Chapter 7 High-Risk Antepartum Nursing Care

Chapter 7  High-Risk Antepartum Nursing Care

Complete Chapter Questions And Answers
 

Sample Questions

Multiple Choice

1. A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety.a. Assess uterine contractions continuously.b. Assess fetal heart rate continuously.c. Assess urinary output.d. Assess respiratory rate.

ANS: d

Feedback
a.
Monitoring contractions does not indicate magnesium toxicity.
b.
Magnesium sulfate will decrease fetal variability and not provide an accurate assessment of magnesium toxicity.
c.
Urinary output does not correlate to decreased deep tendon reflexes.
d.
Correct. Respiratory effort and deep tendon reflexes (DTRs) are involuntary, and a decrease in DTRs could indicate the risk of magnesium sulfate toxicity and the risk for decreased respiratory effort.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Pharmacological/Parenteral Therapies | Difficulty Level: Moderate

2. A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications:a. Premature rupture of membranesb. Gestational diabetesc. Ectopic pregnancyd. Pregnancy-induced hypertension

ANS: c

Feedback
a.
Multiple partners do not increase a woman’s risk of premature rupture of membranes.
b.
Genetics and client diet and weight are contributing factors to gestational diabetes.
c.
Correct. A history of multiple sexual partners places the client at a higher risk of having contracted a sexually transmitted disease that could have ascended the uterus to the fallopian tubes and caused fallopian tube blockage, placing the client at high risk for an ectopic pregnancy.
d.
Multiple sexual partners are not a risk factor for pregnancy-induced hypertension.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

3. Identify the hallmark of placenta previa that differentiates it from abruptio placenta.a. Sudden onset of painless vaginal bleedingb. Board-like abdomen with severe painc. Sudden onset of bright red vaginal bleedingd. Severe vaginal pain with bright red bleeding

ANS: a

Feedback
a.
Correct. When the placenta attaches to the lower uterine segment near or over the cervical os, bleeding may occur without the onset of contractions or pain.
b.
The hallmark for abruptio placenta is pain and a board-like abdomen.
c.
Bright red bleeding could be related to abruptio placenta, placenta previa, or other complications of pregnancy.
d.
Pain is not a hallmark of placenta previa.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

4. Which of the following assessments would indicate instability in the client hospitalized for placenta previa?a. BP <90/60 mm/Hg, Pulse <60 BPM or >120 BPMb. FHR moderate variability without accelerationsc. Dark brown vaginal discharge when voidingd. Oral temperature of 99.9F

ANS: a

Feedback
a.
A decrease in BP accompanied by bradycardia or tachycardia is an indication of hypovolemic shock.
b.
FHR with moderate variability can be absent of accelerations during fetal sleep cycles or after maternal sedation.
c.
Bright red vaginal bleeding is an indication of current bleeding.
d.
Oral temperature may fluctuate based on the client’s hydration status. It should be reassessed. Cause for concern is a temperature of 100.4F or more.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

5. During pregnancy, poorly controlled asthma can place the fetus at risk for:a. Hyperglycemiab. IUGRc. Hypoglycemiad. Macrosomia
ANS: b

Feedback
a.
Maternal asthma does not place the fetus at risk for hyperglycemia.
b.
Compromised pulmonary function can lead to decompensation and hypoxia that decrease oxygen flow to the fetus and can cause intrauterine growth restriction (IUGR).
c.
Asthma does not directly affect glycemic control.
d.
A fetus experiencing hypoxia would be small for gestational age, not large for gestational age.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: AnalysisContent Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate