Chapter 11- The Critically Ill Pregnant Woman My Nursing Test Banks

 

1.

A pregnant woman in her third trimester is in the ICU for minor trauma to her right arm and leg as a result of a car wreck. Her injuries appear to be superficial, but her nose begins bleeding profusely immediately after the nurse places a nasotracheal tube. What is the most likely explanation for the bleeding?

A)

Internal hemorrhaging from trauma

B)

Hemophilia

C)

Rupture of the mucosa, which are extra fragile during pregnancy

D)

Improper placement of tube

2.

An obese woman was admitted to the ICU for diabetic coma caused by advanced diabetic ketoacidosis. On recovering, the patient mentions to the nurse that she missed her last period and has felt nauseated in recent weeks. In reviewing her chart, the nurse compares her current test results with those from her last admission to the hospital, about 3 months ago. She notes that the womans red blood cell count has increased by 20%, her systolic blood pressure has increased by 10 mm Hg, her resting heart rate has increased from 85 to 105 bpm, and her creatinine clearance has increased from 90 to 130 mL/min. Which of these changes is consistent with those that normally accompany pregnancy? Select all that apply.

A)

20% increase in red blood cells

B)

10 mm Hg increase in systolic blood pressure

C)

Increase in resting heart rate from 85 to 105 bpm

D)

Increase in creatinine clearance from 90 to 130 mL/min

3.

A woman in her ninth month of pregnancy is in the ICU, recovering from surgery to remove a stage 1 tumor from her brain. She is still under the effects of general anesthesia. As the nurse is taking her vital signs, the woman regurgitates some fluid from her mouth. What is the most likely cause of the regurgitation?

A)

Esophageal cancer

B)

Displacement of the esophageal sphincter

C)

Airway obstruction

D)

Congenital defect of the esophagus

4.

Blood work results of a pregnant woman in her third trimester in the ICU have recently been delivered, and the nurse is reviewing them. The woman has a hematocrit of 35%, a white blood cell count of 4,000/mm3, and a fibrinogen level of 500 mg/dL. She also has a blood pressure reading of 118/70 mm Hg. Which of these is in the normal range for a pregnant woman? Select all that apply.

A)

Hematocrit of 35%

B)

White blood cell count of 4,000/mm3

C)

Fibrinogen level of 500 mg/dL

D)

Blood pressure of 118/70 mm Hg

5.

A pregnant woman has arrived at the ICU with a blood pressure reading of 170/115, pronounced edema in her hands and feet, and proteinuria. Which condition does the woman most likely have?

A)

Severe preeclampsia

B)

Preeclampsia

C)

Disseminated intravascular coagulation

D)

HELLP syndrome

6.

A patient who experienced severe preeclampsia during her pregnancy has just delivered her baby in the ICU. She has been receiving magnesium sulfate therapy to prevent seizures. Which of the following would be the correct nursing intervention in this situation?

A)

Discontinue the magnesium sulfate therapy immediately.

B)

Continue the magnesium sulfate therapy for 2 hours after delivery.

C)

Continue the magnesium sulfate therapy for 24 hours after delivery.

D)

Explain to the patient that she will have to remain on magnesium sulfate therapy for the rest of her life.

7.

A patient with severe preeclampsia in the ICU has recently had a seizure. She is currently receiving magnesium sulfate therapy. What intervention can the nurse make to reduce the risk for future seizures in this patient?

A)

Turn off the overhead lights in the room.

B)

Stop the magnesium sulfate therapy.

C)

Have the physician prescribe hydralazine to her.

D)

Place a wedge under the womans right hip.

8.

A woman in her seventh month of pregnancy presents to the ICU with hemolysis, elevated liver enzymes, and a low platelet count. Which condition does this woman most likely have, and what is a proper intervention?

A)

Severe preeclampsia; magnesium sulfate therapy

B)

Disseminated intravascular coagulation; broad-spectrum antibiotics

C)

Amniotic fluid embolism; intubation and ventilation with 100% oxygen

D)

HELLP syndrome; antihypertensive agents

9.

The nurse is working with a patient with severe preeclampsia and acute respiratory distress syndrome (ARDS). The patient is receiving mechanical ventilation using positive end-expiratory pressure. Which nursing intervention would be most appropriate in this situation?

A)

Position the patient on her side.

B)

Turn off the overhead light.

C)

Evaluate the patient for neurological symptoms of seizure.

D)

Perform CPR.

10.

A pregnant woman has been admitted to the ICU with disseminated intravascular coagulation (DIC). She exhibits tachycardia, tachypnea, temperature instability, increased cardiac output, and decreased peripheral resistance. What is the most likely underlying cause of DIC in this situation and what is the best intervention?

A)

Preeclampsia; antihypertensive agents

B)

Sepsis; broad-spectrum antibiotics

C)

Amniotic fluid embolism; intubation and ventilation with 100% oxygen

D)

Abruptio placentae; prompt delivery of the fetus

11.

A pregnant woman who is due to give birth in 2 weeks is shot in the shoulder during a robbery. Estimated blood loss at the scene was 500 mL, and she lost another 500 mL during surgical repair. The patient is admitted to the CCU and is in a supine position. Which initial assessment findings would the nurse anticipate?

A)

Vital signs consistent with compensated shock

B)

Slightly high pulse and blood pressure, alert and oriented, skin warm

C)

Severe and constant lower abdominal pain

D)

Severe tachycardia and hypotension, obtunded, skin cool and pale

12.

A pregnant woman was admitted to the CCU for monitoring after an elective surgical procedure. Arterial blood gases are as follows: pH 7.48, PaCO2 27, HCO3 ion 21, PaO2 108, SaO2100%. Respiratory rate is slightly elevated. The patient is receiving oxygen by mask at 40% and maintenance intravenous fluids. What is the most important nursing action?

A)

Reduce inhaled oxygen because the PaO2 and SaO2 are too high.

B)

Medicate for pain because the acidbase balance indicates respiratory alkalosis.

C)

Consider intubation and mechanical ventilation to support gas exchange.

D)

Continue the current plan of care, as results are within normal limits.

13.

A pregnant woman is admitted to a CCU after a motor vehicle crash. She is endotracheally intubated and mechanically ventilated. Respiratory assessment reveals diminished lung sounds at posterior bases, decreased functional residual capacity, and increased spontaneous tidal volume. What is the highest-priority nursing action?

A)

Obtain orders for ventilator setting adjustments to compensate for the abnormal findings.

B)

Suction the patient via the endotracheal tube to stimulate cough.

C)

Continue the present plan of care, as the findings are expected.

D)

Obtain orders for an inhaled bronchodilator for bronchospasm.

14.

A pregnant woman is admitted to the CCU after a traumatic incident. The nurse is concerned that the patient may be having significant and unidentified blood loss. Which assessment findings could indicate significant blood loss?

A)

Slightly decreased hemoglobin and hematocrit

B)

Urine output less than 40 mL/hr

C)

Elevated creatinine and urea clearance rates

D)

Slightly low serum creatinine and blood urea nitrogen

15.

A woman who is 8 months pregnant is being assessed on a routine clinic visit. Which assessment findings require further assessment and treatment?

A)

Blood pressure increased by 10 points from previous visit

B)

Blood pressure 150/95 mm Hg

C)

1+ edema of lower extremities

D)

Urine output 750 mL in 24 hours

16.

A pregnant woman at 30 weeks gestation is in the CCU with severe eclampsia. She is experiencing pulmonary edema, severe oliguria, and hypotension and continues to have seizures. She is endotracheally intubated, supported by a mechanical ventilator, and is receiving intravenous magnesium sulfate at 3 g/hr; the serum magnesium level is 8 mg/dL. She is beginning spontaneous early labor. What is the most important intervention?

A)

Administer medication to delay the onset of labor, as the baby is preterm.

B)

Increase the dose of magnesium sulfate to control seizures.

C)

Facilitate delivery of the baby, as eclampsia is worsening.

D)

Administer high-dose diuretics for the pulmonary edema.

17.

The nurse is caring for a pregnant woman with severe preeclampsia. Based on the pathophysiology of severe preeclampsia, the nurse expects what changes in assessment data?

A)

Pulmonary edema from capillary leakage or diminished left ventricular function

B)

Increased urine output from glomerular capillary damage

C)

Decreased serum creatinine from increased urine output

D)

Decreased serum aspartate aminotransferase (AST) from liver damage

18.

A pregnant woman with severe preeclampsia is receiving intravenous magnesium sulfate at 3 g/hr. Her serum magnesium level is 7 mg/dL. What is the most important nursing assessment?

A)

Decreased incidence and frequency of seizures

B)

Decreased respiratory rate and hyporeflexia

C)

Increased urine output greater than 40 mL/hr

D)

Flushing of skin and diaphoresis

19.

A pregnant woman with severe preeclampsia is being managed with intravenous magnesium sulfate. Which nursing assessment would indicate that the dose of magnesium sulfate would need to be increased?

A)

Increased frequency of seizures

B)

Hyporeflexia and diaphoresis

C)

Serum magnesium level of 16 mg/dL

D)

Increased drowsiness and flushed skin

20.

A woman is admitted to CCU after delivery of a retained demised fetus from abruptio placentae. The patient develops disseminated intravascular coagulation (DIC). What findings are present in DIC?

A)

Diminished platelets and elevated partial thromboplastin time

B)

Elevated white blood cell count and elevated immature neutrophils

C)

Diminished clotting time and prothrombin time

D)

Elevated fibrinogen and diminished fibrinogen split products

21.

The nurse is monitoring a pregnant woman who is at high risk for the development of disseminated intravascular coagulation (DIC). What physical assessment findings would indicate DIC?

A)

Urine clear without sediment at 40 mL/hr

B)

Oozing blood from all intravenous sites

C)

All vital signs within expected parameters for pregnancy

D)

Absence of elevated protein in urine or serum

22.

During a patients cesarean section delivery of twin girls, the patient had a sudden onset of dyspnea and cyanosis with a drop in blood pressure, and then developed cardiac arrest. Based on these clinical events, the nurse suspects what complication?

A)

Disseminated intravascular coagulation

B)

Amniotic fluid embolism

C)

Uterine prolapse

D)

Massive myocardial infarction

23.

A pregnant woman who is close to term is admitted to the emergency room after being involved in a motor vehicle crash. Within moments, she experiences a cardiopulmonary arrest. What is a nursing priority in the care of this woman?

A)

Initiate cardiopulmonary resuscitation as for any patient.

B)

Monitor fetal heart tones continuously.

C)

During care, place a 2-inch wedge under the patients right hip.

D)

Administer oxygen by nasal cannula at 2 L/min.

24.

A pregnant woman is admitted to the emergency room after a motor vehicle crash. She is unresponsive and covered with blood. A cervical spine collar and back board are in place. What should the nurse assess first?

A)

Airway, breathing, circulation, and level of consciousness

B)

Vital signs and urine output and protein

C)

Fetal heart sounds, movement, and position

D)

External and internal bleeding symptoms

25.

A pregnant woman at term who is being cared for in the CCU after a traumatic injury goes into labor. She is critically ill and somewhat unstable. What is the best nursing action to support this patient?

A)

Assign a nurse to be her labor coach and stay with the patient.

B)

Contact the patients planned labor coach to be with the patient.

C)

Sedate the patient so that the labor will not interfere with other care.

D)

Immediately prepare for an emergency cesarean section.

Answer Key

1.

C

2.

A, C, D

3.

B

4.

A, C, D

5.

A

6.

C

7.

A

8.

D

9.

A

10.

B

11.

B

12.

D

13.

C

14.

B

15.

B

16.

C

17.

A

18.

B

19.

A

20.

A

21.

B

22.

B

23.

C

24.

A

25.

B

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