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NUR247 - Maternal OB > MIDTERM CH 19, 21: New Pregnany Complications > Flashcards

MIDTERM CH 19, 21: New Pregnany Complications Flashcards

1
Q

Which of the following are risk factors associated with spontaneous abortion? (SATA)

A. Chromosomal abnormalities

B. Maternal age

C. Presence of human chorionic gonadotropin (hCG)

D. Elective termination of pregnancy

A

A. Chromosomal abnormalities

B. Maternal age

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2
Q

Which condition is most commonly associated with spontaneous abortion in the first trimester?

A. Fetal genetic abnormalities
B. Hypothyroidism
C. Cervical insufficiency
D. Diabetes mellitus

A

A. Fetal genetic abnormalities

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

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3
Q

Which maternal conditions are commonly related to spontaneous abortion in the second trimester? (SATA)

A. Cervical insufficiency
B. Congenital anomaly of the uterine cavity
C. Use of cocaine
D. Chromosomal abnormalities

A

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.

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4
Q

What is the recommended clinical management for a woman experiencing a first-trimester spontaneous abortion at home without a dilation and curettage (D&C) procedure?

A. Frequent monitoring of hCG levels
B. Hospital admission for labor augmentation
C. Immediate surgical intervention
D. Prescribing antibiotics

A

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.

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5
Q

What is the primary focus of nursing care for women admitted to the hospital for a second-trimester spontaneous abortion?

A. Administration of medication
B. Frequent monitoring of hCG levels
C. Surgical intervention
D. Providing emotional support

A

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.

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6
Q

What is the immediate nursing action when a pregnant woman calls and reports vaginal bleeding?

A. Advise her to rest and monitor the situation.
B. Suggest over-the-counter medication.
C. Arrange for her to be seen by a health care professional as soon as possible.
D. Recommend increasing fluid intake.

A

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.

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7
Q

What assessment information should a nurse obtain from a pregnant woman reporting vaginal bleeding? (SATA)

A. Color of the vaginal bleeding
B. Amount of bleeding
C. Frequency of changing peripads
D. Type of food consumed recently

A

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.

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8
Q

Which nursing intervention is appropriate for a woman presenting with passage of products of conception tissue?

A. Instruct her to save and bring any passed tissue or clots to the health care facility.
B. Advise her to discard the tissue and rest.
C. Recommend taking pain medication.
D. Suggest doing physical exercise.

A

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.

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9
Q

What is a critical component of psychological support for a woman experiencing a spontaneous abortion?

A. Advising her to avoid future pregnancies.

B. Reassuring her that the abortion usually results from an abnormality and not her actions.

C. Suggesting she move on quickly.

D. Minimizing the significance of the event.

A

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.

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10
Q

Which ongoing assessments are essential for a woman experiencing a spontaneous abortion? (SATA)

A. Monitoring the amount of vaginal bleeding through pad counts
B. Observing for passage of products of conception tissue
C. Assessing the woman’s pain
D. Checking the woman’s body temperature hourly

A

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

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11
Q

For a woman experiencing a spontaneous abortion, which medication might be administered if she is Rh-negative and not sensitized?

A. Misoprostol
B. Prostaglandin E2 (PGE2)
C. Methotrexate
D. RhoGAM

A

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.

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12
Q

What diagnostic tool is used to confirm if the sac is empty in a threatened abortion?

A. Ultrasound
B. Blood test
C. Vaginal ultrasound
D. Pelvic exam

A

C. Vaginal ultrasound

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

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13
Q

What is the purpose of vacuum curettage in inevitable abortion?

A. To reduce the risk of excessive bleeding and infection if products of conception are not passed
B. To confirm pregnancy
C. To manage pain
D. To prevent future pregnancies

A

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.

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14
Q

What therapeutic management is indicated for incomplete abortion?

A. Bed rest
B. Antibiotic therapy
C. Evacuation of uterus via D&C or prostaglandin analog
D. Dietary changes

A

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.

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15
Q

What is the therapeutic management for a missed abortion if inevitable abortion does not occur?

A. Watchful waiting
B. Antibiotic therapy
C. Hormonal therapy
D. Evacuation of uterus

A

D. Evacuation of uterus

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

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16
Q

What is a possible therapeutic management for recurrent abortion due to incompetent cervix?

A. Hormonal therapy
B. Bed rest
C. Antibiotic therapy
D. Cervical cerclage

A

D. Cervical cerclage

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

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17
Q

What medications might be used to manage an inevitable abortion if tissue fragments are not completely passed?

A. Prostaglandin analogs
B. Antibiotics
C. Hormonal therapy
D. Pain relievers

A

A. Prostaglandin analogs

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

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18
Q

What is the role of client stabilization in the management of incomplete abortion?

A. Providing dietary advice
B. Encouraging physical exercise
C. Stabilizing the client before proceeding with uterine evacuation
D. Measuring body mass index (BMI)

A

C. Stabilizing the client before proceeding with uterine evacuation

Rationale: Client stabilization is crucial before performing uterine evacuation in cases of incomplete abortion.

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19
Q

How is a complete abortion confirmed diagnostically?

A. Blood test
B. Pelvic exam
C. Physical symptoms only
D. Ultrasound

A

D. Ultrasound

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

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20
Q

What ultrasound finding is indicative of a missed abortion?

A. Absent heart rate
B. Identification of products of conception retained in the uterus
C. Enlarged uterus
D. Increased amniotic fluid

A

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.

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21
Q

What are potential underlying causes that may be identified and treated in recurrent abortion?

A. High blood pressure
B. Genetic or chromosomal abnormalities, reproductive tract abnormalities, chronic diseases, or immunologic problems
C. Nutritional deficiencies
D. Physical inactivity

A

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

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22
Q

What are the signs of a missed abortion?

A. Absent uterine contractions and irregular spotting
B. Increased uterine contractions
C. Severe abdominal pain
D. Profuse bleeding

A

A. Absent uterine contractions and irregular spotting

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

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23
Q

What diagnostic tools are used to confirm pregnancy loss in inevitable abortion?

A. Ultrasound and hCG levels
B. Physical exam and blood pressure measurement
C. Blood glucose levels
D. Pelvic MRI

A

A. Ultrasound and hCG levels

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

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24
Q

The health care provider orders PGE2 for a woman to help evacuate the uterus following a spontaneous abortion. Which of the following would be most important for the nurse to do?

A) Use clean technique to administer the drug.

B) Keep the gel cool until ready to use.

C) Maintain the client for hour after administration.

D) Administer intramuscularly into the deltoid area.

A

C) Maintain the client for hour after administration.

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25
Q

After teaching a group of nursing students about the possible causes of spontaneous abortion, the instructor determines that the teaching was successful when the students identify which of the following as the most common cause of first trimester abortions?

A) Maternal disease

B) Cervical insufficiency

C) Fetal genetic abnormalities

D) Uterine fibroids

A

C) Fetal genetic abnormalities

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26
Q

Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate?

A) Why are you crying?

B) Will a pill help your pain?

C) I’m sorry you lost your baby.

D) A baby still wasn’t formed in your uterus.

A

C) I’m sorry you lost your baby.

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27
Q

Which of the following findings is consistent with a threatened abortion?

a) Cervical dilation with heavy vaginal bleeding

b) Mild abdominal cramping with a closed cervical os

c) Passage of tissue with a decrease in pain and bleeding

d) Retention of a nonviable embryo for more than 6 weeks

A

b) Mild abdominal cramping with a closed cervical os

Rationale: In a threatened abortion, the cervical os remains closed, and the patient typically experiences mild abdominal cramping and slight vaginal bleeding.

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28
Q

What is the therapeutic management for an inevitable abortion when products of conception are not completely passed?

a) Dilation and curettage (D&C)

b) No medical or surgical intervention

c) Reduction in activity and increased hydration

d) Prostaglandin analogs such as misoprostol

A

d) Prostaglandin analogs such as misoprostol

Rationale: In an inevitable abortion, prostaglandin analogs like misoprostol are used to empty the uterus of retained tissue if the products of conception are not completely passed.

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29
Q

Which of the following best describes a complete abortion?

a) Passage of some products of conception with heavy bleeding

b) Passage of all products of conception with a subsequent decrease in pain and bleeding

c) Nonviable embryo retained in utero for at least 6 weeks

d) Vaginal bleeding with no cervical dilation or tissue passage

A

b) Passage of all products of conception with a subsequent decrease in pain and bleeding

Rationale: In a complete abortion, all products of conception are passed, resulting in decreased pain and vaginal bleeding.

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30
Q

What diagnostic test confirms a missed abortion?

a) Maternal serum hCG levels

b) Ultrasound demonstrating an empty uterus

c) Ultrasound showing retained products of conception

d) Pelvic examination indicating cervical dilation

A

c) Ultrasound showing retained products of conception

Rationale: A missed abortion is confirmed by an ultrasound that identifies retained products of conception in the uterus, despite the absence of uterine contractions and significant symptoms.

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31
Q

Which clinical finding differentiates an incomplete abortion from other types?

a) Passage of all products of conception

b) Cervical dilation with heavy vaginal bleeding and passage of some products of conception

c) Absence of vaginal bleeding with abdominal pain

d) Irregular spotting without uterine contractions

A

b) Cervical dilation with heavy vaginal bleeding and passage of some products of conception

Rationale: An incomplete abortion involves cervical dilation, heavy vaginal bleeding, and the passage of only some products of conception, requiring intervention to remove the remaining tissue.

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32
Q

Which of the following is the recommended management for a recurrent abortion due to cervical incompetence?

a) Prostaglandin analogs

b) Dilation and curettage (D&C)

c) Induction of labor with PGE2 suppository

d) Cervical cerclage in the second trimester

A

d) Cervical cerclage in the second trimester

Rationale: Cervical cerclage is used to prevent pregnancy loss in cases of recurrent abortion caused by an incompetent cervix.

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33
Q

What is a characteristic finding of a missed abortion?

a) Strong abdominal cramping with cervical dilation

b) Nonviable embryo retained in utero for at least 6 weeks

c) Vaginal bleeding with passage of tissue

d) Closed cervical os with mild cramping

A

b) Nonviable embryo retained in utero for at least 6 weeks

Rationale: In a missed abortion, the nonviable embryo is retained in the uterus for an extended period without uterine contractions or passage of tissue.

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34
Q

What is the most appropriate intervention for a complete abortion?

a) No medical or surgical intervention is needed, but a follow-up appointment is recommended

b) Emergency suction curettage to remove residual products of conception

c) Bed rest and activity reduction

d) Immediate induction of labor

A

a) No medical or surgical intervention is needed, but a follow-up appointment is recommended

Rationale: In a complete abortion, all products of conception are passed, and no medical or surgical intervention is required. A follow-up appointment is necessary for family planning and further assessment.

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35
Q

Where can an ectopic pregnancy implant outside the uterine cavity?

A. Fallopian tubes
B. Cervix
C. Ovary
D. All of the above

A

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.

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36
Q

What is the primary cause of maternal mortality in the first trimester of pregnancy in the United States?

A. Gestational diabetes
B. Ectopic pregnancy
C. Pre-eclampsia
D. Placenta previa

A

B. Ectopic pregnancy

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

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37
Q

What are the potential complications of an ectopic pregnancy if left untreated?

A. Massive hemorrhage, infertility, or death
B. Chronic hypertension, infertility, or death
C. Gestational diabetes, infertility, or death
D. Hyperemesis gravidarum, infertility, or death

A

A. Massive hemorrhage, infertility, or death

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

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38
Q

Why is prediction of tubal rupture before its occurrence crucial in ectopic pregnancies?

A. To schedule routine ultrasounds
B. To manage gestational diabetes
C. To prevent a potentially life-threatening condition
D. To monitor blood pressure

A

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.

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39
Q

What is the most common site for implantation in an ectopic pregnancy?

A. Cervix
B. Ovary
C. Abdominal cavity
D. Fallopian tubes

A

D. Fallopian tubes

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

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40
Q

What typically causes the fertilized ovum to implant outside the uterus in an ectopic pregnancy?

A. Increased uterine size
B. Arrested or altered journey along the fallopian tube
C. Rapid cell division
D. Genetic mutations

A

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.

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41
Q

What are some associated risk factors for ectopic pregnancy? (SATA)

A. Previous tubal surgery
B. Infertility
C. Use of an intrauterine contraceptive system
D. Increased physical activity

A

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

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42
Q

How does smoking affect the risk of ectopic pregnancy?

A. It has no effect
B. It alters tubal motility
C. It reduces tubal scarring
D. It enhances embryo implantation in the uterus

A

B. It alters tubal motility, increasing the risk

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

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43
Q

What are safe and effective treatments for clinically stable women diagnosed with nonruptured ectopic pregnancies?

A. Oral antibiotics
B. Laparoscopic surgery or intramuscular (IM) methotrexate administration
C. Bed rest and hydration
D. Hormonal therapy

A

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.

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44
Q

What classic clinical triad is associated with ectopic pregnancy, although only about half of women present with all three symptoms?

A. Fever, nausea, and vomiting
B. Headache, dizziness, and fatigue
C. Abdominal pain, amenorrhea, and vaginal bleeding
D. Joint pain, rash, and swelling

A

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

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45
Q

What diagnostic procedures are used for a suspected ectopic pregnancy? (SATA)

A. Urine pregnancy test
B. Beta-hCG concentrations
C. Transvaginal ultrasound
D. Complete blood count

A

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

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46
Q

Why is preservation of the affected fallopian tube attempted during surgical intervention for an ectopic pregnancy?

A. To maintain fertility
B. To reduce the risk of infection
C. To improve hormone regulation
D. To enhance blood circulation

A

A. To maintain fertility

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

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47
Q

What criteria must a client meet to be eligible for medical therapy with methotrexate for an ectopic pregnancy?

A. Hemodynamically unstable and high beta-hCG levels

B. Active bleeding in the peritoneal cavity and a ruptured mass

C. Hemodynamically stable

D. Severe persistent abdominal pain and liver disease

A

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.

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48
Q

What is a contraindication to medical treatment with methotrexate for ectopic pregnancy?

A. Low beta-hCG levels

B. Renal or liver disease

C. Small unruptured mass

D. No signs of active bleeding

A

B. Renal or liver disease

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

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49
Q

What are the advantages of using methotrexate for the medical management of ectopic pregnancy? (SATA)

A. Avoidance of surgery
B. Preservation of tubal patency and function
C. Lower cost
D. Immediate pain relief

A

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

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50
Q

What is the main mechanism of action of methotrexate in treating ectopic pregnancy?

A. Promoting embryo growth
B. Increasing blood supply
C. Enhancing tubal motility
D. Inhibiting cell division in the developing embryo

A

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.

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51
Q

What adverse effects are associated with methotrexate treatment for ectopic pregnancy?

A. Nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness
B. Hair loss and weight gain
C. Hypertension and hyperglycemia
D. Skin rash and joint pain

A

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.

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52
Q

What follow-up care is necessary after methotrexate administration for ectopic pregnancy?

A. Monthly check-ups
B. Immediate surgical intervention
C. Weekly laboratory studies until beta-hCG titers decrease
D. Daily physical therapy sessions

A

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.

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53
Q

What surgical procedure might be performed to preserve the fallopian tube in an unruptured ectopic pregnancy?

A. Laparotomy
B. Linear salpingostomy
C. Salpingectomy
D. Hysterectomy

A

B. Linear salpingostomy

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

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54
Q

What is the primary reason for surgery in cases of ruptured ectopic pregnancy?

A. To enhance fertility
B. To control possible uncontrolled hemorrhage
C. To diagnose ectopic pregnancy
D. To prevent future pregnancies

A

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.

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55
Q

What is the significance of monitoring beta-hCG levels until they are undetectable following treatment for ectopic pregnancy?

A. To confirm pregnancy
B. To ensure that any residual trophoblastic tissue that forms the placenta is gone
C. To assess liver function
D. To measure kidney function

A

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.

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56
Q

What is the primary focus of nursing assessment in a woman with a suspected ectopic pregnancy?

A. Determining the presence of urinary tract infection
B. Assessing nutritional status
C. Determining the existence of an ectopic pregnancy and whether or not it has ruptured
D. Evaluating blood glucose levels

A

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.

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57
Q

When do signs and symptoms of ectopic pregnancy typically begin?

A. Immediately after conception
B. At about the 4th or 5th week of gestation
C. At about the 7th or 8th week of gestation
D. At about the 10th or 11th week of gestation

A

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.

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58
Q

What is the hallmark sign of ectopic pregnancy?

A. Severe headache with spotting within 6 to 8 weeks after a missed menstrual period

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

C. High fever with spotting within 6 to 8 weeks after a missed menstrual period

D. Leg cramps with spotting within 6 to 8 weeks after a missed menstrual period

A

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

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59
Q

What are some possible contributing factors to ectopic pregnancy? (SATA)

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

A

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

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60
Q

What symptoms might indicate an unruptured tubal pregnancy?

A. Severe lower back pain and high fever
B. Missed menstrual period, adnexal fullness, and tenderness
C. Chronic cough and difficulty breathing
D. Swelling in the legs

A

B. Missed menstrual period, adnexal fullness, and tenderness

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61
Q

What are common symptoms typical of early pregnancy that can also be present in ectopic pregnancy?

A. High blood pressure and increased urination
B. Breast tenderness, nausea, fatigue, shoulder pain, and low back pain
C. Increased appetite and weight gain
D. Headache and dizziness

A

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

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62
Q

What findings on an ultrasound are diagnostic of ectopic pregnancy?

A. Presence of a gestational sac in the uterus and the absence of an intrauterine gestational sac

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

C. Increased amniotic fluid and the absence of an intrauterine gestational sac

D. Enlarged ovaries and the absence of an intrauterine gestational sac

A

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

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63
Q

How do beta-hCG levels typically behave in a normal intrauterine pregnancy during the first 60 to 90 days after conception?

A. Decrease gradually
B. Remain constant
C. Double every 2 to 4 days
D. Triple every 1 to 2 days

A

C. Double every 2 to 4 days

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64
Q

What do low beta-hCG levels suggest in the context of pregnancy?

A. Ectopic pregnancy or impending abortion
B. Normal intrauterine pregnancy
C. Gestational diabetes
D. Preeclampsia

A

A. Ectopic pregnancy or impending abortion

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65
Q

What signs and symptoms of ectopic rupture should be outlined for a woman receiving outpatient treatment for an ectopic pregnancy?

A. Mild headache and blurred vision

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

C. Frequent urination and increased appetite

D. Sweating and rash

A

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

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66
Q

What should a nurse stress to a woman about the need for follow-up blood testing after an ectopic pregnancy?

A. To confirm pregnancy
B. To check for anemia
C. To assess kidney function
D. To monitor hCG titers until they return to zero, indicating resolution of the ectopic pregnancy

A

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

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67
Q

What risk factors should be reduced to help prevent ectopic pregnancies? (SATA)

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

A

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

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68
Q

Why is seeking prenatal care early important in preventing ectopic pregnancies?

A. To monitor blood pressure
B. To assess weight gain
C. To confirm the location of the pregnancy
D. To improve hair growth

A

C. To confirm the location of the pregnancy

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69
Q

Which of the following data on a clients health history would the nurse identify as contributing to the clients risk for an ectopic pregnancy?

A) Use of oral contraceptives for 5 years

B) Ovarian cyst 2 years ago

C) Recurrent pelvic infections

D) Heavy, irregular menses

A

C) Recurrent pelvic infections

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70
Q

In a woman who is suspected of having a ruptured ectopic pregnancy, the nurse would expect to assess for which of the following as a priority?

A) Hemorrhage

B) Jaundice

C) Edema

D) Infection

A

A) Hemorrhage

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71
Q

What term describes a weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions, leading to pregnancy loss?

A. Cervical insufficiency
B. Placenta previa
C. Preterm labor
D. Gestational diabetes

A

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.

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72
Q

When does cervical insufficiency typically occur during pregnancy?

A. In the first trimester or early second trimester
B. In the second trimester or early third trimester
C. During labor
D. In the postpartum period

A

B. In the second trimester or early third trimester

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73
Q

What structural abnormalities are hypothesized to contribute to cervical insufficiency?

A. Increased elastin and collagen
B. Decreased smooth muscle
C. Less elastin, less collagen, and greater amounts of smooth muscle
D. Increased blood supply

A

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.

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74
Q

What hormonal factor is proposed to play a role in cervical insufficiency?

A. Estrogen
B. Thyroxine
C. Insulin
D. Relaxin

A

D. Relaxin

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

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75
Q

What are some conditions associated with cervical insufficiency?

A. Diabetes and hypertension
B. Previous precipitous birth, prolonged second stage of labor, increased uterine volume
C. Obesity and thyroid dysfunction
D. Chronic kidney disease

A

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

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76
Q

What are some non-surgical treatments for cervical insufficiency?

A. Bed rest, pelvic rest, avoidance of heavy lifting, and progesterone supplementation
B. Immediate labor induction
C. High-intensity exercise
D. Radiation therapy

A

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

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77
Q

What is the purpose of a cervical pessary in the management of cervical insufficiency?

A. To support and reinforce the cervix
B. To increase cervical length
C. To induce labor
D. To prevent infections

A

A. To support and reinforce the cervix

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78
Q

What complications may be associated with cervical cerclage placement?

A. High blood pressure and diabetes
B. Suture displacement, rupture of membranes, and chorioamnionitis
C. Increased risk of cesarean delivery
D. Gestational diabetes

A

B. Suture displacement, rupture of membranes, and chorioamnionitis

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79
Q

Why should the decision to proceed with cerclage be made with caution if a short cervix is identified at or after 20 weeks?

A. To reduce healthcare costs
B. To increase the duration of hospital stay
C. To monitor maternal weight gain
D. To avoid unnecessary interventions if there is no infection

A

D. To avoid unnecessary interventions if there is no infection

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80
Q

What key aspects should a nursing assessment focus on to determine risk factors for cervical insufficiency?

A. Dietary habits and exercise routines
B. Family history of chronic diseases
C. Previous cervical trauma, preterm labor, fetal loss in the second trimester, and previous surgeries or procedures involving the cervix
D. Sleep patterns and hydration levels

A

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

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81
Q

What symptoms might a woman with cervical insufficiency report?

A. Increased appetite and weight gain
B. Pink-tinged vaginal discharge, low pelvic pressure, cramping with vaginal bleeding, and loss of amniotic fluid
C. High fever and chills
D. Headache and dizziness

A

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

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82
Q

What might cervical dilation without uterine contractions indicate during the second trimester?

A. Preterm labor
B. Preeclampsia
C. Placenta previa
D. Cervical Insufficiency

A

D. Cervical Insufficiency

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83
Q

What can be the outcome if cervical insufficiency continues untreated?

A. Pre-eclampsia development
B. Rupture of the membranes, release of amniotic fluid, and uterine contractions leading to delivery of the fetus before viability
C. Increased fetal movements
D. Delayed labor

A

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

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84
Q

When is transvaginal ultrasound typically performed to determine cervical length in pregnancy?

A. Between 8 and 12 weeks’ gestation
B. Between 16 and 24 weeks’ gestation
C. Between 28 and 32 weeks’ gestation
D. At 36 weeks’ gestation

A

B. Between 16 and 24 weeks’ gestation

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85
Q

What can cervical shortening viewed on ultrasound as funneling indicate?

A. Risk of preterm labor
B. Increased fetal movements
C. Normal pregnancy progression
D. Decreased amniotic fluid

A

A. Risk of preterm labor

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86
Q

What symptoms might prompt a woman to undergo serial transvaginal ultrasound evaluations? (SATA)

A. Pelvic pressure
B. Backache
C. Increased mucoid discharge
D. Increased energy levels

A

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

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87
Q

What should nursing management focus on when monitoring a woman for signs of preterm labor?

A. Blood pressure and heart rate
B. Backache, increase in vaginal discharge, rupture of membranes, and uterine contractions
C. Appetite and weight gain
D. Sleep patterns and hydration levels

A

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

88
Q

What is placental abruption?

A. A condition where the placenta implants in the cervix
B. The early separation of a normally implanted placenta after the 20th week of gestation, leading to hemorrhage
C. A type of placental previa
D. A genetic disorder affecting placental function

A

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.

89
Q

What maternal risks are associated with placental abruption?

A. Increased appetite and weight gain

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

C. Gestational diabetes

D. Thyroid dysfunction

A

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

90
Q

What are the proposed causes of placental abruption?

A. Genetic mutations
B. Viral infections
C. Hormonal imbalances
D. Degenerative changes in small maternal blood vessels resulting in blood clotting and vessel rupture

A

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

91
Q

What are the common origins of most placental abruption cases?

A. Gestational diabetes
B. Maternal hypertension and preeclampsia
C. Thyroid dysfunction
D. Obesity

A

B. Maternal hypertension and preeclampsia

92
Q

What classification of placental abruption is associated with no sign of vaginal bleeding or minimal bleeding, marginal separation, and no fetal distress?

A. Grade 0
B. Mild (grade 1)
C. Moderate (grade 2)
D. Severe (grade 3)

A

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.

93
Q

How can placental abruption be classified by the type of bleeding?

A. Concealed or apparent
B. Gradual or sudden
C. Mild or severe
D. Internal or external

A

A. Concealed or apparent

94
Q

What emergency measure is critical to combat hypovolemia in placental abruption?

A. Oral hydration
B. Starting two large-bore IV lines with normal saline or lactated Ringer’s solution
C. Administering antihistamines
D. Providing bed rest

A

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.

95
Q

When is a cesarean birth performed immediately in cases of placental abruption?

A. When maternal blood pressure is stable

B. When the mother reports mild pain

C. If the mother is asymptomatic

D. If fetal distress is evident

A

D. If fetal distress is evident

96
Q

What is the treatment focus if a woman develops disseminated intravascular coagulation (DIC) due to placental abruption?

A. Determining the underlying cause of DIC and correcting it
B. Increasing physical activity
C. Administering antibiotics
D. Providing nutritional supplements

A

A. Determining the underlying cause of DIC and correcting it

97
Q

What should the initial nursing assessment focus on in cases of suspected placental abruption?

A. Maternal diet and exercise
B. Fetal movements and maternal sleep patterns
C. Maternal hemodynamic status and fetal well-being
D. Maternal weight gain and hydration levels

A

C. Maternal hemodynamic status and fetal well-being

98
Q

Why is it important to monitor the woman’s level of consciousness in cases of placental abruption?

A. To assess dietary intake
B. To note any signs or symptoms that may suggest shock
C. To evaluate sleep patterns
D. To monitor physical activity

A

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

99
Q

What are the classic manifestations of placental abruption?

A. High fever and chills
B. Increased appetite and weight gain
C. Headache and dizziness
D. Painful, dark red vaginal bleeding, “knife-like” abdominal pain, uterine tenderness, contractions, and decreased fetal movement

A

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

100
Q

What might a moderate dip in fibrinogen levels suggest in pregnancy, particularly in the context of placental abruption?

A. Normal pregnancy progression
B. Disseminated intravascular coagulation (DIC)
C. Increased fetal movements
D. Decreased immune response

A

B. Disseminated intravascular coagulation (DIC)

101
Q

What does a nonstress test demonstrate in cases of placental abruption?

A. Fetal growth patterns
B. Findings of fetal jeopardy manifested by late decelerations or bradycardia
C. Maternal nutritional status
D. Blood glucose levels

A

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

102
Q

What does a low score on a biophysical profile suggest in clients with chronic placental abruption?

A. Possible fetal compromise
B. Normal fetal development
C. Enhanced immune function
D. Increased amniotic fluid

A

A. Possible fetal compromise

103
Q

Why should maternal vital signs be obtained frequently in cases of placental abruption?

A. To monitor dietary intake
B. To assess sleep patterns
C. To observe for changes suggesting hypovolemic shock
D. To evaluate physical activity levels

A

C. To observe for changes suggesting hypovolemic shock

104
Q

What might an increase in fundal height indicate in cases of placental abruption?

A. Normal pregnancy progression
B. Bleeding
C. Increased amniotic fluid
D. Enhanced fetal growth

A

B. Bleeding

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

105
Q

How can the bleeding present in cases of placental abruption?

A. Always visible
B. Slight, then more profuse
C. Can be concealed or visible
D. Only visible

A

C. Can be concealed or visible

106
Q

How is the discomfort or pain characterized in placenta previa?

A. None
B. Mild cramping
C. Sharp and intermittent
D. Severe and continuous

A

A. None

107
Q

What is the uterine tone in cases of placental abruption?

A. Soft and relaxed
B. Firm to rigid
C. Spongy
D. Intermittent contractions

A

B. Firm to rigid

108
Q

How does the fetal heart rate typically appear in placenta previa?

A. Irregular
B. Elevated
C. Usually in normal range
D. Decreased

A

C. Usually in normal range

109
Q

What is a common fetal presentation in placenta previa?

A. Breech or transverse lie; engagement is absent
B. Vertex presentation
C. Cephalic position
D. Occiput posterior position

A

A. Breech or transverse lie; engagement is absent

110
Q

What type of discomfort or pain is associated with placental abruption?

A. None (painless)
B. Mild cramps
C. Intermittent contractions
D. Constant; uterine tenderness on palpation

A

D. Constant; uterine tenderness on palpation

111
Q

What is the definition of placenta previa?

A. Placenta detachment after birth
B. Placenta inserted wholly or partly into the lower uterine segment, covering the internal cervical opening
C. Placenta formation in the upper uterine segment -
D. Abnormal placental blood flow

A

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

112
Q

During which trimesters does placenta previa typically occur?

A. First trimester
B. Entire pregnancy
C. Postpartum period
D. Last two trimesters

A

D. Last two trimesters

113
Q

What factors determine the therapeutic management approach for placenta previa?

A. Maternal diet and exercise
B. Extent of bleeding, closeness of the placenta to the cervical os, fetal development, fetal position, maternal parity, presence or absence of labor
C. Maternal sleep patterns
D. Maternal hydration levels

A

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

114
Q

Why is maternal age over 35 years considered a risk factor for placenta previa?

A. Higher likelihood of uterine abnormalities
B. Increased physical activity
C. Better nutritional status
D. Decreased maternal weight

A

A. Higher likelihood of uterine abnormalities

115
Q

How does a previous cesarean birth contribute to the risk of placenta previa?

A. Increases amniotic fluid volume
B. Enhances fetal growth
C. Reduces uterine contractions
D. Causes scarring and structural changes in the uterine lining

A

D. Causes scarring and structural changes in the uterine lining

116
Q

What impact does multiparity have on the risk of placenta previa?

A. Increases the chances of placental implantation
B. Decreases uterine elasticity
C. Reduces maternal nutrition
D. Stabilizes fetal movements

A

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.

117
Q

What are some possible risk factors for placenta previa related to previous uterine procedures?

A. Irregular prenatal check-ups, endometrial ablation, and previous myomectomy
B. Previous D&C, endometrial ablation, and previous myomectomy
C. Routine physical exercise, endometrial ablation, and previous myomectomy
D. Dietary supplements

A

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.

118
Q

How does cocaine use affect the risk of placenta previa?

A. Enhances fetal movements
B. Improves maternal hydration
C. Causes vascular constriction and impaired placental attachment
D. Reduces uterine contractions

A

C. Causes vascular constriction and impaired placental attachment

119
Q

Why is a history of infertility treatment considered a risk factor for placenta previa?

A. Increases maternal appetite
B. Enhances fetal growth
C. Often involves procedures that can alter the uterine lining
D. Reduces amniotic fluid

A

C. Often involves procedures that can alter the uterine lining

120
Q

Why is a short interval between pregnancies a risk factor for placenta previa?

A. May not allow sufficient time for uterine healing
B. Reduces maternal energy levels
C. Increases uterine contractions
D. Enhances fetal movement

A

A. May not allow sufficient time for uterine healing

121
Q

What is the classical clinical presentation of placenta previa?

A. Severe cramping with dark red vaginal bleeding during the second or third trimester

B. High fever and chills during the second or third trimester

C. Increased fetal movements during the second or third trimester

D. Painless, bright red vaginal bleeding during the second or third trimester

A

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.

122
Q

Why is bleeding from the implantation site in the lower uterus more difficult to stop in placenta previa?

A. Increased uterine contractions
B. Enhanced placental attachment
C. The uterus cannot contract adequately to stop the flow of blood from open vessels in the lower uterine segment
D. Excessive fetal movements

A

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

123
Q

What uterine characteristics are typically observed upon palpation in placenta previa?

A. Firm and tender
B. Soft and nontender
C. Spongy and painful
D. Rigid and cramping

A

B. Soft and nontender

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

124
Q

What diagnostic test is primarily used to validate the position of the placenta in cases of suspected placenta previa?

A. Abdominal X-ray
B. Amniocenteisis
C. Blood test
D. Transvaginal Ultrasound

A

D. Transvaginal Ultrasound

125
Q

Why might magnetic resonance imaging (MRI) be ordered when preparing for childbirth in cases of placenta previa?

A. To evaluate maternal bone density
B. To assess fetal movements
C. To identify placental abnormalities
D. To monitor maternal heart rate

A

C. To identify placental abnormalities

126
Q

Why should vaginal examinations be avoided in women with placenta previa?

A. To reduce maternal discomfort
B. They may disrupt the placenta and cause hemorrhage
C. To improve fetal movements
D. To enhance uterine contractions

A

B. They may disrupt the placenta and cause hemorrhage

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

127
Q

What should be done if the woman with placenta previa is experiencing active bleeding?

A. Administer antibiotics
B. Increase fluid intake
C. Prepare for blood typing and cross-matching in case a blood transfusion is needed
D. Monitor fetal movements

A

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.

128
Q

What is the purpose of administering Rh immunoglobulin to an Rh-negative woman at 28 weeks’ gestation?

A. To reduce maternal anxiety
B. To enhance fetal growth
C. To prevent Rh sensitization
D. To improve uterine contractions

A

C. To prevent Rh sensitization

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

129
Q

What signs and symptoms should be reported immediately by a woman with placenta previa?

A. Increased appetite and weight gain
B. Frequent urination
C. High fever and chills
D. Any bleeding episodes or backaches

A

D. Any bleeding episodes or backaches

130
Q

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate?

A) My mother lives next door and can drive me here if necessary.

B) I have a toddler and preschooler at home who need my attention.

C) I know to call my health care provider right away if I start to bleed again.

D) I realize the importance of following the instructions for my care.

A

B) I have a toddler and preschooler at home who need my attention.

131
Q

A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.)

A) Dark red vaginal bleeding

B) Insidious onset

C) Absence of pain

D) Rigid uterus

E) Absent fetal heart tones

A

A) Dark red vaginal bleeding

D) Rigid uterus

E) Absent fetal heart tones

132
Q

Which clinical definition characterizes preterm labor?

A. Regular uterine contractions with cervical dilation and effacement before 37 weeks

B. Irregular uterine contractions without cervical changes after 37 weeks

C. Preterm rupture of membranes with no cervical changes

D. Any contractions occurring before 40 weeks

A

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.

133
Q

What is the primary demographic group at nearly twice the risk of experiencing preterm labor?

A. Hispanic clients
B. African American clients
C. Asian clients
D. Caucasian clients

A

B. African American clients

134
Q

Which complication is most commonly associated with preterm birth?

A. Respiratory distress syndrome
B. Gestational diabetes
C. Placental abruption
D. Postpartum hemorrhage

A

A. Respiratory distress syndrome

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

135
Q

Which neonatal condition is directly associated with preterm birth?

A. Kernicterus
B. Thermoregulation problems
C. Esophageal atresia
D. Pyloric stenosis

A

B. Thermoregulation problems

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

136
Q

What is the leading cause of death within the first month of life in the United States?

A. Neonatal sepsis
B. Prematurity
C. Congenital heart defects
D. Hypoxic ischemic encephalopathy

A

B. Prematurity

137
Q

Which long-term sequelae are preterm infants most at risk for?

A. Hypothyroidism and scoliosis
B. Type 1 diabetes and obesity
C. Autism and attention-deficit disorder
D. Cerebral palsy and vision defects

A

D. Cerebral palsy and vision defects

138
Q

Which factor is most likely to influence the decision to administer tocolytic drugs in preterm labor?

A. Presence of gestational diabetes
B. Maternal age
C. Extent of cervical dilation
D. Previous history of preterm birth

A

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.

139
Q

What is the primary goal of administering tocolytic therapy in preterm labor?

A. To stop labor completely
B. To delay labor long enough for steroids to improve fetal lung maturity
C. To prevent infection in the uterus
D. To increase the length of pregnancy by several weeks

A

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.

140
Q

Which medication is commonly used for tocolysis and works by reducing the muscle’s ability to contract?

A. Magnesium sulfate
B. Indomethacin
C. Atosiban
D. Nifedipine

A

A. Magnesium sulfate

141
Q

Which contraindication for tocolytic therapy is related to maternal health?

A. Maternal hemodynamic instability
B. Gestational hypertension
C. Cervical dilation of 4 cm
D. Fetal macrosomia

A

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.

142
Q

What is the recommended administration window for corticosteroids in preterm labor to improve fetal lung maturity?

A. 48 hours before delivery
B. At least 24 hours before delivery
C. Within 7 days of preterm birth
D. Immediately after labor begins

A

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.

143
Q

Which of the following is a potential side effect of using magnesium sulfate for tocolysis?

A. Hyperkalemia
B. Increased blood pressure
C. Respiratory depression
D. Decreased urine output

A

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.

144
Q

Which of the following statements about tocolytic therapy is true?

A. Tocolytic therapy typically prevents preterm birth entirely.

B. Tocolytic therapy is contraindicated for women with gestational diabetes.

C. Tocolytic therapy may delay birth long enough for corticosteroids to be administered.

D. Tocolytic therapy can prolong pregnancy indefinitely.

A

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.

145
Q

Which of the following is a contraindication for the use of tocolytics in preterm labor?

A. Placenta previa
B. Gestational hypertension
C. Mild cervical dilation
D. Postterm pregnancy

A

A. Placenta previa

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

146
Q

What is the recommended management for a woman experiencing preterm labor after 34 weeks of gestation?

A. Administer corticosteroids to enhance fetal lung maturity

B. Delay birth using tocolytic drugs

C. Consider delivery as the risks of continuing pregnancy outweigh the benefits

D. Perform an amniocentesis to assess fetal lung maturity

A

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.

147
Q

Which factor should be assessed when determining whether to initiate tocolytic therapy in a woman presenting with preterm labor?

A. The mother’s ethnicity
B. The gestational age of the fetus
C. The mother’s preference for delivery
D. The presence of maternal asthma

A

B. The gestational age of the fetus

148
Q

Which symptom is most commonly associated with preterm labor and may be overlooked by both the patient and healthcare provider?

A. Severe abdominal pain
B. Increased vaginal discharge with mucus or blood
C. Consistent heavy bleeding
D. Sudden weight gain

A

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.

149
Q

A patient presents with a complaint of low backache and pelvic pressure. These symptoms are indicative of which of the following conditions?

A. Preterm labor
B. Pregnancy-induced hypertension
C. Gestational diabetes
D. Hyperemesis gravidarum

A

A. Preterm labor

150
Q

Which test is most useful for predicting preterm labor by detecting fetal fibronectin levels?

A. Complete blood count
B. Fetal ultrasound
C. Fetal fibronectin test
D. Amniocentesis

A

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.

151
Q

Which of the following factors may reduce the accuracy of the fetal fibronectin test?

A. Maternal age over 35 years
B. Use of lubricants during a pelvic exam
C. High blood pressure
D. Chronic kidney disease

A

B. Use of lubricants during a pelvic exam

152
Q

What does a negative fetal fibronectin result most likely indicate?

A. Preterm labor is imminent
B. There is a high risk of preterm birth in the next two weeks
C. Preterm labor is unlikely within the next two weeks
D. Immediate intervention with tocolytics is required

A

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.

153
Q

What is the primary clinical significance of measuring cervical length in high-risk pregnancies?

A. To diagnose preterm labor immediately
B. To determine the exact date of delivery
C. To predict the likelihood of preterm birth
D. To assess the fetal heart rate variability

A

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.

154
Q

What is a primary use of amniotic fluid analysis in the context of preterm labor?

A. To detect fetal lung maturity and chorioamnionitis
B. To assess fetal position
C. To determine the sex of the baby
D. To evaluate maternal kidney function

A

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.

155
Q

Which of the following statements is true regarding fetal fibronectin testing?

A. It is a definitive test for predicting preterm labor.

B. A positive result indicates that preterm birth will definitely occur within two weeks.

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

D. The test should be used alone to determine the need for treatment.

A

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

156
Q

Which of the following findings would suggest a higher likelihood of preterm labor in a woman between 24 and 34 weeks’ gestation?

A. A cervical length of 4 cm
B. Absence of uterine contractions
C. No change in vaginal discharge
D. A positive fetal fibronectin test

A

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.

157
Q

A nurse is caring for a woman in preterm labor who is receiving magnesium sulfate therapy. Which of the following should the nurse prioritize in monitoring the client?

A) Maternal blood pressure
B) Fetal heart rate variability
C) Maternal respiratory effort and deep tendon reflexes
D) Uterine contraction frequency

A

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.

158
Q

A client at 30 weeks gestation is diagnosed with preterm labor and is receiving nifedipine. Which assessment finding should the nurse report to the healthcare provider immediately?

A) Increased fetal heart rate
B) Increased maternal blood pressure
C) Reflex tachycardia
D) Maternal hypotension

A

D) Maternal hypotension

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

159
Q

Which of the following is a contraindication for administering tocolytic therapy for preterm labor?

A) Active hemorrhage
B) Mild uterine contractions
C) A short cervix
D) A previous preterm birth

A

A) Active hemorrhage

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

160
Q

A nurse is educating a woman at risk for preterm labor about self-monitoring for symptoms. Which of the following instructions is most important to include?

A) “Monitor your blood pressure twice daily.”

B) “Perform kick counts once a week.”

C) “Time your uterine contractions and call the healthcare provider if they last longer than 30 seconds.”

D) “Avoid traveling for long distances in cars or buses.”

A

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.

161
Q

A nurse is caring for a client receiving indomethacin for preterm labor. Which maternal assessment finding should be reported to the healthcare provider?

A) Amniotic fluid index of 5 cm
B) Maternal heart rate of 85 beats per minute
C) Decreased urine output
D) Blood pressure of 120/80 mm Hg

A

C) Decreased urine output

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

162
Q

Which of the following is an appropriate nursing intervention for a woman experiencing preterm labor who is receiving tocolytic therapy?

A) Encourage ambulation to promote fetal circulation
B) Limit vaginal exams to reduce the risk of infection
C) Discontinue oral fluids to reduce uterine irritability
D) Place the client in a supine position to promote uterine perfusion

A

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.

163
Q

A nurse is preparing to administer magnesium sulfate to a client in preterm labor. What is the primary purpose of this medication?

A) To reduce uterine irritability and delay labor
B) To enhance fetal lung maturity
C) To prevent maternal hypotension
D) To promote fetal heart rate stability

A

A) To reduce uterine irritability and delay labor

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

164
Q

A client at 24 weeks gestation reports feeling pelvic pressure and experiencing low back pain. What is the nurse’s priority action?

A) Assess fetal heart rate
B) Instruct the client to lie on her side and drink fluids
C) Administer a tocolytic agent
D) Prepare the client for immediate transport to a tertiary care facility

A

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.

165
Q

A nurse is educating a woman at risk for preterm labor. Which of the following should the nurse advise the client to report to the healthcare provider immediately?

A) Mild uterine cramping
B) Feeling of pelvic pressure or fullness
C) Increased appetite
D) Vaginal discharge that increases in volume

A

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.

166
Q

A client who is 28 weeks pregnant is being treated for preterm labor with magnesium sulfate. What is the nurse’s priority during administration of this medication?

A) Monitor the client for signs of hypocalcemia
B) Assess fetal heart rate for bradycardia
C) Measure the client’s urinary output hourly
D) Administer corticosteroids for fetal lung maturity

A

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.

167
Q

A nurse is educating a client who had a prior preterm birth about strategies to prevent another preterm birth. Which of the following recommendations should the nurse make?

A) Begin progesterone therapy as soon as possible

B) Limit physical activity to bed rest for the duration of the pregnancy

C) Maintain a pregnancy spacing interval of at least 18 months

D) Schedule a cesarean birth to prevent complications

A

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.

168
Q

A nurse is educating a woman with a shortened cervix about cervical cerclage. Which of the following statements by the nurse is correct?

A) “Cervical cerclage is used to prevent preterm labor by strengthening the cervix.”

B) “Cervical cerclage should be removed immediately after labor begins.”

C) “Cervical cerclage is usually placed after 34 weeks of pregnancy.”

D) “Cervical cerclage requires strict bed rest for the duration of the pregnancy.”

A

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.

169
Q

A nurse is caring for a client who is receiving magnesium sulfate for preterm labor. Which of the following findings is indicative of magnesium sulfate toxicity?

A) Deep tendon reflexes of 2+
B) Respiratory rate of 11 breaths per minute
C) Serum magnesium level of 5 mg/dL
D) Urine output of 100 mL per hour

A

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.

170
Q

Which of the following is an important consideration when administering nifedipine to a woman in preterm labor?

A) Monitor for maternal hypotension and reflex tachycardia
B) Administer the medication intravenously for rapid effect
C) Discontinue the medication if fetal tachycardia occurs
D) Administer with food to reduce gastrointestinal upset

A

A) Monitor for maternal hypotension and reflex tachycardia

Rationale: Nifedipine can cause hypotension and reflex tachycardia, so careful monitoring is essential.

171
Q

Which condition is defined as having more than 2,000 mL of amniotic fluid between 32 and 36 weeks of gestation?

A. Polyhydramnios
B. Oligohydramnios
C. Anhydramnios
D. Hydrops fetalis

A

A. Polyhydramnios

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

172
Q

Which maternal condition is most commonly associated with polyhydramnios?

A. Hypertension
B. Diabetes mellitus
C. Hypothyroidism
D. Preeclampsia

A

B. Diabetes mellitus

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

173
Q

Which fetal anomaly is NOT associated with polyhydramnios?

A. Neural tube defects
B. Fetal hydrops
C. Esophageal atresia
D. Spina bifida occulta

A

D. Spina bifida occulta

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

174
Q

What complication is polyhydramnios most likely to cause during labor?

A. Fetal malpresentation
B. Uterine rupture
C. Placental abruption
D. Cephalopelvic disproportion

A

A. Fetal malpresentation

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

175
Q

What is a possible side effect of using indomethacin to treat polyhydramnios?

A. Premature labor
B. Premature closure of the fetal ductus arteriosus
C. Maternal hypertension
D. Reduced placental perfusion

A

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.

176
Q

Which diagnostic test is most commonly used to estimate amniotic fluid volume in polyhydramnios?

A. Amniocentesis
B. Biophysical profile
C. MRI
D. Ultrasound

A

D. Ultrasound

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

177
Q

What symptom is commonly reported by pregnant women with polyhydramnios?

A. Severe back pain
B. Frequent urination
C. Persistent headaches
D. Shortness of breath

A

D. Shortness of breath

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

178
Q

What does a discrepancy between fundal height and gestational age typically indicate in polyhydramnios?

A. Intrauterine growth restriction
B. Uterine rupture
C. Excess amniotic fluid
D. Fetal deceleration

A

C. Excess amniotic fluid

Rationale: Fundal height greater than expected for gestational age may suggest polyhydramnios.

179
Q

Which complication is associated with overstretching of the uterus in polyhydramnios?

A. Uterine atony
B. Placental abruption
C. Preterm uterine contractions
D. Postpartum hemorrhage

A

C. Preterm uterine contractions

Rationale: Uterine overstretching from polyhydramnios may trigger preterm contractions.

180
Q

What is the primary goal of an amniocentesis in polyhydramnios?

A. To assess fetal lung maturity
B. To reduce amniotic fluid volume
C. To identify fetal chromosomal anomalies
D. To prevent preterm labor

A

B. To reduce amniotic fluid volume

Rationale: Amniocentesis may be performed to relieve maternal discomfort by reducing fluid volume.

181
Q

Which risk factor is most relevant when assessing a client for polyhydramnios?

A. Advanced maternal age
B. Maternal diabetes
C. Placenta previa
D. History of preeclampsia

A

B. Maternal diabetes

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

182
Q

What structural fetal anomaly commonly contributes to impaired swallowing and polyhydramnios?

A. Hydrocephaly
B. Cleft lip
C. Esophageal atresia
D. Spinal curvature

A

C. Esophageal atresia

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

183
Q

What physical finding is often noted during abdominal palpation in polyhydramnios?

A. Difficulty identifying fetal parts
B. Reduced fundal height
C. Hypoactive bowel sounds
D. Firm uterine tone

A

A. Difficulty identifying fetal parts

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

184
Q

What is the purpose of monitoring maternal abdominal girth in suspected polyhydramnios?

A. To assess for uterine rupture
B. To measure fluid output
C. To estimate fetal size
D. To evaluate excessive uterine growth

A

D. To evaluate excessive uterine growth

Rationale: Enlarged abdominal girth may indicate increased amniotic fluid volume.

185
Q

What common symptom might result from pressure on the vena cava in polyhydramnios?

A. Maternal hypotension
B. Edema in lower extremities
C. Varicose veins
D. Fainting episodes

A

B. Edema in lower extremities

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

186
Q

What is the primary concern with a cord prolapse in polyhydramnios?

A. Fetal bradycardia
B. Maternal hypotension
C. Placental detachment
D. Premature rupture of membranes

A

A. Fetal bradycardia

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

187
Q

What assessment finding is most concerning in a pregnant woman with polyhydramnios?

A. Mild backache
B. Increased fetal movements
C. Slight ankle swelling
D. Persistent shortness of breath

A

D. Persistent shortness of breath

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

188
Q

Which fetal outcome is associated with polyhydramnios?

A. Low birth weight
B. Fetal macrosomia
C. Respiratory distress
D. Premature birth

A

D. Premature birth

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

189
Q

Which volume of amniotic fluid is diagnostic of oligohydramnios between 32 and 36 weeks of gestation?

A. Less than 1,000 mL
B. Less than 500 mL
C. Less than 700 mL
D. Less than 1,200 mL

A

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.

190
Q

What is the primary fetal risk associated with oligohydramnios?

A. Fetal macrosomia
B. Neural tube defects
C. Cord compression
D. Hyperbilirubinemia

A

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.

191
Q

Which maternal condition is most commonly associated with oligohydramnios?

A. Gestational hypertension
B. Placenta previa
C. Uteroplacental insufficiency
D. Multiple gestation

A

C. Uteroplacental insufficiency

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

192
Q

What fetal condition is most likely to result in oligohydramnios?

A. Neural tube defects
B. Fetal renal agenesis
C. Anencephaly
D. Gastroschisis

A

B. Fetal renal agenesis

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

193
Q

Which diagnostic tool is most effective in confirming oligohydramnios?

A. Amniocentesis
B. Doppler velocimetry
C. Biophysical profile
D. Ultrasound

A

D. Ultrasound

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

194
Q

What is the most appropriate intervention for a term pregnancy with oligohydramnios and compromised fetal well-being?

A. Cesarean delivery
B. Amnioinfusion
C. Serial ultrasounds
D. Bed rest

A

A. Cesarean delivery

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

195
Q

Why is amnioinfusion performed during labor in cases of oligohydramnios?

A. To minimize cord compression
B. To reduce uterine contractions
C. To stimulate fetal lung maturity
D. To reduce maternal discomfort

A

A. To minimize cord compression

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

196
Q

Which fetal heart rate pattern is commonly associated with oligohydramnios?

A. Early decelerations
B. Accelerations
C. Variable decelerations
D. Prolonged decelerations

A

C. Variable decelerations

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

197
Q

In post-term pregnancies, what physiological change often leads to oligohydramnios?

A. Increased fetal movement
B. Decline in amniotic fluid production
C. Placental overperfusion
D. Excess fetal urine output

A

B. Decline in amniotic fluid production

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

198
Q

What maternal complaint may indicate oligohydramnios?

A. Vaginal bleeding
B. Increased fetal movements
C. Frequent urination
D. Fluid leakage from the vagina

A

D. Fluid leakage from the vagina

Rationale: Leakage of amniotic fluid due to membrane rupture can decrease amniotic fluid levels, contributing to oligohydramnios.

199
Q

Which noninvasive assessment tool is essential in managing oligohydramnios?

A. Fetal Doppler
B. Nonstress testing
C. Contraction stress testing
D. Maternal serum alpha-fetoprotein

A

B. Nonstress testing

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

200
Q

Why is frequent perineal care important for women with oligohydramnios undergoing amnioinfusion?

A. To manage leakage of fluid
B. To prevent urinary tract infections
C. To reduce infection risk from catheter placement
D. To prevent skin irritation

A

A. To manage leakage of fluid

Rationale: Fluid leakage during amnioinfusion necessitates frequent perineal care to maintain hygiene and comfort.

201
Q

Which condition in the newborn is commonly assessed after birth in cases of oligohydramnios?

A. Meconium aspiration syndrome
B. Hyperbilirubinemia
C. Respiratory distress
D. Congenital hypothyroidism

A

C. Respiratory distress

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

202
Q

What maternal history finding increases the likelihood of oligohydramnios?

A. Preeclampsia
B. Fetal macrosomia
C. History of twin pregnancy
D. Gestational diabetes

A

A. Preeclampsia

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

203
Q

Which nursing intervention is critical during amnioinfusion for oligohydramnios?

A. Monitoring uterine overdistention
B. Administering tocolytic medications
C. Measuring maternal oxygen saturation
D. Encouraging increased fluid intake

A

A. Monitoring uterine overdistention

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

204
Q

What does the nursing care plan for a client with oligohydramnios prioritize?

A. Monitoring maternal weight gain
B. Preventing maternal infection
C. Encouraging dietary changes
D. Maintaining fetal oxygenation

A

D. Maintaining fetal oxygenation

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

205
Q

A nurse is preparing to perform a fetal fibronectin (fFN) test on a client at 28 weeks gestation. Which of the following actions is most important before collecting the sample?

A) Ensure the client has had no vaginal exams, intercourse, or penetration within 24 hours

B) Instruct the client to empty her bladder prior to the procedure

C) Perform a cervical examination to check for dilation

D) Administer a tocolytic agent to stop contractions

A

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.

206
Q

Which of the following is the best interpretation of a negative fetal fibronectin (fFN) test result in a client at 30 weeks gestation?

A) There is a 50% chance the client will deliver within 1-2 weeks

B) The client is likely to deliver after 36 weeks gestation

C) The client is unlikely to deliver preterm (99% negative predictive value)

D) The client should be treated with corticosteroids to enhance fetal lung maturity

A

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.

207
Q

A client at 24 weeks gestation presents with contractions, and a fetal fibronectin (fFN) test is ordered. Which of the following is the most important consideration before performing the test?

A) Confirm that the client has had no vaginal penetration or intercourse in the past 48 hours

B) Ensure the client has been on bed rest for at least 24 hours prior to the test

C) Confirm that no cervical exams have been performed within the past 24 hours

D) Advise the client to drink fluids to prevent dehydration

A

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.

208
Q

A nurse is educating a client about the fetal fibronectin (fFN) test. Which of the following statements by the client indicates a need for further teaching?

A) “I should not have had any vaginal exams or intercourse within 24 hours of the test.”

B) “A negative test result means I am unlikely to deliver prematurely.”

C) “A positive test result is a definitive indicator that I will deliver within the next week.”

D) “The test will be performed between 22 and 34 weeks of pregnancy.”

A

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.

209
Q

A client at 28 weeks gestation has a fetal fibronectin (fFN) test that comes back positive. Which of the following is the nurse’s priority action?

A) Administer a tocolytic agent to stop labor
B) Instruct the client to remain on strict bed rest until delivery
C) Prepare the client for immediate cesarean section
D) Monitor the client closely for signs and symptoms of preterm labor

A

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.

210
Q

Which of the following is the most accurate time window for performing a fetal fibronectin (fFN) test in a pregnant woman?

A) Between 12 and 20 weeks gestation
B) Between 20 and 22 weeks gestation
C) Between 22 and 34 weeks gestation
D) Between 35 and 37 weeks gestation

A

C) Between 22 and 34 weeks gestation

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

211
Q

What is the origin of monozygotic twins?

a) Fertilization of two separate ova by two separate sperm

b) Fertilization of one ovum by two sperm

c) Splitting of a single fertilized ovum during the first 2 weeks after conception

d) Fusion of two embryos into one

A

c) Splitting of a single fertilized ovum during the first 2 weeks after conception

Rationale: Monozygotic twins develop from the splitting of a single fertilized ovum, leading to genetically identical offspring.

212
Q

What type of twins are formed when two sperm fertilize two separate ova?

a) Monozygotic twins

b) Conjoined twins

c) Dizygotic twins

d) Superfetation twins

A

c) Dizygotic twins

Rationale: Dizygotic twins, also known as fraternal twins, result from the fertilization of two separate ova by two separate sperm.

213
Q

Which of the following is a characteristic of dizygotic twins?

a) They share a single amnion and chorion.

b) They always have separate amnions, chorions, and placentas.

c) They are genetically identical.

d) They are formed when one zygote splits.

A

b) They always have separate amnions, chorions, and placentas.

Rationale: Dizygotic twins develop from two separate ova and always have their own amnions, chorions, and placentas, though these may fuse together.

214
Q

Which of the following statements about monozygotic twins is correct?

a) They are genetically identical because they originate from one fertilized ovum.

b) They are always fraternal and result from two separate fertilized ova.

c) They have completely separate amnions, chorions, and placentas.

d) They are formed when two ova are fertilized by the same sperm.

A

a) They are genetically identical because they originate from one fertilized ovum.

Rationale: Monozygotic twins are genetically identical because they result from the division of a single fertilized ovum.

215
Q

How are the placental structures different between monozygotic and dizygotic twins?

a) Monozygotic twins always share one placenta, while dizygotic twins always have separate placentas.

b) Both monozygotic and dizygotic twins share a single placenta.

c) Dizygotic twins always have separate placentas, while monozygotic twins may or may not share a placenta.

d) Monozygotic twins always have separate placentas, but dizygotic twins may share one placenta.

A

c) Dizygotic twins always have separate placentas, while monozygotic twins may or may not share a placenta.

Rationale: Dizygotic twins develop from two separate ova and always have separate placentas. Monozygotic twins may share a placenta depending on when the fertilized ovum splits.

NUR247 - Maternal OB (16 decks)

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