Deck 38: The Obstetric Patient

Question 1

The treatment plan for management of an obstetric patient with peripartum cardiomyopathy (PPCM)includes which interventions?

A) Oxygen therapy, pain management, and preload enhancement
B) Walking exercises, diuretics, and anticoagulants
C) Diuretics, digoxin, and anticoagulation
D) Fluid resuscitation, beta-blockers, and vasoconstrictors

Answer 1

Diuretics, digoxin, and anticoagulation

Question 2

What is the second leading cause of maternal death in the United States?

A) Sepsis
B) Hemorrhage
C) Hypertensive disease
D) Disseminated intravascular coagulation

Answer 2

Hypertensive disease

Question 3

What is the most common obstetric cause of disseminated intravascular coagulopathy (DIC)?

A) Preeclampsia
B) Abruptio placentae
C) Dead fetus syndrome
D) Amniotic fluid embolism

Answer 3

Abruptio placentae

Question 4

The mnemonic "tone,tissue,trauma,and thrombosis" refers to potential causes of which disorder?

A) Hypoxia
B) Abruptio placentae
C) Postpartum hemorrhage (PPH)
D) Trauma

Question 5

A patient who is 32 weeks pregnant is admitted with a pneumothorax.What must the practitioner consider when placing a chest tube?

A) The diaphragm has been displaced 4 cm upward from its original location.
B) The diaphragm has been flattened and displaced 2 cm downward.
C) The lungs have shrunk to accommodate for the increase in abdominal size.
D) The lower lobes are one-half of their original size.

Question 6

A patient who is 30-weeks pregnant is admitted with severe asthma.The nurse understands that sufficient fetal oxygenation requires what minimum level of maternal oxygenation?

A) PaO₂ greater than 100 mm Hg
B) PaO₂ greater than 70 mm Hg
C) Oxygen saturation of 100%
D) Oxygen saturation greater than 70%

Question 7

When is the greatest risk for the patient who has had a cesarean section to develop a pulmonary embolism?

A) First time patient gets out of bed
B) Postoperative day 2
C) During the procedure
D) Immediate postpartum period

Question 8

Which statement regarding pregnancy and asthma is accurate?

A) Progesterone causes smooth muscle relaxation, which can worsen asthma symptoms.
B) Poorly controlled asthma has been associated with an increased incidence of spontaneous abortion.
C) A decrease in peak expiratory flow rate (PEFR) of more than 20% of the patient's personal best requires a visit to the emergency room.
D) It is estimated that approximately two thirds of patients will have worsening of asthma symptoms.

Question 9

A patient has been admitted with severe preeclampsia.The nurse knows that the patient's treatment plan would include which intervention?

A) Titrating intravenous fluids to maintain urine output greater than 50 mL/h
B) Administering hydralazine to keep the systolic blood pressure less than 120 mm Hg
C) Placing the patient on bed rest to decrease the chance of delivery
D) Administering magnesium sulfate to maintain serum levels of 4 to 7 mEq/L

Question 10

A patient has been admitted with preeclampsia.The nurse understands that this disorder is characterized by what widespread physiologic changes?

A) Increase in circulating plasma volume
B) Vasospasms in the arterial system
C) Disseminated intravascular coagulation
D) High systemic vascular resistance

Question 11

A patient is admitted who is pregnant and has a congenital cardiac disorder.The patient is experiencing complications that include dysrhythmias,heart failure,and thromboembolism.The nurse recognizes that these are symptoms of which condition?

A) Atrial septal defect
B) Ventricular septal defect
C) Patent ductus arteriosus
D) Mitral stenosis

Question 12

A multiparous woman was admitted at 36 weeks' gestation for nausea,vomiting,and severe epigastric pain.The fetal heart rate was normal.Severe preeclampsia was diagnosed.The patient is placed on a magnesium sulfate drip of 3 g/h.After an hour the patient has a seizure.The nurse notifies the practitioner.What order would the nurse anticipate?

A) Administer another 2- to 4-g bolus of magnesium sulfate.
B) Increase the magnesium drip at a rate of 1 to 2 g/h.
C) Prepare the patient for immediate delivery of the baby.
D) Prepare for intubation and mechanical ventilatory support.

Question 13

A patient is admitted who is pregnant and has Marfan syndrome.The nurse knows that this disorder places the patient at risk for what complication?

A) Stroke
B) Pulmonary embolism
C) Heart failure
D) Aortic dissection

Question 14

What intrinsic factor can influence fetal development?

A) Fungal infections
B) Chromosomal abnormalities
C) Radiation exposure
D) Medication exposure

Question 15

A patient has been admitted with severe preeclampsia.The nurse understands the patient is at risk for hemolysis,elevated liver enzymes,and low platelet count (HELLP)syndrome.What clinical manifestations would indicate the patient is developing this condition?

A) Nausea, vomiting, and epigastric pain
B) Jaundice, pruritus, and flank pain
C) Hypoactive bowel sounds, bleeding at puncture sites, and back pain
D) Fever, jugular vein distention, and chest pain

Question 16

According to research,what are the minimal viability parameters for an infant?

A)20 to 21 weeks' gestation and fetal weight between 500 and 1000 g.
B)22 to 23 weeks' gestation and fetal weight between 1000 and 15,000 g.
C)23 to 24 weeks' gestation and fetal weight between 500 and 1000 g.
D)24 to 25 weeks' gestation and fetal weight between 500 and 1200 g.

Question 17

A patient is brought to the unit after delivering a very large baby.The patient suddenly becomes extremely agitated and complains of shortness of breath.An amniotic fluid embolism is suspected.The nurse would immediately prepare for which intervention?

A) Insertion of a pulmonary artery catheter
B) Administration of an ampule of 50% dextrose
C) Administration of magnesium sulfate
D) Intubation and mechanical ventilation

Question 18

What is the most common cause of obstetric cardiac arrest in pregnancy?

A) Anesthetic complications
B) Idiopathic peripartum cardiomyopathy
C) Pregnancy-induced hypertension
D) Hemorrhage

Question 19

A multiparous woman was admitted at 36 weeks' gestation for nausea,vomiting,and severe epigastric pain.The fetal heart rate was normal.Severe preeclampsia was diagnosed.In addition to her clinical signs and symptoms,the patient's laboratory studies demonstrate hemolysis of red blood cells,elevated liver enzymes,and a low platelet count.What would be anticipated as an additional diagnosis?

A) Disseminated intravascular coagulopathy (DIC)
B) Dead fetus syndrome
C) Amniotic fluid embolism
D) HELLP syndrome

Question 20

A multiparous woman was admitted at 36 weeks' gestation for nausea,vomiting,and severe epigastric pain.The fetal heart rate was normal.Severe preeclampsia was diagnosed.What is the treatment goal for this patient?

A) Maintaining maternal blood pressure greater than 140/90 mm Hg
B) Delaying delivery of the fetus as long as possible
C) Preventing maternal seizures, which may compromise fetal oxygenation
D) Limiting fluid intake to avoid postpartum edema.

Question 21

What factors must be considered when making clinical decisions regarding critically ill obstetric patients?

A) Maternal-fetal mortality
B) Parental desires
C) Fetal weight
D) Parameters of maternal age
E) Parameters of gestational age

Question 22

The nurse is caring for a patient with preexisting spinal cord injury (SCI)who is 37 weeks pregnant.The SCI occurred at T₄.Which intervention would be added to the plan of care when the patient goes into labor?

A) Instruct the patient to let the nurse know when labor starts.
B) Administer steroids at the onset of labor.
C) Monitor the patient for signs of autonomic dysreflexia.
D) Prepare the patient for a cesarean section.

Question 23

What is the leading cause of maternal trauma?

A) Burns
B) Motor vehicle accident
C) Falls
D) Domestic violence

Question 24

What conditions or disorders place the obstetric patient at a 25% to 50% risk of maternal mortality?

A) Marfan syndrome with valvular involvement
B) Pulmonary hypertension
C) Coarctation of aorta with valvular involvement
D) Marfan syndrome with aortic involvement
E) Mitral stenosis with atrial fibrillation

Question 25

What is the leading cause of cardiac arrest in pregnancy?

A) Sepsis
B) Pregnancy-induced hypertension
C) Hemorrhage
D) Pulmonary embolism

Question 26

Which statement regarding the use of medications or other therapies for advanced cardiac life support (ACLS)in the pregnant patient is accurate?

A) No contraindications exist for use of atropine in pregnancy.
B) Epinephrine is contraindicated because it decreases uteroplacental perfusion.
C) Lidocaine is contraindicated because it crosses the placenta and has adverse fetal effects.
D) Electric therapies are contraindicated because of the potential for electrocution of the infant.

Question 27

Which obstetric conditions may precipitate disseminated intravascular coagulation (DIC)in an obstetric patient?

A) Abruptio placentae
B) Amniotic fluid embolism
C) Asthma
D) Intracranial hemorrhage
E) Bacterial pneumonia
F) Dead fetus syndrome

Question 28

Which physiologic changes are common in pregnant women?

A) Circulating blood volume decreases by 20% as it is diverted to the placenta.
B) Oxygen consumption increases to accommodate the fetus's needs.
C) Respiratory tidal volumes decrease because of the elevated diaphragm.
D) Gastric motility decreases because of displacement of gastrointestinal structures by the enlarged uterus.
E) The glomerular filtration rate increases as cardiac output rises.

Question 29

A patient has been admitted with severe preeclampsia.The nurse knows that the patient's treatment plan would include which goals?

A) Prevention of seizures
B) Decreasing arterial spasms
C) Prompt delivery of the fetus
D) Support of hypotension
E) Administration of broad-spectrum antibiotics

Question 30

What are some of the unique causes of septic shock in pregnant patients?

A) Postpartum pyelonephritis
B) Ectopic pregnancy
C) Chorioamnionitis
D) Septic abortion
E) Postpartum hemorrhage