Question 1

A woman who is 30 weeks of gestation arrives at the hospital with bleeding.Which differential diagnosis would not be applicable for this client?

Accepted Answer

Spontaneous abortion is another name for miscarriage; it occurs,by definition,early in pregnancy.Placenta previa is a well-known reason for bleeding late in pregnancy.The premature separation of the placenta (abruptio placentae)is a bleeding disorder that can occur late in pregnancy.Cord insertion may cause a bleeding disorder that can also occur late in pregnancy.

Question 2

The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms.While planning care for a client who desires outpatient management after a first-trimester loss,what would the nurse expect the plan to include?

Accepted Answer

Outpatient management of a first-trimester loss is safely accomplished by the intravaginal use of misoprostol for up to 2 days.If the bleeding is uncontrollable,vital signs are unstable,or signs of infection are present,then a surgical evacuation should be performed.D&C is a surgical procedure that requires dilation of the cervix and scraping of the uterine walls to remove the contents of pregnancy.This procedure is commonly performed to treat inevitable or incomplete abortion and should be performed in a hospital.D&E is usually performed after 16 weeks of pregnancy.The cervix is widely dilated,followed by removal of the contents of the uterus.Ergot products such as Methergine or Hemabate may be administered for excessive bleeding after miscarriage.

Question 3

The nurse is preparing to administer methotrexate to the client.This hazardous drug is most often used for which obstetric complication?

Accepted Answer

Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter.Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole,for a missed abortion,or for abruptio placentae.

Question 4

With regard to hemorrhagic complications that may occur during pregnancy,what information is most accurate?

Accepted Answer

Short labors and recurring losses of pregnancy at progressively earlier gestational ages are characteristics of reduced cervical competence.Because diagnostic technology is improving,more ectopic pregnancies are being diagnosed.One ectopic pregnancy places the woman at increased risk for another one.Ectopic pregnancy is a leading cause of infertility.Once invariably fatal,GTN now is the most curable gynecologic malignancy.

Question 5

What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus?

Accepted Answer

Missed abortion refers to the retention of a dead fetus in the uterus.An inevitable abortion means that the cervix is dilating with the contractions.An incomplete abortion means that not all of the products of conception were expelled.With a threatened abortion,the woman has cramping and bleeding but no cervical dilation.

Question 6

In contrast to placenta previa,what is the most prevalent clinical manifestation of abruptio placentae?

Accepted Answer

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

Question 7

The nurse who elects to practice in the area of women's health must have a thorough understanding of miscarriage.Which statement regarding this condition is most accurate?

Accepted Answer

Before the sixth week,the only evidence might be a heavy menstrual flow.After the 12th week,more severe pain,similar to that of labor,is likely.Miscarriage is a natural pregnancy loss,but it occurs,by definition,before 20 weeks of gestation,before the fetus is viable.Miscarriages occur in approximately 10% to 15% of all clinically recognized pregnancies.Miscarriages can be caused by a number of disorders or illnesses outside the mother's control or knowledge.

Question 8

Which laboratory marker is indicative of DIC?

Accepted Answer

Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature.Bleeding time in DIC is normal.Low platelets may occur but are not indicative of DIC because they may be the result from other coagulopathies.Hypofibrinogenemia occurs with DIC.

Question 9

A pregnant woman is being discharged from the hospital after the placement of a cervical cerclage because of a history of recurrent pregnancy loss,secondary to an incompetent cervix.Which information regarding postprocedural care should the nurse emphasize in the discharge teaching?

Accepted Answer

Nursing care should stress the importance of monitoring for the signs and symptoms of preterm labor.Vaginal bleeding needs to be reported to her primary health care provider.Bed rest is an element of care.However,the woman may stand for periods of up to 90 minutes,which allows her the freedom to see her physician.Home uterine activity monitoring may be used to limit the woman's need for visits and to monitor her status safely at home.The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth),or a cesarean birth can be planned.

Question 10

A perinatal nurse is giving discharge instructions to a woman,status postsuction,and 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 by the nurse?

Accepted Answer

Beta-human chorionic gonadotropin (beta-hCG)hormone levels are drawn for 1 year to ensure that the mole is completely gone.The chance of developing choriocarcinoma after the development of a hydatidiform mole is increased.Therefore,the goal is to achieve a zero human chorionic gonadotropin (hCG)level.If the woman were to become pregnant,then it may 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 (IUD)is acceptable.

Question 11

In caring for the woman with DIC,which order should the nurse anticipate?

Accepted Answer

Primary medical management in all cases of DIC involves a correction of the underlying cause,volume replacement,blood component therapy,optimization of oxygenation and perfusion status,and continued reassessment of laboratory parameters.Central monitoring would not be initially ordered in a client with DIC because it could contribute to more areas of bleeding.Management of DIC would include volume replacement,not volume restriction.Steroids are not indicated for the management of DIC.

Question 12

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,which diagnostic procedure will the client most likely have performed?

Accepted Answer

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

Question 13

A woman arrives for evaluation of signs and symptoms that 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.What does this finding indicate?

Accepted Answer

Cullen sign,the blue ecchymosis observed in the umbilical area,indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy.Linea nigra on the abdomen is the normal integumentary change associated with pregnancy and exhibits a brown pigmented,vertical line on the lower abdomen.Turner sign is ecchymosis in the flank area,often associated with pancreatitis.A Chadwick sign is a blue-purple cervix that may be seen during or around the eighth week of pregnancy.

Question 14

A woman arrives at the emergency department with complaints 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 has spotting,mild cramps,and no cervical dilation.A woman with an incomplete abortion would have heavy bleeding,mild-to-severe cramping,and cervical dilation.An inevitable abortion demonstrates the same symptoms as an incomplete abortion: heavy bleeding,mild-to-severe cramping,and cervical dilation.A woman with a septic abortion has malodorous bleeding and typically a dilated cervix.

Question 15

What condition indicates concealed hemorrhage when the client experiences abruptio placentae?

Accepted Answer

Concealed hemorrhage occurs when the edges of the placenta do not separate.The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm,boardlike abdomen.Abdominal pain may increase.The client will have shock symptoms that include tachycardia.As bleeding occurs,the fundal height increases.

Question 16

Which maternal condition always necessitates delivery by cesarean birth?

Accepted Answer

In complete placenta previa,the placenta completely covers the cervical os.A cesarean birth is the acceptable method of delivery.The risk of fetal death occurring is due to preterm birth.If the previa is marginal (i.e.,2 cm or greater away from the cervical os),then labor can be attempted.A cesarean birth is not indicated for an ectopic pregnancy.Labor can be safely induced if the eclampsia is under control.

Question 17

In caring for an immediate postpartum client,the nurse notes petechiae and oozing from her intravenous (IV)site.The client would be closely monitored for which clotting disorder?

Accepted Answer

The diagnosis of DIC is made according to clinical findings and laboratory markers.A physical examination reveals unusual bleeding.Petechiae may appear around a blood pressure cuff on the woman's arm.Excessive bleeding may occur from the site of slight trauma such as venipuncture sites.These symptoms are not associated with AFE,nor is AFE a bleeding disorder.Hemorrhage occurs for a variety of reasons in the postpartum client.These symptoms are associated with DIC.Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself.HELLP syndrome is not a clotting disorder,but it may contribute to the clotting disorder DIC.

Question 18

When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)?

Accepted Answer

A prophylactic cerclage is usually placed at 12 to 14 weeks of gestation.The cerclage is electively removed when the woman reaches 37 weeks of gestation or when her labor begins.Six to 8 weeks of gestation is too early to place the cerclage.Cerclage placement is offered if the cervical length falls to less than 20 to 25 mm before 23 to 24 weeks.Although no consensus has been reached,24 weeks is used as the upper gestational age limit for cerclage placement.

Question 19

What is the correct definition of a spontaneous termination of a pregnancy (abortion)?

Accepted Answer

An abortion is the termination of pregnancy before the age of viability (20 weeks).The weight of the fetus is not considered because some older fetuses may have a low birth weight.A spontaneous abortion may be complete or incomplete and may be caused by many problems,one being intrauterine infection.

Question 20

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

Accepted Answer

Vasa previa is the result of a velamentous insertion of the umbilical cord.The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue.The umbilical blood vessels thus are at risk for laceration at any time,but laceration occurs most frequently during ROM.The sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR without other known risk factors should immediately alert the nurse to the possibility of vasa previa.The presence of placenta previa most likely would be ascertained before labor and is considered a risk factor for this pregnancy.In addition,if the woman had a placenta previa,it is unlikely that she would be allowed to pursue labor and a vaginal birth.With the presence of severe abruptio placentae,the uterine tonicity typically is tetanus (i.e.,a boardlike uterus).DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors,causing widespread external bleeding,internal bleeding,or both.DIC is always a secondary diagnosis,often associated with obstetric risk factors such as the hemolysis,elevated liver enzyme levels,and low platelet levels (HELLP)syndrome.This woman did not have any prior risk factors.

Quiz 28: Hemorrhagic Disorders