Question 1

Which of the following does the nurse recognize as complications of premature birth? (Select all that apply.)

Accepted Answer

Some short-term neonatal morbidities associated with preterm birth include respiratory distress syndrome,intraventricular hemorrhage,periventricular leukomalacia,necrotizing enterocolitis,bronchopulmonary dysplasia,sepsis,and patent ductus arteriosus.Long-term morbidities include cerebral palsy,mental retardation,and retinopathy of prematurity.Osteoporosis and
diabetes are not known complications of premature birth.

Question 2

A nurse is caring for a woman on a continuous IV of magnesium sulfate.Which actions are appropriate for patient safety? (Select all that apply.)

Accepted Answer

Magnesium sulfate is a high-risk,high-alert drug and the nurse must be cautious about administering this drug safely.Some appropriate actions include double-checking any rate or dose changes with a second nurse,performing the handoff report at the bedside so that both nurses can verify the orders and compare them to the IV bag and pump rate,and color-coding IV lines,bags,and pumps for easy identification.The nurse should ensure that a supply of the antidote (calcium gluconate 10%)is available.However,romazicon is the antidote for benzodiazepine overdose.The nurse should use a small-volume IV piggyback for the bolus dose instead of using the main bag to give the bolus to the patient,and then change the infusion rate to the maintenance setting.

Question 3

Match between columns
                        Premises: May be associated with previous cesarean birth
One risk factor is closely spaced pregnancies
Can resolve as the uterus enlarges in the third trimester
Classic sign is vaginal bleeding and severe abdominal pain in the third trimester
Premature separation of the normally implanted placenta from the lining of the uterus
Maternal abdominal trauma is one risk factor
Condition in which the umbilical cord is implanted in the membranes rather than in the placenta
Can be described as complete, partial, or marginal

Accepted Answer

The Answer of Placenta previa and Abruptio placentae and Vasa is...

Question 4

A nurse is caring for a pregnant woman on the high-risk OB unit who is anticipating a long stay on bedrest.Which action by the nurse would be most helpful to help diminish the physical complications associated with imposed bedrest?

Accepted Answer

All activities are appropriate for a woman who is confined to bed prior to childbirth.However,to mitigate the possible physical complications from bedrest,encouraging activity and exercise to her limits is desirable.A physical therapist can design an exercise routine the patient can do in bed.A coping assessment would help with psychosocial complications.Assessing and documenting skin condition does not diminish complications.Nutrition is important and selecting appropriate foods is helpful,but the major complications from bedrest occur in the cardiovascular system.

Question 5

The perinatal nurse is educating a group of women on common causes of miscarriage,or spontaneous abortion.Which of the following does the nurse describe? (Select all that apply.)

Accepted Answer

Early spontaneous abortions have been linked to chromosomal abnormalities,infections,maternal anatomical defects,and immunological and endocrine factors.In some cases,no cause is found.Second-trimester spontaneous abortions can be caused by chronic infection,recreational drug use,maternal uterine or cervical anatomical defects,maternal systemic disease,exposure to fetotoxic agents,and trauma.In general,working during pregnancy is not a risk factor,although the nurse should assess the woman's work setting for environmental/work-related risks,such as fetotoxic agents or ionizing radiation.

Question 6

A pregnant woman who has diabetes mellitus is in the high-risk OB clinic for a checkup.The nurse notes that her hemoglobin A?C (HbAIC)is 5%.Which action by the nurse is most appropriate?

Accepted Answer

Control of maternal glucose levels (< 7.0% in overtly diabetic women)is an important factor in determining fetal outcome.The glycosylated hemoglobin A?c (HbA?c)level is commonly assessed to guide adjustments in the treatment plan throughout pregnancy.Because the maternal serum HbA?c reflects the degree of glycemic control during the preceding 5 to 6 weeks,the test is repeated every trimester.Good diabetic control is reflected by an HbA?c value of 2.5% to 5.9%;an HbA?c value greater than 8% is indicative of poor diabetic control.Because the patient's value indicates good control,the most appropriate action is documentation.The patient may need to see the diabetic nurse educator,depending on other nursing assessments or patient desire.

Question 7

A pregnant patient is admitted with possible deep venous thrombosis (DVT).Orders are left to start warfarin (Coumadin)5 mg p.o.,once daily.Which of the following actions by the nurse is most appropriate?

Accepted Answer

Coumadin is contraindicated in pregnant women because it crosses the placenta.If anticoagulation is needed,heparin is the drug of choice.The nurse should consult with the physician about the orders and carefully document the conversation and results.Teaching is an appropriate nursing activity but is not the priority.The patient on heparin should be counseled to call for assistance before getting up because of the risk for injury,but the priority is obtaining the correct drug.The nurse should not start the Coumadin.

Question 8

A pregnant woman in her second trimester arrives at the labor unit triage station with complaints of lower abdominal cramping and urinary frequency.Appropriate nursing actions include which of the following? (Select all that apply.)

Accepted Answer

Women who experience preterm labor may complain of backache,pelvic aching,menstrual-type cramps,increased vaginal discharge,pelvic pressure,urinary frequency,and intestinal cramping with or without diarrhea.A urinalysis and urine culture and sensitivity should be obtained on all patients with symptoms of preterm labor,and the nurse must remember that symptoms of urinary tract infection often mimic normal pregnancy complaints (e.g.,urgency,frequency).The patient's abdomen should be palpated to assess for contractions,and the fetal heart rate should be monitored.It is not necessary to insert a Foley catheter at this time.

Question 9

A nurse in the perinatal clinic explains to a student nurse that which of the following patients are at highest risk of developing gestational diabetes? (Select all that apply.)

Accepted Answer

The risk factors for developing gestational diabetes include age older than 25;obesity;insulin resistance;polycystic ovary syndrome;history of pregnancy-related diabetes mellitus;history of a large-for-gestational age infant;hydramnios,stillbirth,miscarriage,or an infant with congenital anomalies during a previous pregnancy;family history of type 2 diabetes (first-degree relative);and ethnicity.Being young does not confer additional risk,nor does placenta previa.The 32-year-old is obese,the 10.5-lb baby is large for gestational age,and the mother and sister are first-degree relatives.

Question 10

The perinatal nurse knows that tocolytic agents are most often used to do which of the following? (Select all that apply.)

Accepted Answer

Presently,it is believed that the best reason to use tocolytic drugs is to allow an opportunity to begin the administration of maternal antenatal corticosteroids to accelerate fetal lung maturity.In addition,delaying the preterm birth provides time for maternal transport to a facility that is equipped with a neonatal intensive care unit.Tocolytics themselves do not prevent the development of respiratory complications such as respiratory distress syndrome.Tocoytic agents do not prevent infection and are recommended for use only up to 48 hours.

Question 11

A perinatal nurse is working with a woman who has had four perinatal losses in the first 20 weeks of pregnancy.The nurse should anticipate orders for which of the following diagnostic tests? (Select all that apply.)

Accepted Answer

Patients who experience habitual (three or more)spontaneous abortions may be offered these tests as part of the diagnostic workup: a karyotype obtained from the products of conception and from both parents and an examination of the maternal anatomy,beginning with a hysterosalpingogram.Additional testing may include hysteroscopy or laparoscopy;screening tests for maternal hypothyroidism,diabetes mellitus,antiphospholipid syndrome (APS),and systemic lupus erythematosus (SLE);testing of the serum progesterone level during the luteal phase of the menstrual cycle;cultures of the cervix,vagina,and endometrium;and endometrial biopsy during the luteal phase of the menstrual cycle.Sickle cell screening would not be part of this workup.

Question 12

A nurse is teaching a woman the actions to take in the event the woman believes she is in preterm labor.Which of the following should the nurse include in the teaching plan? (Select all that apply.)

Accepted Answer

The nurse should instruct the woman to empty her bladder,lie down on her side,drink 2 to 3 non-caffeinated beverages,feel for uterine contractions,and either go to the hospital or call the health-care provider if she feels 4 or more contractions in 1 hour.She should not lie down on her back or assess for contractions for over an hour.

Question 13

A nurse is assessing all patients in the perinatal clinic for culturally related increased risk for gestational diabetes mellitus.Which patients would the nurse assess as being in the highest risk groups? (Select all that apply.)

Accepted Answer

Ethnic groups with a higher incidence of gestational diabetes mellitus include African Americans,Asian Americans,Hispanics,and Native Americans.Pacific Islanders also have increased risk.Caucasians do not have an increased risk.

Question 14

A nurse is conducting a nonstress test on a pregnant woman.The nurse understands that which of the following conditions can lead to loss of fetal heart rate reactivity?

Accepted Answer

The most common cause of loss of fetal heart rate reactivity is a fetal sleep cycle.Other causes are related to central nervous system depression (not irritability)and can include fetal acidosis,hypoxia,and certain congenital abnormalities.

Question 15

The perinatal nurse describes risk factors for placenta previa to the student nurse.Which of the following risk factors does the nurse include? (Select all that apply.)

Accepted Answer

Placenta previa may be associated with conditions that cause scarring of the uterus such as prior cesarean birth,multiparity,or increased maternal age.Placenta previa may also occur with a large placental mass,as seen in multiple gestations and erythroblastosis.Other risk factors for placenta previa include smoking,cocaine use,a prior history of placenta previa,closely spaced pregnancies,African or Asian ethnicity,and maternal age greater than 35 years (Clark,2004).

Question 16

A nurse manager on the OB unit is auditing patient charts.One record documents the care of a patient having a seizure.The record describes the time and length of the seizure,medications given,maternal and fetal vital signs,and outcome of treatment.Which action by the manager is best?

Accepted Answer

The elements of complete documentation include what was charted plus associated symptoms,presence (or absence)of uterine contractions,and the presence of other obstetrical complications (e.g.,rupture of membranes).The manager should educate all nurses in the unit about complete documentation needed for patients having a seizure.There is no need to compare this chart with others,and the nurse should not rewrite the documentation (although the nurse may need to use an addendum,depending on how old the record is).

Question 17

A nurse is conducting an educational class for expectant couples.What information about preterm birth does the nurse include in the discussion? (Select all that apply.)

Accepted Answer

Although many pregnant women experience preterm contractions,only those with cervical changes are diagnosed with preterm labor.More than 90% of infants born at 28-29 weeks' gestation survive today.Worldwide,premature birth is the leading cause of infant morbidity and mortality. According to the March of Dimes (2012),the rate of preterm birth is highest for African American infants (18.4 %).In the United States,more than 1 in 8 babies are born too soon.

Question 18

A pregnant woman is HIV-positive.She is asking about ways to decrease the risk of vertical transmission to her baby.Which option given by the nurse would confer the least risk to the baby?

Accepted Answer

Women with HIV should be counseled that the risk of vertical transmission (mother to child)is 25% without antiretroviral medication.With ZDV,the rate is 5 to 8%.When both options are combined,the risk drops to around 2%,so this is the best option.

Question 19

A nurse is caring for a laboring woman from an unfamiliar culture who has limited English skills.Which nursing actions are important to provide nursing care to this patient? (Select all that apply.)

Accepted Answer

Working with patients from unfamiliar cultures can be challenging,especially if the patient has limited English skills.Ways to improve nursing care delivered to these patients includes using a professional interpreter,assessing relevant cultural beliefs,allowing items that hold special religious or cultural significance to remain with the woman,and finding community resources that are culturally acceptable and appropriate.Restricting visitors may cause resentment and suspicion.

Question 20

A nurse is caring for a pregnant 16-year-old who is homeless and occasionally spends time in a homeless shelter.She has been seen in the clinic before for sexually transmitted infections (STIs).She weighs 92 lb (41.8 kg)and occasionally uses crack cocaine.Which risk factors does this patient have for a negative pregnancy outcome? (Select all that apply.)

Accepted Answer

According to Barry (2011)and Porter and Holness (2011),prenatal medical and behavioral risks for the adolescent population include preterm labor and birth-especially when combined with low socioeconomic status,being a single parent,being a smoker,using illicit drugs,prepregnant weight less than 100 lb (45.5 kg),poor weight gain during pregnancy,and inadequate prenatal care.Other factors include anemia;preeclampsia-eclampsia;repeated exposure to sexually transmitted infections;chronic or asymptomatic urinary tract infections;acute pyelonephritis;intrauterine growth restriction/low-birth-weight infants (< 2,500 g);and social issues such as poverty,unmarried status,low educational levels,smoking,and drug use.After age 15 years,the adolescent does not experience any more problems than does the general population.

Quiz 11: Caring for the Woman Experiencing Complications During Pregnancy