Unit I-Labor and Delivery Complications Flashcards
In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states:
a. “I will need to increase my insulin dosage during the first 3 months of pregnancy.”
b. “Insulin dosage will likely need to be increased during the second and third
trimesters.”
c. “Episodes of hypoglycemia are more likely to occur during the first 3 months.”
d. “Insulin needs should return to normal within 7 to 10 days after birth if I am
bottle-feeding.”
ANS: A
Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. “Insulin dosage will likely need to be increased during the second and third trimesters,” “Episodes of hypoglycemia are more likely to occur during the first 3 months,” and “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding” are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy.
Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:
a. frequent episodes of maternal hypoglycemia.
b. congenital anomalies in the fetus.
c. polyhydramnios.
d. hyperemesis gravidarum.
ANS: B
Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contributes to hypoglycemia.
In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the:
a. mother’s age.
b. number of years since diabetes was diagnosed.c. amount of insulin required prenatally.
d. degree of glycemic control during pregnancy.
ANS: D
Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes
Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for:
a. macrosomia.
b. congenital anomalies of the central nervous system.
c. preterm birth.
d. low birth weight
ANS: A
Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman.
A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 lbs less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time?
a. Deficient fluid volume
b. Imbalanced nutrition: less than body requirements
c. Imbalanced nutrition: more than body requirements
d. Disturbed sleep pattern
ANS: B
This patient’s clinical cues include weight loss, which would support the nursing diagnosis of Imbalanced nutrition: less than body requirements. No clinical signs or symptoms support the nursing diagnosis of Deficient fluid volume. This patient reports weight loss, not weight gain. Imbalanced nutrition: more than body requirements is not an appropriate nursing diagnosis. Although the patient reports nervousness based on the patient’s other clinical symptoms the most appropriate nursing diagnosis would be Imbalanced nutrition: less than body requirements.
Maternal phenylketonuria (PKU) is an important health concern during pregnancy because:
a. it is a recognized cause of preterm labor.
b. the fetus may develop neurologic problems.
c. a pregnant woman is more likely to die without dietary control.
d. women with PKU are usually retarded and should not reproduce.
ANS: B
Children born to women with untreated PKU are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PKU has no effect on labor. Women without dietary control of PKU are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first prenatal visit may be warranted, especially in individuals with a family history of the disorder, with low intelligence of uncertain etiology, or who have given birth to microcephalic infants.
In terms of the incidence and classification of diabetes, maternity nurses should know that:
a. type 1 diabetes is most common.
b. type 2 diabetes often goes undiagnosed.
c. gestational diabetes mellitus (GDM) means that the woman will be receiving
insulin treatment until 6 weeks after birth.
d. type 1 diabetes may become type 2 during pregnancy.
ANS: B
Type 2 diabetes often goes undiagnosed because hyperglycemia develops gradually and often
is not severe. Type 2 diabetes, sometimes called adult onset diabetes, is the most common. GDM refers to any degree of glucose intolerance first recognized during pregnancy. Insulin may or may not be needed. People do not go back and forth between type 1 and 2 diabetes.
Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should understand that:
a. insulin crosses the placenta to the fetus only in the first trimester, after which the
fetus secretes its own.
b. women with insulin-dependent diabetes are prone to hyperglycemia during the first
trimester because they are consuming more sugar.
c. during the second and third trimesters, pregnancy exerts a diabetogenic effect that
ensures an abundant supply of glucose for the fetus.
d. maternal insulin requirements steadily decline during pregnancy.
ANS: C
Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own insulin around the 10th week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy.
With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that:
a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
b. Hydramnios occurs approximately twice as often in diabetic pregnancies.
c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies.
d. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being.
ANS: A
Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild-to-moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.
The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc:
a. is now done for all pregnant women, not just those with or likely to have diabetes.
b. is a snapshot of glucose control at the moment.
c. would be considered evidence of good diabetes control with a result of 5% to 6%.
d. is done on the patient’s urine, not her blood.
ANS: C
A score of 5% to 6% indicates good control. This is an extra test for diabetic women, not one done for all pregnant women. This test defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are done on the blood.
A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)?
a. 75 mg/dL before lunch. This is low; better eat now.
b. 115 mg/dL 1 hour after lunch. This is a little high; maybe eat a little less next time.
c. 115 mg/dL 2 hours after lunch; This is too high; it is time for insulin.
d. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack
before going to sleep.
ANS: D
60 mg/dL after waking from a nap is too low. During hours of sleep glucose levels should not be less than 70 mg/dL. Snacks before sleeping can be helpful. The premeal acceptable range is 65 to 95 mg/dL. The readings 1 hour after a meal should be less than 140 mg/dL. Two hours after eating, the readings should be less than 120 mg/dL.
A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding?
a. Hyperthyroidism
b. Phenylketonuria (PKU)
c. Hypothyroidism
d. Thyroid storm
ANS: B
PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine. A woman with hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism.
When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include:
a. a regular heart rate and hypertension.
b. an increased urinary output, tachycardia, and dry cough.
c. shortness of breath, bradycardia, and hypertension.
d. dyspnea; crackles; and an irregular, weak pulse.
ANS: D
Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosisofthelipsandnailbeds.NAURreSgINulGaTrBh.eCaOrtMrateandhypertensionarenotgenerally associated with cardiac decompensation. Tachycardia would indicate cardiac decompensation, but increased urinary output and a dry cough would not. Shortness of breath would indicate cardiac decompensation, but bradycardia and hypertension would not.
While providing care in an obstetric setting, the nurse should understand that after birth care of the woman with cardiac disease:
a. is the same as that for any pregnant woman.
b. includes rest, stool softeners, and monitoring of the effect of activity.
c. includes ambulating frequently, alternating with active range of motion.
d. includes limiting visits with the infant to once per day.
ANS: B
Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. Care of the woman with cardiac disease in the after birth period is tailored to the woman’s functional capacity. The woman will be on bed rest to conserve energy and reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated.
A woman with asthma is experiencing a after birth hemorrhage. Which drug would not be used to treat her bleeding because it may exacerbate her asthma?
a. Pitocin
b. Nonsteroidal anti-inflammatory drugs (NSAIDs)
c. Hemabate
d. Fentanyl
ANS: C
Prostaglandin derivatives should not be used to treat women with asthma because they may exacerbate symptoms. Pitocin would be the drug of choice to treat this woman’s bleeding because it would not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding.
The use of methamphetamine (meth) has been described as a significant drug problem in the United States. In order to provide adequate nursing care to this patient population the nurse must be cognizant that methamphetamine:
a. is similar to opiates.
b. is a stimulant with vasoconstrictive characteristics.
c. should not be discontinued during pregnancy.
d. is associated with a low rate of relapse.
ANS: B
Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and
are used similarly. As is the case with cocaine users, methamphetamine users are urged to immediately stop all use during pregnancy. Unfortunately, because methamphetamine users are extremely psychologically addicted, the rate of relapse is very high.
Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to statistics, how often does cystic fibrosis occur in Caucasian live births?
a. 1 in 100
b. 1 in 1200
c. 1 in 2500
d. 1 in 3000
ANS: D
Cystic fibrosis occurs in about 1 in 3000 Caucasian live births.
Which heart condition is not a contraindication for pregnancy?
a. Peripartum cardiomyopathy
b. Eisenmenger syndrome
c. Heart transplantd. All of these contraindicate pregnancy.
ANS: C
Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation.
During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:
a. euglycemia.
b. rheumatic fever.
c. pneumonia.
d. cardiac decompensation.
ANS: D
Symptoms of cardiac decompensation may appear abruptly or gradually. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not manifest with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation.
NursescaringforantepartumwomNeUnRwSIiNthGTcaBr.dCiOaMcconditionsshouldbeawarethat:
a. stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
b. women with Class II cardiac disease should avoid heavy exertion and any activity
that causes even minor symptoms.
c. women with Class III cardiac disease should have 8 to 10 hours of sleep every day
and limit housework, shopping, and exercise.
d. Women with Class I cardiac disease need bed rest through most of the pregnancy
and face the possibility of hospitalization near term.
ANS: B
Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32, when homodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less than ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can carry on limited normal activities with discretion, although they still need a good amount of sleep.
As related to the care of the patient with anemia, the nurse should be aware that:
a. it is the most common medical disorder of pregnancy.
b. it can trigger reflex brachycardia.
c. the most common form of anemia is caused by folate deficiency.
d. thalassemia is a European version of sickle cell anemia.
ANS: A
Combined with any other complication, anemia can result in congestive heart failure. Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth. The most common form of anemia is iron deficiency anemia. Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas.
The most common neurologic disorder accompanying pregnancy is:
a. eclampsia.
b. Bell’s palsy.
c. epilepsy.
d. multiple sclerosis.
ANS: C
The effects of pregnancy on epilepsy are unpredictable. Eclampsia sometimes may be confused with epilepsy, which is the most common neurologic disorder accompanying pregnancy. Bell’s palsy is a form of facial paralysis. Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth.
With one exception, the safest pregnancy is one in which the woman is drug and alcohol free. For women addicted to opioids, ________________________ treatment is the current standard of care during pregnancy.
a. methadone maintenance
b. detoxification
c. smoking cessation
d. 4 Ps Plus
ANS: A
Methadone maintenance treatment (MMT) is currently considered the standard of care for pregnant women who are dependent on heroin or other narcotics. Buprenorphine is another medication approved for opioid addiction treatment that is increasingly being used during pregnancy. Opioid replacement therapy has been shown to decrease opioid and other drug use, reduce criminal activity, improve individual functioning, and decrease rates of infections such as hepatitis B and C, HIV, and other sexually transmitted infections. Detoxification is the treatment used for alcohol addiction. Pregnant women requiring withdrawal from alcohol should be admitted for inpatient management. Women are more likely to stop smoking during pregnancy than at any other time in their lives. A smoking cessation program can assist in achieving this goal. The 4 Ps Plus is a screening tool designed specifically to identify pregnant women who need in-depth assessment related to substance abuse
Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
a. Hypoglycemia
b. Hypercalcemia
c. Hypobilirubinemia d. Hypoinsulinemia
ANS: A
The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, thus leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth and release large amounts of bilirubin into the neonate’s circulation, with resulting hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, the neonate presents with hyperinsulinemia.
Which factor is known to increase the risk of gestational diabetes mellitus?
a. Underweight before pregnancy
b. Maternal age younger than 25 years
c. Previous birth of large infant
d. Previous diagnosis of type 2 diabetes mellitus
ANS: C
Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years generally is not at risk for gestational diabetes mellitus. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy
Glucose metabolism is profoundly affected during pregnancy because:
a. pancreatic function in the islets of Langerhans is affected by pregnancy.
b. the pregnant woman uses glucose at a more rapid rate than the nonpregnant
woman.
c. the pregnant woman increases her dietary intake significantly.
d. placental hormones are antagonistic to insulin, thus resulting in insulin resistance.
ANS: D
Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin is also broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day.
To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by:
a. eating six small equal meals per day.
b. reducing carbohydrates in her diet.
c. eating her meals and snacks on a fixed schedule.
d. increasing her consumption of protein.
ANS: C
Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates.
When the pregnant diabetic woman experiences hypoglycemia while hospitalized, the nurse should intervene by having the patient:
a. eat six saltine crackers.
b. drink 8 ounces of orange juice with 2 tsp of sugar added.
c. drink 4 ounces of orange juice followed by 8 ounces of milk.
d. eat hard candy or commercial glucose wafers.
ANS: A
Crackers provide carbohydrates inNtUhReSfIoNrGmToBf.CpOoMlysaccharides. Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar. Milk is a disaccharide and orange juice is a monosaccharide. They will provide an increase in blood sugar but will not sustain the level. Hard candy or commercial glucose wafers provide only monosaccharides.
Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin:
a. increases throughout pregnancy and the after birth period.
b. decreases throughout pregnancy and the after birth period.
c. varies depending on the stage of gestation.
d. should not change because the fetus produces its own insulin.
ANS: C
Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. The insulin needs change throughout the different stages of pregnancy.
In caring for a pregnant woman with sickle cell anemia, the nurse is aware that signs and symptoms of sickle cell crisis include:
a. anemia.
b. endometritis.
c. fever and pain.
d. urinary tract infection
ANS: C
Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia, or acidosis. Women with sickle cell anemia are not iron deficient. Therefore, routine iron supplementation, even that found in prenatal vitamins, should be avoided in order to prevent iron overload. Women with sickle cell trait usually are at greater risk for after birth endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign of crisis. These women are at an increased risk for UTIs; however, this is not an indication of sickle cell crisis
Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including: (Select all that apply.)
a. cleft lip.
b. congenital heart disease.
c. neural tube defects.
d. gastroschisis.
e. diaphragmatic hernia.
ANS: A, B, C
Congenital anomalies that can occur with AEDs include cleft lip or palate, congenital heart disease, urogenital defects, and neural tube defects. Gastroschisis and diaphragmatic hernia are not associated with the use of AEDs
Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. These complications include: (Select all that apply.)
a. atherosclerosis.
b. retinopathy.
c. IUFD.
d. nephropathy.
e. neuropathy.
ANS: A, B, D, EThese structural changes are most likely to affect a variety of systems, including the heart, eyes, kidneys, and nerves. Intrauterine fetal death (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication.
Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Identify all disorders that fall into the category of collagen vascular disease.
a. Multiple sclerosis
b. Systemic lupus erythematosus
c. Antiphospholipid syndrome
d. Rheumatoid arthritis
e. Myasthenia gravis
ANS: B, C, D, E
Multiple sclerosis is not an autoimmune disorder. This patchy demyelinization of the spinal cord may be a viral disorder. Autoimmune disorders (collagen vascular disease) make up a large group of conditions that disrupt the function of the immune system of the body. They include those listed, as well as systemic sclerosis.
Women with hyperemesis gravidarum:
a. are a majority because 80% of all pregnant women suffer from it at some time.
b. have vomiting severe and persistent enough to cause weight loss, dehydration, and
electrolyte imbalance.
c. need intravenous (IV) fluid and nutrition for most of their pregnancy.
d. often inspire similar, milder symptoms in their male partners and mothers.
ANS: B
Women with hyperemesis gravidarum have severe vomiting; however, treatment for several days sets things right in most cases. Although 80% of pregnant women experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe level. IV administration may be used at first to restore fluid levels, but it is seldom needed for very long. Women suffering from this condition want sympathy because some authorities believe that difficult relationships with mothers and/or partners may be the cause.
Because pregnant women may need surgery during pregnancy, nurses should be aware that:
a. the diagnosis of appendicitis may be difficult because the normal signs and
symptoms mimic some normal changes in pregnancy.
b. rupture of the appendix is less likely in pregnant women because of the close monitoring.
c. surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy.
d. when pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses.
ANS: A
Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count. Rupture of the appendix is two to three times more likely in pregnant women. Surgery to remove obstructions should be done right away. It usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian problems.
What laboratory marker is indicative of disseminated intravascular coagulation (DIC)?
a. Bleeding time of 10 minutes
b. Presence of fibrin split products
c. Thrombocytopenia
d. Hyperfibrinogenemia
Ans B.Degradation of fibrin leads to the accumulation of fibrin split products in the blood. Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC.
In caring for an immediate after birth patient, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder:
a. disseminated intravascular coagulation (DIC).
b. amniotic fluid embolism (AFE).
c. hemorrhage.
d. HELLP syndrome.
ANS: A
The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman’s arm. Excessive bleeding may occur from the site of slight trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage occurs for a variety of reasons in the after birth patient. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. HELLP is not a clotting disorder, but it may contribute to the clotting disorder DIC.
A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?
a. Blood pressure (BP) increase to 138/86 mm Hg.
b. Weight gain of 0.5 kg during the past 2 weeks.
c. A dipstick value of 3+ for protein in her urine.
d. Pitting pedal edema at the end of the day.
ANS: C
Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or in diastolic pressure of 15 mm Hg. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman’s latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of:
a. eclampsia.
b. disseminated intravascular coagulation (DIC).
c. HELLP syndrome.
d. idiopathic thrombocytopenia.
ANS: C
HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves
hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low
platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential
complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence
of low platelets of unknown cause and is not associated with preeclampsia.
A woman with preeclampsia has a seizure. The nurse’s primary duty during the seizure is to:
a. insert an oral airway.
b. suction the mouth to prevent aspiration.
c. administer oxygen by mask.
d. stay with the patient and call for help.
ANS: D
If a patient becomes eclamptic, the nurse should stay her and call for help. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient’s head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the patient’s mouth. Oxygen would be administered after the convulsion has ended.