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OB Test 5 > Maternity Nursing Chap 21 > Flashcards

Maternity Nursing Chap 21 Flashcards

1
Q

___________, a pregnancy specific condition in which hypertension and proteinuria develop after 20 weeks in a previously normotensive woman, is a multisystem vasospastic disease process. It is usually categorized as mild or severe in terms of management.

A
  • preeclampsia
  • mild
  • severe
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2
Q

__________ is defined as a blood pressure greater than or equal to 140/90. The elevated values must be present on 2 occasions as least 4-6 hours apart.

A

-hypertension

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3
Q

___________ is defined as a protein concentration of 30 g/L (>1+ on a dipstick measurement) or more in at least 2 random urine samples collected at least 6 hours apart.

A

-proteinuria

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4
Q

Although edema is no longer included in the definition of preeclampsia, if present it is assessed for distribution, degree, pitting, and __________, is edema of the lowest, or most dependent, part of the body.

A

-dependent edema

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5
Q

____________ is the presence of at least one of the following in women diagnosed with preeclampsia: systolic BP of at least 160 mm Hg or a diastolic pressure of at least 110 mm Hg; proteinuria of 5 grams or more in a 24 hour collection; oliguria, less than 400 to 500 mL of urine output over 24 hours; cerebral or visual disturbances; and thrombocytopenia with a platelet count less than 100,000/mm^3, pulmonary edema, or impaired liver function may also be present.

A

-severe preeclampsia

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6
Q

_________ is the onset of seizure activity or coma in the woman diagnosed with preeclampsia that cannot be attributed to other causes.

A

-eclampsia

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7
Q

__________ syndrome is a laboratory diagnosis of a variant of severe preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets.

A

-HELLP

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8
Q

The pathologic changes that occur in preeclampsia are caused by ___________ and ___________

A
  • disruptions in placental perfusion

- endothelial cell dysfunction

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9
Q

What are the principles to follow to ensure the accuracy of BP measurement during pregnancy?

A
  • emphasize consistency in position of woman and her arm, the arm used, proper size of cuff, and provision of a rest period before the measurement
  • taking an average of 2 BP readings is recommended
  • take while sitting or lateral recumbent position
  • always take on right hour
  • refrain from tobacco or caffeine use 30 mins prior
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10
Q

True or False: Preeclampsia complicates more than 15% of all pregnancies that progress beyond the first trimester.

A

False – approximately 3% to 7% of all pregnancies

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11
Q

True or False: The major maternal hazard of preeclampsia is liver failure.

A

False – Decreased liver perfusion results in impaired liver function.

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12
Q

True or False: A genetic predispostion might be partly responsible for the development of preeclampsia in some women.

A

True

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13
Q

True or False: HELLP syndrome occurs in approximately 2% to 12% of women with severe preeclampsia.

A

False – anywhere from 5% to 20%

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14
Q

True or False: Calcium gluconate is the antidote for magnesium sulfate toxicity.

A

True

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15
Q

True or False: The therapeutic serum magnesium level for the treatment of severe preeclampsia is 10 to 12 mg/dL.

A

False – therapeutic range is 4 to 7 mEq/L

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16
Q

True or False: Pregnant women with chronic renal disease are at increased risk for developing pregnancy induced hypertension.

A

True

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17
Q

True or False: When on bed rest, the woman with preeclampsia should maintain a dorsal recumbent position.

A

False – gentle exercises are encouraged such as ROM, stretching, kegel exercises, pelvic tilts to help prevent thrombophlebitis

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18
Q

True or False: Sodium should be restricted to a minimal level when a woman has preeclampsia.

A

False – there is no sodium restriction

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19
Q

True or False: Women experiencing the HELLP syndrome often exhibit a platelet count of 400,000/mm^3 or higher.

A

False – The platelet count is low, but coagulation factor assays, prothrobin time (PT), partial thromboplastin time (PTT), and bleeding time remain normal.

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20
Q

True or False: Administration of magnesium sulfate to a woman with severe preeclampsia might precipitate labor by stimulating the uterus to contract.

A

False – may increase the duration of labor. The preeclamptic woman receiving magnesium sulfate may need augmentation with oxytocin during labor.

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21
Q

True or False: An expected outcome for the use of magnesium sulfate is the prevention of progression from preeclampsia to eclampsia.

A

True

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22
Q

True or False: Hydralazine (Apresoline) can be used to lower the BP of a woman with preeclampsia.

A

True

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23
Q

True or False: Epigastric or right upper quadrant pain is one symptom of impending eclampsia.

A

True

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24
Q

True or False: Protein restriction is recommended for women with preeclampsia.

A

False – may have a regular diet

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25
Q

True or False: Prompt treatment of a woman using appropriate medications, bed rest, and proper diet can cure preeclampsia.

A

False – The only thing that can cure preeclampsia is the birth of the baby.

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26
Q

True or False: Methergine is the oxytocic of choice to prevent or treat postpartum hemorrhage for women with preeclampsia.

A

False – Methergine is contraindicated because it increases BP. Oxytocin or Postraglandin are used to control bleeding.

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27
Q

Risk factors associated with gestational hypertension (preeclampsia):

A
  • nulliparity
  • family history of preeclampsia
  • obesity
  • multifetal gestation
  • preeclampsia is previous pregnancy
  • poor outcome in previous pregnancy; intrauterine growth restriction, placental abruption, fetal death
  • preexisting medical-genetic conditions: chronic hypertension, renal disease, type 1 diabetes, thrombophilias
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28
Q

Preeclampsia and eclampsia: effect on fetal well being: describe the effects:

A
  • insufficient uteroplacental circulation leading to IUGR, intrauterine fetal death, or perinatal mortality (espeically if abruptio placentae occurs)
  • preterm labor and birth, acute hypoxia, and abruption can occur with a convulsion
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29
Q

Preeclampsia and eclampsia: effect on fetal well being: fetal surveillance measures:

A

-serial ultrasounds to evaluate fetal growth, nonstress test, and biophysical profile

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30
Q

What diagnosis does this patient have: At 30 weeks of gestation Angela’s BP was 152/96 mm Hg and her 24 hour urine collection contained 2 grams of protein?

A

preeclampsia

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31
Q

What diagnosis does this patient have: At 38 weeks of gestation Mary’s BP rose to 150/92 mm Hg. A urine dipstick was negative for protein?

A

gestational hypertension

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32
Q

What diagnosis does this patient have: Susan, a 34 year old pregnant woman, has had a consistently high BP, ranging from 148/92 to 160/98 mm Hg since she was 28 years old. she does not have proteinuria?

A

chronic hypertension

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33
Q

What diagnosis does this patient have: At 32 weeks of gestation, Maria, with hypertension since 28 weeks, generalized edema, and proteinuria of 4, has a convulsion?

A

eclampsia

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34
Q

What diagnosis does this patient have: Dawn has been hypertensive since her 24th week of pregnancy. Urinalysis indicates a protein content of 3 grams. Further testing reveals a platelet count of 95,000/mm^3 and elevated aspartate aminotransferase and alanine aminotransferase levels, hematocrit is decreased, and burr cells appear on a peripheral smear.

A

HELLP syndrome

35
Q

True or False: Miscarriages are often related to maternal behavior.

A

False – At least 50% result from chromosomal abnormalities. Other possible causes include endocrine imbalance (diabetes), immunologic factors, infections, systemic disorders, and genetic factors.

36
Q

True or False: A missed miscarriage refers to a pregnancy in which the fetus has died but miscarriage does not occur.

A

True

37
Q

True or False: An etiologic factor for incompetent cervix is use of diethylstilbestrol by the woman’s mother during pregnancy.

A

True

38
Q

True or False: The most common site for an ectopic pregnancy is the ampulla of the uterine tube.

A

True

39
Q

True or False: Ectopic pregnancy is the leading pregnancy related cause of second trimester maternal death.

A

False –

40
Q

True or False: Ectopic pregnancy is a leading cause of infertility.

A

True

41
Q

True or False: Infertile women who use clomiphene (Clomid) to stimulate ovulation are at higher risk for development of hydatidiform mole.

A

True

42
Q

True or False: Previous cesarean birth is an important risk factor for placenta previa.

A

True

43
Q

True or False: A vaginal examination performed when a woman is exhibiting signs of placenta previa can result in profound hemorrhage.

A

True

44
Q

True or False: Premature separation of the placenta (abruptio placentae) is associated with a perinatal mortality rate of 20% to 30%.

A

True

45
Q

True or False: Abdominal trauma is the most consistently identified risk factor for premature separation of the placenta.

A

False –

46
Q

True or False: The urinary output of women diagnosed with disseminated intravascular coagulation should be monitored carefully because renal failure is a potential complication.

A

True

47
Q

Common early pregnancy bleeding disorders are __________, ___________, __________, and __________.

A
  • miscarriage
  • premature dilation of the cervix (incompetent cervix)
  • ectopic pregnancy
  • hydatidiform mole (molar pregnancy)
48
Q

Common late pregnancy bleeding disorders are ___________, __________, or ___________, cord insertion, and placental variations.

A
  • placenta previa
  • premature separation of the placenta
  • abruptio placentae
49
Q

________ is a pregnancy that ends before 20 weeks of gestation, before the fetus is viable. A fetal weight of less than 500 g may also be used to define this type of pregnancy loss. There are five types of this form of pregnancy loss: threatened, inevitable, incomplete, complete, and missed.

A

-miscarriage

50
Q

Evaluation of the serum level of the placental hormone ____________ is performed at 48 hours apart. If normal pregnancy is present, the B-hCG level doubles; a falling or inappropriately rising B-hCG level indicates pregnancy loss.

A

-human chorionic gonadotropin (B-hCG)

51
Q

Placenta previa is described as total or complete if the ___________ is entirely covered by the placenta when the cervix is fully dilated and as marginal if only an edge of the placenta extends to within 2.5 cm of the low lying placenta or the exact relationship of the placenta to the internal os has not been determined. Risk for postpartum hemorrhage is increased because the lower uterine segment is unable to contract around the open blood vessels of the placental site.

A

-internal os

52
Q

___________ or abruptio placentae is the detachment of part or all of the placenta from the uterus.

A

-premature separation of the placenta

53
Q

Predisposing conditions for DIC:

A
  • abruptio placentae
  • severe preeclampsia
  • HELLP syndrome
  • retained dead fetus
  • amniotic fluid embolism
  • gram negative sepsis
54
Q

Clinical manifestations for DIC:

A

-look for unusual and/or excessive bleeding, petechiae, oozing from injection sites, hematuria

55
Q

priority nursing care measures for DIC:

A
  • use careful and thorough assessment, including renal function and fetal well being, lateral position, administration of blood, blood products, and oxygen as ordered
  • education and emotional support of woman and family
56
Q

What is placental anomaly in which the cord vessels begin to branch at the membranes and then course out at the placenta?

A

velamentous cord insertion

57
Q

What is fertilized ovum implanted outside the uterine cavity?

A

ectopic pregnancy

58
Q

What is termination of pregnancy before fetal viability as a result of natural causes?

A

miscarriage

59
Q

What is complication of abruptio placentae that occurs when blood accumulates between the placenta and the uterine wall, thereby reducing uterine contractility?

A

couvelaire

60
Q

What is placental implantation in the lower uterine segment?

A

placenta previa

61
Q

What is painless dilation of the cervical os without uterine contractions, often resulting in inability to carry the pregnancy to term?

A

incompetent cervix

62
Q

What is fertilization of an ovum, the nucleus of which has been lost or inactivated, resulting in the formation of a mass of fluid filled vesicles that resembles a bunch of white grapes?

A

hydatidiform mole (complete)

63
Q

What is premature separation of part or all of the placenta from its implantation site?

A

abruptio placentae

64
Q

What is cord insertion at the margin of the placenta?

A

battledore placenta

65
Q

What is placenta divided into two or more separate lobes?

A

succenturiate placenta

66
Q

What kind of effect does trauma have on pregnancy (mother and fetus) and what information do you need to know?

A
  • when injuries occur, types of injuries
  • increased incidence of miscarriage, preterm labor and birth, hemorrhage, abruptio placentae, stillbirth, and fetal and maternal death
  • fetus: impact can include death, skull fracture, and intracranial hemorrhage
67
Q

Observe for clinical signs of abruptio placentae from trauma:

A
  • deformation of the elastic myometruim around the placenta can cause the placenta to separate
  • when the mother survives, fetal death is usually the result of abruptio placentae in the first 24 hours
  • signs include uterine tenderness, pain, irritability, contractions, bleeding, leakage of amniotic fluid, and change in fetal heart rate (FHR) pattern
68
Q

Priorities of care for the pregnant woman following trauma must be to _______________ and _____________. This method of approach in care management is important because fetal survival is dependent on maternal survival. In cases of minor trauma the woman is evaluated for vaginal bleeding; uterine irritability; abdominal tenderness, pain, cramps, or hypovolemia; and evidence of FHR. A change in or absence of fetal activity or leakage of amniotic fluid, and presence of fetal cells in maternal circulation are also included in the assessment. In cases of major trauma the systemic evaluation begins with a primary survey and the initial ABCDs of resuscitation: ___________, _____________, _____________, and ____________.

A
  • Resuscitate the woman first,
  • stabilize her condition;
  • establishment and maintenance of an airway
  • ensuring adequate breathing
  • maintenance of an adequate circulatory volume
  • defibrillation
69
Q

A viral infection of the liver that is transmitted by droplets or hands improperly washed after defecation is ____________.

A

Hepatitis A

70
Q

_________ is a viral infection, also known as the 3 day or German measles, that can produce major congenital anomalies during the first trimester and intrauterine growth restriction and systemic infection after the fourth month.

A

Rubella

71
Q

A protozoan infection transmitted by consumption of infected raw or undercooked meat or with poor handwashing after handling infected cat litter is called ___________. Adverse fetal effects are more common with maternal acute infection.

A

Toxoplasmosis

72
Q

____________ is a viral infection transmitted via contact with body secretions and fluids, including respiratory and genitourinary fluids, breast milk, and blood. Fetal infection can cause death or severe generalized disease, leading to anemia, hepatic damage, mental retardation, microcephaly, and deafness.

A

Cytomegalovirus

73
Q

A viral infection of the liver transmitted in a manner similar to human immunodeficiency virus infection is called _____________. An effective vaccination is available for its prevention.

A

Hepatitis B

74
Q

______________ is a viral infection transmitted primarily by sexual contact. Active infection of the genital tract at the time of labor often requires cesarean birth.

A

Herpes simplex virus

75
Q

When measuring the BP to ensure consistency and facilitate early detection of BP changes consistent with gestational hypertension, the nurse should:

a. place the woman in a supine position
b. allow the woman to rest for at least 15 mins before measuring her BP
c. use the same arm for all BP measurements
d. use a proper size cuff that covers at least 50% of the woman’s upper arm

A

c. use the same arm for all BP measurements

76
Q

When caring for a woman with mild preeclampsia, it is critical that the nurse be alert for signs of progression to severe preeclampsia. Progression to severe preeclampsia is indicated by which one of the following assessment findings?

a. proteinuria of 5 grams in 24 hour collection
b. dependent edema in the ankles and feet at bedtime
c. deep tendon reflexes 2; ankle clonus absent
d. blood pressure of 154/94 and 156/100 mm Hg 6 hours apart

A

a. proteinuria of 5 grams in 24 hour collection

77
Q

A woman’s preeclampsia has advanced to the severe stage. She is admitted to the hospital, and her primary health care provider has ordered an infusion of magnesium sulfate to be started. In implementing this order, the nurse:

a. prepares a solution of 20 g of magnesium sulfate in 100 ml of 5% glucose in water
b. monitors maternal vital signs, fetal heart rate patterns, and uterine contractions every hour
c. expects the maintenance dosage to be approximately 4g/hour
d. reports a respiratory rate of 12 breaths or less per minute to the primary health care provider immediately

A

d. reports a respiratory rate of 12 breaths or less per minute to the primary health care provider immediately

78
Q

A primigravida at 10 weeks of gestation reports slight vaginal spotting without passage of tissue and mild uterine cramping. When examined, no cervical dilation is noted. The nurse caring for this woman:

a. anticipates that the woman will be sent home and placed on bed rest with instructions to avoid stress or orgasm
b. prepares the woman for a dilation and curettage
c. notifies a grief counselor to assist the woman with the imminent loss of her fetus
d. tells the woman that the doctor will most likely perform a cerclage to help her maintain her pregnancy

A

a. anticipates that the woman will be sent home and placed on bed rest with instructions to avoid stress or orgasm

79
Q

A woman is admitted through the ED with a medical diagnosis of ruptured ectopic pregnancy. The primary nursing diagnosis at this time is:

a. acute pain related to irritation of the peritoneum with blood
b. risk for infection related to tissue trauma
c. deficient fluid volume related to blood loss associated with rupture of the uterine tube
d. anticipatory grieving related to unexpected pregnancy outcome

A

c. deficient fluid volume related to blood loss associated with rupture of the uterine tube

80
Q

A woman diagnosed with an ectopic pregnancy is given an intramuscular injection of methotrexate. The nurse tells the woman that:

a. methotrexate is an analgesic that relieves the dull abdominal pain that she is experiencing
b. she should avoid alcohol until her primary care provider tells her that the treatment is complete
c. follow up blood tests are required for at least 6 months after injection of the methotrexate
d. she should continue to take her prenatal vitamins to promote healing

A

b. she should avoid alcohol until her primary care provider tells her that the treatment is complete

81
Q

The primary expected outcome for care associated with the administration of magnesium sulfate is met if the woman:

a. exhibits a decrease in both systolic and diastolic BP
b. experiences no seizures
c. states that she feels more relaxed and calm
d. urinates more frequently, resulting in a decrease in pathologic edema

A

b. experiences no seizures

82
Q

A pregnant woman at 32 weeks gestation comes to the ED because she has begun to experience bright red vaginal bleeding. She reports that she is experiencing no pain. The admission nurse suspects:

a. abruptio placentae
b. disseminated intravascular coagulation
c. placenta previa
d. preterm labor

A

c. placenta previa

83
Q

A pregnant woman at 38 weeks of gestation diagnosed with marginal placenta previa has just given birth to a healthy newborn boy. The nurse recognizes that the immediate focus for the care of this woman is:

a. preventing hemorrhage
b. relieving pain
c. preventing infection
d. fostering attachment of the woman with her new son

A

a. preventing hemorrhage

OB Test 5 (3 decks)

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