Deck 39: The Obstetric Patient

Question 1

A 35-year-old multiparous woman was admitted to the hospital at 36 weeks' gestation for nausea,vomiting,and severe epigastric pain.On admission,her vital signs were as follows: pulse,90 beats/min; blood pressure,165/100 mm Hg; respiratory rate,18 breaths/min; and temperature,99.4° F.The patient reported blurred and double vision and a severe headache.The fetal heart rate was normal.She was placed on bed rest.Urine analysis revealed proteinuria.Her vital signs 6 hours later were as follows: pulse,88 beats/min; blood pressure,185/105 mm Hg; respirations,16 breaths/min; and temperature,98.4° F.The fetal heart rate was normal.Severe pre-eclampsia was diagnosed.In addition to her clinical signs and symptoms,the patient's laboratory studies demonstrate hemolysis of red blood cells,elevated liver enzymes,and a low platelet count.What would be anticipated as an additional diagnosis?

A) DIC
B) Dead fetus syndrome
C) Amniotic fluid embolism
D) HELLP syndrome

Answer 1

HELLP syndrome

Question 2

Complications of HELLP (hemolysis,elevated liver enzymes,and low platelet count)syndrome include

A) abruptio placentae, liver rupture, and pulmonary edema.
B) neutropenia, liver hemorrhage, and pulmonary edema.
C) disseminated intravascular coagulation (DIC), puerperal conditions, and chronic fatigue.
D) pulmonary edema, DIC, and cor pulmonale.

Answer 2

abruptio placentae, liver rupture, and pulmonary edema.

Question 3

The most common obstetric cause of DIC is

A) pre-eclampsia.
B) abruptio placentae.
C) dead fetus syndrome.
D) amniotic fluid embolism.

Answer 3

abruptio placentae.

Question 4

The most teratogenic of all viruses is

A) rubella.
B) measles.
C) mumps.
D) HIV.

Question 5

The second leading cause of maternal death in the United States is

A) sepsis.
B) hemorrhage.
C) hypertensive disease.
D) disseminated intravascular coagulation.

Question 6

The mnemonic tone,tissue,trauma,and thrombosis refers to potential causes of

A) hypoxia.
B) abruptio placentae.
C) postpartum hemorrhage (PPH).
D) trauma.

Question 7

The treatment plan for management of an obstetric patient with peripartum cardiomyopathy includes

A) oxygen therapy, pain management, and preload enhancement.
B) walking exercises, diuretics, and anticoagulants.
C) diuretics, digoxin, and anticoagulation.
D) fluid resuscitation, beta-blockers, and vasoconstrictors.

Question 8

Which animal is the host for the protozoan Toxoplasma gondii?

A) Cattle
B) Pigs
C) Sheep
D) Cats

Question 9

The treatment goals of pregnancy-induced hypertension include

A) increase IV fluids.
B) use antihypertensive agents to decrease blood pressure.
C) place the mother on bed rest to decrease the chance of delivery.
D) give magnesium sulfate.

Question 10

Extrinsic factors that influence fetal development include all the following EXCEPT

A) fungal infections.
B) chromosomal abnormalities.
C) "unknown" causes.
D) medication exposure.

Question 11

Maternal hypoxia is defined as a PaO? less than

A) 60 mm Hg.
B) 80 mm Hg.
C) 100 mm Hg.
D) 120 mm Hg.

Question 12

According to research,the minimal viability parameters of an infant are

A)20 to 21 weeks' gestation and fetal weight between 500 and 1000 g.
B)22 to 23 weeks' gestation and fetal weight between 1000 and 15,000 g.
C)23 to 24 weeks' gestation and fetal weight between 500 and 1000 g.
D)24 to 25 weeks' gestation and fetal weight between 500 and 1200 g

Question 13

Pre-eclampsia is characterized by widespread physiologic changes,including

A) increase in circulating plasma volume.
B) vasospasms in the arterial system.
C) disseminated intravascular coagulation.
D) high systemic vascular resistance

Question 14

The patient has a congenital cardiac disorder and is experiencing complications that include dysrhythmias,heart failure,and thromboembolism.The nurse recognizes that these are symptoms of

A) atrial septal defect.
B) ventricular septal defect.
C) patent ductus arteriosus.
D) mitral stenosis.

Question 15

The most common cause of obstetric cardiac arrest in pregnancy is

A) anesthetic complications.
B) idiopathic peripartum cardiomyopathy.
C) pregnancy-induced hypertension.
D) hemorrhage.

Question 16

Clinical decisions in a critically ill obstetric patient include

A) fetal viability, hospital practices, and exposure to radiation.
B) fetal viability versus maternal death and parental desires.
C) medication use, personal value systems, and hospital policies.
D) parental desires, fetal viability, and community standards.

Question 17

An autosomal dominant disorder that involves the connective tissue and can lead to dissection or rupture of the aorta is known as

A) cystic fibrosis.
B) Eisenmenger syndrome.
C) peripartum cardiomyopathy.
D) Marfan syndrome.

Question 18

A 35-year-old multiparous woman was admitted to the hospital at 36 weeks' gestation for nausea,vomiting,and severe epigastric pain.On admission,her vital signs were as follows: pulse,90 beats/min; blood pressure,165/100 mm Hg; respiratory rate,18 breaths/min; and temperature,99.4° F.The patient reported blurred and double vision and a severe headache.The fetal heart rate was normal.She was placed on bed rest.Urine analysis revealed proteinuria.Her vital signs 6 hours later were as follows: pulse,88 beats/min; blood pressure,185/105 mm Hg; respirations,16 breaths/min; and temperature,98.4° F.The fetal heart rate was normal.Severe pre-eclampsia was diagnosed.The patient is placed on a magnesium sulfate drip of 3 g/hr.After 1 hour,she has a recurrent seizure.The nurse should

A) administer another 2- to 4-g bolus of MgSO?.
B) adjust the MgSO? at a rate of 1 to 2 g/hr.
C) consider delivery.
D) intubate immediately and provide ventilatory support.

Question 19

Anaphylactoid syndrome (amniotic fluid embolism)of pregnancy

A) is easily diagnosed by a blood test.
B) has a low maternal-fetal mortality rate.
C) has maternal symptoms that include chest pain and bronchospasm.
D) is rare but associated with a high maternal mortality rate.

Question 20

A 35-year-old multiparous woman was admitted to the hospital at 36 weeks' gestation for nausea,vomiting,and severe epigastric pain.On admission,her vital signs were as follows: pulse,90 beats/min; blood pressure,165/100 mm Hg; respiratory rate,18 breaths/min; and temperature,99.4° F.The patient reported blurred and double vision and a severe headache.The fetal heart rate was normal.She was placed on bed rest.Urine analysis revealed proteinuria.Her vital signs 6 hours later were as follows: pulse,88 beats/min; blood pressure,185/105 mm Hg; respirations,16 breaths/min; and temperature,98.4° F.The fetal heart rate was normal.Severe pre-eclampsia was diagnosed.Treatment goals of severe pre-eclampsia include

A) maintaining maternal blood pressure greater than 140/90 mm Hg.
B) delaying delivery of the fetus as long as possible.
C) preventing maternal seizures, which may compromise fetal oxygenation.
D) limiting fluid intake to avoid postpartum edema.

Question 21

The leading cause of maternal blunt trauma is

A) cerebrovascular accident.
B) MVA.
C) idiopathic thrombocytopenic purpura.
D) domestic violence.

Question 22

The greatest risk for developing pulmonary embolism (PE)occurs

A) at the beginning of labor.
B) during the transition period of labor.
C) when the mother is pushing during a vaginal delivery.
D) in the immediate postpartum period.

Question 23

Unique causes of septic shock in pregnant patients include

A) postpartum pyelonephritis.
B) ectopic pregnancy.
C) chorioamnionitis.
D) septic abortion.
E) postpartum hemorrhage.

Question 24

Which medication is not commonly used during pulmonary dysfunction that occurs during pregnancy?

A) Antibiotics
B) ?-Adrenergic
C) Theophylline
D) Ipratropium

Question 25

Treatment goals for severe pre-eclampsia include which of the following?

A) Prevention of seizures
B) Decreasing arterial spasms
C) Prompt delivery of the fetus
D) Support of hypotension
E) Administration of broad-spectrum antibiotics

Question 26

Severe neonatal disorders associated with toxoplasmosis infections include

A) microcephaly.
B) respiratory distress.
C) hydrocephalus.
D) dysrhythmias.
E) visual and hearing impairments.

Question 27

Which of the following physiologic changes are common in pregnant women?

A) Circulating blood volume decreases by 20% as it is diverted to the placenta.
B) Oxygen consumption increases to accommodate the fetus's needs.
C) Respiratory tidal volumes decrease because of the elevated diaphragm.
D) Gastric motility decreases because of displacement of gastrointestinal structures by the enlarged uterus.
E) The glomerular filtration rate increases as cardiac output rises.

Question 28

Which medication used in the advanced cardiac life support algorithm is not contraindicated in pregnancy?

A) Atropine
B) Epinephrine
C) Lidocaine
D) Sodium bicarbonate

Question 29

About 25% to 50% of maternal mortality risks include

A) Marfan syndrome with valvular involvement.
B) pulmonary hypertension.
C) co-arctation of aorta with valvular involvement.
D) Marfan syndrome with aortic involvement.
E) mitral stenosis with atrial fibrillation.

Question 30

Which of the following conditions may precipitate DIC in an obstetric patient?

A) Abruptio placentae
B) Anaphylactoid syndrome of pregnancy
C) Acute respiratory distress syndrome
D) Intracranial hemorrhage
E) Bacterial pneumonia
F) Septic abortion