FINAL Chapters 19, 20, and 21 Flashcards

Question

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)

Answer 1

D. Small for Gestational Age (SGA) Rationale: Chronic hypertension increases the risk of the fetus being Small for Gestational Age (SGA).

Answer 2

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.

Answer 3

C. They can cause birth defects Rationale: ACE inhibitors and ARBs need to be switched in pregnant patients because they can cause birth defects.

Answer 4

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.

Answer 5

B. Hydralazine, Labetalol, Nifedipine Rationale: Hydralazine, Labetalol, and Nifedipine are commonly used to manage chronic hypertension in pregnancy.

Answer 6

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.

Answer 7

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).

Answer 8

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.

Answer 9

B. Cardiovascular system C. Hepatic system D. Renal system E. Central nervous system Rationale: Preeclampsia targets the cardiovascular, hepatic, renal, and central nervous systems.

Answer 10

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.

Answer 11

B. After 20 weeks gestation

Answer 12

C. Second half of pregnancy Rationale: Preeclampsia most commonly manifests in the second half of pregnancy.

Answer 13

D. Preeclampsia alone or preeclampsia with severe features Rationale: Preeclampsia is classified into two categories: preeclampsia alone or preeclampsia with severe features.

Answer 14

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.

Answer 15

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.

Answer 16

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).

Answer 17

A. Exact cause unknown Rationale: The exact cause of preeclampsia is still unknown, despite extensive research.

Answer 18

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.

Answer 19

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.

Answer 20

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.

Answer 21

all of the choices are correct

Answer 22

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.

Answer 23

C. 37 weeks Rationale: For non-severe hypertensive disorders in pregnancy, delivery is recommended at 37 weeks.

Answer 24

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.

Answer 25

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.

Answer 26

B. Lateral recumbent position Rationale: The lateral recumbent position is recommended to improve uteroplacental blood flow, reduce blood pressure, and promote diuresis.

Answer 27

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.

Answer 28

B. Every 4 to 6 hours Rationale: She should monitor her blood pressure daily, every 4 to 6 hours while awake.

Answer 29

A. Balanced, nutritional diet with no sodium restriction Rationale: A balanced, nutritional diet with no sodium restriction is advised.

Answer 30

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.

Answer 31

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.

Answer 32

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.

Answer 33

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.

Answer 34

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.

Answer 35

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.

Answer 36

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.

Answer 37

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.

Answer 38

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.

Answer 39

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.

Answer 40

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.

Answer 41

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.

Answer 42

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.

Answer 43

B. Sitting position

Answer 44

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.

Answer 45

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.

Answer 46

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.

Answer 47

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.

Answer 48

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).

Answer 49

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.

Answer 50

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.

Answer 51

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.

Answer 52

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.

Answer 53

D. Limit physical activity Rationale: Limiting physical activity is recommended to promote urination and subsequently decrease blood pressure.

Answer 54

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.

Answer 55

C. To reduce stimulation Rationale: Keeping the room dark and quiet helps reduce stimulation and prevent seizures in a woman with severe preeclampsia.

Answer 56

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.

Answer 57

all of the choices are correct

Answer 58

all of the choices are correct

Answer 59

C. To prevent seizures Rationale: Parenteral magnesium sulfate is administered to prevent seizures in a woman with severe preeclampsia.

Answer 60

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).

Answer 61

B. 4 to 7 mEq/L Rationale: Therapeutic serum magnesium levels for a woman receiving magnesium sulfate range from 4 to 7 mEq/L.

Answer 62

A. Administer calcium gluconate as an antidote Rationale: If signs of magnesium toxicity are observed, calcium gluconate should be administered as an antidote.

Answer 63

D. Confirms CNS involvement Rationale: The presence of clonus confirms CNS involvement in a woman with severe preeclampsia.

Answer 64

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.

Answer 65

A. To prevent seizure activity Rationale: Continuing magnesium sulfate infusion for 24 hours after delivery is to prevent seizure activity.

Answer 66

all of the choices are correct

Answer 67

D. Diuresis and a decrease in proteinuria Rationale: Diuresis, along with a decrease in proteinuria, is a positive sign indicating the resolution of preeclampsia.

Answer 68

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.

Answer 69

C. It increases the risk Rationale: Primiparity, or having a first delivery, increases the risk of preeclampsia.

Answer 70

A. Chronic hypertension C. Chronic renal disease Rationale: Chronic hypertension and chronic renal disease are associated with an increased risk of preeclampsia.

Answer 71

B. Lupus (SLE) Rationale: Lupus (systemic lupus erythematosus, or SLE) is listed as a risk factor for preeclampsia.

Answer 72

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.

Answer 73

D. Eclampsia Rationale: Eclampsia is the hallmark neurologic complication of preeclampsia, characterized by the onset of seizure activity.

Answer 74

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.

Answer 75

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.

Answer 76

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.

Answer 77

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.

Answer 78

B. Magnesium sulfate Rationale: Magnesium sulfate is administered IV to prevent further seizures in eclampsia.

Answer 79

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).

Answer 80

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.

Answer 81

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.

Answer 82

all of the choices are correct

Answer 83

B. Onset of seizure activity Rationale: The onset of eclampsia is identified by the onset of seizure activity

Answer 84

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.

Answer 85

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.

Answer 86

D. Hemolysis, Elevated liver enzymes, Low platelet count

Answer 87

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.

Answer 88

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.

Answer 89

C. Third trimester Rationale: HELLP syndrome generally develops during the third trimester, although it may develop within 48 hours after delivery.

Answer 90

B. Rapid onset with vague symptoms Rationale: HELLP syndrome typically has a rapid onset, and women often present with vague symptoms.

Answer 91

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

Answer 92

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.

Answer 93

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.

Answer 94

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.

Answer 95

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)

Answer 96

A. Elevated LDH B. Elevated AST C. Elevated ALT D. Elevated bilirubin level

Answer 97

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.

Answer 98

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.

Answer 99

D. Hyporeflexia Rationale: Hyporeflexia or absent DTRs are key indicators of magnesium toxicity.

Answer 100

A. Hyporeflexia or absence of DTRs B. Respiratory rate less than 12 breaths per minute C. Decreased urine output (less than 30 mL/hr)

Answer 101

A. Serum magnesium levels B. Respiratory rate D. Urine output

Answer 102

A. Chromosomal abnormalities B. Maternal age

Answer 103

A. Fetal genetic abnormalities Rationale: The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother.

Answer 104

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.

Answer 105

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.

Answer 106

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.

Answer 107

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.

Answer 108

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.

Answer 109

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.

Answer 110

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.

Answer 111

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

Answer 112

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.

Answer 113

C. Vaginal ultrasound Rationale: A vaginal ultrasound is used to confirm if the gestational sac is empty in cases of threatened abortion.

Answer 114

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.

Answer 115

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.

Answer 116

D. Evacuation of uterus Rationale: Therapeutic management includes evacuation of the uterus or induction of labor to empty the uterus without surgical intervention.

Answer 117

D. Cervical cerclage Rationale: Cervical cerclage is a procedure performed in the second trimester if the cause of recurrent abortion is an incompetent cervix.

Answer 118

C. Conservative Treatment Rationale: Conservative supportive treatment includes reducing activity, maintaining a nutritious diet, and ensuring adequate hydration

Answer 119

A. Prostaglandin analogs Rationale: Prostaglandin analogs like misoprostol are used to empty the uterus of retained tissue in inevitable abortion.

Answer 120

C. Stabilizing the client before proceeding with uterine evacuation Rationale: Client stabilization is crucial before performing uterine evacuation in cases of incomplete abortion.

Answer 121

D. Ultrasound Rationale: A complete abortion is confirmed through an ultrasound showing an empty uterus.

Answer 122

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.

Answer 123

B. Genetic or chromosomal abnormalities, reproductive tract abnormalities, chronic diseases, or immunologic problems

Answer 124

A. Absent uterine contractions and irregular spotting Rationale: Missed abortion is characterized by the absence of uterine contractions and irregular spotting.

Answer 125

A. Ultrasound and hCG levels Rationale: Ultrasound and hCG levels are used to confirm pregnancy loss in cases of inevitable abortion.

Answer 126

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.

Answer 127

B. Ectopic pregnancy Rationale: Ectopic pregnancy is the primary cause of maternal mortality during the first trimester of pregnancy in the United States.

Answer 128

A. Massive hemorrhage, infertility, or death Rationale: Untreated ectopic pregnancy can lead to severe complications such as massive hemorrhage, infertility, or death.

Answer 129

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.

Answer 130

D. Fallopian tubes Rationale: The most common site for implantation in an ectopic pregnancy is the fallopian tubes, accounting for 96% of cases.

Answer 131

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.

Answer 132

A. Previous tubal surgery B. Infertility C. Use of an intrauterine contraceptive system

Answer 133

B. It alters tubal motility, increasing the risk Rationale: Smoking alters tubal motility, which increases the risk of ectopic pregnancy.

Answer 134

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.

Answer 135

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

Answer 136

A. Urine pregnancy test B. Beta-hCG concentrations C. Transvaginal ultrasound

Answer 137

A. To maintain fertility Rationale: During surgical intervention for an ectopic pregnancy, preservation of the affected fallopian tube is attempted to maintain fertility.

Answer 138

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.

Answer 139

B. Renal or liver disease Rationale: Renal or liver disease is a contraindication to medical treatment with methotrexate for ectopic pregnancy.

Answer 140

A. Avoidance of surgery B. Preservation of tubal patency and function C. Lower cost

Answer 141

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.

Answer 142

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.

Answer 143

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.

Answer 144

B. Linear salpingostomy Rationale: In an unruptured ectopic pregnancy, a linear salpingostomy may be performed to preserve the fallopian tube and maintain future fertility.

Answer 145

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.

Answer 146

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.

Answer 147

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.

Answer 148

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.

Answer 149

B. Abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period

Answer 150

A. Previous ectopic pregnancy B. History of sexually transmitted infections (STIs) C. Fallopian tube scarring from PID

Answer 151

B. Missed menstrual period, adnexal fullness, and tenderness

Answer 152

B. Breast tenderness, nausea, fatigue, shoulder pain, and low back pain

Answer 153

B. Visualization of an adnexal mass and the absence of an intrauterine gestational sac

Answer 154

C. Double every 2 to 4 days

Answer 155

A. Ectopic pregnancy or impending abortion

Answer 156

B. Severe, sharp, stabbing, unilateral abdominal pain; vertigo/fainting; hypotension; and increased pulse

Answer 157

D. To monitor hCG titers until they return to zero, indicating resolution of the ectopic pregnancy

Answer 158

A. Sexual intercourse with multiple partners B. Intercourse without a condom C. Smoking during childbearing years

Answer 159

C. To confirm the location of the pregnancy

Answer 160

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.

Answer 161

B. In the second trimester or early third trimester

Answer 162

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.

Answer 163

D. Relaxin Rationale: Increased amounts of relaxin are proposed to play a role in cervical insufficiency by affecting the cervix.

Answer 164

B. Previous precipitous birth, prolonged second stage of labor, increased uterine volume

Answer 165

B. It has not been shown to be beneficial in this population

Answer 166

A. Bed rest, pelvic rest, avoidance of heavy lifting, and progesterone supplementation

Answer 167

A. To support and reinforce the cervix

Answer 168

B. Suture displacement, rupture of membranes, and chorioamnionitis

Answer 169

D. To avoid unnecessary interventions if there is no infection

Answer 170

C. Previous cervical trauma, preterm labor, fetal loss in the second trimester, and previous surgeries or procedures involving the cervix

Answer 171

B. Pink-tinged vaginal discharge, low pelvic pressure, cramping with vaginal bleeding, and loss of amniotic fluid

Answer 172

D. Cervical Insufficiency

Answer 173

B. Rupture of the membranes, release of amniotic fluid, and uterine contractions leading to delivery of the fetus before viability

Answer 174

B. Between 16 and 24 weeks’ gestation

Answer 175

A. Risk of preterm labor

Answer 176

A. Pelvic pressure B. Backache C. Increased mucoid discharge

Answer 177

B. Backache, increase in vaginal discharge, rupture of membranes, and uterine contractions

Answer 178

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.

Answer 179

B. Obstetric hemorrhage, need for blood transfusions, emergency hysterectomy, DIC, Sheehan syndrome, and renal failure

Answer 180

D. Degenerative changes in small maternal blood vessels resulting in blood clotting and vessel rupture

Answer 181

B. Maternal hypertension and preeclampsia

Answer 182

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.

Answer 183

A. Concealed or apparent

Answer 184

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.

Answer 185

D. If fetal distress is evident

Answer 186

A. Determining the underlying cause of DIC and correcting it

Answer 187

C. Maternal hemodynamic status and fetal well-being

Answer 188

B. To note any signs or symptoms that may suggest shock

Answer 189

D. Painful, dark red vaginal bleeding, “knife-like” abdominal pain, uterine tenderness, contractions, and decreased fetal movement

Answer 190

B. Disseminated intravascular coagulation (DIC)

Answer 191

B. Findings of fetal jeopardy manifested by late decelerations or bradycardia

Answer 192

A. Possible fetal compromise

Answer 193

C. To observe for changes suggesting hypovolemic shock

Answer 194

B. Bleeding Rationale: An increase in fundal height may indicate bleeding in cases of placental abruption.

Answer 195

B. Insidious

Answer 196

C. Can be concealed or visible

Answer 197

B. Firm to rigid

Answer 198

C. Usually in normal range

Answer 199

A. Breech or transverse lie; engagement is absent

Answer 200

D. Constant; uterine tenderness on palpation

Answer 201

B. Placenta inserted wholly or partly into the lower uterine segment, covering the internal cervical opening

Answer 202

D. Last two trimesters

Answer 203

B. Extent of bleeding, closeness of the placenta to the cervical os, fetal development, fetal position, maternal parity, presence or absence of labor

Answer 204

B. At home with ready access to reliable transportation and the ability to maintain bed rest

Answer 205

A. Higher likelihood of uterine abnormalities

Answer 206

D. Causes scarring and structural changes in the uterine lining

Answer 207

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.

Answer 208

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.

Answer 209

C. Causes vascular constriction and impaired placental attachment

Answer 210

C. Often involves procedures that can alter the uterine lining

Answer 211

A. May not allow sufficient time for uterine healing

Answer 212

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.

Answer 213

C. The uterus cannot contract adequately to stop the flow of blood from open vessels in the lower uterine segment

Answer 214

B. Soft and nontender Rationale: Upon palpation in placenta previa, the uterus is typically soft and nontender.

Answer 215

D. Transvaginal Ultrasound

Answer 216

C. To identify placental abnormalities

Answer 217

B. They may disrupt the placenta and cause hemorrhage Rationale: Vaginal examinations should be avoided because they may disrupt the placenta and cause hemorrhage

Answer 218

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.

Answer 219

C. To prevent Rh sensitization Rationale: Administering Rh immunoglobulin to an Rh-negative woman at 28 weeks’ gestation prevents Rh sensitization

Answer 220

D. Any bleeding episodes or backaches

Answer 221

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.

Answer 222

B. African American clients

Answer 223

A. Respiratory distress syndrome Rationale: Preterm infants often experience respiratory distress syndrome due to immature lungs and insufficient surfactant production.

Answer 224

B. Thermoregulation problems Rationale: Preterm infants have underdeveloped thermoregulatory systems, which can lead to acidosis, hypothermia, and weight loss.

Answer 225

B. Prematurity

Answer 226

D. Cerebral palsy and vision defects

Answer 227

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.

Answer 228

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.

Answer 229

A. Magnesium sulfate

Answer 230

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.

Answer 231

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.

Answer 232

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.

Answer 233

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.

Answer 234

A. Placenta previa Rationale: Tocolytic therapy is contraindicated in cases of placenta previa, as it could worsen bleeding and maternal complications.

Answer 235

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.

Answer 236

B. The gestational age of the fetus

Answer 237

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.

Answer 238

A. Preterm labor

Answer 239

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.

Answer 240

B. Use of lubricants during a pelvic exam

Answer 241

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.

Answer 242

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.

Answer 243

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.

Answer 244

C. A negative result is a strong predictor that preterm labor will not occur within two weeks.

Answer 245

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.

Answer 246

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.

Answer 247

D) Maternal hypotension Rationale: Nifedipine can cause maternal hypotension, which should be promptly reported.

Answer 248

A) Active hemorrhage Rationale: Tocolytic therapy is contraindicated in active hemorrhage as it could worsen the condition.

Answer 249

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.

Answer 250

C) Decreased urine output Rationale: Indomethacin can reduce fetal renal blood flow and decrease urine output, which should be monitored closely.

Answer 251

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.

Answer 252

A) To reduce uterine irritability and delay labor Rationale: Magnesium sulfate is used as a tocolytic agent to reduce uterine irritability and delay labor.

Answer 253

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.

Answer 254

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.

Answer 255

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.

Answer 256

A) Oligohydramnios Rationale: Indomethacin can decrease fetal renal blood flow and cause oligohydramnios if used for more than 48 hours.

Answer 257

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.

Answer 258

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.

Answer 259

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.

Answer 260

A) Monitor for maternal hypotension and reflex tachycardia Rationale: Nifedipine can cause hypotension and reflex tachycardia, so careful monitoring is essential.

Answer 261

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.

Answer 262

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.

Answer 263

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.

Answer 264

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.

Answer 265

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.

Answer 266

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.

Answer 267

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.

Answer 268

A. High levels of estrogen B. Vitamin B6 deficiency D. Genetic predisposition E. Increased psychological stress

Answer 269

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.

Answer 270

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.

Answer 271

A. Acidosis B. Dehydration D. Weight loss E. Electrolyte imbalances

Answer 272

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.

Answer 273

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.

Answer 274

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.

Answer 275

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.

Answer 276

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.

Answer 277

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.

Answer 278

A. Multiple gestation B. Nulliparity C. History of gastroesophageal reflux disease E. H. pylori seropositivity

Answer 279

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.

Answer 280

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.

Answer 281

B. Dehydration Rationale: Elevated hematocrit levels indicate hemoconcentration, which is commonly seen in dehydration due to fluid loss.

Answer 282

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.

Answer 283

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.

Answer 284

B. Administer prescribed potassium supplements. Rationale: Low potassium levels (hypokalemia) and ketones indicate severe dehydration and malnutrition requiring immediate correction.

Answer 285

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.

Answer 286

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.

Answer 287

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.

Answer 288

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.

Answer 289

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.

Answer 290

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.

Answer 291

B. Involuntary movements Rationale: Promethazine may cause extrapyramidal symptoms such as involuntary movements.

Answer 292

A. Elevated liver enzymes

Answer 293

B. Monitoring for sedation and dizziness Rationale: Sedation and dizziness increase the risk of injury, so safety measures are critical.

Answer 294

B. To enhance absorption and effectiveness Rationale: Taking Diclegis on an empty stomach ensures optimal absorption and therapeutic effect.

Answer 295

D. “This medication will completely stop my nausea.” Rationale: Promethazine provides symptomatic relief but may not completely eliminate nausea.

Answer 296

B. Assessing the client for headache and dizziness Rationale: Headache and dizziness are common side effects of ondansetron, requiring close monitoring.

Answer 297

A. Polyhydramnios Rationale: Polyhydramnios refers to an excessive amount of amniotic fluid during pregnancy, defined as over 2,000 mL.

Answer 298

B. Diabetes mellitus Rationale: Approximately 18% of women with diabetes during pregnancy develop polyhydramnios.

Answer 299

D. Spina bifida occulta Rationale: Spina bifida occulta typically does not cause swallowing or fluid uptake issues linked to polyhydramnios.

Answer 300

A. Fetal malpresentation Rationale: Excess amniotic fluid can lead to abnormal fetal positioning, increasing the risk of malpresentation.

Answer 301

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.

Answer 302

D. Ultrasound Rationale: Ultrasound is used to measure amniotic fluid pockets and estimate total fluid volume.

Answer 303

D. Shortness of breath Rationale: Excessive fluid may cause uterine enlargement, leading to diaphragmatic pressure and shortness of breath.

Answer 304

C. Excess amniotic fluid Rationale: Fundal height greater than expected for gestational age may suggest polyhydramnios.

Answer 305

C. Preterm uterine contractions Rationale: Uterine overstretching from polyhydramnios may trigger preterm contractions.

Answer 306

B. To reduce amniotic fluid volume Rationale: Amniocentesis may be performed to relieve maternal discomfort by reducing fluid volume.

Answer 307

B. Maternal diabetes Rationale: Diabetes mellitus is a significant risk factor for polyhydramnios.

Answer 308

C. Esophageal atresia Rationale: Esophageal atresia prevents the fetus from swallowing amniotic fluid, leading to its accumulation.

Answer 309

A. Difficulty identifying fetal parts Rationale: Excess amniotic fluid can make it difficult to palpate fetal parts.

Answer 310

D. To evaluate excessive uterine growth Rationale: Enlarged abdominal girth may indicate increased amniotic fluid volume.

Answer 311

B. Edema in lower extremities Rationale: Increased vena cava pressure can cause fluid accumulation in the lower extremities.

Answer 312

A. Fetal bradycardia Rationale: Cord prolapse can compromise fetal oxygenation, leading to bradycardia.

Answer 313

D. Persistent shortness of breath Rationale: Shortness of breath may indicate significant uterine pressure on the diaphragm.

Answer 314

D. Premature birth Rationale: Polyhydramnios increases the risk of preterm labor and delivery.

Answer 315

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.

Answer 316

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.

Answer 317

C. Uteroplacental insufficiency Rationale: Uteroplacental insufficiency reduces blood flow and nutrient delivery to the fetus, which may decrease amniotic fluid production.

Answer 318

B. Fetal renal agenesis Ratioanle: Renal agenesis prevents urine production, a primary contributor to amniotic fluid volume.

Answer 319

D. Ultrasound Rationale: Ultrasound is used to measure amniotic fluid levels and confirm a diagnosis of oligohydramnios.

Answer 320

A. Cesarean delivery Rationale: If fetal well-being is compromised, immediate delivery may be indicated to reduce perinatal morbidity and mortality.

Answer 321

A. To minimize cord compression Rationale: Amnioinfusion increases amniotic fluid levels, cushioning the umbilical cord to prevent variable decelerations caused by compression.

Answer 322

C. Variable decelerations Rationale: Cord compression due to low amniotic fluid often results in variable decelerations on the fetal monitor.

Answer 323

B. Decline in amniotic fluid production Rationale: Amniotic fluid levels naturally decrease after 38 weeks, increasing the risk of oligohydramnios in post-term pregnancies.

Answer 324

D. Fluid leakage from the vagina Rationale: Leakage of amniotic fluid due to membrane rupture can decrease amniotic fluid levels, contributing to oligohydramnios.

Answer 325

B. Nonstress testing Rationale: Nonstress testing helps evaluate fetal well-being in pregnancies complicated by oligohydramnios.

Answer 326

A. To manage leakage of fluid Rationale: Fluid leakage during amnioinfusion necessitates frequent perineal care to maintain hygiene and comfort.

Answer 327

C. Respiratory distress Rationale: Oligohydramnios is associated with poor lung development, increasing the risk of neonatal respiratory difficulties.

Answer 328

A. Preeclampsia Rationale: Preeclampsia can impair placental function, reducing amniotic fluid production and leading to oligohydramnios.

Answer 329

A. Monitoring uterine overdistention Rationale: Excessive infusion of fluid can lead to uterine overdistention, which requires careful monitoring.

Answer 330

D. Maintaining fetal oxygenation Rationale: Ensuring adequate fetal oxygenation through interventions such as repositioning and monitoring is critical in oligohydramnios management.

Answer 331

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.

Answer 332

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.

Answer 333

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.

Answer 334

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.

Answer 335

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.

Answer 336

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.

Answer 337

C) Between 22 and 34 weeks gestation Rationale: The fetal fibronectin test is typically performed between 22 and 34 weeks gestation.

Answer 338

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.

Answer 339

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.

Answer 340

D) Respiratory depression and hypotension Rationale: Rationale: Respiratory depression, hypotension, and other signs of neuromuscular impairment are common symptoms of magnesium toxicity.

Answer 341

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.

Answer 342

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.

Answer 343

B) Monitor urine output Rationale: Monitoring urine output is essential in magnesium toxicity management as decreased renal function can exacerbate toxicity.

Answer 344

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.

Answer 345

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.

Answer 346

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.

Answer 347

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.

Answer 348

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.

Answer 349

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.

Answer 350

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.

Answer 351

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.

Answer 352

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.

Answer 353

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.

Answer 354

C) Prepregnancy counseling suggested Rationale: Women in Risk Class I cardiac disease may not require frequent cardiology consults but should receive prepregnancy counseling.

Answer 355

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.

Answer 356

D) Risk Class IV Rationale: Severe ventricular dysfunction falls under Risk Class IV, which is characterized by extremely high risks and contraindicates pregnancy.

Answer 357

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.

Answer 358

A) Gestational hypertension Rationale: Obesity during pregnancy increases the risk of gestational hypertension, preeclampsia, and other complications such as gestational diabetes and thromboembolism.

Answer 359

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.

Answer 360

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.

Answer 361

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.

Answer 362

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.

Answer 363

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.

Answer 364

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.

Answer 365

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.

Answer 366

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.

Answer 367

A) Marijuana Rationale: Marijuana use during pregnancy has been linked to increased risks of spontaneous abortion and preterm delivery.

Answer 368

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.

Answer 369

D) Increased risk of cleft lip and palate Rationale: Smoking during pregnancy increases the risk of cleft lip and palate in the newborn.

Answer 370

C) Decreases absorption of iron Rationale: Caffeine decreases iron absorption, which may increase the risk of anemia during pregnancy.

Answer 371

D) Methamphetamine

Answer 372

A) Increased risk of stillbirth Rationale: Smoking during pregnancy significantly increases the risk of stillbirth.

Answer 373

B) Placental abruption Rationale: Methamphetamine use during pregnancy is associated with an increased risk of placental abruption.

Answer 374

C) Methadone Rationale: Methadone maintenance therapy helps reduce withdrawal symptoms in newborns exposed to narcotics.

Answer 375

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.

Answer 376

B) Behavioral problems in childhood Rationale: Smoking during pregnancy increases the risk of childhood behavioral problems, such as ADHD and aggression.

Answer 377

D) Nicotine Rationale: Nicotine causes vasoconstriction, which reduces blood flow to the fetus, contributing to fetal hypoxia.

Answer 378

C) Tobacco Rationale: Tobacco use during pregnancy is linked to cognitive deficits in children, including language and memory issues.

Answer 379

A) Low birth weight Rationale: Cocaine use during pregnancy increases the risk of low birth weight.

Answer 380

B) Increased risk of intellectual disabilities Rationale: Prenatal methamphetamine exposure is associated with an increased risk of developmental and intellectual disabilities.

Answer 381

B) High-pitched cry Rationale: Babies exposed to opioids in utero often exhibit a high-pitched cry as part of neonatal abstinence syndrome (NAS).

Answer 382

C) Nicotine Rationale: Smoking during pregnancy increases the risk of cleft lip and palate.

Answer 383

B) Neonatal abstinence syndrome Rationale: Opiate use during pregnancy is primarily associated with neonatal abstinence syndrome (NAS) in newborns.

Answer 384

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).

Answer 385

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.

Answer 386

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.

Answer 387

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.

Answer 388

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.

Answer 389

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.

Answer 390

B. To screen for syphilis infection Rationale: The RPR or VDRL test is performed to screen for syphilis infection in pregnancy.

Answer 391

B. Penicillin therapy Rationale: Penicillin therapy is the recommended treatment for a pregnant woman who tests positive for syphilis.

Answer 392

B. Vaccination postpartum Rationale: If a pregnant woman is found to be non-immune to rubella, vaccination is recommended postpartum to protect future pregnancies.

Answer 393

D. Administration of antibiotics during labor Rationale: Administration of antibiotics during labor (intrapartum prophylaxis) is recommended to prevent GBS transmission to the newborn.

Answer 394

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).

Answer 395

A. Rapid Plasma Reagin (RPR) B. Venereal Disease Research Laboratory (VDRL) Rationale: RPR and VDRL tests are used to diagnose syphilis in pregnant women.

Answer 396

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.

Answer 397

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.

Answer 398

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.

Answer 399

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.

Answer 400

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.

Answer 401

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.

Answer 402

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.

Answer 403

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.

Answer 404

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.

Answer 405

B. HELLP syndrome Rationale: Elevated liver enzymes (AST/ALT), low platelets (<100,000), and clinical symptoms suggest HELLP syndrome, a severe preeclampsia complication.

Answer 406

C. Preeclampsia Rationale: Elevated uric acid (>6 mg/dL) indicates impaired renal function, often seen in preeclampsia.

Answer 407

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.

Answer 408

C. Notify the provider Rationale: A protein/creatinine ratio ≥0.3 indicates significant proteinuria and suggests preeclampsia.

Answer 409

C. 9.5 g/dL Rationale: Hemoglobin levels <11 g/dL in the second and third trimesters indicate anemia, requiring further evaluation.

Answer 410

B. Hemolysis Rationale: Elevated LDH (>600 U/L) suggests tissue breakdown or hemolysis, common in HELLP syndrome.

Answer 411

C. 90,000/mm³ Rationale: Platelet counts <100,000/mm³ are abnormal and suggest thrombocytopenia, often associated with preeclampsia or HELLP syndrome.

Answer 412

D. Notify the provider Rationale: Elevated creatinine (>1.1 mg/dL) and proteinuria suggest renal dysfunction, likely due to preeclampsia.

Answer 413

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.

Answer 414

C. Recommend iron supplementation Rationale: Hemoglobin <11 g/dL and hematocrit <33% indicate iron-deficiency anemia, commonly treated with iron supplements.

Answer 415

A) Dried fruits B) Peanut butter C) Meats

Answer 416

C) I need to eat foods high in fiber.

Answer 417

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.

Answer 418

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.

Answer 419

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.

Answer 420

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.

Answer 421

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.

Answer 422

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.

Answer 423

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.

Answer 424

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.

Answer 425

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.

Answer 426

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.

Answer 427

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.

Answer 428

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.

Answer 429

c) Insulin Rationale: Insulin is the first-line pharmacologic treatment for GDM when diet and exercise fail to maintain glycemic control.

Answer 430

b) 39-40 weeks Rationale: Delivery at 39-40 weeks is recommended for patients with well-controlled GDM to optimize outcomes and minimize complications.

Answer 431

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.

Answer 432

a) Detect macrosomia and polyhydramnios Rationale: Ultrasound is used to monitor for macrosomia and polyhydramnios, which are common complications of GDM.

Answer 433

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.

Answer 434

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.

Answer 435

C) Pregnancy affects insulin production, so I’ll need to make adjustments in my diet.

Answer 436

B) Degree of glycemic control achieved during the pregnancy

Answer 437

D) Show promising results but more studies are needed to confirm their effectiveness

Answer 438

A) Congenital anomalies

Answer 439

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.

Answer 440

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.

Answer 441

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.

Answer 442

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.

Answer 443

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.

Answer 444

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.

Answer 445

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.

Answer 446

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.

Answer 447

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.

Answer 448

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.

Answer 449

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.

Answer 450

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.

Answer 451

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.

Answer 452

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.

Answer 453

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.

Answer 454

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.