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1. . Women with hyperemesis gravi- ANS: B
darum:
Women with hyperemesis gravidarum
a.
have severe vomiting; however, treatAre a majority, because 80% of all ment for several days sets things right in
pregnant women suffer from it at most cases. Although 80% of pregnant
some time.
women experience nausea and vomitb.
ing, fewer than 1% (0.5%) proceed to this
Have vomiting severe and persis- severe level. IV administration may be
tent enough to cause weight loss, used at first to restore fluid levels, but it
dehydration, and electrolyte im- is seldom needed for very long. Women
balance.
suffering from this condition want symc.
pathy because some authorities believe
Need intravenous (IV) fluid and that difficult relationships with mothers
nutrition for most of their preg- and/or partners may be the cause.
nancy.
d.
Often inspire similar, milder
symptoms in their male partners
and mothers.
2. 2. Because pregnant women may
need surgery during pregnancy,
nurses should be aware that:
a.
The diagnosis of appendicitis
may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy.
b.
Rupture of the appendix is less
likely in pregnant women because of the close monitoring.
c.
Surgery for intestinal obstructions should be delayed as long
as possible because it usually affects the pregnancy.
d.
ANS: A
Both appendicitis and pregnancy are
linked with nausea, vomiting, and increased white blood cell count. Rupture
of the appendix is two to three times
more likely in pregnant women. Surgery
to remove obstructions should be done
right away. It usually does not affect
the pregnancy. Pregnancy predisposes a
woman to ovarian problems.
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When pregnancy takes over, a
woman is less likely to have ovarian problems that require invasive
responses.
3. 3. What laboratory marker is
indicative of disseminated intravascular coagulation (DIC)?
a.
Bleeding time of 10 minutes
c.
Thrombocytopenia
b.
Presence of fibrin split products
d.
Hyperfibrinogenemia
ANS: B
Degradation of fibrin leads to the accumulation of fibrin split products in the
blood. Bleeding time in DIC is normal.
Low platelets may occur with but are not
indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC.
4. 4. In caring for an immediate post- ANS: A
partum client, you note petechiae The diagnosis of DIC is made accordand oozing from her IV site. You ing to clinical findings and laboratory
would monitor her closely for the markers. Physical examination reveals
clotting disorder:
unusual bleeding. Petechiae may appear
a.
around a blood pressure cuff on the
Disseminated intravascular co- woman's arm. Excessive bleeding may
agulation (DIC)
occur from the site of slight trauma such
b.
as venipuncture sites. These symptoms
Amniotic fluid embolism (AFE) are not associated with AFE, nor is AFE
c.
a bleeding disorder. Hemorrhage occurs
Hemorrhage
for a variety of reasons in the postpartum
d.
client. These symptoms are associated
HELLP syndrome
with DIC. Hemorrhage would be a finding
associated with DIC and is not a clotting
disorder in and of itself. HELLP is not a
clotting disorder, but it may contribute to
the clotting disorder DIC.
5. 5. In caring for the woman with ANS: A
disseminated intravascular coag- Primary medical management in all casulation (DIC), what order should es of DIC involves correction of the
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the nurse anticipate?
a.
Administration of blood
b.
Preparation of the client for invasive hemodynamic monitoring
c.
Restriction of intravascular fluids
d.
Administration of steroids
underlying cause, volume replacement,
blood component therapy, optimization
of oxygenation and perfusion status, and
continued reassessment of laboratory
parameters. Central monitoring would
not be ordered initially in a client with
DIC because this can 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.
6. 6. A primigravida is being monitored in her prenatal clinic
for preeclampsia. What finding
should concern her nurse?
a.
Blood pressure (BP) increase to
138/86 mm Hg
b.
Weight gain of 0.5 kg during the
past 2 weeks
c.
A dipstick value of 3+ for protein
in her urine
d.
Pitting pedal edema at the end of
the day
ANS: C
Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should
alert the nurse that additional testing or
assessment should be made. Generally, hypertension is defined as a BP of
140/90 or an increase in systolic pressure of 30 mm Hg or in diastolic pressure
of 15 mm Hg. Preeclampsia may be manifested as a rapid weight gain of more
than 2 kg in 1 week. Edema occurs in
many normal pregnancies and in women
with preeclampsia. Therefore, the presence of edema is no longer considered
diagnostic of preeclampsia.
7. 7. The labor of a pregnant woman
with preeclampsia is going to
be induced. Before initiating the
Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a
platelet count of 90,000, an elevated aspartate transaminase (AST)
level, and a falling hematocrit.
The nurse notifies the physician
ANS: C
HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia
that involves hepatic dysfunction characterized by hemolysis (H), elevated liver
enzymes (EL), and low platelets (LP).
Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is
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because the laboratory results
are indicative of:
a.
Eclampsia.
b.
Disseminated intravascular coagulation (DIC).
c.
HELLP syndrome.
d.
Idiopathic thrombocytopenia.
the presence of low platelets of unknown cause and is not associated with
preeclampsia.
8. 8. A woman with preeclampsia
has a seizure. The nurse's primary duty during the seizure is to:
a.
Insert an oral airway.
b.
Suction the mouth to prevent aspiration.
c.
Administer oxygen by mask.
d.
Stay with the client and call for
help.
ANS: D
If a client becomes eclamptic, the nurse
should stay her and call for help.
Insertion of an oral airway during seizure
activity is no longer the standard of care.
The nurse should attempt to keep the
airway patent by turning the client's head
to the side to prevent aspiration. Once
the seizure has ended, it may be necessary to suction the client's mouth. Oxygen would be administered after the convulsion has ended.
9. 9. A pregnant woman has been
receiving a magnesium sulfate
infusion for treatment of severe
preeclampsia for 24 hours. On
assessment the nurse finds the
following vital signs: temperature of 37.3° C, pulse rate of 88
beats/min, respiratory rate of 10
breaths/min, blood pressure (BP)
of 148/90 mm Hg, absent deep
tendon reflexes, and no ankle
clonus. The client complains, "I'm
so thirsty and warm." The nurse:
ANS: C
The client is displaying clinical signs and
symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the
antidote for magnesium, may be administered. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it
is administered for a systolic BP greater
than 160 mm Hg or a diastolic BP greater
than 110 mm Hg.
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a.
Calls for a stat magnesium sulfate level.
b.
Administers oxygen.
c.
Discontinues the magnesium sulfate infusion.
d.
Prepares to administer hydralazine.
10. 10. A woman with severe
preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The
nurse assesses the woman and
documents the following findings: temperature of 37.1° C,
pulse rate of 96 beats/min, respiratory rate of 24 breaths/min,
blood pressure (BP) of 155/112
mm Hg, 3+ deep tendon reflexes,
and no ankle clonus. The nurse
calls the physician, anticipating
an order for:
a.
Hydralazine.
c.
Diazepam.
b.
Magnesium sulfate bolus.
d.
Calcium gluconate.
ANS: A
Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP greater than 160
mm Hg or a diastolic BP greater than
110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system
irritability related to severe preeclampsia
(e.g., clonus) or if eclampsia develops.
Diazepam sometimes is used to stop or
shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not
currently displaying any signs or symptoms of magnesium toxicity.
11. 11. A woman at 39 weeks of gesta- ANS: D
tion with a history of preeclamp- Uterine tenderness in the presence of insia is admitted to the labor and creasing tone may be the earliest finding
birth unit. She suddenly experi- of premature separation of the placenta
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ences 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.
c.
Placenta previa.
b.
Rupture of the uterus.
d.
Placental abruption.
(abruptio placentae or placental abruption). Women with hypertension are at
increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence
of pain. Placenta previa manifests with
bright red, painless vaginal bleeding.
12. 12. The patient that you are caring for has severe preeclampsia
and is receiving a magnesium
sulfate infusion. You become concerned after assessment when
the woman exhibits:
a.
A sleepy, sedated affect.
c.
Deep tendon reflexes of 2.
b.
A respiratory rate of 10
breaths/min.
d.
Absent ankle clonus.
ANS: B
A respiratory rate of 10 breaths/min indicates that the client is experiencing
respiratory depression from magnesium
toxicity. Because magnesium sulfate is
a central nervous system depressant,
the client will most likely become sedated when the infusion is initiated. Deep
tendon reflexes of 2 and absent ankle
clonus are normal findings.
13. 13. Your patient has been receiving magnesium sulfate for 20
hours for treatment of preeclampsia. She just delivered a viable
infant girl 30 minutes ago. What
uterine findings would you expect to observe/assess in this
client?
a.
ANS: D
Because of the tocolytic effects of magnesium sulfate, this patient most likely would have a boggy uterus with increased amounts of bleeding and a
heavy lochia flow in the postpartum period.
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Absence of uterine bleeding in
the postpartum period
b.
A fundus firm below the level of
the umbilicus
c.
Scant lochia flow
d.
A boggy uterus with heavy lochia
flow
14. 14. Your patient is being inANS: A
duced because of her worsenBecause magnesium sulfate is a tocolyting preeclampsia. She is also
ic agent, its use may increase the dureceiving magnesium sulfate. It ration of labor. The amount of oxytocin
appears that her labor has not
needed to stimulate labor may be more
become active despite several
than that needed for the woman who is
hours of oxytocin administration. not receiving magnesium sulfate. "I don't
She asks the nurse, "Why is it tak- know why it is taking so long" is not an
ing so long?" The most appropri- appropriate statement for the nurse to
ate response by the nurse would make. Although the length of labor does
be:
vary in different women, the most likely
a.
reason this woman's labor is protracted
"The magnesium is relaxing your is the tocolytic effect of magnesium suluterus and competing with the fate. The behavior of the fetus has no
oxytocin. It may increase the du- bearing on the length of labor.
ration of your labor."
b.
"I don't know why it is taking so
long."
c.
"The length of labor varies for different women."
d.
"Your baby is just being stubborn."
15. 15. What nursing diagnosis
would be the most appropriate
ANS: A
Risk for injury to the fetus related to
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for a woman experiencing severe
preeclampsia?
a.
Risk for injury to the fetus related
to uteroplacental insufficiency
b.
Risk for eclampsia
c.
Risk for deficient fluid volume related to increased sodium retention secondary to administration
of MgSO4
d.
Risk for increased cardiac output
related to use of antihypertensive
drugs
uteroplacental insufficiency is the most
appropriate nursing diagnosis for this
client scenario. Other diagnoses include
Risk to fetus related to preterm birth
and abruptio placentae. Eclampsia is a
medical, not a nursing, diagnosis. There
would be a risk for excess, not deficient,
fluid volume related to increased sodium retention. There would be a risk for
decreased, not increased, cardiac output related to the use of antihypertensive
drugs.
16. 16. The nurse caring for pregnant
women must be aware that the
most common medical complication of pregnancy is:
a.
Hypertension.
c.
Hemorrhagic complications.
b.
Hyperemesis gravidarum.
d.
Infections.
ANS: A
Preeclampsia and eclampsia are two
noted deadly forms of hypertension. A
large percentage of pregnant women will
have nausea and vomiting, but a relatively few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common
medical complication of pregnancy; hypertension is the most common.
17. 17. 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, el-
ANS: C
The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and
low platelets (LP). HELLP syndrome is a
variant of severe preeclampsia. HELLP
syndrome is difficult to identify because
the symptoms often are not obvious. It
must be diagnosed in the laboratory.
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evated liver enzymes, and low
Preterm labor is greatly increased, and
platelets.
so is perinatal mortality.
d.
Is associated with preterm labor
but not perinatal mortality.
18. 18. Nurses should be aware that
chronic hypertension:
a.
Is defined as hypertension that
begins during pregnancy and
lasts for the duration of pregnancy.
b.
Is considered severe when the
systolic blood pressure (BP) is
greater than 140 mm Hg or the diastolic BP is greater than 90 mm
Hg.
c.
Is general hypertension plus proteinuria.
d.
Can occur independently of or
simultaneously with gestational
hypertension.
ANS: D
Hypertension is present before pregnancy or diagnosed before 20 weeks of gestation and persists longer than 6 weeks
postpartum. The range for hypertension
is systolic BP greater than 140 mm Hg
or diastolic BP greater than 90 mm Hg.
It becomes severe with a diastolic BP of
110 mm Hg or higher. Proteinuria is an
excessive concentration of protein in the
urine. It is a complication of hypertension, not a defining characteristic.
19. 19. In planning care for
women with preeclampsia, nurses should be aware that:
a.
Induction of labor is likely, as
near term as possible.
b.
If at home, the woman should be
confined to her bed, even with
mild preeclampsia.
c.
A special diet low in protein and
ANS: A
Induction of labor is likely, as near term
as possible; however, at less than 37
weeks of gestation, immediate delivery
may not be in the best interest of the
fetus. Strict bed rest is becoming controversial for mild cases; some women in
the hospital are even allowed to move
around. Diet and fluid recommendations
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salt should be initiated.
d.
Vaginal birth is still an option,
even in severe cases.
tein. Women with severe preeclampsia
should expect a cesarean delivery.
20. 20. Magnesium sulfate is given
to women with preeclampsia and
eclampsia to:
a.
Improve patellar reflexes and increase respiratory efficiency.
b.
Shorten the duration of labor.
c.
Prevent and treat convulsions.
d.
Prevent a boggy uterus and
lessen lochial flow.
ANS: C
Magnesium sulfate is the drug of choice
to prevent convulsions, although it can
generate other problems. Loss of patellar
reflexes and respiratory depression are
signs of magnesium toxicity. Magnesium
sulfate can increase the duration of labor.
Women are at risk for a boggy uterus and
heavy lochial flow as a result of magnesium sulfate therapy.
21. 21. Preeclampsia is a unique disease process related only to human pregnancy. The exact cause
of this condition continues to
elude researchers. The American College of Obstetricians and
Gynecologists has developed a
comprehensive list of risk factors associated with the development of preeclampsia. Which
client exhibits the greatest number of these risk factors?
a.
A 30-year-old obese Caucasian
with her third pregnancy
b.
A 41-year-old Caucasian primigravida
c.
An African-American client who
ANS: C
Three risk factors are present for this
woman. She is of African-American ethnicity, is at the young end of the age distribution, and has a multiple pregnancy.
In planning care for this client the nurse
must monitor blood pressure frequently and teach the woman regarding early warning signs. The 30-year-old client
only has one known risk factor, obesity.
Age distribution appears to be U-shaped,
with women less than 20 years and more
than 40 years being at greatest risk.
Preeclampsia continues to be seen more
frequently in primigravidas; this client is
a multigravida woman. Two risk factors
are present for the 41-year-old client.
Her age and status as a primigravida
put her at increased risk for preeclampsia. Caucasian women are at a low-
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is 19 years old and pregnant with
twins
d.
A 25-year-old Asian-American
whose pregnancy is the result of
donor insemination
er risk than African-American women.
The Asian-American client exhibits only
one risk factor. Pregnancies that result
from donor insemination, oocyte donation, and embryo donation are at an increased risk of developing preeclampsia.
22. 22. A woman presents to 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?
a.
Incomplete
c.
Threatened
b.
Inevitable
d.
Septic
ANS: C
A woman with a threatened abortion presents with spotting, mild cramps, and no
cervical dilation. A woman with an incomplete abortion would present with heavy
bleeding, mild to severe cramping, and
cervical dilation. An inevitable abortion
manifests with the same symptoms as
an incomplete abortion: heavy bleeding,
mild to severe cramping, and cervical
dilation. A woman with a septic abortion
presents with malodorous bleeding and
typically a dilated cervix.
23. 23. The perinatal nurse is givANS: B
ing discharge instructions to
This is an accurate statement. ²-Human
a woman after suction curetchorionic gonadotropin (hCG) levels will
tage secondary to a hydatidiform be drawn for 1 year to ensure that the
mole. The woman asks why she mole is completely gone. There is an inmust take oral contraceptives for creased chance of developing choriocarthe next 12 months. The best re- cinoma after the development of a hydasponse from the nurse would be: tidiform mole. The goal is to achieve a
a.
"zero" hCG level. If the woman were to
"If you get pregnant within 1 year, become pregnant, it could obscure the
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the chance of a successful pregnancy is very small. Therefore, if
you desire a future pregnancy, it
would be better for you to use the
most reliable method of contraception available."
b.
"The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only
by measuring the same hormone
that your body produces during
pregnancy. If you were to get
pregnant, it would make the diagnosis of this cancer more difficult."
c.
"If you can avoid a pregnancy for
the next year, the chance of developing a second molar pregnancy
is rare. Therefore, to improve your
chance of a successful pregnancy, it is better not to get pregnant
at this time."
d.
"Oral contraceptives are the only
form of birth control that will prevent a recurrence of a molar pregnancy."
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 is acceptable.
24. 24. The most prevalent clinical
manifestation of abruptio placentae (as opposed to placenta previa) is:
a.
Bleeding.
c.
Uterine activity.
b.
ANS: B
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.
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Intense abdominal pain.
d.
Cramping.
25. 25. Methotrexate is recommended as part of the treatment plan
for which obstetric complication?
a.
Complete hydatidiform mole
c.
Unruptured ectopic pregnancy
b.
Missed abortion
d.
Abruptio placentae
ANS: C
Methotrexate is an effective, nonsurgical
treatment option for a hemodynamically
stable woman whose ectopic pregnancy is unruptured and less than 4 cm in
diameter. Methotrexate is not indicated
or recommended as a treatment option
for complete hydatidiform mole, missed
abortion, and abruptio placentae.
26. 26. 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, what would be an
expected diagnostic procedure?
a.
Amniocentesis for fetal lung maturity
b.
Ultrasound for placental location
c.
Contraction stress test (CST)
d.
Internal fetal monitoring
ANS: B
The presence of painless bleeding
should always alert the health care team
to the possibility of placenta previa. This
can be confirmed through ultrasonography. Amniocentesis would not be performed on a woman who is experiencing
bleeding. In the event of an imminent
delivery, the fetus would be presumed to
have immature lungs at this gestational age, and the mother would be given
corticosteroids to aid in fetal lung maturity. A CST would not be performed at
a preterm gestational age. Furthermore,
bleeding would be a contraindication to
this test. Internal fetal monitoring would
be contraindicated in the presence of
bleeding.
27. 27. A laboring woman with no
ANS: B
known risk factors suddenly ex- Vasa previa is the result of a velamenperiences spontaneous rupture tous insertion of the umbilical cord. The
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of membranes (ROM). The fluid
consists of bright red blood. Her
contractions are consistent with
her current stage of labor. There
is no change in uterine resting
tone. The fetal heart rate begins
to decline rapidly after the ROM.
The nurse should suspect the
possibility of:
a.
Placenta previa.
b.
Vasa previa.
c.
Severe abruptio placentae.
d.
Disseminated intravascular coagulation (DIC).
umbilical vessels are not surrounded by
Wharton jelly and have no supportive
tissue. They 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 fetal
heart rate 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 would
be 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
would typically be tetanus (i.e., a boardlike uterus). DIC is a pathologic form
of diffuse clotting that consumes large
amounts of clotting factors and causes widespread external bleeding, internal bleeding, or both. DIC is always a
secondary diagnosis, often associated
with obstetric risk factors such as HELLP
syndrome. This woman did not have any
prior risk factors.
28. 28. A woman arrives for evaluation of her symptoms, which 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 and recognizes this assessment finding as:
a.
ANS: C
Cullen's sign, the blue ecchymosis
seen 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. It
manifests as a brown, pigmented, vertical line on the lower abdomen. Turner's
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Normal integumentary changes
associated with pregnancy.
b.
Turner's sign associated with appendicitis.
c.
Cullen's sign associated with a
ruptured ectopic pregnancy.
d.
Chadwick's sign associated with
early pregnancy.
sign is ecchymosis in the flank area, often associated with pancreatitis. Chadwick's sign is the blue-purple color of the
cervix that may be seen during or around
the eighth week of pregnancy.
29. 29. As related to the care of the
patient with miscarriage, nurses
should be aware that:
a.
It is a natural pregnancy loss before labor begins.
b.
It occurs in fewer than 5% of
all clinically recognized pregnancies.
c.
It often can be attributed to careless maternal behavior such as
poor nutrition or excessive exercise.
d.
If it occurs before the twelfth
week of pregnancy, it may manifest only as moderate discomfort
and blood loss.
ANS: D
Before the sixth week the only evidence
may be a heavy menstrual flow. After the
twelfth week more severe pain, similar
to that of labor, is likely. Miscarriage is a
natural pregnancy loss, but by definition
it occurs before 20 weeks of gestation,
before the fetus is viable. Miscarriages
occur in approximately 10% to 15% of all
clinically recognized pregnancies. Miscarriage can be caused by a number
of disorders or illnesses outside of the
mother's control or knowledge.
30. 30. Which condition would not be
classified as a bleeding disorder
in late pregnancy?
a.
Placenta previa.
c.
ANS: C
Spontaneous abortion is another name
for miscarriage; by definition it occurs
early in pregnancy. Placenta previa is a
cause of bleeding disorders in later pregnancy. Abruptio placentae is a cause
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Spontaneous abortion.
b.
Abruptio placentae.
d.
Cord insertion.
of bleeding disorders in later pregnancy.
Cord insertion is a cause of bleeding disorders in later pregnancy.
31. 31. In providing nutritional counseling for the pregnant woman
experiencing cholecystitis, the
nurse would:
a.
Assess the woman's dietary history for adequate calories and
proteins.
b.
Instruct the woman that the bulk
of calories should come from proteins.
c.
Instruct the woman to eat a
low-fat diet and avoid fried foods.
d.
Instruct the woman to eat a
low-cholesterol, low-salt diet.
ANS: C
Instructing the woman to eat a low-fat
diet and avoid fried foods is appropriate nutritional counseling for this client.
Caloric and protein intake do not predispose a woman to the development
of cholecystitis. The woman should be
instructed to limit protein intake and
choose foods that are high in carbohydrates. A low-cholesterol diet may be the
result of limiting fats. However, a low-salt
diet is not indicated.
32. 32. Which maternal condition always necessitates delivery by cesarean section?
a.
Partial abruptio placentae
c.
Ectopic pregnancy
b.
Total placenta previa
d.
Eclampsia
ANS: B
In total placenta previa, the placenta
completely covers the cervical os. The
fetus would die if a vaginal delivery occurred. If the mother has stable vital
signs and the fetus is alive, a vaginal delivery can be attempted in cases of partial abruptio placentae. If the fetus has
died, a vaginal delivery is preferred. The
most common ectopic pregnancy is a
tubal pregnancy, which is usually detected and treated in the first trimester. Labor
can be safely induced if the eclampsia is
under control.
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33. 33. Spontaneous termination of a
pregnancy is considered to be an
abortion if:
a.
The pregnancy is less than 20
weeks.
b.
The fetus weighs less than 1000
g.
c.
The products of conception are
passed intact.
d.
No evidence exists of intrauterine
infection.
ANS: A
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. A
spontaneous abortion may be caused by
many problems, one being intrauterine
infection.
34. 34. An abortion in which the fetus dies but is retained within the
uterus is called a(n):
a.
Inevitable abortion
c.
Incomplete abortion
b.
Missed abortion
d.
Threatened abortion
ANS: B
Missed abortion refers to 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 not cervical
dilation.
35. 35. A placenta previa in which
the placental edge just reaches
the internal os is more commonly
known as:
a.
Total
c.
Complete
b.
Partial
ANS: D
A placenta previa that does not cover
any part of the cervix is termed marginal.
With a total placenta previa, the placenta
completely covers the os. When the patient experiences a partial placenta previa, the lower border of the placenta is
within 3 cm of the internal cervical os but
does not completely cover the os. A complete placenta previa is termed total. The
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d.
Marginal
placenta completely covers the internal
cervical os.
36. 36. What condition indicates concealed hemorrhage when the patient experiences an abruptio placentae?
a.
Decrease in abdominal pain
c.
Hard, boardlike abdomen
b.
Bradycardia
d.
Decrease in fundal height
ANS: C
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 patient
will have shock symptoms that include
tachycardia. As bleeding occurs, the fundal height will increase.
37. 37. The priority nursing intervention when admitting a pregnant
woman who has experienced a
bleeding episode in late pregnancy is to:
a.
Assess fetal heart rate (FHR) and
maternal vital signs
b.
Perform a venipuncture for hemoglobin and hematocrit levels
c.
Place clean disposable pads to
collect any drainage
d.
Monitor uterine contractions
ANS: A
Assessment of the FHR and maternal
vital signs will assist the nurse in determining the degree of the blood loss and
its effect on the mother and fetus. The
most important assessment is to check
mother/fetal well-being. The blood levels
can be obtained later.
It is important to assess future bleeding; however, the top priority remains
mother/fetal well-being. Monitoring uterine contractions is important but not the
top priority.
38. 38. A patient with pregnancy-induced hypertension is admitted complaining of pounding
headache, visual changes, and
epigastric pain. Nursing care is
based on the knowledge that
ANS: B
Headache and visual disturbances are
caused by increased cerebral edema.
Epigastric pain indicates distention of the
hepatic capsules and often warns that a
convulsion is imminent. These are dan18 / 28
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these signs are an indication of:
a.
Anxiety due to hospitalization.
b.
Worsening disease and impending convulsion.
c.
Effects of magnesium sulfate.
d.
Gastrointestinal upset.
ger signs showing increased cerebral
edema and impending convulsion and
should be treated immediately. The patient has not been started on magnesium
sulfate treatment yet. Also, these are not
anticipated effects of the medication.
39. 39. Which order should the nurse ANS: A
expect for a patient admitted with Decreasing the woman's activity level
a threatened abortion?
may alleviate the bleeding and allow the
a.
pregnancy to continue. Ritodrine is not
Bed rest
the first drug of choice for tocolytic medb.
ications. There is no reason for having
Ritodrine IV
the woman placed NPO. At times dehyc.
dration may produce contractions, so hyNPO
dration is important. Narcotic analgesia
d.
will not decrease the contractions. It may
Narcotic analgesia every 3 hours, mask the severity of the contractions.
prn
40. 40. What finding on a prenatal vis- ANS: C
it at 10 weeks could suggest a
The uterus in a hydatidiform molar preghydatidiform mole?
nancy is often larger than would be exa.
pected on the basis of the duration of the
Complaint of frequent mild nau- pregnancy. Nausea increases in a molar
sea
pregnancy because of the increased prob.
duction of hCG. A woman with a molar
Blood pressure of 120/80 mm Hg pregnancy may have early-onset pregc.
nancy-induced hypertension. In the paFundal height measurement of 18 tient's history, bleeding is normally decm
scribed as brownish.
d.
History of bright red spotting for
1 day, weeks ago
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41. 41. A 32-year-old primigravida is
admitted with a diagnosis of ectopic pregnancy. Nursing care is
based on the knowledge that:
a.
Bed rest and analgesics are the
recommended treatment.
b.
She will be unable to conceive in
the future.
c.
A D&C will be performed to remove the products of conception.
d.
Hemorrhage is the major concern.
ANS: D
Severe bleeding occurs if the fallopian
tube ruptures. The recommended treatment is to remove the pregnancy before
rupture in order to prevent hemorrhaging. If the tube must be removed, the
woman's fertility will decrease; however,
she will not be infertile.
D&C is performed on the inside of the
uterine cavity. The ectopic pregnancy is
located within the tubes.
42. 42. Approximately 10% to 15% of
all clinically recognized pregnancies end in miscarriage. Which is
the most common cause of spontaneous abortion?
a.
Chromosomal abnormalities
c.
Endocrine imbalance
b.
Infections
d.
Immunologic factors
ANS: A
At least 50% of pregnancy losses result
from chromosomal abnormalities that
are incompatible with life. Maternal infection may be a cause of early miscarriage.
Endocrine imbalances such as hypothyroidism or diabetes are possible causes
for early pregnancy loss. Women who
have repeated early pregnancy losses
appear to have immunologic factors that
play a role in spontaneous abortion incidents.
43. 43. The nurse caring for a
woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve:
a.
Corticosteroids to reduce inflammation.
ANS: B
Initially, the woman who is unable to
keep down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids have been used successfully to
treat refractory hyperemesis gravidarum;
however, they are not the expected initial
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b.
IV therapy to correct fluid and
electrolyte imbalances.
c.
An antiemetic, such as pyridoxine, to control nausea and vomiting.
d.
Enteral nutrition to correct nutritional deficits.
treatment for this disorder. Pyridoxine is
vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be
prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via
a feeding tube may be necessary to correct maternal nutritional deprivation. This
is not an initial treatment for this patient.
44. 44. A client who has undergone
a dilation and curettage for early pregnancy loss is likely to
be discharged the same day.
The nurse must ensure that vital signs are stable, bleeding has
been controlled, and the woman
has adequately recovered from
the administration of anesthesia.
To promote an optimal recovery, discharge teaching should
include (Select all that apply):
a.
Iron supplementation.
b.
Resumption of intercourse at 6
weeks following the procedure.
c.
Referral to a support group if necessary.
d.
Expectation of heavy bleeding for
at least 2 weeks.
e.
Emphasizing the need for rest.
ANS: A, C, E
The woman should be advised to consume a diet high in iron and protein.
For many women iron supplementation
also is necessary. Acknowledge that the
client has experienced a loss, albeit early. She can be taught to expect mood
swings and possibly depression. Referral
to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the
need for rest. Nothing should be placed
in the vagina for 2 weeks after the procedure. This includes tampons and vaginal
intercourse. The purpose of this recommendation is to prevent infection. Should
infection occur, antibiotics may be prescribed. The client should expect a scant,
dark discharge for 1 to 2 weeks. Should
heavy, profuse, or bright bleeding occur,
she should be instructed to contact her
provider.
45. 45. The reported incidence of ec- ANS: A, B, D, E
topic pregnancy in the United
A missed period or spotting can easily be
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States has risen steadily over
the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and
damage. The popularity of contraceptive devices such as the
IUD has also increased the risk
for ectopic pregnancy. The nurse
who suspects that a patient has
early signs of ectopic pregnancy should be observing her for
symptoms such as (Select all that
apply):
a.
Pelvic pain
b.
Abdominal pain
c.
Unanticipated heavy bleeding
d.
Vaginal spotting or light bleeding
e.
Missed period
mistaken by the patient as early signs of
pregnancy. More subtle signs depend on
exactly where the implantation occurs.
The nurse must be thorough in her assessment because pain is not a normal
symptom of early pregnancy. As the fallopian tube tears open and the embryo
is expelled, the patient often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to
hypovolemic shock with minimal or even
no external bleeding. In about half of
women, shoulder and neck pain results
from irritation of the diaphragm from the
hemorrhage.
46. 16. When measuring the BP to ensure consistency and to
facilitate early detection of BP
changes consistent
with gestational hypertension,
the nurse should:
a. place the woman in a supine
position.
b. allow the woman to rest for at
least 15 minutes
before measuring her BP.
c. use the same arm for each BP
measurement.
d. use a proper sized cuff that
16. c; the woman should be seated or in
a lateral position,
she should rest for 5 to 10 minutes, and
the cuff
should cover 80% of the upper arm.
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covers at least 50% of
her upper arm.
47. 17. When caring for a woman with
mild preeclampsia, it
is critical that during assessment
the nurse is alert for
signs of progress to severe
preeclampsia. Progress to
severe preeclampsia would be indicated by which
one of the following assessment
findings?
a. Proteinuria of 31 or greater
b. Platelet level of 200,000/mm3
c. Deep tendon reflexes 21, ankle
clonus is absent
d. BP of 154/94 and 156/100, 6
hours apart
17. a; with severe preeclampsia, the
DTRs would be
more than 31 with possible ankle clonus;
the BP
would be more than 160/110; thrombocytopenia
with a platelet level less than150,000
mm3.
48. 18. A woman'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 fulfilling this
order the
nurse would implement which of
the following?
(Circle all that apply.)
a. Prepare a loading dose of 2 g of
magnesium sulfate
in 200 ml of 5% glucose in water
to be given
over 15 minutes.
b. Prepare the maintenance solution by mixing 40 g
of magnesium sulfate in 1000 ml
18. b, d, and f; the loading dose should
be an IV of 4 to
6 g diluted in 100 mL of intravenous fluid;
maternal
assessment should occur every 15 to 30
minutes and
FHR and UC continuously; respirations
should be
less than 12
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of lactated
Ringer's solution.
c. Monitor maternal vital signs, fetal heart rate
(FHR) patterns, and uterine contractions every
2 hours.
d. Expect the maintenance dose
to be approximately
2 g/hour.
e. Report a respiratory rate of 14
breaths or less
per minute to the primary health
care provider
immediately.
f. Recognize that urinary output
should be at least
25-30 ml per hour.
49. 19. The primary expected out19. b; magnesium sulfate is a CNS decome for care associated
pressant given to
with the administration of magne- prevent seizures.
sium sulfate would
be met if the woman exhibits
which of the following?
a. Exhibits a decrease in both
systolic and diastolic BP
b. Experiences no seizures
c. States that she feels more relaxed and calm
d. Urinates more frequently, resulting in a decrease
in pathologic edema
50. A woman has been diagnosed
with mild preeclampsia
and will be treated at home. The
nurse, in teaching
this woman about her treatment
20. b, d, and e; magnesium sulfate is
administered intravenously
in the hospital with severe preeclampsia;
a
clean catch, midstream urine specimen
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regimen for mild
preeclampsia, would tell her to do
which of the following?
(Circle all that apply.)
a. Check her respirations before
and after taking her
oral dose of magnesium sulfate
b. Place a dipstick into a
clean-catch sample of her
urine to test for protein
c. Reduce her fluid intake to four
to five 8-ounce
glasses each day
d. Do gentle exercises such as
hand and feet circles
and gently tensing and relaxing
arm and leg
muscles
e. Avoid excessively salty foods
f. Maintain strict bed rest in a quiet dimly lighted
room with minimal stimuli
should be
used to assess urine for protein using a
dipstick; fluid
intake should be 6 to 8 (8 oz.) glasses a
day along
with roughage to prevent constipation;
gentle exercise
improves circulation and helps preserve
muscle
tone and a sense of well-being; modified
bed rest
with diversional activities is recommended for mild
preeclampsia.
51. 21. A woman 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
care management
of this woman would include
which of the
following?
a. Administering labetalol to control nausea and
vomiting
21. b; labetalol is a beta blocker used for
hypertension;
oral hygiene is important when NPO and
after vomiting
episodes to maintain the integrity of oral
mucosa;
taking fluids between, not with, meals
reduces nausea,
thereby increasing tolerance for oral nutrition.
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b. Assessing the woman's urine
for ketones
c. Avoiding oral hygiene until the
woman is able to
tolerate oral fluids
d. Providing small frequent meals
consisting of
bland foods and warm fluids together once the
woman begins to respond to
treatment
52. 22. A primigravida at 10 weeks of
gestation reports
slight vaginal spotting without
passage of tissue and
mild uterine cramping. When examined, no cervical
dilation is noted. The nurse caring for this woman
would:
a. anticipate that the woman will
be sent home and
placed on bed rest with instructions to avoid stress
and orgasm.
b. prepare the woman for a dilation and curettage.
c. inform the woman that frequent
blood tests will
be required to check the level of
estrogen.
d. tell the woman that the doctor
will most likely
perform a cerclage to help her
maintain her
pregnancy.
22. a; the woman is experiencing a
threatened abortion;
therefore, a conservative approach is attempted
first; b reflects management of an inevitable and
complete or incomplete abortion; blood
tests for
HCG and progesterone levels would be
done; cerclage
or suturing of the cervix is done for recurrent,
spontaneous abortion associated with
premature
dilation of the cervix.
53.
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23. A woman is admitted through
the emergency room
with a medical diagnosis of ruptured ectopic pregnancy.
The primary nursing diagnosis at
this time
would be:
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
23. c; a, b, and d are appropriate nursing
diagnoses, but
deficient fluid is the most immediate concern, placing
the woman's well-being at greatest risk.
54. 24. A woman diagnosed with an
ectopic pregnancy is
given an intramuscular injection
of methotrexate. The
nurse would tell the woman
which of the following?
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. Follow-up blood tests will be
required every other
month for 6 months after the injection of the
methotrexate.
d. She should continue to take
24. b; methotrexate destroys rapidly
growing tissue, in
this case the fetus and placenta, to avoid
rupture of the
tube and need for surgery; follow-up with
blood tests
is needed for 2 to 8 weeks; alcohol and
vitamins containing
folic acid increase the risk for side effects
with
this medication or exacerbating the ectopic rupture.
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her prenatal vitamin
and folic acid to enhance healing.
55. 25. A pregnant woman at 32
weeks of gestation comes
to the emergency room because
she has begun to
experience bright red vaginal
bleeding. She reports
that she is experiencing no pain.
The admission
nurse suspects:
a. abruptio placentae.
b. disseminated intravascular coagulation.
c. placenta previa.
d. preterm labor.
25. c; the clinical manifestations of placenta previa are
described; dark red bleeding with pain is
characteristic
of abruptio placentae; massive bleeding
from
many sites is associated with DIC; bleeding is not a
sign of preterm labor.
56. 26. A pregnant woman, at 38
weeks of gestation diagnosed
with marginal placenta previa,
has just given
birth to a healthy newborn male.
The nurse recognizes
that the immediate focus for the
care of this
woman would be:
a. preventing hemorrhage.
b. relieving pain.
c. preventing infection.
d. fostering attachment of the
woman with her
new son.
26. a; hemorrhage is a major potential
postpartum
complication because the implantation
site of theplacenta is in the lower uterine
segment, which has a
limited capacity to contract after birth;
infection is
another major complication, but it is not
the immediate
focus of care; b and d are also important
but not
to the same degree as hemorrhage,
which is life
threatening.
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