Deck 30: Medical-Surgical Disorders

Question 1

A woman has experienced iron deficiency anemia during her pregnancy.She had been taking iron for 3 months before the birth.The client gave birth by cesarean 2 days earlier and has been having problems with constipation.After assisting her back to bed from the bathroom,the nurse notes that the woman's stools are dark (greenish-black).What should the nurse's initial action be?

A) Perform a guaiac test, and record the results.
B) Recognize the finding as abnormal, and report it to the primary health care provider.
C) Recognize the finding as a normal result of iron therapy.
D) Check the woman's next stool to validate the observation.

Answer 1

Recognize the finding as a normal result of iron therapy.

Question 2

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 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 EFM for a minimum of 4 hours

Answer 2

Using continuous EFM for a minimum of 4 hours

Question 3

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.

Answer 3

Women with Bell palsy have an increased risk for hypertension.

Question 4

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 5

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) Dyspnea, crackles, and an irregular, weak pulse

Question 6

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) Trauma and motor vehicle accidents (MVAs)
C) Hemorrhage and infection
D) Underlying chronic conditions

Question 7

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 8

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

Question 9

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 10

Which condition would require prophylaxis to prevent subacute bacterial endocarditis (SBE)both antepartum and intrapartum?

A) Valvular heart disease
B) Congestive heart disease
C) Arrhythmias
D) Postmyocardial infarction

Question 11

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 12

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 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) Hemabate
D) Fentanyl

Question 14

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 15

A lupus flare-up during pregnancy or early postpartum occurs in 15% to 60% of women with this disorder.Which conditions associated with systemic lupus erythematosus (SLE)are maternal risks?

A) Miscarriage
B) Intrauterine growth restriction (IUGR)
C) Nephritis
D) Preeclampsia
E) Cesarean birth

Question 16

A woman at 28 weeks of gestation experiences blunt abdominal trauma as the result of a fall.The nurse must closely observe the client for what?

A) Alteration in maternal vital signs, especially blood pressure
B) Complaints of abdominal pain
C) Placental absorption
D) Hemorrhage

Question 17

Which neurologic condition would require preconception counseling,if at all possible?

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

Question 18

Which congenital anomalies can occur as a result of the use of antiepileptic drugs (AEDs)in pregnancy?

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

Question 19

Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?

A) Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
B) Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
C) Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
D) Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.

Question 20

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

Question 21

In caring for a pregnant woman with sickle cell anemia,the nurse must be aware of the signs and symptoms of a sickle cell crisis.What do these include?

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

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. As a result 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

Question 23

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. As a result 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 24

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. As a result 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 25

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. As a result 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 26

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. As a result 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 27

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?

A) Multiple sclerosis
B) SLE
C) Antiphospholipid syndrome
D) Rheumatoid arthritis
E) Myasthenia gravis