chapter-14 pregnancy risk gestational issues

Question 1

Which is true about women who experience hyperemesis gravidarum?
a. Seventy percent of all pregnant women suffer from it at some point in pregnancy.
b. Such women have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.
c. They need intravenous (IV) fluid and nutrition for most of their pregnancy.
d. They often inspire similar, milder symptoms in their male partners and mothers.

Answer 1

b

Question 2

What should the nurse be aware of in relation to women who may need surgery during pregnancy?
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. When pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses.

Answer 2

A

Question 3

Which laboratory result is indicative of disseminated intravascular coagulation (DIC)?
a. Increased platelets
b. Decreased fibrinogen
c. Increased factor V
d. Decreased fibrin degradation fragment

Answer 3

B

Question 4

In caring for an immediate postpartum patient, the nurse notes petechiae and oozing from her IV site. Based on this assessment, what clotting disorder would the nurse monitor this patient closely for?
a. Disseminated intravascular coagulation (DIC)
b. Amniotic fluid embolism (AFE)
c. Hemorrhage
d. HELLP syndrome

Answer 4

A

Question 5

In caring for the woman with disseminated intravascular coagulation (DIC), which order should the nurse anticipate?
a. Administration of blood
b. Preparation of the patient for invasive hemodynamic monitoring
c. Restriction of intravascular fluids
d. Administration of steroids

Answer 5

A

Question 6

Which finding is of concern in a primigravida that is being monitored in the prenatal clinic for pre-eclampsia?
a. Blood pressure (BP) increase to 138/86 mm Hg
b. Weight gain of 0.5 kg during the past 2 weeks
c. Urine protein reading of 0.05 g/L on two occasions
d. Pitting pedal edema at the end of the day

Answer 6

C

Question 7

The labour of a pregnant woman with pre-eclampsia is going to be induced. Before initiating the oxytocin infusion, the nurse reviews the woman’s latest laboratory test findings, which reveal a platelet count of 96 x 109/L, an elevated aspartate transaminase (AST) level, and a falling hematocrit. What are these findings indicative of?
a. Eclampsia
b. Disseminated intravascular coagulation (DIC)
c. HELLP syndrome
d. Idiopathic thrombocytopenia

Answer 7

C

Question 8

A woman with pre-eclampsia has a seizure. What is the nurse’s priority intervention?
a. Ensure a patent airway.
b. Suction the mouth to prevent aspiration.
c. Administer oxygen by mask.
d. Stay with the patient to provide emotional support.

Answer 8

A

Question 9

A pregnant woman has been receiving a magnesium sulphate infusion for treatment of severe pre-eclampsia 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 patient complains, “I’m so thirsty and warm.” What is the nurse’s initial intervention?
a. Call for a stat magnesium sulphate level.
b. Administer oxygen.
c. Discontinue the magnesium sulphate infusion.
d. Prepare to administer hydralazine.

Answer 9

C

Question 10

A woman with severe pre-eclampsia has been receiving magnesium sulphate 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. Which medication should the nurse anticipate will be ordered for this patient?
a. Hydralazine
b. Magnesium sulphate bolus
c. Diazepam
d. Calcium gluconate

Answer 10

A

Question 11

A woman at 39 weeks of gestation with a history of pre-eclampsia is admitted to the labour and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of which condition?
a. Eclamptic seizure
b. Rupture of the uterus
c. Placenta previa
d. Placental abruption

Answer 11

D

Question 12

Which should the nurse be concerned about when caring for a woman with severe pre-eclampsia who is receiving a magnesium sulphate infusion?
a. A sleepy, sedated affect
b. A respiratory rate of 10 breaths/min
c. Deep tendon reflexes of 2
d. Absent ankle clonus

Answer 12

B

Question 13

A patient has been on magnesium sulphate for 20 hours for treatment of pre-eclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would the nurse expect to assess in this patient?
a. 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

Answer 13

D

Question 14

Which is correct when providing follow-up management for a woman who had a hydatidiform mole?
a. The follow-up assessment period is generally 2 years.
b. Weekly hCG levels until normal for 3 consecutive weeks
c. Pregnancy is to be avoided for at least 3 months.
d. Monthly serum β-hCG for 6 months

Answer 14

D

Question 15

What is the classification of placenta previa when the placental edge is 2.0 cm from the internal cervical os?
a. Complete
b. Marginal
c. Class 2
d. Class 3

Answer 15

B

Question 16

What is the most common medical complication of pregnancy?
a. Hypertension
b. Hyperemesis gravidarum
c. Hemorrhagic complications
d. Infections

Answer 16

A

Question 17

Which is true in relation to HELLP syndrome?
a. It is a mild form of pre-eclampsia.
b. It can be diagnosed by a nurse alert to its symptoms.
c. It is characterized by hemolysis, elevated liver enzymes, and low platelets.
d. It is associated with preterm labour but not perinatal mortality.

Answer 17

C

Question 18

Which statement is true of pre-existing hypertension?
a. It is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy.
b. It 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. It is general hypertension plus proteinuria.
d. It can be accompanied by pre-eclampsia during pregnancy.

Answer 18

D

Question 19

What should the nurse be aware of when planning care for women with pre-eclampsia?
a. Induction of labour is likely, as near term as possible.
b. If at home, the woman should be confined to her bed, even with mild pre-eclampsia.
c. A special diet low in protein and salt should be initiated.
d. Vaginal birth is still an option, even in severe cases.

Answer 19

A

Question 20

What is the purpose of administering magnesium sulphate to women with pre-eclampsia and eclampsia?
a. It improves patellar reflexes and increases respiratory efficiency.
b. It shortens the duration of labour.
c. It prevents or controls convulsions.
d. It prevents a boggy uterus and lessens lochial flow.

Answer 20

C

Question 21

Which patient exhibits the greatest number of risk factors associated with pre-eclampsia?
a. A 30-year-old obese White woman with her third pregnancy
b. A 41-year-old White primigravida
c. An Inuit patient who is 42 years old, weighs 92 kg, and is pregnant with twins
d. A 25-year-old Métis woman whose pregnancy is the result of donor insemination

Answer 21

C

Question 22

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary 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
b. Inevitable
c. Threatened
d. Septic

Answer 22

C

Question 23

The perinatal nurse is giving discharge instructions to a woman who had a suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the basis for the nurse’s response?
a. The chance of a successful pregnancy within 1 year of this condition is very small.
b. A major risk after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that the body produces during pregnancy; therefore, pregnancy would make the diagnosis of this cancer more difficult.
c. The chance of developing a second molar pregnancy after 1 year is rare.
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy.

Answer 23

B

Question 24

What is the most prevalent clinical manifestation of placental abruption, as opposed to placenta previa?
a. Bleeding
b. Intense abdominal pain
c. Uterine activity
d. Cramping

Answer 24

B

Question 25

Methotrexate is recommended as part of the treatment plan for which obstetrical complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic pregnancy
d. Abruptio placentae

Answer 25

C

Question 26

A 26-year-old pregnant woman, 2-1-0-0-1, 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

Answer 26

B

Question 27

What is occurring when some of the umbilical vessels cross the cervical os below the presenting part?
a. Placenta previa
b. Vasa previa
c. Severe abruptio placentae
d. Disseminated intravascular coagulation (DIC)

Answer 27

B

Question 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. How should the nurse interpret this assessment finding?
a. This is a normal integumentary change associated with pregnancy.
b. This is Turner’s sign, associated with appendicitis.
c. This is Cullen’s sign, associated with a ruptured ectopic pregnancy.
d. This is Chadwick’s sign, associated with early pregnancy.

Answer 28

C

Question 29

What should nurses be aware of regarding miscarriage?
a. It is a natural pregnancy loss before labour begins.
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
c. It often can be attributed to careless maternal behaviour, such as poor nutrition or excessive exercise.
d. If it occurs before the twelfth week of pregnancy, it may present only as moderate discomfort and blood loss.

Answer 29

D