Final Exam: NSG 432/ NSG432 (Latest 2025/ 2026 Update) Nursing Care of the Childbearing Family Complete | Questions & Answers | 100% Correct| Grade A (Verified Solutions) – GCU

//Final Exam: NSG 432/ NSG432 (Latest 2025/ 2026 Update) Nursing Care of the Childbearing Family Complete | Questions & Answers | 100% Correct| Grade A (Verified Solutions) – GCU. A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine ―several times‖ during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category? a. Blood pressure, age, and BMI b. Drug/alcohol use, age, and family history c. Family history, blood pressure, and BMI d. Family history, BMI, and drug/alcohol abuse Family history, BMI, and drug/alcohol abuse Her family history of NTD, low BMI, and substance abuse all are high risk factors of pregnancy. The woman's BP is normal, and her age does not put her at risk. Her BMI is low and may indicate poor nutritional status, which would be a high risk. The woman's drug/alcohol use and family history put her in a high risk category, but her age does not. The woman's family history puts her in a high risk category. Her BMI is low and may indicate poor nutritional status, which would be high risk. Her BP is normal. A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time? a. Ultrasound examination b. Maternal serum alpha-fetoprotein (MSAFP) screening c. Amniocentesis d. Nonstress test (NST) Ultrasound examination An ultrasound examination could be done to confirm the pregnancy and determine the gestational age of the fetus. It is too early in the pregnancy to perform MSAFP screening, amniocentesis, or NST. MSAFP screening is performed at 16 to 18 weeks of gestation, followed by amniocentesis if MSAFP levels are abnormal or if fetal/maternal anomalies are detected. NST is performed to assess fetal well-being in the third trimester. The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what other tool would be useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts Doppler blood flow analysis Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, CST is not performed on a woman whose fetus is preterm. Indications for amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR. A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. Maternal serum alpha-fetoprotein (MSAFP) screening d. Percutaneous umbilical blood sampling (PUBS) Biophysical profile (BPP) Real-time ultrasound permits detailed assessment of the physical and physiologic characteristics of the developing fetus and cataloging of normal and abnormal biophysical responses to stimuli. BPP is a noninvasive, dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease. An ultrasound for fetal anomalies would most likely have been performed earlier in the pregnancy. It is too late in the pregnancy to perform MSAFP screening. Also, MSAFP screening does not provide information related to fetal well-being. Indications for PUBS include prenatal diagnosis or inherited blood disorders, karyotyping of malformed fetuses, detection of fetal infection, determination of the acid-base status of a fetus with IUGR, and assessment and treatment of isoimmunization and thrombocytopenia in the fetus. A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time? a. Biophysical profile (BPP) b. Amniocentesis c. Maternal serum alpha-fetoprotein (MSAFP) screening d. Transvaginal ultrasound Transvaginal ultrasound Ultrasound would be performed at this gestational age for biophysical assessment of the infant. BPP would be a method of biophysical assessment of fetal well-being in the third trimester. Amniocentesis is performed after the 14th week of pregnancy. MSAFP screening is performed from week 15 to week 22 of gestation (weeks 16 to 18 are ideal). A patient asks her nurse, ―My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?‖ The best response by the nurse is a. ―Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.‖ b. ―Your placenta isn't working properly, and your baby is in danger.‖ c. ―This means that we will need to perform an amniocentesis to detect if you have any placental damage.‖ d. ―Don't worry about it. Everything is fine.‖ Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.‖ An accurate and appropriate response is, ―Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby.‖ Although ―Your placenta isn't working properly, and your baby is in danger‖ may be valid, it does not reflect therapeutic communication techniques and is likely to alarm the patient. An ultrasound, not an amniocentesis, is the method of assessment used to determine placental maturation. The response ―Don't worry about it. Everything is fine‖ is not appropriate and discredits the patient's concerns. A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be a. negative. b. positive. c. satisfactory. d. unsatisfactory. negative. Adequate uterine activity necessary for a CST consists of the presence of three contractions in a 10-minute time frame. If no decelerations are observed in the FHR pattern with the contractions, the findings are considered to be negative. A positive CST indicates the presence of repetitive later FHR decelerations. Satisfactory and unsatisfactory are not applicable terms. When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that a. alcohol or cigarette smoke can irritate the fetus into greater activity. b. ―kick counts‖ should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off. c. the fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. obese mothers familiar with their bodies can assess fetal movement as well as average-size women. the fetal alarm signal should go off when fetal movements stop entirely for 12 hours. No movement in a 12-hour period is cause for investigation and possibly intervention. Alcohol and cigarette smoke temporarily reduce fetal movement. The mother should count fetal activity (―kick counts‖) two or three times daily for 60 minutes each time. Obese women have a harder time assessing fetal movement. In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their patients that a. both require the woman to have a full bladder. b. the abdominal examination is more useful in the first trimester. c. initially the transvaginal examination can be painful. d. the transvaginal examination allows pelvic anatomy to be evaluated in greater detail. the transvaginal examination allows pelvic anatomy to be evaluated in greater detail. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail and allows intrauterine pregnancies to be diagnosed earlier. The abdominal examination requires a full bladder; the transvaginal examination requires an empty bladder. The transvaginal examination is more useful in the first trimester; the abdominal examination works better after the first trimester. Neither method should be painful, although with the transvaginal examination the woman feels pressure as the probe is moved. In the first trimester, ultrasonography can be used to gain information on a. amniotic fluid volume. b. location of gestational sacs. c. placental location and maturity. d. cervical length. location of gestational sacs. During the first trimester, ultrasound examination is performed to obtain information regarding the number, size, and location of gestational sacs; the presence or absence of fetal cardiac and body movements; the presences or absence of uterine abnormalities (e.g., bicornuate uterus or fibroids) or adnexal masses (e.g., ovarian cysts or an ectopic pregnancy); and pregnancy dating. Nurses should be aware that the biophysical profile (BPP) a. is an accurate indicator of impending fetal death. b. is a compilation of health risk factors of the mother during the later stages of pregnancy. c. consists of a Doppler blood flow analysis and an amniotic fluid index. d. involves an invasive form of ultrasound examination. is an accurate indicator of impending fetal death. An abnormal BPP score is an indication that labor should be induced. The BPP evaluates the health of the fetus, requires many different measures, and is a noninvasive procedure. Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment a. has no known contraindications. b. has fewer false-positive results. c. is more sensitive in detecting fetal compromise. d. is slightly more expensive. has no known contraindications. CST has several contraindications. NST has a high rate of false-positive results, is less sensitive than the CST, and is relatively inexpensive. The nurse providing care for the antepartum woman should understand that contraction stress test (CST) a. sometimes uses vibroacoustic stimulation. b. is an invasive test; however, contractions are stimulated. c. is considered negative if no late decelerations are observed with the contractions. d. is more effective than nonstress test (NST) if the membranes have already been ruptured. is considered negative if no late decelerations are observed with the contractions. No late decelerations are good news. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is by intravenous oxytocin but not if by nipple stimulation and is contraindicated if the membranes have ruptured. Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring patient with diabetes mellitus, the nurse is aware that she is at a greater risk for a. oligohydramnios. b. polyhydramnios. c. postterm pregnancy. d. chromosomal abnormalities. polyhydramnios. Polyhydramnios (amniotic fluid 2000 mL) is 10 times more likely to occur in diabetic compared with nondiabetic pregnancies. Polyhydramnios puts the mother at risk for premature rupture of membranes, premature labor, and after birth hemorrhage. Prolonged rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and renal agenesis (Potter syndrome) all put the patient at risk for developing oligohydramnios. Anencephaly, placental insufficiency, and perinatal hypoxia all contribute to the risk for postterm pregnancy. Maternal age older than 35 years and balanced translocation (maternal and paternal) are risk factors for chromosome abnormalities. A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is a. ―The test results are within normal limits.‖ b. ―Immediate delivery by cesarean birth is being considered.‖ c. ―Further testing will be performed to determine the meaning of this score.‖ d. ―An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery.‖ ―The test results are within normal limits.‖ The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. Scores less than 4 should be investigated, and delivery could be initiated sooner than planned. This score is within normal range, and no further testing is required at this time. The results of the biophysical profile are usually available immediately after the procedure is performed. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Multiple-marker screening b. Lecithin/sphingomyelin [L/S] ratio c. Biophysical profile d. Type and crossmatch of maternal and fetal serum Multiple-marker screening Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. The multiple-marker screening may predict chromosomal defects in the fetus. The L/S ratio is used to determine fetal lung maturity. A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. The blood type and crossmatch would not predict chromosomal defects in the fetus. While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at a. 4 weeks. b. 8 weeks. c. 10 weeks. d. 14 weeks. 10 weeks CVS can be performed in the first or second trimester, ideally between 10 and 13 weeks of gestation. During this procedure, a small piece of tissue is removed from the fetal portion of the placenta. If performed after 9 completed weeks of gestation, the risk of limb reduction is no greater than in the general population Which nursing intervention is necessary before a second-trimester transabdominal ultrasound? a. Place the woman NPO for 12 hours. b. Instruct the woman not void until after the test. c. Administer an enema. d. Perform an abdominal preparation. Instruct the woman not void until after the test. When the uterus is still in the pelvis, visualization may be difficult. It is necessary to perform the test when the woman has a full bladder, which provides a ―window‖ through which the uterus and its contents can be viewed. The woman needs a full bladder to elevate the uterus; therefore, being NPO is not appropriate. Neither an enema nor an abdominal preparation is necessary for this procedure. The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is a. nonreactive. b. positive. c. negative. d. reactive. reactive. The NST is reactive (normal) when two or more FHR accelerations of at least 15 beats/min (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. A positive result is not used with NST. Contraction stress test (CST) uses positive as a result term. A negative result is not used with NST. CST uses negative as a result term. Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors. (Select all that apply.) a. Poor material weight gain b. Chronic maternal infections c. Gestational hypertension d. Premature rupture of membranes e. Smoking A, B, C, E Poor material weight gain, chronic infections disease, gestational hypertension, and smoking are all risk factors associated with IUGR. Premature rupture of membranes is associated with preterm labor, not IUGR. Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations. (Select all that apply.) a. Establish gestational age b. Obesity c. Fetal abnormalities d. Amniotic fluid volume e. Ectopic pregnancy A, B, C, E Transvaginal ultrasound is useful in obese women whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used for identifying ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states a. ―I will need to increase my insulin dosage during the first 3 months of pregnancy.‖ b. ―Insulin dosage will likely need to be increased during the second and third trimesters.‖ c. ―Episodes of hypoglycemia are more likely to occur during the first 3 months.‖ d. ―Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding.‖ ―I will need to increase my insulin dosage during the first 3 months of pregnancy.‖ Insulin needs are reduced in the first trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. ―Insulin dosage will likely need to be increased during the second and third trimesters,‖ ―Episodes of hypoglycemia are more likely to occur during the first 3 months,‖ and ―Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding‖ are accurate statements and signify that the woman has understood the teachings regarding control of her diabetes during pregnancy Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with a. frequent episodes of maternal hypoglycemia. b. congenital anomalies in the fetus. c. polyhydramnios. d. hyperemesis gravidarum. congenital anomalies in the fetus. Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of pregnancy. Hyperemesis gravidarum may exacerbate hypoglycemic events because the decreased food intake by the mother and glucose transfer to the fetus contributes to hypoglycemia. In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the a. mother's age. b. number of years since diabetes was diagnosed. c. amount of insulin required prenatally. d. degree of glycemic control during pregnancy. degree of glycemic control during pregnancy. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for a. macrosomia. b. congenital anomalies of the central nervous system. c. preterm birth. d. low birth weight. macrosomia Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman. A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 lbs less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. What nursing diagnosis is most appropriate for the woman at this time? a. Deficient fluid volume b. Imbalanced nutrition: less than body requirements c. Imbalanced nutrition: more than body requirements d. Disturbed sleep pattern Imbalanced nutrition: less than body requirements This patient's clinical cues include weight loss, which would support the nursing diagnosis of Imbalanced nutrition: less than body requirements. No clinical signs or symptoms support the nursing diagnosis of Deficient fluid volume. This patient reports weight loss, not weight gain. Imbalanced nutrition: more than body requirements is not an appropriate nursing diagnosis. Although the patient reports nervousness based on the patient's other clinical symptoms the most appropriate nursing diagnosis would be Imbalanced nutrition: less than body requirements. Maternal phenylalanine hydroxylase deficiency (PAH) is an important health concern during pregnancy because a. it is a recognized cause of preterm labor. b. the fetus may develop neurologic problems. c. a pregnant woman is more likely to die without dietary control. d. women with PKU are usually retarded and should not reproduce. the fetus may develop neurologic problems. Children born to women with untreated PAH are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight. Maternal PAH has no effect on labor. Women without dietary control of PAH are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PAH at the first prenatal visit may be warranted, especially in individuals with a family history of the disorder, with low intelligence of uncertain etiology, or who have given birth to microcephalic infants. In terms of the incidence and classification of diabetes, maternity nurses should know that a. type 1 diabetes is most common. b. type 2 diabetes often goes undiagnosed. c. gestational diabetes mellitus (GDM) means that the woman will be receiving insulin treatment until 6 weeks after birth. d. type 1 diabetes may become type 2 during pregnancy. type 2 diabetes often goes undiagnosed. Type 2 diabetes often goes undiagnosed because hyperglycemia develops gradually and often is not severe. Type 2 diabetes, sometimes called adult-onset diabetes, is the most common. GDM refers to any degree of glucose intolerance first recognized during pregnancy. Insulin may or may not be needed. People do not go back and forth between type 1 and 2 diabetes. Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should understand that a. insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. b. women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. c. during the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. d. maternal insulin requirements steadily decline during pregnancy. during the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. Pregnant women develop increased insulin resistance during the second and third trimesters. Insulin never crosses the placenta; the fetus starts making its own insulin around the 10th week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by the end of pregnancy. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that a. diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. b. hydramnios occurs approximately twice as often in diabetic pregnancies. c. infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. d. even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being. diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios occurs 10 times more often in diabetic pregnancies. Infections are more common and more serious in pregnant women with diabetes. Mild-to-moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being. The nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc a. is now done for all pregnant women, not just those with or likely to have diabetes. b. is a snapshot of glucose control at the moment. c. would be considered evidence of good diabetes control with a result of 5% to 6%. d. is done on the patient's urine, not her blood. would be considered evidence of good diabetes control with a result of 5% to 6%. A score of 5% to 6% indicates good control. This is an extra test for diabetic women, not one done for all pregnant women. This test defines glycemic control over the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are done on the blood. A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)? a. 75 mg/dL before lunch. This is low; better eat now. b. 115 mg/dL 1 hour after lunch. This is a little high; maybe eat a little less next time. c. 115 mg/dL 2 hours after lunch; This is too high; it is time for insulin. d. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep. 60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep. 60 mg/dL after waking from a nap is too low. During hours of sleep glucose levels should not be less than 70 mg/dL. Snacks before sleeping can be helpful. The premeal acceptable range is 65 to 95 mg/dL. The readings 1 hour after a meal should be less than 140 mg/dL. Two hours after eating, the readings should be less than 120 mg/dL. A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding? a. Hyperthyroidism b. Phenylalanine hydroxylase deficiency (PAH) c. Hypothyroidism d. Thyroid storm Phenylalanine hydroxylase deficiency (PAH) PAH is a cause of mental retardation in infants; mothers with PAH pass on phenylalanine. A woman with hyperthyroidism or hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a complication of hyperthyroidism. When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include a. a regular heart rate and hypertension. b. an increased urinary output, tachycardia, and dry cough. c. shortness of breath, bradycardia, and hypertension. d. dyspnea; crackles; and an irregular, weak pulse. dyspnea; crackles; and an irregular, weak pulse. Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nail beds. A regular heart rate and hypertension are not generally associated with cardiac decompensation. Tachycardia would indicate cardiac decompensation, but increased urinary output and a dry cough would not. Shortness of breath would indicate cardiac decompensation, but bradycardia and hypertension would not. While providing care in an obstetric setting, the nurse should understand that after birth care of the woman with cardiac disease a. is the same as that for any pregnant woman. b. includes rest, stool softeners, and monitoring of the effect of activity. c. includes ambulating frequently, alternating with active range of motion. d. includes limiting visits with the infant to once per day. includes rest, stool softeners, and monitoring of the effect of activity. Bed rest may be ordered, with or without bathroom privileges. Bowel movements without stress or strain for the woman are promoted with stool softeners, diet, and fluid. Care of the woman with cardiac disease in the after-birth period is tailored to the woman's functional capacity. The woman will be on bed rest to conserve energy and reduce the strain on the heart. Although the woman may need help caring for the infant, breastfeeding and infant visits are not contraindicated. A woman with asthma is experiencing a after birth hemorrhage. Which drug would not be used to treat her bleeding because it may exacerbate her asthma? a. Pitocin b. Nonsteroidal anti-inflammatory drugs (NSAIDs) c. Hemabate d. Fentanyl Hemabate Prostaglandin derivatives should not be used to treat women with asthma because they may exacerbate symptoms. Pitocin would be the drug of choice to treat this woman's bleeding because it would not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding The use of methamphetamine (meth) has been described as a significant drug problem in the United States. In order to provide adequate nursing care to this patient population the nurse must be cognizant that methamphetamine a. is similar to opiates. b. is a stimulant with vasoconstrictive characteristics. c. should not be discontinued during pregnancy. d. is associated with a low rate of relapse. is a stimulant with vasoconstrictive characteristics. Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are used similarly. As is the case with cocaine users, methamphetamine users are urged to immediately stop all use during pregnancy. Unfortunately, because methamphetamine users are extremely psychologically addicted, the rate of relapse is very high. Which heart condition is not a contraindication for pregnancy? a. Peripartum cardiomyopathy b. Eisenmenger syndrome c. Heart transplant d. All of these contraindicate pregnancy Heart transplant Pregnancy is contraindicated for peripartum cardiomyopathy and Eisenmenger syndrome. Women who have had heart transplants are successfully having babies. However, conception should be postponed for at least 1 year after transplantation. During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of a. euglycemia. b. rheumatic fever. c. pneumonia. d. cardiac decompensation. cardiac decompensation. Symptoms of cardiac decompensation may appear abruptly or gradually. Euglycemia is a condition of normal glucose levels. These symptoms indicate cardiac decompensation. Rheumatic fever can cause heart problems, but it does not manifest with these symptoms, which indicate cardiac decompensation. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation Nurses caring for antepartum women with cardiac conditions should be aware that a. stress on the heart is greatest in the first trimester and the last 2 weeks before labor. b. women with Class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms. c. women with Class III cardiac disease should have 8 to 10 hours of sleep every day and limit housework, shopping, and exercise. d. women with Class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term. women with Class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms. Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32, when homodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less than ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can carry on limited normal activities with discretion, although they still need a good amount of sleep. As related to the care of the patient with anemia, the nurse should be aware that a. it is the most common medical disorder of pregnancy. b. it can trigger reflex bradycardia. c. the most common form of anemia is caused by folate deficiency. d. thalassemia is a European version of sickle cell anemia. it is the most common medical disorder of pregnancy. Combined with any other complication, anemia can result in congestive heart failure. Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth. The most common form of anemia is iron deficiency anemia. Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas. The most common neurologic disorder accompanying pregnancy is a. eclampsia. b. Bell's palsy. c. epilepsy. d. multiple sclerosis. epilepsy. The effects of pregnancy on epilepsy are unpredictable. Eclampsia sometimes may be confused with epilepsy, which is the most common neurologic disorder accompanying pregnancy. Bell's palsy is a form of facial paralysis. Multiple sclerosis is a patchy demyelinization of the spinal cord that does not affect the normal course of pregnancy or birth. With one exception, the safest pregnancy is one in which the woman is drug and alcohol free. For women addicted to opioids, treatment is the current standard of care during pregnancy. a. methadone maintenance b. detoxification c. smoking cessation d. 4 Ps Plus methadone maintenance Methadone maintenance treatment (MMT) is currently considered the standard of care for pregnant women who are dependent on heroin or other narcotics. Buprenorphine is another medication approved for opioid addiction treatment that is increasingly being used during pregnancy. Opioid replacement therapy has been shown to decrease opioid and other drug use, reduce criminal activity, improve individual functioning, and decrease rates of infections such as hepatitis B and C, HIV, and other sexually transmitted infections. Detoxification is the treatment used for alcohol addiction. Pregnant women requiring withdrawal from alcohol should be admitted for inpatient management. Women are more likely to stop smoking during pregnancy than at any other time in their lives. A smoking cessation program can assist in achieving this goal. The 4 Ps Plus is a screening tool designed specifically to identify pregnant women who need in-depth assessment related to substance abuse. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? a. Hypoglycemia b. Hypercalcemia c. Hypobilirubinemia d. Hypoinsulinemia Hypoglycemia The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, thus leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth and release large amounts of bilirubin into the neonate's circulation, with resulting hyperbilirubinemia. Because fetal insulin production is accelerated during pregnancy, the neonate presents with hyperinsulinemia. Which factor is known to increase the risk of gestational diabetes mellitus? a. Underweight before pregnancy b. Maternal age younger than 25 years c. Previous birth of large infant d. Previous diagnosis of type 2 diabetes mellitus Previous birth of large infant Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes. A woman younger than 25 years generally is not at risk for gestational diabetes mellitus. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy. Glucose metabolism is profoundly affected during pregnancy because a. pancreatic function in the islets of Langerhans is affected by pregnancy. b. the pregnant woman uses glucose at a more rapid rate than the nonpregnant woman. c. the pregnant woman increases her dietary intake significantly. d. placental hormones are antagonistic to insulin, thus resulting in insulin resistance. placental hormones are antagonistic to insulin, thus resulting in insulin resistance. Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin is also broken down more quickly by the enzyme placental insulinase. Pancreatic functioning is not affected by pregnancy. The glucose requirements differ because of the growing fetus. The pregnant woman should increase her intake by 200 calories a day. To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by a. eating six small equal meals per day. b. reducing carbohydrates in her diet. c. eating her meals and snacks on a fixed schedule. d. increasing her consumption of protein. eating her meals and snacks on a fixed schedule. Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications. It is more important to have a fixed meal schedule than equal division of food intake. Approximately 45% of the food eaten should be in the form of carbohydrates. When the pregnant diabetic woman experiences hypoglycemia while hospitalized, the nurse should intervene by having the patient a. eat six saltine crackers. b. drink 8 ounces of orange juice with 2 tsp of sugar added. c. drink 4 ounces of orange juice followed by 8 ounces of milk. d. eat hard candy or commercial glucose wafers. eat six saltine crackers Crackers provide carbohydrates in the form of polysaccharides. Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar. Milk is a disaccharide and orange juice is a monosaccharide. They will provide an increase in blood sugar but will not sustain the level. Hard candy or commercial glucose wafers provide only monosaccharides. Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin a. increases throughout pregnancy and the after-birth period. b. decreases throughout pregnancy and the after-birth period. c. varies depending on the stage of gestation. d. should not change because the fetus produces its own insulin. varies depending on the stage of gestation. Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells. The insulin needs change throughout the different stages of pregnancy. In caring for a pregnant woman with sickle cell anemia, the nurse is aware that signs and symptoms of sickle cell crisis include a. anemia. b. endometritis. c. fever and pain. d. urinary tract infection. fever and pain. Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia, or acidosis. Women with sickle cell anemia are not iron deficient. Therefore, routine iron supplementation, even that found in prenatal vitamins, should be avoided in order to prevent iron overload. Women with sickle cell trait usually are at greater risk for after birth endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign of crisis. These women are at an increased risk for UTIs; however, this is not an indication of sickle cell crisis. Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including (Select all that apply.) a. cleft lip. b. congenital heart disease. c. neural tube defects. d. gastroschisis. e. diaphragmatic hernia. A, B, C Congenital anomalies that can occur with AEDs include cleft lip or palate, congenital heart disease, urogenital defects, and neural tube defects. Gastroschisis and diaphragmatic hernia are not associated with the use of AEDs. Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. These complications include (Select all that apply.) a. atherosclerosis. b. retinopathy. c. IUFD. d. nephropathy. e. neuropathy. A, B, D, E These structural changes are most likely to affect a variety of systems, including the heart, eyes, kidneys, and nerves. Intrauterine fetal death (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication. Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Identify all disorders that fall into the category of collagen vascular disease. (Select all that apply.) a. Multiple sclerosis b. Systemic lupus erythematosus c. Antiphospholipid syndrome d. Rheumatoid arthritis e. Myasthenia gravis B, C, D, E Multiple sclerosis is not an autoimmune disorder. This patchy demyelinization of the spinal cord may be a viral disorder. Autoimmune disorders (collagen vascular disease) make up a large group of conditions that disrupt the function of the immune system of the body. They include those listed, as well as systemic sclerosis. 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. have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance. Women with hyperemesis gravidarum have severe vomiting; however, treatment for several days sets things right in most cases. Although 80% of pregnant women experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe level. IV administration may be used at first to restore fluid levels, but it is seldom needed for very long. Women suffering from this condition want sympathy because some authorities believe that difficult relationships with mothers and/or partners may be the cause. Because pregnant women may need surgery during pregnancy, nurses should be aware that a. the diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy. b. rupture of the appendix is less likely in pregnant women because of the close monitoring. c. surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy. d. when pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses. the diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy. Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count. Rupture of the appendix is two to three times more likely in pregnant women. Surgery to remove obstructions should be done right away. It usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian problems. What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Bleeding time of 10 minutes b. Presence of fibrin split products c. Thrombocytopenia d. Hyperfibrinogenemia Presence of fibrin split products Degradation of fibrin leads to the accumulation of fibrin split products in the blood. Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC. In caring for an immediate after birth patient, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder a. disseminated intravascular coagulation (DIC). b. amniotic fluid embolism (AFE). c. hemorrhage. d. HELLP syndrome. disseminated intravascular coagulation (DIC). The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman's arm. Excessive bleeding may occur from the site of slight trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage occurs for a variety of reasons in the after birth patient. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. HELLP is not a clotting disorder, but it may contribute to the clotting disorder DIC. 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 Administration of blood 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. Central monitoring would not be ordered initially in a patient with DIC because this can contribute to more areas of bleeding. Management of DIC would include volume replacement, not volume restriction. Steroids are not indicated for the management of DIC. A primigravida is being monitored in her prenatal clinic for preeclampsia. What 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. A dipstick value of 3+ for protein in her urine. Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or in diastolic pressure of 15 mm Hg. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia. 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. HELLP syndrome. 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). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia. A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to a. insert an oral airway. b. suction the mouth to prevent aspiration. c. administer oxygen by mask. d. stay with the patient and call for help. stay with the patient and call for help. If a patient becomes eclamptic, the nurse should stay her and call for help. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the patient's mouth. Oxygen would be administered after the convulsion has ended 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. discontinues the magnesium sulfate infusion. 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. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically, it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg. A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1 C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for a. hydralazine. b. magnesium sulfate bolus. c. diazepam. d. calcium gluconate. hydralazine. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically, it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The patient is not currently displaying any signs or symptoms of magnesium toxicity. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of a. eclamptic seizure. b. rupture of the uterus. c. placenta previa. d. placental abruption. placental abruption. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa manifests with bright red, painless vaginal bleeding. The patient that you are caring for has severe preeclampsia and is receiving a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits a. a sleepy, sedated affect. b. a respiratory rate of 10 breaths/min. c. deep tendon reflexes of 2. d. absent ankle clonus. a respiratory rate of 10 breaths/min. A respiratory rate of 10 breaths/min indicates that the patient is experiencing respiratory depression from magnesium toxicity. Because magnesium sulfate is a central nervous system depressant, the patient will most likely become sedated when the infusion is initiated. Deep tendon reflexes of two and absent ankle clonus are normal findings. The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is a. hypertension. b. hyperemesis gravidarum. c. hemorrhagic complications. d. infections. hypertension. Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women will have nausea and vomiting, but a relatively few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common. Nurses should be aware that HELLP syndrome a. is a mild form of preeclampsia. b. can be diagnosed by a nurse alert to its symptoms. c. is characterized by hemolysis, elevated liver enzymes, and low platelets. d. is associated with preterm labor but not perinatal mortality. is characterized by hemolysis, elevated liver enzymes, and low platelets. The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. HELLP syndrome is difficult to identify because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased, and so is perinatal mortality. Nurses should be aware that chronic hypertension a. is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy. b. is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg. c. is general hypertension plus proteinuria. d. can occur independently of or simultaneously with gestational hypertension. can occur independently of or simultaneously with gestational hypertension. Hypertension is present before pregnancy or diagnosed before 20 weeks of gestation and persists longer than 6 weeks after birth. The range for hypertension is systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg. It becomes severe with a diastolic BP of 110 mm Hg or higher. Proteinuria is an excessive concentration of protein in the urine. It is a complication of hypertension, not a defining characteristic. In planning care for women with preeclampsia, nurses should be aware that a. induction of labor is likely, as near term as possible. b. if at home, the woman should be confined to her bed, even with mild preeclampsia. c. a special diet low in protein and salt should be initiated. d. vaginal birth is still an option, even in severe cases. induction of labor is likely, as near term as possible. Induction of labor is likely, as near term as possible; however, at less than 37 weeks of gestation, immediate delivery may not be in the best interest of the fetus. Strict bed rest is becoming controversial for mild cases; some women in the hospital are even allowed to move around. Diet and fluid recommendations are much the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe preeclampsia should expect a cesarean delivery. Magnesium sulfate is given to women with preeclampsia and eclampsia to a. improve patellar reflexes and increase respiratory efficiency. b. shorten the duration of labor. c. prevent and treat convulsions. d. prevent a boggy uterus and lessen lochial flow. prevent and treat convulsions. Magnesium sulfate is the drug of choice to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy. A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? a. Incomplete b. Inevitable c. Threatened d. Septic Threatened A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would present with heavy bleeding, mild to severe cramping, and cervical dilation. An inevitable abortion manifests with the same symptoms as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation. A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix. The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse would be a. ―If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available.‖ b. ―The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult.‖ c. ―If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at ―The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult.‖ This is an accurate statement. Beta-human chorionic gonadotropin (hCG) levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a ―zero‖ hCG level. If the woman were to become pregnant, it could obscure the presence of the potentially carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an intrauterine device is acceptable. The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is a. bleeding. b. intense abdominal pain. c. uterine activity. d. cramping intense abdominal pain. Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity and cramping may be present with both placental conditions. Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae Unruptured ectopic pregnancy Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole, missed abortion, and abruptio placentae. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure? a. Amniocentesis for fetal lung maturity b. Ultrasound for placental location c. Contraction stress test (CST) d. Internal fetal monitoring Ultrasound for placental location The presence of painless bleeding should always alert the health care team to the possibility of placenta previa. This can be confirmed through ultrasonography. Amniocentesis would not be performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus would be presumed to have immature lungs at this gestational age, and the mother would be given corticosteroids to aid in fetal lung maturity. A CST would not be performed at a preterm gestational age. Furthermore, bleeding would be a contraindication to this test. Internal fetal monitoring would be contraindicated in the presence of bleeding. A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of a. placenta previa. b. vasa previa. c. severe abruptio placentae. d. disseminated intravascular coagulation (DIC). vasa previa. Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessel