Question 1

A patient on the high-risk OB unit is receiving magnesium sulfate.The nurse notes that her magnesium level is 14 mEq/L.Which of the following actions by the nurse is most appropriate?

Accepted Answer

This woman's magnesium level has nearly reached the level associated with respiratory arrest.The nurse should prepare to administer the antidote,10% calcium gluconate.The nurse should have someone else bring the crash cart into the room in case respiratory arrest does occur.Documentation is important,but this needs to be done after the woman is cared for.Additional magnesium levels will be drawn,but ordering them now instead of treating the patient is an inappropriate action.

Question 2

The nurse has admitted a patient to the high-risk OB unit with preterm premature rupture of the membranes.After obtaining maternal vital signs and the fetal heart rate,which action should the nurse do next?

Accepted Answer

Management of premature rupture of the membranes consists of prolonged maternal and fetal monitoring and modified bedrest.The nurse should attach the fetal monitor to the patient.In high-risk pregnancies,coping skills are often exhausted,and the nurse would do well to assess the state of coping in this patient,but this does not take priority.Providing diversionary activities would help enhance the bedrest experience,but,again,this does not take priority.There is no indication that the woman has chorioamnionitis,although it is a common cause of premature rupture of membranes.If diagnostic data indicate an infection,an antibiotic would be appropriate at that time.

Question 3

A nurse wants to conduct a community education session for women at high risk of preterm birth.Which teaching site would best meet this objective?

Accepted Answer

The March of Dimes reports that the ethnic group with the highest rate of preterm births is African American women,at 18.4%.Although teaching all women about preterm births is an important goal,to reach the group with the highest risk,the nurse should plan to teach at a predominantly African American church over the other sites.

Question 4

A woman who is in her third trimester and is at risk for preterm birth calls the clinic to get the results of her fetal fibronectin test (fFN).The nurse sees the result is negative.Which advice to the patient is most appropriate?

Accepted Answer

A negative fFN test indicates that the chance of a woman giving birth in the next week is approximately 1%,so she should continue her management plan already in place.There is no need for a screening ultrasound or hospitalization.Betamethasone is a corticosteroid shown to improve outcomes in premature birth.Because this woman is at low risk of delivery within the next week,betamethasone is not indicated.

Question 5

A woman pregnant with triplets is a patient in the high-risk OB unit.Which action by the nurse is most appropriate?

Accepted Answer

Fetal monitoring of multiples may be difficult,but triplet monitors are available and should be used,if possible,for triplets.This is preferable to obtaining serial,individual tracings.The fetuses are labeled in ascending order,with the presenting fetus labeled "A." It is not necessary to monitor the fetuses in presenting order so long as they are clearly labeled.

Question 6

A patient in the high-risk OB unit has suffered a seizure and is now postictal.She is on oxygen at 2L/minute.Which assessment by the nurse warrants immediate intervention?

Accepted Answer

After a seizure,all fetuses must be checked and accounted for.Fetal heart rate may show variability or bradycardia.A fetal heart rate of 98 is bradycardic,and the nurse should intervene immediately.Oxygen saturation of 94% is normal,a postictal patient will be drowsy and difficult to arouse,and a respiratory rate of 12 breaths/minute is normal.

Question 7

A student nurse asks the perinatal nurse why teenagers might be vulnerable to intimate partner violence.Which answer by the nurse is best?

Accepted Answer

Teenagers,especially the younger ones,are very dependent on others for the basics of their everyday lives,and this vulnerability often makes it difficult to leave an abusive situation in which they depend on their abusers.The other options are inaccurate,dismissive,and stereotypical.

Question 8

A woman who is 28 weeks pregnant is admitted to the high-risk OB unit with preterm premature rupture of the membranes.Four hours after admission,the nurse notes the following: temperature: 38.5°C (101.5°F),maternal pulse: 122 beats/minute,and white blood cell count: 23,000 mm³.Which action by the nurse takes priority?

Accepted Answer

Delivery for a woman with premature rupture of membranes should be accomplished immediately for signs of maternal infection,advanced labor,vaginal bleeding,or nonreassuring fetal signs.This patient's vital signs and WBC indicate infection.The nurse should document the findings and notify the health-care provider so that arrangements can proceed.Fern testing or Nitrazine testing is done to help diagnose rupture of the membranes and is not needed at this time.Giving acetaminophen at this time is not a priority and may be contraindicated if the woman needs to be placed on NPO status.

Question 9

A new nurse is caring for a woman previously diagnosed with preeclampsia who was admitted to the high-risk OB unit after suffering a seizure in the perinatal clinic.The new nurse is preparing to administer a dose of magnesium sulfate (Sulfamag).Which action by the nurse warrants intervention by the unit manager?

Accepted Answer

Magnesium sulfate should be infused on an infusion pump piggybacked into the main line,not as the primary IV line.The other actions are appropriate.

Question 10

A nurse is caring for a pregnant woman admitted to the high-risk OB unit.Which finding indicates to the nurse that outcomes for a priority nursing diagnosis have been met?

Accepted Answer

All options show that outcomes for important nursing diagnoses for a high-risk pregnancy have been met.However,physical needs take priority over psychosocial needs,so describing community resources and coping skills are not the most important.Prenatal care is important to help prevent adverse outcomes,but the patient is describing actions she intends to take for a subsequent,not current,pregnancy.For physical needs,airway,breathing,and circulation take priority.A stable blood pressure without orthostatic changes demonstrates hemodynamic stability and shows that outcomes for the diagnosis of risk for deficient fluid volume have been met.

Question 11

A perinatal nurse has developed a birth plan with a woman who is in her third trimester and has a physical disability.Which action by the nurse would be best for this patient?

Accepted Answer

Consulting with the clinical nurse specialist (or the unit manager)allows for special needs to be documented and prepared for.There is no indication that the woman needs a social worker to visit her at home after the birth,but home health-care options should be investigated and planned ahead of time,if needed or desired.Simply telling the unit manager about this woman's upcoming birth will not allow for her needs to be anticipated and planned for.Although a written copy of a birth plan is good to facilitate communication,this alone will not allow for pre-planning for any special needs.

Question 12

A woman at 32 weeks' gestation is admitted to the high-risk OB unit with a diagnosis of preterm labor.On assessment the nurse finds the following: blood pressure,182/96 mm Hg;pulse,106 beats/minute;respirations,16 breaths/minute;regular uterine contractions of 5 in 10 minutes;and fetal heart rate of 145 beats/minute.She is dilated to 8 cm.Which action by the nurse is best?

Accepted Answer

The administration of antenatal corticosteroids (betamethasone)is the most beneficial intervention for improvement of neonatal outcomes among women who give birth preterm.A single course of corticosteroids is recommended for pregnant women between 24 and 34 weeks of gestation who are at risk of preterm delivery within 7 days.Although the woman is mildly tachycardic,there is no need for an EKG without further information.There is no indication that delivery is imminent.Magnesium sulfate is a tocolytic drug used to stop labor,but it is contraindicated in women with advanced cervical dilation.

Question 13

A pregnant patient with a long-standing history of cardiovascular disease is admitted to the high-risk OB unit.The patient will have internal continuous electronic fetal monitoring until delivery.Which action by the nurse takes priority?

Accepted Answer

Internal electronic fetal monitoring is an invasive procedure that carries the risk of infection.Because the patient has a history of cardiac disease,the nurse should consult with the physician about antibiotics in case the woman is at risk for endocarditis.If the patient is stable and not in labor,hourly vital signs are not needed.Education is always an important responsibility,but patient safety and infection control are higher priorities.There is no indication that the woman needs magnesium sulfate.

Question 14

A pregnant patient is brought to the emergency department after a roll-over motor vehicle crash.After assessing and stabilizing the patient's airway,breathing,and circulation,which of the following actions should the nurse perform next?

Accepted Answer

Maternal trauma accounts for about 50% of fetal deaths.Seemingly minor injuries to the woman may cause serious injury or death to the fetus.Because the fetal heart rate is one of the first signs to change in fetal distress,all pregnant trauma patients need continuous fetal monitoring.Assessing the woman for further injuries and determining the date of the woman's last tetanus booster are both appropriate actions;however,they do not take priority over fetal monitoring.The woman may or may not need to be transferred to the delivery suite.

Question 15

A nurse is preparing to dismiss a woman and her infant from the hospital.The woman is Rh(D)-negative and the infant is Rh(D)-positive.This was her first pregnancy.Which nursing action is most appropriate?

Accepted Answer

Administering RhoGAM correctly and documenting it is a critical nursing action when indicated.An unsensitized Rh(D)-negative woman should be given RhoGAM within 72 hours of delivery of an Rh(D)-positive baby.RhoGAM is not administered to the father or to the baby.If an Rh(D)-negative woman gives birth to an Rh(D)-negative baby,she does not need RhoGAM.The woman should be tested for sensitivity during her next,and all subsequent,pregnancies.

Question 16

A nurse is caring for a woman receiving continuous electronic fetal monitoring.Which action by the nurse is most important?

Accepted Answer

Fetal monitoring strips (along with other documentation)can show that the standard of care was met if questions arise.An important nursing responsibility in caring for women with electronic fetal monitoring is to ensure strips are clear enough to be interpreted and strips are placed in the patient's chart according to facility policy.Education and diversionary activities are important actions,but do not take priority over this legal responsibility.Restricting visitors may or may not be appropriate.

Question 17

A woman is admitted to the high-risk OB unit with the diagnosis of preterm labor.Orders include bedrest with continuous fetal monitoring,administration of magnesium sulfate (Sulfamag)and betamethasone (Celestone),and laboratory work.In reviewing the patient's record,the nurse notes a history of hypertension that is well controlled with nifedipine (Procardia)and diet-controlled diabetes mellitus type 2.Which action by the nurse is best?

Accepted Answer

The combination of nifedipine and magnesium sulfate can cause sudden cardiac death.The nurse should contact the health-care provider to question the orders.The nurse should also document all aspects of this communication clearly.The woman may or may not need assistance in choosing food items appropriate for her diabetes.All patients need a full skin assessment and,depending on how long bedrest is anticipated,a pressure-relieving mattress overlay might be appropriate.The nurse should not give the medications without further clarification.

Question 18

A woman with a history of heart failure is in labor and has the following vital signs: blood pressure: 100/58 mm Hg,pulse: 120 beats/minute,respiratory rate: 36 breaths/minute,oxygen saturation: 88%.Which action should the nurse perform first?

Accepted Answer

The patient is exhibiting signs of decreased cardiac output and her low SaO₂ indicates that she needs oxygen,which should be supplied at 10 L/min per rebreather mask.Calling the provider and documentation are important actions but do not take priority over promptly treating the woman.She does not need increased IV fluids,and,in fact,increasing the IV fluid rate will likely worsen her condition.

Question 19

A woman who is 36 weeks pregnant presents to the perinatal clinic with complaints of backache,pelvic fullness,and uterine contractions.Which action by the nurse is most appropriate?

Accepted Answer

Infection is a predisposing factor for preterm labor,so the nurse would be wise to collect a urine sample,which may be obtained via clean-catch or catheterized specimen.Arranging admission to the hospital is premature.Also,there is no indication that the patient will need blood imminently,and tocolytic agents to stop preterm labor are not used after the 34th week of gestation.

Question 20

A postpartum woman being dismissed complains to the nurse that she has extreme fatigue,shoulder pain,and has noticed what looks like blood in her urine.Which laboratory finding would the nurse correlate with these symptoms?

Accepted Answer

This woman has symptoms of possible HELLP syndrome,which is characterized by poor liver function and thrombocytopenia.The platelet count is very low,consistent with this condition.The other laboratory values are within normal limits.

Quiz 11: Caring for the Woman Experiencing Complications During Pregnancy