Deck 10: Complications of Pregnancy

Question 1

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

A) monitor uterine contractions.
B) assess fetal heart rate and maternal vital signs.
C) place clean disposable pads to collect any drainage.
D) perform a venipuncture for hemoglobin and hematocrit levels.

Answer 1

assess fetal heart rate and maternal vital signs.

Question 2

Which maternal condition always necessitates delivery by cesarean birth?

A) Partial abruptio placentae
B) Total placenta previa
C) Ectopic pregnancy
D) Eclampsia

Answer 2

Total placenta previa

Question 3

Which data found on a patient's health history would place her at risk for an ectopic pregnancy?

A) Ovarian cyst 2 years ago
B) Recurrent pelvic infections
C) Use of oral contraceptives for 5 years
D) Heavy menstrual flow of 4 days' duration

Answer 3

Recurrent pelvic infections

Question 4

A placenta previa when the placental edge just reaches the internal os is called

A) total.
B) partial.
C) low-lying.
D) marginal.

Question 5

An abortion when the fetus dies but is retained in the uterus is called

A) inevitable.
B) missed.
C) incomplete.
D) threatened.

Question 6

A patient taking magnesium sulfate has a respiratory rate of 10 breaths per minute. In addition to discontinuing the medication, which action should the nurse take?

A) Increase the patient's IV fluids.
B) Administer calcium gluconate.
C) Vigorously stimulate the patient.
D) Instruct the patient to take deep breaths.

Question 7

Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole?

A) Blood pressure of 120/80 mm Hg
B) Complaint of frequent mild nausea
C) Fundal height measurement of 18 cm
D) History of bright red spotting for 1 day weeks ago

Question 8

Which intrapartal assessment should be avoided when caring for a patient with HELLP syndrome?

A) Abdominal palpation
B) Venous sample of blood
C) Checking deep tendon reflexes
D) Auscultation of the heart and lungs

Question 9

A patient with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a

A) diuretic.
B) tocolytic.
C) anticonvulsant.
D) antihypertensive.

Question 10

In which situation would a dilation and curettage (D&C) be 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

Question 11

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

A) gastrointestinal upset.
B) effects of magnesium sulfate.
C) anxiety caused by hospitalization.
D) worsening disease and impending convulsion.

Question 12

A laboratory finding indicative of DIC is one that shows

A) decreased fibrinogen.
B) increased platelets.
C) increased hematocrit.
D) decreased thromboplastin time.

Question 13

Which clinical intervention is the only known cure for preeclampsia?

A) Magnesium sulfate
B) Delivery of the fetus
C) Antihypertensive medications
D) Administration of aspirin (ASA) every day of the pregnancy

Question 14

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

A) +1
B) +2
C) +3
D) +4

Question 15

Which finding would indicate concealed hemorrhage in abruptio placentae?

A) Bradycardia
B) Hard boardlike abdomen
C) Decrease in fundal height
D) Decrease in abdominal pain

Question 16

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) there is no evidence of intrauterine infection.

Question 17

The clinic nurse is performing a prenatal assessment on a pregnant patient at risk for preeclampsia. Which clinical sign would not present as a symptom of preeclampsia?

A) Edema
B) Proteinuria
C) Glucosuria
D) Hypertension

Question 18

Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?

A) Determining cervical dilation and effacement
B) Monitoring FHR and maternal vital signs
C) Observing vaginal bleeding or leakage of amniotic fluid
D) Determining frequency, duration, and intensity of contractions

Question 19

Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication?

A) Drowsiness
B) Urinary output of 20 mL/hour
C) Normal deep tendon reflexes
D) Respiratory rate of 10 to 12 breaths per minute

Question 20

Rh incompatibility can occur if the patient is Rh-negative and the

A) fetus is Rh-negative.
B) fetus is Rh-positive.
C) father is Rh-positive.
D) father and fetus are both Rh-negative.

Question 21

Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae?

A) Saturated perineal pad in 1 hour
B) Pain level 0 on a scale of 0 to 10
C) Cervical dilation at 2 cm
D) Fetal heart rate at 160 bpm

Question 22

Which finding in the assessment of a patient following an abruption placenta could indicate a major complication?

A) Urine output of 30 mL in 1 hour
B) Blood pressure of 110/60 mm Hg
C) Bleeding at IV insertion site
D) Respiratory rate of 16 breaths per minute

Question 23

Which intervention is the priority for the patient diagnosed with an intact tubal pregnancy?

A) Assessment of pain level
B) Administration of methotrexate
C) Administration of Rh immune globulin
D) Explanation of the common side effects of the treatment plan

Question 24

A high-risk labor patient progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via cesarean birth. Which finding in the immediate postoperative period indicates that the patient is at risk of developing HELLP syndrome?

A) Platelet count of 50,000/mcL
B) Liver enzyme levels within normal range
C) Negative for edema
D) No evidence of nausea or vomiting

Question 25

Which finding in the exam of a patient with a diagnosis of threatened abortion would change the diagnosis to inevitable abortion?

A) Presence of backache
B) Rise in hCG level
C) Clear fluid from vagina
D) Pelvic pressure

Question 26

A patient with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the patient is questioned, she relates that there is history of heart disease in her family; but, that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the patient is discharged. The patient returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension is the patient is exhibiting?

A) Pregnancy-induced hypertension (PIH)
B) Gestational hypertension
C) Preeclampsia superimposed on chronic hypertension
D) Undiagnosed chronic hypertension

Question 27

What is the priority nursing intervention for the patient who has had an incomplete abortion?

A) Methylergonovine (Methergine), 0.2 mg IM
B) Preoperative teaching for surgery
C) Insertion of IV line for fluid replacement
D) Positioning of patient in left side-lying position

Question 28

For the patient who delivered at 6:30 AM on January 10, Rho(D) immune globulin (RhoGAM) must be administered prior to

A) 6:30 AM on January 13.
B) 6:30 PM on January 13.
C) 6:30 PM on January 14.
D) 6:30 AM on January 15.

Question 29

Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant patient with diabetes?

A) Evaluation of retinopathy by an ophthalmologist
B) The patient's stable emotional and psychological status
C) Degree of glycemic control before and during the pregnancy
D) Total protein excretion and creatinine clearance within normal limits

Question 30

As the triage nurse in the emergency room, you are reviewing results for the high-risk obstetric patient who is in labor because of traumatic injury experienced as a result of a motor vehicle accident (MVA). You note that the Kleihauer-Betke test is positive. Based on this information, you anticipate that

A) immediate birth is required.
B) the patient should be transferred to the critical care unit for closer observation.
C) RhoGAM should be administered.
D) a tetanus shot should be administered.

Question 31

What should the nurse recognize as evidence that the patient is recovering from preeclampsia?

A) 1+ protein in urine
B) 2+ pitting edema in lower extremities
C) Urine output >100 mL/hour
D) Deep tendon reflexes +2

Question 32

A patient who had premature rupture of the membranes (PROM) earlier in the pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she is now in labor. The labor and birth nurse performs the following assessments. The vaginal exam is deferred until the physician is in attendance. The patient is placed on electronic fetal monitoring (EFM) and a baseline FHR of 130 bpm is noted. No contraction pattern is observed. The patient is then transferred to the antepartum unit for continued observation. Several hours later, the patient complains that she does not feel the baby move. Examination of the abdomen reveals a fundal height of 34 cm. Muscle tone is no different from earlier in the hospital admission. The patient is placed on the EFM and no fetal heart tones are observed. What does the nurse suspect is occurring?

A) Placental previa
B) Active labor has started
C) Placental abruption
D) Hidden placental abruption

Question 33

A patient who was pregnant had a spontaneous abortion at approximately 4 weeks' gestation. At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the patient presents at the clinic office complaining of "crampy" abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100°F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/minute (bpm), and respirations, 20 breaths per minute. Based on this assessment data, what does the nurse anticipate as a clinical diagnosis?

A) Ectopic pregnancy
B) Uterine infection
C) Gestational trophoblastic disease
D) Endometriosis

Question 34

A labor and birth nurse receives a call from the laboratory regarding a preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patient's magnesium level is 7.6 mg/dL. What is the nurse's priority action?

A) Stop the infusion of magnesium.
B) Assess the patient's respiratory rate.
C) Assess the patient's deep tendon reflexes.
D) Notify the health care provider of the magnesium level.

Question 35

Which factor is known to increase the risk of gestational diabetes mellitus?

A) Previous birth of large infant
B) Maternal age younger than 25 years
C) Underweight prior to pregnancy
D) Previous diagnosis of type 2 diabetes mellitus

Question 36

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on which of the following?

A) Hemorrhage is the primary concern.
B) She will be unable to conceive in the future.
C) Bed rest and analgesics are the recommended treatment.
D) A D&C will be performed to remove the products of conception.

Question 37

The labor and birth nurse is reviewing the risk factors for placenta previa with a group of nursing students. The nurse determines that the students understood the discussion when they identify which patient being at the highest risk for developing a placenta previa?

A) Female fetus, Mexican-American, primigravida
B) Male fetus, Asian-American, previous preterm birth
C) Male fetus, African-American, previous cesarean birth
D) Female fetus, European-American, previous spontaneous abortion

Question 38

A blood-soaked peripad weighs 900g. The nurse would document a blood loss of _____ mL.

A) 1800
B) 450
C) 900
D) 90

Question 39

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

A) Hypoglycemia
B) Hypercalcemia
C) Hypoinsulinemia
D) Hypobilirubinemia

Question 40

Fraternal twins are delivered by your Rh-negative patient. Twin A is Rh-positive and twin B is Rh-negative. Prior to administering Rho(D) immune globulin (RhoGAM), the nurse should determine the results of the

A) direct Coombs test of twin A.
B) direct Coombs test of twin B.
C) indirect Coombs test of the mother.
D) transcutaneous bilirubin level for both twins.

Question 41

A patient has tested HIV-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis?

A) "I know I will need to have an abortion as soon as possible."
B) "Even though my test is positive, my baby might not be affected."
C) "My baby is certain to have AIDS and die within the first year of life."
D) "This pregnancy will probably decrease the chance that I will develop AIDS."

Question 42

Which disease process improves during pregnancy?

A) Epilepsy
B) Bell's palsy
C) Rheumatoid arthritis
D) Systemic lupus erythematosus (SLE)

Question 43

Anti-infective prophylaxis is indicated for a pregnant patient with a history of mitral valve stenosis related to rheumatic heart disease because the patient is at risk of developing

A) hypertension.
B) postpartum infection.
C) bacterial endocarditis.
D) upper respiratory infections.

Question 44

A patient has a history of drug use and is screened for hepatitis B during the first trimester. Which action is most appropriate?

A) Practice respiratory isolation.
B) Plan for retesting during the third trimester.
C) Discuss the recommendation to bottle feed her baby.
D) Anticipate administering the vaccination for hepatitis B as soon as possible.

Question 45

Which form of heart disease in women of childbearing years usually has a benign effect on pregnancy?

A) Cardiomyopathy
B) Mitral valve prolapse
C) Rheumatic heart disease
D) Congenital heart disease

Question 46

What is the value of the main line fluid rate for your patient, whose total fluid intake is ordered at 150 mL/hour and who is also being given magnesium sulfate at 1 g/hour (1 g = 25 mL/hour) IV piggyback and pitocin at 15 mU/minute (l mU/minute = 1 mL/hour) IV piggyback. ______

Question 47

The nurse is monitoring a patient with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.)

A) Cool, clammy skin
B) Altered sensorium
C) Pulse oximeter reading of 95%
D) Respiratory rate of less than 12 breaths per minute
E) Absence of deep tendon reflexes

Question 48

Which postpartum patient requires further assessment?

A) G4 P4 who has had four saturated pads during the last 12 hours
B) G1 P1 with Class II heart disease who complains of frequent coughing
C) G2 P2 with gestational diabetes whose fasting blood sugar level is 100 mg/dL
D) G3 P2 postcesarean patient who has active herpes lesions on the labia

Question 49

Which instructions should the nurse include when teaching a pregnant patient with Class II heart disease?

A) Advise her to gain at least 30 lb.
B) Instruct her to avoid strenuous activity.
C) Inform her of the need to limit fluid intake.
D) Explain the importance of a diet high in calcium.

Question 50

The labor nurse is admitting a patient in active labor with a history of genital herpes. On assessment, the patient reports a recent outbreak, and the nurse verifies lesions on the perineum. What is the nurse's next action?

A) Ask the patient when she last had anything to eat or drink.
B) Take a culture of the lesions to verify the involved organism.
C) Ask the patient if she has had unprotected sex since her outbreak.
D) Use electronic fetal surveillance to determine a baseline fetal heart rate.

Question 51

The rate of obesity in the United States has reached epidemic proportions. Morbidity and mortality for both the mother and baby are increased in these circumstances. The nurse caring for the patient with an elevated BMI should be cognizant of these potential complications and plan care accordingly. Significant risks include (Select all that apply.)

A) Breech presentation
B) Ectopic pregnancy
C) Birth defects
D) Venous thromboembolism
E) Postpartum anemia

Question 52

Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality?

A) Rubella
B) Cytomegalovirus (CMV)
C) Syphilis
D) HIV

Question 53

The nurse is reviewing the instructions given to a patient at 24 weeks' gestation for a glucose challenge test (GCT). The nurse determines that the patient understands the teaching when she makes which statement?

A) "I have to fast the night before the test."
B) "I will drink a sugary solution containing 100 g of glucose."
C) "I will have blood drawn at 1 hour after I drink the glucose solution."
D) "I should keep track of my baby's movements between now and the test."

Question 54

A patient, who delivered her third child yesterday, has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her?

A) Her two children should be treated with acyclovir before she goes home from the hospital.
B) The baby will acquire immunity from her and will not be susceptible to chickenpox.
C) The children can visit their mother and baby in the hospital as planned but must wear gowns and masks.
D) She must make arrangements to stay somewhere other than her home until the children are no longer contagious.

Question 55

Nursing intervention for pregnant patients with diabetes is based on the knowledge that the need for insulin is

A) varied depending on the stage of gestation.
B) increased throughout pregnancy and the postpartum period.
C) decreased throughout pregnancy and the postpartum period.
D) should not change because the fetus produces its own insulin.