Chapter 30: Medical-Surgical Problems in Pregnancy My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 30: Medical-Surgical Problems in Pregnancy

Test Bank

MULTIPLE CHOICE

1. 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 cyanosis of the lips and nailbeds.

A regular heart rate and hypertension are not generally associated with cardiac decompensation.

Of the symptoms of increased urinary output, tachycardia, and dry cough, only tachycardia is indicative of cardiac decompensation.

Of the symptoms of shortness of breath, bradycardia, and hypertension, only dyspnea is indicative of cardiac decompensation.

DIF: Cognitive Level: Comprehension REF: 714

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

2. Prophylaxis of subacute bacterial endocarditis (SBE) is given before and after birth when a pregnant woman has:

a.

Valvular disease

b.

Congestive heart disease

c.

Arrhythmias

d.

Postmyocardial infarction

ANS: A

Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve prolapse.

Prophylaxis for intrapartum endocarditis is not indicated for a client with congestive heart disease.

Prophylaxis for intrapartum endocarditis is not necessary for a woman with underlying arrhythmias.

A woman who is postmyocardial infarction does not require prophylaxis for intrapartum endocarditis.

DIF: Cognitive Level: Comprehension REF: 712

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

3. While providing care in an obstetric setting, the nurse should understand that postpartum 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 exercises

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 postpartum period is tailored to the womans 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.

DIF: Cognitive Level: Comprehension REF: 718

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

4. A woman was anemic during her pregnancy. She had been taking iron for 3 months before the birth. She gave birth by cesarean 2 days ago and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the womans stools are dark (greenish-black). The nurse:

a.

Performs a guaiac test and records the results

b.

Recognizes the finding as abnormal and reports it to the primary health care provider

c.

Recognizes the finding as normal as a result of iron therapy

d.

Checks the womans next stool to validate the observation

ANS: C

Dark stools are a common side effect of iron therapy.

A guaiac test would be indicated if there was a suspicion of gastrointestinal (GI) bleeding.

GI irritation including dark stools is a common side effect of iron therapy.

Observation of stool formation is a normal nursing activity. However, the nurse should recognize that dark stools are common in clients who are taking iron replacement therapy.

DIF: Cognitive Level: Application REF: 720

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation

5. A woman with asthma is experiencing a postpartum hemorrhage. Which drug is not used to treat her bleeding because it may exacerbate her asthma?

a.

Oxytocin (Pitocin)

b.

Nonsteroidal antiinflammatory drugs (NSAIDs)

c.

Hemabate

d.

Fentanyl

ANS: C

Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms.

Oxytocin is the drug of choice to treat this womans bleeding, because it will not exacerbate her asthma.

NSAIDs are not used to treat bleeding.

Fentanyl is used to treat pain, not bleeding.

DIF: Cognitive Level: Analysis REF: 723

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

6. In providing nutritional counseling for a pregnant woman experiencing cholecystitis, the nurse:

a.

Assesses the womans dietary history for adequate calories and proteins

b.

Instructs the woman that the bulk of calories should come from proteins

c.

Instructs the woman to eat a low-fat diet and avoid fried foods

d.

Instructs the woman to eat a low-cholesterol, low-salt diet

ANS: C

This is appropriate nutritional counseling for this client.

Caloric and protein intake do not predispose a woman to the development of cholecystitis.

The woman should be instructed to limit protein intake and choose foods that are high in carbohydrates.

A low-cholesterol diet may be the result of limiting fats. However, a low-salt diet is not indicated.

DIF: Cognitive Level: Application REF: 730

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

7. 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 (crises) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when red blood cells (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 postpartum endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign

These women are at an increased risk for urinary tract infections (UTIs); however, this is not an indication of sickle cell crisis.

DIF: Cognitive Level: Comprehension REF: 721

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

8. Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment?

a.

Intake and output (I&O), IV site

b.

Signs and symptoms of infection

c.

Vital signs and incision

d.

Fetal heart rate and uterine activity

ANS: D

Care of a pregnant woman undergoing surgery for appendicitis differs from that for a nonpregnant woman in one significant aspect: the presence of the fetus. Continuous fetal monitoring and uterine monitoring should take place.

I&O along with IV site assessment are normal postoperative care procedures.

Evaluating the client for signs and symptoms of infection is part of routine postoperative care.

Routine vital signs and evaluation of the incision site are expected components of postoperative care.

DIF: Cognitive Level: Application REF: 732

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

9. 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 1000

c.

1 in 2000

d.

1 in 3200

ANS: D

Cystic fibrosis occurs in about 1 in 3200 Caucasian live births.

1 in 100 occurrences is far too often.

1 in 1000 occurrences is too high.

1 in 2000 live births is too frequent an occurrence for cystic fibrosis.

DIF: Cognitive Level: Comprehension REF: 722

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

10. With what heart condition is pregnancy not usually contraindicated?

a.

Peripartum cardiomyopathy

b.

Severe pulmonary hypertension

c.

Heart transplant

d.

All of these contraindicate pregnancy.

ANS: C

Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation. The woman should also be stabilized on her immunosuppressant regimen.

Pregnancy is contraindicated for women with peripartum cardiomyopathy. Maternal mortality has been established in the range of 30% to 40%.

Pregnancy is contraindicated for women who have severe pulmonary hypertension.

Pregnancy is contraindicated for women with peripartum cardiomyopathy and pulmonary hypertension. Women who have had heart transplants are successfully having babies.

DIF: Cognitive Level: Comprehension REF: 714

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

11. Nurses caring for antepartum women with cardiac conditions should be aware that:

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 avoid any activity that causes even minor symptoms

c.

Women with class III cardiac disease should get 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 hemodynamic 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.

DIF: Cognitive Level: Comprehension REF: 710

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

12. With regard to anemia, nurses should be aware that:

a.

It is the most common medical disorder of pregnancy

b.

It can trigger reflex bradycardia

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, it 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.

DIF: Cognitive Level: Knowledge REF: 720

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

13. The most common neurologic disorder accompanying pregnancy is:

a.

Eclampsia

b.

Bells 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.

Bells palsy is a form of facial paralysis. Epilepsy is the most common neurologic disorder accompanying pregnancy.

Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth. Epilepsy is the most common neurologic disorder accompanying pregnancy.

DIF: Cognitive Level: Knowledge REF: 727

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

14. Marfan syndrome is an autosomal dominant genetic disorder that displays as weakness of the connective tissue, joint deformities, ocular dislocation, and weakness of the aortic wall and root. While providing care to a client with Marfan syndrome during labor, the nurse must determine which of the following interventions should be completed first:

a.

Antibiotic prophylaxis

b.

Beta-blockers

c.

Surgery

d.

Regional anesthesia

ANS: A

Because of the potential for cardiac involvement during the third trimester and postpartally, treatment with prophylactic antibiotics is highly recommended.

Beta-blockers and restricted activity are recommended as treatment modalities earlier in the pregnancy.

Regional anesthesia is well tolerated by clients with Marfan syndrome; however, it is not essential to care. Adequate labor support may be all that is necessary if an epidural is not part of the womans birth plan.

Surgery for cardiovascular changes such as mitral valve prolapse, aortic regurgitation, root dilation, or dissection may be necessary. Mortality rates may be as high as 50% in women who have severe cardiac disease.

DIF: Cognitive Level: Analysis REF: 712

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

MULTIPLE RESPONSE

1. Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including (choose 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.

Congenital anomalies of gastroschisis and diaphragmatic hernia are not associated with the use of AEDs.

DIF: Cognitive Level: Comprehension REF: 727

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

2. Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory disease that affects the skin, joints, kidney, lungs, central nervous system (CNS), liver, and other organs. A lupus flare-up during pregnancy or early postpartum occurs in 15% to 60% of women with this disorder. Maternal risks include (choose all that apply):

a.

Miscarriage

b.

Intrauterine growth restriction (IUGR)

c.

Nephritis

d.

Preeclampsia

e.

Cesarean birth

ANS: A, C, D, E

Maternal risks associated with SLE include miscarriage, nephritis, preeclampsia, and cesarean birth.

IUGR is a fetal risk related to SLE. Other fetal risks include stillbirth and prematurity.

DIF: Cognitive Level: Comprehension REF: 728

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

TRUE/FALSE

1. Urinary tract infections (UTIs) are the most common medical complications of pregnancy. Is this statement true or false?

ANS: T

UTIs are the most common medical complication of pregnancy, occurring in approximately 20% of all pregnancies. They are also responsible for 10% of hospitalizations during pregnancy. UTIs include asymptomatic bacteriuria, cystitis, and pyelonephritis.

DIF: Cognitive Level: Knowledge REF: 730

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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