Chapter 11 Caring for the Woman Experiencing Complications During Pregnancy

Chapter 11  Caring for the Woman Experiencing Complications During Pregnancy

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. 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?
A.
Laparoscopic salpingostomy
B.
Methotrexate
C.
Partial salpingectomy
D.
Salpingectomy by laparotomy

ANS: B
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.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

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?
A.
Chronic hypertension
B.
Gestational hypertension
C.
Preeclampsia
D.
Transient hypertension

ANS: A
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.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

3. 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?
A.
Educate the woman on benefits of corticosteroids.
B.
Facilitate admission to the high-risk OB unit.
C.
Prepare to administer a dose of magnesium sulfate.
D.
Reassure the woman that she is not in preterm labor.

ANS: D
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.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

4. 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?
A.
Arrange admission to the high-risk OB unit.
B.
Instruct the woman on strict bedrest.
C.
Obtain a clean-catch urine sample.
D.
Prepare to administer IV anti-hypertensives.

ANS: C
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.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

5. 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?
A.
Assess the woman for sexually transmitted infections.
B.
Collect a urine sample for pregnancy testing.
C.
Obtain informed consent for a salpingectomy.
D.
Start two large-bore IVs for fluid replacement.

ANS: D
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.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1