Evolve Chap 19 and 21 Flashcards
A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman would indicate a correct understanding of the test?
a. “I will need to have a full bladder for the test to be done accurately.”
b. “I should have my husband drive me home after the test because I may be nauseous.”
c. “This test will help to determine whether the baby has Down syndrome or a neural tube defect.”
d. “This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”
d. “This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.”
Which choice gives indicators for performing a contraction stress test?
a. Increased fetal movement and small for gestational age
b. Maternal diabetes mellitus and postmaturity
c. Adolescent pregnancy and poor prenatal care
d. History of preterm labor and intrauterine growth restriction
b. Maternal diabetes mellitus and postmaturity
- Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test.
The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?
a. Doppler blood flow analysis
b. Contraction stress test (CST)
c. Amniocentesis
d. Daily fetal movement counts
a. Doppler blood flow analysis
- Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor.
A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time?
a. Biophysical profile
b. Amniocentesis
c. Maternal serum alpha-fetoprotein (MSAFP)
d. Transvaginal ultrasound
d. Transvaginal ultrasound
- An ultrasound is the method of biophysical assessment of the infant that would be performed at this gestational age.
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:
a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis.
b. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects.
c. Percutaneous umbilical blood sampling (PUBS) is one of the triple-marker tests for Down syndrome.
d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.
- MSAFP is a screening tool, not a diagnostic tool.
The nurse providing care for the antepartum woman should understand that the contraction stress test (CST):
a. Sometimes uses vibroacoustic stimulation.
b. Is an invasive test; however, contractions are stimulated.
c. Is considered negative if no late decelerations are observed with the contractions.
d. Is more effective than the nonstress test (NST) if the membranes have already been ruptured.
c. Is considered negative if no late decelerations are observed with the contractions.
- No late decelerations is good news.
In the past factors to determine whether a woman was likely to develop a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high risk pregnancy has been adopted today. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. These categories include all of the following except:
a. Biophysical.
b. Psychosocial.
c. Geographic.
d. Environmental.
c. Geographic.
MSAFP levels have been used as a screening tool for ______________________________ in pregnancy.
- neural tube defects
- Maternal serum alpha-fetoprotein screening is recommended for all pregnant women. Through this technique approximately 80% to 85% of all open NTDs and open abdominal wall defects can be detected early in pregnancy
A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:
a. A sleepy, sedated affect.
b. A respiratory rate of 10 breaths/min.
c. Deep tendon reflexes of 2.
d. Absent ankle clonus.
b.
-A respiratory rate of 10 breaths/min indicates that the woman is experiencing respiratory depression from magnesium toxicity.
The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman would indicate a correct understanding of the discharge instructions?
a. “I will not experience mood swings since I was only at 10 weeks of gestation.”
b. “I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months.”
c. “I should eat foods that are high in iron and protein to help my body heal.”
d. “I should expect the bleeding to be heavy and bright red for at least 1 week.”
c.
-A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss.
Because pregnant women may need surgery during pregnancy, nurses should be aware that:
a. The diagnosis of appendicitis may be difficult to make, 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.
a.
-Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count.
In caring for an immediate postpartum woman, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder:
a. Disseminated intravascular coagulation (DIC)
b. Amniotic fluid embolism (AFE)
c. Hemorrhage
d. HELLP syndrome
a.
-The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman’s arm. Excessive bleeding may occur from the site of a slight trauma such as venipuncture sites.
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.
b. Magnesium sulfate bolus.
c. Diazepam.
d. Calcium gluconate.
a.
-Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.
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, elevated liver enzymes, and low platelets.
d. Is associated with preterm labor but not perinatal mortality.
c.
-The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor 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:
a. Eclamptic seizure.
b. Rupture of the uterus.
c. Placenta previa.
d. Placental abruption.
d.
- Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption.
