Deck 21: Childbirth at Risk: Pre-Labor Complications

Question 1

The nurse has received an end of shift report in the high-risk maternity unit. Which patient should the nurse see first?

A)26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement
B)30 weeks' gestation with placenta previa whose fetal monitor strip shows late decelerations
C)35 weeks' gestation with grade I abruptio placentae in labor who has a strong urge to push
D)37 weeks' gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

Answer 1

26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement

Question 2

Hydramnios most likely would be suspected when:

A)There is less amniotic fluid than normal for gestation.
B)The fundal height increases disproportionately to the gestation.
C)The woman has a twin gestation.
D)The quadruple screen comes back positive.

Answer 2

The fundal height increases disproportionately to the gestation.

Question 3

The patient at 38 weeks' gestation has been diagnosed with oligohydramnios. Which statement indicates that teaching has been effective?

A)"My gestational diabetes may have caused this problem to develop."
B)"When I go into labor, I should come to the hospital right away."
C)"This problem is common and will likely occur with my next pregnancy."
D)"Women with this condition usually go into labor after their due date."

Answer 3

"When I go into labor, I should come to the hospital right away."

Question 4

In counseling a newly pregnant gravida 1 at 8 weeks' twin gestation, the nurse teaches the woman about the need for increased caloric intake. The nurse would tell the woman that the minimum recommended intake should be:

A)2,500 kcal and 120 grams protein.
B)3,000 kcal and 150 grams protein.
C)3,500 kcal and 175 grams protein.
D)4,000 kcal and 190 grams protein.

Question 5

A 26-year-old woman who is pregnant with her first child is admitted to the obstetrics unit with a diagnosis of cervical insufficiency. Based upon the patient's diagnosis, how is she most likely to describe her symptoms?

A)"I've been having contractions every four hours."
B)"My cervical pain has gotten much worse over the past two days."
C)"I'm not having any pain, but my contractions are getting stronger."
D)"I'm not having any pain and I don't feel any contractions."

Question 6

The charge nurse is reviewing the physician's notes describing the diagnosis of abruptio placentae in a patient who is currently admitted. The physician describes the woman's placental separation as being "central." Based upon this description, what can the nurse infer about the woman's condition?

A)Blood is trapped between the woman's placenta and the uterine wall, and she may have concealed bleeding.
B)The total separation of the woman's placenta from the uterine wall will lead to massive hemorrhage.
C)Blood is passing between the fetal membranes and the woman's uterine wall, which will lead to some vaginal bleeding.
D)The slight separation of the woman's placenta from the uterine wall will not produce any bleeding.

Question 7

A clinical nurse coordinator is teaching a class of nursing students about surgical and postoperative care of the woman who undergoes cerclage. Which nursing student's statement indicates the need for further clarification of the teaching?

A)"Sometimes cerclage can be performed on an outpatient basis."
B)"If cerclage is performed emergently, the woman will usually be hospitalized for at least five days."
C)"If the woman's amniotic sac is bulging, the cerclage is contraindicated and the procedure cannot be performed."
D)"After 37 weeks' gestation, the woman's cerclage may be cut in order to allow for vaginal delivery."

Question 8

The patient at 30 weeks' gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes:

A)Limiting vaginal exams to only one per 24-hour period.
B)Evaluating the fetal heart rate with an internal monitor.
C)Monitoring for blood loss, pain, and uterine contractibility.
D)Assessing blood pressure every 2 hours.

Question 9

The nurse is planning an in-service educational program to talk about disseminating intravascular coagulation (DIC). The nurse should identify which of the following as risk factors for developing DIC?

A)Diabetes mellitus
B)Abruptio placentae
C)Prolonged retention of a fetus after demise
D)Multiparity
E)Preterm labor

Question 10

A multigravida patient is admitted to labor and delivery in active labor. Nursing diagnoses that might apply to the patient with suspected abruptio placentae include:

A)Fluid volume, risk for deficit related to hypovolemia.
B)Tissue perfusion, risk for altered related to blood loss.
C)Anxiety related to concern for own safety.
D)Knowledge deficit related to lack of information about inherited genetic defects.

Question 11

The nurse is admitting a patient who was diagnosed with hydramnios. The patient asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with:

A)Chest pain, dyspnea, tachycardia, and hypotension.
B)Postmaturity syndrome.
C)Renal malformation or dysfunction.
D)Maternal diabetes.
E)Large-for-gestational-age infants.

Question 12

The home health nurse is admitting a patient at 18 weeks who is pregnant with twins. Which nursing action is most important?

A)Teach the patient about foods that are good sources of protein.
B)Assess the patient's blood pressure in her upper right arm.
C)Determine whether the pregnancy is a result of infertility treatment.
D)Collect a cervicovaginal fetal fibronectin (fFN) specimen.

Question 13

When caring for a laboring patient with oligohydramnios, the nurse should be aware that:

A)There is an increased risk of cord compression.
B)There is less fluid available for the fetus to use during fetal breathing movements; therefore, pulmonary hypoplasia can develop, which could cause respiratory difficulties at birth.
C)Labor progress is often more rapid than average.
D)Early decelerations are more likely.

Question 14

The nurse is caring for a patient at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (PPROM). Which statement indicates that the patient needs additional teaching? "If I:

A)"Were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured."
B)"Develop a urinary tract infection in my next pregnancy, I might rupture membranes early again."
C)"Want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy."
D)"Have bleeding in the third trimester of my next pregnancy, I might rupture membranes again."