Deck 20: Pregnancy at Risk: Gestational Onset

Question 1

A patient is being admitted to the labor area with the diagnosis of eclampsia. Which actions by the nurse are appropriate at this time?

A) Tape a tongue blade to the head of the bed.
B) Pad the siderails and head of the bed.
C) Provide the patient with needed stimulation.
D) Provide the patient with grief counseling.
E) Pull the blinds and provide a dark, quiet environment.

Answer 1

Pad the siderails and head of the bed.
Pull the blinds and provide a dark, quiet environment.

Question 2

The nurse educator is presenting a class on the different kinds of miscarriages. Miscarriages, or spontaneous abortions, are classified clinically into different categories, including:

A) Threatened abortion.
B) Incomplete abortion.
C) Complete abortion.
D) Missed abortion.
E) Acute abortion.

Answer 2

Threatened abortion.
Incomplete abortion.
Complete abortion.
Missed abortion.

Question 3

The nurse is presenting a class on the pathophysiology of the different abortions. Some of the causes are:

A) Chromosomal defects.
B) Insufficient or excessive hormonal levels.
C) Sexual intercourse in the first trimester.
D) Infections in the first trimester.
E) Cervical insufficiency.

Answer 3

Chromosomal defects.
Insufficient or excessive hormonal levels.
Infections in the first trimester.
Cervical insufficiency.

Question 4

The community nurse is working with a patient at 32 weeks' gestation who has been diagnosed with preeclampsia. Which statement by the patient would indicate that additional information is needed?

A) "I should call the doctor if I develop a headache or blurred vision."
B) "Lying on my left side as much as possible is good for the baby."
C) "My urine could become darker and smaller in amount each day."
D) "Pain in the top of my abdomen is a sign my condition is worsening."

Question 5

A patient at 18 weeks' gestation has been diagnosed with a hydatidiform mole. In addition to vaginal bleeding, which signs or symptoms would the nurse expect to see?

A) Hyperemesis and hypertension
B) Diarrhea and hyperthermia
C) Uterine enlargement greater than expected
D) Polydipsia
E) Vaginal bleeding

Question 6

The nurse receives the following report on a patient who delivered 36 hours ago: para 1, rubella-immune, A-negative, antibody screen negative, newborn B-positive, Coombs' negative, discharge orders are written for both mother and newborn. What should be the priority action by the nurse?

A) Ask whether the mother is breast- or bottle-feeding.
B) Administer rubella vaccine.
C) Determine whether RhoGAM has been given.
D) Discuss the discharge education with the patient.

Question 7

The patient with blood type A, Rh-negative, delivered yesterday. Her infant is blood type AB, Rh-positive. Which statement indicates that teaching has been effective?

A) "I need to get RhoGAM so I don't have problems with my next pregnancy."
B) "Because my baby is Rh-positive, I don't need RhoGAM."
C) "If my baby had the same blood type I do, it might cause complications."
D) "Before my next pregnancy, I will need to have a RhoGAM shot."

Question 8

A patient who is 11 weeks pregnant presents to the emergency department with complaints of dizziness, lower abdominal pain, and right shoulder pain. Laboratory tests reveal a beta-hCG at a lower-than-expected level for this gestational age. An adnexal mass is palpable. Ultrasound confirms no intrauterine gestation. The patient is crying and asks what is happening. The nurse knows that the most likely diagnosis is an ectopic pregnancy. Which statement should the nurse include?

A) "You're feeling dizzy because the pregnancy is compressing your vena cava."
B) "The pain is due to the baby putting pressure on nerves internally."
C) "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding."
D) "This is a minor problem. The doctor will be right back to explain it to you."

Question 9

The nurse is caring for a patient who was just admitted to rule out ectopic pregnancy. Which orders are the most important for the nurse to perform?

A) Assess the patient's temperature.
B) Document the time of the patient's last meal.
C) Obtain urine for urinalysis and culture.
D) Report complaints of dizziness or weakness.
E) Have lab draw blood for B-hCG level every 48 hours.

Question 10

Which maternal-child patient should the nurse see first?

A) Blood type O, Rh-negative
B) Indirect Coombs' test negative
C) Direct Coombs' test positive
D) Blood type B, Rh-positive

Question 11

A woman is hospitalized with severe preeclampsia. The nurse is meal-planning with the patient and encourages a diet that is high in:

A) Sodium.
B) Carbohydrates.
C) Protein.
D) Fruits.

Question 12

The nurse identifies the following assessment findings on a client with preeclampsia: blood pressure 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 11 on dipstick; and edema of the hands, ankles, and feet. On the next hourly assessment, which new assessment finding would be an indication of worsening of the preeclampsia?

A) Blood pressure 158/104
B) Urinary output 20 mL/hour
C) Reflexes 21
D) Platelet count 150,000

Question 13

A patient has been admitted with a diagnosis of hyperemesis. Which orders written by the primary health care provider are the highest priority for the nurse to implement?

A) Obtain complete blood count.
B) Start intravenous with multivitamins.
C) Check admission weight.
D) Obtain urine for urinalysis.
E) Give a medication to stop the nausea and vomiting.

Question 14

A woman at 7 weeks' gestation is diagnosed with hyperemesis gravidarum. Which nursing diagnosis would receive priority?

A) Fluid Volume Deficit
B) Decreased Cardiac Output
C) Risk for Injury
D) Alteration in Nutrition: Less than body requirements

Question 15

A patient has preeclampsia. She is 36 weeks pregnant, and comes to the high-risk screening center for a contraction stress test. The nurse should explain to the patient that the contraction stress test is being done to determine:

A) What effect her hypertension has had on the fetus.
B) Whether the fetus will be able to tolerate labor.
C) Whether fetal movement increases with contractions.
D) What effect contractions will have on her blood pressure.

Question 16

A woman is 16 weeks pregnant. She has had cramping, backache, and mild bleeding for the past 3 days. Her physician determines that her cervix is dilated to 2 centimeters, with 10% effacement, but membranes are still intact. She is crying, and says to the nurse, "Is my baby going to be okay?" In addition to acknowledging the patient's fear, the nurse should also say:

A) "Your baby will be fine. We'll start IV, and get this stopped in no time at all."
B) "Your cervix is beginning to dilate. That is a serious sign. We will continue to monitor you and the baby for now."
C) "You are going to miscarry. But you should be relieved, because most miscarriages are the result of abnormalities in the fetus."
D) "I really can't say. However, when your physician comes, I'll ask her to talk to you about it."

Question 17

The nurse is supervising care in the emergency department. Which situation most requires an intervention?

A) Moderate vaginal bleeding at 36 weeks' gestation; client has an IV of lactated Ringer's solution running at 125 mL/hour
B) Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in 1 hour
C) Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20
D) Dark red bleeding at 30 weeks' gestation with normal vital signs; patient reports an absence of fetal movement

Question 18

A woman is being treated for preterm labor with magnesium sulfate. The nurse is concerned that the patient is experiencing early drug toxicity. What assessment finding by the nurse indicates early magnesium sulfate toxicity?

A) Patellar reflexes are weak or absent.
B) Complaints by the patient of feeling flushed and warm
C) Respiratory rate of 16
D) Fetal heart rate of 120

Question 19

A clinic nurse is planning when to administer Rh immune globulin (RhoGAM) to an Rh-negative pregnant patient. When should the first dose of RhoGAM be administered?

A) After the birth of the infant
B) 1 month postpartum
C) During labor
D) At 28 weeks' gestation

Question 20

A woman is experiencing preterm labor. The patient asks why she is on betamethasone (Celestone). The best response by the nurse would be "This medication:

A) "Will halt the labor process until the baby is more mature."
B) "Will relax the smooth muscles in the infant's lungs so the baby can breathe."
C) "Is effective in stimulating lung development in the preterm infant."
D) "Is an antibiotic that will treat your urinary tract infection, which caused preterm labor."

Question 21

A woman has a hydatidiform mole (molar pregnancy) evacuated, and is prepared for discharge. The nurse should make certain that the patient understands that it is essential that she:

A) Not become pregnant until after the follow-up program is completed.
B) Receive RhoGAM with her next pregnancy and birth.
C) Have her blood pressure checked weekly for the next 30 days.
D) Seek genetic counseling with her partner before the next pregnancy.

Question 22

The nurse is presenting a class to newly pregnant families. What form of trauma will the nurse describe as the leading cause of fetal and maternal death?

A) Falls
B) Domestic violence
C) Gun accidents
D) Motor vehicle accidents

Question 23

The patient presents to the clinic for an initial prenatal examination. She asks the nurse whether there might be a problem for her baby because she has type B Rh-positive blood and her husband has type O Rh-negative blood, or because her sister's baby had ABO incompatibility. What is the nurse's best answer?

A) "Your baby would be at risk for Rh problems if your husband were Rh-negative."
B) "Rh problems only occur when the mother is Rh-negative and the father is not."
C) "ABO incompatibility occurs only after the baby is born."
D) "We don't know for sure, but we can test for ABO incompatibility."
E) "Your husband's being type B puts you at risk for ABO incompatibility."

Question 24

During her first prenatal visit to the clinic at 7 weeks' gestation, a 24-year-old primiparous patient comments, "My blood type is A negative, and my husband's blood type is B positive. Will that cause problems with my pregnancy?" The nurse's best response would be:

A) "There is no danger to your baby, but there could be a few minor complications for you. Let's talk about what we can do to prevent those."
B) "We will do a blood test to see whether your body is responding to the baby's blood type. If so, we will give the baby some medication to prevent harm."
C) "Because your partner is positive and you are negative, there is some risk to the baby, but because this is your first pregnancy, the risks are very small."
D) "If you were O negative, you might have ABO incompatibility because of your partner's blood type; but since you are type A, there should be no problem."

Question 25

During a prenatal exam, a patient describes several psychosomatic symptoms and has several vague complaints. What could these behaviors indicate?

A) Abuse
B) Mental illness
C) Depression
D) Nothing, they are normal.

Question 26

A patient at 10 weeks' gestation has developed cholecystitis. If surgery is required, the safest time during pregnancy would be:

A) Immediately, before the fetus gets any bigger.
B) Early in the second trimester.
C) As close to term as possible.
D) The risks are too high to do it anytime in pregnancy.

Question 27

The patient at 34 weeks' gestation has been stabbed in the low abdomen by her boyfriend. She is brought to the emergency department for treatment. Which statements indicate that the patient understands the treatment being administered?

A) "The baby needs to be monitored to check the heart rate."
B) "My bowel has probably been lacerated by the knife."
C) "I might need an ultrasound to look at the baby."
D) "The catheter in my bladder will prevent urinary complications."
E) "The IV in my arm will replace the amniotic fluid if it is leaking."

Question 28

A patient is admitted to the labor suite. It is essential that the nurse assess the woman's status in relation to which infectious diseases?

A) Hepatitis B
B) Rubeola
C) Varicella
D) Group B streptococcus
E) HIV/AIDS

Question 29

The nurse knows that a mother who has been treated for Beta streptococcus passes this risk on to her newborn. Risk factors for neonatal sepsis caused by Beta streptococcus include:

A) Prematurity.
B) Maternal intrapartum fever.
C) Membranes ruptured for longer than 18 hours.
D) A previously infected infant with GBS disease.
E) An older mother having her first baby.

Question 30

A patient is concerned because she has been told her blood type and her baby's are incompatible. The best response by the nurse would be:

A) "This is called ABO incompatibility, and if the baby becomes jaundiced, she can be treated with a special light treatment."
B) "This is a serious condition, and additional blood studies are currently in process to determine whether you need a medication to prevent it from occurring with a future pregnancy."
C) "This is a condition caused by a blood incompatibility between you and your husband, but does not affect the baby."
D) "This type of condition is very common, and the baby can receive a medication to prevent jaundice from occurring."