FINAL Chapters 19, 20, and 21 Flashcards
A client at 28 weeks’ gestation presents with a blood pressure of 150/92 mm Hg on two separate occasions, 6 hours apart. No proteinuria is noted. What is the most likely diagnosis?
a. Preeclampsia
b. Chronic hypertension
c. Gestational hypertension
d. Eclampsia
c. Gestational hypertension
Rationale: Gestational hypertension is characterized by a blood pressure higher than 140/90 mm Hg after 20 weeks of gestation in a previously normotensive client, without proteinuria.
Which of the following findings would differentiate gestational hypertension from preeclampsia?
a. Elevated liver enzymes
b. Proteinuria
c. Hypertension
d. Hyperreflexia
b. Proteinuria
Rationale: Preeclampsia involves both hypertension and proteinuria, while gestational hypertension is diagnosed in the absence of proteinuria.
At what point postpartum does gestational hypertension typically resolve?
a. 6 weeks
b. 8 weeks
c. 12 weeks
d. 20 weeks
c. 12 weeks
Rationale: Gestational hypertension typically resolves by 12 weeks postpartum.
A client at 22 weeks of gestation is diagnosed with hypertension and reports a history of elevated blood pressure prior to pregnancy. What is the most appropriate diagnosis?
a. Chronic hypertension
b. Gestational hypertension
c. Preeclampsia
d. White coat hypertension
a. Chronic hypertension
Rationale: Hypertension present before 20 weeks of gestation or prior to pregnancy is classified as chronic hypertension.
A nurse is caring for a client with gestational hypertension. Which statement indicates that the client understands the condition?
a. “This condition is likely to resolve after delivery.”
b. “I will need to take antihypertensives for the rest of my life.”
c. “This condition always progresses to preeclampsia.”
d. “I am at no risk for developing complications.”
a. “This condition is likely to resolve after delivery.”
Rationale: Gestational hypertension typically resolves after delivery, but it can progress to preeclampsia in some cases.
Which client is at highest risk for developing gestational hypertension?
a. A 25-year-old gravida 2 para 1 with a history of chronic hypertension
b. A 30-year-old primigravida with no medical history
c. A 20-year-old gravida 3 para 2 with obesity
d. A 40-year-old primigravida with a history of gestational diabetes
d. A 40-year-old primigravida with a history of gestational diabetes
Rationale: Advanced maternal age and a history of gestational diabetes increase the risk for gestational hypertension.
What is the primary criterion for diagnosing gestational hypertension?
a. Systolic blood pressure > 140 mm Hg or diastolic > 90 mm Hg before 20 weeks
b. Hypertension with proteinuria after 20 weeks
c. Hypertension without proteinuria after 20 weeks
d. Severe headache and blurred vision
c. Hypertension without proteinuria after 20 weeks
Rationale: Gestational hypertension is defined as new-onset hypertension (≥140/90 mm Hg) after 20 weeks of gestation in the absence of proteinuria.
What is the definition of gestational hypertension?
A. Hypertension with proteinuria after the 20th week of pregnancy
B. Hypertension without proteinuria after the 20th week of pregnancy
C. Hypertension before the 20th week of pregnancy
D. Hypertension after childbirth
B. Hypertension without proteinuria after the 20th week of pregnancy
Rationale: Gestational hypertension is defined as the onset of hypertension after the 20th week of pregnancy without protein in the urine and normal lab results.
Which blood pressure reading meets the criteria for gestational hypertension?
A. SBP 130 or DBP 80
B. SBP 135 or DBP 85
C. SBP 140 or DBP 90
D. SBP 120 or DBP 70
C. SBP 140 or DBP 90
Rationale: Gestational hypertension is diagnosed with a systolic blood pressure (SBP) greater than 140 mmHg or a diastolic blood pressure (DBP) greater than 90 mmHg.
At what gestational age is gestational hypertension most commonly diagnosed?
A. At or before 20 weeks
B. At or after 37 weeks
C. Between 30 to 36 weeks
D. After childbirth
B. At or after 37 weeks
Rationale: Gestational hypertension most commonly occurs at or after 37 weeks of gestation.
Which group has the highest incidence of gestational hypertension?
A. Primigravidas
B. Women with twins
C. Women with a history of chronic hypertension
D. Multiparous women
D. Multiparous women
Rationale: Multiparous women have a higher incidence of gestational hypertension, ranging from 6% to 17%.
What potential complication should women with gestational hypertension be monitored for?
A. Diabetes
B. Anemia
C. Preeclampsia
D. Preterm labor
C. Preeclampsia
Rationale: Women with gestational hypertension should be monitored for signs of preeclampsia, such as checking urine, lab results, deep tendon reflexes (DTR), and symptoms.
What is the most frequent cause of hypertension during pregnancy?
A. Chronic hypertension
B. Pre-existing hypertension
C. Preeclampsia
D. Gestational hypertension
D. Gestational hypertension
Rationale: The most frequent cause of hypertension during pregnancy is gestational hypertension.
According to ACOG, what blood pressure levels classify as severe chronic hypertension?
A. SBP > 140 or DBP > 90 mm Hg
B. SBP > 150 or DBP > 95 mm Hg
C. SBP > 160 or DBP > 100 mm Hg
D. SBP > 160 or DBP > 110 mm Hg
D. SBP > 160 or DBP > 110 mm Hg
Rationale: ACOG classifies severe chronic hypertension in pregnancy as systolic BP higher than 160 mm Hg or diastolic BP higher than 110 mm Hg.
What is the recommended course of action if maternal blood pressure exceeds 160/100 mm Hg?
A. Antihypertensive drug treatment
B. No treatment necessary
C. Lifestyle changes only
D. Monitoring blood pressure only
A. Antihypertensive drug treatment
Rationale: If maternal blood pressure exceeds 160/100 mm Hg, drug treatment is recommended to prevent long-term sequelae such as stroke or acute renal failure.
Which of the following groups has a higher prevalence of chronic hypertension in pregnancy?
A. Younger women with a low BMI
B. Older women with a high BMI
C. Women of average weight
D. Women who are underweight
B. Older women with a high BMI
Rationale: The prevalence of chronic hypertension varies according to age, race, and BMI, with higher prevalence seen in older women with a high BMI.
Why is antihypertensive therapy not generally recommended for mild chronic hypertension during pregnancy?
A. It is not effective
B. It increases the risk of preeclampsia
C. It causes severe hypertension
D. It can lead to intrauterine growth restriction
D. It can lead to intrauterine growth restriction
Rationale: Pharmacologic treatment of mild hypertension does not reduce the likelihood of developing preeclampsia and increases the likelihood of intrauterine growth restriction.
Which statement is true regarding chronic hypertension and pregnancy?
A. It always resolves after pregnancy
B. It only occurs in the third trimester
C. It is diagnosed before 20 weeks’ gestation
D. It is only seen in women with a history of hypertension
C. It is diagnosed before 20 weeks’ gestation
Rationale: Chronic hypertension is diagnosed before 20 weeks’ gestation and is often pre-existing before pregnancy.
At what point in gestation does chronic hypertension typically occur?
A. After 20 weeks gestation
B. Prior to 20 weeks gestation
C. At birth
D. During labor
B. Prior to 20 weeks gestation
Rationale: Chronic hypertension is defined as occurring prior to 20 weeks gestation.
Which age group is 10 times more likely to experience chronic hypertension in pregnancy compared to younger women?
A. Women aged 20-30 years
B. Women aged 30-40 years
C. Women aged 40 years or older
D. Women younger than 20 years
C. Women aged 40 years or older
Rationale: Women aged 40 years or older are 10 times more likely to experience chronic hypertension compared to those younger than 20 years.
What are the increased risks associated with chronic hypertension during pregnancy?
A. Increased risk for preterm delivery and fetal growth restriction
B. Increased risk for gestational diabetes
C. Increased risk for anemia
D. Increased risk for excessive weight gain
A. Increased risk for preterm delivery and fetal growth restriction
Rationale: Chronic hypertension is associated with an increased risk for preterm delivery and fetal growth restriction.
What is a potential risk for patients with chronic hypertension during pregnancy?
A. Placental abruption
B. Gestational diabetes
C. Anemia
D. Polyhydramnios
A. Placental abruption
Rationale: Patients with chronic hypertension are at risk for placental abruption, which is when the placenta detaches from the uterus.
What is the impact of chronic hypertension on perinatal mortality?
A. No impact
B. Decreases mortality
C. Unpredictable impact
D. Increases mortality
D. Increases mortality
Rationale: Chronic hypertension is associated with increased perinatal mortality (fetal death).
What is the risk of intrauterine fetal demise (IUFD) associated with chronic hypertension?
A. Low risk
B. Moderate risk
C. High risk
D. No risk
C. High risk
Rationale: Patients with chronic hypertension are at high risk for intrauterine fetal demise (IUFD).
Which fetal growth complication is associated with chronic hypertension?
A. Macrosomia
B. Normal growth
C. LGA (Large for Gestational Age)
D. Small for Gestational Age (SGA)
D. Small for Gestational Age (SGA)
Rationale: Chronic hypertension increases the risk of the fetus being Small for Gestational Age (SGA).
Which vital signs and assessments are crucial for managing chronic hypertension in pregnant patients?
A. Vital signs, DTRs, clonus, I&O, level of consciousness
B. Pulse rate, temperature, weight, skin turgor
C. Respiratory rate, capillary refill, bowel sounds, reflexes
D. Hemoglobin levels, white blood cell count, platelet count, height
A. Vital signs, DTRs, clonus, I&O, level of consciousness
Rationale: The crucial assessments include vital signs, deep tendon reflexes (DTRs), clonus, intake and output (I&O), and level of consciousness to monitor the patient’s condition effectively.
Why are ACE inhibitors and ARBs contraindicated in pregnant patients with chronic hypertension?
A. They can cause hypoglycemia
B. They are ineffective during pregnancy
C. They can cause birth defects
D. They lower blood pressure too rapidly
C. They can cause birth defects
Rationale: ACE inhibitors and ARBs need to be switched in pregnant patients because they can cause birth defects.
When is antihypertensive medication administration indicated for pregnant patients with chronic hypertension?
A. SBP > 140 or DBP > 90 mm Hg
B. SBP > 150 or DBP > 100 mm Hg
C. SBP > 160 or DBP > 110 mm Hg
D. SBP > 170 or DBP > 120 mm Hg
C. SBP > 160 or DBP > 110 mm Hg
Rationale: Antihypertensive medication administration is indicated for systolic blood pressure (SBP) greater than 160 mm Hg or diastolic blood pressure (DBP) greater than 110 mm Hg.
Which antihypertensive medications are commonly used to manage chronic hypertension in pregnancy?
A. Metoprolol, Verapamil, Propranolol
B. Hydralazine, Labetalol, Nifedipine
C. Losartan, Enalapril, Candesartan
D. Amlodipine, Clonidine, Atenolol
B. Hydralazine, Labetalol, Nifedipine
Rationale: Hydralazine, Labetalol, and Nifedipine are commonly used to manage chronic hypertension in pregnancy.
What is a critical monitoring parameter for worsening chronic hypertension in pregnancy?
A. Laboratory values, symptoms, rising blood pressure, and fetal surveillance
B. Height and weight measurements
C. Fetal heart rate and movement, and oxygen saturation levels
D. Oxygen saturation levels, and height and weight measurements
A. Laboratory values, symptoms, rising blood pressure, and fetal surveillance
Rationale: Monitoring for worsening of chronic hypertension includes checking laboratory values, symptoms, rising blood pressure, and conducting fetal surveillance starting at 28 weeks, including growth ultrasounds.
Which of the following is true regarding preeclampsia? (Select all that apply)
A. It is characterized by new-onset hypertension.
B. It is always accompanied by proteinuria.
C. It can target multiple organ systems, including cardiovascular, hepatic, renal, and CNS.
D. It is one of the leading causes of maternal morbidity and mortality worldwide.
A. It is characterized by new-onset hypertension.
C. It can target multiple organ systems, including cardiovascular, hepatic, renal, and CNS.
D. It is one of the leading causes of maternal morbidity and mortality worldwide.
Rationale: Preeclampsia is described as new-onset hypertension (A) that may be accompanied by proteinuria and/or maternal organ dysfunction affecting multiple systems (C), and it remains a leading cause of maternal morbidity and mortality worldwide (D). Proteinuria is not always present (B).
What distinguishes severe preeclampsia from mild preeclampsia?
A. Presence of headaches
B. Presence of maternal organ dysfunction
C. Absence of hypertension
D. Decreased fetal movement
B. Presence of maternal organ dysfunction
Rationale: Severe preeclampsia is distinguished by the presence of maternal organ dysfunction, which can impact the cardiovascular, hepatic, renal, and CNS systems.
Which organ systems are commonly targeted in preeclampsia? (Select all that apply)
A. Respiratory system
B. Cardiovascular system
C. Hepatic system
D. Renal system
E. Central nervous system
B. Cardiovascular system
C. Hepatic system
D. Renal system
E. Central nervous system
Rationale: Preeclampsia targets the cardiovascular, hepatic, renal, and central nervous systems.
What clinical presentation is indicative of preeclampsia?
A. Chronic hypertension without proteinuria
B. New-onset hypertension with or without proteinuria and organ dysfunction
C. Hypertension only during labor
D. Proteinuria with or without hypertension and organ dysfunction
B. New-onset hypertension with or without proteinuria and organ dysfunction
Rationale: Preeclampsia is characterized by new-onset hypertension with or without proteinuria and maternal organ dysfunction.
At what point in gestation do hypertension (HTN) and proteinuria typically develop in preeclampsia?
A. Before 20 weeks gestation
B. After 20 weeks gestation
C. At the time of delivery
D. During the first trimester
B. After 20 weeks gestation
During which period of pregnancy does preeclampsia most commonly manifest?
A. First trimester
B. First half of pregnancy
C. Second half of pregnancy
D. Third trimester
C. Second half of pregnancy
Rationale: Preeclampsia most commonly manifests in the second half of pregnancy.
How is preeclampsia classified?
A. Preeclampsia with anemia or preeclampsia with diabetes
B. Preeclampsia with heart failure or preeclampsia with renal failure
C. Preeclampsia with infection or preeclampsia with edema
D. Preeclampsia alone or preeclampsia with severe features
D. Preeclampsia alone or preeclampsia with severe features
Rationale: Preeclampsia is classified into two categories: preeclampsia alone or preeclampsia with severe features.
Which of the following symptoms are associated with the widespread pathologic changes seen in preeclampsia? (Select all that apply)
A. Pulmonary edema
B. Hyperglycemia
C. Oliguria
D. Seizures
E. Thrombocytopenia
F. Abnormal liver enzymes
A. Pulmonary edema
C. Oliguria
D. Seizures
E. Thrombocytopenia
F. Abnormal liver enzymes
Rationale: Preeclampsia can cause pulmonary edema (A), oliguria (C), seizures (D), thrombocytopenia (E), and abnormal liver enzymes (F). Hyperglycemia is not a typical symptom.
What effect does decreased kidney perfusion have in preeclampsia?
A. Decreased glomerular filtration rate and increased serum levels of sodium, BUN, uric acid, and creatinine
B. Decreased urine output and increased serum levels of sodium, BUN, uric acid, and creatinine
C. Decreased serum sodium levels and increased serum levels of sodium, BUN, uric acid, and creatinine
D. Decreased renal function and increased serum levels of sodium, BUN, uric acid, and creatinine
A. Decreased glomerular filtration rate and increased serum levels of sodium, BUN, uric acid, and creatinine
Rationale: Decreased kidney perfusion leads to a decreased glomerular filtration rate and increased serum levels of sodium, blood urea nitrogen (BUN), uric acid, and creatinine.
Which fetal complications are associated with poor placental perfusion in preeclampsia? (Select all that apply)
A. Intrauterine growth restriction
B. Placental abruption
C. Persistent fetal hypoxia
D. Fetal acidosis
E. Polycythemia
A. Intrauterine growth restriction
B. Placental abruption
C. Persistent fetal hypoxia
D. Fetal acidosis
Rationale: Poor placental perfusion in preeclampsia is associated with intrauterine growth restriction (A), placental abruption (B), persistent fetal hypoxia (C), and fetal acidosis (D).
What is a known contributing factor to the development of preeclampsia?
A. Exact cause unknown
B. High maternal BMI
C. Low maternal glucose levels
D. High maternal cholesterol levels
A. Exact cause unknown
Rationale: The exact cause of preeclampsia is still unknown, despite extensive research.
What abnormality in placental development is associated with preeclampsia?
A. Excessive placental growth
B. Abnormal placental implantation
C. Increased placental blood flow
D. Normal trophoblast function
B. Abnormal placental implantation
Rationale: Preeclampsia is associated with abnormal placental implantation, where trophoblasts fail to convert high-resistance vessels to low-resistance vessels, reducing placental blood flow.
What is the definitive cure for preeclampsia/eclampsia?
A. Antihypertensive medication
B. Bed rest
C. Low-sodium diet
D. Delivery of the placenta
D. Delivery of the placenta
Rationale: The definitive cure for preeclampsia/eclampsia is the delivery of the placenta. The resolution of symptoms following the expulsion of the placenta supports theories related to its influence on the disease.
When should daily low-dose aspirin be initiated for women at high risk of developing preeclampsia?
A. From 12 weeks’ gestation until delivery
B. From the first trimester until 20 weeks’ gestation
C. From 20 weeks’ gestation until 30 weeks’ gestation
D. From 30 weeks’ gestation until delivery
A. From 12 weeks’ gestation until delivery
Rationale: Recent studies recommend the prevention of preeclampsia with daily low-dose aspirin (75 to 150 mg) from 12 weeks’ gestation until delivery for women considered high risk.
Which of the following are risk factors for the development of preeclampsia? (Select all that apply)
A. Multifetal gestation
B. Previous pregnancy with preeclampsia
C. Chronic hypertension
D. Renal disease
E. Obesity
all of the choices are correct
How is a mild case of preeclampsia typically managed?
A. Inpatient monitoring with continuous fetal surveillance
B. Outpatient monitoring of blood pressure and serial assessments
C. Immediate delivery of the fetus
D. No intervention needed
B. Outpatient monitoring of blood pressure and serial assessments
Rationale: A mild case of preeclampsia is typically managed with outpatient monitoring of blood pressure and serial assessments.
At what gestational age is delivery recommended for non-severe hypertensive disorders in pregnancy?
A. 32 weeks
B. 34 weeks
C. 37 weeks
D. 40 weeks
C. 37 weeks
Rationale: For non-severe hypertensive disorders in pregnancy, delivery is recommended at 37 weeks.
What intervention is recommended for a fetus less than 36 weeks’ gestation in a woman with preeclampsia?
A. Immediate cesarean section
B. Bed rest with pain medication (Motrin)
C. Administration of antenatal steroids (betamethasone)
D. Increased dietary intake of calcium
C. Administration of antenatal steroids (betamethasone)
Rationale: For a fetus less than 36 weeks’ gestation in a woman with preeclampsia, administering antenatal steroids (betamethasone IM x 2 doses 24 hours apart) is recommended to promote fetal lung maturity.
What criteria determine the use of conservative strategies for preeclampsia without severe features?
A. Presence of severe hypertension
B. Signs of renal or hepatic dysfunction or coagulopathy
C. High sodium intake
D. Absence of signs of renal or hepatic dysfunction or coagulopathy
D. Absence of signs of renal or hepatic dysfunction or coagulopathy
Rationale: Conservative strategies are used if the woman exhibits no signs of renal or hepatic dysfunction or coagulopathy.
What position is recommended for a woman with mild elevation in blood pressure due to preeclampsia?
A. Supine position
B. Lateral recumbent position
C. Prone position
D. Fowler’s position
B. Lateral recumbent position
Rationale: The lateral recumbent position is recommended to improve uteroplacental blood flow, reduce blood pressure, and promote diuresis.
What additional prenatal visits and diagnostic tests are recommended for women with mild preeclampsia? (Select all that apply)
A. CBC
B. Clotting studies
C. Liver enzymes
D. Platelet levels
E. Blood glucose levels
A. CBC
B. Clotting studies
C. Liver enzymes
D. Platelet levels
Rationale: Increased frequency of prenatal visits and diagnostic tests such as CBC, clotting studies, liver enzymes, and platelet levels are recommended for monitoring.
How often should a woman with preeclampsia without severe features monitor her blood pressure at home?
A. Once a week
B. Every 4 to 6 hours
C. Every 2 to 4 hours
D. Once a month
B. Every 4 to 6 hours
Rationale: She should monitor her blood pressure daily, every 4 to 6 hours while awake.
What dietary recommendation is given to a woman with mild preeclampsia?
A. Balanced, nutritional diet with no sodium restriction
B. High-sodium diet
C. Low-calorie diet
D. High-protein diet
A. Balanced, nutritional diet with no sodium restriction
Rationale: A balanced, nutritional diet with no sodium restriction is advised.
What is included in the current management of preeclampsia for high-risk women? (Select all that apply)
A. Preconception counseling
B. Prenatal aspirin therapy
C. Antenatal steroids (betamethasone) for women prior to 34 weeks’ gestation
D. Parenteral magnesium sulfate prophylaxis
E. Low-calorie diet
F. Follow-up of postpartum blood pressures
A. Preconception counseling
B. Prenatal aspirin therapy
C. Antenatal steroids (betamethasone) for women prior to 34 weeks’ gestation
D. Parenteral magnesium sulfate prophylaxis
F. Follow-up of postpartum blood pressures
Rationale: High-risk women with preeclampsia receive preconception counseling, prenatal aspirin therapy, antenatal steroids for women prior to 34 weeks’ gestation, parenteral magnesium sulfate prophylaxis, and follow-up of postpartum blood pressures.
Which symptoms signal preeclampsia with severe features?
A. Low blood pressure and headaches
B. High blood pressure (>160/110 mm Hg) and cerebral and visual symptoms
C. Decreased liver function and thrombocytopenia
D. Low blood pressure and proteinuria
B. High blood pressure (>160/110 mm Hg) and cerebral and visual symptoms
Rationale: Symptoms that signal preeclampsia with severe features include high blood pressure (>160/110 mm Hg), cerebral and visual symptoms, pulmonary edema, epigastric pain, impaired liver function, thrombocytopenia, and progressive renal insufficiency.
What is the antidote for magnesium sulfate overdose?
A. Vitamin K
B. Potassium chloride
C. Sodium bicarbonate
D. Calcium gluconate
D. Calcium gluconate
Rationale: Calcium gluconate (10 mL of a 10% solution injected IV over 3 minutes) is an effective antidote for magnesium sulfate overdose.
Why is a vaginal delivery preferred over a cesarean birth for women with preeclampsia with severe features?
A. Less risk of infection
B. Better maternal outcomes
C. Easier for the healthcare provider
D. Faster delivery process
B. Better maternal outcomes
Rationale: A vaginal delivery is preferred as it offers better maternal outcomes and poses less risk compared to a surgical birth.
What should a newborn whose mother received high doses of magnesium sulfate be monitored for?
A. Hyperactivity, hypotonia and increased muscle tone
B. Increased blood pressure, hypotonia and tachycardia
C. Hypercalcemia, hypotonia and hyperreflexia
D. Respiratory depression, hypocalcemia, and hypotonia
D. Respiratory depression, hypocalcemia, and hypotonia
Rationale: A newborn whose mother received high doses of magnesium sulfate should be monitored for respiratory depression, hypocalcemia, and hypotonia.
What is the focus of therapy for preeclampsia with severe features during labor?
A. Controlling hypertension and preventing seizures
B. Increasing maternal weight gain
C. Reducing maternal heart rate
D. Increasing dietary sodium intake
A. Controlling hypertension and preventing seizures
Rationale: The focus of therapy during labor is on controlling hypertension, preventing seizures, preventing long-term morbidity, and preventing maternal, fetal, or newborn death.
Which assessments are crucial for monitoring a woman with preeclampsia? (Select all that apply)
A. Pitting edema
B. Deep tendon reflexes (DTRs)
C. Clonus
D. Blood sugar levels
E. Blood pressure
A. Pitting edema
B. Deep tendon reflexes (DTRs)
C. Clonus
E. Blood pressure
Rationale: Crucial assessments for monitoring a woman with preeclampsia include pitting edema, deep tendon reflexes (DTRs), clonus, and blood pressure.
Which diagnostic tests are important in the management of preeclampsia? (Select all that apply)
A. Chemistry panel (LFTs, BUN, creatinine)
B. Elevated lactate dehydrogenase (LDH)
C. Complete blood count (CBC) and platelets
D. Blood glucose test
E. Uric acid level >5 mg/dL
A. Chemistry panel (LFTs, BUN, creatinine)
B. Elevated lactate dehydrogenase (LDH)
C. Complete blood count (CBC) and platelets
E. Uric acid level >5 mg/dL
Rationale: Important diagnostic tests in the management of preeclampsia include chemistry panel (LFTs, BUN, creatinine), elevated lactate dehydrogenase (LDH), complete blood count (CBC) and platelets, and uric acid level >5 mg/dL.
Why is monitoring for protein in urine significant in preeclampsia?
A. It indicates dehydration
B. It signals renal impairment
C. It shows normal kidney function
D. It indicates hyperglycemia
B. It signals renal impairment
Rationale: Monitoring for protein in urine is significant in preeclampsia because it signals renal impairment, which is a critical aspect of the condition.
Which subjective complaints should nurses assess for in clients with preeclampsia to detect disease progression? (Select all that apply)
A. Visual changes
B. Severe headaches
C. Unusual bleeding or bruising
D. Epigastric pain
E. Increased appetite
A. Visual changes
B. Severe headaches
C. Unusual bleeding or bruising
D. Epigastric pain
Rationale: Nurses should assess for subjective complaints such as visual changes, severe headaches, unusual bleeding or bruising, and epigastric pain to detect progression of preeclampsia.
What is the risk associated with the late detection of preeclampsia symptoms?
A. Severe gestational hypertension
B. Mild hypertension
C. Decreased maternal health
D. Reduced need for medical intervention
A. Severe gestational hypertension
Rationale: By the time symptoms are noticed, gestational hypertension can be severe, which underscores the importance of regular monitoring and assessment.
What are some risk factors for preeclampsia? (Select all that apply)
A. Primigravida status
B. Chromosomal abnormalities
C. History of diabetes
D. African American ethnicity
E. Age between 20 and 35
A. Primigravida status
B. Chromosomal abnormalities
C. History of diabetes
D. African American ethnicity
Rationale: Risk factors for preeclampsia include primigravida status, chromosomal abnormalities, history of diabetes, African American ethnicity, among others. Age younger than 20 or older than 35 is also a risk factor, not age between 20 and 35.
What nutritional aspects should be assessed in a woman at risk for preeclampsia? (Select all that apply)
A. Usual intake of protein
B. Daily calcium intake
C. Amount of carbohydrates consumed
D. Total daily calories
E. Fluid intake
A. Usual intake of protein
B. Daily calcium intake
D. Total daily calories
E. Fluid intake
Rationale: A nutritional assessment for a woman at risk for preeclampsia should include her usual intake of protein, daily calcium intake, total daily calories, and fluid intake.
Which position yields the highest blood pressure reading during prenatal visits?
A. Supine position
B. Sitting position
C. Prone position
D. Side-lying position
B. Sitting position
What laboratory tests are typically performed to evaluate a woman with preeclampsia? (Select all that apply)
A. Complete blood count (CBC)
B. Serum electrolytes
C. Blood urea nitrogen (BUN)
D. Serum glucose levels
E. Creatinine
F. Hepatic enzyme levels
A. Complete blood count (CBC)
B. Serum electrolytes
C. Blood urea nitrogen (BUN)
E. Creatinine
F. Hepatic enzyme levels
Rationale: Laboratory tests typically performed to evaluate a woman with preeclampsia include a CBC, serum electrolytes, BUN, creatinine, and hepatic enzyme levels. Serum glucose levels are not specifically mentioned in the provided text.
What is the next step if protein levels of 1 to 2+ or greater are found in a urine specimen of a woman with preeclampsia?
A. No further testing is needed
B. Immediate delivery of the fetus
C. 24-hour urine collection
D. Administration of diuretics
C. 24-hour urine collection
Rationale: If protein levels of 1 to 2+ or greater are found in a urine specimen, a 24-hour urine collection is completed to further assess the extent of proteinuria.
What blood pressure measurement confirms a diagnosis of preeclampsia?
A. Systolic BP > 130 or Diastolic BP > 80 on one occasion at least 5 hours apart
B. Systolic BP > 140 or Diastolic BP > 90 on two occasions at least 4 hours apart
C. Systolic BP > 120 or Diastolic BP > 70 on two occasions at least 3 hours apart
D. Systolic BP > 150 or Diastolic BP > 100 on one occasions at least 2 hours apart
B. Systolic BP > 140 or Diastolic BP > 90 on two occasions at least 4 hours apart
Rationale: Preeclampsia is confirmed with a blood pressure measurement of systolic BP > 140 or diastolic BP > 90 on two occasions at least 4 hours apart.
What is the diagnostic criterion for proteinuria in preeclampsia?
A. 24-hour urine specimen of > 100mg/dL or a protein/creatinine ratio of 0.3 mg/dL
B. 24-hour urine specimen of > 200mg/dL or a protein/creatinine ratio of 0.3 mg/dL
C. 24-hour urine specimen of > 300mg/dL or a protein/creatinine ratio of 0.3 mg/dL
D. 24-hour urine specimen of > 400mg/dL or a protein/creatinine ratio of 0.3 mg/dL
C. 24-hour urine specimen of > 300mg/dL or a protein/creatinine ratio of 0.3 mg/dL
Rationale: Proteinuria in preeclampsia is diagnosed with a 24-hour urine specimen of > 300mg/dL or a protein/creatinine ratio of 0.3 mg/dL. A dipstick reading of +1 may also be used in the absence of quantifiable testing.
Which of the following can be used to diagnose preeclampsia in the absence of proteinuria? (Select all that apply)
A. Thrombocytopenia (PLT <100K)
B. Impaired liver function (elevated LFTs (AST/ALT) twice the baseline value)
C. New onset of renal insufficiency (creatinine >1.1 or doubling of serum)
D. Pulmonary edema
E. Headache or Visual Disturbance (cerebral symptoms)
A. Thrombocytopenia (PLT <100K)
B. Impaired liver function (elevated LFTs (AST/ALT) twice the baseline value)
C. New onset of renal insufficiency (creatinine >1.1 or doubling of serum)
D. Pulmonary edema
E. Headache or Visual Disturbance (cerebral symptoms)
Rationale: In the absence of proteinuria, preeclampsia can be diagnosed with thrombocytopenia (PLT <100K), impaired liver function (elevated LFTs (AST/ALT) twice the baseline value), new onset of renal insufficiency (creatinine >1.1 or doubling of serum), pulmonary edema, or headache or visual disturbances (cerebral symptoms).
Which dietary recommendations are given to women with preeclampsia without severe features? (Select all that apply)
A. High-protein diet
B. High-fiber foods
C. High-calorie diet
D. Drink eight to 10 glasses of water daily
A. High-protein diet
B. High-fiber foods
D. Drink eight to 10 glasses of water daily
Rationale: Women are advised to consume a balanced, high-protein diet including high-fiber foods and drink eight to 10 glasses of water daily.
What self-monitoring instructions should be given to women with preeclampsia without severe features? (Select all that apply)
A. Take blood pressure twice daily
B. Record the number of fetal kicks daily
C. Monitor blood sugar levels
D. Track weight daily
A. Take blood pressure twice daily
B. Record the number of fetal kicks daily
Rationale: Women should be instructed to take their own blood pressure twice daily and record the number of fetal kicks daily.
Which symptoms should prompt a woman with preeclampsia without severe features to contact the home health nurse immediately? (Select all that apply)
A. Increase in blood pressure
B. Decrease in fetal activity or movement
C. Stomach pain or excessive heartburn
D. Improved appetite
E. Easy or excessive bruising
A. Increase in blood pressure
B. Decrease in fetal activity or movement
C. Stomach pain or excessive heartburn
E. Easy or excessive bruising
Rationale: Women should contact the home health nurse if they experience an increase in blood pressure, decrease in fetal activity or movement, stomach pain or excessive heartburn, or easy or excessive bruising.
What action should be taken if the condition of a woman with preeclampsia without severe features worsens despite home care?
A. Increase the frequency of home visits
B. Immediately admit her to the hospital
C. Change her dietary plan
D. Increase her physical activity
B. Immediately admit her to the hospital
Rationale: If the condition worsens despite home care, the woman should be immediately admitted to the hospital for further management.
What lifestyle modification is recommended to promote urination and decrease blood pressure in women with preeclampsia without severe features?
A. Increase caloric intake
B. Avoid all forms of exercise
C. Increase salt intake
D. Limit physical activity
D. Limit physical activity
Rationale: Limiting physical activity is recommended to promote urination and subsequently decrease blood pressure.
What position should a woman with severe preeclampsia be kept in while hospitalized?
A. Supine position
B. Left lateral lying position
C. Prone position
D. Sitting position
B. Left lateral lying position
Rationale: The woman with severe preeclampsia should be kept in the left lateral lying position to improve uteroplacental blood flow and reduce blood pressure.
Why should the room be dark and quiet for a woman with severe preeclampsia?
A. To help her sleep
B. To improve her appetite
C. To reduce stimulation
D. To monitor her vital signs
C. To reduce stimulation
Rationale: Keeping the room dark and quiet helps reduce stimulation and prevent seizures in a woman with severe preeclampsia.
What dietary recommendation is given to a woman with severe preeclampsia?
A. High-protein diet with eight to 10 glasses of water daily
B. Low-calorie diet
C. High-carbohydrate diet
D. Low-sodium diet
A. High-protein diet with eight to 10 glasses of water daily
Rationale: A high-protein diet with eight to 10 glasses of water daily is recommended for a woman with severe preeclampsia.
Which signs and symptoms indicate pulmonary edema in a woman with severe preeclampsia? (Select all that apply)
A. Crackles and wheezing on auscultation
B. Dyspnea
C. Decreased oxygen saturation levels
D. Neck vein distention
E. Cough
all of the choices are correct
What testing may be performed to evaluate fetal status in preeclampsia? (Select all that apply)
A. Nonstress test
B. Serial ultrasounds
C. Amniocentesis
D. Doppler velocimetry
E. Biophysical profile
all of the choices are correct
What is the purpose of administering parenteral magnesium sulfate to a woman with severe preeclampsia?
A. To reduce blood pressure
B. To enhance fetal lung maturity
C. To prevent seizures
D. To treat pulmonary edema
C. To prevent seizures
Rationale: Parenteral magnesium sulfate is administered to prevent seizures in a woman with severe preeclampsia.
What indicates magnesium toxicity in a woman receiving magnesium sulfate for severe preeclampsia? (Select all that apply)
A. Respiratory rate less than 12 breaths per minute
B. Absence of deep tendon reflexes (DTRs)
C. Increase in urinary output
D. Decrease in urinary output (less than 30 mL/hr)
A. Respiratory rate less than 12 breaths per minute
B. Absence of deep tendon reflexes (DTRs)
D. Decrease in urinary output (less than 30 mL/hr)
Rationale: Signs of magnesium toxicity include a respiratory rate less than 12 breaths per minute, absence of DTRs, and a decrease in urinary output (less than 30 mL/hr).
What is considered a therapeutic serum magnesium level for a woman receiving magnesium sulfate?
A. 1 to 3 mEq/L
B. 4 to 7 mEq/L
C. 8 to 10 mEq/L
D. 10 to 12 mEq/L
B. 4 to 7 mEq/L
Rationale: Therapeutic serum magnesium levels for a woman receiving magnesium sulfate range from 4 to 7 mEq/L.
What should be done if signs of magnesium toxicity are observed?
A. Administer calcium gluconate as an antidote
B. Continue the current dose of magnesium sulfate
C. Decrease the dose of magnesium sulfate
D. Stop all medications
A. Administer calcium gluconate as an antidote
Rationale: If signs of magnesium toxicity are observed, calcium gluconate should be administered as an antidote.
What is the significance of clonus in a woman with severe preeclampsia?
A. Indicates decreased kidney function
B. Shows decreased neurological status
C. Demonstrates increased risk of seizures
D. Confirms CNS involvement
D. Confirms CNS involvement
Rationale: The presence of clonus confirms CNS involvement in a woman with severe preeclampsia.
How long should the client be monitored for signs and symptoms of preeclampsia/eclampsia after the birth of the newborn?
A. 24 hours
B. 48 hours
C. 72 hours
D. One week
B. 48 hours
Rationale: After the birth of the newborn, the client should be monitored for signs and symptoms of preeclampsia/eclampsia for at least 48 hours.
What is the purpose of continuing magnesium sulfate infusion for 24 hours after delivery?
A. To prevent seizure activity
B. To increase blood pressure
C. To promote diuresis
D. To monitor heart rate
A. To prevent seizure activity
Rationale: Continuing magnesium sulfate infusion for 24 hours after delivery is to prevent seizure activity.
Which routine postpartum assessments should be performed at least every 4 hours? (Select all that apply)
A. Fundus
B. Lochia
C. Breasts
D. Bladder
E. Emotional state
all of the choices are correct
What is a positive sign indicating the resolution of preeclampsia?
A. Increased proteinuria and a decrease in proteinuria
B. Decreased blood pressure and a decrease in proteinuria
C. Decreased urine output and a decrease in proteinuria
D. Diuresis and a decrease in proteinuria
D. Diuresis and a decrease in proteinuria
Rationale: Diuresis, along with a decrease in proteinuria, is a positive sign indicating the resolution of preeclampsia.
Which of the following is a significant risk factor for developing preeclampsia in a subsequent pregnancy?
A. Previous pregnancy without complications
B. Preeclampsia in a prior pregnancy
C. History of anemia
D. Young maternal age
B. Preeclampsia in a prior pregnancy
Rationale: Having preeclampsia in a prior pregnancy is a significant risk factor for developing it again in a subsequent pregnancy.
How does primiparity (first delivery) affect the risk of preeclampsia?
A. It decreases the risk
B. It has no effect on the risk
C. It increases the risk
D. It eliminates the risk
C. It increases the risk
Rationale: Primiparity, or having a first delivery, increases the risk of preeclampsia.
Which chronic condition is associated with an increased risk of preeclampsia? (Select all that apply)
A. Chronic hypertension
B. Chronic bronchitis
C. Chronic renal disease
D. Chronic hyperthyroidism
A. Chronic hypertension
C. Chronic renal disease
Rationale: Chronic hypertension and chronic renal disease are associated with an increased risk of preeclampsia.
Which autoimmune condition is listed as a risk factor for preeclampsia?
A. Rheumatoid arthritis
B. Lupus (SLE)
C. Psoriasi
D. Crohn’s disease
B. Lupus (SLE)
Rationale: Lupus (systemic lupus erythematosus, or SLE) is listed as a risk factor for preeclampsia.
How does maternal age influence the risk of preeclampsia?
A. Age younger than 20 or older than 40 increases the risk
B. Age between 30 and 35 reduces the risk
C. Age younger than 30 has no effect on the risk
D. Age between 35 and 40 with comorbid conditions increases the risk
D. Age between 35 and 40 with comorbid conditions increases the risk
Rationale: Maternal age older than 40, or age 35 with comorbid conditions, increases the risk of developing preeclampsia.
What is the hallmark neurologic complication of preeclampsia?
A. Stroke
B. Hypoglycemia
C. Hypertension
D.Eclampsia
D. Eclampsia
Rationale: Eclampsia is the hallmark neurologic complication of preeclampsia, characterized by the onset of seizure activity.
What is the initial management step during an eclamptic seizure?
A. Administering antihypertensive medication
B. Clearing the airway and administering oxygen
C. Giving IV fluids
D. Monitoring blood pressure
B. Clearing the airway and administering oxygen
Rationale: The initial management step during an eclamptic seizure is to clear the airway and administer adequate oxygen.
What are the complications that can occur during an eclamptic seizure? (Select all that apply)
A. Tongue biting
B. Head trauma
C. Broken bones
D. Aspiration
E. Hyperglycemia
A. Tongue biting
B. Head trauma
C. Broken bones
D. Aspiration
Rationale: Complications during an eclamptic seizure include tongue biting, head trauma, broken bones, and aspiration.
How long should magnesium sulfate be continued after a woman’s last eclamptic seizure?
A. 12 hours
B. 24 hours
C. 36 hours
D. 48 hours
B. 24 hours
Rationale: Magnesium sulfate should be continued for at least 24 hours after the woman’s last eclamptic seizure to prevent further seizures.
What should be closely monitored in women receiving magnesium sulfate? (Select all that apply)
A. Serum magnesium levels
B. Respiratory rate
C. Deep tendon reflexes (DTRs)
D. Urine output
E. Blood glucose levels
A. Serum magnesium levels
B. Respiratory rate
C. Deep tendon reflexes (DTRs)
D. Urine output
Rationale: Serum magnesium levels, respiratory rate, deep tendon reflexes (DTRs), and urine output should be closely monitored to avoid magnesium toxicity.
Which medication is administered IV to prevent further seizures in eclampsia?
A. Calcium gluconate
B. Magnesium sulfate
C. Labetalol
D. Hydralazine
B. Magnesium sulfate
Rationale: Magnesium sulfate is administered IV to prevent further seizures in eclampsia.
What indicates magnesium toxicity in a woman receiving magnesium sulfate? (Select all that apply)
A. Respiratory rate less than 12 breaths per minute
B. Hyperreflexia
C. Absence of deep tendon reflexes (DTRs)
D. Decrease in urinary output (less than 30 mL/hr)
E. Elevated blood pressure
A. Respiratory rate less than 12 breaths per minute
C. Absence of deep tendon reflexes (DTRs)
D. Decrease in urinary output (less than 30 mL/hr)
Rationale: Signs of magnesium toxicity include a respiratory rate less than 12 breaths per minute, absence of deep tendon reflexes (DTRs), and a decrease in urinary output (less than 30 mL/hr).
When should birth via induction or cesarean be performed in a woman with eclampsia?
A. Immediately after the first seizure
B. After the woman’s seizures are controlled
C. Only if the woman remains unstable
D. After 48 hours of observation
B. After the woman’s seizures are controlled
Rationale: Birth via induction or cesarean should be performed after the woman’s seizures are controlled and her stability is assessed.
What is eclampsia characterized by?
A. Onset of coma or seizure in women with preeclampsia
B. Chronic hypertension
C. Severe anemia
D. Hypoglycemia
A. Onset of coma or seizure in women with preeclampsia
Rationale: Eclampsia is characterized by the onset of coma or seizure in women with preeclampsia.
What are the premonitory signs of eclampsia? (Select all that apply)
A. Persistent headache
B. Blurred vision
C. Epigastric or right upper quadrant (RUQ) pain
D. Altered mental status
E. Elevated blood pressure alone
all of the choices are correct
What identifies the onset of eclampsia?
A. High blood pressure
B. Onset of seizure activity
C. Decreased urine output
D. Hyperglycemia
B. Onset of seizure activity
Rationale: The onset of eclampsia is identified by the onset of seizure activity
Which interventions should be performed after seizure activity has ceased? (Select all that apply)
A. Suction the nasopharynx as necessary
B. Administer oxygen
C. Administer antihypertensive medication
D. Continue the magnesium sulfate infusion
E. Encourage the client to walk around
A. Suction the nasopharynx as necessary
B. Administer oxygen
D. Continue the magnesium sulfate infusion
Rationale: After seizure activity has ceased, interventions should include suctioning the nasopharynx as necessary, administering oxygen, and continuing the magnesium sulfate infusion to prevent further seizures. Administering antihypertensive medication may also be necessary, but encouraging the client to walk around is not appropriate immediately after a seizure.
Why should the client be prepared for the birthing process as soon as possible after stabilization?
A. To reduce the risk of preterm birth
B. To minimize the need for pain relief
C. To reduce the risk of perinatal mortality
D. To improve maternal weight gain
C. To reduce the risk of perinatal mortality
Rationale: After the client is stabilized, preparing her for the birthing process as soon as possible helps reduce the risk of perinatal mortality.
What does HELLP syndrome stand for?
A. Hypertension, Elevated liver enzymes, Low platelet count
B. Hypoglycemia, Elevated liver enzymes, Low platelet count
C. Hyperlipidemia, Elevated liver enzymes, Low platelet count
D. Hemolysis, Elevated liver enzymes, Low platelet count
D. Hemolysis, Elevated liver enzymes, Low platelet count
What is the essential phenomenon in the development of HELLP syndrome?
A. Excessive weight gain due to inadequate maternal immune tolerance
B. Abnormal trophoblastic invasion due to inadequate maternal immune tolerance
C. High blood glucose levels due to inadequate maternal immune tolerance
D. Increased dietary salt intake due to inadequate maternal immune tolerance
B. Abnormal trophoblastic invasion due to inadequate maternal immune tolerance
Rationale: The essential phenomenon in the development of HELLP syndrome is abnormal trophoblastic invasion due to inadequate maternal immune tolerance.
Which complications are women with HELLP syndrome at increased risk for? (Select all that apply)
A. Cerebral hemorrhage
B. Retinal detachment
C. Hematoma/liver rupture
D. Deep vein thrombosis (DVT)
E. Disseminated intravascular coagulation (DIC)
A. Cerebral hemorrhage
B. Retinal detachment
C. Hematoma/liver rupture
E. Disseminated intravascular coagulation (DIC)
Rationale: Women with HELLP syndrome are at increased risk for complications such as cerebral hemorrhage, retinal detachment, hematoma/liver rupture, and DIC.
When does HELLP syndrome typically develop in pregnant women?
A. First trimester
B. Second trimester
C. Third trimester
D. Postpartum period only
C. Third trimester
Rationale: HELLP syndrome generally develops during the third trimester, although it may develop within 48 hours after delivery.
What is a characteristic feature of the onset of HELLP syndrome?
A. Slow and progressive onset
B. Rapid onset with vague symptoms
C. Gradual onset with specific symptoms
D. Delayed onset after delivery
B. Rapid onset with vague symptoms
Rationale: HELLP syndrome typically has a rapid onset, and women often present with vague symptoms.
What are the mainstays of treatment for HELLP syndrome? (Select all that apply)
A. Lowering high blood pressure with rapid-acting antihypertensive agents
B. Prevention of convulsions or further seizures with magnesium sulfate
C. Use of steroids for fetal lung maturity if necessary
D. Increasing dietary protein intake
E. Birth of the infant and placenta
A. Lowering high blood pressure with rapid-acting antihypertensive agents
B. Prevention of convulsions or further seizures with magnesium sulfate
C. Use of steroids for fetal lung maturity if necessary
E. Birth of the infant and placenta
Why might birth be delayed up to 96 hours in the management of HELLP syndrome?
A. To reduce maternal weight to stimulate lung maturation in the preterm fetus
B. To allow time for betamethasone or dexamethasone to stimulate lung maturation in the preterm fetus
C. To increase maternal blood pressure to stimulate lung maturation in the preterm fetus
D. To monitor maternal glucose levels to stimulate lung maturation in the preterm fetus
B. To allow time for betamethasone or dexamethasone to stimulate lung maturation in the preterm fetus
Rationale: Birth may be delayed up to 96 hours to allow time for betamethasone or dexamethasone to stimulate lung maturation in the preterm fetus.
What additional treatment is indicated for correcting the coagulopathies that accompany HELLP syndrome?
A. Blood component therapy
B. Administration of diuretics
C. Increased fluid intake
D. Increased salt intake
A. Blood component therapy
Rationale: Blood component therapy, such as the administration of fresh-frozen plasma, packed red blood cells, or platelets, is indicated to address the coagulopathies that accompany HELLP syndrome.
What common symptoms should nurses be alert for in a woman with HELLP syndrome? (Select all that apply)
A. Nausea (with or without vomiting)
B. Malaise
C. Epigastric or right upper quadrant pain
D. Headache
E. Changes in vision
F. Increased appetite
A. Nausea (with or without vomiting)
B. Malaise
C. Epigastric or right upper quadrant pain
D. Headache
E. Changes in vision
Rationale: Nurses should be alert for complaints of nausea (with or without vomiting), malaise, epigastric or right upper quadrant pain, headache, and changes in vision in a woman with HELLP syndrome. Increased appetite is not a typical symptom.
Which laboratory test results are indicative of HELLP syndrome? (Select all that apply)
A. Low hematocrit not explained by any blood loss
B. Elevated LDH
C. Decreased AST and ALT
D. Elevated BUN
E. Elevated uric acid and creatinine levels
F. Low platelet count (less than 100,000 cells/mm³)
A. Low hematocrit not explained by any blood loss
B. Elevated LDH
D. Elevated BUN
E. Elevated uric acid and creatinine levels
F. Low platelet count (less than 100,000 cells/mm³)
What specific laboratory findings suggest liver impairment in HELLP syndrome? (Select all that apply)
A. Elevated LDH
B. Elevated AST
C. Elevated ALT
D. Elevated bilirubin level
E. Low creatinine levels
A. Elevated LDH
B. Elevated AST
C. Elevated ALT
D. Elevated bilirubin level
Which other medications are often used alongside magnesium sulfate in the management of preeclampsia? SATA
A. Antihypertensives (such as labetalol or hydralazine)
B. Betamethasone or dexamethasone
C. Diuretics (such as furosemide)
D. Antibiotics
A. Antihypertensives (such as labetalol or hydralazine)
B. Betamethasone or dexamethasone
Rationale: Antihypertensives and steroids like betamethasone or dexamethasone are often used alongside magnesium sulfate in managing preeclampsia.
What nursing interventions are necessary for a patient on magnesium sulfate for preeclampsia? (Select all that apply)
A. Close monitoring of vital signs
B. Monitoring deep tendon reflexes (DTRs)
C. Assessing urine output
D. Encouraging high fluid intake
A. Close monitoring of vital signs
B. Monitoring deep tendon reflexes (DTRs)
C. Assessing urine output
Rationale: Nursing interventions include close monitoring of vital signs, DTRs, and urine output to detect signs of magnesium toxicity and ensure patient safety.
Which clinical sign is a key indicator of magnesium toxicity?
A. Hyperreflexia
B. Increased blood pressure
C. Hyperventilation
D. Hyporeflexia
D. Hyporeflexia
Rationale: Hyporeflexia or absent DTRs are key indicators of magnesium toxicity.
What are the signs and symptoms of magnesium toxicity? (Select all that apply)
A. Hyporeflexia or absence of DTRs
B. Respiratory rate less than 12 breaths per minute
C. Decreased urine output (less than 30 mL/hr)
D. Increased heart rate
A. Hyporeflexia or absence of DTRs
B. Respiratory rate less than 12 breaths per minute
C. Decreased urine output (less than 30 mL/hr)
What should be monitored closely to avoid magnesium toxicity? (Select all that apply)
A. Serum magnesium levels
B. Respiratory rate
C. Blood glucose levels
D. Urine output
A. Serum magnesium levels
B. Respiratory rate
D. Urine output
Which of the following are risk factors associated with spontaneous abortion? (SATA)
A. Chromosomal abnormalities
B. Maternal age
C. Presence of human chorionic gonadotropin (hCG)
D. Elective termination of pregnancy
A. Chromosomal abnormalities
B. Maternal age
Which condition is most commonly associated with spontaneous abortion in the first trimester?
A. Fetal genetic abnormalities
B. Hypothyroidism
C. Cervical insufficiency
D. Diabetes mellitus
A. Fetal genetic abnormalities
Rationale: The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother.
Which maternal conditions are commonly related to spontaneous abortion in the second trimester? (SATA)
A. Cervical insufficiency
B. Congenital anomaly of the uterine cavity
C. Use of cocaine
D. Chromosomal abnormalities
A. Cervical insufficiency
B. Congenital anomaly of the uterine cavity
C. Use of cocaine
Rationale: Spontaneous abortions during the second trimester are more likely related to maternal conditions such as cervical insufficiency, congenital anomalies of the uterine cavity, and the use of cocaine. Chromosomal abnormalities are more likely to cause spontaneous abortion in the first trimester.
What is the recommended clinical management for a woman experiencing a first-trimester spontaneous abortion at home without a dilation and curettage (D&C) procedure?
A. Frequent monitoring of hCG levels
B. Hospital admission for labor augmentation
C. Immediate surgical intervention
D. Prescribing antibiotics
A. Frequent monitoring of hCG levels
Rationale: Women experiencing a first-trimester abortion at home without a D&C procedure require frequent monitoring of hCG levels to ensure that all conceptus tissues have been expelled.
What is the primary focus of nursing care for women admitted to the hospital for a second-trimester spontaneous abortion?
A. Administration of medication
B. Frequent monitoring of hCG levels
C. Surgical intervention
D. Providing emotional support
D. Providing emotional support
Rationale: Nursing care for women admitted to the hospital for a second-trimester spontaneous abortion focuses on the care of the laboring woman and providing tremendous emotional support to the woman and her family.
What is the immediate nursing action when a pregnant woman calls and reports vaginal bleeding?
A. Advise her to rest and monitor the situation.
B. Suggest over-the-counter medication.
C. Arrange for her to be seen by a health care professional as soon as possible.
D. Recommend increasing fluid intake.
C. Arrange for her to be seen by a health care professional as soon as possible.
Rationale: When a pregnant woman reports vaginal bleeding, it is crucial for her to be seen by a health care professional as soon as possible to determine the cause.
What assessment information should a nurse obtain from a pregnant woman reporting vaginal bleeding? (SATA)
A. Color of the vaginal bleeding
B. Amount of bleeding
C. Frequency of changing peripads
D. Type of food consumed recently
A. Color of the vaginal bleeding
B. Amount of bleeding
C. Frequency of changing peripad
Rationale: The nurse should ask about the color and amount of vaginal bleeding, and the frequency of changing peripads to determine the severity of the bleeding. The type of food consumed is irrelevant in this situation.
Which nursing intervention is appropriate for a woman presenting with passage of products of conception tissue?
A. Instruct her to save and bring any passed tissue or clots to the health care facility.
B. Advise her to discard the tissue and rest.
C. Recommend taking pain medication.
D. Suggest doing physical exercise.
A. Instruct her to save and bring any passed tissue or clots to the health care facility.
Rationale: The nurse should instruct the woman to save and bring any passed tissue or clots to the health care facility for evaluation.
What is a critical component of psychological support for a woman experiencing a spontaneous abortion?
A. Advising her to avoid future pregnancies.
B. Reassuring her that the abortion usually results from an abnormality and not her actions.
C. Suggesting she move on quickly.
D. Minimizing the significance of the event.
B. Reassuring her that the abortion usually results from an abnormality and not her actions.
Rationale: It is important to reassure the woman that spontaneous abortions usually result from an abnormality and that her actions did not cause the abortion, which helps alleviate guilt and provide psychological support.
Which ongoing assessments are essential for a woman experiencing a spontaneous abortion? (SATA)
A. Monitoring the amount of vaginal bleeding through pad counts
B. Observing for passage of products of conception tissue
C. Assessing the woman’s pain
D. Checking the woman’s body temperature hourly
A. Monitoring the amount of vaginal bleeding through pad counts
B. Observing for passage of products of conception tissue
C. Assessing the woman’s pain
For a woman experiencing a spontaneous abortion, which medication might be administered if she is Rh-negative and not sensitized?
A. Misoprostol
B. Prostaglandin E2 (PGE2)
C. Methotrexate
D. RhoGAM
D. RhoGAM
Rationale: If the woman is Rh-negative and not sensitized, RhoGAM should be administered within 72 hours after the abortion is complete to prevent Rh sensitization.
What diagnostic tool is used to confirm if the sac is empty in a threatened abortion?
A. Ultrasound
B. Blood test
C. Vaginal ultrasound
D. Pelvic exam
C. Vaginal ultrasound
Rationale: A vaginal ultrasound is used to confirm if the gestational sac is empty in cases of threatened abortion.
What is the purpose of vacuum curettage in inevitable abortion?
A. To reduce the risk of excessive bleeding and infection if products of conception are not passed
B. To confirm pregnancy
C. To manage pain
D. To prevent future pregnancies
A. To reduce the risk of excessive bleeding and infection if products of conception are not passed
Rationale: Vacuum curettage is performed to reduce the risk of excessive bleeding and infection if the products of conception are not passed.
What therapeutic management is indicated for incomplete abortion?
A. Bed rest
B. Antibiotic therapy
C. Evacuation of uterus via D&C or prostaglandin analog
D. Dietary changes
C. Evacuation of uterus via D&C or prostaglandin analog
Rationale: Incomplete abortion requires evacuation of the uterus via dilation and curettage (D&C) or administration of prostaglandin analog.
What is the therapeutic management for a missed abortion if inevitable abortion does not occur?
A. Watchful waiting
B. Antibiotic therapy
C. Hormonal therapy
D. Evacuation of uterus
D. Evacuation of uterus
Rationale: Therapeutic management includes evacuation of the uterus or induction of labor to empty the uterus without surgical intervention.
What is a possible therapeutic management for recurrent abortion due to incompetent cervix?
A. Hormonal therapy
B. Bed rest
C. Antibiotic therapy
D. Cervical cerclage
D. Cervical cerclage
Rationale: Cervical cerclage is a procedure performed in the second trimester if the cause of recurrent abortion is an incompetent cervix.
What conservative supportive treatment might be recommended for a woman with threatened abortion?
A. Increased physical activity
B. Antibiotic therapy
C. Conservative Treatment
D. Immediate surgical intervention
C. Conservative Treatment
Rationale: Conservative supportive treatment includes reducing activity, maintaining a nutritious diet, and ensuring adequate hydration
What medications might be used to manage an inevitable abortion if tissue fragments are not completely passed?
A. Prostaglandin analogs
B. Antibiotics
C. Hormonal therapy
D. Pain relievers
A. Prostaglandin analogs
Rationale: Prostaglandin analogs like misoprostol are used to empty the uterus of retained tissue in inevitable abortion.
What is the role of client stabilization in the management of incomplete abortion?
A. Providing dietary advice
B. Encouraging physical exercise
C. Stabilizing the client before proceeding with uterine evacuation
D. Measuring body mass index (BMI)
C. Stabilizing the client before proceeding with uterine evacuation
Rationale: Client stabilization is crucial before performing uterine evacuation in cases of incomplete abortion.
How is a complete abortion confirmed diagnostically?
A. Blood test
B. Pelvic exam
C. Physical symptoms only
D. Ultrasound
D. Ultrasound
Rationale: A complete abortion is confirmed through an ultrasound showing an empty uterus.
What ultrasound finding is indicative of a missed abortion?
A. Absent heart rate
B. Identification of products of conception retained in the uterus
C. Enlarged uterus
D. Increased amniotic fluid
B. Identification of products of conception retained in the uterus
Rationale: Ultrasound can identify the presence of retained products of conception, indicating a missed abortion.
What are potential underlying causes that may be identified and treated in recurrent abortion?
A. High blood pressure
B. Genetic or chromosomal abnormalities, reproductive tract abnormalities, chronic diseases, or immunologic problems
C. Nutritional deficiencies
D. Physical inactivity
B. Genetic or chromosomal abnormalities, reproductive tract abnormalities, chronic diseases, or immunologic problems
What are the signs of a missed abortion?
A. Absent uterine contractions and irregular spotting
B. Increased uterine contractions
C. Severe abdominal pain
D. Profuse bleeding
A. Absent uterine contractions and irregular spotting
Rationale: Missed abortion is characterized by the absence of uterine contractions and irregular spotting.
What diagnostic tools are used to confirm pregnancy loss in inevitable abortion?
A. Ultrasound and hCG levels
B. Physical exam and blood pressure measurement
C. Blood glucose levels
D. Pelvic MRI
A. Ultrasound and hCG levels
Rationale: Ultrasound and hCG levels are used to confirm pregnancy loss in cases of inevitable abortion.
Where can an ectopic pregnancy implant outside the uterine cavity?
A. Fallopian tubes
B. Cervix
C. Ovary
D. All of the above
D. All of the above
Rationale: An ectopic pregnancy can implant in various locations outside the uterine cavity, including the fallopian tubes, cervix, ovary, and the abdominal cavity.
What is the primary cause of maternal mortality in the first trimester of pregnancy in the United States?
A. Gestational diabetes
B. Ectopic pregnancy
C. Pre-eclampsia
D. Placenta previa
B. Ectopic pregnancy
Rationale: Ectopic pregnancy is the primary cause of maternal mortality during the first trimester of pregnancy in the United States.
What are the potential complications of an ectopic pregnancy if left untreated?
A. Massive hemorrhage, infertility, or death
B. Chronic hypertension, infertility, or death
C. Gestational diabetes, infertility, or death
D. Hyperemesis gravidarum, infertility, or death
A. Massive hemorrhage, infertility, or death
Rationale: Untreated ectopic pregnancy can lead to severe complications such as massive hemorrhage, infertility, or death.
Why is prediction of tubal rupture before its occurrence crucial in ectopic pregnancies?
A. To schedule routine ultrasounds
B. To manage gestational diabetes
C. To prevent a potentially life-threatening condition
D. To monitor blood pressure
C. To prevent a potentially life-threatening condition
Rationale: Predicting tubal rupture before it occurs is crucial in ectopic pregnancies to prevent a potentially life-threatening condition and manage the pregnancy loss effectively.
What is the most common site for implantation in an ectopic pregnancy?
A. Cervix
B. Ovary
C. Abdominal cavity
D. Fallopian tubes
D. Fallopian tubes
Rationale: The most common site for implantation in an ectopic pregnancy is the fallopian tubes, accounting for 96% of cases.
What typically causes the fertilized ovum to implant outside the uterus in an ectopic pregnancy?
A. Increased uterine size
B. Arrested or altered journey along the fallopian tube
C. Rapid cell division
D. Genetic mutations
B. Arrested or altered journey along the fallopian tube
Rationale: In an ectopic pregnancy, the fertilized ovum implants outside the uterus due to an arrested or altered journey along the fallopian tube.
What are some associated risk factors for ectopic pregnancy? (SATA)
A. Previous tubal surgery
B. Infertility
C. Use of an intrauterine contraceptive system
D. Increased physical activity
A. Previous tubal surgery
B. Infertility
C. Use of an intrauterine contraceptive system
How does smoking affect the risk of ectopic pregnancy?
A. It has no effect
B. It alters tubal motility
C. It reduces tubal scarring
D. It enhances embryo implantation in the uterus
B. It alters tubal motility, increasing the risk
Rationale: Smoking alters tubal motility, which increases the risk of ectopic pregnancy.
What are safe and effective treatments for clinically stable women diagnosed with nonruptured ectopic pregnancies?
A. Oral antibiotics
B. Laparoscopic surgery or intramuscular (IM) methotrexate administration
C. Bed rest and hydration
D. Hormonal therapy
B. Laparoscopic surgery or intramuscular (IM) methotrexate administration
Rationale: Laparoscopic surgery or intramuscular (IM) methotrexate administration are considered safe and effective treatments for clinically stable women diagnosed with nonruptured ectopic pregnancies.
What classic clinical triad is associated with ectopic pregnancy, although only about half of women present with all three symptoms?
A. Fever, nausea, and vomiting
B. Headache, dizziness, and fatigue
C. Abdominal pain, amenorrhea, and vaginal bleeding
D. Joint pain, rash, and swelling
C. Abdominal pain, amenorrhea, and vaginal bleeding
Rationale: The classic clinical triad of ectopic pregnancy includes abdominal pain, amenorrhea, and vaginal bleeding, although only about half of women present with all three symptoms
What diagnostic procedures are used for a suspected ectopic pregnancy? (SATA)
A. Urine pregnancy test
B. Beta-hCG concentrations
C. Transvaginal ultrasound
D. Complete blood count
A. Urine pregnancy test
B. Beta-hCG concentrations
C. Transvaginal ultrasound
Why is preservation of the affected fallopian tube attempted during surgical intervention for an ectopic pregnancy?
A. To maintain fertility
B. To reduce the risk of infection
C. To improve hormone regulation
D. To enhance blood circulation
A. To maintain fertility
Rationale: During surgical intervention for an ectopic pregnancy, preservation of the affected fallopian tube is attempted to maintain fertility.
What criteria must a client meet to be eligible for medical therapy with methotrexate for an ectopic pregnancy?
A. Hemodynamically unstable and high beta-hCG levels
B. Active bleeding in the peritoneal cavity and a ruptured mass
C. Hemodynamically stable
D. Severe persistent abdominal pain and liver disease
C. Hemodynamically stable
Rationale: To be eligible for medical therapy with methotrexate, the client must be hemodynamically stable, with no signs of active bleeding in the peritoneal cavity, low beta-hCG levels (lower than 5,000 mIU/mL), and the mass must be unruptured and measure less than 4 cm as determined by ultrasound.
What is a contraindication to medical treatment with methotrexate for ectopic pregnancy?
A. Low beta-hCG levels
B. Renal or liver disease
C. Small unruptured mass
D. No signs of active bleeding
B. Renal or liver disease
Rationale: Renal or liver disease is a contraindication to medical treatment with methotrexate for ectopic pregnancy.
What are the advantages of using methotrexate for the medical management of ectopic pregnancy? (SATA)
A. Avoidance of surgery
B. Preservation of tubal patency and function
C. Lower cost
D. Immediate pain relief
A. Avoidance of surgery
B. Preservation of tubal patency and function
C. Lower cost
What is the main mechanism of action of methotrexate in treating ectopic pregnancy?
A. Promoting embryo growth
B. Increasing blood supply
C. Enhancing tubal motility
D. Inhibiting cell division in the developing embryo
D. Inhibiting cell division in the developing embryo
Rationale: Methotrexate is a folic acid antagonist that inhibits cell division in the developing embryo, which is its main mechanism of action in treating ectopic pregnancy.
What adverse effects are associated with methotrexate treatment for ectopic pregnancy?
A. Nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness
B. Hair loss and weight gain
C. Hypertension and hyperglycemia
D. Skin rash and joint pain
A. Nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness
Rationale: Adverse effects associated with methotrexate treatment for ectopic pregnancy include nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness.
What follow-up care is necessary after methotrexate administration for ectopic pregnancy?
A. Monthly check-ups
B. Immediate surgical intervention
C. Weekly laboratory studies until beta-hCG titers decrease
D. Daily physical therapy sessions
C. Weekly laboratory studies until beta-hCG titers decrease
Rationale: After methotrexate administration for ectopic pregnancy, the woman is instructed to return weekly for follow-up laboratory studies until beta-hCG titers decrease.
What surgical procedure might be performed to preserve the fallopian tube in an unruptured ectopic pregnancy?
A. Laparotomy
B. Linear salpingostomy
C. Salpingectomy
D. Hysterectomy
B. Linear salpingostomy
Rationale: In an unruptured ectopic pregnancy, a linear salpingostomy may be performed to preserve the fallopian tube and maintain future fertility.
What is the primary reason for surgery in cases of ruptured ectopic pregnancy?
A. To enhance fertility
B. To control possible uncontrolled hemorrhage
C. To diagnose ectopic pregnancy
D. To prevent future pregnancies
B. To control possible uncontrolled hemorrhage
Rationale: Surgery is necessary in cases of ruptured ectopic pregnancy to control possible uncontrolled hemorrhage, which is a medical emergency.
What is the significance of monitoring beta-hCG levels until they are undetectable following treatment for ectopic pregnancy?
A. To confirm pregnancy
B. To ensure that any residual trophoblastic tissue that forms the placenta is gone
C. To assess liver function
D. To measure kidney function
B. To ensure that any residual trophoblastic tissue that forms the placenta is gone
Rationale: Monitoring beta-hCG levels until they are undetectable ensures that any residual trophoblastic tissue that forms the placenta is completely removed.
What is the primary focus of nursing assessment in a woman with a suspected ectopic pregnancy?
A. Determining the presence of urinary tract infection
B. Assessing nutritional status
C. Determining the existence of an ectopic pregnancy and whether or not it has ruptured
D. Evaluating blood glucose levels
C. Determining the existence of an ectopic pregnancy and whether or not it has ruptured
Rationale: The primary focus of nursing assessment is determining the existence of an ectopic pregnancy and whether or not it has ruptured.
When do signs and symptoms of ectopic pregnancy typically begin?
A. Immediately after conception
B. At about the 4th or 5th week of gestation
C. At about the 7th or 8th week of gestation
D. At about the 10th or 11th week of gestation
C. At about the 7th or 8th week of gestation
Rationale: The signs and symptoms of ectopic pregnancy usually begin at about the 7th or 8th week of gestation.
What is the hallmark sign of ectopic pregnancy?
A. Severe headache with spotting within 6 to 8 weeks after a missed menstrual period
B. Abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period
C. High fever with spotting within 6 to 8 weeks after a missed menstrual period
D. Leg cramps with spotting within 6 to 8 weeks after a missed menstrual period
B. Abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period
What are some possible contributing factors to ectopic pregnancy? (SATA)
A. Previous ectopic pregnancy
B. History of sexually transmitted infections (STIs)
C. Fallopian tube scarring from PID
D. Recent physical trauma
A. Previous ectopic pregnancy
B. History of sexually transmitted infections (STIs)
C. Fallopian tube scarring from PID
What symptoms might indicate an unruptured tubal pregnancy?
A. Severe lower back pain and high fever
B. Missed menstrual period, adnexal fullness, and tenderness
C. Chronic cough and difficulty breathing
D. Swelling in the legs
B. Missed menstrual period, adnexal fullness, and tenderness
What are common symptoms typical of early pregnancy that can also be present in ectopic pregnancy?
A. High blood pressure and increased urination
B. Breast tenderness, nausea, fatigue, shoulder pain, and low back pain
C. Increased appetite and weight gain
D. Headache and dizziness
B. Breast tenderness, nausea, fatigue, shoulder pain, and low back pain
What findings on an ultrasound are diagnostic of ectopic pregnancy?
A. Presence of a gestational sac in the uterus and the absence of an intrauterine gestational sac
B. Visualization of an adnexal mass and the absence of an intrauterine gestational sac
C. Increased amniotic fluid and the absence of an intrauterine gestational sac
D. Enlarged ovaries and the absence of an intrauterine gestational sac
B. Visualization of an adnexal mass and the absence of an intrauterine gestational sac
How do beta-hCG levels typically behave in a normal intrauterine pregnancy during the first 60 to 90 days after conception?
A. Decrease gradually
B. Remain constant
C. Double every 2 to 4 days
D. Triple every 1 to 2 days
C. Double every 2 to 4 days
What do low beta-hCG levels suggest in the context of pregnancy?
A. Ectopic pregnancy or impending abortion
B. Normal intrauterine pregnancy
C. Gestational diabetes
D. Preeclampsia
A. Ectopic pregnancy or impending abortion
What signs and symptoms of ectopic rupture should be outlined for a woman receiving outpatient treatment for an ectopic pregnancy?
A. Mild headache and blurred vision
B. Severe, sharp, stabbing, unilateral abdominal pain; vertigo/fainting; hypotension; and increased pulse
C. Frequent urination and increased appetite
D. Sweating and rash
B. Severe, sharp, stabbing, unilateral abdominal pain; vertigo/fainting; hypotension; and increased pulse
What should a nurse stress to a woman about the need for follow-up blood testing after an ectopic pregnancy?
A. To confirm pregnancy
B. To check for anemia
C. To assess kidney function
D. To monitor hCG titers until they return to zero, indicating resolution of the ectopic pregnancy
D. To monitor hCG titers until they return to zero, indicating resolution of the ectopic pregnancy
What risk factors should be reduced to help prevent ectopic pregnancies? (SATA)
A. Sexual intercourse with multiple partners
B. Intercourse without a condom
C. Smoking during childbearing years
D. Consuming dairy products
A. Sexual intercourse with multiple partners
B. Intercourse without a condom
C. Smoking during childbearing years
Why is seeking prenatal care early important in preventing ectopic pregnancies?
A. To monitor blood pressure
B. To assess weight gain
C. To confirm the location of the pregnancy
D. To improve hair growth
C. To confirm the location of the pregnancy
What term describes a weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions, leading to pregnancy loss?
A. Cervical insufficiency
B. Placenta previa
C. Preterm labor
D. Gestational diabetes
A. Cervical insufficiency
Rationale: Cervical insufficiency, also known as premature dilation of the cervix, describes a weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions, resulting in pregnancy loss.
When does cervical insufficiency typically occur during pregnancy?
A. In the first trimester or early second trimester
B. In the second trimester or early third trimester
C. During labor
D. In the postpartum period
B. In the second trimester or early third trimester
What structural abnormalities are hypothesized to contribute to cervical insufficiency?
A. Increased elastin and collagen
B. Decreased smooth muscle
C. Less elastin, less collagen, and greater amounts of smooth muscle
D. Increased blood supply
C. Less elastin, less collagen, and greater amounts of smooth muscle
Rationale: The cervix in cases of cervical insufficiency may have less elastin, less collagen, and greater amounts of smooth muscle, leading to a loss of sphincter tone.
What hormonal factor is proposed to play a role in cervical insufficiency?
A. Estrogen
B. Thyroxine
C. Insulin
D. Relaxin
D. Relaxin
Rationale: Increased amounts of relaxin are proposed to play a role in cervical insufficiency by affecting the cervix.
What are some conditions associated with cervical insufficiency?
A. Diabetes and hypertension
B. Previous precipitous birth, prolonged second stage of labor, increased uterine volume
C. Obesity and thyroid dysfunction
D. Chronic kidney disease
B. Previous precipitous birth, prolonged second stage of labor, increased uterine volume
Why does the ACOG not recommend cerclage placement for women with short cervixes who do not have a history of preterm birth?
A. It is too expensive
B. It has not been shown to be beneficial in this population
C. It requires extensive hospitalization
D. It is associated with high complication rates
B. It has not been shown to be beneficial in this population
What are some non-surgical treatments for cervical insufficiency?
A. Bed rest, pelvic rest, avoidance of heavy lifting, and progesterone supplementation
B. Immediate labor induction
C. High-intensity exercise
D. Radiation therapy
A. Bed rest, pelvic rest, avoidance of heavy lifting, and progesterone supplementation
What is the purpose of a cervical pessary in the management of cervical insufficiency?
A. To support and reinforce the cervix
B. To increase cervical length
C. To induce labor
D. To prevent infections
A. To support and reinforce the cervix
What complications may be associated with cervical cerclage placement?
A. High blood pressure and diabetes
B. Suture displacement, rupture of membranes, and chorioamnionitis
C. Increased risk of cesarean delivery
D. Gestational diabetes
B. Suture displacement, rupture of membranes, and chorioamnionitis
Why should the decision to proceed with cerclage be made with caution if a short cervix is identified at or after 20 weeks?
A. To reduce healthcare costs
B. To increase the duration of hospital stay
C. To monitor maternal weight gain
D. To avoid unnecessary interventions if there is no infection
D. To avoid unnecessary interventions if there is no infection
What key aspects should a nursing assessment focus on to determine risk factors for cervical insufficiency?
A. Dietary habits and exercise routines
B. Family history of chronic diseases
C. Previous cervical trauma, preterm labor, fetal loss in the second trimester, and previous surgeries or procedures involving the cervix
D. Sleep patterns and hydration levels
C. Previous cervical trauma, preterm labor, fetal loss in the second trimester, and previous surgeries or procedures involving the cervix
What symptoms might a woman with cervical insufficiency report?
A. Increased appetite and weight gain
B. Pink-tinged vaginal discharge, low pelvic pressure, cramping with vaginal bleeding, and loss of amniotic fluid
C. High fever and chills
D. Headache and dizziness
B. Pink-tinged vaginal discharge, low pelvic pressure, cramping with vaginal bleeding, and loss of amniotic fluid
What might cervical dilation without uterine contractions indicate during the second trimester?
A. Preterm labor
B. Preeclampsia
C. Placenta previa
D. Cervical Insufficiency
D. Cervical Insufficiency
What can be the outcome if cervical insufficiency continues untreated?
A. Pre-eclampsia development
B. Rupture of the membranes, release of amniotic fluid, and uterine contractions leading to delivery of the fetus before viability
C. Increased fetal movements
D. Delayed labor
B. Rupture of the membranes, release of amniotic fluid, and uterine contractions leading to delivery of the fetus before viability
When is transvaginal ultrasound typically performed to determine cervical length in pregnancy?
A. Between 8 and 12 weeks’ gestation
B. Between 16 and 24 weeks’ gestation
C. Between 28 and 32 weeks’ gestation
D. At 36 weeks’ gestation
B. Between 16 and 24 weeks’ gestation
What can cervical shortening viewed on ultrasound as funneling indicate?
A. Risk of preterm labor
B. Increased fetal movements
C. Normal pregnancy progression
D. Decreased amniotic fluid
A. Risk of preterm labor
What symptoms might prompt a woman to undergo serial transvaginal ultrasound evaluations? (SATA)
A. Pelvic pressure
B. Backache
C. Increased mucoid discharge
D. Increased energy levels
A. Pelvic pressure
B. Backache
C. Increased mucoid discharge
What should nursing management focus on when monitoring a woman for signs of preterm labor?
A. Blood pressure and heart rate
B. Backache, increase in vaginal discharge, rupture of membranes, and uterine contractions
C. Appetite and weight gain
D. Sleep patterns and hydration levels
B. Backache, increase in vaginal discharge, rupture of membranes, and uterine contractions
What is placental abruption?
A. A condition where the placenta implants in the cervix
B. The early separation of a normally implanted placenta after the 20th week of gestation, leading to hemorrhage
C. A type of placental previa
D. A genetic disorder affecting placental function
B. The early separation of a normally implanted placenta after the 20th week of gestation, leading to hemorrhage
Rationale: Placental abruption is the early separation of a normally implanted placenta after the 20th week of gestation, which leads to hemorrhage.
What maternal risks are associated with placental abruption?
A. Increased appetite and weight gain
B. Obstetric hemorrhage, need for blood transfusions, emergency hysterectomy, DIC, Sheehan syndrome, and renal failure
C. Gestational diabetes
D. Thyroid dysfunction
B. Obstetric hemorrhage, need for blood transfusions, emergency hysterectomy, DIC, Sheehan syndrome, and renal failure
What are the proposed causes of placental abruption?
A. Genetic mutations
B. Viral infections
C. Hormonal imbalances
D. Degenerative changes in small maternal blood vessels resulting in blood clotting and vessel rupture
D. Degenerative changes in small maternal blood vessels resulting in blood clotting and vessel rupture
What are the common origins of most placental abruption cases?
A. Gestational diabetes
B. Maternal hypertension and preeclampsia
C. Thyroid dysfunction
D. Obesity
B. Maternal hypertension and preeclampsia
What classification of placental abruption is associated with no sign of vaginal bleeding or minimal bleeding, marginal separation, and no fetal distress?
A. Grade 0
B. Mild (grade 1)
C. Moderate (grade 2)
D. Severe (grade 3)
B. Mild (grade 1)
Rationale: Mild (grade 1) placental abruption is associated with no sign of vaginal bleeding or minimal bleeding, marginal separation, and no fetal distress.
How can placental abruption be classified by the type of bleeding?
A. Concealed or apparent
B. Gradual or sudden
C. Mild or severe
D. Internal or external
A. Concealed or apparent
What emergency measure is critical to combat hypovolemia in placental abruption?
A. Oral hydration
B. Starting two large-bore IV lines with normal saline or lactated Ringer’s solution
C. Administering antihistamines
D. Providing bed rest
B. Starting two large-bore IV lines with normal saline or lactated Ringer’s solution
Rationale: Starting two large-bore IV lines with normal saline or lactated Ringer’s solution is critical to combat hypovolemia in placental abruption.
When is a cesarean birth performed immediately in cases of placental abruption?
A. When maternal blood pressure is stable
B. When the mother reports mild pain
C. If the mother is asymptomatic
D. If fetal distress is evident
D. If fetal distress is evident
What is the treatment focus if a woman develops disseminated intravascular coagulation (DIC) due to placental abruption?
A. Determining the underlying cause of DIC and correcting it
B. Increasing physical activity
C. Administering antibiotics
D. Providing nutritional supplements
A. Determining the underlying cause of DIC and correcting it
*What should the initial nursing assessment focus on in cases of suspected placental abruption?
A. Maternal diet and exercise
B. Fetal movements and maternal sleep patterns
C. Maternal hemodynamic status and fetal well-being
D. Maternal weight gain and hydration levels
C. Maternal hemodynamic status and fetal well-being
Why is it important to monitor the woman’s level of consciousness in cases of placental abruption?
A. To assess dietary intake
B. To note any signs or symptoms that may suggest shock
C. To evaluate sleep patterns
D. To monitor physical activity
B. To note any signs or symptoms that may suggest shock
What are the classic manifestations of placental abruption?
A. High fever and chills
B. Increased appetite and weight gain
C. Headache and dizziness
D. Painful, dark red vaginal bleeding, “knife-like” abdominal pain, uterine tenderness, contractions, and decreased fetal movement
D. Painful, dark red vaginal bleeding, “knife-like” abdominal pain, uterine tenderness, contractions, and decreased fetal movement
What might a moderate dip in fibrinogen levels suggest in pregnancy, particularly in the context of placental abruption?
A. Normal pregnancy progression
B. Disseminated intravascular coagulation (DIC)
C. Increased fetal movements
D. Decreased immune response
B. Disseminated intravascular coagulation (DIC)
What does a nonstress test demonstrate in cases of placental abruption?
A. Fetal growth patterns
B. Findings of fetal jeopardy manifested by late decelerations or bradycardia
C. Maternal nutritional status
D. Blood glucose levels
B. Findings of fetal jeopardy manifested by late decelerations or bradycardia
What does a low score on a biophysical profile suggest in clients with chronic placental abruption?
A. Possible fetal compromise
B. Normal fetal development
C. Enhanced immune function
D. Increased amniotic fluid
A. Possible fetal compromise
Why should maternal vital signs be obtained frequently in cases of placental abruption?
A. To monitor dietary intake
B. To assess sleep patterns
C. To observe for changes suggesting hypovolemic shock
D. To evaluate physical activity levels
C. To observe for changes suggesting hypovolemic shock
What might an increase in fundal height indicate in cases of placental abruption?
A. Normal pregnancy progression
B. Bleeding
C. Increased amniotic fluid
D. Enhanced fetal growth
B. Bleeding
Rationale: An increase in fundal height may indicate bleeding in cases of placental abruption.
What is the onset of bleeding in placenta previa?
A. Sudden
B. Insidious
C. Intermittent
D. Continuous
B. Insidious
How can the bleeding present in cases of placental abruption?
A. Always visible
B. Slight, then more profuse
C. Can be concealed or visible
D. Only visible
C. Can be concealed or visible
How is the discomfort or pain characterized in placenta previa?
A. None
B. Mild cramping
C. Sharp and intermittent
D. Severe and continuous
A. None
What is the uterine tone in cases of placental abruption?
A. Soft and relaxed
B. Firm to rigid
C. Spongy
D. Intermittent contractions
B. Firm to rigid
How does the fetal heart rate typically appear in placenta previa?
A. Irregular
B. Elevated
C. Usually in normal range
D. Decreased
C. Usually in normal range
What is a common fetal presentation in placenta previa?
A. Breech or transverse lie; engagement is absent
B. Vertex presentation
C. Cephalic position
D. Occiput posterior position
A. Breech or transverse lie; engagement is absent
What type of discomfort or pain is associated with placental abruption?
A. None (painless)
B. Mild cramps
C. Intermittent contractions
D. Constant; uterine tenderness on palpation
D. Constant; uterine tenderness on palpation
What is the definition of placenta previa?
A. Placenta detachment after birth
B. Placenta inserted wholly or partly into the lower uterine segment, covering the internal cervical opening
C. Placenta formation in the upper uterine segment -
D. Abnormal placental blood flow
B. Placenta inserted wholly or partly into the lower uterine segment, covering the internal cervical opening
During which trimesters does placenta previa typically occur?
A. First trimester
B. Entire pregnancy
C. Postpartum period
D. Last two trimesters
D. Last two trimesters
What factors determine the therapeutic management approach for placenta previa?
A. Maternal diet and exercise
B. Extent of bleeding, closeness of the placenta to the cervical os, fetal development, fetal position, maternal parity, presence or absence of labor
C. Maternal sleep patterns
D. Maternal hydration levels
B. Extent of bleeding, closeness of the placenta to the cervical os, fetal development, fetal position, maternal parity, presence or absence of labor
What is the appropriate setting for expectant care if the mother and fetus are both stable and there is no active bleeding?
A. Intensive care unit
B. At home with ready access to reliable transportation and the ability to maintain bed rest
C. Outpatient clinic
D. Surgical ward
B. At home with ready access to reliable transportation and the ability to maintain bed rest
Why is maternal age over 35 years considered a risk factor for placenta previa?
A. Higher likelihood of uterine abnormalities
B. Increased physical activity
C. Better nutritional status
D. Decreased maternal weight
A. Higher likelihood of uterine abnormalities
How does a previous cesarean birth contribute to the risk of placenta previa?
A. Increases amniotic fluid volume
B. Enhances fetal growth
C. Reduces uterine contractions
D. Causes scarring and structural changes in the uterine lining
D. Causes scarring and structural changes in the uterine lining
What impact does multiparity have on the risk of placenta previa?
A. Increases the chances of placental implantation
B. Decreases uterine elasticity
C. Reduces maternal nutrition
D. Stabilizes fetal movements
A. Increases the chances of placental implantation
Rationale: Multiparity increases the chances of placental implantation in the lower uterine segment, raising the risk of placenta previa.
What are some possible risk factors for placenta previa related to previous uterine procedures?
A. Irregular prenatal check-ups, endometrial ablation, and previous myomectomy
B. Previous D&C, endometrial ablation, and previous myomectomy
C. Routine physical exercise, endometrial ablation, and previous myomectomy
D. Dietary supplements
B. Previous D&C, endometrial ablation, and previous myomectomy
Rationale: Previous uterine procedures such as D&C, endometrial ablation, and previous myomectomy are risk factors for placenta previa.
How does cocaine use affect the risk of placenta previa?
A. Enhances fetal movements
B. Improves maternal hydration
C. Causes vascular constriction and impaired placental attachment
D. Reduces uterine contractions
C. Causes vascular constriction and impaired placental attachment
Why is a history of infertility treatment considered a risk factor for placenta previa?
A. Increases maternal appetite
B. Enhances fetal growth
C. Often involves procedures that can alter the uterine lining
D. Reduces amniotic fluid
C. Often involves procedures that can alter the uterine lining
Why is a short interval between pregnancies a risk factor for placenta previa?
A. May not allow sufficient time for uterine healing
B. Reduces maternal energy levels
C. Increases uterine contractions
D. Enhances fetal movement
A. May not allow sufficient time for uterine healing
What is the classical clinical presentation of placenta previa?
A. Severe cramping with dark red vaginal bleeding during the second or third trimester
B. High fever and chills during the second or third trimester
C. Increased fetal movements during the second or third trimester
D. Painless, bright red vaginal bleeding during the second or third trimester
D. Painless, bright red vaginal bleeding during the second or third trimester
Rationale: The classical clinical presentation of placenta previa is painless, bright red vaginal bleeding occurring during the second or third trimester.
Why is bleeding from the implantation site in the lower uterus more difficult to stop in placenta previa?
A. Increased uterine contractions
B. Enhanced placental attachment
C. The uterus cannot contract adequately to stop the flow of blood from open vessels in the lower uterine segment
D. Excessive fetal movements
C. The uterus cannot contract adequately to stop the flow of blood from open vessels in the lower uterine segment
What uterine characteristics are typically observed upon palpation in placenta previa?
A. Firm and tender
B. Soft and nontender
C. Spongy and painful
D. Rigid and cramping
B. Soft and nontender
Rationale: Upon palpation in placenta previa, the uterus is typically soft and nontender.
What diagnostic test is primarily used to validate the position of the placenta in cases of suspected placenta previa?
A. Abdominal X-ray
B. Amniocenteisis
C. Blood test
D. Transvaginal Ultrasound
D. Transvaginal Ultrasound
Why might magnetic resonance imaging (MRI) be ordered when preparing for childbirth in cases of placenta previa?
A. To evaluate maternal bone density
B. To assess fetal movements
C. To identify placental abnormalities
D. To monitor maternal heart rate
C. To identify placental abnormalities
Why should vaginal examinations be avoided in women with placenta previa?
A. To reduce maternal discomfort
B. They may disrupt the placenta and cause hemorrhage
C. To improve fetal movements
D. To enhance uterine contractions
B. They may disrupt the placenta and cause hemorrhage
Rationale: Vaginal examinations should be avoided because they may disrupt the placenta and cause hemorrhage
What should be done if the woman with placenta previa is experiencing active bleeding?
A. Administer antibiotics
B. Increase fluid intake
C. Prepare for blood typing and cross-matching in case a blood transfusion is needed
D. Monitor fetal movements
C. Prepare for blood typing and cross-matching in case a blood transfusion is needed
Rationale: If the woman is experiencing active bleeding, blood typing and cross-matching should be prepared in case a blood transfusion is needed.
*What is the purpose of administering Rh immunoglobulin to an Rh-negative woman at 28 weeks’ gestation?
A. To reduce maternal anxiety
B. To enhance fetal growth
C. To prevent Rh sensitization
D. To improve uterine contractions
C. To prevent Rh sensitization
Rationale: Administering Rh immunoglobulin to an Rh-negative woman at 28 weeks’ gestation prevents Rh sensitization
What signs and symptoms should be reported immediately by a woman with placenta previa?
A. Increased appetite and weight gain
B. Frequent urination
C. High fever and chills
D. Any bleeding episodes or backaches
D. Any bleeding episodes or backaches
Which clinical definition characterizes preterm labor?
A. Regular uterine contractions with cervical dilation and effacement before 37 weeks
B. Irregular uterine contractions without cervical changes after 37 weeks
C. Preterm rupture of membranes with no cervical changes
D. Any contractions occurring before 40 weeks
A. Regular uterine contractions with cervical dilation and effacement before 37 weeks
Rationale: Preterm labor involves uterine contractions leading to cervical changes before 37 weeks of gestation.
What is the primary demographic group at nearly twice the risk of experiencing preterm labor?
A. Hispanic clients
B. African American clients
C. Asian clients
D. Caucasian clients
B. African American clients
Which complication is most commonly associated with preterm birth?
A. Respiratory distress syndrome
B. Gestational diabetes
C. Placental abruption
D. Postpartum hemorrhage
A. Respiratory distress syndrome
Rationale: Preterm infants often experience respiratory distress syndrome due to immature lungs and insufficient surfactant production.
Which neonatal condition is directly associated with preterm birth?
A. Kernicterus
B. Thermoregulation problems
C. Esophageal atresia
D. Pyloric stenosis
B. Thermoregulation problems
Rationale: Preterm infants have underdeveloped thermoregulatory systems, which can lead to acidosis, hypothermia, and weight loss.
What is the leading cause of death within the first month of life in the United States?
A. Neonatal sepsis
B. Prematurity
C. Congenital heart defects
D. Hypoxic ischemic encephalopathy
B. Prematurity
Which long-term sequelae are preterm infants most at risk for?
A. Hypothyroidism and scoliosis
B. Type 1 diabetes and obesity
C. Autism and attention-deficit disorder
D. Cerebral palsy and vision defects
D. Cerebral palsy and vision defects
Which factor is most likely to influence the decision to administer tocolytic drugs in preterm labor?
A. Presence of gestational diabetes
B. Maternal age
C. Extent of cervical dilation
D. Previous history of preterm birth
C. Extent of cervical dilation
Rationale: The decision to administer tocolytic drugs depends on several factors, including the extent of cervical dilation, as more dilation may indicate a higher likelihood of imminent preterm birth.
What is the primary goal of administering tocolytic therapy in preterm labor?
A. To stop labor completely
B. To delay labor long enough for steroids to improve fetal lung maturity
C. To prevent infection in the uterus
D. To increase the length of pregnancy by several weeks
B. To delay labor long enough for steroids to improve fetal lung maturity
Rationale: Tocolytic therapy aims to delay preterm labor long enough to administer corticosteroids, which enhance fetal lung development and reduce neonatal respiratory distress syndrome.
Which medication is commonly used for tocolysis and works by reducing the muscle’s ability to contract?
A. Magnesium sulfate
B. Indomethacin
C. Atosiban
D. Nifedipine
A. Magnesium sulfate
Which contraindication for tocolytic therapy is related to maternal health?
A. Maternal hemodynamic instability
B. Gestational hypertension
C. Cervical dilation of 4 cm
D. Fetal macrosomia
A. Maternal hemodynamic instability
Rationale: Tocolytic therapy is contraindicated in cases of maternal hemodynamic instability, as it could exacerbate the condition and compromise both maternal and fetal health.
What is the recommended administration window for corticosteroids in preterm labor to improve fetal lung maturity?
A. 48 hours before delivery
B. At least 24 hours before delivery
C. Within 7 days of preterm birth
D. Immediately after labor begins
B. At least 24 hours before delivery
Rationale: Corticosteroids should be administered at least 24 hours before delivery to be effective in promoting fetal lung maturation and reducing respiratory distress syndrome.
Which of the following is a potential side effect of using magnesium sulfate for tocolysis?
A. Hyperkalemia
B. Increased blood pressure
C. Respiratory depression
D. Decreased urine output
C. Respiratory depression
Rationale: Magnesium sulfate can cause respiratory depression as a side effect, requiring careful monitoring of the woman’s respiratory status during administration.
Which of the following statements about tocolytic therapy is true?
A. Tocolytic therapy typically prevents preterm birth entirely.
B. Tocolytic therapy is contraindicated for women with gestational diabetes.
C. Tocolytic therapy may delay birth long enough for corticosteroids to be administered.
D. Tocolytic therapy can prolong pregnancy indefinitely.
C. Tocolytic therapy may delay birth long enough for corticosteroids to be administered.
Rationale: Tocolytics are not designed to prevent preterm birth completely but to delay labor, allowing time for corticosteroids to enhance fetal lung maturity.
Which of the following is a contraindication for the use of tocolytics in preterm labor?
A. Placenta previa
B. Gestational hypertension
C. Mild cervical dilation
D. Postterm pregnancy
A. Placenta previa
Rationale: Tocolytic therapy is contraindicated in cases of placenta previa, as it could worsen bleeding and maternal complications.
What is the recommended management for a woman experiencing preterm labor after 34 weeks of gestation?
A. Administer corticosteroids to enhance fetal lung maturity
B. Delay birth using tocolytic drugs
C. Consider delivery as the risks of continuing pregnancy outweigh the benefits
D. Perform an amniocentesis to assess fetal lung maturity
C. Consider delivery as the risks of continuing pregnancy outweigh the benefits
Rationale: After 34 weeks, the risks of prematurity decrease significantly, so delivery is often recommended over further attempts to delay labor.
Which factor should be assessed when determining whether to initiate tocolytic therapy in a woman presenting with preterm labor?
A. The mother’s ethnicity
B. The gestational age of the fetus
C. The mother’s preference for delivery
D. The presence of maternal asthma
B. The gestational age of the fetus
Which symptom is most commonly associated with preterm labor and may be overlooked by both the patient and healthcare provider?
A. Severe abdominal pain
B. Increased vaginal discharge with mucus or blood
C. Consistent heavy bleeding
D. Sudden weight gain
B. Increased vaginal discharge with mucus or blood
Rationale: One of the subtle signs of preterm labor is a change or increase in vaginal discharge, which may contain mucus, water, or blood.
A patient presents with a complaint of low backache and pelvic pressure. These symptoms are indicative of which of the following conditions?
A. Preterm labor
B. Pregnancy-induced hypertension
C. Gestational diabetes
D. Hyperemesis gravidarum
A. Preterm labor
Which test is most useful for predicting preterm labor by detecting fetal fibronectin levels?
A. Complete blood count
B. Fetal ultrasound
C. Fetal fibronectin test
D. Amniocentesis
C. Fetal fibronectin test
Rationale: The fetal fibronectin test is valuable for assessing the risk of preterm labor, as high levels of fetal fibronectin are associated with impending preterm birth.
Which of the following factors may reduce the accuracy of the fetal fibronectin test?
A. Maternal age over 35 years
B. Use of lubricants during a pelvic exam
C. High blood pressure
D. Chronic kidney disease
B. Use of lubricants during a pelvic exam
What does a negative fetal fibronectin result most likely indicate?
A. Preterm labor is imminent
B. There is a high risk of preterm birth in the next two weeks
C. Preterm labor is unlikely within the next two weeks
D. Immediate intervention with tocolytics is required
C. Preterm labor is unlikely within the next two weeks
Rationale: A negative fetal fibronectin result is a strong predictor that preterm labor is unlikely in the next two weeks, reducing the need for aggressive interventions.
What is the primary clinical significance of measuring cervical length in high-risk pregnancies?
A. To diagnose preterm labor immediately
B. To determine the exact date of delivery
C. To predict the likelihood of preterm birth
D. To assess the fetal heart rate variability
C. To predict the likelihood of preterm birth
Rationale: Measuring cervical length helps predict the likelihood of preterm birth, especially in high-risk pregnancies, by identifying women at greater risk based on cervical shortening.
What is a primary use of amniotic fluid analysis in the context of preterm labor?
A. To detect fetal lung maturity and chorioamnionitis
B. To assess fetal position
C. To determine the sex of the baby
D. To evaluate maternal kidney function
A. To detect fetal lung maturity and chorioamnionitis
Rationale: Amniotic fluid analysis is used to assess fetal lung maturity and detect signs of chorioamnionitis, which could contribute to preterm labor.
Which of the following statements is true regarding fetal fibronectin testing?
A. It is a definitive test for predicting preterm labor.
B. A positive result indicates that preterm birth will definitely occur within two weeks.
C. A negative result is a strong predictor that preterm labor will not occur within two weeks.
D. The test should be used alone to determine the need for treatment.
C. A negative result is a strong predictor that preterm labor will not occur within two weeks.
Which of the following findings would suggest a higher likelihood of preterm labor in a woman between 24 and 34 weeks’ gestation?
A. A cervical length of 4 cm
B. Absence of uterine contractions
C. No change in vaginal discharge
D. A positive fetal fibronectin test
D. A positive fetal fibronectin test
Rationale: A positive fetal fibronectin test, along with clinical signs such as uterine contractions, increases the likelihood of preterm labor in the following two weeks.
A nurse is caring for a woman in preterm labor who is receiving magnesium sulfate therapy. Which of the following should the nurse prioritize in monitoring the client?
A) Maternal blood pressure
B) Fetal heart rate variability
C) Maternal respiratory effort and deep tendon reflexes
D) Uterine contraction frequency
C) Maternal respiratory effort and deep tendon reflexes
Rationale: Magnesium sulfate requires frequent monitoring of maternal respiratory effort and deep tendon reflexes for early signs of overdose.
A client at 30 weeks gestation is diagnosed with preterm labor and is receiving nifedipine. Which assessment finding should the nurse report to the healthcare provider immediately?
A) Increased fetal heart rate
B) Increased maternal blood pressure
C) Reflex tachycardia
D) Maternal hypotension
D) Maternal hypotension
Rationale: Nifedipine can cause maternal hypotension, which should be promptly reported.
Which of the following is a contraindication for administering tocolytic therapy for preterm labor?
A) Active hemorrhage
B) Mild uterine contractions
C) A short cervix
D) A previous preterm birth
A) Active hemorrhage
Rationale: Tocolytic therapy is contraindicated in active hemorrhage as it could worsen the condition.
A nurse is educating a woman at risk for preterm labor about self-monitoring for symptoms. Which of the following instructions is most important to include?
A) “Monitor your blood pressure twice daily.”
B) “Perform kick counts once a week.”
C) “Time your uterine contractions and call the healthcare provider if they last longer than 30 seconds.”
D) “Avoid traveling for long distances in cars or buses.”
D) “Avoid traveling for long distances in cars or buses.”
Rationale: Avoiding long-distance travel is part of preventing preterm labor by minimizing stress and exertion.
A nurse is caring for a client receiving indomethacin for preterm labor. Which maternal assessment finding should be reported to the healthcare provider?
A) Amniotic fluid index of 5 cm
B) Maternal heart rate of 85 beats per minute
C) Decreased urine output
D) Blood pressure of 120/80 mm Hg
C) Decreased urine output
Rationale: Indomethacin can reduce fetal renal blood flow and decrease urine output, which should be monitored closely.
Which of the following is an appropriate nursing intervention for a woman experiencing preterm labor who is receiving tocolytic therapy?
A) Encourage ambulation to promote fetal circulation
B) Limit vaginal exams to reduce the risk of infection
C) Discontinue oral fluids to reduce uterine irritability
D) Place the client in a supine position to promote uterine perfusion
B) Limit vaginal exams to reduce the risk of infection
Rationale: Vaginal exams should be limited to reduce the risk of ascending infection during preterm labor.
A nurse is preparing to administer magnesium sulfate to a client in preterm labor. What is the primary purpose of this medication?
A) To reduce uterine irritability and delay labor
B) To enhance fetal lung maturity
C) To prevent maternal hypotension
D) To promote fetal heart rate stability
A) To reduce uterine irritability and delay labor
Rationale: Magnesium sulfate is used as a tocolytic agent to reduce uterine irritability and delay labor.
A client at 24 weeks gestation reports feeling pelvic pressure and experiencing low back pain. What is the nurse’s priority action?
A) Assess fetal heart rate
B) Instruct the client to lie on her side and drink fluids
C) Administer a tocolytic agent
D) Prepare the client for immediate transport to a tertiary care facility
B) Instruct the client to lie on her side and drink fluids
Rationale: The nurse should initially instruct the client to rest, lie on her side, and hydrate to see if symptoms subside before taking further action.
A nurse is educating a woman at risk for preterm labor. Which of the following should the nurse advise the client to report to the healthcare provider immediately?
A) Mild uterine cramping
B) Feeling of pelvic pressure or fullness
C) Increased appetite
D) Vaginal discharge that increases in volume
D) Vaginal discharge that increases in volume
Rationale: An increase in vaginal discharge with mucus or blood may indicate preterm labor and requires immediate medical attention.
A client who is 28 weeks pregnant is being treated for preterm labor with magnesium sulfate. What is the nurse’s priority during administration of this medication?
A) Monitor the client for signs of hypocalcemia
B) Assess fetal heart rate for bradycardia
C) Measure the client’s urinary output hourly
D) Administer corticosteroids for fetal lung maturity
C) Measure the client’s urinary output hourly
Rationale: Magnesium sulfate is excreted by the kidneys, so monitoring urinary output is critical for safe administration.
Which of the following is a potential complication of using indomethacin as a tocolytic agent?
A) Oligohydramnios
B) Uterine rupture
C) Increased fetal heart rate variability
D) Hyperkalemia
A) Oligohydramnios
Rationale: Indomethacin can decrease fetal renal blood flow and cause oligohydramnios if used for more than 48 hours.
A nurse is educating a client who had a prior preterm birth about strategies to prevent another preterm birth. Which of the following recommendations should the nurse make?
A) Begin progesterone therapy as soon as possible
B) Limit physical activity to bed rest for the duration of the pregnancy
C) Maintain a pregnancy spacing interval of at least 18 months
D) Schedule a cesarean birth to prevent complications
C) Maintain a pregnancy spacing interval of at least 18 months
Rationale: Maintaining an appropriate pregnancy spacing interval of at least 18 months reduces the risk of preterm labor.
A nurse is educating a woman with a shortened cervix about cervical cerclage. Which of the following statements by the nurse is correct?
A) “Cervical cerclage is used to prevent preterm labor by strengthening the cervix.”
B) “Cervical cerclage should be removed immediately after labor begins.”
C) “Cervical cerclage is usually placed after 34 weeks of pregnancy.”
D) “Cervical cerclage requires strict bed rest for the duration of the pregnancy.”
A) “Cervical cerclage is used to prevent preterm labor by strengthening the cervix.”
Rationale: Cervical cerclage is used to prevent premature cervical dilation and preterm labor in women with a shortened cervix.
A nurse is caring for a client who is receiving magnesium sulfate for preterm labor. Which of the following findings is indicative of magnesium sulfate toxicity?
A) Deep tendon reflexes of 2+
B) Respiratory rate of 11 breaths per minute
C) Serum magnesium level of 5 mg/dL
D) Urine output of 100 mL per hour
B) Respiratory rate of 11 breaths per minute
Rationale: A respiratory rate of less than 12 breaths per minute is a sign of magnesium sulfate toxicity, requiring immediate intervention.
Which of the following is an important consideration when administering nifedipine to a woman in preterm labor?
A) Monitor for maternal hypotension and reflex tachycardia
B) Administer the medication intravenously for rapid effect
C) Discontinue the medication if fetal tachycardia occurs
D) Administer with food to reduce gastrointestinal upset
A) Monitor for maternal hypotension and reflex tachycardia
Rationale: Nifedipine can cause hypotension and reflex tachycardia, so careful monitoring is essential.
A nurse is caring for a pregnant patient diagnosed with hyperemesis gravidarum. Which assessment finding should the nurse prioritize?
A. Maternal weight loss of 3% of prepregnancy weight
B. Serum potassium level of 2.8 mEq/L
C. Blood pressure of 100/70 mmHg
D. Nausea and vomiting resolving after eating
B. Serum potassium level of 2.8 mEq/L
Rationale: Hypokalemia (serum potassium <3.5 mEq/L) can result from severe vomiting and may lead to life-threatening cardiac arrhythmias. Weight loss of 3% is not as critical as electrolyte imbalances, blood pressure is within normal limits, and nausea resolving after eating is not typical in hyperemesis gravidarum.
The nurse is providing discharge teaching to a patient diagnosed with hyperemesis gravidarum. Which statement indicates the need for further teaching?
A. “I should eat small, frequent meals throughout the day.”
B. “I will avoid triggers like strong smells or spicy foods.”
C. “It’s safe to take over-the-counter antiemetics if I start vomiting again.”
D. “I should report signs of dehydration, such as dark urine or dizziness.”
C. “It’s safe to take over-the-counter antiemetics if I start vomiting again.”
Rationale: Over-the-counter antiemetics may not be effective for hyperemesis gravidarum and could interact with prescribed medications. The patient should consult her healthcare provider before taking any medications. The other statements reflect appropriate management strategies.
A patient at 10 weeks’ gestation is admitted with hyperemesis gravidarum. Which nursing intervention is most appropriate initially?
A. Encourage oral intake of clear fluids
B. Provide antiemetics via the oral route
C. Begin total parenteral nutrition immediately
D. Administer intravenous fluids with electrolytes
D. Administer intravenous fluids with electrolytes
Rationale: The priority intervention is to correct dehydration and electrolyte imbalances with IV fluids. Oral intake is typically not tolerated initially. Antiemetics should be given intravenously in severe cases. TPN is reserved for refractory cases.
Which of the following patients is at the highest risk for developing hyperemesis gravidarum?
A. A 25-year-old in her first pregnancy with no significant medical history
B. A 30-year-old with a history of molar pregnancy
C. A 28-year-old pregnant with twins and no previous history of hyperemesis
D. A 35-year-old with a history of preeclampsia in her previous pregnancy
B. A 30-year-old with a history of molar pregnancy
Rationale: A history of molar pregnancy significantly increases the risk of hyperemesis gravidarum. Twin pregnancies also increase risk, but the absence of prior hyperemesis makes this less likely. A history of preeclampsia does not increase the risk of hyperemesis.
The nurse is evaluating the laboratory results of a patient with hyperemesis gravidarum. Which result is most concerning?
A. Urine ketones positive
B. Blood glucose of 85 mg/dL
C. Sodium level of 138 mEq/L
D. Hematocrit of 35%
A. Urine ketones positive
Rationale: Positive ketones in the urine indicate ketosis, a sign of significant malnutrition and fat breakdown due to prolonged vomiting. The other lab values are within normal limits.
A patient with hyperemesis gravidarum asks why she needs hospitalization. The nurse explains that the main goal of hospitalization is to:
A. Ensure that the baby continues to grow normally.
B. Provide nutritional support and fluid replacement.
C. Rule out other pregnancy complications.
D. Teach strategies to manage nausea and vomiting.
B. Provide nutritional support and fluid replacement.
Rationale: The primary goal of hospitalization is to correct dehydration, restore electrolyte balance, and provide nutritional support. While fetal growth and patient education are important, they are secondary to addressing the immediate health risks.
A nurse is assessing a patient with hyperemesis gravidarum. Which clinical finding most supports the pathophysiology of this condition?
A. Decreased serum human chorionic gonadotropin (hCG) levels
B. Prolonged vomiting leading to metabolic alkalosis
C. High serum hCG levels extending beyond the first trimester
D. Increased maternal blood flow during early pregnancy
C. High serum hCG levels extending beyond the first trimester
Rationale: Hyperemesis gravidarum is associated with elevated and prolonged hCG levels beyond the first trimester, which exacerbate nausea and vomiting. Decreased hCG is not characteristic, and metabolic acidosis, not alkalosis, may result from dehydration and starvation.
Which factors are thought to contribute to the development of hyperemesis gravidarum? (Select all that apply.)
A. High levels of estrogen
B. Vitamin B6 deficiency
C. Maternal history of diabetes
D. Genetic predisposition
E. Increased psychological stress
A. High levels of estrogen
B. Vitamin B6 deficiency
D. Genetic predisposition
E. Increased psychological stress
The nurse is caring for a patient with hyperemesis gravidarum. Which complication should the nurse monitor for that is directly related to dehydration?
A. Preterm labor
B. Gestational hypertension
C. Fetal macrosomia
D. Placenta previa
A. Preterm labor
Rationale: Dehydration can lead to uterine irritability, increasing the risk of preterm labor. Gestational hypertension, fetal macrosomia, and placenta previa are not directly linked to dehydration in hyperemesis gravidarum.
A patient with hyperemesis gravidarum asks why her symptoms are more severe than typical morning sickness. Which response by the nurse is most accurate?
A. “Your symptoms are due to low levels of vitamin B12.”
B. “Higher levels of hCG and estrogen are prolonging your symptoms.”
C. “Psychological stress is the main cause of your symptoms.”
D. “Your vomiting is caused by decreased blood flow to the placenta.”
B. “Higher levels of hCG and estrogen are prolonging your symptoms.”
Rationale: Hyperemesis gravidarum is linked to elevated and prolonged levels of hCG and estrogen. Vitamin B12 deficiency and psychological stress may contribute but are not the primary causes. Placental blood flow decreases due to the effects of dehydration but does not directly cause vomiting.
The nurse is reviewing the potential complications of hyperemesis gravidarum with a group of students. Which complications should the nurse include? (SATA)
A. Acidosis
B. Dehydration
C. Increased placental blood flow
D. Weight loss
E. Electrolyte imbalances
A. Acidosis
B. Dehydration
D. Weight loss
E. Electrolyte imbalances
A patient with hyperemesis gravidarum is hospitalized for persistent symptoms despite home management. Which intervention should the nurse expect to implement first?
A. Start the patient on total parenteral nutrition (TPN).
B. Initiate oral antiemetic therapy with Diclegis.
C. Administer normal saline with vitamin B6 intravenously.
D. Place the patient on a high-protein, low-fat oral diet.
C. Administer normal saline with vitamin B6 intravenously.
Rationale: The first step in hospital management involves rehydrating the patient with IV fluids, typically normal saline with added vitamins like B6, to correct dehydration and nutrient deficiencies. TPN and oral therapy are used later if symptoms persist.
Which interventions are included in the initial management of hyperemesis gravidarum in a hospitalized patient? (SATA)
A. Resting the gastrointestinal tract by keeping the patient NPO
B. Administering antiemetics intravenously or rectally
C. Starting a high-fiber diet immediately
D. Administering dimenhydrinate (Dramamine) as a second-line therapy
E. Monitoring for electrolyte imbalances and ketosis
A. Resting the gastrointestinal tract by keeping the patient NPO
B. Administering antiemetics intravenously or rectally
D. Administering dimenhydrinate (Dramamine) as a second-line therapy
E. Monitoring for electrolyte imbalances and ketosis
Rationale: Initial management involves gut rest (NPO), IV or rectal administration of antiemetics, monitoring for complications like electrolyte imbalances, and considering second-line therapies like dimenhydrinate if first-line drugs are ineffective. A high-fiber diet is not introduced during the initial phase.
A nurse is caring for a patient with hyperemesis gravidarum who has not improved after several days of IV fluids and antiemetics. What intervention should the nurse anticipate next?
A. Administration of Diclegis orally
B. Initiation of total parenteral nutrition (TPN)
C. Placement of a nasogastric tube for feeding
D. Use of complementary therapies like acupressure
B. Initiation of total parenteral nutrition (TPN)
Rationale: If the patient fails to improve with IV fluids, antiemetics, and dietary measures, TPN is initiated to prevent malnutrition. Complementary therapies and oral Diclegis are supplementary but not the priority in severe cases.
A patient with hyperemesis gravidarum asks why she cannot eat or drink while hospitalized. What is the nurse’s best response?
A. “We need to monitor your nutritional intake carefully first.”
B. “Eating right now may worsen your dehydration.”
C. “We want to let your stomach and digestive system rest.”
D. “Your symptoms will improve faster if you don’t eat.”
C. “We want to let your stomach and digestive system rest.”
Rationale: Gut rest (keeping the patient NPO) allows the gastrointestinal tract to recover and reduces nausea and vomiting. Other options do not accurately address the rationale for NPO status.
Which statement by a patient with hyperemesis gravidarum indicates a need for further education about her treatment?
A. “I will wear Sea-Bands to help with nausea.”
B. “I can use hypnosis or massage to supplement my treatment.”
C. “If Diclegis doesn’t work, I won’t be able to try anything else.”
D. “I should notify my provider if my symptoms worsen.”
C. “If Diclegis doesn’t work, I won’t be able to try anything else.”
Rationale: Treatment for hyperemesis gravidarum often involves trial and error with different classes of antiemetics. Diclegis is a first-line treatment, but alternatives like dimenhydrinate, promethazine, and ondansetron are available.
A nurse is assessing a patient with hyperemesis gravidarum. Which finding is most indicative of dehydration?
A. Dry mucous membranes and poor skin turgor
B. Blood pressure of 140/90 mmHg
C. Presence of ptyalism (excessive salivation)
D. Weight loss of 2% of prepregnancy body weight
A. Dry mucous membranes and poor skin turgor
Rationale: Dry mucous membranes and poor skin turgor are physical signs of dehydration. Blood pressure in dehydration is typically hypotensive, and weight loss exceeding 5% of body mass is more indicative of hyperemesis gravidarum.
When reviewing a patient’s health history, which risk factors should the nurse identify as increasing the likelihood of hyperemesis gravidarum? Select all that apply.
A. Multiple gestation
B. Nulliparity
C. History of gastroesophageal reflux disease
D. Low prepregnancy BMI
E. H. pylori seropositivity
A. Multiple gestation
B. Nulliparity
C. History of gastroesophageal reflux disease
E. H. pylori seropositivity
A nurse is reviewing the lab results of a patient with hyperemesis gravidarum. Which finding is most concerning?
A. Potassium level of 3.4 mEq/L
B. Urine ketones present
C. Serum sodium level of 132 mEq/L
D. pH of 7.50
B. Urine ketones present
Rationale: The presence of urine ketones indicates ketosis due to prolonged vomiting and malnutrition, a hallmark of hyperemesis gravidarum. While the other findings require monitoring, ketones are directly indicative of the severity of the condition.
What should the nurse include in the physical assessment of a patient with hyperemesis gravidarum? Select all that apply.
A. Check for hypotension and signs of orthostatic changes.
B. Inspect the mucous membranes for dryness.
C. Assess for evidence of retinal hemorrhage.
D. Monitor weight loss relative to prepregnancy weight.
E. Test for the presence of H. pylori using a stool sample.
A. Check for hypotension and signs of orthostatic changes.
B. Inspect the mucous membranes for dryness.
C. Assess for evidence of retinal hemorrhage.
D. Monitor weight loss relative to prepregnancy weight.
Rationale: Assessment of hypotension, dry mucous membranes, retinal hemorrhage, and weight loss are key to evaluating the severity of hyperemesis gravidarum. H. pylori seropositivity is determined through blood tests, not stool samples.
A patient with hyperemesis gravidarum has lab results indicating elevated hematocrit levels. What does this finding most likely suggest?
A. Anemia
B. Dehydration
C. Liver dysfunction
D. Electrolyte imbalance
B. Dehydration
Rationale: Elevated hematocrit levels indicate hemoconcentration, which is commonly seen in dehydration due to fluid loss.
Which laboratory test result would most support a diagnosis of hyperemesis gravidarum?
A. Urine specific gravity of 1.030
B. Serum sodium level of 145 mEq/L
C. Decreased red blood cell count
D. TSH level of 1.5 µIU/mL
A. Urine specific gravity of 1.030
Rationale: A urine specific gravity greater than 1.025 indicates concentrated urine, which is commonly seen in dehydration associated with hyperemesis gravidarum.
Which diagnostic tests are used to evaluate the severity or etiology of hyperemesis gravidarum? Select all that apply.
A. Liver enzymes (AST, ALT)
B. Ultrasound
C. Serum glucose
D. CBC
E. TSH and T4
A. Liver enzymes (AST, ALT)
B. Ultrasound
C. Serum glucose
E. TSH and T4
Rationale: Liver enzymes rule out liver dysfunction; ultrasound evaluates for molar pregnancy or multiple gestations; CBC assesses hydration status; and TSH and T4 rule out thyroid disease. Serum glucose is not typically used for hyperemesis gravidarum diagnosis.
A nurse reviews a patient’s lab results and notes the presence of urine ketones and decreased potassium levels. What is the priority nursing action?
A. Encourage the patient to increase oral fluid intake.
B. Administer prescribed potassium supplements.
C. Start the patient on a soft diet.
D. Notify the healthcare provider immediately.
B. Administer prescribed potassium supplements.
Rationale: Low potassium levels (hypokalemia) and ketones indicate severe dehydration and malnutrition requiring immediate correction.
A pregnant patient with suspected hyperemesis gravidarum undergoes an ultrasound. What is the purpose of this test in her diagnostic workup?
A. Assess placental perfusion
B. Evaluate liver function
C. Identify possible molar pregnancy or multiple gestation
D. Measure fetal heart rate
C. Identify possible molar pregnancy or multiple gestation
Rationale: An ultrasound evaluates for underlying conditions like molar pregnancy or multiple gestation, which are associated with hyperemesis gravidarum.
A nurse is caring for a client with hyperemesis gravidarum who is receiving IV fluids. Which assessment is most critical to prevent complications related to fluid therapy?
A. Monitoring intake and output
B. Assessing serum electrolyte levels
C. Inspecting the IV insertion site
D. Monitoring for signs of fluid overload
D. Monitoring for signs of fluid overload
Rationale: While all options are important, monitoring for fluid overload is critical as excessive IV fluid administration can lead to complications such as pulmonary edema.
The nurse is providing dietary education to a client with hyperemesis gravidarum. Which statement by the client indicates the need for further teaching?
A. “I will eat small, frequent meals throughout the day.”
B. “I should avoid lying down for two hours after eating.”
C. “I’ll drink fluids with my meals to stay hydrated.”
D. “Carbonated beverages can help settle my stomach.”
C. “I’ll drink fluids with my meals to stay hydrated.”
Rationale: Fluids should be consumed between meals rather than with meals to minimize nausea.
A client with hyperemesis gravidarum asks why she feels exhausted and anxious. What is the best response by the nurse?
A. “This is due to your body working harder to support your pregnancy.”
B. “Your symptoms and the stress of feeling sick can make you feel this way.”
C. “It’s likely a result of hormonal changes causing mood swings.”
D. “This is normal and will improve once you can tolerate food again.”
B. “Your symptoms and the stress of feeling sick can make you feel this way.”
Rationale: Hyperemesis gravidarum can lead to physical exhaustion and emotional stress, causing anxiety and fatigue.
Which interventions should the nurse include when managing a client with hyperemesis gravidarum? Select all that apply.
A. Encourage small, frequent meals.
B. Monitor serum electrolyte levels regularly.
C. Introduce high-fat foods early in recovery.
D. Teach the client to separate fluids from meals.
E. Administer electrolyte replacement therapy as ordered.
A. Encourage small, frequent meals.
B. Monitor serum electrolyte levels regularly.
D. Teach the client to separate fluids from meals.
E. Administer electrolyte replacement therapy as ordered.
The nurse is preparing discharge teaching for a client with hyperemesis gravidarum. Which instruction is most appropriate?
A. “Eat three large meals per day to maximize caloric intake.”
B. “Avoid nausea by eliminating all physical activity.”
C. “Gradually reintroduce foods starting with dry toast or crackers.”
D. “Avoid resting during the day to reduce fatigue.”
C. “Gradually reintroduce foods starting with dry toast or crackers.”
Rationale: Reintroducing food with bland options like crackers helps avoid exacerbating nausea as the client transitions from NPO status.
A client with hyperemesis gravidarum is prescribed promethazine (Phenergan). Which side effect should the nurse monitor for?
A. Increased appetite
B. Involuntary movements
C. Hyperactivity
D. Tachycardia
B. Involuntary movements
Rationale: Promethazine may cause extrapyramidal symptoms such as involuntary movements.
A nurse is reviewing laboratory results for a client on ondansetron (Zofran). Which result should prompt immediate follow-up?
A. Elevated liver enzymes
B. Mild constipation
C. Fatigue complaints
D. Slight abdominal pain
A. Elevated liver enzymes
Which is the most important safety measure when administering promethazine (Phenergan) to a client with hyperemesis gravidarum?
A. Offering fluids with the medication
B. Monitoring for sedation and dizziness
C. Administering the drug with food
D. Checking for signs of hyperactivity
B. Monitoring for sedation and dizziness
Rationale: Sedation and dizziness increase the risk of injury, so safety measures are critical.
A client is prescribed pyridoxine and doxylamine (Diclegis). What is the rationale for taking this medication on an empty stomach with water?
A. To reduce the risk of gastrointestinal upset
B. To enhance absorption and effectiveness
C. To prevent interactions with other medications
D. To avoid dehydration
B. To enhance absorption and effectiveness
Rationale: Taking Diclegis on an empty stomach ensures optimal absorption and therapeutic effect.
Which client statement indicates a need for further teaching about promethazine (Phenergan)?
A. “I will use hard candy to help with mouth dryness.”
B. “I need to be careful getting up to avoid dizziness.”
C. “I might feel sleepy after taking this medication.”
D. “This medication will completely stop my nausea.”
D. “This medication will completely stop my nausea.”
Rationale: Promethazine provides symptomatic relief but may not completely eliminate nausea.
When administering ondansetron (Zofran), which nursing action is most important?
A. Monitoring for signs of dehydration
B. Assessing the client for headache and dizziness
C. Encouraging the client to lie down after taking the medication
D. Offering the medication with high-fat meals
B. Assessing the client for headache and dizziness
Rationale: Headache and dizziness are common side effects of ondansetron, requiring close monitoring.
Which condition is defined as having more than 2,000 mL of amniotic fluid between 32 and 36 weeks of gestation?
A. Polyhydramnios
B. Oligohydramnios
C. Anhydramnios
D. Hydrops fetalis
A. Polyhydramnios
Rationale: Polyhydramnios refers to an excessive amount of amniotic fluid during pregnancy, defined as over 2,000 mL.
Which maternal condition is most commonly associated with polyhydramnios?
A. Hypertension
B. Diabetes mellitus
C. Hypothyroidism
D. Preeclampsia
B. Diabetes mellitus
Rationale: Approximately 18% of women with diabetes during pregnancy develop polyhydramnios.
Which fetal anomaly is NOT associated with polyhydramnios?
A. Neural tube defects
B. Fetal hydrops
C. Esophageal atresia
D. Spina bifida occulta
D. Spina bifida occulta
Rationale: Spina bifida occulta typically does not cause swallowing or fluid uptake issues linked to polyhydramnios.
What complication is polyhydramnios most likely to cause during labor?
A. Fetal malpresentation
B. Uterine rupture
C. Placental abruption
D. Cephalopelvic disproportion
A. Fetal malpresentation
Rationale: Excess amniotic fluid can lead to abnormal fetal positioning, increasing the risk of malpresentation.
What is a possible side effect of using indomethacin to treat polyhydramnios?
A. Premature labor
B. Premature closure of the fetal ductus arteriosus
C. Maternal hypertension
D. Reduced placental perfusion
B. Premature closure of the fetal ductus arteriosus
Rationale: Indomethacin can decrease amniotic fluid volume but may cause premature closure of the fetal ductus arteriosus.
Which diagnostic test is most commonly used to estimate amniotic fluid volume in polyhydramnios?
A. Amniocentesis
B. Biophysical profile
C. MRI
D. Ultrasound
D. Ultrasound
Rationale: Ultrasound is used to measure amniotic fluid pockets and estimate total fluid volume.
What symptom is commonly reported by pregnant women with polyhydramnios?
A. Severe back pain
B. Frequent urination
C. Persistent headaches
D. Shortness of breath
D. Shortness of breath
Rationale: Excessive fluid may cause uterine enlargement, leading to diaphragmatic pressure and shortness of breath.
What does a discrepancy between fundal height and gestational age typically indicate in polyhydramnios?
A. Intrauterine growth restriction
B. Uterine rupture
C. Excess amniotic fluid
D. Fetal deceleration
C. Excess amniotic fluid
Rationale: Fundal height greater than expected for gestational age may suggest polyhydramnios.
Which complication is associated with overstretching of the uterus in polyhydramnios?
A. Uterine atony
B. Placental abruption
C. Preterm uterine contractions
D. Postpartum hemorrhage
C. Preterm uterine contractions
Rationale: Uterine overstretching from polyhydramnios may trigger preterm contractions.
What is the primary goal of an amniocentesis in polyhydramnios?
A. To assess fetal lung maturity
B. To reduce amniotic fluid volume
C. To identify fetal chromosomal anomalies
D. To prevent preterm labor
B. To reduce amniotic fluid volume
Rationale: Amniocentesis may be performed to relieve maternal discomfort by reducing fluid volume.
Which risk factor is most relevant when assessing a client for polyhydramnios?
A. Advanced maternal age
B. Maternal diabetes
C. Placenta previa
D. History of preeclampsia
B. Maternal diabetes
Rationale: Diabetes mellitus is a significant risk factor for polyhydramnios.
What structural fetal anomaly commonly contributes to impaired swallowing and polyhydramnios?
A. Hydrocephaly
B. Cleft lip
C. Esophageal atresia
D. Spinal curvature
C. Esophageal atresia
Rationale: Esophageal atresia prevents the fetus from swallowing amniotic fluid, leading to its accumulation.
What physical finding is often noted during abdominal palpation in polyhydramnios?
A. Difficulty identifying fetal parts
B. Reduced fundal height
C. Hypoactive bowel sounds
D. Firm uterine tone
A. Difficulty identifying fetal parts
Rationale: Excess amniotic fluid can make it difficult to palpate fetal parts.
What is the purpose of monitoring maternal abdominal girth in suspected polyhydramnios?
A. To assess for uterine rupture
B. To measure fluid output
C. To estimate fetal size
D. To evaluate excessive uterine growth
D. To evaluate excessive uterine growth
Rationale: Enlarged abdominal girth may indicate increased amniotic fluid volume.
What common symptom might result from pressure on the vena cava in polyhydramnios?
A. Maternal hypotension
B. Edema in lower extremities
C. Varicose veins
D. Fainting episodes
B. Edema in lower extremities
Rationale: Increased vena cava pressure can cause fluid accumulation in the lower extremities.
What is the primary concern with a cord prolapse in polyhydramnios?
A. Fetal bradycardia
B. Maternal hypotension
C. Placental detachment
D. Premature rupture of membranes
A. Fetal bradycardia
Rationale: Cord prolapse can compromise fetal oxygenation, leading to bradycardia.
What assessment finding is most concerning in a pregnant woman with polyhydramnios?
A. Mild backache
B. Increased fetal movements
C. Slight ankle swelling
D. Persistent shortness of breath
D. Persistent shortness of breath
Rationale: Shortness of breath may indicate significant uterine pressure on the diaphragm.
Which fetal outcome is associated with polyhydramnios?
A. Low birth weight
B. Fetal macrosomia
C. Respiratory distress
D. Premature birth
D. Premature birth
Rationale: Polyhydramnios increases the risk of preterm labor and delivery.
Which volume of amniotic fluid is diagnostic of oligohydramnios between 32 and 36 weeks of gestation?
A. Less than 1,000 mL
B. Less than 500 mL
C. Less than 700 mL
D. Less than 1,200 mL
B. Less than 500 mL
Rationale: Oligohydramnios is defined as a decreased amniotic fluid volume of less than 500 mL during the specified gestational period.
What is the primary fetal risk associated with oligohydramnios?
A. Fetal macrosomia
B. Neural tube defects
C. Cord compression
D. Hyperbilirubinemia
C. Cord compression
Rationale: Reduced amniotic fluid limits the fetus’s ability to move freely, increasing the risk of cord compression, intrapartal hypoxia, and fetal death.
Which maternal condition is most commonly associated with oligohydramnios?
A. Gestational hypertension
B. Placenta previa
C. Uteroplacental insufficiency
D. Multiple gestation
C. Uteroplacental insufficiency
Rationale: Uteroplacental insufficiency reduces blood flow and nutrient delivery to the fetus, which may decrease amniotic fluid production.
What fetal condition is most likely to result in oligohydramnios?
A. Neural tube defects
B. Fetal renal agenesis
C. Anencephaly
D. Gastroschisis
B. Fetal renal agenesis
Ratioanle: Renal agenesis prevents urine production, a primary contributor to amniotic fluid volume.
Which diagnostic tool is most effective in confirming oligohydramnios?
A. Amniocentesis
B. Doppler velocimetry
C. Biophysical profile
D. Ultrasound
D. Ultrasound
Rationale: Ultrasound is used to measure amniotic fluid levels and confirm a diagnosis of oligohydramnios.
What is the most appropriate intervention for a term pregnancy with oligohydramnios and compromised fetal well-being?
A. Cesarean delivery
B. Amnioinfusion
C. Serial ultrasounds
D. Bed rest
A. Cesarean delivery
Rationale: If fetal well-being is compromised, immediate delivery may be indicated to reduce perinatal morbidity and mortality.
Why is amnioinfusion performed during labor in cases of oligohydramnios?
A. To minimize cord compression
B. To reduce uterine contractions
C. To stimulate fetal lung maturity
D. To reduce maternal discomfort
A. To minimize cord compression
Rationale: Amnioinfusion increases amniotic fluid levels, cushioning the umbilical cord to prevent variable decelerations caused by compression.
Which fetal heart rate pattern is commonly associated with oligohydramnios?
A. Early decelerations
B. Accelerations
C. Variable decelerations
D. Prolonged decelerations
C. Variable decelerations
Rationale: Cord compression due to low amniotic fluid often results in variable decelerations on the fetal monitor.
In post-term pregnancies, what physiological change often leads to oligohydramnios?
A. Increased fetal movement
B. Decline in amniotic fluid production
C. Placental overperfusion
D. Excess fetal urine output
B. Decline in amniotic fluid production
Rationale: Amniotic fluid levels naturally decrease after 38 weeks, increasing the risk of oligohydramnios in post-term pregnancies.
What maternal complaint may indicate oligohydramnios?
A. Vaginal bleeding
B. Increased fetal movements
C. Frequent urination
D. Fluid leakage from the vagina
D. Fluid leakage from the vagina
Rationale: Leakage of amniotic fluid due to membrane rupture can decrease amniotic fluid levels, contributing to oligohydramnios.
Which noninvasive assessment tool is essential in managing oligohydramnios?
A. Fetal Doppler
B. Nonstress testing
C. Contraction stress testing
D. Maternal serum alpha-fetoprotein
B. Nonstress testing
Rationale: Nonstress testing helps evaluate fetal well-being in pregnancies complicated by oligohydramnios.
Why is frequent perineal care important for women with oligohydramnios undergoing amnioinfusion?
A. To manage leakage of fluid
B. To prevent urinary tract infections
C. To reduce infection risk from catheter placement
D. To prevent skin irritation
A. To manage leakage of fluid
Rationale: Fluid leakage during amnioinfusion necessitates frequent perineal care to maintain hygiene and comfort.
Which condition in the newborn is commonly assessed after birth in cases of oligohydramnios?
A. Meconium aspiration syndrome
B. Hyperbilirubinemia
C. Respiratory distress
D. Congenital hypothyroidism
C. Respiratory distress
Rationale: Oligohydramnios is associated with poor lung development, increasing the risk of neonatal respiratory difficulties.
What maternal history finding increases the likelihood of oligohydramnios?
A. Preeclampsia
B. Fetal macrosomia
C. History of twin pregnancy
D. Gestational diabetes
A. Preeclampsia
Rationale: Preeclampsia can impair placental function, reducing amniotic fluid production and leading to oligohydramnios.
Which nursing intervention is critical during amnioinfusion for oligohydramnios?
A. Monitoring uterine overdistention
B. Administering tocolytic medications
C. Measuring maternal oxygen saturation
D. Encouraging increased fluid intake
A. Monitoring uterine overdistention
Rationale: Excessive infusion of fluid can lead to uterine overdistention, which requires careful monitoring.
What does the nursing care plan for a client with oligohydramnios prioritize?
A. Monitoring maternal weight gain
B. Preventing maternal infection
C. Encouraging dietary changes
D. Maintaining fetal oxygenation
D. Maintaining fetal oxygenation
Rationale: Ensuring adequate fetal oxygenation through interventions such as repositioning and monitoring is critical in oligohydramnios management.
A nurse is preparing to perform a fetal fibronectin (fFN) test on a client at 28 weeks gestation. Which of the following actions is most important before collecting the sample?
A) Ensure the client has had no vaginal exams, intercourse, or penetration within 24 hours
B) Instruct the client to empty her bladder prior to the procedure
C) Perform a cervical examination to check for dilation
D) Administer a tocolytic agent to stop contractions
A) Ensure the client has had no vaginal exams, intercourse, or penetration within 24 hours
Rationale: Vaginal exams, intercourse, or penetration within 24 hours can lead to a false positive result, so it’s essential to ensure these activities have not occurred.
Which of the following is the best interpretation of a negative fetal fibronectin (fFN) test result in a client at 30 weeks gestation?
A) There is a 50% chance the client will deliver within 1-2 weeks
B) The client is likely to deliver after 36 weeks gestation
C) The client is unlikely to deliver preterm (99% negative predictive value)
D) The client should be treated with corticosteroids to enhance fetal lung maturity
C) The client is unlikely to deliver preterm (99% negative predictive value)
Rationale: A negative fFN test result is highly predictive that preterm labor will not occur, with a 99% negative predictive value.
A client at 24 weeks gestation presents with contractions, and a fetal fibronectin (fFN) test is ordered. Which of the following is the most important consideration before performing the test?
A) Confirm that the client has had no vaginal penetration or intercourse in the past 48 hours
B) Ensure the client has been on bed rest for at least 24 hours prior to the test
C) Confirm that no cervical exams have been performed within the past 24 hours
D) Advise the client to drink fluids to prevent dehydration
C) Confirm that no cervical exams have been performed within the past 24 hours
Rationale: The presence of cervical exams within 24 hours can lead to false results, so this must be confirmed before performing the test.
A nurse is educating a client about the fetal fibronectin (fFN) test. Which of the following statements by the client indicates a need for further teaching?
A) “I should not have had any vaginal exams or intercourse within 24 hours of the test.”
B) “A negative test result means I am unlikely to deliver prematurely.”
C) “A positive test result is a definitive indicator that I will deliver within the next week.”
D) “The test will be performed between 22 and 34 weeks of pregnancy.”
C) “A positive test result is a definitive indicator that I will deliver within the next week.”
Rationale: A positive fFN test result is not a definitive indicator of preterm delivery; it only suggests a likelihood, with delivery often occurring within 1-2 weeks, but the result can be false positive.
A nurse is performing a fetal fibronectin (fFN) test on a pregnant client. Which of the following is the correct procedure for collecting the specimen?
A) Insert a swab into the vagina to collect cervical mucus
B) Use a sterile speculum to collect the sample from behind the posterior portion of the cervix
C) Collect the sample from the anterior cervix using a non-sterile swab
D) Obtain the sample through a blood draw
B) Use a sterile speculum to collect the sample from behind the posterior portion of the cervix
Rationale: The correct technique involves using a sterile speculum and collecting the sample from behind the posterior portion of the cervix.
A client at 28 weeks gestation has a fetal fibronectin (fFN) test that comes back positive. Which of the following is the nurse’s priority action?
A) Administer a tocolytic agent to stop labor
B) Instruct the client to remain on strict bed rest until delivery
C) Prepare the client for immediate cesarean section
D) Monitor the client closely for signs and symptoms of preterm labor
D) Monitor the client closely for signs and symptoms of preterm labor
Rationale: A positive fFN result suggests a potential for preterm labor, so the nurse should monitor the client closely for symptoms and manage care accordingly.
Which of the following is the most accurate time window for performing a fetal fibronectin (fFN) test in a pregnant woman?
A) Between 12 and 20 weeks gestation
B) Between 20 and 22 weeks gestation
C) Between 22 and 34 weeks gestation
D) Between 35 and 37 weeks gestation
C) Between 22 and 34 weeks gestation
Rationale: The fetal fibronectin test is typically performed between 22 and 34 weeks gestation.
A pregnant client is scheduled for a fetal fibronectin (fFN) test. Which of the following conditions would contraindicate performing the test?
A) The client had a vaginal exam 12 hours ago
B) The client is 30 weeks gestation
C) The client has mild cramping
D) The client has a history of preterm birth
A) The client had a vaginal exam 12 hours ago
Rationale: A vaginal exam within 24 hours of the test can result in a false positive, so it is contraindicated before performing the fFN test.
A nurse is caring for a client receiving magnesium sulfate for preterm labor and suspects magnesium toxicity. Which of the following is the first action the nurse should take?
A) Administer a dose of calcium gluconate
B) Stop the magnesium sulfate infusion
C) Notify the provider immediately
D) Obtain a stat magnesium level
B) Stop the magnesium sulfate infusion
Rationale: The first action to take when magnesium toxicity is suspected is to stop the magnesium sulfate infusion to prevent further accumulation of the drug.
A nurse is assessing a client receiving magnesium sulfate and suspects magnesium toxicity. Which of the following signs would most likely indicate magnesium toxicity?
A) Hyperactive reflexes and hypotension
B) Increased urinary output and hypotension
C) Elevated heart rate and hypotension
D) Respiratory depression and hypotension
D) Respiratory depression and hypotension
Rationale: Rationale: Respiratory depression, hypotension, and other signs of neuromuscular impairment are common symptoms of magnesium toxicity.
A client receiving magnesium sulfate is exhibiting signs of magnesium toxicity. What is the nurse’s next step after stopping the infusion and administering calcium gluconate?
A) Obtain the client’s vital signs
B) Increase the client’s intravenous fluids
C) Administer an additional dose of magnesium sulfate
D) Prepare the client for an immediate cesarean section
A) Obtain the client’s vital signs
Rationale: After stopping the infusion and administering calcium gluconate, the nurse should obtain vital signs to assess the client’s status and response to the treatment.
A nurse is caring for a client with suspected magnesium toxicity. Which of the following assessments is essential to ensure fetal well-being during this emergency?
A) Maternal blood pressure
B) Urinary output
C) Fetal heart rate pattern
D) Maternal respiratory rate
C) Fetal heart rate pattern
Rationale: The nurse should assess the fetal heart rate pattern to ensure reassuring fetal status, as magnesium sulfate can affect both maternal and fetal systems.
A client receiving magnesium sulfate for preterm labor is showing signs of magnesium toxicity. What is the nurse’s priority action after notifying the provider?
A) Monitor the client’s oxygen saturation
B) Monitor urine output
C) Administer an additional dose of magnesium sulfate
D) Prepare the client for delivery
B) Monitor urine output
Rationale: Monitoring urine output is essential in magnesium toxicity management as decreased renal function can exacerbate toxicity.
A nurse is administering magnesium sulfate to a client in preterm labor. Which of the following is the primary reason for administering magnesium sulfate in this scenario?
A) To relieve uterine pain and discomfort
B) To inhibit uterine contractions and delay preterm labor
C) To prevent the development of preeclampsia
D) To promote fetal lung maturity
B) To inhibit uterine contractions and delay preterm labor
Rationale: Magnesium sulfate is used to inhibit uterine contractions and delay preterm labor, providing additional time for fetal lung maturation and other interventions.
A nurse is caring for a client receiving magnesium sulfate for preterm labor. Which of the following is the most common maternal side effect of magnesium sulfate therapy?
A) Hyperkalemia
B) Tachycardia
C) Nausea and vomiting
D) Hypotension
C) Nausea and vomiting
Rationale: Nausea and vomiting are common side effects of magnesium sulfate therapy, along with other symptoms such as weakness and drowsiness.
A nurse is assessing a client receiving magnesium sulfate for preterm labor. The client’s deep tendon reflexes (DTRs) are diminished. What is the nurse’s next action?
A) Increase the magnesium sulfate infusion rate
B) Notify the healthcare provider immediately
C) Decrease the infusion rate of magnesium sulfate
D) Document the finding as normal
C) Decrease the infusion rate of magnesium sulfate
Rationale: Diminished DTRs may be a sign of magnesium toxicity. The nurse should decrease the infusion rate and notify the healthcare provider.
A client in preterm labor is receiving magnesium sulfate for contraction inhibition. The nurse notes a decrease in the fetal heart rate variability. What is the nurse’s priority action?
A) Increase the magnesium sulfate dose
B) Notify the healthcare provider
C) Administer oxygen via face mask to the client
D) Discontinue magnesium sulfate and assess for signs of toxicity
D) Discontinue magnesium sulfate and assess for signs of toxicity
Rationale: A decrease in fetal heart rate variability can be a sign of magnesium toxicity. The nurse should discontinue the magnesium sulfate and assess for signs of toxicity in the mother.
A nurse is caring for a pregnant woman with a diagnosis of pulmonary stenosis. Based on the World Health Organization (WHO) classification, which risk class would this patient fall into?
A) Risk Class I
B) Risk Class II
C) Risk Class III
D) Risk Class IV
A) Risk Class I
Rationale: Pulmonary stenosis is categorized as a condition under Risk Class I, which indicates no detectable increased risk of maternal mortality and a mild increase in morbidity.
A pregnant woman with a repaired tetralogy of Fallot defects is classified under which of the following WHO cardiovascular risk categories?
A) Risk Class I
B) Risk Class II
C) Risk Class III
D) Risk Class IV
B) Risk Class II
Rationale: A repaired tetralogy of Fallot defect is classified as Risk Class II, where there is a small increased risk of maternal mortality or moderate morbidity.
A pregnant woman with severe mitral stenosis is classified under which WHO cardiovascular risk class?
A) Risk Class I
B) Risk Class II
C) Risk Class III
D) Risk Class IV
D) Risk Class IV
Rationale: Severe mitral stenosis falls under Risk Class IV, which represents extremely high risk of maternal mortality or severe morbidity. Pregnancy is contraindicated in this class.
Which of the following actions is most appropriate for a woman in Risk Class III of the WHO cardiovascular classification during pregnancy?
A) No need for special care
B) Monthly cardiology consultations and delivery at an appropriate hospital
C) Cardiology consult only at the beginning of pregnancy
D) No cardiology consultation needed
B) Monthly cardiology consultations and delivery at an appropriate hospital
Rationale: Women in Risk Class III require cardiology consultations every other month and should deliver at an appropriate level hospital due to significant increased risk of maternal mortality or morbidity.
A woman with moderate left ventricular impairment is classified under which of the following WHO cardiovascular risk categories?
A) Risk Class I
B) Risk Class II
C) Risk Class III
D) Risk Class IV
C) Risk Class III
Rationale: Moderate left ventricular impairment is classified as Risk Class III, which involves a significantly increased risk of maternal mortality or severe morbidity.
What is the recommended course of action for women with Risk Class IV cardiac conditions considering pregnancy?
A) They should be closely monitored but can proceed with pregnancy.
B) Pregnancy should be avoided, and they should receive preconception counseling.
C) Pregnancy can proceed with regular cardiology consultations every trimester.
D) Immediate induction of labor is necessary for these patients.
B) Pregnancy should be avoided, and they should receive preconception counseling.
Rationale: Women in Risk Class IV should typically avoid pregnancy due to the extremely high risk of maternal mortality or severe morbidity. Preconception counseling is advised.
A pregnant woman in Risk Class I cardiac disease should receive which of the following during her pregnancy?
A) Cardiology consults every trimester
B) Monthly follow-up with a cardiologist
C) Prepregnancy counseling suggested
D) Delivery only at a tertiary care hospital
C) Prepregnancy counseling suggested
Rationale: Women in Risk Class I cardiac disease may not require frequent cardiology consults but should receive prepregnancy counseling.
Which of the following cardiac conditions would most likely result in a classification of Risk Class II for a pregnant woman?
A) Pulmonary arterial hypertension
B) Moderate mitral stenosis
C) Severe left ventricular dysfunction
D) Atrial or ventricular septal defect
D) Atrial or ventricular septal defect
Rationale: An atrial or ventricular septal defect is classified as Risk Class II, indicating a small increased risk of maternal mortality or moderate morbidity.
A pregnant woman with severe ventricular dysfunction is in which of the following WHO cardiovascular risk classes?
A) Risk Class I
B) Risk Class II
C) Risk Class III
D) Risk Class IV
D) Risk Class IV
Rationale: Severe ventricular dysfunction falls under Risk Class IV, which is characterized by extremely high risks and contraindicates pregnancy.
Which of the following statements is true regarding a woman with Risk Class II cardiac disease during pregnancy?
A) Pregnancy counseling and cardiology consultations are not necessary.
B) The risk of maternal mortality is significantly increased.
C) Delivery at an appropriate hospital is recommended.
D) Pregnancy is contraindicated for this classification.
C) Delivery at an appropriate hospital is recommended.
Rationale: Women in Risk Class II should have pregnancy counseling and cardiology consultations every trimester, and delivery at an appropriate level hospital is recommended due to a small increased risk of maternal mortality or moderate morbidity.
A 28-year-old pregnant woman with a BMI of 32 kg/m² is seeking prenatal care. Which of the following complications is she at an increased risk for due to her obesity?
A) Gestational hypertension
B) Hyperthyroidism
C) Hypoglycemia
D) Anemia
A) Gestational hypertension
Rationale: Obesity during pregnancy increases the risk of gestational hypertension, preeclampsia, and other complications such as gestational diabetes and thromboembolism.
A nurse is educating a pregnant woman with obesity on the risks associated with excess weight gain during pregnancy. Which of the following outcomes is most strongly linked to excessive gestational weight gain?
A) Increased risk of childhood obesity in the offspring
B) Increased risk of gestational diabetes
C) Increased risk of cesarean birth
D) Lower incidence of preterm birth
A) Increased risk of childhood obesity in the offspring
Rationale: Excessive weight gain during pregnancy is strongly associated with an increased risk of childhood obesity in the offspring and postpartum weight retention for the mother.
A 32-year-old pregnant woman with obesity presents for her first prenatal visit. The nurse notes her BMI is 33 kg/m². Which of the following should the nurse emphasize during counseling?
A) Discontinuing exercise due to the increased risk of preterm birth
B) Avoiding physical activity to prevent excessive weight gain
C) Promoting gradual weight gain according to the recommended guidelines for her BMI
D) Advising weight loss during pregnancy to reduce risk of complications
C) Promoting gradual weight gain according to the recommended guidelines for her BMI
Rationale: The nurse should encourage the woman to follow the recommended weight gain guidelines for her BMI and emphasize the importance of gradual and controlled weight gain during pregnancy.
Which of the following pregnancy-related complications is most commonly associated with obesity?
A) Congenital anomalies
B) Hyperemesis gravidarum
C) Fetal macrosomia
D) Early pregnancy loss
C) Fetal macrosomia
Rationale: Obesity increases the risk of fetal macrosomia, which is a condition where the baby weighs over 4,000 g at birth.
Which of the following is a potential psychological consequence for obese women during pregnancy?
A) Increased risk of anxiety disorders
B) Depression due to societal stigma and discrimination
C) Lack of interest in prenatal care
D) Reduced ability to bond with the fetus
B) Depression due to societal stigma and discrimination
Rationale: Obese women may experience depression due to societal stigma, negative attitudes, and discrimination, which can impact their mental health during pregnancy.
A 35-year-old obese pregnant woman is at an increased risk for which of the following outcomes?
A) Higher rates of breastfeeding success
B) Increased risk of maternal mortality
C) Reduced risk of cesarean section
D) Decreased incidence of postpartum hemorrhage
B) Increased risk of maternal mortality
Rationale: Obesity during pregnancy increases the risk of maternal mortality due to complications such as preeclampsia, thromboembolism, and cesarean birth.
A nurse is providing care for an obese pregnant woman. Which of the following should the nurse include when discussing postpartum care?
A) Postpartum weight retention is a risk, and the woman should be encouraged to maintain a healthy diet and exercise plan
B) The woman should focus on strict calorie restriction to lose weight rapidly
C) The woman should avoid physical activity for at least six months postpartum
D) Weight loss is unnecessary if the woman exclusively breastfeeds
A) Postpartum weight retention is a risk, and the woman should be encouraged to maintain a healthy diet and exercise plan
Rationale: Postpartum weight retention is common among obese women, so encouraging a healthy diet and regular exercise plan is crucial for long-term health and preventing further weight gain.
Which of the following is an expected outcome for obese pregnant women who receive individualized nursing care and counseling regarding weight, diet, and exercise?
A) Reduced risk of fetal macrosomia and cesarean birth
B) Increased risk of preterm labor and birth
C) Lower incidence of gestational diabetes
D) Improved mental health and self-esteem
A) Reduced risk of fetal macrosomia and cesarean birth
Rationale: Individualized nursing care and counseling focusing on managing weight, diet, and exercise can reduce the risk of fetal macrosomia, cesarean birth, and other complications associated with obesity in pregnancy.
Which of the following is the most common harmful effect of heroin use during pregnancy?
A) Spontaneous abortion
B) Neonatal abstinence syndrome
C) Placental abruption
D) Fetal growth restriction
B) Neonatal abstinence syndrome
Rationale: Heroin use during pregnancy is most commonly associated with neonatal abstinence syndrome (NAS), which includes symptoms like irritability, vomiting, and seizures in the newborn.
Which substance is linked to an increased risk of spontaneous abortion and preterm delivery during pregnancy?
A) Marijuana
B) Caffeine
C) Alcohol
D) Cocaine
A) Marijuana
Rationale: Marijuana use during pregnancy has been linked to increased risks of spontaneous abortion and preterm delivery.
What is the recommended treatment for pregnant women with opioid use disorder?
A) Abstinence from all substances
B) Methadone or buprenorphine maintenance therapy
C) Immediate detoxification
D) Benzodiazepine therapy
B) Methadone or buprenorphine maintenance therapy
Rationale: Methadone or buprenorphine are recommended for maintenance therapy during pregnancy to reduce withdrawal symptoms and the risks to the fetus.
Which of the following is a potential effect of nicotine use during pregnancy?
A) Neural tube defects
B) Hyperactivity in adulthood
C) Increased risk of uterine rupture
D) Increased risk of cleft lip and palate
D) Increased risk of cleft lip and palate
Rationale: Smoking during pregnancy increases the risk of cleft lip and palate in the newborn.
What effect does caffeine have on iron absorption during pregnancy?
A) Increases absorption of iron
B) No effect on iron absorption
C) Decreases absorption of iron
D) Increases iron deficiency anemia
C) Decreases absorption of iron
Rationale: Caffeine decreases iron absorption, which may increase the risk of anemia during pregnancy.
Which of the following substances is most commonly abused during pregnancy in the United States?
A) Heroin
B) Cocaine
C) Marijuana
D) Methamphetamine
D) Methamphetamine
What is the primary risk associated with smoking during pregnancy?
A) Increased risk of stillbirth
B) Fetal alcohol syndrome
C) Placenta previa
D) Neonatal abstinence syndrome
A) Increased risk of stillbirth
Rationale: Smoking during pregnancy significantly increases the risk of stillbirth.
Which of the following is a risk associated with maternal methamphetamine use during pregnancy?
A) Neural tube defects
B) Placental abruption
C) Increased amniotic fluid
D) Postpartum depression
B) Placental abruption
Rationale: Methamphetamine use during pregnancy is associated with an increased risk of placental abruption.
Which of the following drugs has been shown to reduce withdrawal symptoms in newborns exposed to narcotics in utero?
A) Naloxone
B) Buprenorphine
C) Methadone
D) Diazepam
C) Methadone
Rationale: Methadone maintenance therapy helps reduce withdrawal symptoms in newborns exposed to narcotics.
What condition is associated with neonatal exposure to marijuana?
A) Neonatal abstinence syndrome
B) Increased tremulousness and high-pitched cry
C) Low birth weight
D) Cognitive deficits
B) Increased tremulousness and high-pitched cry
Rationale: Infants exposed to marijuana in utero may show symptoms like increased tremulousness and a high-pitched cry.
Which of the following is a long-term consequence of smoking during pregnancy?
A) Increased risk of placental abruption
B) Behavioral problems in childhood
C) Increased risk of neural tube defects
D) Reduced maternal appetite
B) Behavioral problems in childhood
Rationale: Smoking during pregnancy increases the risk of childhood behavioral problems, such as ADHD and aggression.
Which substance is known to cause vasoconstriction during pregnancy and reduce blood flow to the fetus?
A) Marijuana
B) Caffeine
C) Alcohol
D) Nicotine
D) Nicotine
Rationale: Nicotine causes vasoconstriction, which reduces blood flow to the fetus, contributing to fetal hypoxia.
Which of the following substances is linked to increased risk of cognitive deficits, particularly in language and memory, in children exposed in utero?
A) Cocaine
B) Caffeine
C) Tobacco
D) Alcohol
C) Tobacco
Rationale: Tobacco use during pregnancy is linked to cognitive deficits in children, including language and memory issues.
What is a primary risk of using cocaine during pregnancy?
A) Low birth weight
B) Increased appetite
C) Increased risk of SIDS
D) Spontaneous abortion
A) Low birth weight
Rationale: Cocaine use during pregnancy increases the risk of low birth weight.
Which of the following is a possible long-term effect of prenatal methamphetamine exposure?
A) Decreased birth weight
B) Increased risk of intellectual disabilities
C) Increased risk of SIDS
D) Neonatal abstinence syndrome
B) Increased risk of intellectual disabilities
Rationale: Prenatal methamphetamine exposure is associated with an increased risk of developmental and intellectual disabilities.
Which of the following is a characteristic of babies exposed to opioids in utero?
A) Decreased irritability
B) High-pitched cry
C) Decreased sensitivity to pain
D) Improved muscle tone
B) High-pitched cry
Rationale: Babies exposed to opioids in utero often exhibit a high-pitched cry as part of neonatal abstinence syndrome (NAS).
Which of the following substances has been associated with an increased risk of cleft lip and palate in infants?
A) Marijuana
B) Caffeine
C) Nicotine
D) Alcohol
C) Nicotine
Rationale: Smoking during pregnancy increases the risk of cleft lip and palate.
What is the primary effect of opiate use during pregnancy on the fetus?
A) Preterm labor
B) Neonatal abstinence syndrome
C) Increased risk of neural tube defects
D) Increased risk of asthma
B) Neonatal abstinence syndrome
Rationale: Opiate use during pregnancy is primarily associated with neonatal abstinence syndrome (NAS) in newborns.
What is the purpose of the ABO and antibody screen in pregnancy?
A. To determine blood glucose levels
B. To identify the mother’s blood type and screen for antibodies that may affect the baby
C. To check for anemia
D. To assess kidney function
B. To identify the mother’s blood type and screen for antibodies that may affect the baby
Rationale: The ABO and antibody screen is used to determine the mother’s blood type and screen for antibodies that may cause hemolytic disease of the fetus and newborn (HDFN).
What treatment is available if maternal antibodies against fetal red blood cells are identified?
A. Vitamin supplements
B. Immunoglobulin therapy
C. Rh immunoglobulin (RhIg) administration
D. Antihypertensive medications
C. Rh immunoglobulin (RhIg) administration
Rationale: If maternal antibodies against fetal red blood cells are identified, Rh immunoglobulin (RhIg) can be administered to prevent alloimmunization and hemolytic disease of the fetus and newborn.
What is the recommended treatment for an Rh-negative mother with an Rh-positive baby?
A. Rh immunoglobulin (RhIg) administration at 28 weeks and within 72 hours postpartum
B. Blood transfusion
C. Antibiotics
D. Bed rest
A. Rh immunoglobulin (RhIg) administration at 28 weeks and within 72 hours postpartum
Rationale: Rh immunoglobulin (RhIg) is administered to an Rh-negative mother at 28 weeks of gestation and within 72 hours postpartum if the baby is Rh-positive to prevent alloimmunization.
What is the treatment for a pregnant woman who tests positive for Hepatitis C?
A. Antiviral medications specific for Hepatitis C
B. Immediate delivery
C. Blood transfusion
D. Folic acid supplementation
A. Antiviral medications specific for Hepatitis C
Rationale: Antiviral medications specific for Hepatitis C can be used to manage the infection in a pregnant woman.
What is the recommended treatment for a pregnant woman with an active HSV infection at the time of delivery?
A. Antiviral therapy
B. Immediate delivery
C. Antibiotics
D. Bed rest
A. Antiviral therapy
Rationale: Antiviral therapy (e.g., acyclovir) is recommended to manage HSV infection, and cesarean delivery may be considered to prevent neonatal transmission.
What is the purpose of HBsAG screening in pregnancy?
A. To screen for HIV
B. To check for anemia
C. To assess thyroid function
D. To identify Hepatitis B infection in the mother
D. To identify Hepatitis B infection in the mother
Rationale: HBsAG screening is performed to identify Hepatitis B infection in the mother, which can be transmitted to the baby.
What is the purpose of the RPR or VDRL test in pregnancy?
A. To identify Hepatitis C infection
B. To screen for syphilis infection
C. To monitor blood glucose levels
D. To check for anemia
B. To screen for syphilis infection
Rationale: The RPR or VDRL test is performed to screen for syphilis infection in pregnancy.
What is the recommended treatment for a pregnant woman who tests positive for syphilis?
A. Antiviral medications
B. Penicillin therapy
C. Blood transfusion
D. Folic acid supplementation
B. Penicillin therapy
Rationale: Penicillin therapy is the recommended treatment for a pregnant woman who tests positive for syphilis.
What is the recommended action if a pregnant woman is found to be non-immune to rubella?
A. Immediate vaccination during pregnancy
B. Vaccination postpartum
C. Administration of antiviral medications
D. Immediate delivery
B. Vaccination postpartum
Rationale: If a pregnant woman is found to be non-immune to rubella, vaccination is recommended postpartum to protect future pregnancies.
What is the recommended treatment for a pregnant woman who tests positive for GBS colonization?
A. Immediate delivery
B. Blood transfusion
C. Folic acid supplementation
D. Administration of antibiotics during labor
D. Administration of antibiotics during labor
Rationale: Administration of antibiotics during labor (intrapartum prophylaxis) is recommended to prevent GBS transmission to the newborn.
Why is it important to screen for ABO and Rh incompatibility during pregnancy?
A. To prevent gestational diabetes
B. To prevent hemolytic disease of the fetus and newborn
C. To monitor thyroid function
D. To assess kidney function
B. To prevent hemolytic disease of the fetus and newborn
Rationale: Screening for ABO and Rh incompatibility is important to prevent hemolytic disease of the fetus and newborn (HDFN).
What laboratory tests are used to diagnose syphilis in pregnant women? (Select all that apply)
A. Rapid Plasma Reagin (RPR)
B. Venereal Disease Research Laboratory (VDRL)
C. Hepatitis B surface antigen (HBsAG)
D. Rubella immunity status
A. Rapid Plasma Reagin (RPR)
B. Venereal Disease Research Laboratory (VDRL)
Rationale: RPR and VDRL tests are used to diagnose syphilis in pregnant women.
What are the potential risks to the baby if a pregnant woman tests positive for Hepatitis C?
A. Preterm birth and low birth weight
B. Gestational diabetes and low birth weight
C. Hyperthyroidism and low birth weight
D. Increased risk of blood clots and low birth weight
A. Preterm birth and low birth weight
Rationale: A pregnant woman with Hepatitis C may have an increased risk of preterm birth and low birth weight for her baby.
Which lab test is used to screen for syphilis in pregnant women, and why is this screening important?
A. Hepatitis B surface antigen (HBsAG); to prevent liver disease
B. Rubella immunity status; to prevent rubella infection
C. Rapid Plasma Reagin (RPR); to prevent congenital syphilis
D. Blood glucose levels; to monitor for gestational diabetes
C. Rapid Plasma Reagin (RPR); to prevent congenital syphilis
Rationale: The Rapid Plasma Reagin (RPR) test is used to screen for syphilis in pregnant women, and this screening is important to prevent congenital syphilis.
A pregnant woman presents to the clinic for her routine prenatal visit. She asks if it is safe to receive the live attenuated MMR vaccine during her pregnancy. Which of the following is the nurse’s best response?
A. “Yes, it is safe to receive the MMR vaccine during pregnancy.”
B. “The MMR vaccine is contraindicated during pregnancy due to the risk of fetal harm.”
C. “You should wait until after your baby is born to receive the MMR vaccine.”
D. “You should receive the MMR vaccine immediately, as it will protect both you and your baby.”
B. “The MMR vaccine is contraindicated during pregnancy due to the risk of fetal harm.”
Rationale: The MMR vaccine contains live viruses, which are contraindicated during pregnancy due to the potential risk of teratogenic effects on the fetus.
A pregnant woman in her first trimester is due for a flu shot. The nurse educates her on the importance of vaccination. Which of the following flu vaccines should be avoided during pregnancy?
A. Live attenuated influenza vaccine (LAIV)
B. Inactivated influenza vaccine (IIV)
C. Recombinant influenza vaccine (RIV)
D. Both IIV and RIV
A. Live attenuated influenza vaccine (LAIV)
Rationale: The live attenuated influenza vaccine (LAIV) should be avoided during pregnancy, especially in the first trimester, because it contains live viruses.
A pregnant woman asks if she should receive the varicella vaccine during her pregnancy. Which response is most appropriate?
A. “You should receive the varicella vaccine immediately to protect both you and your baby.”
B. “The varicella vaccine is safe during pregnancy and recommended if you have not had chickenpox.”
C. “You should wait until after delivery to receive the varicella vaccine.
D. “You should avoid the varicella vaccine during pregnancy, as it is a live vaccine.”
D. “You should avoid the varicella vaccine during pregnancy, as it is a live vaccine.”
Rationale: The varicella vaccine is a live vaccine and is contraindicated during pregnancy due to potential teratogenic effects on the fetus.
A pregnant woman in her second trimester asks about receiving the yellow fever vaccine for travel purposes. What is the nurse’s best response?
A. “The yellow fever vaccine is safe to take during pregnancy.”
B. “The yellow fever vaccine is contraindicated during pregnancy, unless travel is essential.”
C. “You should receive the yellow fever vaccine before becoming pregnant.”
D. “The yellow fever vaccine can be safely administered in any trimester.”
B. “The yellow fever vaccine is contraindicated during pregnancy, unless travel is essential.”
Rationale: The yellow fever vaccine is a live vaccine and is contraindicated during pregnancy due to potential harm to the fetus. It should only be given if absolutely necessary.
Which of the following vaccines should be administered during pregnancy to protect both the mother and fetus?
A. Live attenuated influenza vaccine (LAIV)
B. Measles, mumps, and rubella (MMR)
C. Tetanus, diphtheria, and acellular pertussis (Tdap)
D. Varicella
C. Tetanus, diphtheria, and acellular pertussis (Tdap)
Rationale: The Tdap vaccine is recommended during pregnancy to protect the newborn from pertussis (whooping cough) and is safe during pregnancy, typically administered between 27 and 36 weeks of gestation.
A pregnant woman comes into the clinic asking about the hepatitis A vaccine. She is concerned about contracting the virus during her pregnancy. Which of the following statements by the nurse is most appropriate?
A. “The hepatitis A vaccine is safe during pregnancy and should be given as soon as possible.”
B. “The hepatitis A vaccine is a live vaccine and should be avoided during pregnancy.”
C. “The hepatitis A vaccine is safe and recommended only if you are at high risk for exposure.”
D. “You should delay the hepatitis A vaccine until after you give birth.”
C. “The hepatitis A vaccine is safe and recommended only if you are at high risk for exposure.”
Rationale: The hepatitis A vaccine is considered safe during pregnancy, but it is typically only recommended for women at high risk of exposure.
A woman in her first trimester asks about the HPV vaccine. Which statement by the nurse is correct?
A. “The HPV vaccine is safe during pregnancy, and you should get vaccinated as soon as possible.”
B. “The HPV vaccine is a live vaccine and should be avoided during pregnancy.”
C. “The HPV vaccine is not recommended during pregnancy, but it is safe if needed.”
D. “You should delay the HPV vaccine until after your baby is born.”
D. “You should delay the HPV vaccine until after your baby is born.”
Rationale: The HPV vaccine is not recommended during pregnancy. If a woman becomes pregnant after starting the vaccination series, she should delay the remaining doses until after delivery.
A pregnant client at 32 weeks presents with a persistent headache, epigastric pain, and visual disturbances. Laboratory results reveal: AST 85 U/L, ALT 90 U/L, and platelets 90,000/mm³. What is the most likely condition?
A. Gestational diabetes
B. HELLP syndrome
C. Hyperemesis gravidarum
D. Placenta previa
B. HELLP syndrome
Rationale: Elevated liver enzymes (AST/ALT), low platelets (<100,000), and clinical symptoms suggest HELLP syndrome, a severe preeclampsia complication.
A client at 28 weeks has a uric acid level of 7 mg/dL. What should the nurse suspect?
A. Normal finding in pregnancy
B. Iron-deficiency anemia
C. Preeclampsia
D. Hyperthyroidism
C. Preeclampsia
Rationale: Elevated uric acid (>6 mg/dL) indicates impaired renal function, often seen in preeclampsia.
Which of the following is an abnormal WBC count for a pregnant client at 38 weeks?
A. 8,000/mm³
B. 12,000/mm³
C. 16,000/mm³
D. 25,000/mm³
D. 25,000/mm³
Rationale: WBC counts typically rise during pregnancy but should remain below 20,000/mm³. A value above this indicates infection or another complication.
A protein/creatinine ratio of 0.35 is noted in a pregnant client at 30 weeks. What should the nurse do next?
A. Document as normal
B. Reassess in 24 hours
C. Notify the provider
D. Initiate seizure precautions
C. Notify the provider
Rationale: A protein/creatinine ratio ≥0.3 indicates significant proteinuria and suggests preeclampsia.
Which hemoglobin value is abnormal in a pregnant client at 36 weeks?
A. 10.8 g/dL
B. 11.2 g/dL
C. 9.5 g/dL
D. 12 g/dL
C. 9.5 g/dL
Rationale: Hemoglobin levels <11 g/dL in the second and third trimesters indicate anemia, requiring further evaluation.
A postpartum client with preeclampsia has LDH of 700 U/L. What does this indicate?
A. Normal postpartum finding
B. Hemolysis
C. Impaired clotting
D. Hypovolemia
B. Hemolysis
Rationale: Elevated LDH (>600 U/L) suggests tissue breakdown or hemolysis, common in HELLP syndrome.
Which platelet count is concerning for a client at 34 weeks gestation?
A. 160,000/mm³
B. 140,000/mm³
C. 90,000/mm³
D. 120,000/mm³
C. 90,000/mm³
Rationale: Platelet counts <100,000/mm³ are abnormal and suggest thrombocytopenia, often associated with preeclampsia or HELLP syndrome.
A client at 28 weeks has serum creatinine of 1.3 mg/dL and proteinuria on urinalysis. What is the priority nursing action?
A. Recommend increased hydration
B. Monitor fetal movements
C. Encourage a low-protein diet
D. Notify the provider
D. Notify the provider
Rationale: Elevated creatinine (>1.1 mg/dL) and proteinuria suggest renal dysfunction, likely due to preeclampsia.
Which condition is most likely in a pregnant client with AST 105 U/L, ALT 120 U/L, and severe right upper quadrant pain?
A. Acute fatty liver of pregnancy
B. Gestational hypertension
C. Preeclampsia without severe features
D. Chorioamnionitis
A. Acute fatty liver of pregnancy
Rationale: Extremely elevated liver enzymes and upper quadrant pain suggest liver dysfunction, indicative of acute fatty liver of pregnancy.
A nurse assesses a client at 36 weeks with hemoglobin 10.2 g/dL and hematocrit 29%. Which intervention is most appropriate?
A. Reassure the client this is normal
B. Administer IV fluids
C. Recommend iron supplementation
D. Perform a blood transfusion
C. Recommend iron supplementation
Rationale: Hemoglobin <11 g/dL and hematocrit <33% indicate iron-deficiency anemia, commonly treated with iron supplements.
After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which of the following as being good sources of iron in her diet? (Select all that apply.)
A) Dried fruits
B) Peanut butter
C) Meats
D) Milk
E) White bread
A) Dried fruits
B) Peanut butter
C) Meats
After teaching a pregnant woman with iron deficiency anemia about her prescribed iron supplement, which statement indicates successful teaching?
A) I should take my iron with milk.
B) I should avoid drinking orange juice.
C) I need to eat foods high in fiber.
D) I’ll call the doctor if my stool is black and tarry.
C) I need to eat foods high in fiber.
What is the most common type of anemia during pregnancy, and why does it occur?
a) Sickle cell anemia due to a genetic mutation
b) Megaloblastic anemia due to folate deficiency
c) Iron deficiency anemia due to increased blood volume
d) Anemia of chronic disease due to inflammation
c) Iron deficiency anemia due to increased blood volume
Rationale: Iron deficiency anemia is the most common type of anemia in pregnancy because of the increased blood volume, which dilutes hemoglobin and increases the demand for iron.
Which of the following maternal symptoms are associated with iron deficiency anemia during pregnancy?
(Select all that apply)
a) Fatigue
b) Impaired cognition
c) Pica
d) Restless leg syndrome
e) Hyperactivity
a) Fatigue
b) Impaired cognition
c) Pica
d) Restless leg syndrome
Rationale: Fatigue, impaired cognition, pica (craving nonfood substances), and restless leg syndrome are common symptoms of iron deficiency anemia in pregnancy. Hyperactivity is not associated with this condition.
What fetal risks are associated with maternal iron deficiency anemia?
a) High birth weight and advanced psychomotor development
b) Preterm birth and large for gestational age (LGA) infants
c) Low birth weight and poor psychomotor development
d) Neural tube defects and cardiac malformations
c) Low birth weight and poor psychomotor development
Rationale: Maternal iron deficiency anemia can lead to fetal risks such as low birth weight and delayed psychomotor development due to inadequate oxygen and nutrient delivery.
What is a priority management strategy for iron deficiency anemia during pregnancy?
a) Avoiding iron-rich foods to prevent gastrointestinal distress
b) Monitoring hemoglobin and hematocrit levels and initiating iron supplementation
c) Administering prophylactic antibiotics to prevent infection
d) Avoiding physical activity to conserve energy
b) Monitoring hemoglobin and hematocrit levels and initiating iron supplementation
Rationale: Iron deficiency anemia is managed by monitoring hemoglobin and hematocrit levels, providing iron supplements, and educating patients about iron-rich foods.
What are the maternal risks associated with sickle cell anemia during pregnancy?
a) Neural tube defects and postpartum hemorrhage
b) Preeclampsia, preterm birth, and low birth weight
c) Gestational diabetes and macrosomia
d) Placenta previa and large for gestational age infants
b) Preeclampsia, preterm birth, and low birth weight
Rationale: Pregnant women with sickle cell anemia are at increased risk for preeclampsia, preterm birth, and low birth weight due to vascular complications and reduced placental perfusion.
What is a key nursing intervention for managing sickle cell anemia during labor?
a) Administering folic acid supplements to prevent megaloblastic anemia
b) Monitoring for sickle cell crisis and providing supportive care
c) Restricting fluid intake to reduce blood volume
d) Delaying delivery to prolong fetal growth
b) Monitoring for sickle cell crisis and providing supportive care
Rationale: Supportive care during labor for patients with sickle cell anemia includes close monitoring for signs of a sickle cell crisis and addressing pain, hydration, and oxygenation needs.
What is the primary difference between PROM and PPROM?
a) PROM occurs after 37 weeks, while PPROM occurs before 37 weeks.
b) PROM requires immediate delivery, while PPROM does not.
c) PROM is associated with infection, while PPROM is not.
d) PROM includes labor onset, while PPROM does not.
a) PROM occurs after 37 weeks, while PPROM occurs before 37 weeks.
Rationale: Rationale:** PROM refers to the rupture of membranes after 37 weeks without labor onset, while PPROM occurs before 37 weeks.
Which intervention is indicated for PPROM to enhance fetal lung maturity?
a) Intravenous antibiotics
b) Tocolytic therapy
c) Administration of corticosteroids
d) Immediate induction of labor
c) Administration of corticosteroids
Rationale: Corticosteroids are administered in cases of PPROM to enhance fetal lung maturity and reduce the risk of neonatal respiratory distress syndrome.
What is a key management priority for both PROM and PPROM?
a) Monitoring for signs of infection, such as chorioamnionitis
b) Administering magnesium sulfate for neuroprotection
c) Delaying delivery until 40 weeks gestation
d) Immediate induction of labor in all cases
a) Monitoring for signs of infection, such as chorioamnionitis
Rationale: Infection, particularly chorioamnionitis, is a significant risk following the rupture of membranes and must be closely monitored in both PROM and PPROM.
Which of the following symptoms would most likely indicate chorioamnionitis in a patient with PPROM?
a) Maternal fever, uterine tenderness, and foul-smelling discharge
b) Fetal tachycardia and maternal hypotension
c) Clear amniotic fluid with no symptoms of infection
d) Painless vaginal bleeding and fetal bradycardia
a) Maternal fever, uterine tenderness, and foul-smelling discharge
Rationale: Chorioamnionitis is suggested by signs such as maternal fever, uterine tenderness, and foul-smelling discharge in the context of PPROM.
Which of the following is the target fasting blood glucose level for patients with gestational diabetes?
a) ≤95 mg/dL
b) ≤120 mg/dL
c) ≤140 mg/dL
d) ≤100 mg/dL
a) ≤95 mg/dL
Rationale: The target fasting blood glucose level for patients with GDM is ≤95 mg/dL to minimize risks to both the mother and fetus.
What are the primary risks to the fetus associated with poorly controlled gestational diabetes? (Select all that apply)
a) Macrosomia
b) Intrauterine growth restriction (IUGR)
c) Hypoglycemia after birth
d) Congenital malformations
e) Polyhydramnios
a) Macrosomia
c) Hypoglycemia after birth
e) Polyhydramnios
Rationale: Poorly controlled GDM increases the risk of macrosomia, neonatal hypoglycemia, and polyhydramnios. Congenital malformations are more commonly associated with pregestational diabetes.
Which medication is commonly used if blood glucose levels cannot be managed with diet and exercise in GDM?
a) Metformin
b) Glyburide
c) Insulin
d) Glipizide
c) Insulin
Rationale: Insulin is the first-line pharmacologic treatment for GDM when diet and exercise fail to maintain glycemic control.
What is the recommended timing for delivery in a patient with well-controlled GDM?
a) 37 weeks
b) 39-40 weeks
c) 41 weeks
d) 36-38 weeks weeks
b) 39-40 weeks
Rationale: Delivery at 39-40 weeks is recommended for patients with well-controlled GDM to optimize outcomes and minimize complications.
Which postpartum complication is more likely in women with gestational diabetes?
a) Preeclampsia
b) Postpartum hemorrhage
c) Development of type 2 diabetes
d) Thromboembolism
c) Development of type 2 diabetes
Rationale: Women with GDM have a higher risk of developing type 2 diabetes later in life, necessitating postpartum glucose testing and lifestyle interventions.
What is the purpose of monitoring fetal growth with ultrasound in a patient with gestational diabetes?
a) Detect macrosomia and polyhydramnios
b) Assess fetal heart rate variability
c) Confirm gestational age
d) Evaluate placental aging
a) Detect macrosomia and polyhydramnios
Rationale: Ultrasound is used to monitor for macrosomia and polyhydramnios, which are common complications of GDM.
Which of the following are key components of dietary management for GDM? (Select all that apply)
a) Limiting carbohydrate intake to 33-40% of daily calories
b) Including protein with every meal
c) Avoiding all forms of sugar
d) Eating small, frequent meals throughout the day
e) Increasing dietary fat intake
a) Limiting carbohydrate intake to 33-40% of daily calories
b) Including protein with every meal
d) Eating small, frequent meals throughout the day
e) Increasing dietary fat intake
Rationale: Dietary management of GDM involves balancing macronutrients, limiting carbohydrates, and eating frequent meals to maintain stable blood glucose levels.
Which postpartum test is recommended for women with a history of GDM to screen for type 2 diabetes?
a) Hemoglobin A1c at 6 weeks postpartum
b) 2-hour oral glucose tolerance test (OGTT) at 6-12 weeks postpartum
c) Random blood glucose test at 1 week postpartum
d) Fasting blood glucose test at 3 days postpartum
b) 2-hour oral glucose tolerance test (OGTT) at 6-12 weeks postpartum
Rationale: Women with a history of GDM should undergo a 2-hour OGTT 6-12 weeks postpartum to screen for the development of type 2 diabetes.
The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurses teaching was successful?
A) I’ll basically follow the same diet that I was following before I became pregnant.
B) Because I need extra protein, I’ll have to increase my intake of milk and meat.
C) Pregnancy affects insulin production, so I’ll need to make adjustments in my diet.
D) I’ll adjust my diet and insulin based on the results of my urine tests for glucose.
C) Pregnancy affects insulin production, so I’ll need to make adjustments in my diet.
A nurse is developing a program for pregnant women with diabetes about reducing complications. Which factor would the nurse identify as being most important in helping to reduce the maternal/fetal/neonatal complications associated with pregnancy and diabetes?
A) Stability of the woman’s emotional and psychological status
B) Degree of glycemic control achieved during the pregnancy
C) Evaluation of retinopathy by an ophthalmologist
D) Blood urea nitrogen level (BUN. within normal limits
B) Degree of glycemic control achieved during the pregnancy
A woman with diabetes is considering becoming pregnant. She asks the nurse whether she will be able to take oral hypoglycemics when she is pregnant. The nurses response is based on the understanding that oral hypoglycemics:
A) Can be used as long as they control serum glucose levels
B) Can be taken until the degeneration of the placenta occurs
C) Are usually suggested primarily for women who develop gestational diabetes
D) Show promising results but more studies are needed to confirm their effectiveness
D) Show promising results but more studies are needed to confirm their effectiveness
A 10-week pregnant woman with diabetes has a glycosylated hemoglobin (HbA1C) level of 13%. At this time the nurse should be most concerned about which of the following possible fetal outcomes?
A) Congenital anomalies
B) Incompetent cervix
C) Placenta previa
D) Abruptio placentae
A) Congenital anomalies
A nurse is caring for a patient in labor who has a history of a previous cesarean section. Which assessment finding is most concerning for uterine rupture?
A) Gradual increase in contraction intensity
B) Persistent uterine contractions with no rest period
C) Sudden onset of severe abdominal pain followed by cessation of contractions
D) Fetal heart rate of 150 bpm with moderate variability
C) Sudden onset of severe abdominal pain followed by cessation of contractions
Rationale: Uterine rupture presents with sudden, severe pain, loss of uterine tone, and cessation of contractions due to disruption of uterine musculature. Other signs include fetal distress, maternal tachycardia, and vaginal bleeding.
A nurse is monitoring a patient undergoing a trial of labor after cesarean (TOLAC). Which fetal heart rate (FHR) pattern suggests possible uterine rupture?
A) Early decelerations with each contraction
B) Recurrent late decelerations and sudden fetal bradycardia
C) Accelerations with fetal movement
D) Moderate variability with no decelerations
B) Recurrent late decelerations and sudden fetal bradycardia
Rationale: Late decelerations and bradycardia suggest uteroplacental insufficiency, which occurs when the uterus ruptures and disrupts fetal oxygen supply. Immediate emergency C-section is needed.
A nurse is assessing a patient with suspected uterine rupture. Which additional symptom supports this diagnosis?
A) Firm, board-like abdomen
B) Sudden relief of pain with a palpable fetal part in the abdomen
C) Gradual increase in contraction intensity
D) Vaginal discharge with a foul odor
B) Sudden relief of pain with a palpable fetal part in the abdomen
Rationale: In complete uterine rupture, the fetus may be expelled into the peritoneal cavity, leading to a palpable fetal part and sudden relief of pain as the uterus is no longer contracting effectively.
A patient at 40 weeks gestation is undergoing an induction with oxytocin. Which assessment finding should prompt the nurse to immediately stop the infusion and notify the provider?
A) Contractions occurring every 2–3 minutes
B) Fetal heart rate of 140 bpm with moderate variability
C) Sudden maternal hypotension and sharp abdominal pain
D) Cervical dilation progressing from 4 cm to 6 cm within an hour
C) Sudden maternal hypotension and sharp abdominal pain
Rationale: Oxytocin increases the risk of uterine rupture, especially in patients with previous C-sections or uterine surgery. Hypotension, severe pain, and fetal distress indicate possible rupture and require immediate intervention.
A nurse is teaching a patient about risk factors for uterine rupture. Which statement by the patient indicates a need for further teaching?
A) “Since I had a C-section before, my risk is higher.”
B) “If I have too much amniotic fluid, my uterus might rupture.”
C) “Carrying twins increases my risk.”
D) “My risk is lower since I’ve had three prior C-sections.”
D) “My risk is lower since I’ve had three prior C-sections.”
Rationale: Multiple prior C-sections increase the risk of uterine rupture due to scar weakening. Other risk factors include polyhydramnios, multiple gestations, excessive uterine stimulation, and previous uterine surgery.
A nurse is preparing for an emergency C-section due to suspected uterine rupture. What is the priority action?
A) Increase the oxytocin infusion to speed up labor
B) Administer oxygen and prepare for blood transfusion
C) Place the patient in high-Fowler’s position
D) Offer pain medication and provide reassurance
B) Administer oxygen and prepare for blood transfusion
Rationale: Uterine rupture can cause severe maternal hemorrhage. Oxygen and blood products help stabilize the patient while preparing for an emergency C-section.
A nurse is caring for a patient with a previous classical C-section who is requesting a vaginal birth after cesarean (VBAC). What is the nurse’s best response?
A) “You are a good candidate for VBAC since you’ve had a prior C-section.”
B) “A VBAC is only safe if you go into labor naturally without induction.”
C) “You are not a candidate for VBAC due to your previous classical incision.”
D) “You can attempt VBAC, but only if you deliver in a birthing center.”
C) “You are not a candidate for VBAC due to your previous classical incision.”
Rationale: A classical (vertical) C-section incision significantly increases the risk of uterine rupture and is a contraindication for VBAC. Only low-transverse incisions are considered for VBAC.
A postpartum nurse is assessing a patient who had a uterine rupture repaired after an emergency C-section. Which finding requires immediate intervention?
A) Moderate vaginal bleeding and fundal height at the umbilicus
B) Blood pressure of 88/50 mmHg and heart rate of 120 bpm
C) Firm uterine fundus with lochia rubra
D) Pain at the incision site rated 5/10
B) Blood pressure of 88/50 mmHg and heart rate of 120 bpm
Rationale: Hypotension and tachycardia suggest ongoing hemorrhage or hypovolemic shock, which can occur after uterine rupture. Immediate fluid resuscitation and possible blood transfusion are needed.
A nurse is assessing a laboring patient when she notices a sudden fetal bradycardia on the monitor. Upon performing a vaginal exam, she palpates the umbilical cord in the birth canal. What is the priority nursing intervention?
A) Reposition the patient into a high-Fowler’s position
B) Administer oxygen via non-rebreather mask at 10 L/min
C) Use sterile gloved fingers to elevate the presenting fetal part off the cord
D) Immediately obtain fetal scalp blood sampling to assess oxygenation
C) Use sterile gloved fingers to elevate the presenting fetal part off the cord
Rationale: The priority intervention in umbilical cord prolapse is to relieve pressure on the cord by using a sterile gloved hand to lift the presenting fetal part off the cord. This maintains fetal oxygenation until an emergency C-section can be performed.
A nurse is caring for a patient at 39 weeks gestation who experiences spontaneous rupture of membranes (SROM). Which finding should prompt the nurse to immediately assess for cord prolapse?
A) Clear amniotic fluid with a mild odor
B) Meconium-stained amniotic fluid
C) Sudden variable decelerations on the fetal heart monitor
D) Increased maternal temperature and tachycardia
C) Sudden variable decelerations on the fetal heart monitor
Rationale: Variable decelerations are a sign of umbilical cord compression, which occurs in cord prolapse when the cord is trapped between the fetus and the birth canal. The nurse should immediately perform a vaginal exam to assess for a prolapsed cord.
A nurse identifies a prolapsed umbilical cord in a patient at 38 weeks gestation. After elevating the presenting fetal part, which action is most appropriate?
A) Assist the patient into knee-chest or Trendelenburg position
B) Cover the exposed cord with a dry, sterile dressing
C) Perform an immediate artificial rupture of membranes (AROM)
D) Apply fundal pressure to speed up delivery
A) Assist the patient into knee-chest or Trendelenburg position
Rationale: The knee-chest or Trendelenburg position uses gravity to relieve pressure on the prolapsed cord, improving fetal oxygenation while preparing for an emergency C-section.
A nurse is assisting with an emergency C-section for a patient with umbilical cord prolapse. What is the best statement to make to the patient?
A) “Your baby is not getting enough oxygen, so we need to deliver immediately.”
B) “We will do everything we can, but there is a chance your baby won’t survive.”
C) “You will need to stay completely still while we prepare for surgery.”
D) “We need to deliver your baby quickly to keep them safe, and you will meet them soon.”
D) “We need to deliver your baby quickly to keep them safe, and you will meet them soon.”
Rationale: Providing reassurance while maintaining clear, non-alarming communication is crucial in emergencies. The nurse should focus on safety, urgency, and reassurance without causing unnecessary distress.
Which patient is at the highest risk for umbilical cord prolapse?
A) A patient at 41 weeks gestation with a fetus in vertex position
B) A patient at 39 weeks gestation with oligohydramnios
C) A patient at 35 weeks gestation with polyhydramnios and a breech fetus
D) A patient with ruptured membranes who is 8 cm dilated and +2 station
C) A patient at 35 weeks gestation with polyhydramnios and a breech fetus
Rationale: Risk factors for cord prolapse include polyhydramnios (excess amniotic fluid), preterm gestation, and malpresentations (breech, transverse, etc.), which allow the cord to slip past the presenting part when membranes rupture.
A nurse is performing a vaginal exam and finds an umbilical cord protruding through the cervix into the vagina. What is the priority action?
A) Apply warm sterile saline gauze to the exposed cord
B) Call for immediate assistance and prepare for a C-section
C) Gently push the cord back into the uterus
D) Increase IV fluid rate and administer terbutaline
A) Apply warm sterile saline gauze to the exposed cord
Rationale: If the umbilical cord is exposed, it is at risk for vasospasm and drying, which can further compromise fetal oxygenation. The nurse should keep the cord moist with warm sterile saline gauze while awaiting emergency delivery.
A nurse is educating a patient at 32 weeks gestation who is at risk for umbilical cord prolapse. Which statement by the patient indicates a need for further teaching?
A) “If my water breaks at home, I should lie down and call 911.”
B) “If I see or feel the umbilical cord, I should gently push it back inside.”
C) “I should avoid laboring in a position where the baby’s head is not engaged.”
D) “I will come to the hospital immediately if my water breaks suddenly.”
B) “If I see or feel the umbilical cord, I should gently push it back inside.”
Rationale: The cord should never be pushed back inside, as this can worsen compression and damage the umbilical vessels. Instead, the patient should get into a knee-chest position and seek emergency medical care immediately.
A nurse is preparing a patient with umbilical cord prolapse for an emergency C-section. Which intervention is most important in the preoperative period?
A) Administering antibiotics to prevent infection
B) Encouraging maternal pushing efforts
C) Administering IV fluids and oxygen
D) Performing an amnioinfusion to relieve cord compression
C) Administering IV fluids and oxygen
Rationale: Maternal hypotension and hypoxia can worsen fetal distress in cord prolapse. IV fluids and oxygen improve maternal circulation, ensuring the fetus receives adequate oxygenation before delivery.
