Deck 16: Pregnancy at Risk: Gestational Onset

Question 1

Which situation in the high-risk antepartal unit requires immediate intervention?

A)A third-trimester patient pregnant with twins who required an appendectomy yesterday is positioned in a supine position.
B)Oxygen is being administered at 2 L via nasal cannula to a patient in her third trimester who underwent an urolithotomy today.
C)Fetal monitoring is being performed on a patient in her third trimester who is scheduled for a cholecystectomy tomorrow.
D)The patient in her third trimester who returned from bowel resection surgery has a nasogastric tube attached to intermittent suction.

Answer 1

A third-trimester patient pregnant with twins who required an appendectomy yesterday is positioned in a supine position.

Question 2

Which maternal-child patient should the nurse see first?

A)Blood type O, Rh-negative
B)Indirect Coombs' test negative
C)Direct Coombs' test positive
D)Blood type B, Rh-positive

Answer 2

Direct Coombs' test positive

Question 3

The nurse identifies the following assessment findings on a patient with pre-eclampsia: blood pressure 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 11 on dipstick; and edema of the hands, ankles, and feet. On the next hourly assessment, which of the following new assessment findings would be an indication of worsening of the pre-eclampsia?

A)Blood pressure 158/104
B)Urinary output 20 mL/hour
C)Reflexes 21
D)Platelet count 150,000

Answer 3

Urinary output 20 mL/hour

Question 4

A patient who is at 32 weeks' gestation is determined to be at high risk for ABO incompatibility. Which intervention should the nurse anticipate implementing?

A)Intramuscular administration of 300 mcg of Rh immune globulin (RhoGAM) to the patient
B)Notify the patient's primary care provider and document the potential need for treatment of fetal hemolytic anemia in the patient's baby after delivery.
C)Obtain an antibody screen (indirect Coombs' test) to determine whether the patient has developed isoimmunity.
D)Note the potential for ABO incompatibility and plan to carefully assess the patient's neonate for the development of hyperbilirubinemia.

Question 5

The prenatal clinic nurse is caring for a patient with hyperemesis gravidarum at 14 weeks' gestation. The vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first?

A)Weigh the patient.
B)Give 1 liter of lactated Ringer's solution IV.
C)Administer 30 ml Maalox (magnesium hydroxide) orally.
D)Encourage clear liquids orally.

Question 6

The nurse is admitting a patient at 28 weeks' gestation to the emergency department following an episode of domestic abuse resulting in ecchymosis and lacerations. Which question is most critical to ask?

A)"What did you do to make your spouse so angry?"
B)"How many times has this happened in the past?"
C)"Do you have a safe place that you can go?"
D)"Will you be pressing charges against your spouse?"

Question 7

Which statement indicates that teaching has been effective?

A)"Because I have toxoplasmosis, my baby might be born with an abnormally long body."
B)"The rubella infection I experienced in my second trimester may lead me to become deaf."
C)"My baby may develop a serious blood infection because I have group B strep in my vagina."
D)"My 8-year-old's parvovirus infection won't affect my baby because I am four months along."

Question 8

The patient with blood type A, Rh-negative delivered yesterday. Her infant is blood type AB, Rh-positive. Which statement indicates that teaching has been effective?

A)"I need to get RhoGAM so I don't have problems with my next pregnancy."
B)"Because my baby is Rh-positive, I don't need RhoGAM."
C)"If my baby had the same blood type I do, it might cause complications."
D)"Before my next pregnancy, I will need to have a RhoGAM shot."

Question 9

The nurse is supervising care in the emergency department. Which situation most requires an intervention?

A)Moderate vaginal bleeding at 36 weeks' gestation; patient has an IV of lactated Ringer's solution running at 125 mL/hour
B)Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in one hour
C)Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20
D)Dark red bleeding at 30 weeks' gestation with normal vital signs; patient reports an absence of fetal movement

Question 10

The community nurse is working with a patient at 32 weeks' gestation who has been diagnosed with pre-eclampsia. Which statement indicates that additional information is needed?

A)"I should call the doctor if I develop a headache or blurred vision."
B)"Lying on my left side as much as possible is good for the baby."
C)"My urine may become darker and smaller in amount each day."
D)"Pain in the top of my abdomen is a sign my condition is worsening."

Question 11

The nurse is assessing a newly admitted patient who is 32 weeks' gestation. The patient's chief complaints are sudden onset of intense nausea and a frontal headache for the past two days. The patient's initial blood pressure is 158/98 and she reports scant urination over the past 24 hours. Which intervention should the nurse anticipate implementing?

A)Placing a wedge under the patient's left hip so that she is in a right lateral tilt position
B)Administration of diuretics and facilitating a dietary regimen of strict sodium restriction
C)Conducting a urine dipstick test to assess for proteinuria
D)Ordering a low-protein diet plan for the patient

Question 12

While preparing a class on maternal-fetal ABO incompatibility for antepartum patients, the nurse is creating a brochure. Which statement should be included in the brochure information?

A)In most cases, ABO incompatibility is limited to type A mothers with a type B or O fetus.
B)Group A infants, because they have no antigenic sites on the red blood cells (RBCs), are never affected regardless of the mother's blood type.
C)In most cases, ABO incompatibility is limited to type O mothers with a type A or B fetus.
D)ABO incompatibility occurs as a result of the fetal serum antibodies present and interaction between the antigen sites on the maternal RBCs.

Question 13

The nurse receives the following report on a patient who delivered 36 hours ago: para 1, rubella immune, A-negative, antibody screen negative, newborn B-positive, Coombs' negative, discharge orders are written for both mother and newborn. What should be the priority action by the nurse?

A)Ask if she is breast- or bottle-feeding.
B)Administer rubella vaccine.
C)Determine if RhoGAM has been given.
D)Discuss the discharge education with the patient.

Question 14

A 28-year-old woman who is at 16 weeks' gestation has just undergone screening for ABO incompatibility. She asks the nurse why her blood contains anti-A antibodies. What is the nurse's best response?

A)"Anti-A antibodies occur naturally, as a result of exposure to foods and different infections."
B)"It's most likely that you contracted anti-A antibodies through sexual activity."
C)"Anti-A antibodies are inherited; usually, they are genetically passed down from father to daughter."
D)"You may have contracted anti-A antibodies as a result of a viral infection."

Question 15

The nurse is caring for a patient at 35 weeks' gestation who has been critically injured in a shooting. Which statement by the paramedics bringing the woman to the hospital would cause the greatest concern?

A)"Blood pressure 110/68, pulse 90."
B)"Entrance wound present below the umbilicus."
C)"Patient is positioned in a left lateral tilt."
D)"Clear fluid is leaking from the vagina."