Ch. 5 Complications During Pregnancy

Question 1

List at least four nursing interventions for the woman with hyperemesis gravidarum.

Answer 1

Maintain adequate intake and output. 
Avoid cooking odors.  
Carbohydrates are best tolerated. 
Drink liquids between meals. 
Eat frequently in small quantities.	
Sit upright after meals to reduce gastric reflux. 
Keep visual reminders of nausea, such as emesis basins, out of sight. 
Provide emotional support

Question 2

Placenta Previa: List the common signs to each of the following characteristics.

Pain
Bleeding
Fetal anemia or hypoxia
Consistency of the uterus
Blood coagulation
Risk for postpartum hemorrhage
Risk for postpartum infection

Answer 2

No unusual pain
Characteristics of bleeding: Bright red, obvious
Fetal anemia and/or hypoxia Fetus may lose some blood as vessels are disrupted with cervical dilation and effacement; maternal hypovolemia may reduce oxygen delivery to the fetus
Consistency of the uterus: No unusual contractions or irritability
No blood clotting abnormalities are expected
Risk for postpartum hemorrhage is higher because lower uterus does not have as much muscle to compress open vessels
Risk for postpartum infection is higher because placenta is implanted near vagina and organisms can easily ascend and infect it

Question 3

Placenta Abruptio: List the common signs to each of the following characteristics.

Pain
Bleeding
Fetal anemia or hypoxia
Consistency of the uterus
Blood coagulation
Risk for postpartum hemorrhage
Risk for postpartum infection

Answer 3

Bleeding is accompanied by pain; low uterine tenderness
Bleeding is often concealed behind the placenta with little external bleeding
Fetal anemia or hypoxia: some blood behind the placenta is fetal blood; maternal hypovolemia may reduce oxygen delivery to the fetus
Consistency of the uterus: frequent cramp like contractions
Blood coagulation: DIC may occur due to large clot behind the placenta with consumption of clotting factors
Risk for postpartum hemorrhage is higher because injured muscles at placenta site may not contract as well
Risk for postpartum infection is higher because injured tissue is more susceptible to microbial invasion

Question 4

What are some signs that suggest a possible seizure?

Answer 4

Signs that suggest a possible seizure include:
Abdominal and/or epigastric pain (related to liver edema, ischemia, and necrosis; precedes seizure; abruptio placentae is also more likely and may be cause of pain)
Persistent vomiting (may occur with hyperemesis gravidarum, but may also be caused by same mechanisms noted above)
Edema of face and hands (large excess of tissue fluid, although edema is not essential to diagnosis and may occur for many different reasons)
Severe persistent headache (brain edema and small hemorrhages; often precedes seizure)
Blurred vision or dizziness (arterial spasm and edema near retina; often precedes a convulsion)

Question 5

List 6 or more factors that increase a woman’s risk for development of GH.

Answer 5

First pregnancy 
Obesity 
Family history of gestational hypertension 
Age younger than 19 or older than 40 years 
Multi-fetal pregnancy 
Chronic hypertension 
Chronic renal disease 
Diabetes Mellitus

Question 6

Describe gestational hypertension in pregnancy.

Answer 6

Development of blood pressure ≥ 140/90 mm Hg in a

previously in a normotensive woman after 20 weeks; blood pressure returns to normal 6 weeks postpartum.

Question 7

Describe hypertension in preeclampsia

Answer 7

Includes proteinuria with hypertension

Question 8

Describe hypertension in eclampsia

Answer 8

Hypertension with ≥ 1 seizure

Question 9

Describe chronic hypertension

Answer 9

Existence of hypertension before 20 weeks of gestation or persistence for 6 weeks after birth, when gestational hypertension is expected to be resolved

Question 10

Describe preeclampsia with superimposed chronic hyptension

Answer 10

Hypertension that has a new occurrence of proteinuria, thrombocytopenia, and increased liver enzymes)

Question 11

What does the acronym HELLP

Answer 11

HELLP (includes proteinuria plus abnormalities of coagulation and liver studies)

Question 12

What blood pressure elevation is significant during pregnancy?

Answer 12

140/90 mm Hg or higher

Question 13

What is the benefit of activity restriction in treatment of preeclampsia?

Answer 13

Reduces blood flow to mother’s skeletal muscles, making more available to her vital organs and for perfusion of the placenta

Question 14

What observations are needed for a woman who is receiving magnesium sulfate as treatment for hypertension?

Answer 14

Edema; fluid leaves blood vessels abnormally and enters tissue spaces

Question 15

What drug should be on hand if a woman is receiving magnesium sulfate?

Answer 15

Calcium Gluconate

Question 16

Describe the manisfestations and cause of preeclampsia.

Answer 16

Hypertension (vasospasm)

Edema (fluid leaves blood vessels abnormally and enters tissue spaces)

Proteinuria (reduced blood flow to the kidneys)

Central nervous system changes such as severe headache or hyperactive reflexes (brain edema and small cerebral hemorrhages [severe])

Visual disturbances (arterial spasm and edema around retina [severe])

Reduced urine output (reduced blood flow to the kidneys)

Pulmonary edema (movement of fluid from vessels to lung tissue [severe])

Epigastric pain or nausea (liver edema, ischemia, and necrosis [severe])

Lab studies (liver enzymes elevated because of decreased circulation, edema, and small hemorrhages [severe]); coagulation abnormalities due to low platelet levels and accumulation of platelets at sites of vessel damage [severe]

Question 17

List 4 reasons in which RhoGam is indicated?

Answer 17

28 weeks of gestation
Within 72 hours of birth
After spontaneous abortion
Bleeding during pregnancy

Question 18

Which type of diabetes occurs only during pregnancy

Answer 18

gestational

Question 19

Describe the test used to screen for gestational diabetes.

Answer 19

The woman drinks 50 g of an oral glucose solution and fasting is not needed. In 1 hour, a blood sample is analyzed for glucose level.

Question 20

What is the normal glucose level in a woman who is pregnant?

Answer 20

The result should be less than 140 mg/dL. The test is done at 24–28 weeks gestation.

Question 21

What is the preferred drug used to control the blood glucose during pregnancy and Why?

Answer 21

Insulin; does not cross the placenta

Question 22

Describe how insulin requirements change during the course of pregnancy and after birth.

Answer 22

Insulin needs may be less during the first trimester due to the effect of nausea and vomiting on food intake. Insulin needs rise steadily throughout pregnancy but then fall dramatically after birth, often below the prepregnancy requirements.

Question 23

Why is urine testing performed in the management of diabetes of a pregnant woman?

Answer 23

To test for ketones, which might require an adjustment in diet or signal onset of infection

Question 24

What is the purpose of the biophysical profile?

Answer 24

The biophysical profile includes five evaluations associated with placental function : nonstress test, fetal breathing movements, fetal body movements, fetal tone, and volume of amniotic fluid.

Question 25

If a pregnant woman is not immune to rubella, what is the expected action?

Answer 25

Rubella vaccine can cross the placenta and could adversely affect the fetus. It can be given in the immediate postpartum period (2) and the woman should be advised not to become pregnant for at least 3 months.

Question 26

What is the most appropriate teaching for the woman who is prone to urinary tract infections?

Answer 26

Wiping front to back after toileting (1) reduces introduction of anal organisms into the bladder.

Question 27

If a woman has cardiac disease, what are the main risks to the fetus are related to?

Answer 27

poor oxygenation; If the mother’s heart cannot meet the demands of her own body, placental blood flow will be reduced, leading to fetal hypoxia

Question 28

Which fetal or neonatal problem should the nurse anticipate if a woman has persistent hyperemesis gravidarum?

Answer 28

Continual vomiting reduces calories available to the fetus. Overall small size is a greater risk with persistent hyperemesis gravidarum

Question 29

What are 3 reasons why a pregnant woman needs increased iron.

Answer 29

Increased blood volume b. Iron transfer to the fetus c. Cushion against the blood lost naturally at birth

Question 30

What type of foods are high in iron?

Answer 30

green leafy vegetables, whole or enriched grain products, nuts, blackstrap molasses, tofu, eggs, dried fruits

Question 31

What type of foods are high in folic acid?

Answer 31

Folic acid: green leafy vegetables, asparagus, green beans, fruits, whole grains, liver, legumes, yeast

Question 32

What type of foods are high in vitamin C?

Answer 32

Vitamin C: citrus, strawberries, cantaloupe, cabbage, green and red peppers, tomatoes, potatoes, green leafy vegetables

Question 33

What type of foods are good to take with an iron supplement and why?

Answer 33

Foods containing vitamin C may enhance iron absorption.

Question 34

What type of foods or drugs should be avoided at the time an iron supplement is taken and why?

Answer 34

Milk and high-calcium products such as antacids or calcium supplements inhibit absorption of the iron.

Question 35

Why should the nurse emphasize the importance of long-term follow-up care for the woman who has a hydatidiform mole?

Answer 35

to detect the occurrence of vesicles of hydatidiform mole that may undergo malignant change, leading to choriocarcinoma

Question 36

A pregnant patient tells the nurse that she has been nauseated and vomiting. How will the nurse explain that hyperemesis gravidarum is distinguished from morning sickness?

Answer 36

Hyperemesis gravidarum causes dehydration and electrolyte imbalances.

Rationale: Dehydration and electrolyte imbalances result from persistent nausea and vomiting associated with hyperemesis gravidarum. Dehydration impairs the perfusion to the placenta.

Question 37

A woman is 9 weeks pregnant and experiencing heavy bleeding and cramping. She reports passing some tissue. Cervical dilation is noted on examination. What is the most likely cause of these symptoms?

Answer 37

Incomplete abortion

Rationale: Signs and symptoms of an incomplete abortion are similar to those of an inevitable abortion, but some tissue is passed.

Question 38

The nurse finds a woman crying after she has undergone a dilation and evacuation (D&E) for a missed abortion. What is the most appropriate statement by the nurse?

Answer 38

“I’m here if you need to talk.”

Rationale: An effective technique when communicating with a woman experiencing pregnancy loss is to say, “I’m here if you need to talk.” The nurse listens and acknowledges the woman’s grief.

Question 39

A woman who is 8 weeks pregnant becomes concerned when she has light vaginal bleeding accompanied by abdominal pain. An ectopic pregnancy is confirmed by ultrasound. Which statement indicates that the woman understands the explanation of an ectopic pregnancy?

Answer 39

“The embryo is implanted in the fallopian tube.”

Rationale: Ectopic pregnancy occurs when the fertilized ovum is implanted outside of the uterine cavity.

Question 40

An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the entire cervical os. What does the nurse understand best describes this condition?

Answer 40

A total placenta previa describes a condition in which the placenta completely covers the cervical opening.

Rationale: A total placenta previa describes a condition in which the placenta completely covers the cervical opening.

Question 41

What symptom presented by a pregnant women is indicative of abruptio placentae?

Answer 41

Vaginal bleeding and back pain

Rationale: Bleeding accompanied by abdominal or lower back pain is a typical manifestation of abruptio placentae.

Question 42

What situation would concern the nurse about the presence of Rh incompatibility?

Answer 42

Rh-negative mother, Rh-positive fetus

Rationale: Rh incompatibility can occur only if the mother is Rh negative and the fetus is Rh positive.

Question 43

A primigravida in her first trimester is Rh negative. What will this woman receive to prevent anti-Rh antibodies from forming?

Answer 43

Rh immune globulin at 28 weeks and within 72 hours after the birth of an Rh-positive infant

Rationale: An Rh-negative woman would receive Rh immune globulin at 28 weeks of gestation and within 72 hours after the birth of an Rh-positive infant or abortion.

Question 44

A woman seeking prenatal care relates a history of macrosomic infants, two stillbirths, and polyhydramnios with each pregnancy. What does the nurse recognize these factors highly suggest?

Answer 44

Diabetes mellitus

Rationale: Large (macrosomic) infants over 9 pounds are linked to

Question 45

________________________ is the leading cause of perinatal infections that have a high mortality rate.

Answer 45

Group B streptococcus (GBS)

Rationale: Group B streptococcus (GBS) is a leading cause of perinatal infections that have a high neonatal mortality rate. The organism can be found in the woman’s rectum, vagina, cervix, throat, or skin.

Question 46

The nurse cautions that the consumption of as few as ________ alcoholic drink(s) during pregnancy can lead to the loss of fetal brain cells.

Answer 46

two

Rationale: Studies have shown that even as few as two alcoholic drinks consumed during pregnancy can cause loss of fetal brain cells. A drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of liquor.

Question 47

The nurse explains that ___________ is a procedure in which an incompetent cervix is sutured closed to prevent its opening when the fetus presses against it.

Answer 47

cerclage

Rationale: Cerclage is the procedure that sutures the cervix closed to prevent its opening when the fetus presses against it.

Question 48

A(n) _________________________________ consists of a group of five fetal assessments: fetal heart rate and reactivity (the NST), fetal breathing movements, fetal body movements, fetal tone (closure of the hand), and volume of amniotic fluid.

Answer 48

biophysical profile

Rationale: A biophysical profile consists of a group of five fetal assessments: fetal heart rate and reactivity (the NST), fetal breathing movements, fetal body movements, fetal tone (closure of the hand), and volume of amniotic fluid.

Question 49

The nurse educates prenatal patients about the threat of TORCH infections. Which infections are included in this classification? (Select all that apply.)

Answer 49

Toxoplasmosis
Cytomegalovirus
Rubella
Herpes simplex

Rationale: The TORCH infections are toxoplasmosis, rubella, cytomegalovirus, and herpes simplex.

Question 50

The nurse is preparing a pregnant patient for an abdominal ultrasound at 8 weeks’ gestation. What intervention will the nurse implement before this diagnostic test?

Answer 50

Encourage the patient to drink 1 to 2 quarts of water before the test.

Rationale: Ultrasound uses high-frequency sound waves to visualize structures within the body; the examination may use a transvaginal probe or an abdominal transducer; abdominal ultrasound during early pregnancy requires a full bladder for proper visualization (have the woman drink 1 to 2 quarts of water before the examination

Question 51

A(n) _________________________________ consists of a group of five fetal assessments: fetal heart rate and reactivity (the NST), fetal breathing movements, fetal body movements, fetal tone (closure of the hand), and volume of amniotic fluid.

Answer 51

biophysical profile

Rationale: A biophysical profile consists of a group of five fetal assessments: fetal heart rate and reactivity (the NST), fetal breathing movements, fetal body movements, fetal tone (closure of the hand), and volume of amniotic fluid.

Question 52

The nurse is caring for a prenatal patient diagnosed with a placenta previa. What is the best position for this patient?

Answer 52

On her side to prevent supine hypotension

Rationale: The prenatal patient with placenta previa is best placed on her side with a pillow for support. This position not only reduces stress on the placenta but also reduces the possibility of supine hypotension.

Question 53

The nurse is obtaining history and physical information on a new patient attending her first prenatal visit. After recording current height, weight, and BMI, it is determined that the patient is obese. What complications related to obesity will the nurse assess this patient for during pregnancy? (Select all that apply.)

Answer 53

Gestational diabetes
Hypertension
Pre-eclampsia

Rationale: The obese woman who is pregnant has a high risk for developing complications during pregnancy such as gestational diabetes, hypertension, cardiac problems, pre-eclampsia, and respiratory problems.

Question 54

The nurse teaches a woman who is 8 weeks pregnant about how rubella can affect the developing fetus. What can result from maternal rubella during pregnancy?

Answer 54

Mental retardation

Rationale: Rubella can have devastating effects on the developing fetus. Some effects of rubella on the embryo or fetus include microcephaly, mental retardation, cardiac defects, cataracts, and deafness.

Question 55

The nurse is caring for a pregnant woman receiving an intravenous infusion with magnesium sulfate. What is the most appropriate nursing intervention?

Answer 55

Count respirations and report a rate of less than 12 breaths/min.

Rationale: Excessive magnesium sulfate may cause respiratory depression.

Question 56

The nurse is obtaining history and physical information on a new patient attending her first prenatal visit. After recording current height, weight, and BMI, it is determined that the patient is obese. What complications related to obesity will the nurse assess this patient for during pregnancy? (Select all that apply.)

Answer 56

Gestational diabetes
Hypertension
Pre-eclampsia

Rationale: The obese woman who is pregnant has a high risk for developing complications during pregnancy such as gestational diabetes, hypertension, cardiac problems, preeclampsia, and respiratory problems.

Question 57

The nurse teaches a woman who is 8 weeks pregnant about how rubella can affect the developing fetus. What can result from maternal rubella during pregnancy?

Answer 57

Mental retardation

Rationale: Rubella can have devastating effects on the developing fetus. Some effects of rubella on the embryo or fetus include microcephaly, mental retardation, cardiac defects, cataracts, and deafness.

Question 58

The nurse is caring for a macrosomic newborn of a diabetic patient. What complications will the nurse assess for in the newborn?

Answer 58

Hypoglycemia

Rationale: The fetus responds to the hyperglycemia from the mother’s blood and produces increased insulin. This insulin may cause hypoglycemia in the infant after it is no longer exposed to the mother’s blood.

Question 59

A patient who is 28 weeks pregnant presents with consistent hypertension. What need would the home health nurse make the first priority?

Answer 59

Activity restriction

Rationale: Bed rest reduces the flow of blood to skeletal muscles, making more blood available to the placenta and enhancing fetal oxygenation.

Question 60

What will the nurse begin with when asking a patient about drug use during a prenatal history?

Answer 60

“What over-the-counter and prescription drugs have you taken in the past 3 months?”

Rationale: Screening for drug use should begin in a nonthreatening way by asking about prescription and OTC medications and how the information can help provide safe and appropriate prenatal care.

Question 61

A nurse is providing prenatal education. The nurse will explain that pregnancy affects glucose metabolism in what way?

Answer 61

Insulin cells cannot meet the body’s demands as the woman’s weight increases.

Rationale: Hormones and enzymes produced by the placenta increase the resistance of cells to insulin.

Question 62

What drug will the nurse plan to have available for immediate IV administration whenever magnesium sulfate is administered to a maternity patient?

Answer 62

Calcium gluconate

Rationale: Calcium gluconate reverses the effects of magnesium sulfate and should be available for immediate use when a woman receives magnesium sulfate.

Question 63

A pregnant woman comes to the clinic stating that she has been exposed to hepatitis B. She is afraid that her infant will also contract hepatitis B. What will the nurse explain to this woman?

Answer 63

The infant will be given a single dose of hepatitis immune globulin after birth.

Rationale: The infant will be given immune globulin immediately after birth for temporary immunity followed by hepatitis B vaccine. Immunization is not recommended for women who are pregnant.

Question 64

A nurse is providing prenatal education. The nurse will explain that pregnancy affects glucose metabolism in what way?

Answer 64

Insulin cells cannot meet the body’s demands as the woman’s weight increases.

Rationale: Hormones and enzymes produced by the placenta increase the resistance of cells to insulin.

Question 65

The nurse assesses a pregnant woman for pregnancy-induced hypertension. What is the first sign of fluid retention suggestive of this complication?

Answer 65

Sudden weight gain

Rationale: Sudden, excessive weight gain is the first sign of fluid retention; facial swelling and swelling of the feet, legs, and hands follow weight gain.

Question 66

A woman who is 35 weeks pregnant has a total placenta previa. She asks the nurse, “Will I be able to deliver vaginally?” What explanation by the nurse is the most appropriate?

Answer 66

“A cesarean section is performed when the mother has a total placenta previa.”

Rationale: A cesarean delivery is done for a partial or total placenta previa.

Question 67

The nurse is caring for a pregnant woman diagnosed with preeclampsia. What will the nurse explain is the objective of magnesium sulfate therapy for this patient?

Answer 67

To prevent convulsions

Rationale: Magnesium sulfate is a central nervous system depressant given to prevent seizures.

Question 68

Why does the woman taking oral hypoglycemic agents to control diabetes mellitus need to take insulin during pregnancy?

Answer 68

Insulin does not cross the placental barrier to the fetus

Rationale: Oral hypoglycemic agents are not used during pregnancy because they can cross the placenta, possibly resulting in fetal birth defects or hypoglycemia.

Question 69

What would the nurse include in a teaching plan for the pregnant patient who has iron deficiency anemia and has been placed on iron supplements? (Select all that apply.)

Answer 69

Citrus fruits enhance absorption of iron.
The iron therapy will continue for about 3 months.
Tea should be avoided while taking iron.

Rationale: Calcium, bran, and milk interfere with the absorption of iron. Vitamin C helps with the absorption of iron, the therapy usually lasts 3 months, and the tannic acid in tea does interfere with the absorption of iron.

Question 70

The nurse emphasizes to a patient with a high-risk pregnancy that the impact of such a pregnancy might result in which problems? (Select all that apply.)

Answer 70

Disruption of family roles
Financial pressures
Frustration with activity restriction
Alteration in child care practices

Rationale: High-risk pregnancies may produce problems such as disruption of family roles, financial pressures, delayed attachment to the infant, alteration in child care practices, and frustration with activity restriction.

Question 71

The young prenatal patient with gestational diabetes mellitus (GDM) says, “I am frightened that I will have to deal with insulin injections for the rest of my life.” What is the best response by the nurse?

Answer 71

“It will most likely resolve 6 weeks or so after the baby is born.”

Rationale: GDM usually resolves by 6 weeks after delivery.

Question 72

A patient with gestational hypertension is exhibiting all of the signs below. What should the nurse report immediately?

Answer 72

Blurred vision

Rationale: Visual disturbances indicate worsening pregnancy-induced hypertension and must be reported promptly for effective intervention to prevent preeclampsia and convulsion.

Question 73

A nurse is providing prenatal education. The nurse will explain that pregnancy affects glucose metabolism in what way?

Answer 73

Placental hormones increase the resistance of cells to insulin.

Rationale: Hormones and enzymes produced by the placenta increase the resistance of cells to insulin.

Question 74

What maternal sign or symptom is most characteristic of hypovolemic shock associated with blood loss in a pregnant woman?

Answer 74

Weak pulse that increased in rate; A rising pulse and falling blood pressure are characteristic in a woman with hypovolemic shock from blood loss. If she is pregnant, the fetal heart rate often rises initially.

Question 75

What assessment should be promptly reported to the physician when a woman is being observed in the emergency department for possible ectopic pregnancy

Answer 75

decreased urine output to 20 mL/hr; Signs of hypovolemia from ectopic pregnancy, characterized by initially reduced urine output

Question 76

Why should the nurse should emphasize the importance of long-term follow up care for the woman who has a hydatididform mole?

Answer 76

the occurrence of a choriocarcinoma; Vesicles of hydatidiform mole may undergo malignant change, leading to choriocarcinoma

Question 77

What is a major difference between abruptio placentae and placenta previa?

Answer 77

Abruptio placentae is characterized by dark or concealed bleeding, while placenta previa is marked by profuse bleeding.

Question 78

What test should the nurse expect in a woman who is being admitted to the hospital with painless vaginal bleeding at 36 weeks of gestation?

Answer 78

Percutaneous umbilical blood sampling serves to obtain a fetal blood sample from a placental vessel or from the umbilical cord; this may be used to give a blood transfusion to an anemic fetus. Ultrasound examination identifies placental location, which is important because third trimester bleeding is often due to placenta previa or abruptio placentae. Placenta previa can be diagnosed with ultrasound, although it is not as reliable for abruptio placentae.

Question 79

Why should a woman who is being hospitalized with severe preeclampsia be closely observed?

Answer 79

Severe preeclampsia may progress to eclampsia, manifested by occurrence of one or more seizures

Question 80

What should be included in the teaching of a woman who has an active herpes virus infection during pregnancy?

Answer 80

Herpes virus infection rarely crosses the placenta, but the fetus can acquire infection if born when lesions are in or near the vagina. An antiviral will be given. Thus, cesarean birth may be done for active herpes virus infection at the time of birth.

Question 81

A woman diagnosed with gestational DM, what information should the nurse include?

Answer 81

The pregnant woman must check blood glucose levels several times each day to keep her glucose levels as close to normal as possible

Question 82

What nursing intervention can improve circulation to the placenta in a pregnant woman who has been in a serious car accident?

Answer 82

Place a pillow or similar object under one hip tilts her uterus off the great vessels, improving blood return to her heart and circulation to the placenta

Question 83

You are helping to care for a woman receiving mg sulfate. You note urine output 20 mg/hr. What is the significant finding of your observation? What is the appropriate action? Why?

Answer 83

Magnesium is excreted by the kidneys. If administration continues, yet the kidneys are not excreting the drug, a buildup to toxic levels may occur. The early manifestations of a too high magnesium level is depressed reflexes, followed by depressed respiration. If not corrected, collapse and death may occur from depression of cardiac function. An LPN/LVN should promptly bring the low urine output to the attention of an RN so that the administration of magnesium can be stopped and the blood level, reflexes, and respiratory status can be assessed.