CH 29 Care of High Risk Mother Test 2

Question 1

A patient is admitted to the hospital with hyperemesis gravidarum. The patient is malnourished and severely dehydrated. The care plan should be altered to include which interventions?
a. Hyperalimentation
b. IV fluids and electrolyte replacement
c. Hormone replacement therapy
d. Vitamin supplements

Answer 1

ANS: B
Medical treatment is aimed at meeting fluid and electrolyte replacement.

Question 2

A patient with hyperemesis gravidarum asks the nurse what would have happened if she had not come to the hospital. What result is the best response by the nurse?
a. A large for gestational age infant
b. Anorexia nervosa
c. Preterm delivery
d. Maternal or fetal death

Answer 2

ANS: D
If untreated, hyperemesis gravidarum can result in maternal or fetal death.

Question 3

How should twins who share a placenta and come from one fertilized ovum be identified?
a. Dizygotic
b. Trizygotic
c. Genetically different
d. Monozygotic

Answer 3

ANS: D
Monozygotic twins, also known as identical twins, originate from one fertilized ovum and share a placenta. Monozygotic twins carry the same genetic code. Dizygotic twins are the result of two separate ova being fertilized at the same time.

Question 4

What complication of delivery should the nurse expect with the birth of multiple fetuses?
a. An ectopic tendency
b. Difficulty with breast-feeding
c. A vaginal delivery
d. Loss of uterine tone

Answer 4

ANS: D
Delivery of multiple fetuses is often complicated by loss of uterine tone. Oftentimes multiple fetuses are delivered by cesarean. An ectopic tendency would present before delivery. While it can be difficult to breastfeed multiple infants, this does not relate to the delivery.

Question 5

A patient is admitted to the hospital with signs of an ectopic pregnancy. What should the plan of care include for the patient?
a. Long-term bed rest
b. Episodes of extreme hypertension
c. Surgery to remove the embryo/fetus
d. Treatment for dehydration

Answer 5

ANS: C
An ectopic implantation occurs somewhere outside the uterus and either resolves itself in a spontaneous abortion or requires surgical intervention.

Question 6

What percent of first-trimester pregnancies spontaneously abort?
a. 5% to 10%
b. 10% to15%
c. 20% to 25%
d. 40% to 50%

Answer 6

ANS: B
It is estimated that 10% to 15% of first-trimester pregnancies end in spontaneous abortion.

Question 7

What symptom, no matter what stage of pregnancy, should be reported immediately?
a. Backache
b. Urinary frequency
c. Vaginal bleeding
d. Uterine tightening

Answer 7

ANS: C
Women should be instructed to contact their health care provider if any bleeding occurs during pregnancy.

Question 8

A patient in her second trimester of pregnancy arrives at the hospital complaining of bright red, painless vaginal bleeding. What condition should the nurse immediately suspect?
a. Abruptio placentae
b. Hemorrhage
c. Placenta previa
d. Placentitis

Answer 8

ANS: C
Placenta previa is a serious condition that consists of bright red painless vaginal bleeding occurring after 20 weeks of pregnancy. The major symptoms of abruptio placentae are severe abdominal pain and uterine rigidity.

Question 9

A pregnant woman comes to the hospital 3 weeks before her estimated date of birth (EDB) complaining of severe pain and a rigid abdomen. What should the nurse immediately suspect as the cause of the pain?
a. Placenta previa
b. Appendicitis
c. Ectopic pregnancy
d. Abruptio placentae

Answer 9

ANS: D
The major symptoms of abruptio placentae are severe pain and a rigid abdomen. Placenta previa consists of painless bleeding. Appendicitis is not usually accompanied by a rigid abdomen. Symptoms of an ectopic pregnancy would usually occur in the first trimester.

Question 10

A patient presents with symptoms of abruptio placentae. To facilitate uterine-placental perfusion, in what position would the nurse place the patient?
a. Prone position
b. Trendelenburg’s position
c. Supine position
d. Modified side-lying position

Answer 10

ANS: D
A modified side-lying position facilitates uterine-placental perfusion.

Question 11

A pregnant woman visits a clinic visit during her 21st week of pregnancy. The nurse identifies edema, hypertension, and proteinuria. What condition does the nurse suspect?
a. Allergy
b. Protein deficiency
c. Circulatory problem
d. Gestational hypertension

Answer 11

ANS: D
Gestational hypertension (GH), formerly referred to as pregnancy-induced hypertension (PIH), is a disease encountered during pregnancy or early in the puerperium, characterized by increasing hypertension, proteinuria, and generalized edema. These signs generally appear after the 20th week of pregnancy.

Question 12

What condition is a possible cause of gestational hypertension?
a. Too much salt
b. A toxin
c. Renal disease
d. Diabetes

Answer 12

ANS: C
Gestational hypertension may be caused by other existing conditions, such as renal disease.

Question 13

What should the nurse hope to identify by keeping a record of a patient’s blood pressure during prenatal visits?
a. Ketoacidosis
b. Placenta previa
c. Gestational diabetes
d. Gestational hypertension

Answer 13

ANS: D
Blood pressure should be assessed routinely during pregnancy, because symptoms of gestational hypertension include hypertension.

Question 14

The nurse is assessing a “kick count” for a patient with gestational hypertension. What result should be a cause for concern?
a. Less than three kicks per hour
b. Less than five kicks per hour
c. Less than seven kicks per hour
d. Less than nine kicks per hour

Answer 14

ANS: A
A kick count of fewer than three per hour is considered serious and a cause for concern.

Question 15

When discussing toxoplasmosis infection during pregnancy, what should the nurse caution the patient to avoid?
a. Contacting with an infected person
b. Emptying cat litter boxes bare-handed
c. Having unprotected sex
d. Eating excessive amounts of shellfish

Answer 15

ANS: B
A pregnant woman should wear gloves whenever having contact with cat feces as this is a possible source of toxoplasmosis infection.

Question 16

What is a major complication of gestational diabetes that affects the infant?
a. Lack of nutrition
b. Dehydration
c. Hypoglycemia
d. Hyperglycemia

Answer 16

ANS: C
A result of gestational diabetes is neonatal hypoglycemia.

Question 17

A pregnant patient who has type 2 diabetes (NIDDM) may require insulin. Why is the insulin necessary?
a. The growing baby will require more glucose.
b. Oral hypoglycemic agents may be teratogenic.
c. Increased hormone levels raise blood glucose.
d. Oral hypoglycemics do not reach the fetus.

Answer 17

ANS: B
Oral hypoglycemics are discontinued because of teratogenic effects.

Question 18

Why is the fetus dependent on the mother for glucose control?
a. The insulin requirements are higher.
b. Insulin is destroyed by the placenta.
c. Insulin does not cross the placenta.
d. Insulin is absorbed by the fetus.

Answer 18

ANS: C
Insulin will not cross the placenta, but high glucose levels do. Therefore, it is imperative that the mother control glucose levels.

Question 19

A patient with a history of rheumatic heart disease is being admitted to the labor and delivery unit. To prevent further stress on the heart, what should the nurse anticipate to be ordered?
a. Oxygen administration
b. Administering large amount of IV fluids
c. Positioning the patient on her back
d. Encouraging activity between contractions

Answer 19

ANS: A
Oxygen is administered to increase blood oxygen saturation and decrease the stress on the heart. IV fluid administration is kept to a minimum to prevent fluid overload. The patient would be positioned in a semi-Fowler’s position to improve circulation. The patient should be encouraged to rest between contractions to conserve energy.

Question 20

A 14-year-old pregnant adolescent arrives at the hospital in early labor. The nurse should recognize that the adolescent is at a greater risk for which problem?
a. Calcium deficit
b. Cephalopelvic disproportion
c. Bleeding tendency
d. Low hemoglobin levels

Answer 20

ANS: B
There are several physiologic concerns for pregnant adolescents, including cephalopelvic disproportion.

Question 21

When should the gestational age of the infant be determined?
a. Within 5 to 10 minutes of delivery
b. Within 1 to 2 hours of delivery
c. Within 2 to 8 hours of delivery
d. Within 12 to 24 hours of delivery

Answer 21

ANS: C
The gestational age tests are done within 2 to 8 hours of delivery.

Question 22

The newborn infant has oxygenation problems and a lack of subcutaneous fat. What should the nurse determine as the gestational age of this infant?
a. 20 to 37 completed weeks of pregnancy
b. 38 to 41 completed weeks of pregnancy
c. 14 to 36 completed weeks of pregnancy
d. 42 or more completed weeks of pregnancy

Answer 22

ANS: A
The lungs of preterm infants have not fully developed; therefore, they have problems with oxygenation. Preterm infants also lack subcutaneous fat. The gestational age of the preterm is classified as 20 to 37 complete weeks of pregnancy.

Question 23

Compared to older infants of comparable weight, how much higher is the morbidity and mortality rate for preterm infants?
a. One to two times
b. Two to three times
c. Three to four times
d. Four to five times

Answer 23

ANS: C
The morbidity and mortality rate for preterm infants is higher by three to four times that of an older infant of similar weight.

Question 24

A neonate is born with weak muscle tone, froglike extremities, and ears that fold easily. From these observations, what gestational age should the nurse give this infant?
a. Full term
b. Small for gestational age
c. Preterm
d. Postterm

Answer 24

ANS: C
Preterm infant posture is froglike, the muscle tone is weak, and the ears are easily folded.

Question 25

A primigravida is Rh negative and her husband is Rh positive. She is concerned about the health of the fetus. The nurse explains that there is little danger to the fetus if it is Rh positive; however, the mother would become sensitized during delivery. If this were the case, the mother would produce what in subsequent pregnancies? a. Rh-negative blood cells b. Rh-positive blood cells c. Rh-negative antibodies d. Rh-positive antibodies

Answer 25

ANS: D If the mother is exposed to the Rh antigen, Rh-positive antibodies will be produced after delivery of an Rh-positive baby. If the baby is Rh negative, no antibodies will be produced.

Question 26

The nurse assures a patient who has become sensitized to the Rh antigen that she can be protected for future pregnancies by receiving what injection? a. Iron b. Vitamin B12 c. RhoGAM d. Type O blood

Answer 26

ANS: C RhoGAM prevents the development of naturally occurring maternal antibodies.

Question 27

The nurse is assessing the newborn and discovers a yellowing of the skin. What is true for jaundice that appears at birth? a. Within normal limits b. Pathologic c. A result of iron deficiency d. Indicating possible hepatitis

Answer 27

ANS: B Jaundice observed at birth is considered an indicator of a pathologic condition, erythroblastosis fetalis. It is conside red abnormal.

Question 28

What test is used to identify the maternal level of Rh antibodies in the mother’s blood? a. Indirect Coombs’ test b. Hemolytic test c. Rh antibody test d. Direct Coombs’ test

Answer 28

ANS: A The indirect Coombs’ test measures the maternal level of antibodies.

Question 29

A nursery nurse is implementing phototherapy for a jaundiced infant. What is the purpose of the phototherapy? a. It is initiated when the bilirubin level reaches 5 mg/dL. b. It converts bilirubin to a water-soluble form to be excreted in the urine. c. It changes bilirubin to a bile salt to be excreted through the bowel. d. It requires eye patches to remain in place 24 hours a day.

Answer 29

ANS: B Phototherapy converts the bilirubin into a water-soluble form to be excreted by the kidneys. It is initiated when the bilirubin level reaches 12 to 15 mg/dL. The eye patches are worn during therapy, but removed for feeding, bathing, and socialization.

Question 30

Why do alcohol and illegal drugs endanger the fetus? a. Both are absorbed into the bloodstream. b. Both affect the mother. c. Both cross the placental barrier. d. Both increase the heart rate of the fetus.

Answer 30

ANS: C Alcohol and illicit drugs cross the placental barrier and affect the fetus.

Question 31

Cognitive impairment, facial abnormalities, and growth retardation are characteristics of which abnormality in a fetus? a. Fetal dependency b. Fetal immaturity c. Malnutrition dependency d. Fetal alcohol syndrome

Answer 31

ANS: D Use of alcohol may result in multiple anomalies called fetal alcohol syndrome. The fetus may also be born with alcohol dependency and immaturity, but the characteristics noted are specific for fetal alcohol syndrome.

Question 32

What should be specifically monitored in a patient who is hospitalized with gestational hypertension? a. Blood sugar b. Temperature c. Level of consciousness d. Deep tendon reflexes

Answer 32

ANS: D If the patient is hospitalized for gestational hypertension, deep tendon reflexes are monitored. The blood sugar, temperature, and LOC will also be monitored, but they are not the priority in the hypertensive patient.

Question 33

What is the antidote for magnesium sulfate toxicity? a. Vitamin K b. Calcium gluconate c. Potassium sulfate d. Calcium carbonate

Answer 33

ANS: B The antidote for magnesium sulfate toxicity is calcium gluconate.

Question 34

What is a prominent feature of postpartum depression? a. Failure to thrive b. Rejection of the infant c. Inability to care for the baby d. Problems with the baby’s father

Answer 34

ANS: B A prominent feature of PPD is rejection of the infant.

Question 35

What is the usual treatment for severe postpartum depression? a. Improved nutrition b. Vitamin therapy c. Pharmacologic interventions d. Support group therapy

Answer 35

ANS: C Support therapy is not enough for major PPD. Pharmacologic interventions are needed in most instances.

Question 36

A pregnant patient with tuberculosis asks the nurse how the disease will affect her pregnancy and her newborn. What statements by the nurse are most appropriate? (Select all that apply.) a. “You have nothing to worry about. You will be disease free before you deliver.” b. “The tuberculosis can be transmitted to the fetus in rare occurrences.” c. “Your newborn will be tested for tuberculosis after delivery.” d. “There is no approved treatment for the infant if she tests positive for the disease.” e. “You will not be able to hold your newborn until you have been cleared according to the health department guidelines.”

Answer 36

ANS: B, C, E TB can be transmitted to a fetus in the womb. Newborns of infected mothers are skin tested for TB after birth and treated if the skin test is positive. Mothers who have TB are not allowed to have exposure to their newborn until they have been cleared according to the health department standards.