Chapter 25: Pregnancy-Related Complications My Nursing Test Banks

Chapter 25: Pregnancy-Related Complications

Test Bank

MULTIPLE CHOICE

1. The perinatal nurse is giving discharge instructions to a woman, status post suction and 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 is

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. Pregnancy raises hCG levels which increases the risk for choriocarcinoma.

B

This is an accurate statement. Beta-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 IUD is acceptable.

PTS: 1 DIF: Cognitive Level: Application REF: p. 582

OBJ: Nursing Process: Planning and Implementation

MSC: Client Needs: Physiologic Integrity

2. Which maternal condition always necessitates delivery by cesarean section?

a.

Partial abruptio placentae

b.

Total placenta previa

c.

Ectopic pregnancy

d.

Eclampsia

ANS: B

Feedback

A

If the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted. If the fetus has died, a vaginal delivery is preferred.

B

In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred.

C

The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester.

D

Labor can be safely induced if the eclampsia is under control.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 583, 585

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

3. Spontaneous termination of a pregnancy is considered to be an abortion if

a.

The pregnancy is less than 20 weeks.

b.

The fetus weighs less than 1000 g.

c.

The products of conception are passed intact.

d.

No evidence exists of intrauterine infection.

ANS: A

Feedback

A

An abortion is the termination of pregnancy before the age of viability (20 weeks).

B

The weight of the fetus is not considered because some fetuses of an older age may have a low birth weight.

C

A spontaneous abortion may be complete or incomplete.

D

A spontaneous abortion may be caused by many problems, one being intrauterine infection.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 576

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

4. An abortion in which the fetus dies but is retained in the uterus is called _____ abortion.

a.

Inevitable

b.

Missed

c.

Incomplete

d.

Threatened

ANS: B

Feedback

A

An inevitable abortion means that the cervix is dilating with the contractions.

B

Missed abortion refers to a dead fetus being retained in the uterus.

C

An incomplete abortion means that not all of the products of conception were expelled.

D

With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 578

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

5. A placenta previa in which the placental edge just reaches the internal os is called

a.

Total

b.

Partial

c.

Complete

d.

Marginal

ANS: D

Feedback

A

With a total placenta previa the placenta completely covers the os.

B

With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os, but does not completely cover the os.

C

A complete previa is termed total. The placenta completely covers the internal cervical os.

D

A placenta previa that does not cover any part of the cervix is termed marginal.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 583

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

6. What condition indicates concealed hemorrhage in an abruptio placentae?

a.

Decrease in abdominal pain

b.

Bradycardia

c.

Hard, boardlike abdomen

d.

Decrease in fundal height

ANS: C

Feedback

A

Abdominal pain may increase.

B

The patient will have shock symptoms that include tachycardia.

C

Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen.

D

The fundal height will increase as bleeding occurs.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 586

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

7. The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to

a.

Assess fetal heart rate (FHR) and maternal vital signs.

b.

Perform a venipuncture for hemoglobin and hematocrit levels.

c.

Place clean disposable pads to collect any drainage.

d.

Monitor uterine contractions.

ANS: A

Feedback

A

Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus.

B

The most important assessment is to check mother/fetal well-being. The blood levels can be obtained later.

C

It is important to assess future bleeding, but the top priority is mother/fetal well-being.

D

Monitoring uterine contractions is important, but not the top priority.

PTS: 1 DIF: Cognitive Level: Application REF: p. 587

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

8. A pregnant woman is being discharged from the hospital after placement of a cerclage because of a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that

a.

Any vaginal discharge should be reported immediately to her care provider.

b.

The presence of any contractions, rupture of membranes, or severe perineal pressure should be reported.

c.

She will need to make arrangements for care at home, because her activity level will be restricted.

d.

She will be scheduled for a cesarean birth.

ANS: B

Feedback

A

Vaginal bleeding needs to be reported to her primary care provider.

B

Nursing care should stress the importance of monitoring signs and symptoms of preterm labor.

C

Bed rest is an element of care. However, the woman may stand for periods of up to 90 minutes, which allows her the freedom to see her physician. Home uterine activity monitoring may be used to limit the womans need for visits and to safely monitor her status at home.

D

The cerclage can be removed at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planned.

PTS: 1 DIF: Cognitive Level: Application REF: p. 579

OBJ: Nursing Process: Planning and Implementation

MSC: Client Needs: Health Promotion and Maintenance

9. A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is

a.

Tocolytic

b.

Anticonvulsant

c.

Antihypertensive

d.

Diuretic

ANS: B

Feedback

A

A tocolytic drug does slow the frequency and intensity of uterine contractions but is not used for that purpose in this scenario.

B

Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity.

C

Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate.

D

Diuresis is a therapeutic response to magnesium sulfate.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 594

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

10. What is the only known cure for preeclampsia?

a.

Magnesium sulfate

b.

Antihypertensive medications

c.

Delivery of the fetus

d.

Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C

Feedback

A

Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia.

B

Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia.

C

If the fetus is viable and near term, delivery is the only known cure for preeclampsia.

D

Low doses of ASA (60 to 80 mg) have been administered to women at high risk for developing preeclampsia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 593

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

11. Which clinical sign is not included in the classic symptoms of preeclampsia?

a.

Hypertension

b.

Edema

c.

Proteinuria

d.

Glycosuria

ANS: D

Feedback

A

The first indication of preeclampsia is usually an increase in the maternal blood pressure.

B

The first sign noted by the pregnant woman is a rapid weight gain and edema of the hands and face.

C

Proteinuria usually develops later than the edema and hypertension.

D

Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 592

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

12. Which assessment finding should convince the nurse to hold the next dose of magnesium sulfate?

a.

Absence of deep tendon reflexes

b.

Urinary output of 100 mL total for the previous 2 hours

c.

Respiratory rate of 14 breaths/min

d.

Decrease in blood pressure from 160/100 to 140/85

ANS: A

Feedback

A

Because absence of deep tendon reflexes is a sign of magnesium toxicity, the next scheduled dose should not be administered. Calcium gluconate is the antidote that should be administered.

B

An hourly output of less than 30 mL could indicate toxicity.

C

A respiratory rate of less than 12 breaths/min could indicate toxicity.

D

Decrease in blood pressure is an expected side effect of magnesium sulfate.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 600

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

13. 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 low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician, because the lab results are indicative of

a.

Eclampsia

b.

Disseminated intravascular coagulation

c.

HELLP syndrome

d.

Rh incompatibility

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

These are not clinical indications of Rh incompatibility.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 600-601

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

14. The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area?

a.

+1 edema

b.

+2 edema

c.

+3 edema

d.

+4 edema

ANS: C

Feedback

A

Edema classified as +1 indicates minimal edema of the lower extremities.

B

Marked edema of the lower extremities is termed +2 edema.

C

Edema of the extremities, face, and sacral area is classified as +3 edema.

D

Generalized massive edema (+4) includes accumulation of fluid in the peritoneal cavity.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 593 | Table 25-2

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

15. A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?

a.

Blood pressure 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 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 as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 592

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

16. A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate

a.

Anxiety due to hospitalization

b.

Worsening disease and impending convulsion

c.

Effects of magnesium sulfate

d.

Gastrointestinal upset

ANS: B

Feedback

A

These are danger signs and should be treated.

B

Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent.

C

She has not been started on magnesium sulfate as a treatment yet. Also, these are not expected effects of the medication.

D

These are danger signs showing increased cerebral edema and impending convulsion.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 599-600

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

17. Rh incompatibility can occur if the woman is Rh negative and her

a.

Fetus is Rh positive

b.

Husband is Rh positive

c.

Fetus is Rh negative

d.

Husband and fetus are both Rh negative

ANS: A

Feedback

A

For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive.

B

The husbands Rh factor is a concern only as it relates to the possible Rh factor of the fetus.

C

If the fetus is Rh negative, the blood types are compatible and no problems should occur.

D

If the fetus is Rh negative, the blood type with the mother is compatible. The husbands blood type does not enter into the problem.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 601

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

18. In which situation is a dilation and curettage (D&C) indicated?

a.

Complete abortion at 8 weeks

b.

Incomplete abortion at 16 weeks

c.

Threatened abortion at 6 weeks

d.

Incomplete abortion at 10 weeks

ANS: D

Feedback

A

If all the products of conception have been passed (complete abortion), a D&C is not used.

B

D&C is used to remove the products of conception from the uterus and can be done safely until week 14 of gestation.

C

If the pregnancy is still viable (threatened abortion), a D&C is not used.

D

D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 578

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

19. What order should the nurse expect for a patient admitted with a threatened abortion?

a.

Bed rest

b.

Ritodrine IV

c.

NPO

d.

Narcotic analgesia every 3 hours, prn

ANS: A

Feedback

A

Decreasing the womans activity level may alleviate the bleeding and allow the pregnancy to continue.

B

Ritodrine is not the first drug of choice for tocolytic medications.

C

There is no reason for having the woman NPO. At times dehydration may produce contractions, so hydration is important.

D

Narcotic analgesia will not decrease the contractions. It may mask the severity of the contractions.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 577

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

20. What data on a patients health history places her at risk for an ectopic pregnancy?

a.

Use of oral contraceptives for 5 years

b.

Recurrent pelvic infections

c.

Ovarian cyst 2 years ago

d.

Heavy menstrual flow of 4 days duration

ANS: B

Feedback

A

Oral contraceptives do not increase the risk for ectopic pregnancies.

B

Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation.

C

Ovarian cysts do not cause scarring of the fallopian tubes.

D

This will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 580 | Box 25-1

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

21. What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole?

a.

Complaint of frequent mild nausea

b.

Blood pressure of 120/80 mm Hg

c.

Fundal height measurement of 18 cm

d.

History of bright red spotting for 1 day, weeks ago

ANS: C

Feedback

A

Nausea increases in a molar pregnancy because of the increased production of hCG.

B

A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension.

C

The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy.

D

The history of bleeding is normally described as being brownish.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 582

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

22. What routine nursing assessment is contraindicated in the patient admitted with suspected placenta previa?

a.

Monitoring FHR and maternal vital signs

b.

Observing vaginal bleeding or leakage of amniotic fluid

c.

Determining frequency, duration, and intensity of contractions

d.

Determining cervical dilation and effacement

ANS: D

Feedback

A

Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman.

B

Monitoring for bleeding and rupture of membranes is not contraindicated with this woman.

C

Monitoring contractions is not contraindicated with this woman.

D

Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 584

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

23. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is

a.

Vaginal bleeding

b.

Rupture of membranes

c.

Presence of abdominal pain

d.

Changes in maternal vital signs

ANS: C

Feedback

A

Both may have vaginal bleeding.

B

Rupture of membranes may occur with both conditions.

C

Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding.

D

Maternal vital signs may change with both if bleeding is pronounced.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 585

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

24. Which 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 multiple fibrin clots throughout the bodys vasculature.

C

Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies.

D

Hypofibrinogenemia occurs with DIC.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 578

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

25. A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should

a.

Vigorously stimulate the woman.

b.

Instruct her to take deep breaths.

c.

Administer calcium gluconate.

d.

Increase her IV fluids.

ANS: C

Feedback

A

Stimulation will not increase the respirations.

B

This will not be successful in reversing the effects of the magnesium sulfate.

C

Calcium gluconate reverses the effects of magnesium sulfate.

D

Increasing her IV fluids will not reverse the effects of the medication.

PTS: 1 DIF: Cognitive Level: Application REF: p. 595

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

26. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that

a.

Bed rest and analgesics are the recommended treatment.

b.

She will be unable to conceive in the future.

c.

A D&C will be performed to remove the products of conception.

d.

Hemorrhage is the major concern.

ANS: D

Feedback

A

The recommended treatment is to remove the pregnancy before hemorrhaging.

B

If the tube must be removed, her fertility will decrease but she will not be infertile.

C

A D&C is done on the inside of the uterine cavity. The ectopic is located within the tubes.

D

Severe bleeding occurs if the fallopian tube ruptures.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 580

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

27. Approximately 12% to 26% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion?

a.

Chromosomal abnormalities

b.

Infections

c.

Endocrine imbalance

d.

Immunologic factors

ANS: A

Feedback

A

At least 60% of pregnancy losses result from chromosomal abnormalities that are incompatible with life.

B

Maternal infection may be a cause of early miscarriage.

C

Endocrine imbalances such as hypothyroidism or diabetes are possible causes for early pregnancy loss.

D

Women who have repeated early pregnancy losses appear to have immunologic factors the play a role in spontaneous abortion incidents.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 576

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

28. 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 a complete hydatidiform mole.

B

Methotrexate is not indicated or recommended as a treatment option for missed abortions.

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 abruptio placentae.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 580

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

29. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves

a.

Corticosteroids to reduce inflammation

b.

IV therapy to correct fluid and electrolyte imbalances

c.

An antiemetic, such as pyridoxine, to control nausea and vomiting

d.

Enteral nutrition to correct nutritional deficits

ANS: B

Feedback

A

Corticosteroids have been used successfully to treat refractory hyperemesis gravidarum, but they are not the expected initial treatment for this disorder.

B

Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances.

C

Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed.

D

In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 590

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

30. A woman with preeclampsia has a seizure. The nurses 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

Feedback

A

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 patients head to the side to prevent aspiration.

B

Once the seizure has ended, it may be necessary to suction the patients mouth.

C

Oxygen would be administered after the convulsion has ended.

D

If a patient becomes eclamptic, the nurse should stay with her and call for help. Nursing actions during a convulsion are directed towards ensuring a patent airway and patient safety.

PTS: 1 DIF: Cognitive Level: Application REF: p. 597

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE

1. Throughout the world the rate of ectopic pregnancy has increased dramatically over the past 20 years. This is believed to be due primarily to scarring of the fallopian tubes as a result of pelvic infection, inflammation, or surgery. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (select all that apply)

a.

Pelvic pain

b.

Abdominal pain

c.

Unanticipated heavy bleeding

d.

Vaginal spotting or light bleeding

e.

Missed period

ANS: A, B, D, E

Feedback

Correct

A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy.

Incorrect

As the fallopian tube tears open and the embryo is expelled, the patient often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about half of women, shoulder and neck pain occurs due to irritation of the diaphragm from the hemorrhage.

PTS: 1 DIF: Cognitive Level: Application REF: p. 580

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

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

a.

Iron supplementation

b.

Resumption of intercourse at 6 weeks post-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 postprocedure. 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. Should heavy, profuse, or bright bleeding occur she should be instructed to contact her provider.

PTS: 1 DIF: Cognitive Level: Application REF: p. 579, 583

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

COMPLETION

1. Recurrent spontaneous abortion refers to a condition in which a woman experiences three or more consecutive abortions or miscarriages. This is also known as ________ abortion.

ANS:

habitual

Primary causes are believed to be genetic or chromosomal abnormalities of the fetus. For the mother who repeatedly aborts, the cause is often an anomaly of the reproductive tract such as bicornate uterus or incompetent cervix. Systemic illnesses such as lupus erythematosus and diabetes mellitus have been implicated in this condition as well. Treatment depends entirely on the cause and therefore varies between medical and surgical approaches.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 578

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

2. The condition in which the placenta is implanted in the lower uterine segment near or over the internal cervical os is _____________.

ANS:

placenta previa

In placenta previa, the placenta is implanted in the lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 583

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

3. The antidote administered to reverse magnesium toxicity is ______________.

ANS:

calcium gluconate

Calcium gluconate is the antidote necessary to reverse magnesium toxicity. The nurse caring for this patient should keep calcium gluconate in the room along with secured, syringes and needles.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 595

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

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