dilated cervix. DIF: Cognitive Level: Understand REF: p. 670 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

6. A woman with worsening preeclampsia is admitted to the hospital's labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information? a. "I will help my wife use the breathing techniques that we learned in our childbirth classes." b. "I will give my wife ice chips to eat during labor." c. "Since we will be here for a while, I will call my mother so she can bring the two boys—2 years and 4 years of age—to visit their mother." d. "I will stay with my wife during her labor, just as we planned."

ANS: C Arranging a visit with their two children indicates that the husband does not understand the importance of the quiet, subdued environment that is needed to prevent his wife's condition from worsening. Implementing breathing techniques is indicative of adequate knowledge related to pain management during labor. Administering ice chips indicates an understanding of nutritional needs during labor. Staying with his wife during labor demonstrates the husband's support for his wife and is appropriate. DIF: Cognitive Level: Apply REF: p. 662 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity

20. What condition indicates concealed hemorrhage when the client experiences abruptio placentae? a. Decrease in abdominal pain b. Bradycardia c. Hard, boardlike abdomen d. Decrease in fundal height

ANS: C Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. Abdominal pain may increase. The client will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height increases. DIF: Cognitive Level: Analyze REF: p. 683 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

6. A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the woman's umbilicus. What does this finding indicate? a. Normal integumentary changes associated with pregnancy b. Turner sign associated with appendicitis c. Cullen sign associated with a ruptured ectopic pregnancy d. Chadwick sign associated with early pregnancy

ANS: C Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the abdomen is the normal integumentary change associated with pregnancy and exhibits a brown pigmented, vertical line on the lower abdomen. Turner sign is ecchymosis in the flank area, often associated with pancreatitis. A Chadwick sign is a blue-purple cervix that may be seen during or around the eighth week of pregnancy. DIF: Cognitive Level: Analyze REF: p. 676 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective? a."I will need to eat 600 more calories per day because I am pregnant." b."I can continue with the same diet as before pregnancy as long as it is well balanced." c."Diet and insulin needs change during pregnancy." d."I will plan my diet based on the results of urine glucose testing."

ANS: C Diet and insulin needs change during the pregnancy in direct correlation to hormonal changes and energy needs. In the third trimester, insulin needs may double or even quadruple. The diet is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. Energy needs are usually calculated on the basis of 30 to 35 calories per kilogram of ideal body weight. Dietary management during a diabetic pregnancy must be based on blood, not urine, glucose changes.

2. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition? a. Eclampsia b. Disseminated intravascular coagulation (DIC) syndrome c. Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome d. Idiopathic thrombocytopenia

ANS: C HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver (EL) enzymes, and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia. DIF: Cognitive Level: Understand REF: p. 657 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet? a.Eat six small equal meals per day. b.Reduce the carbohydrates in her diet. c.Eat her meals and snacks on a fixed schedule. d.Increase her consumption of protein.

ANS: C Having a fixed meal schedule will provide the woman and the fetus with a steady blood sugar level, provide a good balance with insulin administration, and help prevent complications. Having a fixed meal schedule is more important than the equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates.

Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct? a.The laboratory test for glycosylated hemoglobin Alc is performed for all pregnant women, not only those with or likely to have diabetes. b.This laboratory test is a snapshot of glucose control at the moment. c.This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%. d.This laboratory test is performed on the woman's urine, not her blood.

ANS: C Hemoglobin Alc levels greater than 7% indicate an elevated glucose level during the previous 4 to 6 weeks. This extra laboratory test is for diabetic women and defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are performed on the blood

12. What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia? a. To improve patellar reflexes and increase respiratory efficiency b. To shorten the duration of labor c. To prevent convulsions d. To prevent a boggy uterus and lessen lochial flow

ANS: C Magnesium sulfate is the drug of choice used to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can also increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy. DIF: Cognitive Level: Understand REF: p. 664 TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

3. The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

ANS: C Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole, for a missed abortion, or for abruptio placentae. DIF: Cognitive Level: Apply REF: p. 677 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

14. Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest? a. Thrombophlebitis b. Psychologic stress c. Fluid retention d. Cardiovascular deconditioning

ANS: C No evidence has been found that supports the practice of bed rest to improve pregnancy outcome. Fluid retention is not an adverse outcome of prolonged bed rest. The woman is more likely to experience diuresis with accompanying fluid and electrolyte imbalance and weight loss. Prolonged bed rest is known to increase the risk for thrombophlebitis. Psychologic stress is known to begin on the first day of bed rest and continue for the duration of the therapy. Therefore, restricted activity, rather than complete bed rest, is recommended. Cardiovascular deconditioning is a known complication of bed rest. DIF: Cognitive Level: Understand REF: p. 661 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

10. The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include? a. Dilation and curettage (D&C) b. Dilation and evacuation (D&E) c. Misoprostol d. Ergot products

ANS: C Outpatient management of a first-trimester loss is safely accomplished by the intravaginal use of misoprostol for up to 2 days. If the bleeding is uncontrollable, vital signs are unstable, or signs of infection are present, then a surgical evacuation should be performed. D&C is a surgical procedure that requires dilation of the cervix and scraping of the uterine walls to remove the contents of pregnancy. This procedure is commonly performed to treat inevitable or incomplete abortion and should be performed in a hospital. D&E is usually performed after 16 weeks of pregnancy. The cervix is widely dilated, followed by removal of the contents of the uterus. Ergot products such as Methergine or Hemabate may be administered for excessive bleeding after miscarriage. DIF: Cognitive Level: Apply REF: p. 672 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurse's plan of care? a.Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b.Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. c.During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d.Maternal insulin requirements steadily decline during pregnancy.

ANS: C Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own around the 10th week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy.

1. A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse? a. Blood pressure (BP) increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. Dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ alerts the nurse that additional testing or assessment should be performed. A 24-hour urine collection is preferred over dipstick testing attributable to accuracy. Generally, hypertension is defined as a BP of 140/90 mm Hg or an increase in systolic pressure of 30 mm Hg or diastolic pressure of 15 mm Hg. Preeclampsia may be demonstrated as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies, as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia. DIF: Cognitive Level: Analyze REF: p. 660 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

4. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3° C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, "I'm so thirsty and warm." What is the nurse's immediate action? a. To call for an immediate magnesium sulfate level b. To administer oxygen c. To discontinue the magnesium sulfate infusion d. To prepare to administer hydralazine

ANS: C Regardless of the magnesium level, the client is displaying the clinical signs and symptoms of magnesium toxicity. The first action by the nurse should be to discontinue the infusion of magnesium sulfate. In addition, calcium gluconate, the antidote for magnesium, may be administered. Hydralazine is an antihypertensive drug commonly used to treat hypertension in severe preeclampsia. Typically, hydralazine is administered for a systolic BP higher than 160 mm Hg or a diastolic BP higher than 110 mm Hg. DIF: Cognitive Level: Apply REF: p. 664 TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

8. A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client? a. Placenta previa b. Abruptio placentae c. Spontaneous abortion d. Cord insertion

ANS: C Spontaneous abortion is another name for miscarriage; it occurs, by definition, early in pregnancy. Placenta previa is a well-known reason for bleeding late in pregnancy. The premature separation of the placenta (abruptio placentae) is a bleeding disorder that can occur late in pregnancy. Cord insertion may cause a bleeding disorder that can also occur late in pregnancy. DIF: Cognitive Level: Understand REF: p. 669 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity, Physiologic Adaptation

20. Which statement most accurately describes the HELLP syndrome? a. Mild form of preeclampsia b. Diagnosed by a nurse alert to its symptoms c. Characterized by hemolysis, elevated liver enzymes, and low platelets d. Associated with preterm labor but not perinatal mortality

ANS: C The acronym HELLP stands for hemolysis (H), elevated liver (EL) enzymes, and low platelets (LP). The HELLP syndrome is a variant of severe preeclampsia and is difficult to identify because the symptoms are not often obvious. The HELLP syndrome must be diagnosed in the laboratory. Preterm labor is greatly increased; therefore, so is perinatal mortality. DIF: Cognitive Level: Understand REF: p. 657 TOP: Nursing Process: Diagnosis | Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

23. Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Nausea increases in a molar pregnancy because of the increased production of hCG. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. In the client's history, bleeding is normally described as brownish. DIF: Cognitive Level: Analyze REF: p. 678 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

13. The American College of Obstetricians and Gynecologists (ACOG) has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? a. 30-year-old obese Caucasian with her third pregnancy b. 41-year-old Caucasian primigravida c. 19-year-old African American who is pregnant with twins d. 25-year-old Asian American whose pregnancy is the result of donor insemination

ANS: C Three risk factors are present in the 19-year-old African-American client. She has African-American ethnicity, is at the young end of the age distribution, and has a multiple pregnancy. In planning care for this client, the nurse must frequently monitor her BP and teach her to recognize the early warning signs of preeclampsia. The 30-year-old obese Caucasian client has only has one known risk factor: obesity. Age distribution appears to be U-shaped, with women younger than 20 years of age and women older than 40 years of age being at greatest risk. Preeclampsia continues to be more frequently observed in primigravidas; this client is a multigravida woman. Two risk factors are present for the 41-year-old Caucasian primigravida client. Her age and status as a primigravida place her at increased risk for preeclampsia. Caucasian women are at a lower risk than are African-American women. The 25-year-old Asian-American client exhibits only one risk factor. Pregnancies that result from donor insemination, oocyte donation, and embryo donation are at an increased risk of developing preeclampsia. DIF: Cognitive Level: Analyze REF: p. 655 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they include? (Select all that apply.) a.Hot flashes b.Weight loss c.Lethargy d.Decrease in exercise capacity e.Cold intolerance

ANS: C, D, E Symptoms include weight gain, lethargy, decrease in exercise capacity, and intolerance to cold. Other presentations might include constipation, hoarseness, hair loss, and dry skin. Thyroid supplements are used to treat hyperthyroidism in pregnancy.

therapeutic abortion

termination of pregnancy by medical means or surgical procedure if bleeding & infection are not present (fetus isn't passing)

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates? a.75 mg/dl before lunch. This is low; better eat now. b.115 mg/dl 1 hour after lunch. This is a little high; maybe eat a little less next time. c.115 mg/dl 2 hours after lunch. This is too high; it is time for insulin. d.50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

ANS: D 50 mg/dl after waking from a nap is too low. During hours of sleep, glucose levels should not be less than 60 mg/dl. Snacks before sleeping can be helpful. The premeal acceptable range is 60 to 99 mg/dl. The readings 1 hour after a meal should be less than 129 mg/dl. Two hours after eating, the readings should be less than 120 mg/dl.

7. The nurse who elects to practice in the area of women's health must have a thorough understanding of miscarriage. Which statement regarding this condition is most accurate? a. A miscarriage is a natural pregnancy loss before labor begins. b. It occurs in fewer than 5% of all clinically recognized pregnancies. c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factor in causing a miscarriage. d. If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as moderate discomfort and blood loss.

ANS: D Before the sixth week, the only evidence might be a heavy menstrual flow. After the 12th week, more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but it occurs, by definition, before 20 weeks of gestation, before the fetus is viable. Miscarriages occur in approximately 10% to 15% of all clinically recognized pregnancies. Miscarriages can be caused by a number of disorders or illnesses outside the mother's control or knowledge. DIF: Cognitive Level: Understand REF: p. 670 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

16. The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score? a. Sluggish or diminished b. Brisk, hyperactive, with intermittent or transient clonus c. Active or expected response d. More brisk than expected, slightly hyperactive

ANS: D DTRs reflect the balance between the cerebral cortex and the spinal cord. They are evaluated at baseline and to detect changes. A slightly hyperactive and brisk response indicates a grade 3+ response. DIF: Cognitive Level: Apply REF: p. 660 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?

Assess the client's vital signs

7. The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client? a. Absence of uterine bleeding in the postpartum period b. Fundus firm below the level of the umbilicus c. Scant lochia flow d. Boggy uterus with heavy lochia flow

ANS: D High serum levels of magnesium can cause a relaxation of smooth muscle such as the uterus. Because of this tocolytic effect, the client will most likely have a boggy uterus with increased amounts of bleeding. All women experience uterine bleeding in the postpartum period, especially those who have received magnesium therapy. Rather than scant lochial flow, however, this client will most likely have a heavy flow attributable to the relaxation of the uterine wall caused by magnesium administration. DIF: Cognitive Level: Analyze REF: p. 664 TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. A woman with preeclampsia has a seizure. What is the nurse's highest priority during a seizure? a. To insert an oral airway b. To suction the mouth to prevent aspiration c. To administer oxygen by mask d. To stay with the client and call for help

ANS: D If a client becomes eclamptic, then the nurse should stay with the client and call for help. Nursing actions during a convulsion are directed toward ensuring a patent airway and client safety. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the client's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the client's mouth. Oxygen is administered after the convulsion has ended. DIF: Cognitive Level: Apply REF: p. 666 TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

Which physiologic alteration of pregnancy most significantly affects glucose metabolism? a.Pancreatic function in the islets of Langerhans is affected by pregnancy. b.Pregnant women use glucose at a more rapid rate than nonpregnant women. c.Pregnant women significantly increase their dietary intake. d.Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.

ANS: D Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin is also broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day.

24. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care? a. Bed rest and analgesics are the recommended treatment. b. She will be unable to conceive in the future. c. A D&C will be performed to remove the products of conception. d. Hemorrhage is the primary concern.

ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture to prevent hemorrhaging. If the tube must be removed, then the woman's fertility will decrease; however, she will not be infertile. A D&C is performed on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes. DIF: Cognitive Level: Apply REF: p. 676 TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

5. A woman 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 clinical change does the nurse anticipate? a. Eclamptic seizure b. Rupture of the uterus c. Placenta previa d. Abruptio placentae

ANS: D Uterine tenderness in the presence of increasing tone may be the earliest sign of abruptio placentae. Women with preeclampsia are at increased risk for an abruption attributable to decreased placental perfusion. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture exhibits hypotonic uterine activity, signs of hypovolemia, and, in many cases, the absence of pain. Placenta previa exhibits bright red, painless vaginal bleeding. DIF: Cognitive Level: Understand REF: p. 662 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

10. Which statement best describes chronic hypertension? a. Chronic hypertension is defined as hypertension that begins during pregnancy and lasts for the duration of the pregnancy. b. Chronic hypertension is considered severe when the systolic BP is higher than 140 mm Hg or the diastolic BP is higher than 90 mm Hg. c. Chronic hypertension is general hypertension plus proteinuria. d. Chronic hypertension can occur independently of or simultaneously with preeclampsia.

ANS: D Women with chronic hypertension may develop superimposed preeclampsia, which increases the morbidity for both the mother and the fetus. Chronic hypertension is present before pregnancy or diagnosed before the 20 weeks of gestation and persists longer than 6 weeks postpartum. Chronic hypertension becomes severe with a diastolic BP of 110 mm Hg or higher. Proteinuria is an excessive concentration of protein in the urine and is a complication of hypertension, not a defining characteristic. DIF: Cognitive Level: Understand REF: p. 667 TOP: Nursing Process: Diagnosis | Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

A pregnant client is diagnosed with abruptio placentae. What signs and symptoms would the nurse find in the client?

Abdominal pain vaginal bleeding uterine tenderness

What sign tells you that the postpartum mom is ready to come off of magnesium sulfate?

Adequate diuresis (tells us that our organs are being perfused!)

A client with severe gestational hypertension is prescribed hydralazine (Apresoline). What is a priority nursing intervention in this case?

Assess blood pressure frequently.

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?

Amniocentesis

Women with preeclampsia demonstrate hyper responsiveness to which two hormones?

Angiotensin II and Epinephrine

The nurse is assessing a client who is in the third trimester of pregnancy. Which finding would require immediate intervention by the nurse? A) Blood pressure of 142/92 B) Pulse of 92 beats per minute C) Respiratory rate of 24 per minute D) Weight gain of 16 oz per week

Answer: A Explanation: A) A pregnant client's blood pressure should not be greater than 140/90, and if it is elevated, it could be a sign of gestational hypertension or preeclampsia. The pregnant client's heart and respiratory rates will increase slightly as a result of an increased circulatory volume and a decrease in intrathoracic space. Weight gain should average a pound per week in the second and third trimesters.

The community nurse is caring for a client who is 32 weeks pregnant and diagnosed with preeclampsia. Which statement indicates that the client requires additional teaching? A) "My urine may become darker and smaller in amount each day." B) "I should call the doctor if I develop a headache or blurred vision." C) "Pain in the top of my abdomen is a sign my condition is worsening." D) "Lying on my left side as much as possible is good for the baby."

Answer: A Explanation: A) Oliguria is a complication of preeclampsia caused by renal involvement and is a sign that the condition is worsening. It is not an expected outcome and should be reported to the physician. Headache and blurred vision or other visual disturbances are an indication of worsening preeclampsia, and should be reported to the physician. Left lateral position maximizes uterine and renal blood flow, and therefore is the optimal position for a client with preeclampsia. Epigastric pain is an indication of liver enlargement, a symptom of worsening preeclampsia, and should be reported to the physician.

A nurse working in Labor and Delivery cares for clients with preeclampsia. The nurse understands that the exact cause of this condition is not known; however, research suggests: A) It is a disorder of placental dysfunction. B) It is a disorder of fetal liver compromise. C) It is a disorder of maternal hyporesponsiveness to vasoactive peptides. D) It is a disorder of excess trophoblast invasion within the placenta.

Answer: A Explanation: A) The exact cause of preeclampsia is unknown. However, it has been identified as a disorder of placental dysfunction leading to a syndrome of endothelial dysfunction with associated vasospasm.

During a routine prenatal visit, a client who is 24 weeks pregnant has an increased blood pressure. The nurse identifies which nursing diagnosis as appropriate for the client at this time? A) Fluid Volume Excess B) Anxiety C) Excess Fluid Volume D) Ineffective Coping

Answer: A Explanation: A) The rise in blood pressure could be caused by fluid retention as seen in preeclampsia. The client would be at risk for fluid volume excess. Not enough information is provided to determine if the client is experiencing fluid volume overload. There is no information to support ineffective coping or anxiety in the client.

A pregnant client with preeclampsia delivers the fetus. What care will the client need within the first 48 hours after delivery? Select all that apply. A) Antihypertensives as prescribed B) Frequent assessment of serum electrolytes C) Oxygen 2 liters nasal cannula as prescribed D) Seizure precautions E) Vital sign assessment every 4 hours

Answer: A, D, E Explanation: A) Even though the client with preeclampsia usually improves rapidly after giving birth, seizures can still occur during the first 48 hours postpartum. The client may also continue to receive antihypertensives as prescribed. Nursing management during the postpartal period also includes vital sign assessment every 4 hours for 48 hours. The client's hematocrit should be assessed and not necessarily serum electrolytes. Oxygen is not usually indicated after delivery.

Which clinical consideration should the nurse implement for the client in labor who has been diagnosed with preeclampsia? A) Place the client in the room closest to the nurse's station, even if it is a shared room. B) Place the client in left lateral position when the client feels the urge to push. C) Monitor client's fetus intermittently while client is in first stage of labor. D) Encourage the client to be alone in the room without family in order to maintain a quiet environment.

Answer: B Explanation: B) A laboring client with preeclampsia is at risk for the development of eclampsia with subsequent seizures. The nurse should place the client in left lateral position when the client feels the urge to push because this position improves circulation to the placenta and fetus. If possible, the nurse should place the client in a private room to promote a non-stimulating environment. However, the client should always have support with her, not be alone during labor. The nurse will monitor the client's fetus continuously during labor.

A client with preeclampsia begins to seize. What should the nurse should do to protect the client and fetus from injury? A) Elevate the client's legs. B) Place the client on the left side and protect the airway. C) Place the client in the supine position. D) Elevate the head of the bed.

Answer: B Explanation: B) The client should be placed on the side to aid in circulation to the placenta. The airway needs to be maintained to ensure oxygenation throughout the seizure. The client should not be placed in the supine position. The head of the bed should not be elevated. The client's legs should not be elevated.

A pregnant client is diagnosed with HELLP syndrome. The client's nurse understands that which clinical finding is not a manifestation of this condition? A) Elevated liver enzymes B) Hemolysis C) Elevated lipid panel D) Decreased platelet count

Answer: C Explanation: C) HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) is thought to be related to severe preeclampsia. Elevated lipid panel is not a characteristic of HELLP syndrome.

The nurse identifies assessment findings for an African-American client with preeclampsia. Blood pressure is 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 1+; 1+ edema hands, feet, ankles. On the next hourly assessment, which new assessment finding would indicate worsening of the condition? A) Blood pressure 158/100 B) Platelet count 150,000 C) Urinary output 20 mL/hour D) Reflexes 2+

Answer: C Explanation: C) The decrease in urine output is an indication of decrease in glomerular filtration rate, which indicates a loss of renal perfusion. The assessment finding most abnormal and life-threatening is the urine output change. The blood pressure increase is not significant. The reflexes are normal at 2+. The platelet count is normal, though it is at the lower end.

A nurse working in Labor and Delivery is caring for a client with preeclampsia. Which clinical manifestation is the nurse most likely to find in this client? A) Increased nitric oxide production B) Decreased serum sodium C) Decreased blood urea nitrogen (BUN) D) Increased serum creatinine

Answer: D Explanation: D) Preeclampsia decreases renal perfusion, causing an increase in both serum creatinine and blood urea nitrogen (BUN). Preeclampsia also causes a decrease in nitric oxide production and the retention of serum sodium.

The nurse is assessing a client who is 20 weeks pregnant. Which health issue should the nurse recognize as increasing this client's risk for the development of eclampsia? A) Treatment for vitamin D deficiency B) Surgery for ruptured appendix 1 year prior C) Fibrocystic breast disease D) Obesity

Answer: D Explanation: D) Risk factors for the development of eclampsia include obesity. The other choices will not predispose the client to developing eclampsia.

A nurse working in Labor and Delivery is teaching a group of pregnant clients regarding seizures associated with eclampsia. The nurse will include which statement? A) "The tonic phase of a grand mal seizure is evidenced by alternate contraction and relaxation of the muscles." B) "The clonic phase of a grand mal seizure is evidenced by muscular contraction and rigidity." C) "Seizures are rare in eclampsia, but they occur sometimes." D) "Seizures do not occur in preeclampsia."

Answer: D Explanation: D) Seizures do not occur in preeclampsia; eclampsia is diagnosed once a client has a seizure, so seizures are not rare in eclampsia. The tonic phase of a grand mal seizure is evidenced by muscular contraction and rigidity. The clonic phase of a grand mal seizure is evidenced by alternate contraction and relaxation of the muscles.

The nurse identifies the diagnosis of Risk for Injury as appropriate for a client with preeclampsia. What should the nurse include in this client's plan of care? A) Suggest family and friends phone frequently. B) Place in a semiprivate room. C) Provide stimulation with television and visitors. D) Limit phone calls and visitors.

Answer: D Explanation: D) The client with preeclampsia who is at risk for injury needs to be placed in a private room near the nurses' station. The room should be a quiet, with phone calls and visitors limited. The semiprivate room might provide too much stimulation. Television and visitors should be limited to reduce stimulation. Frequent phone calls would provide too much stimulation and should be limited.

A client presents to the OB triage unit with a report of bright red vaginal bleeding that has saturated a peripad over the last hour. The nurse observes the fetal heart rate with a baseline of 130 decreasing to 100 for 60 seconds and then returning to 130. There are no contractions present. Which are the priority nursing interventions?

Ask client time of last oral intake and prepare to start an IV

3. A client presents to labor and delivery at 18 weeks of gestation with a temperature of 103° F, malodorous vaginal bleeding, and abdominal tenderness. The health care provider suspects a septic miscarriage. While planning her care the nurse recognizes that usual management of this condition includes: Select all that apply. A. Bed rest B. Immediate termination of pregnancy C. Cervical culture and sensitivity D. Treatment for septic shock E. Prophylactic cerclage

B C D Bed rest as a treatment modality is appropriate for threatened abortion. Despite its frequent use, bed rest has not been proven effective. Prophylactic cerclage is done for recurrent miscarriage. This pregnancy should be terminated immediately by whatever method is deemed appropriate for this duration of pregnancy. Once the culture is obtained, treatment with broad spectrum antibiotics should be initiated. Treatment for septic shock is a priority.

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. Maternal serum alpha-fetoprotein screening (MSAFP) d. Percutaneous umbilical blood sampling (PUBS)

B ~ Feedback A An ultrasound for fetal anomalies would most likely have occurred earlier in the pregnancy. B Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. The BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. C It is too late in the pregnancy to perform an MSAFP. Furthermore, it does not provide information related to fetal well-being. D Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus.

The eclamptic mother just had a seizure. Her ABGs are drawn. The mother asks why this is being done. The best answer by the nurse is A. It gives us a good indication of you CNS sensitivity B. It will tell us the affect the seizure had on your oxygenation status C. It will tell us if the seizure cause a drop in your pH D. It gives us a baseline assessment incase you have another seizure

B. It will tell us the affect the seizure had on your oxygenation status (Seizure cause lack of O2)

The nurse is comforting and listening to a young couple who just suffered a miscarriage. When asked why this happened, which reason should the nurse share as a common cause?

Chromosomal abnormality

In the United States today: a. More than 20% of pregnancies meet the definition of high risk to either the mother or the infant. b. Other than biophysical criteria, the greatest socioeconomic risk factor in high risk pregnancies is the inability to access prenatal care. c. High risk pregnancy status extends from first confirmation of pregnancy to birth. d. High risk pregnancy is a less critical medical concern because of the reduction in family size and the decrease in unwanted pregnancies.

B ~ Feedback A Approximately 500,000 of the four million births (12.5%) in the United States will be categorized as high risk. B Lack of access to prenatal care poses the greatest socioeconomic risk to these patients. Other factors include low income, marital status, and ethnicity. C The high risk status for the mother extends through 30 days after childbirth. D These factors, along with technologic advances that both facilitate pregnancies in previously infertile couples and advance the potential of care, have enhanced emphasis on delivering babies safely.

A maternal serum alpha-fetoprotein (AFP) test indicates an elevated level. It is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus? a. Percutaneous umbilical blood sampling (PUBS) b. Ultrasound for fetal anomalies c. Biophysical profile (BPP) for fetal well-being d. Amniocentesis for genetic anomalies

B ~ Feedback A Indications for use of PUBS include prenatal diagnosis of inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of fetuses with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. B If AFP findings are abnormal, follow-up procedures include genetic counseling for families with a history of neural tube defect, repeated AFP, ultrasound examination, and possibly amniocentesis. C A BPP is a method of assessing fetal well-being in the third trimester. D Before an amniocentesis is considered, the woman first would have an ultrasound for direct visualization of the fetus.

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring woman with diabetes mellitus, the nurse is aware that she is at a greater risk for: a. Oligohydramnios. b. Polyhydramnios. c. Postterm pregnancy. d. Chromosomal abnormalities.

B ~ Feedback A Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the patient at risk for developing oligohydramnios. B Polyhydramnios or amniotic fluid in excess of 2000 ml is 10 times more likely to occur in diabetic rather than nondiabetic pregnancies. This will put the mother at risk for premature rupture of membranes, premature labor, and postpartum hemorrhage. C Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. D Maternal age greater than 35 and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities.

In the first trimester, ultrasonography can be used to gain information on: a. Amniotic fluid volume. b. Uterine abnormalities. c. Placental location and maturity. d. Cervical length.

B ~ Feedback A This information would not be available via ultrasonography until the second or third trimester. B Ultrasonography can detect certain uterine abnormalities such as bicornate uterus and fibroids. C This information would not be available via ultrasonography until the second or third trimester. D This information would not be available via ultrasonography until the second or third trimester.

Which of the following are characteristics of severe preeclampsia? (Select all that apply) A. Transient headache B. BP of 162/112 C. 24 hour urine 350 mg D. Complaints of persistent blurred vision E. Epigastric pain F. 1+ dipstick proteinuria

B. BP of 162/112 D. Complaints of persistent blurred vision E. Epigastric pain

Select all of the above that are associated with preeclampsia. A. Increased colloid osmotic pressure B. Edema C. Tissue hypoxia D. Seizure activity E. Proteinuria

B. Edema C. Tissue hypoxia E. Proteinuria

Which of the following is the most common manifestation related to poor liver perfusion? A. Headache B. Epigastric pain C. Blurred vision D. Generalized tissue edema

B. Epigastric pain

Which of the following describes the etiology behind preeclampsia? A. Decreased vascular resistance in thin vessel walls B. Increased resistance with thick walled vessels C. Plaques build up in the uterine vessels D. Increased placenta perfusion causes hemorrhage and changes in LOC

B. Increased resistance with thick walled vessels

For a mother with severe preeclampsia, she is going to deliver preterm with a scheduled c-section. She is given 2 doses of dexamethasone every 24 hours. What is the main purpose of the dexamethasone? A. Increases surface area of lung tissue B. Increases surfactant production in the lungs C. Prevents the need of a ventilator D. Prevents any lung infection from setting in

B. Increases surfactant production in the lungs

Reduced perfusion to the kidneys causes A. Polyuria B. Proteinuria C. Flank pain D. Hypotension

B. Proteinuria Causes protein to spill out of the urine, oliguria, H2o and Na+ retention (edema)

The nurse is evaluating a woman at 48 hours postpartum who experienced pregnancy-induced hypertension (PIH). Which assessment would lead the nurse to conclude that the PIH has not resolved? A. Blood pressure is returned to baseline. B. Client complains of headache and blurred vision. C. Urine output is increasing. D. Client complains of perineal pain.

B. Rationale: Headache and blurred vision are symptoms of the disorder, indicating that the PIH has not resolved. Baseline blood pressure and increasing urine output are signs that PIH is resolving. Perineal pain is unrelated to PIH.

The nurse is performing a routine prenatal assessment of a 36-year-old renal client at 23 weeks' gestation, with suspected pregnancy-induced hypertension (PIH). Which factor is indicative of PIH? A. Glucose in the urine B. Proteinuria C. A baseline blood pressure of 122/80 D. Complaints of low back pain

B. Rationale: PIH begins to occur at 20 weeks' gestation, and proteinuria is one sign that the client is experiencing PIH; pre-existing renal disease is a risk factor for preeclampsia with symptoms often occurring before 32 weeks' gestation. A baseline pressure is not a determining factor for PIH. Glucose in the urine indicates possible gestational diabetes, which puts the client at risk for PIH, but is not diagnostic for PIH. Back pain is unrelated to PIH.

The nursing instructor is teaching a group of students about the Magnetic Resonance Imaging (MRI) scan. Which statement made by a student indicates the need for further teaching? A: "The client should stay completely still during the scan." B: "MRI shows accurate fetal anatomic details." C: "MRI provides both a biophysical and a biochemical profile of the mother and fetus." D: "The patient will not be exposed to any ionizing radiation or injected iodine dye during the scan."

B: "MRI shows accurate fetal anatomic details." MRI takes 20 to 60 minutes, depending on the reason for study. Accurate anatomic details would not be obtained, because there is a possibility of fetal movement. The client should be completely still during the procedure, with short breaks, because physical movement would alter the effectiveness of the scan. MRI helps evaluate the fetal structure, overall growth, biochemical status, and the placenta. MRI is a noninvasive procedure. Unlike with a computed tomography (CT) scan, iodine dye would not be injected, and MRI does not use ionizing radiation.

The primary health care provider suspects a pregnant client to be at risk for an ectopic pregnancy and instructs the nurse to prepare the client for ultrasonography. How does the nurse prepare the client for the test? A :Instruct the client not to void prior to the test. B: Assist the client into a lithotomy position during the test. C: Inform the client that moderate pain will be felt during the test. D: Use pillows to elevate the client's head and knees during the test.

B: Assist the client into a lithotomy position during the test. An ectopic pregnancy is detected using transvaginal ultrasonography. The client should be placed in a lithotomy position, because this position enables the primary health care provider to conduct the test with ease and provides comfort to the client. If abdominal and not transvaginal ultrasonography is being performed, then the client would be instructed to avoid voiding. Transvaginal ultrasonography does not cause pain; the client would only feel a slight pressure due to insertion of the probe. The client 's head and knees are elevated using pillows while performing abdominal ultrasonography. While performing transvaginal ultrasonography, the nurse should place a pillow to elevate the client 's pelvis.

When preparing a multigravid client who has undergone evacuation of hyaditdform mole for discharge, the nurse explains the need for follow-up care. The nurse determines that the client understands the instruction when she says that she is at risk for developing which of the following?

Choriocarcinoma

Which risk is a fetus subject to if chorionic villus sampling (CVS) is conducted in the 7th week of gestation? A: Reduced heart rate B: Limb reduction defects C: Decreased lung maturity D: Neural tube defect

B: Limb reduction defects Chorionic villus sampling (CVS) can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. Studies indicate that the fetus may be at increased risk for limb reduction defects when the test is performed before the ninth completed week of gestation. Ultrasonography is used to monitor the fetal heart rate. CVS does not affect the fetal heart rate. Fetal lung maturity is detected by amniocentesis. CVS does not impair fetal lung maturity. Neural tube defects are caused by improper folic acid supply to the fetus. CVS does not cause neural tube defects.

What is an appropriate indicator for performing a contraction stress test? A: Increased fetal movement and small for gestational age B: Maternal diabetes mellitus and postmaturity C: Adolescent pregnancy and poor prenatal care D: History of preterm labor and intrauterine growth restriction

B: Maternal diabetes mellitus and postmaturity Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test. Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Although adolescent pregnancy and poor prenatal care are risk factors for poor fetal outcomes, they are not indicators for performing a contraction stress test. Intrauterine growth restriction is an indicator; history of a previous stillbirth, not preterm labor, is another indicator.

A nurse is providing instruction for an obstetric client 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 client can monitor fetal activity once daily for a 60-minute period and note activity. C: Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. D: Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. E: The test must be done in a clinic or hospital under the supervision of a nurse or physician.

B: The client can monitor fetal activity once daily for a 60-minute period and note activity. C: Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. D: Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. Client monitoring of fetal activity once daily for a 60-minute period, and noting the activity is a protocol that can be used to perform DFMC. Monitoring fetal activity two times a day either after meals or before bed for a period of two hours or until 10 fetal movements are noted is a protocol that can be used to perform DFMC. Counting all fetal movements in a 12-hour period daily until 10 fetal movements are noted is a protocol that can be used to perform DFMC. The fetal alarm signal is noted when there are no fetal movements noted for a period of 12 hours. That the test must be done in a clinic or hospital under the supervision of a nurse or physician is incorrect. It is assessed at home and does not interfere with a woman's daily routine.

While reviewing the laboratory reports of 38-year-old pregnant client, the nurse finds that the lecithin/sphingomyelin (L/S) ratio is 2:1, amniotic fluid index is 12 cm, and inhibin A level is low. What does the nurse infer from this finding? A: The fetus may have risk of lung immaturity. B: The fetus may have risk of Down syndrome. C: The fetus may have risk of Potter syndrome. D: The fetus may have risk of neural tube defect.

B: The fetus may have risk of Down syndrome. Inhibin A is the hormone that is secreted by the placenta. Low levels of inhibin A indicate that the fetus has a chromosomal abnormality, which indicates a risk of Down syndrome. A L/S ration of 2:1 is a normal finding and does not indicate fetal lung immaturity. The normal amniotic fluid index is 10 to 25 cm. If the amniotic fluid index is more than 25, the fetus has a risk of Potter syndrome. If the amniotic fluid index is less than 5 cm, the fetus has chromosomal abnormalities and a neural tube defect. Therefore, the nurse does not anticipate that the fetus has a risk of Potter syndrome or neural tube defect.

The nurse recognizes that documenting accurate blood pressures is vital in the diagnosing of preeclampsia and eclampsia. The nurse suspects preeclampsia based on which finding?

BP of 140/90 mm Hg on two occasions 6 hours apart

The nurse is assisting a client who has just undergone an amniocentesis. Blood results indicate the mother has type O blood and the fetus has type AB blood. The nurse should point out the mother and fetus are at an increased risk for which situation related to this procedure?

Baby developing postbirth jaundice

In which of the following maternal locations would the nurse place the ultasound transducer of the external electronic fetal heart rate monitor if a fetus at 34 weeks' gestation is in the left occipitoanterior (LOA) position?

Below the umbilicus on the left side

A pregnant client at 30 weeks of gestation has preterm labor. The nurse understands that the preterm baby may be born with immature lungs. What medication would be administered to help in lung maturation?

Betamethasone (celestone)

When would the best timeframe to establish gestational age based on ultrasonography?

Between 14 and 22 weeks of gestation

The nurse is caring for a patient with preeclampsia. Which laboratory findings indicate that the disorder has progressed to HELLP syndrome? Select all that apply. Bilirubin 3.2 Potassium 4.9 Hemoglobin 12 Platelet 138.000 Elevated AST 58 and ALT 90

Bilirubin 3.2 Platelet 138.000 Elevated AST 58 and ALT 90

After receiving shift report, the nurse reviews the blood pressures of the assigned patients. The nurse understands that which patient is at greatest risk for the development of gestational hypertension? Blood pressure 125/88, diagnosed at 36 weeks' gestation Blood pressure 118/72, diagnosed at 10 weeks' gestation Blood pressure 142/80, diagnosed at 19 weeks' gestation Blood pressure 150/90, diagnosed at 36 weeks' gestation

Blood pressure 142/80, diagnosed at 19 weeks' gestation

What are the severe clinical manifestations of preeclampsia?

Blood pressure greater than or equal to 160/110, debilitating headache, persistent right upper quadrant pain or epigastric pain, S. creatinine greater than 1.1 mg/dL or double the client's baseline, elevated liver enzymes to at least twice the upper limit of normal, pulmonary edema, altered mental status or seizure, and visual disturbances like blurry vision, scotomata, and blindness.

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that: a. Alcohol or cigarette smoke can irritate the fetus, causing greater activity. b. Kick counts should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off. c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women can.

C ~ Feedback A Alcohol and cigarette smoke temporarily reduce fetal movement. B The mother should count fetal activity (kick counts) two or three times daily for 60 minutes each time. C No movement in a 12-hour period is cause for investigation and possibly intervention. D Obese women have a harder time assessing fetal movement.

What are the possible causes of miscarriage during early pregnancy

Chromosomal Abnormalities Endocrine imbalance Hypothyroidism Antiphospholipid antibodies

Which of the following presentations is associated with early pregnancy loss occurring in less than 12 weeks gestation?

Chromosomal abnormalities Antiphospholipid syndrome hypothyroidism

At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytics are administered and she is placed on bed rest, she continues to experience regular uterine contractions, and her cervix is beginning to dilate and efface. What would be an important test for fetal well-being at this time? a. Percutaneous umbilical blood sampling (PUBS) b. Ultrasound for fetal size c. Amniocentesis for fetal lung maturity d. Nonstress test

C ~ Feedback A Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of the fetus with intrauterine growth restriction, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. B Typically fetal size is determined by ultrasound during the second trimester and is not indicated in this scenario. C Amniocentesis would be performed to assess fetal lung maturity in the event of a preterm birth. D A nonstress test measures the fetal response to fetal movement in a noncontracting mother.

CNS irritability which results from poor perfusion to the _______ can cause _________ A. Brain, scotoma B. Liver, decreased liver enzymes C. Brain, hyperreflexia D. Kidneys, oliguria

C. Brain, hyperreflexia

Which of the following is not a component of HELLP syndrome? A. Hemolysis B. Low platelets C. Decreased liver enzymes D. Likely to have nausea/vomiting

C. Decreased liver enzymes INCREASED liver enzymes

Which of the following places of edema would be of most concern for the hypertensive mother? A. Sacral B. Legs C. Face D. Toes

C. Face Face and hands are of most concern. Leg swelling can occur as a normal part of pregnancy.

With poor perfusion to the placenta, this may result in A. Placenta previa B. Contractions C. IUGR D. Macrosomia

C. IUGR

When can eclamptic seizures occur? A. Only during the laboring process B. Only in the prenatal period C. In all parts of pregnancy and post partum D. In the post partum period only

C. In all parts of pregnancy and post partum

What is one of the main nursing consideration for the postpartum mom on magnesium sulfate? A. Monitor for hemorrhage B. Monitor for increase respiratory pattern C. Make sure another family member is in the room while the baby is there D. Assessing vital signs q8hr

C. Make sure another family member is in the room while the baby is there Mag sulfate is a muscle relaxer and it is safest for the infant if there is another family member present.

The nurse begins to administer a 5 gram bolus of magnesium sulfate via IV infusion for her preeclamptic patient with CNS hyperreflexia. The patient states they have a headache and feel very hot and flushed. The nurse's next best action would be to A. Document the findings in the patients chart B. Decrease the mag sulfate rate to 2 g/hr C. Offer the patient a cool cloth and a cold drink D. Stop the magnesium sulfate infusion

C. Offer the patient a cool cloth and a cold drink These are normal, common side effects associated with magnesium sulfate. The nurse would provide symptomatic relief, but this would not be cause for concern to decrease or turn off the infusion.

The nurse is caring for a client with severe pregnancy-induced hypertension who is in the hospital on a magnesium sulfate drip. The nurse monitors the client for which sign of magnesium toxicity? A. Decreased appetite B. Awkward movements C. Diminished reflexes D. Slurring of speech

C. Rationale: Diminished reflexes signify magnesium toxicity. Slurred speech, decreased appetite, and awkward movements indicate a therapeutic magnesium level.

The nurse is caring for a woman who has been admitted with early pregnancy-induced hypertension (PIH) that has progressed to eclampsia. The priority intervention by the nurse is to: A. check the blood pressure and fetal heart tones. B. administer oxygen. C. maintain a patent airway. D. prepare to administer magnesium sulfate.

C. Rationale: The woman experiencing eclampsia is at great risk for seizures, and the highest priority of care is a patent airway. Checking blood pressure, fetal heart tones, and administering magnesium sulfate and oxygen are all components of care but are of lower priority than maintaining a patent airway.

The primary health care provider orders a specialized ultrasonography test for a client. What is the objective of performing the test? A: To determine fetal cardiac activity B: To assess the amniotic fluid volume C: To determine the presence of polyhydramnios D: To assess the fetal position during delivery

C: To determine the presence of polyhydramnios Specialized ultrasonography is used to detect physiologic and anatomic abnormalities in the fetus. Polyhydramnios, or an increased amount of amniotic fluid in the fetal sac, is a physiologic abnormality that can be assessed by specialized ultrasonography. Fetal cardiac activity is checked in a standard ultrasonographic test. Amniotic fluid volume is measured in a standard ultrasonographic test. Fetal position during delivery is determined using limited ultrasonography.

A physician orders magnesium sulfate IV for a primigravida client at 37​ weeks' gestation diagnosed with severe preeclampsia. Which medication would the nurse have readily available at the​ client's bedside?

Calcium

The nurse observes that intravenous (IV) administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant client with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP?

Calcium gluconate

A primigravid at 34 weeks gestation is experiencing contractions every 3 to 4 minutes lasting for 35 seconds. Her cervix is 2 cm dilated and 50% effaced. While the nurse is assessing the client's vital signs, the client says, "I think my bag of waters just broke." Which of the following would the nurse do FIRST?

Check the status of the fetal heart rate.

When developing the collaborative plan of care with the health care provider for a multigravid client at 10 weeks' gestation with a history of cardiac disease who was being treated with digitalis therapy before this pregnancy. The nurse should instruct the client about which of the following regarding the client's drug therapy regimen?

Continuation of the same dosage

The nurse is caring for a pregnant woman who is admitted with preeclampsia. The nurse plans care based on the nursing diagnosis of deficient fluid volume related to fluid shifts from vasospasms. Which nursing intervention is a priority for this client? (Select all that apply.) A. Monitor for increased urine output. B. Assess blood pressure every 8 hours. C. Place client in the left lateral recumbent position. D. Weigh client weekly. E. Assess deep tendon reflexes.

D & E Rationale: The left lateral position reduces pressure on the vena cava, thereby increasing venous return. Hyperreflexia indicates central nervous involvement and is a sign of progression toward eclampsia. Blood pressure is assessed every 1-4 hours. Urine output is decreased in preeclampsia; the client is weighed daily for fluid status.

In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their patients that: a. Both require the woman to have a full bladder. b. The abdominal examination is more useful in the first trimester. c. Initially the transvaginal examination can be painful. d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

D ~ Feedback A The abdominal examination requires a full bladder; the transvaginal examination requires an empty one. B The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. C Neither method should be painful, although with the transvaginal examination the woman will feel pressure as the probe is moved. D It also allows intrauterine pregnancies to be diagnosed earlier.

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old and has a body mass index (BMI) of 17.5. She admits to having used cocaine several times during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category? a. Blood pressure, age, BMI b. Drug/alcohol use, age, family history c. Family history, blood pressure, BMI d. Family history, BMI, drug/alcohol abuse

D ~ Feedback A The womans BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which would be a high risk. B The womans drug/alcohol use and family history put her in a high risk category, but her age does not. C The womans family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal. D Her family history of NTD, low BMI, and substance abuse are all high risk factors of pregnancy.

The nurse concludes that a client is at risk for pregnancy-induced hypertension (PIH) when the vital signs taken during pregnancy show that the blood pressure increases from: A. 90/56 to 110/70. B. 134/80 to 140/88. C. 122/80 to 138/86. D. 100/60 to 130/76.

D. Rationale: An increase of 30 mmHg systolic and 15 mmHg diastolic on two occasions is diagnostic for PIH. The other examples do not meet these criteria.

After delivery of the baby, mom is restarted on magnesium sulfate infusion. The main reason for this is A. To increase contractions and firm the uterus B. To provide CNS stimulation C. To prevent poor fetal circulation D. To allow for adequate diuresis

D. To allow for adequate diuresis

increased

the incidence of ectopic pregnancy has _______________ recently due to STDs, assisted reproduction, IUDs, tubal surgery.

On reviewing the results of the Doppler umbilical flow analysis of a pregnant client, the nurse finds that the client has an elevated S/D ratio. Which does this finding signify in the client? A: Trisomy 13 B: Potter syndrome C: Down syndrome D: Lupus erythematosus

D: Lupus erythematosus Lupus erythematosus is an autoimmune disorder that affects different body systems. An elevated S/D ratio indicates a poorly perfused placenta, which may be due lupus erythematosus. An elevated S/D ratio is not indicative of trisomy 13, which is a chromosomal abnormality. Potter syndrome is an atypical physical appearance of the fetus. Oligohydramnios may result in Potter syndrome, but an elevated S/D ratio is not indicative of Potter syndrome. Down syndrome is a chromosomal abnormality. An elevated S/D ratio does not indicate Down syndrome.

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

Dark brown vaginal discharge

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?

Dark red, "clumpy" vaginal discharge

A patient with preeclampsia is admitted for observation. During the patient assessment, which findings require immediate attention from the nurse? Deep tendon reflexes (DTR) 4+ Painful urination Fetal heart rate 146 beats/minute Lower extremity 1+ edema

Deep tendon reflexes (DTR) 4+

A mother who was induced at 37 weeks begins to experience shortness of breath, fine crackles heard in the base of the lungs, and an O2 SAT of 90. She is currently on magnesium sulfate for preeclampsia. What would the nurse assess?

Deep tendon reflexes to check for mag toxicity.

When educating the family of a patient admitted for preeclampsia, the nurse should include which instructions? Select all that apply. Dim the lights. Place on bed rest. Increase fluid intake. Turn off the television. Limit the number of visitors.

Dim the lights. Place on bed rest. Turn off the television. Limit the number of visitors.

During assessment of a patient receiving magnesium sulfate, the nurse notes respirations of 10 breaths/minute, deep tendon reflexes 1+, and lethargy. Which intervention should the nurse implement first? Increase IV fluids. Administer oxygen. Assess blood pressure. Discontinue magnesium sulfate.

Discontinue magnesium sulfate.

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. Which specific lab result should the nurse assess?

Indirect Coombs test

The nurse is caring for a pregnant client with gestational diabetes. What does the nurse teach the client about diet during pregnancy?

Eat three meals a day with two or three snacks.

A 28-year-old client with a history of endometriosis presents to the emergency department with severe abdominal pain and nausea and vomiting. The client also reports her periods are irregular with the last one being 2 months ago. The nurse prepares to assess for which possible cause for this client's complaints?

Ectopic pregnancy

A client with preeclampsia at 32 weeks​' gestation has been admitted to the hospital with signs of a worsening condition. She tells the nurse that she is worried about injury to her baby. Which action may the nurse take to help the client remain calm about her own and her​ baby's condition? ​(Select all that​ apply.)

Educate the client on how to monitor and record fetal movement throughout the day Inform the client that a nurse will be with her to offer support during the administration of any tests for fetal​ well-being Invite the client to identify and discuss any concerns she has about her​ baby's well-being Keep the client and her family informed about fetal status

During the patient interview, the patient reports a new onset of epigastric pain, nausea, and vomiting. Which physical assessment finding would indicate the possibility of HELLP syndrome? Headache Enlarged liver Generalized edema Elevated blood sugar

Enlarged liver

What does the nurse administer to a client if there is excessive bleeding after suction curettage?

Ergonovine (Methergine)

True or false. The symptoms of preeclampsia occur simultaneously as the pathophysiological cellular changes occur.

FALSE. The physiological changes at the cellular level often occur before any symptoms even manifest.

True or false. All pregnant women that have severe preeclampsia have HELLP syndrome.

FALSE. You can have preeclampsia but not have HELLP syndrome.

The nurse is caring for a pregnant client who is scheduled for cordocentesis. What could be the consequences of the test on the fetus?

Fetomaternal hemorrhage

Blood pressure elevation that presents at 30 weeks' gestation, resolves within 2 weeks after delivery, and with no other associated symptoms is classified as which hypertensive condition? Preeclampsia HELLP syndrome Chronic hypertension Gestational hypertension

Gestational hypertension

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for what?

Hemorrhage

A 36-year-old African American woman in her 3rd trimester has a history of hypertension, diabetes, and asthma. What puts her at risk for preeclampsia?

Her age, ethnicity, trimester, hypertension, and diabetes. Others include obesity, nulliparity, multiparty, family hx, coagulation disorders, kidney dysfunction, and congenital abnormalities.

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/minute, respiratory rate 24 breaths/minute, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for what medication?

Hydralazine

The nurse is caring for a client with an ectopic pregnancy. Which symptom is a sign that the tube has ruptured?

Hypovolemic shock

At a prenatal​ visit, a client with gestational hypertension laments the amount of weight she has gained since her last appointment. Her blood pressure and other vital signs are within acceptable limits. What does the client say that indicates that she needs additional education about good​ nutrition?

I try not to eat more than​ 1,200 calories a​ day

A preeclamptic mom had her platelets checked monday during her OB visit and levels were 180,000. She has come to triage Thursday and thinks she is experiencing preterm labor. Platelet levels are rechecked and she is at 80,000. Would she be a candidate for an epidural?

NO. She has had a major acute drop in platelets. This can cause a significant problem with bleeding for the mom.

A client at 15 weeks' gestation is admitted with dark brown vaginal bleeding and continuous nausea and vomiting. Her blood pressure is 142/98 and fundal height is 19 cm. The nurse should prepare to do which of the following?

Obtain an ultrasound

During assessment of a prenatal patient, the nurse notes an elevated blood pressure and 3+ edema in the lower extremities. Which additional assessments should the nurse perform next? Select all that apply. Obtain urinalysis Assess oxygen saturation Assess patient's current weight Establish presence of support system Compare with patient's baseline blood pressure

Obtain urinalysis Assess patient's current weight Compare with patient's baseline blood pressure

A laboring client at -2 station has a spontaneous rupture of the membranes and a cord immediately protrudes from the vagina. The nurse should FIRST:

Place gentle pressure upward on the fetal head.

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

Placental Previa

The nurse is preparing to administer intravenous magnesium sulfate to a client with preeclampsia. Meanwhile, the student nurse positions the client in a supine position, monitors the fetal heart rate (FHR), checks for baseline variability, and monitors for the absence of late decelerations. Which action by the student nurse needs correction?

Placing the client in a supine position

When assessing the neonate born to a mother with preeclampsia, low birth weight may be attributed to which factor? Maternal diabetes Limited maternal diet Maternal hypotension Poor placental perfusion

Poor placental perfusion

A nurse is monitoring a client's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern?

Positive clonus response elicited unilaterally

The nurse is caring for a 22-year-old G 2, P 2 client who has disseminated intravascular coagulation after delivering a dead fetus. Which finding is the highest priority to report to the health care provider?

Urinary output of 25 mL in the past hour

A 38-year-old client at about 14 weeks' gestation is admitted to the hospital with a diagnosis of complete hyaditiform mole. Soon after admission, the nurse would assess the client for signs and symptoms of which of the following?

Pregnancy-induced hypertension

What is the patient now began to develop absent reflexes, 10 respirations/min, and a numb tongue?

Probably want to stop the mag infusion as these ae signs of mag toxicity.

The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours. Why would the nurse do this?

Pulmonary edema

A multigravid client diagnosed with a probable ruptured ectopic pregnancy is scheduled for emergency surgery. In addition to monitoring the client's blood pressure before surgery, which of the following would the nurse assess?

Pulse rate

The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV) magnesium sulfate (Sulfamag) infusion. The nurse assesses the client every 20 minutes. Which maternal findings require immediate intervention by the nurse?

Respiratory rate of 9 breaths/minute

A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy?

Rho(D) immune globulin administration to Rh-negative women

before rupture

S/S of ectopic pregnancy _______ ___________: - ab pain - dull LQ pain on one side - diffuse, constant, lower ab pain - mild-moderate dark red/brown vaginal bleeding

after rupture

S/S of ectopic pregnancy ___________ ____________: - sudden, severe one-sided pain - referred shoulder pain - Shock - no vaginal bleeding (internal) - cullen sign: ecchymosis around umbilicus.

6-8

S/S of ectopic pregnancy occur usually _____-_____ weeks after the last normal menstrual period.

The nurse is caring for a patient with preeclampsia, and explains that progression of the disorder may lead to which complication? Seizures Facial edema Respiratory depression Diminished deep tendon reflexes

Seizures

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if what happens?

Seizures do not occur

The nurse is assessing a pregnant client at 16 weeks of gestation. Which diagnostic test should the nurse say is used to identify neural tube defects in the fetus?

Serum alpha-fetoprotein

The nurse is caring for a pregnant client at 19 weeks of gestation. On reviewing the ultrasound reports, the nurse notes that the fetus has a ventricular septal defect (VSD). Which type of ultrasound helps detect VSD?

Specialized or targeted examination

At 38 weeks' gestation, a primigravid client with poorly controlled diabetes and severe preeclampsia is admitted for a cesarean birth. The nurse explains to the client that childbirth helps to prevent which of the following?

Stillbirth

During assessment of a patient diagnosed with preeclampsia, the nurse notes a respiratory rate of 10 breaths/minute, lethargy, and absent deep tendon reflexes. Which action should the nurse take first? Elevate head of the bed. Stop magnesium sulfate infusion. Perform range of motion exercises. Perform bag-valve mask ventilation.

Stop magnesium sulfate infusion.

miscarriage

a pregnancy that ends as a result of natural causes before the 20th week of gestation.

True or false. Magnesium sulfate infusions can cause decreased fetal variability.

TRUE. Decreased variability is expected, but absent variability should not be tolerated. Fetus should be on continuous monitoring while on mag infusion.

Which observation might lead a nurse to modify the plan of care for a client with​ preeclampsia?

The client cannot verbalize the implications of treatment.

The amniotic fluid index (AFI) in a client is 15. What should the nurse interpret form this finding?

The client has normal AFI.

Following a cesarean birth for abruptio placentae, a multigravid client tells the nurse, "I feel like a failure such a failure. None of my other childbirths were like this." The nurse's response to the client is based on the understanding of which of the following?

The client's feeling of grief is a normal reaction.

A client with severe preeclampsia is 12 hours postpartum after delivering a healthy baby. Why has the health care provider ordered a magnesium sulfate infusion to be continued for this ​client?

There is the possibility of seizures after delivery.

During a prenatal check-up a client who is 7 months pregnant reports that she is able to feel about two kicks in an hour. The nurse refers the client for an ultrasound. What is the primary reason for this referral?

To check for fetal well-being

What is the only cure for hypertensive disorders of the pregnant woman (eclampsia, DIC, HELLP, etc.)?

To deliver the baby and the placenta (get rid of the causative agent)

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?

Transvaginal ultrasound

A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?

Twin-to-twin transfusion syndrome (TTTS)

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

The nurse is planning care for a multigravid client hospitalized at 36 weeks' gestations with confirmed rupture of membranes and no evidence of labor. Which of the following would the nurse expect the primary health care provider to prescribe?

Vaginal culture for Nisseria gonorrhea

The primary health care provider prescribes whole blood replacement for a multgravid client with abruptio placentate. Before administering the intravenous blood product, the nurse should FIRST:

Validate client information and the blood product with another nurse

A​ 34-year-old client with preeclampsia delivers a baby whose birth weight graphs in the 10th percentile although he is full term and the delivery was uncomplicated. Which causal factor of preeclampsia may have contributed to the low birth​ weight?

Vasospasm

A patient with preeclampsia has an emergency delivery at 32-weeks gestation. Which is a likely finding in this premature neonate? Select all that apply. Yellow skin Weight of 2250 g Axillary temperature of 97.7°F Heart rate of 120 beats/minute Respirations are 16 breaths/minute

Yellow skin Weight of 2250 g Respirations are 16 breaths/minute

conservative

____________ management of incompetent cervix includes bedrest, hydration, meds like progesterone or nifedipine to stay pregnant.

Hypertension that occurs in the second half of pregnancy in a previously normotensive mother? a. gestational hypertension b. preeclampsia c. chronic hypertension d. eclampsia e. superimposed preeclampsia

a

Seizures can occur up to how many hours post birth? a. 48 hours b. 72 hours c. 24 hours d. 12 hours

a

rescue

a cerclage can be used as a ___________ if it's used between 16-23 weeks.

36

a cerclage is usually left in place until _____ weeks gestation, spontaneous labor, scheduled cesarean or if PPROM occurs.

14-23

a cerclage may be used prophylactically between _____-_____ weeks.

12-20

a late miscarriage is between ______-______ weeks gestation. - usually a maternal cause - infections, age, disease

B, C, D

a woman diagnosed with an ectopic pregnancy is to receive methotrexate. The nurse should explain to the woman that: (select all that apply) A. methotrexate is an analgesic that will relieve the dull abdominal pain she is experiencing B. she should double-flush the toilet with the lid down for 72 hrs after receiving. C. she will receive the med IM D. she must stop taking folic acid supplements as long as she is on methotrexate E. her partner should use a condom during intercourse F. she must return weekly or a measurement of her progesterone level to determine if the methotrexate therapy has been effective

partial mole

often have embryonic or fetal parts & amniotic sac. - milder symptoms - chromosomes from both parents (genetic counseling) - congenital anomalies - risk for tumor is less

A high-risk pregnant client is determined to have gestational hypertension. The nurse suspects that the client has developed severe preeclampsia based on which finding?

blurred vision

Diagnosis of gestational hypertension is made when a client has a BP of ______. a. 150/90 at least twice and 6 hours apart b. 130/60at least twice and 6 hours apart c. 140/90 at least twice and 6 hours apart d. 140/80 at least twice and 6 hours apart

c

Which is classified as hypertension prior to pregancy? a. gestational hypertension b. preeclampsia c. chronic hypertension d. eclampsia

c

placenta previa

classic sign: painless bright red vaginal bleeding in 2nd/3rd trimester.

5

contractions < ______ mins apart is an emergent sign after a cerclage. Need to return to hospital.

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

yes

do you have to assess Rh-- and give RhoGAM for a spontaneous abortion/miscarriage?

Hypertension that worsens and is resistant to treatment or hypertension related end organ dysfunction in pregnancy. a. gestational hypertension b. preeclampsia c. chronic hypertension d. eclampsia e. superimposed preeclampsia

e

What are some interventions that may be appropriate to include in the plan of care for the client with gestational ​hypertension? ​(Select all that​ apply.)

educating the client about the effect of the disease process on pregnancy consider cultural limitations when education the client about nutritious meal planning taking frequent blood pressure readings

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

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?

fetal distress related to hypoxia

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements?

gestational hypertension

2

grade ____ abruptio placenta - 20-50% separation - tenderness and increased uterine tonicity - bleeding may or may not be apparent. - fetal distress present

3

grade _____ of abruptio placenta - > 50% separation - absent-moderate bleed - severe tetany and persistent contractions (boardlike) - severe fetal distress - agonizing pain, maternal shock

What does HELLP stand for?

hemolysis, elevated liver enzymes, and low platelet count

go to hospital

if a woman gets a cerclage and has vaginal bleeding, perineal pressure, or PPROM, what should she do?

36

if baby is > _______ weeks in placenta previa, then baby will be delivered.

snowstorm

in a molar pregnancy, a transvaginal ultrasound is the most accurate. it will reveal a ____________ pattern.

placenta previa

involves implantation of the placenta in the lower uterine segment such that it completely or partially covers the cervix. Or is close enough to the cervix to cause bleeding when it dilates.

yes

is RhoGAM needed for a molar pregnancy?

Intrapartum: Severe range blood pressure may be treated with IV.....?

labetelol or hydralazine

Some women experience a rupture of their membranes before going into true labor. A nurse recognizes that a woman who presents with PPROM has completed how many weeks of gestation?

less than 37 week

What would be the physiologic basis for a placenta previa?

low placental implantation

The nurse is preparing the plan of care for a woman hospitalized for hyperemesis gravidarum. Which interventions interventions should the nurse prioritze? Select all that apply.

maintaining NPO status for the first day administering antiemetic agents obtaining baseline blood electrolyte levels monitoring intake and output

late

major causes of ________ pregnancy bleeding are 1. abruptio placentae 2. placenta previa

hemorrhage

major complication of placenta previa is ?

6-12

manifestations of miscarriage _____-_____ weeks: moderate discomfort/blood loss

12

manifestations of miscarriage after ______ weeks: severe pain (labor) because the fetus must be expelled.

6

manifestations of miscarriage before week ______: may report a heavy menstrual flow. May not know it was a miscarriage.

molar pregnancy

manifestatons: - vaginal bleeding - uterus larger - elevated Hcg - anemia - excess N/V - ab cramping - early onset preeclampsia - hyperthyroidism - absent of FHTs

Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy?

methotrexate

3

more aggressive management of incompetent cervix includes cerclage & is usually used in women with more than ________ losses or preterm births.

complete mole

most common type - no fetus, placenta, amniotic membrane - diffuse trophoblastic hyperplasia - chromosomes paternal - gestational tumors develop in 20%

A 28-year-old primigravida client with type 2 diabetes mellitus 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?

normal response to the pregnancy

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?

observation for bleeding

transabdominal

placenta previa is diagnosed through ________________ ultrasound. - NOT transvaginal

placental abruption

premature separation of the placenta. - detachment of part or all of the placenta from implantation site after 20 weeks gestation. - severe pain, hard abdomen.

A woman in week 35 of her pregnancy with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client?

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 RhoGAM after the birth of her infant. When asked by the client the reason for this injection, which reason should the nurse point out?

prevent maternal D antibody formation

A pregnant client has an Rh-negative blood type. Following the birth of the client's infant, the nurse administers her Rho(D) immune globulin. The purpose of this is to:

prevent maternal D antibody formation.

early

the majority of spontaneous abortions occur __________ in pregnancy (before 12 weeks)

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

yes

should someone that is expecting a miscarriage avoid intercourse?

yes

should you give RhoGAM for an ectopic pregnancy?

A client with​ pregnancy-induced hypertension desires to deliver vaginally. In which position will the nurse place this client to facilitate a vaginal​ birth?

sims' position

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding?

slight vaginal bleeding

threatened

spotting of blood with the cervical os closed - mild cramping may be present

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion?

strong abdominal cramping

prostaglandins

these meds may be given if there is a threatened abortion past 12 wks gestation. Side effects must be treated.

placenta previa

this condition is associated with: - multiparity - advanced maternal age - prior casarean delivery - induced abortion - cigarettes, high altitude - male fetus - prior ________ ___________

oxytocin

this is given after a D&C or D&E to prevent hemorrhage.

methotrexate

this med is most effective for an unruptured ectopic pregnancy. - dissolves tubal pregnancy by destroying rapidly dividing cells.

misoprostol

this med is often given for a medical/therapeutic abortion. - miscarriage completes within 7 days.

HcG

this test is always performed to diagnose a miscarriage or spontaneous abortion.

Hcg, progesterone

to differentiate ectopic pregnancy from something else, these 2 hormone tests help diagnose.

hcg

to dx molar pregnancy, a transvaginal ultrasound is performed and serum ______ levels are tested. Usually very high.

true

true/false: placenta abruption accounts for significant maternal and fetal morbidity and mortality.

true

true/false: the goal of care management is to protect the women's fertility and reproductive future.

true

true/false: women who have had an ectopic pregnancy have an increased incidence for a repeat if able to conceive.

spontaneous

type of abortion/miscarriage where pregnancy ends as result of natural cause before 20 weeks gestation

hydatidiform mole

type of gestational trophoblastic disease. - no viable fetus - Benign proliferative growth of the placental trophoblast in which the chorionic villi develop into edematous, cystic, avascular transparent vesicles that hang in a grapelike cluster

complete

type of miscarriage where cervix is already closed after all of the fetal tissue was expelled.

incomplete

type of miscarriage where fetus is expelled, but the placenta and membranes are retained. - need D & C

missed

type of miscarriage where the fetus has died, but the products of conception are retained in uteru for up to several weeks. NO ROM or cervical opening. - may have no bleeding or cramping - dx by ultrasound because uterus stops growing.