Question 1

A woman is being dismissed after undergoing placement of a cerclage.The woman is married with a husband who travels frequently and the couple has two other children.Which action by the nurse is most helpful?

Accepted Answer

After cerclage placement,bedrest is necessary.It is often difficult for a woman to maintain bedrest,especially if she has other children.A social worker can be helpful in assisting the woman to make contact with support organizations and in developing a working plan to care for the other children and household obligations.IV antibiotics are not routinely needed.Education on bedrest is important,but without acknowledging and acting on the profound disruptions that it can cause for a family,education alone is likely to be unsuccessful in promoting bedrest.Metachlopramide is used for nausea.

Question 2

The prenatal clinic nurse assesses a woman at 15 weeks' gestation.The patient's blood pressure,measured twice at intervals 1 hour apart with a cuff that fits appropriately,is 146/96 mm Hg.The nurse understands the patient has which condition?

Accepted Answer

Chronic hypertension is defined as hypertension that is present and observable prior to pregnancy,or hypertension that is diagnosed before the 20th week of gestation.Hypertension is defined as a blood pressure greater than 140/90 mm Hg.Hypertension for which a diagnosis is confirmed for the first time during pregnancy and that persists beyond the 84th day postpartum is also classified as chronic hypertension.Gestational hypertension occurs after 28 weeks without proteinuria and is a temporary diagnosis used until more diagnostic testing can be accomplished. Preeclampsia is an increased blood pressure seen after 20 weeks' gestation accompanied by proteinuria.Transient hypertension describes women who develop gestational hypertension but have no preeclampsia and whose blood pressure returns to normal within 12 weeks postpartum.This diagnosis is used only after pregnancy.

Question 3

A student in a perinatal clinic asks the clinic nurse what an incomplete abortion is.Which response by the nurse is best?

Accepted Answer

An incomplete abortion is the expulsion of some,but not all,products of conception prior to 20 weeks.Fetal death with retention of all products of conception prior to 20 weeks is called a missed abortion.Complete expulsion of all products of conception before 20 weeks is a complete spontaneous abortion.If a patient chooses to have an abortion,it is termed an elective abortion.

Question 4

The perinatal nurse is assessing a woman who is at 35 weeks' gestation in her first pregnancy.She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes.The fetal heart rate is 136 beats/minute.A vaginal examination performed by the health-care provider reveals no cervical changes since her last examination.Ultrasound examination reveals the presence of V-shaped cervical funneling.Which action by the nurse is most appropriate?

Accepted Answer

Preterm labor is defined as regular uterine contractions and cervical changes before the end of the 37th week of gestation.Many patients present with preterm contractions but only those who demonstrate changes in the cervix are diagnosed with preterm labor.Because this woman has no demonstrated cervical changes,she does not have the diagnosis.Also reassuring is the infrequency of her contractions; a defining characteristic of preterm labor is persistent uterine contractions (4 every 20 minutes or 8 per hour).Another reassuring finding is the presence of V-shaped cervical funneling ; a change to U-shaped cervical funneling in a woman with a shortened cervix is associated with preterm labor in high-risk women with a prior spontaneous preterm birth.The woman does not require corticosteroids or magnesium sulfate or admission to the high-risk OB unit.

Question 5

A woman presents to the perinatal clinic with abdominal pain.She has missed one period and,following a transvaginal ultrasound,pregnancy is confirmed.However,implantation has occurred in the right fallopian tube.The ectopic mass is 3 cm and has not ruptured.The nurse prepares the patient for which therapy?

Accepted Answer

Methotrexate,a chemotherapeutic drug and folic acid inhibitor that stops cell production and destroys remaining trophoblastic tissue,is used in the management of uncomplicated,non-life-threatening ectopic pregnancies.Patients are considered to be eligible for methotrexate therapy if the ectopic mass is unruptured and measures 4 cm or less on ultrasound examination.The other options would not be needed.

Question 6

A nurse is assessing a woman in the perinatal clinical with diagnosed cervical insufficiency.The woman is in her 18th week of a viable pregnancy.Which action by the nurse is most appropriate?

Accepted Answer

Because the woman has diagnosed cervical insufficiency,a cerclage is appropriate therapy.This purse-string suture closes the cervix so the uterus can contain the pregnancy.It is usually removed in the 37th week to allow for vaginal delivery.Because it is an invasive procedure,informed consent is required.The other options are not necessary in this situation,although if the woman has unresolved grief following prior spontaneous abortions,a referral would be appropriate.

Question 7

A nurse has admitted a patient with hyperemesis gravidarum and is reviewing the physician's orders.Which order should the nurse question?

Accepted Answer

Dimenhydrinate,metoclopramide,promethazine,and pyridoxine are all used to treat nausea and vomiting of pregnancy.Betamethasone is used to decrease the chance of respiratory distress syndrome in premature infants.It is given in 2 doses,12 hours apart,at a dose of 12 mg.

Question 8

A 22-year-old woman presents to the emergency department with abdominal pain and
Vaginal bleeding.Her blood pressure is 90/58 mm Hg,her pulse is 120 beats/minute,and she complains of dizziness.Which action by the nurse takes priority?

Accepted Answer

This patient has both signs (hypotension,tachycardia)and symptoms (complaints of dizziness)of acute volume loss.The nurse should consider a ruptured ectopic pregnancy as a possible problem in this patient and assess her for other manifestations and risk factors.However,the priority is starting large-bore IV lines for fluid resuscitation.The nurse may need to obtain informed consent for an operative procedure once a definitive diagnosis is made.

Question 9

A woman with a history of previous abruptio placentae with fetal demise is being seen in the
Perinatal clinic.She is now pregnant again in her early second trimester.She tells the nurse she is a Jehovah's Witness and she wants her chart to reflect her refusal to accept blood products if she hemorrhages again.Which action by the nurse is best?

Accepted Answer

Jehovah's Witnesses do not accept blood products or their derivatives as part of their medical care.Because this woman is at high risk for a complicated pregnancy (another abruptio placentae)and hemorrhage,she should be advised to deliver in a tertiary care center that is prepared to manage catastrophic hemorrhage.The nurse should facilitate this discussion as part of providing holistic care.Asking the woman to reconsider (and go against her religious beliefs)is disrespectful.The nurse should document the information and inform the care provider,but this action in itself is incomplete.Telling the woman that a court can order her to have transfusions,although a true statement,is likely to be perceived as threatening and disrespectful,and certainly does not allow the nurse to provide care in a holistic manner.

Question 10

A woman in her second trimester of pregnancy presents to the perinatal clinic with complaints of scant vaginal bleeding,abdominal pain,and shoulder pain.What action should the nurse perform first?

Accepted Answer

This woman is displaying symptoms of a possible ruptured ectopic pregnancy (vaginal bleeding,abdominal pain,shoulder pain).Shoulder pain can occur from nerve irritation due to the presence of blood in the pelvic cavity.A b-hCG test finding will be lower than expected for the gestational age.The woman will most likely need a pelvic exam.However,to facilitate a rapid diagnosis,the nurse should first obtain and send a blood sample for b-hCG test.The nurse can then assess the woman for risk factors for ectopic pregnancy.However,preterm labor is not a risk factor.Methotrexate is used for uncomplicated,non-life-threatening ectopic pregnancies.It would not be indicated in this patient because she has manifestations of rupture.

Question 11

A pregnant patient in the second trimester is in the emergency department after a motor vehicle crash.She has a severe laceration of her arm resulting in a large blood loss.Which assessment should the nurse perform first?

Accepted Answer

Because a woman's blood volume can increase dramatically during pregnancy,blood pressure is an unreliable indicator of a volume deficit.Maternal pulse and fetal heart rate are much more accurate indicators.Because the priority in care of the pregnant trauma patient is care of the mother,the nurse should assess the mother's blood pressure first.

Question 12

The nurse manager in a perinatal clinic is reviewing research related to care of patients with cervical insufficiency and preterm birth.What practice change might result from this review of the literature?

Accepted Answer

According to a meta-analysis by Berghella and Mackeen (2011),singleton gestations in women with prior preterm birth might be monitored safely with transvaginal ultrasound cervical length screening,and they suggested that cerclage placement be reserved for the minority of women who actually develop a short cervical length.Administration of Rh_oGAM is not related.Only women with a history of preterm birth need cervical length measurement according to current practice.Celestone is not used for long-term therapy.

Question 13

The nurse finds a woman who has recently suffered her third complete abortion crying and saying "Why me? What did I do to deserve being punished like this?" Which response by the nurse is best?

Accepted Answer

Women (and their partners)frequently need support with any perinatal loss.The best option here would be for the nurse to offer to call a clergy member or social worker to visit and offer assistance.Asking if the woman uses illicit drugs or drinks alcohol sounds as if the nurse is trying to blame the woman for the miscarriages.Simply explaining that most spontaneous abortions involve a fetus with chromosomal abnormalities does nothing to address the woman's feelings,although it should be part of a comprehensive plan of action.Simply reassuring the woman that she is not being punished sounds paternalistic.

Question 14

A nurse is caring for a patient who has been diagnosed with an incomplete molar pregnancy.Which action by the nurse is most appropriate?

Accepted Answer

Gestational trophoblastic disease (GTD)is a disease characterized by an abnormal placental development that results in the production of fluid-filled grapelike clusters (instead of normal placental tissue)and a vast proliferation of trophoblastic tissue.GTD includes the diagnosis of hydatidiform mole ("molar pregnancy").Complete moles have a proliferation of trophoblastic tissue,but no fetal parts.An incomplete mole is associated with a coexistent fetus that is genetically abnormal and usually only survives a few weeks before being spontaneously aborted.Support groups for grieving parents are an important community resource,and the nurse should ensure that the woman has information on local organizations.Management includes emptying the uterus of its contents with strict follow-up.Women should not become pregnant for at least a year afterward.Incomplete moles are almost always benign,so a consultation for a radiation oncology nurse is most likely not needed.Screening for SLE is done in women who have habitual abortions.

Question 15

The perinatal nurse is caring for a woman at 26 weeks' gestation who has a history of hypertension that has been well controlled.Today she presents with a blood pressure of 156/102 mm Hg and she has 2+ protein on urine dipstick.Which initial action by the nurse is most appropriate?

Accepted Answer

Preeclampsia can occur in a woman who has chronic hypertension.This woman has the characteristics of hypertension after a period of good control and proteinuria of at least 2+ on dipstick (100 mg/dL).The nurse needs to ensure protein levels are assessed in two samples at least 4 hours apart and ensure the woman has no signs of a urinary tract infection,as protein can occur in a sample of infected urine.The nurse should obtain a clean-catch urine sample to send to the laboratory for analysis.Asymptomatic UTI can occur in up to 11% of pregnant women,so assessing for signs and symptoms may not be accurate.The woman does not need admission to the high-risk OB unit,strict bedrest,or IV anti-hypertensives at this point.

Question 16

A nurse has admitted a woman pregnant in her third trimester with moderate vaginal bleeding and severe abdominal pain.After assessing maternal vital signs,obtaining the fetal heart rate,and starting an IV line,which action should the nurse do next?

Accepted Answer

Women who present with third-trimester vaginal bleeding should be examined carefully for placenta previa or abruptio placentae.Bleeding accompanied by abdominal pain is the classic sign of placental abruption.Care includes obtaining maternal vital signs,assessing fetal heart rate,and starting an IV for fluid resuscitation or transfusion if needed.Blood work should be obtained for CBC,type and screen,coagulation studies,and a Kleihauer Betke determination,Betamethasone is given if delivery is not imminent.Continuous electronic fetal monitoring is the standard of care,and although the nurse should educate the patient on its use,this discussion does not take priority over obtaining diagnostic laboratory studies.An emergent delivery is a possible (not certain)outcome,but obtaining consent does not take priority over the diagnostic blood work.

Question 17

A woman is hospitalized with hyperemesis gravidarum.Which other member of the health-care team should the nurse ensure is involved in this patient's care as a priority?

Accepted Answer

Although all members of the health-care team have important roles to play and may be needed in the care of this patient,the dietician is the priority.Patients with hyperemesis gravidarum have extreme nausea and vomiting unrelated to other causes.They demonstrate weight loss and measures of starvation such as ketosis.Serious complications arise if the woman cannot maintain her weight despite antiemetics.The dietician will be helpful in assisting the woman to plan appropriate meals and snacks or,if the woman needs enteral or parenteral feedings,in providing nutritional information to guide therapy.

Question 18

A nurse is teaching a woman pregnant in the second trimester who has been diagnosed with a partial placenta previa.Which information is most important to document?

Accepted Answer

If the patient needs care from another health-care provider,she must tell him or her that due to her placenta previa,all vaginal exams are prohibited.This is an important safety measure that must be taught and clearly documented.Assessing (and documenting)the psychosocial status of the patient and partner are important too,but safety takes priority.A partial placental previa only partly covers the cervical os.The statement that the patient received information and understood it well is vague and does not constitute an example of acceptable charting.

Question 19

A woman who recently had a miscarriage is in the clinic for follow-up.She sees the diagnosis "spontaneous abortion" on her chart and becomes visibly upset,stating,"I did not have an abortion!" Which response by the nurse is best?

Accepted Answer

The term "spontaneous abortion" is the medical term for miscarriage before 20 weeks' gestation.Medical terms are often confusing to laypeople,and it is the nurse's duty to inform patients of their meaning.Nurses should also be aware that the term "abortion" is politically and emotionally laden,so it should not be surprising that an uninformed layperson might become upset at its use.The nurse should acknowledge the woman's feelings and explain the term.Telling the woman not to be upset is paternalistic and does nothing to educate her.Offering to come back later would be a useful option after the nurse has acknowledged the woman's feelings and discovered that she does not want to talk right now; otherwise,this statement might seem like rejection.Stating that no one is accusing the woman of having an abortion is defensive.

Question 20

A nurse is assessing a 52-year-old primigravida woman who presents complaining of moderate dark-brown vaginal bleeding.On physical exam,her uterus is large for dates.Which action by the nurse is most appropriate?

Accepted Answer

The incidence of gestational trophoblastic disease (GTD),including hydatidiform mole,increases in women of advanced age (especially over 50).Dark-brown vaginal bleeding is one symptom of this condition,and the nurse should be cognizant of its possibility.Because hydatidiform mole is diagnosed with ultrasound,the nurse should facilitate this testing.A diet low in folic acid is a risk factor,but the nurse should delay assessing for risk factors until after he or she has facilitated the ultrasound.Because molar pregnancies are either associated with no fetus or one that is generally spontaneously aborted,instructing the woman on fetal kick counts is not appropriate.The patient does not need pelvic cultures for this condition.

Quiz 11: Caring for the Woman Experiencing Complications During Pregnancy