116 terms

Chapter 26-34 WH

A 34 year old women at 36 weeks gestation has been scheduled for a biophysical profile. She asks the nurse why the tests needs to be performed. The nurse tells her that the test is performed because it-
a) determines how well her baby will breathe after its born.
b) evaluates the response of her baby's heart to uterine contractions.
c) measures her babes head and length
D) observes her baby's activity in utero to ensure that her baby is getting enough oxygen.
As part of preparing a 24 year old women at 42 weeks gestation for a non stress test, the nurse should-
a) tell the women to fast for 8 hours before the test
b) explain that the test will evaluate how well her baby is moving inside her uterus.
C) show her how to indicate when her baby moves
d) attach a spinal electrode to the presenting part to determine FHR patterns
A 40 year old women at 18 weeks of gestation is having a triple marker test performed. She is obese, and her health HX reveals that she is Rh negative. The primary purpose of this test is to screen for-
a) spina bifida
b) gestational diabetes
C) down syndrome
d) Rh antibodies
During a contraction stress test, four contractions lasting 45-55 seconds were recorded in the 10 minutes period. A late deceleration was noted during the 3rd contraction. The nurse conducting the test documents the result as-
a) negative
b) positive
C) equivocal-suspicious
d) unsatisfactory
A pregnant women is scheduled for a transvaginal ultrasound test to establish gestational age. In preparing this women for the test the nurse should-
A) place the women in supine position with her hips elevated on a folded pillow
b) instruct her to come for the test with a full bladder
c) administer an analgesic 30 minutes before the test
d) lubricate the vaginal probe with transmission gel
A pregnant women at 42 weeks gestation is undergoing a non stress test. During the test an evaluation of the monitor tracing indicated that 2 accelerations of the FHR occurred within a 20 minute period. The 1st acceleration of 18 bpm lasted 20 seconds and the 2nd acceleration of 20 bpm lasted 16 seconds. The nurse conducting the test records the test result as-
A) reactive
b) positive
c) nonreactive
d) equivocal hyperstimulatory
When measuring the blood pressure to ensure consistency and to facilitate early detection of B/P changes consistent with preeclampsia, the nurse should-
A) place the women in a sitting position with feet flat on the floor
b) allow the women to rest for 10 mins after positioning before measuring her B/P
c) record Korotkoff phase IV (muffled sound) as the diastolic pressure
d) use a proper sized cuff that covers at least 50% of he upper arm.
When caring for a women with mild preeclampsia, it is critical that during assessment the nurse be alert for signs of progress to severe preeclampsia. Progress to severe preeclampsia is indicated by the assessment finding-
a) proteinuria greater than 2+, in two specimens collected 6 hours apart
b) platelet count of 180,000/mm3
C) positive ankle clonus response
d) B/P of 154/94 and 156/100, 6 hours apart
A women's preeclampsia has advanced to the severe stage. She is admitted to the hospital and her primary health care provider has ordered an infusion of magnesium sulfate be started. In implementing this order, the nurse should- (select all that apply)
a) prepare a solution of 20g of magnesium sulfate in 100ml of 5% glucose in water
b) monitor maternal VS, FHR patterns and uterine contractions q hr.
C) expect the maintenance dose to be approximately 2g/hr
D) administer loading dose of 4-6g over 15-30 minutes
e) prepare to administer Hydralazine (Apresoline) if signs of magnesium toxicity occur
F) report resp. rate of 12 breathes or less per min to the primary care provider immediately
The primary expected outcome for nursing care associated with the administration of magnesium sulfate would be met if which assessment findings is present? The women-
a) exhibits a decrease in both systolic and diastolic B/P
B) experiences no seizures
c) states that he feels more relaxed and calm
d) urinates more frequently resulting in a decrease in pathologic edema
A women has been diagnosed with mild preeclampsia and will be treated at home. In teaching this women about her treatment regimen for mild preeclampsia, the nurse should tell her to- (select all that apply)
a) follow a low salt diet
B) use a dipstick to check urine for protein
C) maintain fluid intake to 6-8, 8 oz glasses of H20 each day
D) increase the roughage in her diet
E) perform gentle range of motion exercises for her upper and lower extremities
f) ask her friends to avoid visiting for calling her because she needs to rest.
The women with severe preeclampsia is receiving Nifedipine (Procardia). She asks the nurse what this medication is for. The nurse should tell her that nifedipine is used to.-
a) prevent seizures
b) relieve the head aches she is starting to have
C) decrease her B/P
d) reduce the edema in her hands and legs
A women with preeclampsia gave birth by c-section 1 hr ago. She is still receiving a magnesium sulfate infusion at 1g/hr. A major concern regarding the administration of magnesium sulfate at this time is-
a) increased risk for seizures
B) central nervous system depression
c) hypotension
d) diuresis
Following vaginal birth 2 hrs ago a women with preeclampsia is experiencing a heavy flow as a result of a boggy uterus. It is determined that she will require medication to reduce the amount of blood loss. Which medication would the nurse anticipate administering?
a) methyergonovine (methergine)
b) calcium gluconate
C) oxytocin (pitocin)
d) labetolol (normodyne)
A women, at 35 weeks of gestation with preeclampsia, has a seizure. Immediately after the seizure, the nurse's priority action is to:
a) evaluate FHR and pattern for signs of decreasing variability, later decelerations, or bradycardia.
B) assess status of the maternal airway, resp effort, and pulse
c) determine if membranes have ruptured and if the amniotic fluid contains meconium
d) prepare to increase the amount of magnesium sulfate being infused from 1g/hr to 2g/hr
A primigravida at 10 weeks of gestation reports mild uterine cramping and slight vaginal spotting without passage of tissue. When she is examined, no cervical dilation is noted. The nurse caring for this women should?
A) anticipate that the women will be sent home with instructions to limit her activity and to avoid stress or orgasm.
b) prepare the women for dilation and curettage
c) notify a grief counselor to assist the women with the imminent loss of her fetus
d) tell the women that the doctor will most likely perform a cerclage to help her maintain her pregnancy
A women is admitted through the emergency dept. with a medical diagnosis of ruptured ectopic pregnancy. The primary nursing diagnosis at this time is:
a) acute pain related to irritation of the peritoneum with blood
b) risk for infection related to tissue trauma
C) deficient fluid volume related to blood loss associated with rupture of the uterine tube
d) anticipatory grieving related to unexpected pregnancy outcome
A women diagnosised with an ectopic pregnancy is to receive methotrexate. The nurse should explain that - (select all that apply)
a) methotrexate is an analgesic that will relieve the dull abdominal pain she is experiencing
B) she should avoid alcohol until her primary care provider tells her the treatment is complete
C) she will receive the medication intramuscularly
D) She must stop taking folic acid supplements as long as she is on methotrexate.
e) her partner should use a condom during intercourse
f) she must return for a measurement of her progesterone level to determine if a second dose of methotrexate is required.
A pregnant women at 32 weeks of gestation comes to the emergency dept because she has begun to experience bright red vaginal bleeding. She reports that she has no pain. The admission nurse suspects that the women is experiencing-
a) abruptio placentae
b) disseminated intravascular coagulation
C) placenta previa
d) preterm labor
A pregnant women at 38 weeks gestation diagnosed with marginal placenta previa has just given birth to a healthy newborn boy. The nurse recognizes that the immediate focus for the care of this women is-
A) preventing hemorrhage
b) relieving acute pain
c) preventing infection
d) fostering attachment of the women with her son
A pregestational diabetic women at 20 weeks gestation exhibits the following- thirst, N/V, abd. pain, drowsiness, and increased urination. Her skin is flushed and dry, and her breathing is rapid, with a fruity odor. A priority nursing action when caring for this women is to-
a) provide the women with a simple carbohydrate immediately.
b) request an order for an antiemetic
c) assist the women into a lateral position to rest
D) administer insulin according to the women's blood glucose level
During her pregnancy a women with pre gestational diabetes has been monitoring her blood glucose level several times a day. Which level requires further assessment?-
a) 85 mg/dl - 15 min prior to breakfast
b) 90 mg/dl - prior to lunch
C) 140 mg/dl - 2 hours after lunch
d) 135 mg/dl - 1 hour after supper
Specific guidelines should be followed when planning a diet with pre gestational diabetic women BMI- 24 to ensure a euglycemic state. Which dietary practices does the women need to modify?
A) follows a diet that reflects 45 K/Cal per kg daily based on her preconception BMI
b) eats three meals a day along with midmorning, mid afternoon and a bedtime snack.
C) drinks a cup of tea and a piece of dry toast as her bedtime snack
D) divides her daily carb intake at 50% carb and 50% complex carbs
e) maintain a fat intake of approx. 25% of the total daily kcal recommendation
f) monitors the appropriateness of her nutritional intake by checking her glucose levels before and after meals
An obese pregnant women with gestational diabetes is learning self-injection, the nurse evaluates that the women understands the instructions when she:
a) washes her hands and puts on a pair of clean gloves
B) gently rotates the NPH insulin vial to fully mix the insulin
c) draws the NPH insulin into her syringe first when mixing it with regular insulin
D) spreads her skin taut and punctures the skin at a 90 degree angle
e) cleanses the injection site vigorously with an alcohol swab.
F) covers the injection site with a sterilize gauze as she removes the needle then applies gentle pressure.
A women has just been admitted with a diagnosis of hyperemesis gravidarum. she has been unable to retain any oral intake and as a result has lost weight and is exhibiting signs of dehydration with electrolyte imbalance and acetonuria. The nurse anticipates that the care management of this women will include-
a) administering vitamin K to control N/V
B) separating liquids from solids, alternating then q 2-3 hrs
c) avoiding oral hygiene until the women is able tolerate oral fluids
d) providing 3 daily meals of bland foods with warm liquids once the women is able to tolerate oral intake
When assessing a pregnant women at 28 weeks gestation who is diagnosed with mitral valve stenosis , it is important that the nurse be alert for S/S indicating cardiac decompensation. S/S of cardiac decompensation include-
A) dry, hacking cough
b) orthopenea
c) wheezing with inspirational expiration
D) rapid pulse that is regular and weak
E) women reports that shoes and rings are tight
f) supine hypotension
A women at 30 weeks of gestation with a class II cardiac disorder calls her primary health care provider's office and speaks to the nurse practitioner. She tells the nurse that she has been experiencing a frequent moist cough for the past few days. In addition she has been feeling more tired and is having difficulty completing her routine activities as a result of some difficulty with breathing. The nurses' best response is-
A) "have someone bring you to the office so we can assess your cardiac status"
b) "Try to get more rest during the day, because this is a difficult time for your heart"
c) "take an extra diuretic tonight before you go to bed, because you may be developing some fluid in your lungs"
d) "ask your family to come over and do your housework for the next few days so you can rest"
A pregnant women with a valvular disorder of her heart requires medication to prevent clot formation. In preparing the women for this treatment measure, the nurse expects to teach the women about self administration of
a) furosemide (lasix)
b) propranolol (inderal)
C) heparin
d) warfarin (coumadin)
At a previous antepartal visit, the nurse taught a pregnant women diagnosed with a class II cardiac disorder about measures to use to lower her risk for cardiac decompensation. This women indicates a need for further instruction if she-
a) increases roughage in her diet
B) remains on bed rest, getting out of bed only to go to the bathroom.
c) sleeps ten hours q night and rests after meals
d) states she will call the nurse immediately if she experiences any pain or swelling in her legs
A pregnant women has been diagnosed with cholelithiasis. An important component of her treatment regimen is dietary modification. The nurse helps this women plan a diet that:
a) reduces dietary fat to approximately 60g/day
B) limits protein to 30% of total calories
c) choose foods that ensure that most calories come from carbohydrates
d) avoids putting spices in foods
A nurse caring for a pregnant women evaluates the omens most recent arterial blood gas (ABG) values. Which arterial blood gas falls within the expected range for a pregnant women?
a) pH 7.30
B) PO2 105mm Hg
c) PCO2 50mm Hg
d) bicarbonate 16 mEq/L
A pulmonary artery catheter will be one of the monitoring techniques used during the care of a critically ill pregnant women. As part of the protocol for a pulmonary artery catheter insertion and care, the nurse will - (select all that apply-
a) assist the women into supine position, with the head of the bed elevated slightly to facilitate catheter insertion
B) ensure that a signed informed consent is attached to the womens chart
C) perform catheter site care once per shift or daily according to unit infection control policy
d) keep hydralazine on hand in care an arrhythmia develops
E) apply pressure to the catheter site for ten mins following the catheters removal
f) document the women's response to the insertion protocol
A nurse is performing a full assessment of a pregnant trauma victim just admitted to the emergency department. As part of the assessment, the nurse determines the women's glasgow coma scale score. Which data should the nurse use in calculating this score?
A) eyes open to verbal command
b) B/P- 110/60
c) pupils constricted equally to light
D) able to indicate location of pain
e) apical pulse 98 bpm, regular, moderate strength
F) communication clear but is unsure where she is and what happened to her.
When positioning a critically ill pregnant women, which position should the nurse use to provide optimal cardias output?
a) supine
b) prone
c) fowler
D) right or left lateral
The most common risk associated with an intraarterial line is:
a) hemorrhage
b) thrombus formation
c) embolization
D) infection
A critically ill pregnant women is to have an arterial pressure catheter inserted to monitor her systolic, diastolic, and mean arterial pressure. Before insertion the nurse performs an Allen test and reports the results to the DR. who will be inserting the catheter. When performing this test, the nurse should:
a) perform the test on the women's dominate hand
B) occlude the ulnar and radial arteries simultaneously while raising the hand
c) instruct the pt. to keep her fist tightly clenched during the test
d) release the pressure on both arteries at the same time, noting the time for capillary refill
Nurses caring for postpartum women experiencing depression need to be aware of the safety of administering antidepressants. Which antidepressant should be avoided by women who wish to continue breastfeeding?
a) Desipramine (Norpramin)
b) Sertraline (Zoloft)
C) Doxepin (Sinequan)
d) Paroxetine (Paxil)
Which measure is least effective in helping a women prevent postpartum depression?
a) share feelings and emotions with family members and her partner.
b) recognize that emotional problems after having a baby are not unusual
C) care for the baby by herself to increase her level of self confidence and self-esteem.
d) ask friends and family members to take care of the baby while she sleeps or has a date with he partner.
A pregnant women being treated for major depression arrives for her first prenatal visit. During the health HX interview she shows the nurse the cough medication that she just bought for a cold. The nurse notes that the cough medicine contains dextromethorphan. The nurse is concerned if the women reports taking which medication for her depression?
A) citalopram (Celexa)
b) desipramine (Norpamin)
c) doxepine (sinequan)
d) Amoxapine (asendin)
A priority question to ask a women experiencing postpartum depression is:
A) have you thought of hurting yourself?
b) does it seem like your mind is filled with cobwebs?
c) have you been feeling insecure, fragile, or vulnerable?
d) does the responsibility of motherhood seem overwhelming?
The nurse should recognize that a complication of pregnancy associated with the intravenous use of cocaine is-
a) prolonged, difficult labor
B) premature separation of the placenta
c) increased risk for vaginal and urinary tract infections
When conducting a health HX interview during a pregnant women's first prenatal visit, the nurse must determine if the women is substance dependent. The nurses first question should relate to the women's use of:
a) alcohol
b) caffeine
c) cocaine
D) OTC and prescription medications
When assessing a pregnant women, the nurse is alert to for factors associated with preterm labor. Which factors if exhibited by this women increases her risk for spontaneous preterm labor and birth?- select all that apply
a) caucasion race
B) obstetric HX - 3-0-2-0-1
C) HX of bleeding at 20 weeks
D) currently being treated for second bladder infection in 2 months
E) employed as a nurse in a trauma ICU
f) BMI of 22 and height of 158 cm
Bed rest for prevention of preterm birth can result in:
A) bone demineralization with Ca+ loss
b) weight gain
C) fatigue
D) dysphoria and guilt
e) increased cardias output
F) emotional lability
A women's labor is being suppressed using IV magnesium sulfate . Which measure should be implemented during the infusion.
A) limit intravenous fluid intake to 125ml/hr
b) D/C infusion if maternal respirations are less than 14 breaths/min
c) ensure that indomethacin is available should toxicity occur
d) assist women to maintain a comfortable semi recumbent position
A DR. has ordered that dinoprostone (cervidil) be administered to ripen a pregnant womens cervix in preparation for a induced labor. In fulfilling this order the nurse should
a) insert the cervidil into the cervical canal jus below the internal os
b) tell the women to remain in bed for at least 15 mins.
C) observe the women for signs of uterine tachysystole
d) remove the cervidil as soon as the women begins to experience uterine contractions
A nulliparous women experiencing a post term pregnancy is admitted for labor induction. Assessment reveals a Bishop score of 9. the nurse should-
a) call the women's primary health care provider to order cervidil ripening agent
b) mix 20 units for oxytocin (pitocin) in 500 ml of 5% glucose in H2O
c) Piggy back the oxytocin solution into the port nearest the drip chamber of the primary IV tubing
D) Begin the infusion at a rate between 1 miliunits/min as determined by the induction protocol
A women's labor is being induced. The nurse assesses the women's status and that of her fetus and the labor process just before an infusion increment of 2 mu/min. The nurse D/C's the infusion and notifies the women's primary health care provider if during this assessment she notes:
A) frequency of uterine contractions- q 1.5 mins
b) variability of FHR - present
c) deceleration patterns- early decelerations noted with several contractions
d) intensity of uterine contractions at their peaks- 80-85 mm/Hg
A laboring women's vaginal exam reveals the following - 3cm, 50%, LSA, 0. The nurse caring for this women should
a) place the ultrasound transducer in the left lower quadrant for the women's abdomen
b) recognize that passage of the meconium would be a definitive sign of fetal distress
C) expect the progress of fetal descent to be slower than usual
d) assist the women into a knee-chest position for each contraction
A nurse is caring for a pregnant women at 30 weeks gestation in preterm labor. The women's physician orders betamethasone 12mg IM for 2 doses with the first dose to begin at 11am. In implementing this order the nurse should-
a) consult the physician because the dose is too high
b) explain to the women that this medication will reduce her HR and help her breath easier
c) assess the women for tachycardia and hypotension
D) schedule the second dose for 11am the next day
A nurse caring for a pregnant women suspects of being in preterm labor recognizes this sign as diagnostic of preterm labor.
A) cervical dilation of at least 2 cm
b) uterine contractions occuring q 15 mins
c) spontaneous rupture of the membranes
d) presence of fetal fibronectin in cervical secretions
A women 27 weeks gestation experiences some mild uterine cramping. Which action should we take?
A) empty bladder
b) call her nurse midwife immediately
c) relax in a chair
D) drink 2-3 glasses of H2O or juice
E) palpate her uterus for 1 hr.
f) resume the activity she was doing if the cramping subsides
A women is in active labor. On spontaneous rupture of her membranes, the nurse caring for this women notices variable deceleration patterns during evaluation of the monitor tracing. When preparing to perform a vaginal exam, the nurse observes a small section of the umbilical cord protruding from the vagina. What should the nurse do next?
a) increase IV drip rate
b) admin. O2 to the women via mask at 8-10 L/min
C) place sterile gloved hand into the vagina and hold the presenting part off the cord while calling for assistance
d) wrap the cord loosely with sterile towel saturated with warm normal saline
Methylergonovine (methergine) 0.2mg is ordered for a women who gave birth vaginally 1 hour ago, it is to be administered IM to treat a profuse lochial flow with clots. Her fundus is boggy and does not respond well to massage. She is still being treated for preeclampsia with IV magnesium sulfate at 1g/hr. Her B/P, measured 5 min ago was 155/98 mm Hg. In fulfilling this order, the nurse should
a) measure the women's B/P again 5 mins after administering the med
B) question the order, based on the women's hypertensive status
c) admin. the med because it is the best choice to counteract the possible uterine relaxation
d) tell the women that the med will lead to uterine cramping
A postpartum women in the fourth stage of labor received 15-methlprostaglandin f2a (hemabate) 0.25 mg IM. The expected outcome of care for the administration of this medication is
a) relief from the pain of uterine cramping
b) prevention of intrauterine infection
c) reduction in the bloods ability to clot
D) limitation of excessive blood loss that is occurring after birth
The nurse responsible for the care of postpartum women recognizes that the first sign of puerperal infection most likely is-
A) temp elevation of 38 degrees Celsius or higher after the first 24 hours following birth
b) increased while blood cell count
c) foul smelling profuse lochia
d) bradycardia
A breast feeding women's c-section birth occurs 2 days ago. Investigation of the pain, tenderness, and swelling in her left leg led to a medical diagnosis of DVT. Care management for this women during the acute stage of DVT involves- (select all that apply)
a) explaining that she will need to stop breastfeeding until anticoagulation therapy is completed
b) administering warfarin (coumadin) orally
C) placing the women on bed rest with her let leg elevated
d) fitting the women with an elastic stocking so that she can exercise her leg.
e) telling her to avoid changing her position for the first 24 hours
F) administering heparin IV for 3-5 days
Prenatal visits are how often?
monthly to 28 weeks, 29-36 weeks q 2 weeks, 36 weeks -birth q week
Misoprostol (Cytotec) -
PGE, ripens the cervix- making it softer and causing it to begin to dilate and efface it, stimulates uterine contractions. Recommended initial dose 25 mcg. Continuous fetal monitoring
Dinoprostone (Cervidil) -
tampon-like; 10mg gradually released over 12 hours; continuous fetal monitoring
A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?
a) Biophysical profile
b) Amniocentesis
c) Maternal serum alpha-fetoprotein (MSAFP)
D) Transvaginal ultrasound
A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):
a) Sometimes uses vibroacoustic stimulation
b)Is an invasive test; however, contractions are stimulated
C) Is considered negative if no late decelerations are observed with the contractions
d)Is more effective than nonstress test (NST) if the membranes have already been ruptured
In the past, factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader more comprehensive approach to high risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. These categories include all of these except:
a) Biophysical
b) Psychosocial
C) Geographic
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test?
a) "I will need to have a full bladder for the test to be done accurately."
b) "I should have my husband drive me home after the test because I may be nauseated."
c) "This test will help to determine if the baby has Down syndrome or a neural tube defect."
D) "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."
What is an appropriate indicator for performing a contraction stress test?
a) Increased fetal movement and small for gestational age
B) Maternal diabetes mellitus and postmaturity
c) Adolescent pregnancy and poor prenatal care
d) History of preterm labor and intrauterine growth restriction
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?
A) Doppler blood flow analysis
b) Contraction stress test (CST)
c) Amniocentesis
d) Daily fetal movement counts
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:
a) Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis
b) Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects
c) Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome
D) MSAFP is a screening tool only; it identifies candidates for more definitive procedures
A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:
a) sleepy, sedated affect
B) A respiratory rate of 10 breaths/min
c) Deep tendon reflexes of 2+
d) Absent ankle clonus
A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:
A. Hypertension
b. Hyperemesis gravidarum
c. Hemorrhagic complications
d. Infections
With regard to preeclampsia and eclampsia, nurses should be aware that:
a. Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters
B. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain
c. The causes of preeclampsia and eclampsia are well documented
d. Severe preeclampsia is defined as preeclampsia plus proteinuria
A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if:
a. Blood pressure is reduced to prepregnant baseline
B. Seizures do not occur
c. Deep tendon reflexes become hypotonic
d. Diuresis reduces fluid retention
A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:
A. Hydralazine
b. Magnesium sulfate bolus
c. Diazepam
d. Calcium gluconate
Nurses should be aware that HELLP syndrome:
a. Is a mild form of preeclampsia
b. Can be diagnosed by a nurse alert to its symptoms
C. Is characterized by hemolysis, elevated liver enzymes, and low platelets
d. Is associated with preterm labor but not perinatal mortality
A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion?
A. Incomplete
b. Inevitable
c. Threatened
d. Septic
The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:
a. Bleeding
B. Intense abdominal pain
c. Uterine activity
d. Cramping
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:
a. Eclamptic seizure
b. Rupture of the uterus
c. Placenta previa
D. Placental abruption
In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?
A. Administration of blood
b. Preparation of the woman for invasive hemodynamic monitoring
c. Restriction of intravascular fluids
d. Administration of steroids
Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion?
a. Prepare the woman for a dilation and curettage (D&C).
b. Place the woman on bed rest for at least 1 week and reevaluate.
C. Prepare the woman for an ultrasound and bloodwork.
d. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.
A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for:
A. Hemorrhage
b. Infection
c. Urinary retention
d. Thrombophlebitis
In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the:
a. Mother's age
b. Number of years since diabetes was diagnosed
c. Amount of insulin required prenatally
D. Degree of glycemic control during pregnancy
Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:
a. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern
B. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations
c. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring
d. At birth, the neonate of a diabetic mother is no longer in any greater risk
A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that:
a. Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin
b. Dietary modifications and insulin are both required for adequate treatment
c. Glucose levels are monitored by testing urine four times a day and at bedtime
D. Dietary management involves distributing nutrient requirements over three meals and two or three snacks
Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for all except:
a. Miscarriage
B. Macrosomia
c. Gestational hypertension
d. Placental abruption
A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time is to:
a. Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours
b. Reduce emotional distress by encouraging the woman to discuss her feelings
C. Reverse fluid, electrolyte, and acid-base imbalances
d. Restore the woman's ability to take and retain oral fluid and foods
Appendicitis is more difficult to diagnose during pregnancy because the appendix is:
a. Covered by the uterus
b. Displaced to the left
c. Low and to the right
D. High and to the right
A nurse is caring for a woman with mitral stenosis who is in the active stage. Which action should the nurse take to promote cardiac function?
A. Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics.
b. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics.
c. Encourage the woman to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function.
d. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.
During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:
a. Euglycemia
b. Rheumatic fever
c. Pneumonia
D. Cardiac decompensation
Thalassemia is a relatively common anemia in which:
A. An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs)
b. RBCs have a normal life span but are sickled in shape
c. Folate deficiency occurs
d. There are inadequate levels of vitamin B12
From 4% to 8% of pregnant women have asthma, making it one of the most common preexisting conditions of pregnancy. Severity of symptoms usually peaks:
a. In the first trimester
B. Between 24 to 36 weeks of gestation
c. During the last 4 weeks of pregnancy
d. Immediately postpartum
A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often:
a. Orthopnea
B. Decreasing energy levels
c. Moist frequent cough and frothy sputum
d. Crackles (rales) at the bases of the lungs on auscultation
The nurse caring for a critically ill pregnant woman at 36 weeks of gestation with a pulmonary artery catheter in place obtains the following hemodynamic profile: CVP, 3 mm Hg; PAP, 40/18 mm Hg; PCWP, 18 mm Hg; CO, 7 L/min. Which hemodynamic value(s) is/are normal?
a. CVP only
B. CO and CVP
c. PAP and PCWP
d. PAP only
With regard to physical trauma during pregnancy, nurses should be aware that:
a. Pregnant women have fewer traumatic injuries because they are so careful of themselves, and their families are so protective of them
b. More cases of trauma are reported in the first trimester because that is when women are most normally active
c. Maternal death by trauma is most usually the result of penetrating abdominal trauma
D. Priorities of care after trauma must be to resuscitate the woman and stabilize her condition first and then consider fetal needs
The gradient controlling whether fluid remains inside of the capillary or moves into the interstitial space is known as:
A. Colloid osmotic pressure (COP)
b. Capillary hydrostatic pressure
c. Pulmonary capillary wedge pressure
d. Systemic vascular resistance
In recent years the number of women who require obstetric critical care has increased. The safest and most economic method of providing care for the critically ill obstetric client who requires either mechanical ventilation or hemodynamic monitoring depends on the facility. Even in large tertiary care settings, the most usual site for this type of care is:
a. Labor and birth
d. Surgical suite
A pregnant woman comes into the emergency department after receiving minor blunt trauma to her abdomen during a minor car accident. The nurse should carefully evaluate the woman for:
a. Disseminated intravascular coagulation (DIC)
b. The ABCs of resuscitation: airway, breathing, circulation
C. Abruptio placentae
d. Pelvic fracture
Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes?
A. Heroin
b. Alcohol
c. Phencyclidine palmitate (PCP)
d. Cocaine
During pregnancy, alcohol withdrawal may be treated using:
a. Disulfiram (Antabuse)
b. Corticosteroids
C. Benzodiazepines
d. Aminophylline
To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features:
a. Is more likely to occur in women with more than two children
b. Is rarely delusional and then usually about someone trying to harm her (the mother)
c. Although serious, is not likely to need psychiatric hospitalization
D. Is typified by auditory or visual hallucinations
Nurses must be cognizant of the growing problem of methamphetamine use during pregnancy. When caring for a woman who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance?
a. Methamphetamine is a depressant.
b. All methamphetamines are vasodilators.
C. Methamphetamine users are extremely psychologically addicted.
d. Rehabilitation is usually successful.
Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps-Plus is a screening tool designed specifically to identify when there is a need for a more in-depth assessment. The 4 Ps include all except:
A. Present
b. Partner
c. Past
d. Pregnancy
A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring?
a. Estriol is not found in maternal saliva.
b. Irregular, mild uterine contractions are occurring every 12 to 15 minutes.
c. Fetal fibronectin is present in vaginal secretions.
D. The cervix is effacing and dilated to 2 cm.
In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, the nurse includes which information?
a. "Because this is a repeat procedure, you are at the lowest risk for complications."
B. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures."
c. "Because this is your second cesarean birth, you will recover faster."
d. "You will not need preoperative teaching because this is your second cesarean birth."
For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse?
a. Fetal heart rate of 116 beats/min
b. Cervix dilated 2 cm and 50% effaced
c. Score of 8 on the biophysical profile
D. One fetal movement noted in 1 hour of assessment by the mother
A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority?
A. Place the woman in the knee-chest position.
b. Cover the cord in a sterile towel saturated with warm normal saline.
c. Prepare the woman for a cesarean birth.
d. Start oxygen by face mask.
A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of:
a. Uterine contractions occurring every 8 to 10 minutes
B. A fetal heart rate (FHR) of 180 with absence of variability
c. The client needing to void
d. Rupture of the client's amniotic membranes
With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:
a. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks
b. There are no important maternal (as opposed to fetal) contraindications
C. Its most important function is to afford the opportunity to administer antenatal glucocorticoids
d. If the client develops pulmonary edema while on tocolytics, IV fluids should be given
With regard to dysfunctional labor, nurses should be aware that:
a. Women who are underweight are more at risk
B. Women experiencing precipitous labor are about the only dysfunctionals not to be exhausted
c. Hypertonic uterine dysfunction is more common than hypotonic dysfunction
d. Abnormal labor patterns are most common in older women
A nurse providing care to a woman in labor should be aware that cesarean birth:
a. Is declining in frequency in the United States
b. Is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier clients do
C. Is performed primarily for the benefit of the fetus
d. Can be either elected or refused by women as their absolute legal right
Which statement is most likely to be associated with a breech presentation?
a. Least common malpresentation
b. Descent is rapid
c. Diagnosis by ultrasound only
D. High rate of neuromuscular disorders
The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:
a. Call the woman's primary health care provider
b. Administer the standing order for an oxytocic
C. Palpate the uterus and massage it if it is boggy
d. Assess maternal blood pressure and pulse for signs of hypovolemic shock
Which PPH conditions are considered medical emergencies that require immediate treatment?
A. Inversion of the uterus and hypovolemic shock
b. Hypotonic uterus and coagulopathies
c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura
d. Uterine atony and disseminated intravascular coagulation (DIC)
Which postpartum infection is most often contracted by first-time mothers who are breastfeeding?
a. Endometritis
b. Wound infections
C. Mastitis
d. Urinary tract infections (UTIs)
Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is:
a. Cryoprecipitate
b. Factor VIII and vWf
C. Desmopressin
d. Hemabate
Herbal remedies have been used with some success to control PPH after initial management. Some herbs have homeostatic actions, whereas others work as oxytocic agents to contract the uterus. _______________ is a commonly used oxytocic herbal remedy.
a. Witch hazel
b. Ladys mantel
C. Blue cohosh
d. Yarrow
A thrombosis results from the formation of a blood clot or clots inside a blood vessel and is caused by inflammation or partial obstruction of the vessel. Three thromboembolic conditions are of concern during the postpartum period and include all except:
A. Amniotic fluid embolism (AFE)
b. Superficial venous thrombosis
c. Deep vein thrombosis
d. Pulmonary embolism
What two drugs DO NOT cross the placenta?
heparin and insulin