Deck 13: Pregnancy at Risk: Gestational Conditions

Question 1

A woman at 39 weeks of gestation with a history of pre-eclampsia is admitted to the labour 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 which of the following?

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

Answer 1

Placental abruption

Question 2

Your patient is being induced because of her worsening pre-eclampsia.She is also receiving magnesium sulphate.It appears that her labour has not become active,despite several hours of oxytocin administration.She asks the nurse,"Why is it taking so long?" What is the most appropriate response by the nurse?

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

Answer 2

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

Question 3

Which statement is true of pre-existing hypertension?

A) It is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy.
B) It 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) It is general hypertension plus proteinuria.
D) It can be accompanied by preeclampsia during pregnancy.

Answer 3

It can be accompanied by preeclampsia during pregnancy.

Question 4

A woman with pre-eclampsia has a seizure.What is the nurse's priority intervention?

A) Ensure a patent airway.
B) Suction the mouth to prevent aspiration.
C) Administer oxygen by mask.
D) Stay with the patient to provide emotional support.

Question 5

A woman with severe pre-eclampsia has been receiving magnesium sulfphate 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 should anticipate a doctor's order for which of the following?

A) Hydralazine
B) Magnesium sulphate bolus
C) Diazepam
D) Calcium gluconate

Question 6

A primigravida is being monitored in her prenatal clinic for pre-eclampsia.Which 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) Urine protein reading of 0.05 g/L on two occasions
D) Pitting pedal edema at the end of the day

Question 7

Which statement is true about women who experience hyperemesis gravidarum?

A) Seventy percent of all pregnant women suffer from it at some point in pregnancy.
B) Such women have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.
C) They need intravenous (IV) fluid and nutrition for most of their pregnancy.
D) They often inspire similar, milder symptoms in their male partners and mothers.

Question 8

A woman with severe pre-eclampsia is receiving a magnesium sulphate infusion.Which finding should the nurse be concerned about?

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

Question 9

In caring for an immediate postpartum patient,you note petechiae and oozing from her IV site.Based on this assessment,what clotting disorder would the nurse monitor her closely for?

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

Question 10

What should the nurse be aware of in relation to women who may need surgery during pregnancy?

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 11

Which of the following is true in relation to HELLP syndrome?

A) It is a mild form of pre-eclampsia.
B) It can be diagnosed by a nurse alert to its symptoms.
C) It is characterized by hemolysis, elevated liver enzymes, and low platelets.
D) It is associated with preterm labour but not perinatal mortality.

Question 12

What nursing diagnosis would be most appropriate for a woman experiencing severe pre-eclampsia?

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 13

The labour of a pregnant woman with pre-eclampsia is going to be induced.Before initiating the oxytocin 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.These findings are indicative of which of the following?

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

Question 14

In planning care for women with pre-eclampsia,what should the nurse be aware of?

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

Question 15

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

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

Question 16

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

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

Question 17

Which 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 18

Your patient has been on magnesium sulphate for 20 hours for treatment of pre-eclampsia.She just delivered a viable infant girl 30 minutes ago.What uterine findings would you expect to assess in this patient?

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 19

What is the purpose of administering magnesium sulphate to women with pre-eclampsia and eclampsia?

A) It improves patellar reflexes and increases respiratory efficiency.
B) It shortens the duration of labour.
C) It prevents and treats convulsions.
D) It prevents a boggy uterus and lessens lochial flow.

Question 20

A pregnant woman has been receiving a magnesium sulphate infusion for treatment of severe pre-eclampsia 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 patient complains,"I'm so thirsty and warm." What is the nurse's initial intervention?

A) Call for a stat magnesium sulphate level.
B) Administer oxygen.
C) Discontinue the magnesium sulphate infusion.
D) Prepare to administer hydralazine.

Question 21

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?

A) This is a normal integumentary change associated with pregnancy.
B) This is Turner's sign, associated with appendicitis.
C) This is Cullen's sign, associated with a ruptured ectopic pregnancy.
D) This is Chadwick's sign, associated with early pregnancy.

Question 22

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

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

Question 23

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

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

Question 24

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 25

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?

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 26

What should nurses be aware of regarding miscarriage?

A) It is a natural pregnancy loss before labour begins.
B) It occurs in fewer than 5% of all clinically recognized pregnancies.
C) It often can be attributed to careless maternal behaviour, 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 27

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

A) A 30-year-old obese White woman with her third pregnancy
B) A 41-year-old White primigravida
C) An Inuit patient who is 19 years old, weighs 92 kg, and is pregnant with twins
D) A 25-year-old Métis woman whose pregnancy is the result of donor insemination

Question 28

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

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

Question 29

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 30

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

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

Question 31

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?

A) Iron supplementation
B) Resumption of intercourse at 6 weeks following the procedure
C) Can resume normal activity level with no restrictions
D) Expectation of heavy bleeding for at least 2 weeks