Question 1

A woman arrives for evaluation of her symptoms,which 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.How should the nurse interpret this assessment finding?

Accepted Answer

Cullen's sign,the blue ecchymosis seen in the umbilical area,indicates hematoperitoneum associated with an undiagnosed ruptured intra-abdominal ectopic pregnancy.Linea nigra on the abdomen is the normal integumentary change associated with pregnancy.It presents as a brown,pigmented,vertical line on the lower abdomen.Turner's sign is ecchymosis in the flank area,often associated with pancreatitis.Chadwick's sign is the blue-purple colour of the cervix that may be seen during or around the eighth week of pregnancy.

Question 2

Which of the following is NOT a bleeding disorder in late pregnancy?

Accepted Answer

Spontaneous abortion is another name for miscarriage; by definition it occurs early in pregnancy and is not considered a bleeding disorder.Placenta previa is a cause of bleeding disorders in later pregnancy.Abruptio placentae is a cause of bleeding disorders in later pregnancy.Cord insertion is a cause of bleeding disorders in later pregnancy.

Question 3

Methotrexate is recommended as part of the treatment plan for which obstetrical complication?

Accepted Answer

Methotrexate is an effective,nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured.Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole,missed abortion,or abruptio placentae.

Question 4

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 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?

Accepted Answer

A woman with a threatened abortion presents with spotting,mild cramps,and no cervical dilation.A woman with an incomplete abortion would present with heavy bleeding,mild-to-severe cramping,and cervical dilation.An inevitable abortion presents with the same symptoms as an incomplete abortion: heavy bleeding,mild-to-severe cramping,and cervical dilation.A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.

Question 5

The perinatal nurse is giving discharge instructions to a woman,status postsuction curettage secondary to a hydatidiform mole.The woman asks why she must take oral contraceptives for the next 12 months.What is the best response from the nurse?

Accepted Answer

This is an accurate statement.b-Human chorionic gonadotropin (hCG)levels will be drawn for 1 year to ensure that the mole is completely gone.There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole.The goal is to achieve a "zero" hCG level.If the woman were to become pregnant,it might 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 is acceptable.

Question 6

What should nurses be aware of regarding miscarriage?

Accepted Answer

Before the sixth week the only evidence might be a heavy menstrual flow.After the twelfth week more severe pain,similar to that of labour,is likely.Miscarriage is a natural pregnancy loss,but by definition it occurs before 20 weeks of gestation,before the fetus is viable.Miscarriages occur in approximately 15% of all clinically recognized pregnancies.Miscarriage can be caused by a number of disorders or illnesses outside of the mother's control or knowledge.

Question 7

Which patient exhibits the greatest number of the risk factors associated with pre-eclampsia?

Accepted Answer

Three risk factors are present for this woman.She is obese,is at the young end of the age distribution,and has a multiple pregnancy.In planning care for this patient,the nurse must monitor blood pressure frequently and teach the woman about early warning signs.The 30-year-old patient only has one known risk factor: obesity.Age distribution appears to be U-shaped,with women less than 20 years and more than 40 years of age being at greatest risk.Pre-eclampsia continues to be seen more frequently in primigravidas; this patient is a multigravida woman.Two risk factors are present for the 41-year-old patient.Her age and status as a primigravida put her at increased risk for pre-eclampsia.The Métis patient exhibits only one risk factor.Pregnancies that result from donor insemination,oocyte donation,and embryo donation are at an increased risk of developing pre-eclampsia.

Question 8

What is occurring when some of the umbilical vessels cross the cervical os below the presenting part?

Accepted Answer

Vasa previa is occurring when some of the umbilical vessels cross the cervical os below the presenting part.The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue.The presence of placenta previa most likely would be ascertained before labour and would be considered a risk factor for this pregnancy.With the presence of severe abruptio placentae,the uterine tonicity would typically be tetanus (i.e.,a boardlike uterus).DIC is a pathological form of diffuse clotting that consumes large amounts of clotting factors,causing widespread external bleeding,internal bleeding,or both.

Question 9

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,what would be an expected diagnostic procedure?

Accepted Answer

The presence of painless bleeding should always alert the health care team to the possibility of placenta previa.This can be confirmed through ultrasonography.Amniocentesis would not be performed on a woman who is experiencing bleeding.In the event of an imminent delivery,the fetus would be presumed to have immature lungs at this gestational age,and the mother would be given corticosteroids to aid in fetal lung maturity.A CST would not be performed at a preterm gestational age.Furthermore,bleeding would be a contraindication to this test.Internal fetal monitoring would be contraindicated in the presence of bleeding.

Question 10

What is the most prevalent clinical manifestation of abruptio placentae,as opposed to placenta previa?

Accepted Answer

Pain is absent with placenta previa and may be agonizing with abruptio placentae,especially grade 3.Bleeding may be present in varying degrees for both placental conditions.Uterine activity and cramping may be present with both placental conditions.

Question 11

A patient who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day.Her vital signs are stable,bleeding has been controlled,and she has a low-normal hemoglobin level.To promote an optimal recovery,which of the following should be part of discharge teaching for this woman?

Accepted Answer

The woman should be advised to consume a diet high in iron and protein.For many women iron supplementation also is necessary.Discharge teaching should emphasize the need for rest rather than an immediate return to normal activity level.Nothing should be placed in the vagina for 2 weeks after the procedure.This includes tampons and vaginal intercourse.The purpose of this recommendation is to prevent infection.Should infection occur,antibiotics may be prescribed.The patient 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.

Quiz 13: Pregnancy at Risk: Gestational Conditions