Maternity Nursing Chap 21

Question 1

___________, 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.

Answer 1

• preeclampsia
• mild
• severe

Question 2

__________ 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.

Answer 2

-hypertension

Question 3

___________ 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.

Answer 3

-proteinuria

Question 4

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.

Answer 4

-dependent edema

Question 5

____________ 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.

Answer 5

-severe preeclampsia

Question 6

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

Answer 6

-eclampsia

Question 7

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

Answer 7

-HELLP

Question 8

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

Answer 8

• disruptions in placental perfusion

- endothelial cell dysfunction

Question 9

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

Answer 9

• 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

Question 10

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

Answer 10

False – approximately 3% to 7% of all pregnancies

Question 11

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

Answer 11

False – Decreased liver perfusion results in impaired liver function.

Question 12

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

Answer 12

True

Question 13

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

Answer 13

False – anywhere from 5% to 20%

Question 14

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

Answer 14

True

Question 15

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

Answer 15

False – therapeutic range is 4 to 7 mEq/L

Question 16

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

Answer 16

True

Question 17

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

Answer 17

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

Question 18

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

Answer 18

False – there is no sodium restriction

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

True

Question 22

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

Answer 22

True

Question 23

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

Answer 23

True

Question 24

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

Answer 24

False – may have a regular diet

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

Risk factors associated with gestational hypertension (preeclampsia):

Answer 27

- 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

Question 28

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

Answer 28

- 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

Question 29

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

Answer 29

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

Question 30

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?

Answer 30

preeclampsia

Question 31

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?

Answer 31

gestational hypertension

Question 32

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?

Answer 32

chronic hypertension

Question 33

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?

Answer 33

eclampsia

Question 34

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.

Answer 34

HELLP syndrome

Question 35

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

Answer 35

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

Question 36

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

Answer 36

True

Question 37

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

Answer 37

True

Question 38

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

Answer 38

True

Question 39

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

Answer 39

False --

Question 40

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

Answer 40

True

Question 41

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

Answer 41

True

Question 42

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

Answer 42

True

Question 43

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

Answer 43

True

Question 44

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

Answer 44

True

Question 45

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

Answer 45

False --

Question 46

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

Answer 46

True

Question 47

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

Answer 47

- miscarriage - premature dilation of the cervix (incompetent cervix) - ectopic pregnancy - hydatidiform mole (molar pregnancy)

Question 48

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

Answer 48

- placenta previa - premature separation of the placenta - abruptio placentae

Question 49

________ 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.

Answer 49

-miscarriage

Question 50

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.

Answer 50

-human chorionic gonadotropin (B-hCG)

Question 51

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.

Answer 51

-internal os

Question 52

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

Answer 52

-premature separation of the placenta

Question 53

Predisposing conditions for DIC:

Answer 53

- abruptio placentae - severe preeclampsia - HELLP syndrome - retained dead fetus - amniotic fluid embolism - gram negative sepsis

Question 54

Clinical manifestations for DIC:

Answer 54

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

Question 55

priority nursing care measures for DIC:

Answer 55

- 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

Question 56

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

Answer 56

velamentous cord insertion

Question 57

What is fertilized ovum implanted outside the uterine cavity?

Answer 57

ectopic pregnancy

Question 58

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

Answer 58

miscarriage

Question 59

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

Answer 59

couvelaire

Question 60

What is placental implantation in the lower uterine segment?

Answer 60

placenta previa

Question 61

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

Answer 61

incompetent cervix

Question 62

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?

Answer 62

hydatidiform mole (complete)

Question 63

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

Answer 63

abruptio placentae

Question 64

What is cord insertion at the margin of the placenta?

Answer 64

battledore placenta

Question 65

What is placenta divided into two or more separate lobes?

Answer 65

succenturiate placenta

Question 66

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

Answer 66

- 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

Question 67

Observe for clinical signs of abruptio placentae from trauma:

Answer 67

- 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

Question 68

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 ____________.

Answer 68

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

Question 69

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

Answer 69

Hepatitis A

Question 70

_________ 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.

Answer 70

Rubella

Question 71

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.

Answer 71

Toxoplasmosis

Question 72

____________ 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.

Answer 72

Cytomegalovirus

Question 73

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.

Answer 73

Hepatitis B

Question 74

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

Answer 74

Herpes simplex virus

Question 75

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

Answer 75

c. use the same arm for all BP measurements

Question 76

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

Answer 76

a. proteinuria of 5 grams in 24 hour collection

Question 77

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

Answer 77

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

Question 78

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

Answer 78

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

Question 79

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

Answer 79

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

Question 80

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

Answer 80

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

Question 81

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

Answer 81

b. experiences no seizures

Question 82

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

Answer 82

c. placenta previa

Question 83

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

Answer 83

a. preventing hemorrhage