Question 1

The nurse educator is describing the different kinds of abruptio placentae to a group of students, explaining that in a complete abruptio placentae:

Accepted Answer

In a complete abruptio placentae, there is almost total separation of the placenta from the uterine wall, leading to massive vaginal bleeding.

Question 2

The nurse is admitting a patient for a cerclage procedure. The patient asks for information about the procedure. What is the nurse's most accurate response?

Accepted Answer

Cerclage is a procedure in which a stitch is placed in the cervix to prevent a spontaneous abortion or premature birth. It is usually done in the second trimester.

Question 3

The labor nurse is caring for a patient at 38 weeks' gestation who has been diagnosed with symptomatic placenta previa. Which physician order should the nurse question?

Accepted Answer

The nurse should question the order to begin an oxytocin drip rate since it can increase uterine contractions and cause bleeding in patients with placenta previa. The other orders are appropriate for the management of a patient with symptomatic placenta previa. Assessment of fetal heart rate can help monitor fetal well-being, weighing vaginal pads can help estimate blood loss, and assessing hematocrit and hemoglobin can help monitor for anemia due to blood loss.

Question 4

The nurse is planning an in-service educational program to talk about disseminating intravascular coagulation (DIC). The nurse should include which of the following as risk factors for developing DIC? () Standard Text:

Accepted Answer

DIC can be caused by a variety of conditions which include sepsis, trauma, cancer, obstetric complications such as abruptio placentae and prolonged retention of a fetus after demise. Therefore, options B and C are correct choices. Options A, D, and E are not typically associated with an increased risk for developing DIC.

Question 5

The nurse is planning an in-service educational program to talk about disseminated intravascular coagulation (DIC). The nurse should identify which conditions as risk factors for developing DIC?

Accepted Answer

Abruptio placentae (premature separation of the placenta from the uterus) and prolonged retention of a fetus (retention of a dead fetus for more than 4 weeks) are both recognized as risk factors for DIC. Diabetes mellitus, multiparity, and preterm labor are not established as risk factors for DIC.

Question 6

A multigravida patient is admitted to the labor and delivery unit in active labor. Nursing diagnoses that might apply to the patient with suspected abruptio placentae include:

Accepted Answer

Abruptio placentae, a condition where the placenta detaches from the uterus wall before delivery, can lead to significant blood loss, causing hypovolemia (A) and potentially altering tissue perfusion (B). The situation can also understandably cause anxiety in the patient due to concerns for their own safety and the safety of their baby (C). Knowledge Deficit related to inherited genetic defects (D) and Alteration in Respiratory Function (E) are not directly related to the typical complications of abruptio placentae.

Question 7

During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. The nurse's priority action is to:

Accepted Answer

The priority action in the case of a suspected prolapsed umbilical cord is to relieve compression on the cord to maintain fetal oxygenation. This can be achieved by repositioning the mother or manually elevating the fetal head to reduce pressure on the cord, often utilizing gravity by placing the mother in a position that elevates the hips or using manual elevation techniques.

Question 8

The patient at 30 weeks' gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes:

Accepted Answer

Expectant management for painless late vaginal bleeding at 30 weeks' gestation includes monitoring for blood loss, pain, and uterine contractibility. Limiting vaginal exams to only one per 24-hour period and assessing blood pressure every 2 hours are not specifically part of expectant management for this condition. Evaluating the fetal heart rate with an internal monitor may be done, but it is not the most essential aspect of expectant management.

Question 9

The client is admitted to Labor and Delivery with a history of ruptured membranes for two hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. This client is at risk for:

Accepted Answer

The client's history of ruptured membranes for two hours puts her at risk for complications such as abruptio placentae, which is the premature separation of the placenta from the uterine wall. The client's age, alcohol and cigarette use may also increase her risk for this complication. Gestational diabetes, placenta previa, and placenta accrete are not directly related to the client's current situation.

Question 10

A pregnant patient is admitted to the emergency department with bleeding. The nurse realizes that the patient might have placenta previa. Which signs would be suggestive of placenta previa?

Accepted Answer

Bright red vaginal bleeding is a common sign of placenta previa, which occurs when the placenta covers the cervical opening, leading to bleeding during pregnancy. Sudden onset of bleeding and increase in size of the abdomen may also be present, but a firm and stony hard uterus is not typically associated with placenta previa.

Question 11

A patient at 32 weeks' gestation is admitted with painless vaginal bleeding. Placenta previa has been confirmed by ultrasound. What should be included in the nursing plan?

Accepted Answer

A) No vaginal exams should be performed as they can cause further bleeding in cases of placenta previa.
D) Fetal heart rate should be evaluated with an external monitor to assess for fetal distress or hypoxia.
E) Monitoring blood loss, pain, and uterine contractility is essential to assess for any changes, which may indicate worsening or improvement of the condition. Encouraging activity may increase bleeding and should be avoided. Intravenous access may be necessary for administering medications or fluids, so it should not be avoided until labor begins.

Question 12

The nurse is caring for a patient at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (PPROM). Which statement indicates that the patient needs additional teaching? "If I:

Accepted Answer

The statement indicating the need for additional teaching is the belief that one must plan on being on bed rest for the entire pregnancy if they want to become pregnant again after experiencing PPROM. While bed rest may be recommended in some high-risk pregnancies, it is not a universal requirement for all subsequent pregnancies after PPROM. Each pregnancy is unique, and recommendations for care are tailored to the individual's specific circumstances and risk factors.

Question 13

A patient is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. This patient is at risk for:

Accepted Answer

The patient's history of ruptured membranes for 2 hours puts her at risk for abruptio placentae, which is a serious complication where the placenta partially or completely separates from the uterus before the baby is born. This can cause heavy bleeding and compromise the baby's oxygen supply. The patient's age, history of multiple deliveries, and substance use (alcohol and cigarettes) further increase her risk for this complication. The other choices, gestational diabetes (A), placenta previa (B), and placenta accreta (D), do not seem to be related to the patient's specific risk factors.

Question 14

A primigravida is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes and FHR of 150 bpm. Her membranes rupture spontaneously, and the FHR drops to 90 bpm with variable decelerations. The initial response from the nurse would be to:

Accepted Answer

The answer of A primigravida is admitted to the birth...

Question 15

A patient in her second trimester is complaining of spotting. Causes for spotting in the second trimester are diagnosed primarily through the use of:

Accepted Answer

An ultrasound is the best choice for diagnosing the cause of spotting in the second trimester. This can help determine if there is any placental separation or if the cervix has started to shorten or open. Nonstress tests, vibroacoustic stimulation tests, and contraction stress tests are used to monitor fetal well-being in later stages of pregnancy and are not useful in diagnosing the cause of spotting.

Question 16

The nurse admits into the labor area a patient who is in preterm labor. The assessment finding that would constitute a diagnosis of preterm labor is:

Accepted Answer

Preterm labor is diagnosed when there are more frequent contractions, such as eight or more in one hour, which can lead to changes in the cervix indicative of labor. This frequency of contractions is a significant indicator of preterm labor.

Question 17

A patient was admitted to the labor area at 5 cm with ruptured membranes about 14 hours ago. The assessment data that would be most beneficial is:

Accepted Answer

With ruptured membranes, the most important assessment data is the patient's temperature as it can indicate the presence of infection or chorioamnionitis. Blood pressure, pulse, and respiration are also important to assess, but temperature takes priority in this case.

Question 18

The nurse has received end-of-shift reports in the high-risk maternity unit. Which patient should the nurse see first?

Accepted Answer

The patient with placenta previa experiencing bleeding is at the highest risk for hemorrhage and should be seen first.

Question 19

The nurse has admitted a woman with cervical insufficiency. The nurse is aware that causes of this condition include:

Accepted Answer

The answer of The nurse has admitted a woman with...

Question 20

The nurse is presenting a class on preterm labor, its causes, and treatments to a group of newly pregnant couples. Which statements are true regarding preterm labor? Note: Credit will be given only of all correct choices and no incorrect choices are selected. Standard Text:

Accepted Answer

Antepartum hemorrhage, trauma, and infection are all recognized causes of preterm labor. Magnesium sulfate is commonly used in obstetric care to stop contractions and delay preterm labor. Sedatives and narcotics may be used for pain management but are not primary treatments to stop labor.

Quiz 26: Childbirth at Risk: Prelabor Complications