Chapter 5: Nursing Care of Women With Complications During Pregnancy My Nursing Test Banks

Chapter 5: Nursing Care of Women With Complications During Pregnancy

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. A pregnant patient tells the nurse that she has been nauseated and vomiting. The nurse explains that hyperemesis gravidarum is distinguished from morning sickness because:

a.

Hyperemesis gravidarum usually lasts for the duration of the pregnancy.

b.

Hyperemesis gravidarum causes dehydration and electrolyte imbalances.

c.

With hyperemesis gravidarum, sensitivity to smells is usually the cause of vomiting.

d.

The woman with hyperemesis gravidarum will have persistent vomiting without weight loss.

ANS: B

Dehydration and electrolyte imbalances result from persistent nausea and vomiting associated with hyperemesis gravidarum.

DIF: Cognitive Level: Analysis REF: Text Reference: 79

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. A woman who is 9 weeks pregnant is experiencing heavy bleeding and cramping. She reports passing some tissue. Cervical dilation is noted on examination. This woman most likely had:

a.

An inevitable abortion

b.

An incomplete abortion

c.

A complete abortion

d.

A missed abortion

ANS: B

Signs and symptoms of an incomplete abortion are similar to those of an inevitable abortion, but some tissue is passed.

DIF: Cognitive Level: Analysis REF: Text Reference: 82, Figure 5-2

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse finds a woman crying after she has undergone a dilation and evacuation (D & E) for a missed abortion. The most appropriate statement made by the nurse would be:

a.

There is usually something wrong with the fetus when this happens early in pregnancy.

b.

Now there. You can try to conceive on your next cycle.

c.

I am here if you need to talk.

d.

You are young and strong. I know you can have a healthy pregnancy.

ANS: C

An effective technique when communicating with a woman experiencing pregnancy loss is to say, Im here if you need to talk. The nurse listens and acknowledges the womans grief.

DIF: Cognitive Level: Application REF: Text Reference: 84

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

4. A woman who is 8 weeks pregnant becomes concerned when she has light vaginal bleeding accompanied by abdominal pain. An ectopic pregnancy is confirmed by ultrasound. The statement that indicates that the woman understands the explanation of an ectopic pregnancy is:

a.

The chorionic villi develop vesicles within the uterus.

b.

The placenta develops in the lower part of the uterus.

c.

The fetus dies in the uterus during the first half of the pregnancy.

d.

The embryo is implanted in the fallopian tube.

ANS: D

Ectopic pregnancy occurs when the fertilized ovum is implanted outside of the uterine cavity.

DIF: Cognitive Level: Analysis REF: Text Reference: 84

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the entire cervical os. The nurse understands that this condition is known as:

a.

Low-lying placenta

b.

Marginal placenta previa

c.

Partial placenta previa

d.

Total placenta previa

ANS: D

A total placenta previa describes a condition in which the placenta completely covers the cervical opening.

DIF: Cognitive Level: Analysis REF: Text Reference: 88

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. The nurse would suspect abruptio placentae when the pregnant woman presents with:

a.

Painless vaginal bleeding

b.

Uterine irritability with contractions

c.

Vaginal bleeding and back pain

d.

Premature rupture of membranes

ANS: C

Bleeding accompanied by abdominal or lower back pain is a typical manifestation of abruptio placentae.

DIF: Cognitive Level: Analysis REF: Text Reference: 95

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

7. Rh incompatibility occurs in which of the following situations:

a.

Rh-negative mother, Rh-positive fetus

b.

Rh-positive mother, Rh-negative fetus

c.

Rh-negative mother, Rh-negative fetus

d.

Rh-positive mother, Rh-positive fetus

ANS: A

Rh incompatibility can only occur if the mother is Rh-negative and the fetus is Rh-positive.

DIF: Cognitive Level: Analysis REF: Text Reference: 95

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: N/A

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. A primigravida in her first trimester is Rh-negative. To prevent anti-Rh antibodies from forming, this woman would receive:

a.

Rh immune globulin during labor

b.

Intrauterine transfusions with O-negative blood

c.

Rh immune globulin at 28 weeks and within 72 hours after the birth of an Rh-positive infant

d.

Rh immune globulin now and again in the last trimester

ANS: C

An Rh-negative woman would receive Rh immune globulin at 28 weeks of gestation and within 72 hours after the birth of an Rh-positive infant or abortion.

DIF: Cognitive Level: Application REF: Text Reference: 96

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

9. A woman seeking prenatal care relates a history of macrosomic infants, two stillbirths, and polyhydramnios with each pregnancy. The nurse recognizes that these factors are highly suggestive of:

a.

Toxoplasmosis

b.

Abruptio placentae

c.

Hydatidiform mole

d.

Diabetes mellitus

ANS: D

Large (macrosomic) infants over 9 pounds are linked to gestational diabetes.

DIF: Cognitive Level: Analysis REF: Text Reference: 97

OBJ: Objective: 5 TOP: Topic: Pregnancy Complicated by Medical Conditions

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. The nurse explains that pregnancy affects glucose metabolism because:

a.

Placental hormones increase the resistance of cells to insulin

b.

Insulin cells cannot meet the bodys demands as the womans weight increases

c.

There is a decreased production of insulin during pregnancy

d.

The speed of insulin breakdown is decreased during pregnancy

ANS: A

Hormones and enzymes produced by the placenta increase the resistance of cells to insulin.

DIF: Cognitive Level: Knowledge REF: Text Reference: 97

OBJ: Objective: 5 TOP: Topic: Pregnancy Complicated by Medical Conditions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. The nurse explains that a woman who uses oral hypoglycemic agents to control diabetes mellitus will need to take insulin during pregnancy because:

a.

Insulin can cross the placental barrier to the fetus

b.

Insulin does not cross the placental barrier to the fetus

c.

Oral agents do not cross the placenta

d.

Oral agents are not sufficient to meet maternal insulin needs

ANS: B

Oral hypoglycemic agents are not used during pregnancy because they can cross the placenta, possibly resulting in fetal birth defects or hypoglycemia.

DIF: Cognitive Level: Comprehension REF: Text Reference: 98

OBJ: Objective: 5 TOP: Topic: Pregnancy Complicated by Medical Conditions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. The pregnant woman comes to the clinic stating that she has been exposed to hepatitis B. She is afraid that her baby will also contract hepatitis B. The nurse counsels that the baby:

a.

Will be given a single dose of hepatitis immune globulin at birth after the first bath

b.

Will be able to use the antibodies from the immunizations given to the patient before delivery

c.

Will not have hepatitis B because the virus does not pass through the placental barrier

d.

Will be immune to hepatitis B because of the mothers infection

ANS: A

The infant will be given immune globulin immediately after birth for temporary immunity followed by Hepatitis B vaccine. Immunization is not recommended for women who are pregnant.

DIF: Cognitive Level: Application REF: Text Reference: 105

OBJ: Objective: 5 TOP: Topic: Pregnancy Complicated by Medical Conditions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. When the nurse asks a patient about drug use during a prenatal history, she might begin the questioning with:

a.

Do you smoke, drink alcohol, or use drugs?

b.

Do you ever use prescription or street drugs?

c.

What over-the-counter and prescription drugs have you taken in the past 3 months?

d.

We need to know if you take drugs so we can help your baby.

ANS: C

Screening for drug use should begin in a nonthreatening way by asking about prescription and OTC medications.

DIF: Cognitive Level: Application REF: Text Reference: 109

OBJ: Objective: 6 TOP: Topic: Environmental Hazards During Pregnancy

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

14. The nurse assesses a pregnant woman for pregnancy-induced hypertension. The first sign of fluid retention suggestive of this complication is:

a.

Abdominal enlargement

b.

Facial swelling

c.

Sudden weight gain

d.

Swelling of the feet and ankles

ANS: C

Sudden, excessive weight gain is the first sign of fluid retention.

DIF: Cognitive Level: Analysis REF: Text Reference: 91

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. The patient with gestational hypertension has all the signs below. The nurse immediately reports:

a.

Diarrhea

b.

Decreased urine output

c.

Blurred vision

d.

Backache

ANS: C

Visual disturbances indicate worsening pregnancy-induced hypertension and must be reported promptly for effective intervention to prevent preeclampsia.

DIF: Cognitive Level: Analysis REF: Text Reference: 91

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

16. The patient who is 28 weeks pregnant presents with consistent hypertension. The home health nurse would give priority to the need for:

a.

Activity restriction

b.

Balanced nutrition

c.

Increased fluid intake to ensure adequate hydration

d.

Instruction about the effect of diuretics

ANS: A

Bed rest reduces the flow of blood to skeletal muscles, making more blood available to the placenta and enhancing fetal oxygenation.

DIF: Cognitive Level: Application REF: Text Reference: 92

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

17. The nurse explains that the objective of magnesium sulfate therapy for the patient with preeclampsia is to:

a.

Prevent convulsions

b.

Promote diaphoresis

c.

Increase reflex irritability

d.

Act as a saline cathartic

ANS: A

Magnesium sulfate is a central nervous system depressant given to prevent seizures.

DIF: Cognitive Level: Knowledge REF: Text Reference: 92

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

18. The nurse caring for a pregnant woman who is receiving an intravenous infusion with magnesium sulfate will:

a.

Count respirations and report a rate of less than 12 breaths per minute.

b.

Count respirations and report a rate of more than 20 breaths per minute.

c.

Check blood pressure and report a rate of less than 100/60.

d.

Monitor urinary output and report a rate of less than 100 ml per hour.

ANS: A

Excessive magnesium sulfate may cause respiratory depression.

DIF: Cognitive Level: Application REF: Text Reference: 92

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

19. The drug the nurse plans to have available for immediate IV administration whenever magnesium sulfate is administered to a maternity patient is:

a.

Ergonovine maleate (Ergotrate)

b.

Oxytocin

c.

Calcium gluconate

d.

Hydralazine (Apresoline)

ANS: C

Calcium gluconate reverses the effects of magnesium sulfate and should be available for immediate use when a woman receives magnesium sulfate.

DIF: Cognitive Level: Analysis REF: Text Reference: 92

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

20. A woman who is 35 weeks pregnant has a total placenta previa. She asks the nurse, Will I be able to deliver vaginally? The nurse should explain:

a.

Yes, you can deliver vaginally until 36 weeks.

b.

A vaginal delivery can be attempted, but if bleeding occurs, a cesarean section is done.

c.

A cesarean section is performed when the mother has a total placenta previa.

d.

There is no reason why you cannot have a vaginal delivery.

ANS: C

A cesarean delivery is done for a partial or total placenta previa.

DIF: Cognitive Level: Application REF: Text Reference: 80

OBJ: Objective: 3 TOP: Topic: Pregnancy-Related Complications

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

21. The nurse teaches a woman who is 8 weeks pregnant about how rubella can affect the developing fetus. The nurse realizes the woman understands the information when she says that rubella during pregnancy can result in:

a.

Facial abnormalities

b.

Mental retardation

c.

Liver failure

d.

Limb deformities

ANS: B

Rubella can have devastating effects on the developing fetus. Some effects of rubella on the embryo/fetus include: microcephaly, mental retardation, cardiac defects, cataracts, and deafness.

DIF: Cognitive Level: Analysis REF: Text Reference: 104

OBJ: Objective: 5 TOP: Topic: Pregnancy Complicated by Medical Conditions

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

22. The nurse would suspect pyelonephritis when a pregnant woman reports:

a.

Frequency and urgency of urination

b.

Nausea and weight loss

c.

Burning sensation when voiding

d.

Tenderness in the flank area

ANS: D

Pyelonephritis is a particularly serious infection in pregnancy. Signs and symptoms include high fever, chills, flank pain or tenderness, nausea, and vomiting.

DIF: Cognitive Level: Analysis REF: Text Reference: 102

OBJ: Objective: 5 TOP: Topic: Pregnancy Complicated by Medical Conditions

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

MULTIPLE RESPONSE

1. The nurse educates prenatal patients about the threat of TORCH infections. These infections include:

Select all that apply.

a.

Toxoplasmosis

b.

Toxemia

c.

Cytomegalovirus

d.

Rubella

e.

Herpes simplex

ANS: A, C, D, E

The TORCH infections are toxoplasmosis, rubella, cytomegalovirus, and herpes simplex.

DIF: Cognitive Level: Comprehension REF: Text Reference: 104

OBJ: Objective: 6 TOP: Topic: TORCH Infections

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. The nurse emphasizes to a patient with a high-risk pregnancy that the impact of such a pregnancy might result in:

Select all that apply.

a.

Disruption of family roles

b.

Financial pressures

c.

Delayed attachment to infant

d.

Frustration with activity restriction

e.

Alteration in child care practices

ANS: A, B, C, D, E

High-risk pregnancies have an impact on family roles, financial needs, alterations in attachment to the infant and child care practices, and frustration with the restricted activity.

DIF: Cognitive Level: Application REF: Text Reference: 112

OBJ: Objective: 8 TOP: Topic: Impact of High-Risk Pregnancies

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. A patient who is 30 weeks pregnant delivers a stillborn child in the emergency room. The ER nurse should offer:

Select all that apply.

a.

Privacy

b.

An opportunity to hold the infant

c.

Materials about support groups

d.

A memento (footprint or lock of hair)

e.

An opportunity to grieve

ANS: A, B, C, D, E

All the listed interventions are appropriate.

DIF: Cognitive Level: Application REF: Text Reference: 113

OBJ: Objective: 8 TOP: Topic: Stillborn Baby

KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

4. The nurse would include in a teaching plan for the pregnant patient who has iron deficiency anemia and who has been placed on iron supplement that:

Select all that apply.

a.

Citrus fruits enhance absorption of iron.

b.

Bran products support iron deficiency.

c.

Milk will disguise the taste of the iron.

d.

The iron therapy will continue for about 3 months.

e.

Tea should be avoided while taking iron.

ANS: A, D, E

Calcium, bran, and tannic acid in tea interfere with the absorption of iron. The therapy usually lasts 3 months, and vitamin C helps with the absorption of iron.

DIF: Cognitive Level: Application REF: Text Reference: 103

OBJ: Objective: 5 TOP: Topic: Iron Deficiency Anemia

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

COMPLETION

1. The nurse cautions that the consumption of as few as ________ alcoholic drink(s) during pregnancy can lead to the loss of fetal brain cells.

ANS: 2

DIF: Cognitive Level: Comprehension REF: Text Reference: 109

OBJ: Objective: 5 TOP: Topic: Fetal Alcohol Syndrome

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

NOT: Rationale: Studies have shown that even as few as two alcoholic drinks consumed during pregnancy can cause loss of fetal brain cells. A drink is defined as 12 oz. of beer, 5 oz. of wine, or 1.5 oz. of liquor.

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