Deck 14: Pregnancy at Risk: Gestational Conditions

Question 1

Your client is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse,"Why is it taking so long?" The most appropriate response by the nurse would be:

A)"The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."
B)"I don't know why it is taking so long."
C)"The length of labor varies for different women."
D)"Your baby is just being stubborn."

Answer 1

"The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."

Question 2

Magnesium sulfate is given to women with preeclampsia and eclampsia to:

A)Improve patellar reflexes and increase respiratory efficiency.
B)Shorten the duration of labor.
C)Prevent and treat convulsions.
D)Prevent a boggy uterus and lessen lochial flow.

Answer 2

Prevent and treat convulsions.

Question 3

Nurses should be aware that chronic hypertension:

A)Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy.
B)Is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg.
C)Is general hypertension plus proteinuria.
D)Can occur independently of or simultaneously with gestational hypertension.

Answer 3

Can occur independently of or simultaneously with gestational hypertension.

Question 4

In caring for an immediate postpartum client,you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder:

A)Disseminated intravascular coagulation (DIC)
B)Amniotic fluid embolism (AFE)
C)Hemorrhage
D)HELLP syndrome

Question 5

Nurses should be aware that HELLP syndrome:

A)Is a mild form of preeclampsia.
B)Can be diagnosed by a nurse alert to its symptoms.
C)Is characterized by hemolysis,elevated liver enzymes,and low platelets.
D)Is associated with preterm labor but not perinatal mortality.

Question 6

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?

A)Blood pressure (BP) increase to 138/86 mm Hg
B)Weight gain of 0.5 kg during the past 2 weeks
C)A dipstick value of 3+ for protein in her urine
D)Pitting pedal edema at the end of the day

Question 7

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:

A)A sleepy,sedated affect.
B)A respiratory rate of 10 breaths/min.
C)Deep tendon reflexes of 2.
D)Absent ankle clonus.

Question 8

Women with hyperemesis gravidarum:

A)Are a majority,because 70% of all pregnant women suffer from it at some time.
B)Have vomiting severe and persistent enough to cause weight loss,dehydration,and electrolyte imbalance.
C)Need intravenous (IV) fluid and nutrition for most of their pregnancy.
D)Often inspire similar,milder symptoms in their male partners and mothers.

Question 9

What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia?

A)Risk for injury to the fetus related to uteroplacental insufficiency
B)Risk for eclampsia
C)Risk for deficient fluid volume related to increased sodium retention secondary to administration of MgSO4
D)Risk for increased cardiac output related to use of antihypertensive drugs

Question 10

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to:

A)Insert an oral airway.
B)Suction the mouth to prevent aspiration.
C)Administer oxygen by mask.
D)Stay with the client and call for help.

Question 11

In planning care for women with preeclampsia,nurses should be aware that:

A)Induction of labor is likely,as near term as possible.
B)If at home,the woman should be confined to her bed,even with mild preeclampsia.
C)A special diet low in protein and salt should be initiated.
D)Vaginal birth is still an option,even in severe cases.

Question 12

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C,pulse rate of 96 beats/min,respiratory rate of 24 breaths/min,blood pressure (BP) of 155/112 mm Hg,3+ deep tendon reflexes,and no ankle clonus. The nurse calls the physician,anticipating an order for:

A)Hydralazine.
B)Magnesium sulfate bolus.
C)Diazepam.
D)Calcium gluconate.

Question 13

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes;dark red vaginal bleeding;and a tense,painful abdomen. The nurse suspects the onset of:

A)Eclamptic seizure.
B)Rupture of the uterus.
C)Placenta previa.
D)Placental abruption.

Question 14

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)?

A)Bleeding time of 10 minutes
B)Presence of fibrin split products
C)Thrombocytopenia
D)Hyperfibrinogenemia

Question 15

In caring for the woman with disseminated intravascular coagulation (DIC),what order should the nurse anticipate?

A)Administration of blood
B)Preparation of the client for invasive hemodynamic monitoring
C)Restriction of intravascular fluids
D)Administration of steroids

Question 16

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C,pulse rate of 88 beats/min,respiratory rate of 10 breaths/min,blood pressure (BP) of 148/90 mm Hg,absent deep tendon reflexes,and no ankle clonus. The client complains,"I'm so thirsty and warm." The nurse:

A)Calls for a stat magnesium sulfate level.
B)Administers oxygen.
C)Discontinues the magnesium sulfate infusion.
D)Prepares to administer hydralazine.

Question 17

Your client has been on magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client?

A)Absence of uterine bleeding in the postpartum period
B)A fundus firm below the level of the umbilicus
C)Scant lochia flow
D)A boggy uterus with heavy lochia flow

Question 18

The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:

A)Hypertension.
B)Hyperemesis gravidarum.
C)Hemorrhagic complications.
D)Infections.

Question 19

Because pregnant women may need surgery during pregnancy,nurses should be aware that:

A)The diagnosis of appendicitis may be difficult,because the normal signs and symptoms mimic some normal changes in pregnancy.
B)Rupture of the appendix is less likely in pregnant women because of the close monitoring.
C)Surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy.
D)When pregnancy takes over,a woman is less likely to have ovarian problems that require invasive responses.

Question 20

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion,the nurse reviews the woman's latest laboratory test findings,which reveal a platelet count of 90,000,an elevated aspartate transaminase (AST) level,and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of:

A)Eclampsia.
B)Disseminated intravascular coagulation (DIC).
C)HELLP syndrome.
D)Idiopathic thrombocytopenia.

Question 21

With regard to miscarriage,nurses should be aware that:

A)It is a natural pregnancy loss before labor begins.
B)It occurs in fewer than 5% of all clinically recognized pregnancies.
C)It often can be attributed to careless maternal behavior such as poor nutrition or excessive exercise.
D)If it occurs before the twelfth week of pregnancy,it may present only as moderate discomfort and blood loss.

Question 22

Bleeding disorders in late pregnancy include all of these except:

A)Placenta previa.
B)Abruptio placentae.
C)Spontaneous abortion.
D)Cord insertion.

Question 23

A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of:

A)Placenta previa.
B)Vasa previa.
C)Severe abruptio placentae.
D)Disseminated intravascular coagulation (DIC).

Question 24

The antidote administered to reverse magnesium toxicity is _____________________.

Question 25

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:

A)Bleeding.
B)Intense abdominal pain.
C)Uterine activity.
D)Cramping.

Question 26

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?

A)Incomplete
B)Inevitable
C)Threatened
D)Septic

Question 27

A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable,bleeding has been controlled,and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery,discharge teaching should include (choose all that apply):

A)Iron supplementation.
B)Resumption of intercourse at 6 weeks following the procedure.
C)Referral to a support group if necessary.
D)Expectation of heavy bleeding for at least 2 weeks.
E)Emphasizing the need for rest.

Question 28

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?

A)Amniocentesis for fetal lung maturity
B)Ultrasound for placental location
C)Contraction stress test (CST)
D)Internal fetal monitoring

Question 29

The condition in which the placenta is implanted in the lower uterine segment near or over the internal cervical os is _________________________.

Question 30

Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors?

A)A 30-year-old obese Caucasian with her third pregnancy
B)A 41-year-old Caucasian primigravida
C)An African-American client who is 19 years old and pregnant with twins
D)A 25-year-old Asian-American,whose pregnancy is the result of donor insemination

Question 31

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

A)Complete hydatidiform mole
B)Missed abortion
C)Unruptured ectopic pregnancy
D)Abruptio placentae

Question 32

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. The best response from the nurse would be:

A)"If you get pregnant within 1 year,the chance of a successful pregnancy is very small. Therefore,if you desire a future pregnancy,it would be better for you to use the most reliable method of contraception available."
B)"The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant,it would make the diagnosis of this cancer more difficult."
C)"If you can avoid a pregnancy for the next year,the chance of developing a second molar pregnancy is rare. Therefore,to improve your chance of a successful pregnancy,it is better not to get pregnant at this time."
D)"Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

Question 33

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 and recognizes this assessment finding as:

A)Normal integumentary changes associated with pregnancy.
B)Turner's sign associated with appendicitis.
C)Cullen's sign associated with a ruptured ectopic pregnancy.
D)Chadwick's sign associated with early pregnancy.

Question 34

_________________________ is responsible for 9% of all maternal mortality and is the leading cause of infertility.