MIDTERM CH 19, 21: New Pregnany Complications Flashcards

Question

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

Answer 1

C) Fetal genetic abnormalities

Answer 2

C) I'm sorry you lost your baby.

Answer 3

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.

Answer 4

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.

Answer 5

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.

Answer 6

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.

Answer 7

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.

Answer 8

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.

Answer 9

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.

Answer 10

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.

Answer 11

D. All of the above Rationale: An ectopic pregnancy can implant in various locations outside the uterine cavity, including the fallopian tubes, cervix, ovary, and the abdominal cavity.

Answer 12

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

Answer 13

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

Answer 14

C. To prevent a potentially life-threatening condition Rationale: Predicting tubal rupture before it occurs is crucial in ectopic pregnancies to prevent a potentially life-threatening condition and manage the pregnancy loss effectively.

Answer 15

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

Answer 16

B. Arrested or altered journey along the fallopian tube Rationale: In an ectopic pregnancy, the fertilized ovum implants outside the uterus due to an arrested or altered journey along the fallopian tube.

Answer 17

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

Answer 18

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

Answer 19

B. Laparoscopic surgery or intramuscular (IM) methotrexate administration Rationale: Laparoscopic surgery or intramuscular (IM) methotrexate administration are considered safe and effective treatments for clinically stable women diagnosed with nonruptured ectopic pregnancies.

Answer 20

C. Abdominal pain, amenorrhea, and vaginal bleeding Rationale: The classic clinical triad of ectopic pregnancy includes abdominal pain, amenorrhea, and vaginal bleeding, although only about half of women present with all three symptoms

Answer 21

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

Answer 22

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

Answer 23

C. Hemodynamically stable Rationale: To be eligible for medical therapy with methotrexate, the client must be hemodynamically stable, with no signs of active bleeding in the peritoneal cavity, low beta-hCG levels (lower than 5,000 mIU/mL), and the mass must be unruptured and measure less than 4 cm as determined by ultrasound.

Answer 24

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

Answer 25

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

Answer 26

D. Inhibiting cell division in the developing embryo Rationale: Methotrexate is a folic acid antagonist that inhibits cell division in the developing embryo, which is its main mechanism of action in treating ectopic pregnancy.

Answer 27

A. Nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness Rationale: Adverse effects associated with methotrexate treatment for ectopic pregnancy include nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness.

Answer 28

C. Weekly laboratory studies until beta-hCG titers decrease Rationale: After methotrexate administration for ectopic pregnancy, the woman is instructed to return weekly for follow-up laboratory studies until beta-hCG titers decrease.

Answer 29

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

Answer 30

B. To control possible uncontrolled hemorrhage Rationale: Surgery is necessary in cases of ruptured ectopic pregnancy to control possible uncontrolled hemorrhage, which is a medical emergency.

Answer 31

B. To ensure that any residual trophoblastic tissue that forms the placenta is gone Rationale: Monitoring beta-hCG levels until they are undetectable ensures that any residual trophoblastic tissue that forms the placenta is completely removed.

Answer 32

C. Determining the existence of an ectopic pregnancy and whether or not it has ruptured Rationale: The primary focus of nursing assessment is determining the existence of an ectopic pregnancy and whether or not it has ruptured.

Answer 33

C. At about the 7th or 8th week of gestation Rationale: The signs and symptoms of ectopic pregnancy usually begin at about the 7th or 8th week of gestation.

Answer 34

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

Answer 35

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

Answer 36

B. Missed menstrual period, adnexal fullness, and tenderness

Answer 37

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

Answer 38

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

Answer 39

C. Double every 2 to 4 days

Answer 40

A. Ectopic pregnancy or impending abortion

Answer 41

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

Answer 42

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

Answer 43

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

Answer 44

C. To confirm the location of the pregnancy

Answer 45

C) Recurrent pelvic infections

Answer 46

A) Hemorrhage

Answer 47

A. Cervical insufficiency Rationale: Cervical insufficiency, also known as premature dilation of the cervix, describes a weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions, resulting in pregnancy loss.

Answer 48

B. In the second trimester or early third trimester

Answer 49

C. Less elastin, less collagen, and greater amounts of smooth muscle Rationale: The cervix in cases of cervical insufficiency may have less elastin, less collagen, and greater amounts of smooth muscle, leading to a loss of sphincter tone.

Answer 50

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

Answer 51

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

Answer 52

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

Answer 53

A. To support and reinforce the cervix

Answer 54

B. Suture displacement, rupture of membranes, and chorioamnionitis

Answer 55

D. To avoid unnecessary interventions if there is no infection

Answer 56

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

Answer 57

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

Answer 58

D. Cervical Insufficiency

Answer 59

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

Answer 60

B. Between 16 and 24 weeks’ gestation

Answer 61

A. Risk of preterm labor

Answer 62

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

Answer 63

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

Answer 64

B. The early separation of a normally implanted placenta after the 20th week of gestation, leading to hemorrhage Rationale: Placental abruption is the early separation of a normally implanted placenta after the 20th week of gestation, which leads to hemorrhage.

Answer 65

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

Answer 66

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

Answer 67

B. Maternal hypertension and preeclampsia

Answer 68

B. Mild (grade 1) Rationale: Mild (grade 1) placental abruption is associated with no sign of vaginal bleeding or minimal bleeding, marginal separation, and no fetal distress.

Answer 69

A. Concealed or apparent

Answer 70

B. Starting two large-bore IV lines with normal saline or lactated Ringer’s solution Rationale: Starting two large-bore IV lines with normal saline or lactated Ringer’s solution is critical to combat hypovolemia in placental abruption.

Answer 71

D. If fetal distress is evident

Answer 72

A. Determining the underlying cause of DIC and correcting it

Answer 73

C. Maternal hemodynamic status and fetal well-being

Answer 74

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

Answer 75

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

Answer 76

B. Disseminated intravascular coagulation (DIC)

Answer 77

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

Answer 78

A. Possible fetal compromise

Answer 79

C. To observe for changes suggesting hypovolemic shock

Answer 80

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

Answer 81

C. Can be concealed or visible

Answer 82

B. Firm to rigid

Answer 83

C. Usually in normal range

Answer 84

A. Breech or transverse lie; engagement is absent

Answer 85

D. Constant; uterine tenderness on palpation

Answer 86

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

Answer 87

D. Last two trimesters

Answer 88

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

Answer 89

A. Higher likelihood of uterine abnormalities

Answer 90

D. Causes scarring and structural changes in the uterine lining

Answer 91

A. Increases the chances of placental implantation Rationale: Multiparity increases the chances of placental implantation in the lower uterine segment, raising the risk of placenta previa.

Answer 92

B. Previous D&C, endometrial ablation, and previous myomectomy Rationale: Previous uterine procedures such as D&C, endometrial ablation, and previous myomectomy are risk factors for placenta previa.

Answer 93

C. Causes vascular constriction and impaired placental attachment

Answer 94

C. Often involves procedures that can alter the uterine lining

Answer 95

A. May not allow sufficient time for uterine healing

Answer 96

D. Painless, bright red vaginal bleeding during the second or third trimester Rationale: The classical clinical presentation of placenta previa is painless, bright red vaginal bleeding occurring during the second or third trimester.

Answer 97

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

Answer 98

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

Answer 99

D. Transvaginal Ultrasound

Answer 100

C. To identify placental abnormalities

Answer 101

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

Answer 102

C. Prepare for blood typing and cross-matching in case a blood transfusion is needed Rationale: If the woman is experiencing active bleeding, blood typing and cross-matching should be prepared in case a blood transfusion is needed.

Answer 103

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

Answer 104

D. Any bleeding episodes or backaches

Answer 105

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

Answer 106

A) Dark red vaginal bleeding D) Rigid uterus E) Absent fetal heart tones

Answer 107

A. Regular uterine contractions with cervical dilation and effacement before 37 weeks Rationale: Preterm labor involves uterine contractions leading to cervical changes before 37 weeks of gestation.

Answer 108

B. African American clients

Answer 109

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

Answer 110

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

Answer 111

B. Prematurity

Answer 112

D. Cerebral palsy and vision defects

Answer 113

C. Extent of cervical dilation Rationale: The decision to administer tocolytic drugs depends on several factors, including the extent of cervical dilation, as more dilation may indicate a higher likelihood of imminent preterm birth.

Answer 114

B. To delay labor long enough for steroids to improve fetal lung maturity Rationale: Tocolytic therapy aims to delay preterm labor long enough to administer corticosteroids, which enhance fetal lung development and reduce neonatal respiratory distress syndrome.

Answer 115

A. Magnesium sulfate

Answer 116

A. Maternal hemodynamic instability Rationale: Tocolytic therapy is contraindicated in cases of maternal hemodynamic instability, as it could exacerbate the condition and compromise both maternal and fetal health.

Answer 117

B. At least 24 hours before delivery Rationale: Corticosteroids should be administered at least 24 hours before delivery to be effective in promoting fetal lung maturation and reducing respiratory distress syndrome.

Answer 118

C. Respiratory depression Rationale: Magnesium sulfate can cause respiratory depression as a side effect, requiring careful monitoring of the woman’s respiratory status during administration.

Answer 119

C. Tocolytic therapy may delay birth long enough for corticosteroids to be administered. Rationale: Tocolytics are not designed to prevent preterm birth completely but to delay labor, allowing time for corticosteroids to enhance fetal lung maturity.

Answer 120

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

Answer 121

C. Consider delivery as the risks of continuing pregnancy outweigh the benefits Rationale: After 34 weeks, the risks of prematurity decrease significantly, so delivery is often recommended over further attempts to delay labor.

Answer 122

B. The gestational age of the fetus

Answer 123

B. Increased vaginal discharge with mucus or blood Rationale: One of the subtle signs of preterm labor is a change or increase in vaginal discharge, which may contain mucus, water, or blood.

Answer 124

A. Preterm labor

Answer 125

C. Fetal fibronectin test Rationale: The fetal fibronectin test is valuable for assessing the risk of preterm labor, as high levels of fetal fibronectin are associated with impending preterm birth.

Answer 126

B. Use of lubricants during a pelvic exam

Answer 127

C. Preterm labor is unlikely within the next two weeks Rationale: A negative fetal fibronectin result is a strong predictor that preterm labor is unlikely in the next two weeks, reducing the need for aggressive interventions.

Answer 128

C. To predict the likelihood of preterm birth Rationale: Measuring cervical length helps predict the likelihood of preterm birth, especially in high-risk pregnancies, by identifying women at greater risk based on cervical shortening.

Answer 129

A. To detect fetal lung maturity and chorioamnionitis Rationale: Amniotic fluid analysis is used to assess fetal lung maturity and detect signs of chorioamnionitis, which could contribute to preterm labor.

Answer 130

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

Answer 131

D. A positive fetal fibronectin test Rationale: A positive fetal fibronectin test, along with clinical signs such as uterine contractions, increases the likelihood of preterm labor in the following two weeks.

Answer 132

C) Maternal respiratory effort and deep tendon reflexes Rationale: Magnesium sulfate requires frequent monitoring of maternal respiratory effort and deep tendon reflexes for early signs of overdose.

Answer 133

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

Answer 134

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

Answer 135

D) “Avoid traveling for long distances in cars or buses.” Rationale: Avoiding long-distance travel is part of preventing preterm labor by minimizing stress and exertion.

Answer 136

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

Answer 137

B) Limit vaginal exams to reduce the risk of infection Rationale: Vaginal exams should be limited to reduce the risk of ascending infection during preterm labor.

Answer 138

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

Answer 139

B) Instruct the client to lie on her side and drink fluids Rationale: The nurse should initially instruct the client to rest, lie on her side, and hydrate to see if symptoms subside before taking further action.

Answer 140

D) Vaginal discharge that increases in volume Rationale: An increase in vaginal discharge with mucus or blood may indicate preterm labor and requires immediate medical attention.

Answer 141

C) Measure the client’s urinary output hourly Rationale: Magnesium sulfate is excreted by the kidneys, so monitoring urinary output is critical for safe administration.

Answer 142

C) Maintain a pregnancy spacing interval of at least 18 months Rationale: Maintaining an appropriate pregnancy spacing interval of at least 18 months reduces the risk of preterm labor.

Answer 143

A) “Cervical cerclage is used to prevent preterm labor by strengthening the cervix.” Rationale: Cervical cerclage is used to prevent premature cervical dilation and preterm labor in women with a shortened cervix.

Answer 144

B) Respiratory rate of 11 breaths per minute Rationale: A respiratory rate of less than 12 breaths per minute is a sign of magnesium sulfate toxicity, requiring immediate intervention.

Answer 145

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

Answer 146

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

Answer 147

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

Answer 148

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

Answer 149

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

Answer 150

B. Premature closure of the fetal ductus arteriosus Rationale: Indomethacin can decrease amniotic fluid volume but may cause premature closure of the fetal ductus arteriosus.

Answer 151

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

Answer 152

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

Answer 153

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

Answer 154

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

Answer 155

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

Answer 156

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

Answer 157

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

Answer 158

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

Answer 159

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

Answer 160

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

Answer 161

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

Answer 162

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

Answer 163

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

Answer 164

B. Less than 500 mL Rationale: Oligohydramnios is defined as a decreased amniotic fluid volume of less than 500 mL during the specified gestational period.

Answer 165

C. Cord compression Rationale: Reduced amniotic fluid limits the fetus’s ability to move freely, increasing the risk of cord compression, intrapartal hypoxia, and fetal death.

Answer 166

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

Answer 167

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

Answer 168

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

Answer 169

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

Answer 170

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

Answer 171

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

Answer 172

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

Answer 173

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

Answer 174

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

Answer 175

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

Answer 176

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

Answer 177

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

Answer 178

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

Answer 179

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

Answer 180

A) Ensure the client has had no vaginal exams, intercourse, or penetration within 24 hours Rationale: Vaginal exams, intercourse, or penetration within 24 hours can lead to a false positive result, so it’s essential to ensure these activities have not occurred.

Answer 181

C) The client is unlikely to deliver preterm (99% negative predictive value) Rationale: A negative fFN test result is highly predictive that preterm labor will not occur, with a 99% negative predictive value.

Answer 182

C) Confirm that no cervical exams have been performed within the past 24 hours Rationale: The presence of cervical exams within 24 hours can lead to false results, so this must be confirmed before performing the test.

Answer 183

C) “A positive test result is a definitive indicator that I will deliver within the next week.” Rationale: A positive fFN test result is not a definitive indicator of preterm delivery; it only suggests a likelihood, with delivery often occurring within 1-2 weeks, but the result can be false positive.

Answer 184

D) Monitor the client closely for signs and symptoms of preterm labor Rationale: A positive fFN result suggests a potential for preterm labor, so the nurse should monitor the client closely for symptoms and manage care accordingly.

Answer 185

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

Answer 186

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.

Answer 187

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

Answer 188

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.

Answer 189

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.

Answer 190

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.