Deck 30: Medical-Surgical Disorders

Question 1

A pregnant woman at term is transported to the emergency department (ED)after a severe vehicular accident.The obstetric nurse responds and rushes to the ED with a fetal monitor.Cardiopulmonary arrest occurs as the obstetric nurse arrives.What is the highest priority for the trauma team?

A) Obtaining IV access,and starting aggressive fluid resuscitation
B) Quickly applying the fetal monitor to determine whether the fetus viability
C) Starting cardiopulmonary resuscitation (CPR)
D) Transferring the woman to the surgical unit for an emergency cesarean delivery in case the fetus is still alive

Answer 1

Starting cardiopulmonary resuscitation (CPR)

Question 2

Since the gene for cystic fibrosis was identified in 1989,data can be collected for the purposes of genetic counseling for couples regarding carrier status.According to the most recent statistics,how often does cystic fibrosis occur in Caucasian live births?

A) 1 in 100
B) 1 in 1000
C) 1 in 2000
D) 1 in 3200

Answer 2

1 in 3200

Question 3

Which neurologic condition would require preconception counseling,if possible?

A) Eclampsia
B) Bell palsy
C) Epilepsy
D) Multiple sclerosis

Answer 3

Epilepsy

Question 4

Because most pregnant women continue their usual activities,trauma remains a common complication during pregnancy.Approximately 1 in 12 pregnancies in the United States are complicated by trauma each year.Because of the physiologic alterations that accompany pregnancy,special considerations for the mother and fetus are necessary when trauma occurs.Match the maternal system adaptation in pregnancy with the clinical response to trauma.

Increased risk of thrombus formation

A)Increased oxygen consumption
B)Increased heart rate
C)Decreased gastric motility
D)Displacement of abdominal viscera
E)Increase in clotting factors

Question 5

Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment?

A) Intake and output (I&O)and intravenous (IV)site
B) Signs and symptoms of infection
C) Vital signs and incision
D) Fetal heart rate (FHR)and uterine activity

Question 6

A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident.The client is experiencing no pain and no vaginal bleeding,her vital signs are stable,and the fetal heart rate (FHR)is 132 beats per minute with variability.What is the nurse's highest priority?

A) Monitoring the woman for a ruptured spleen
B) Obtaining a physician's order to discharge her home
C) Monitoring her for 24 hours
D) Using continuous electronic fetal monitoring (EFM)for a minimum of 4 hours

Question 7

Bell palsy is an acute idiopathic facial paralysis,the cause for which remains unknown.Which statement regarding this condition is correct?

A) Bell palsy is the sudden development of bilateral facial weakness.
B) Women with Bell palsy have an increased risk for hypertension.
C) Pregnant women are affected twice as often as nonpregnant women.
D) Bell palsy occurs most frequently in the first trimester.

Question 8

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age.Which disorders fall into the category of collagen vascular disease? (Select all that apply. )

A) Multiple sclerosis
B) Systemic lupus erythematosus (SLE)
C) Antiphospholipid syndrome
D) Rheumatoid arthritis
E) Myasthenia gravis

Question 9

Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis?

A) Assess the woman's dietary history for adequate calories and proteins.
B) Teach the woman that the bulk of calories should come from proteins.
C) Instruct the woman to eat a low-fat diet and to avoid fried foods.
D) Instruct the woman to eat a low-cholesterol,low-salt diet.

Question 10

It is extremely rare for a woman to die in childbirth;however,it can happen.In the United States,the annual occurrence of maternal death is 12 per 100,000 cases of live birth.What are the leading causes of maternal death?

A) Embolism and preeclampsia
B) Falls and motor vehicle accidents (MVAs)
C) Hemorrhage and infection
D) Underlying chronic conditions

Question 11

Which information should the nurse take into consideration when planning care for a postpartum client with cardiac disease?

A) The plan of care for a postpartum client is the same as the plan for any pregnant woman.
B) The plan of care includes rest,stool softeners,and monitoring of the effect of activity.
C) The plan of care includes frequent ambulating,alternating with active range-of-motion exercises.
D) The plan of care includes limiting visits with the infant to once per day.

Question 12

Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP).A client asks the nurse why she has developed this condition and what can be done.What is the nurse's best response?

A) PUPPP is associated with decreased maternal weight gain.
B) The rate of hypertension decreases with PUPPP.
C) This common pregnancy-specific condition is associated with a poor fetal outcome.
D) The goal of therapy is to relieve discomfort.

Question 13

A woman with asthma is experiencing a postpartum hemorrhage.Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma?

A) Oxytocin (Pitocin)
B) Nonsteroidal antiinflammatory drugs (NSAIDs)
C) 15-methyl PGF2 $\alpha$
D) Fentanyl

Question 14

The client makes an appointment for preconception counseling.The woman has a known heart condition and is unsure if she should become pregnant.Which is the only cardiac condition that would cause concern?

A) Marfan syndrome
B) Eisenmenger syndrome
C) Heart transplant
D) Ventricular septal defect (VSD)

Question 15

Because most pregnant women continue their usual activities,trauma remains a common complication during pregnancy.Approximately 1 in 12 pregnancies in the United States are complicated by trauma each year.Because of the physiologic alterations that accompany pregnancy,special considerations for the mother and fetus are necessary when trauma occurs.Match the maternal system adaptation in pregnancy with the clinical response to trauma.

Decreased placental perfusion in the supine position

A)Increased oxygen consumption
B)Increased heart rate
C)Decreased gastric motility
D)Displacement of abdominal viscera
E)Increase in clotting factors

Question 16

In caring for a pregnant woman diagnosed with sickle cell anemia,the nurse must be aware of the signs and symptoms of a sickle cell crisis.What do these include? (Select all that apply. )

A) Fever
B) Endometritis
C) Abdominal pain
D) Joint pain
E) Urinary tract infection (UTI)

Question 17

What form of heart disease in women of childbearing years generally has a benign effect on pregnancy?

A) Cardiomyopathy
B) Rheumatic heart disease
C) Congenital heart disease
D) Mitral valve prolapse

Question 18

When caring for a pregnant woman with cardiac problems,the nurse must be alert for the signs and symptoms of cardiac decompensation.Which critical findings would the nurse find on assessment of the client experiencing this condition?

A) Regular heart rate and hypertension
B) Increased urinary output,tachycardia,and dry cough
C) Shortness of breath,bradycardia,and hypertension
D) Edema,crackles,and cyanosis of nails and lips

Question 19

Which congenital anomalies can occur because of the use of antiepileptic drugs (AEDs)in pregnancy? (Select all that apply. )

A) Cleft lip
B) Congenital heart disease
C) Neural tube defects
D) Gastroschisis
E) Diaphragmatic hernia

Question 20

Because most pregnant women continue their usual activities,trauma remains a common complication during pregnancy.Approximately 1 in 12 pregnancies in the United States are complicated by trauma each year.Because of the physiologic alterations that accompany pregnancy,special considerations for the mother and fetus are necessary when trauma occurs.Match the maternal system adaptation in pregnancy with the clinical response to trauma.

Altered pain referral

A)Increased oxygen consumption
B)Increased heart rate
C)Decreased gastric motility
D)Displacement of abdominal viscera
E)Increase in clotting factors

Question 21

Because most pregnant women continue their usual activities,trauma remains a common complication during pregnancy.Approximately 1 in 12 pregnancies in the United States are complicated by trauma each year.Because of the physiologic alterations that accompany pregnancy,special considerations for the mother and fetus are necessary when trauma occurs.Match the maternal system adaptation in pregnancy with the clinical response to trauma.

Increased risk of acidosis

A)Increased oxygen consumption
B)Increased heart rate
C)Decreased gastric motility
D)Displacement of abdominal viscera
E)Increase in clotting factors

Question 22

Because most pregnant women continue their usual activities,trauma remains a common complication during pregnancy.Approximately 1 in 12 pregnancies in the United States are complicated by trauma each year.Because of the physiologic alterations that accompany pregnancy,special considerations for the mother and fetus are necessary when trauma occurs.Match the maternal system adaptation in pregnancy with the clinical response to trauma.

Increased risk of aspiration

A)Increased oxygen consumption
B)Increased heart rate
C)Decreased gastric motility
D)Displacement of abdominal viscera
E)Increase in clotting factors