Chapter 21 Pregnancy at Risk: Gestational Conditions

Chapter 21  Pregnancy at Risk: Gestational Conditions

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A primigravida is being monitored in her prenatal clinic for preeclampsia. Which finding should concern her nurse?
a.
Blood pressure (BP) increase to 138/86 mm Hg
b.
Weight gain of 0.5 kg during the past 2 weeks
c.
A dipstick value of 3+ for protein in her urine
d.
Pitting pedal edema at the end of the day

ANS: C

Feedback
A
Generally hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or 15 mm Hg diastolic pressure.
B
Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week.
C
Proteinuria is defined as a concentration of (30 mg/dl) 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made.
D
Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore the presence of edema is no longer considered diagnostic of preeclampsia.

DIF: Cognitive Level: Analysis REF: 626
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

2. In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?
a.
Administration of blood
b.
Preparation of the patient for invasive hemodynamic monitoring
c.
Restriction of intravascular fluids
d.
Administration of steroids

ANS: A

Feedback
A
Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters.
B
Central monitoring would not be ordered initially in a patient with DIC because this can contribute to more areas of bleeding.
C
Management of DIC would include volume replacement, not volume restriction.
D
Steroids are not indicated for the management of DIC.

DIF: Cognitive Level: Comprehension REF: 659
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

3. Women with hyperemesis gravidarum:
a.
Are a majority, because 80% of all pregnant women suffer from it at some time.
b.
Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.
c.
Need intravenous (IV) fluid and nutrition for most of their pregnancy.
d.
Often inspire similar, milder symptoms in their male partners and mothers.

ANS: B

Feedback
A
Although 80% of pregnant women experience nausea and vomiting, fewer than 0.5% proceed to this severe level.
B
However, treatment for several days sets things right in most cases.
C
IV administration may be used at first to restore fluid levels, but they are seldom needed for very long.
D
Women suffering from this condition want sympathy, because some authorities believe that difficult relationships with mothers and/or partners may be the cause.

DIF: Cognitive Level: Comprehension REF: 641
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

4. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman’s latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of:
a.
Eclampsia.
b.
Disseminated intravascular coagulation (DIC).
c.
HELLP syndrome.
d.
Idiopathic thrombocytopenia.

ANS: C

Feedback
A
Eclampsia is determined by the presence of seizures.
B
DIC is a potential complication associated with HELLP syndrome.
C
HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).
D
Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia.

DIF: Cognitive Level: Comprehension REF: 627
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

5. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The patient complains, “I’m so thirsty and warm.” The nurse:
a.
Calls for a stat magnesium sulfate level.
b.
Administers oxygen.
c.
Discontinues the magnesium sulfate infusion.
d.
Prepares to administer hydralazine.

ANS: C

Feedback
A
Regardless of the magnesium level, the patient is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the antidote for magnesium, may be administered.
B
The patient is displaying signs of magnesium sulfate toxicity. The first action by the nurse should be to discontinue the infusion of magnesium sulfate.
C
The patient is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the antidote for magnesium, may be administered.
D
Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.

DIF: Cognitive Level: Application REF: 636
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Implementation