Antepartum Pregnancy complications

Question 1

Prolapsed cord

Answer 1

when the umbilical cord descends before the fetus

Question 2

Prolapsed cord s/s

Answer 2

Abnormal FHR and pattern (bradycardia, absent, minimal variability and variable or prolonged decelerations)
Bleeding
Inadequate uterine relaxation (contractions)
Prolapsed cord may or may not be visible at the vaginal opening
Client may have a feeling that something is coming through the vagina
FHR is irregular and slow
Variable decelerations or bradycardia after ROM

Question 3

Prolapsed cord interventions

Answer 3

Goal: relieve cord compression to ensure fetus receive adequate oxygenation
Summon help. Do not leave client
Prepare for immediate birth
Give oxygen at 8-10 L/min to increase maternal concentration which in turn will make more oxygen available to the fetus
Terbutaline: rapid onset; inhibits contractions, increase blood flow and reduce the pressure of the fetus against the pelvis and the cord
Start IV fluids
If cord is protruding from vagina, wrap a warm sterile towel with normal saline
Position client so that the hips are higher than her head to shift the fetus and relieve the cord compression
o Knee-chest position
o Trendelenburg position
o Modified Sim’s position
Notify NICU to prepare for neonatal resuscitation
DO NOT attempt to push the cord into cervix because attempting to do so may cause trauma or vasospasm of the cord

Question 4

Placenta previa

Answer 4

when the placenta is near or cover the cervix

Question 5

placenta previa interventions

Answer 5

hysterectomy; no sex or vaginal delivery

for total placenta previa cesarean section is preferred because fetus would die with vaginal delivery

Question 6

placenta previa s/s

Answer 6

painless bright red bleeding

Question 7

Placenta abruptio

Answer 7

placenta is detaching from the uterus

Question 8

placenta abruptio s/s

Answer 8

agonizing pain and dark red bleeding

Bleeding accompanied by abdominal or lower back pain

Question 9

Group Beta Streptococcus

Answer 9

a type of bacteria that lives in the intestines, vagina and rectum

this bacteria can cause illness to newborns, pregnant women and elderly

Question 10

Treatment for GBS

Answer 10

Penicillin G or Ampicillin

Question 11

Gonorrhea s/s

Answer 11

increased vaginal discharge; Painful urination; Vaginal bleeding between periods, such as after vaginal intercourse; Abdominal or pelvic pain

Question 12

Gonorrhea

Answer 12

sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae.

Question 13

Gonorrhea Tx

Answer 13

ceftriaxone

Question 14

Syphillis

Answer 14

sexually transmitted disease caused by the bacterium Treponema pallidum

Question 15

Syphillis s/s

Answer 15

a primary lesion or “chancre” develops at the site of inoculation….
Chancre (lesion) major indicator
…progresses from papule to ulcer
Painless, indurated
Highly infectious and heals within 3-6 weeks
Can have multiple chancres - sometimes mimics herpes but lesions are larger and indurated(deep)
Regional lymphadenopathy

Question 16

Syphillis Tx

Answer 16

Benzathine penicillin G.

If allergic to penicillin, erythromycin will do

Question 17

Herpes Tx

Answer 17

Acyclovir

Question 18

Disseminated Intravascular Coagulation (DIC)

Answer 18

DIC (consumptive coagulopathy)
A life-threatening complication of missed abortion, abruptio placenta, and preeclampsia

Pro-coagulation and anti-coagulation factors are simultaneously activated.

The priority in treating DIC is delivery of the fetus and placenta
Blood replacement products and cryoprecipitate are administered to maintain circulating volume

Question 19

Monitoring for Signs of Hypovolemic Shock

Answer 19

Increased pulse rate, falling blood pressure, increased respiratory rate
Weak, diminished, or “thready” peripheral pulses
Cool, moist skin; pallor; or cyanosis (late sign)
Decreased urine output
Decreased hemoglobin and hematocrit
Change in mental status

Question 20

Preterm labor

Question 21

preterm labor Tx

Answer 21

Tocolytics:

1. terbutaline - monitor HR. DO NOT administer if mom bp > 110bpm
2. magnesium sulfate
3. indomethacin

Question 22

preterm labor interventions

Answer 22

administer tocolytics to stop contractions and labor

administer bethamethasone or dextamethsone to mom so that fetal lung can mature. 2 doses are given 24 hours apart

Question 23

toxoplasmosis

Question 24

Preeclampsia

Question 25

hyperemesis gravidarum

Question 26

ectopic pregnancy

Question 27

hydatidiform mole

Question 28

vena cava syndrome

Question 29

A client who is 23-weeks pregnant is having premature labor. She had SROM and is 4cm dilated . There are no signs of infection. The nurse anticipates that the provider will order which of these? Select all that apply

Answer 29

Terbutaline
Magnesium sulfate
Betamethasone IM.

Question 30

A pregnant woman has been receiving a magnesium sulfate infusion for the treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs : temperature o 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 war” What should I do?

Answer 30

Discontinue the magnesium sulfate infusion.

Question 31

A prenatal nurse is providing information to a group of pregnant clients regarding measure to prevent toxoplasmosis. Which statement is made by one of the clients indicates a need for further instructions?

Answer 31

I need to give my cat away until after the pregnancy

Do not touch cat litter

Coook raw meat thoroughly

Question 32

The client is admitted with the diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary health care provider is the highest priority for the nurse to complete?

Answer 32

Start intravenous with multivitamins

Question 33

Which of the following findings would the nurse expect to see when assessing a first-trimester gravida suspected of having the gestational trophoblastic (hydatidiform mole) that the nurse would not expect to see when assessing the first trimester gravida with a normal pregnancy. Select all that apply

Answer 33

“Snowstorm” pattern on ultrasound with no evidence of developing fetus
Rapid uterine growth
Severe nausea and vomiting

Question 34

Which nursing action must be initiated first when evidence of prolapsed cord is found?

Answer 34

Reposition the mother with her hips higher than her head.

Trendelenberg
Modified Sims
Knee chest

Question 35

Which action should be initiated to limit hypovolemic shock when uterine inversion occurs?

Answer 35

Increase the intravenous infusion rate.

Intravenous fluids are necessary to replace the lost blood volume that occurs in uterine
inversion. The woman may need blood products as well.

Question 36

What factor found in maternal history should alert the nurse to the potential for a prolapsed umbilical cord?

Answer 36

Presenting part at station –3

Because the fetal presenting part is positioned high in the pelvis and is not well applied to
the cervix, a prolapsed cord could occur if the membranes rupture. Hydramnios puts the
woman at high risk for a prolapsed umbilical cord. A very small fetus, normally preterm,
puts the woman at risk for a prolapsed umbilical cord.

Question 37

The nurse should suspect uterine rupture if

Answer 37

contractions abruptly stop during labor.

A large rupture of the uterus will disrupt its ability to contract.