Chapter 21: Pregnancy at Risk: Gestational Conditions My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 21: Pregnancy at Risk: Gestational Conditions

Test Bank 

MULTIPLE CHOICE

1. A primigravida is being monitored in her prenatal clinic for preeclampsia. Which 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

Feedback
A Generally hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or 15 mm Hg diastolic pressure.
B Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week.
C Proteinuria is defined as a concentration of (30 mg/dl) 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made.
D Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore the presence of edema is no longer considered diagnostic of preeclampsia.

DIF:Cognitive Level: AnalysisREF:626

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

2. In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?

a. Administration of blood
b. Preparation of the patient for invasive hemodynamic monitoring
c. Restriction of intravascular fluids
d. Administration of steroids

ANS: A

Feedback
A Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters.
B Central monitoring would not be ordered initially in a patient with DIC because this can contribute to more areas of bleeding.
C Management of DIC would include volume replacement, not volume restriction.
D Steroids are not indicated for the management of DIC.

DIF:Cognitive Level: ComprehensionREF:659

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

3. 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

Feedback
A Although 80% of pregnant women experience nausea and vomiting, fewer than 0.5% proceed to this severe level.
B However, treatment for several days sets things right in most cases.
C IV administration may be used at first to restore fluid levels, but they are seldom needed for very long.
D Women suffering from this condition want sympathy, because some authorities believe that difficult relationships with mothers and/or partners may be the cause.

DIF:Cognitive Level: ComprehensionREF:641

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

4. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the womans 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

Feedback
A Eclampsia is determined by the presence of seizures.
B DIC is a potential complication associated with HELLP syndrome.
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).
D Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia.

DIF:Cognitive Level: ComprehensionREF:627

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

5. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3 C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The patient complains, Im so thirsty and warm. The nurse:

a. Calls for a stat magnesium sulfate level.
b. Administers oxygen.
c. Discontinues the magnesium sulfate infusion.
d. Prepares to administer hydralazine.

ANS: C

Feedback
A Regardless of the magnesium level, the patient is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the antidote for magnesium, may be administered.
B The patient is displaying signs of magnesium sulfate toxicity. The first action by the nurse should be to discontinue the infusion of magnesium sulfate.
C The patient is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the antidote for magnesium, may be administered.
D Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.

DIF:Cognitive Level: ApplicationREF:636

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

6. 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

Feedback
A Bleeding time in DIC is normal.
B Degradation of fibrin leads to the accumulation of fibrin split products in the blood.
C Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies.
D Hypofibrinogenemia would occur with DIC.

DIF:Cognitive Level: KnowledgeREF:660

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

7. Your patient has been on magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this patient?

a. Absence of uterine bleeding in the postpartum period
b. A fundus firm below the level of the umbilicus
c. Scant lochia flow
d. A boggy uterus with heavy lochia flow

ANS: D

Feedback
A Because of the tocolytic effects of magnesium sulfate, this patient most likely would have a boggy uterus with increased amounts of bleeding.
B Because of the tocolytic effects of magnesium sulfate, this patient most likely would have a boggy uterus.
C Because of the tocolytic effects of magnesium sulfate, this patient most likely would have a heavy lochia flow in the postpartum period.
D Because of the tocolytic effects of magnesium sulfate, this patient most likely would have a boggy uterus with increased amounts of bleeding.

DIF:Cognitive Level: AnalysisREF:636

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

8. The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:

a. Hypertension.
b. Hyperemesis gravidarum.
c. Hemorrhagic complications.
d. Infections.

ANS: A

Feedback
A Preeclampsia and eclampsia are two noted deadly forms of hypertension.
B A large percentage of pregnant women have nausea and vomiting, but relatively few have the severe form called hyperemesis gravidarum.
C Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common.
D Hypertension is the most common medical complication of pregnancy.

DIF:Cognitive Level: ComprehensionREF:624

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Diagnosis, Planning

9. Nurses should be aware that chronic hypertension:

a. Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy.
b. Is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg.
c. Is general hypertension plus proteinuria.
d. Can occur independently of or simultaneously with gestational hypertension.

ANS: D

Feedback
A Chronic hypertension is present before pregnancy or diagnosed before the twentieth week of gestation and persists longer than 6 weeks postpartum.
B This is the range for hypertension. It becomes severe with a diastolic BP of 110 mm Hg or higher.
C Proteinuria is an excessive concentration of protein in the urine. It is a complication of hypertension, not a defining characteristic.
D Hypertension is present before pregnancy or diagnosed before 20 weeks of gestation.

DIF:Cognitive Level: ComprehensionREF:626

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Diagnosis, Planning

10. A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?

a. Incomplete
b. Inevitable
c. Threatened
d. Septic

ANS: C

Feedback
A A woman with an incomplete abortion would present with heavy bleeding, mild-to-severe cramping, and cervical dilation.
B An inevitable abortion presents with the same symptoms as an incomplete abortion: heavy bleeding, mild-to-severe cramping, and cervical dilation.
C A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation.
D A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.

DIF:Cognitive Level: ComprehensionREF:643

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

11. Your patient is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse, Why is it taking so long? The most appropriate response by the nurse would be:

a. The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.
b. I dont know why it is taking so long.
c. The length of labor varies for different women.
d. Your baby is just being stubborn.

ANS: A

Feedback
A Because magnesium sulfate is a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate.
B This statement is not appropriate for the nurse to make.
C Although this statement generally is true, the most likely reason this womans labor is protracted is the tocolytic effects of magnesium sulfate.
D The behavior of the fetus has no bearing on the length of labor.

DIF:Cognitive Level: ApplicationREF:636

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

12. The perinatal nurse is giving discharge instructions to a woman, status postsuction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse would be:

a. If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available.
b. The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult.
c. If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time.
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy.

ANS: B

Feedback
A Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole.
B This is an accurate statement. Human chorionic gonadotropin (hCG) levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a zero hCG level. If the woman were to become pregnant, it may obscure the presence of the potentially carcinogenic cells.
C The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present.
D Any contraceptive method except an intrauterine device is acceptable.

DIF:Cognitive Level: ApplicationREF:652

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Planning, Implementation

13. The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:

a. Bleeding.
b. Intense abdominal pain.
c. Uterine activity.
d. Cramping.

ANS: B

Feedback
A Bleeding may be present in varying degrees for both placental conditions.
B Pain is absent with placenta previa and may be agonizing with abruptio placentae.
C Uterine activity may be present with both placental conditions.
D Cramping is a form of uterine activity that may be present in both placental conditions.

DIF:Cognitive Level: KnowledgeREF:653

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

14. In planning care for women with preeclampsia, nurses should be aware that:

a. Induction of labor is likely, as near term as possible.
b. If at home, the woman should be confined to her bed, even with mild preeclampsia.
c. A special diet low in protein and salt should be initiated.
d. Vaginal birth is still an option, even in severe cases.

ANS: A

Feedback
A However, at less than 37 weeks of gestation, immediate delivery may not be in the best interest of the fetus.
B Strict bed rest is becoming controversial for mild cases; even some women staying in the hospital because of preeclampsia are allowed to move around.
C Diet and fluid recommendations are much the same as for healthy pregnant women, although some authorities have suggested a diet high in protein.
D Women with severe preeclampsia should expect a cesarean delivery.

DIF:Cognitive Level: ComprehensionREF:634

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

15. Methotrexate is recommended as part of the treatment plan for which obstetric complication?

a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic pregnancy
d. Abruptio placentae

ANS: C

Feedback
A Methotrexate is not indicated or recommended as a treatment option for this condition.
B Methotrexate is not indicated or recommended as a treatment option for this condition.
C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter.
D Methotrexate is not indicated or recommended as a treatment option for this condition.

DIF:Cognitive Level: KnowledgeREF:650

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

16. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure?

a. Amniocentesis for fetal lung maturity
b. Ultrasound for placental location
c. Contraction stress test (CST)
d. Internal fetal monitoring

ANS: B

Feedback
A Amniocentesis would not be performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus would be presumed to have immature lungs at this gestational age, and the mother would be given corticosteroids to aid in fetal lung maturity.
B The presence of painless bleeding should always alert the health care team to the possibility of placenta previa. This can be confirmed through ultrasonography.
C A CST would not be performed at a preterm gestational age. Furthermore, bleeding would be a contraindication to this test.
D Internal fetal monitoring would be contraindicated in the presence of bleeding.

DIF:Cognitive Level: ApplicationREF:654

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

17. A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of:

a. Placenta previa.
b. Vasa previa.
c. Severe abruptio placentae.
d. Disseminated intravascular coagulation (DIC).

ANS: B

Feedback
A The presence of placenta previa most likely would be ascertained before labor and would be considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth.
B Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. They are at risk for laceration at anytime, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the fetal heart rate without other known risk factors should immediately alert the nurse to the possibility of vasa previa.
C With the presence of severe abruptio placentae, the uterine tonicity would typically be tetanus (i.e., a boardlike uterus).
D DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as HELLP syndrome. This woman did not have any prior risk factors.

DIF:Cognitive Level: AnalysisREF:658

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

18. A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the womans umbilicus and recognizes this assessment finding as:

a. Normal integumentary changes associated with pregnancy.
b. Turners sign associated with appendicitis.
c. Cullens sign associated with a ruptured ectopic pregnancy.
d. Chadwicks sign associated with early pregnancy.

ANS: C

Feedback
A Linea nigra on the abdomen is the normal integumentary change associated with pregnancy. It presents as a brown, pigmented, vertical line on the lower abdomen.
B Turners sign is ecchymosis in the flank area, often associated with pancreatitis.
C Cullens sign, the blue ecchymosis seen in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy.
D Chadwicks sign is the blue-purple color of the cervix that may be seen during or around the eighth week of pregnancy.

DIF:Cognitive Level: AnalysisREF:649

OBJ: Client Needs: Physiologic Integrity: TOP: Nursing Process: Assessment

19. With regard to miscarriage, nurses should be aware that:

a. It is a natural pregnancy loss before labor begins.
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
c. It often can be attributed to careless maternal behavior such as poor nutrition or excessive exercise.
d. If it occurs before the twelfth week of pregnancy, it may present only as moderate discomfort and blood loss.

ANS: D

Feedback
A Miscarriage is a natural pregnancy loss, but by definition, it occurs before 20 weeks of gestation, before the fetus is viable.
B Miscarriages occur in approximately 10% to 15% of all clinically recognized pregnancies.
C Miscarriage can be caused by a number of disorders or illnesses outside of the mothers control or knowledge.
D Before the sixth week, the only evidence might be a heavy menstrual flow. After the twelfth week, more severe pain, similar to that of labor, is likely.

DIF:Cognitive Level: ComprehensionREF:643

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

20. Magnesium sulfate is given to women with preeclampsia and eclampsia to:

a. Improve patellar reflexes and increase respiratory efficiency.
b. Shorten the duration of labor.
c. Prevent and treat convulsions.
d. Prevent a boggy uterus and lessen lochial flow.

ANS: C

Feedback
A Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity.
B Magnesium sulfate can increase the duration of labor.
C Magnesium sulfate is the drug of choice to prevent convulsions, although it can generate other problems.
D Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy.

DIF:Cognitive Level: ComprehensionREF:636

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

MULTIPLE RESPONSE

1. A patient who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include (choose all that apply):

a. Iron supplementation.
b. Resumption of intercourse at 6 weeks following the procedure.
c. Referral to a support group if necessary.
d. Expectation of heavy bleeding for at least 2 weeks.
e. Emphasizing the need for rest.

ANS: A, C, E

Feedback
Correct The woman should be advised to consume a diet high in iron and protein. For many women, iron supplementation also is necessary. Acknowledge that the patient has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest.
Incorrect Nothing should be placed in the vagina for 2 weeks after the procedure. This includes tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The patient should expect a scant, dark discharge for 1 to 2 weeks. If heavy, profuse, or bright bleeding occurs, she should be instructed to contact her provider.

DIF:Cognitive Level: ApplicationREF:647

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

COMPLETION

1. The antidote administered to reverse magnesium toxicity is _____________________.

ANS:

Calcium gluconate

If magnesium toxicity is suspected, the infusion should be discontinued immediately. Calcium gluconate, the antidote for magnesium sulfate, may also be ordered and given by slow IV push over at least 3 minutes (usually by the physician) to prevent undesirable reactions such as arrhythmias, bradycardia, and ventricular fibrillation.

DIF:Cognitive Level: ComprehensionREF:636

OBJ:Client Needs: Physiologic Integrity: Pharmacologic Therapies

TOP: Nursing Process: Planning

Leave a Reply