Mod 9 ATI Notes

molar pregnancy

Growth of a nonviable fertilized egg or overgrowth of trophoblasts, resulting in a nonviable pregnancy. 

cervical insufficiency

Condition in which the cervix dilates prematurely. 

ectopic pregnancy

A pregnancy that occurs outside of the uterus. 

endometrium

Innermost layer of the uterus that thickens before ovulation to receive a fertilized egg and support the placenta. If contraception does not occur, the buildup of the lining is shed, and a menstrual period occurs. 

embryo

The term used for an egg fertilized by sperm when it implants in the uterus. 

ovum

Egg released by female ovaries. 

blastocyst

A cluster of dividing cells made by a fertilized egg, which is the early stage of an embryo.

human chorionic gonadotropin (hCG)

A hormone that is produced by the placenta during pregnancy and can be detected in maternal serum.  

corpus luteum

A structure that develops in an ovary where ovulation took place that synthesizes and secretes estrogen and progesterone until the placenta takes over.

internal cervical os

Opening of the cervix at the uterus. 

external cervical os

Also known as endocervical canal, it is the passage that connects the vagina to the uterus. 

prothrombotic state

A blood condition that increases the risk of clots to form in blood vessels. 

fibrinolysis

A process that prevents clots from forming or breaks down clots that formed.  

spontaneous abortion

Spontaneous pregnancy loss that occurs prior to 20 weeks gestation. 

threatened abortion

The products of conception are threatened with expulsion through uterine cramping and bleeding. The embryo continues to be viable, and the cervix remains closed.  

inevitable abortion

The products of conception have not passed through the client’s dilated cervix; abortion is unavoidable. 

incomplete abortion

A partial passing of the products of conception from the cervical os.  

complete abortion

All products of conception have been completely expelled. 

septic abortion

Occurs when products of conception are retained and become infected. 

missed abortion

Passage of some products of conception. The cervix is closed, but there is no fetal cardiac activity. 

products of conception

Fetal or placental tissue. 

thrombophilia

Blood disorder that causes blood clots. 

antiphospholipid syndrome

A condition in which the immune system creates antibodies that attack tissues in the body. 

A nurse is caring for a client who has experienced a spontaneous abortion. Which of the following are possible causes of spontaneous abortion?

Chromosomal abnormalities

Maternal age of 42 at pregnancy

Malnutrition

tachycardia

Heart rate greater than 100 beats per minute. 

Ultrasound Findings That Confirm Spontaneous Abortion

• A fetal crown-rump length 7 mm or greater and no heartbeat.

• A mean gestational sac diameter 25 mm or greater and no embryo.

• A follow-up ultrasound with absence of an embryo with a heartbeat that occurs 2 or more weeks after a scan that showed a gestational sac without a yolk sac.

• A follow-up ultrasound with absence of an embryo with a heartbeat that occurs 11 or more days after a scan that showed a gestational sac with a yolk sac.

A nurse is caring for a client who states that they are 8 weeks pregnant and have had vaginal bleeding for 4 hours. Which of the following provider interventions should the nurse anticipate?

Perform a transvaginal ultrasound to evaluate pregnancy location and viability.

Perform a bimanual exam to assess cervical dilation and cervical motion tenderness.

Perform a pelvic exam with a speculum to visualize the cervix.

suction curettage

A procedure to remove fetal tissue from inside the uterus through the use of suction.

curettage

A procedure using a curette, which can be a sharp instrument or suction device, to remove tissue in the uterus. 

A nurse is caring for a client who is experiencing a spontaneous abortion. Which of the following treatments indicate that the client is receiving medical management?

Administration of misoprostol

Administration of mifepristone

alloimmunization

An immune response to foreign antigens from another person, most commonly occurring after pregnancy or blood transfusion. 

hemolytic disease

A disorder in which there is anemia caused by premature destruction of RBCs. 

disseminated intravascular coagulation (DIC)

A condition in which blood clots excessively form in blood vessels. Because of that, clotting factors are used up, and then bleeding occurs excessively anywhere in the body. 

A nurse is teaching a client about ways to decrease the risk of spontaneous abortions. Which of the following should the nurse include in the teaching?

Begin a daily prenatal vitamin.

Maintain a healthy weight.

Eat a balanced diet.

A nurse is providing discharge teaching to a client following a spontaneous abortion. Which of the following instructions should the nurse include?

Teach the client to seek care for heavy vaginal bleeding.

Instruct the client to report fever or abnormal vaginal discharge.

Provide information about emotional support and follow-up resources.

Which of the following is important for the nurse to address during this conversation?

Providing emotional resources

Discussing any potential impacts on the client’s fertility

Allowing the client’s husband to participate in decisions

hypovolemia

hypovolemia

Which of the following cues in the client's statement should cause concern?

The client has vaginal bleeding.

The client passed tissue.

The client is 12 weeks pregnant.

Which of the following should the nurse anticipate including in the plan of care of this client?

Determining the client’s blood type

Evaluating hemoglobin and hematocrit

Quantifying bleeding

Drawing lab to evaluate Rh status

The nurse is providing discharge teaching to Lisa. Which of the following statements by the client demonstrates the client understood the teaching?

“I will call the provider if I have heavy bleeding.”

gestational trophoblastic disease

Lesions or tumors, including placental site nodules, exaggerated placental sites, and molar pregnancies, that demonstrate unexpected growth of trophoblast of the placenta; usually nonneoplastic but can become cancerous; highly curable if treated early. 

gestational trophoblastic neoplasia (GTN)

A malignancy that includes an invasive mole, a choriocarcinoma, a placental site trophoblastic tumor, or an epithelioid trophoblastic tumor. All GTN have the ability to metastasize and may be fatal without treatment.

myometrium

Middle layer of the uterine wall. 

Complete molar pregnancy

no fetal tissue; fertilization of an empty ovum

partial molar pregnancy

presence of fetal tissue with abnormal chromosomes

gestational trophoblastic neoplasia

malignant proliferation of trophoblastic tissue after evacuation

invasive mole

molar tissue that invades the myometrium

hydropic villi

Small projections that connect the placenta to the uterus.  

A nurse is caring for a client who has an invasive mole. Which of the following areas do invasive moles grow into?

Myometrium

Vascular sites

Extrauterine spaces

Which of the following clients are at risk for molar pregnancy?

A 42-year-old who has a history of two spontaneous abortions 

A 15-year-old who is pregnant for the first time 

A 36-year-old who has a history of infertility 

A 32-year-old client who has a history of molar pregnancy

preeclampsia

A complication of pregnancy that causes hypertension and increased levels of protein in the urine. 

hyperthyroidism

Condition where the thyroid gland produces too much thyroid hormone. 

A nurse is caring for a client who has a molar pregnancy. Which of the following are manifestations of a molar pregnancy?

Vaginal bleeding

Pelvic pain

Missed period

A nurse is caring for a client in the second trimester who has a suspected molar pregnancy. Which of the following conditions may develop?

Preeclampsia

Hyperthyroidism

Severe nausea and vomiting

A nurse is caring for a client who has undergone uterine evacuation for a molar pregnancy and is experiencing trophoblastic embolization. Which of the following manifestations should the nurse expect?

Shortness of breath

Rapid breathing

Chest pain

Increased heart rate

Oxytocin

Class: Oxytocin

Action: Stimulates uterine smooth muscle, causing uterine contraction

Therapeutic Use: Induction of labor, control of postpartum bleeding

Adverse Effects: Coma, seizures, hypotension, water intoxication

Interactions: Oxytocin following vasopressors can cause severe hypertension.

Contraindications: Hypersensitivity, anticipated nonvaginal delivery

Client Teaching: Advise client about contractions similar to menstrual cramps.

Rho(D) immune globulin (RhoGAM)

Class: Immune globulins

Action: Prevents production of anti-Rho(D) antibodies in Rho(D)-negative clients who were exposed to Rho(D)-positive blood

Therapeutic Use: Prevention of antibody response and hemolytic disease of the newborn in future pregnancies

Adverse Effects: Dizziness, headache, rash, DIC, acute renal failure, diarrhea, nausea, vomiting

Interactions: May decrease effect of live-virus vaccines

Contraindications: Previous hypersensitivity

Client Teaching: Teach the client that this medication is used to protect future pregnancies with Rho(D)-positive infants.

lutein cysts

Benign ovarian lesion.

laparoscopically

Surgery using a fiber-optic instrument inserted through the abdominal wall. 

A nurse is caring for a client who has a complete mole and risk factors for gestational trophoblastic neoplasia. Which of the following are risk factors for gestational trophoblastic neoplasia?

Age greater than 40 years

Uterine size larger than expected for gestational age

A nurse is providing discharge teaching to a client who is receiving treatment for gestational trophoblastic neoplasia. Which of the following instructions should the nurse include?

Use reliable contraception during treatment and follow-up monitoring.

Attend scheduled follow-up appointments for serial hCG testing.

Avoid becoming pregnant until hCG levels remain normal for the recommended time period.

hyperemesis gravidarum

Nausea and vomiting in pregnancy that is severe and persistent. 

A nurse is assessing a client who is suspected of having a molar pregnancy. Which of the following findings are consistent with this condition?

hCG level greater than 100,000 mIU/mL

Vaginal bleeding in early pregnancy

Uterine size greater than expected for gestational age

Severe nausea and vomiting

Absent fetal heart tones

hysterectomy

Surgical removal of all or part of the uterus. 

Which of the following statements by Jennie indicates that she understands the discharge instructions?

“I will call my doctor if I soak two pads in an hour.”

embolization

A procedure that blocks a blood vessel. 

loop electrosurgical excision procedure

A procedure in which an electric current heats a wire loop and is used to remove cells and tissue in a female client’s lower genital tract to test for cancer. 

cold knife conization

A surgical procedure used to diagnose or treat cervical dysplasia. 

Mullerian anomaly

An anomaly of the uterus formation that occurs during fetal development. 

A nurse is caring for a client who has cervical insufficiency. Which of the following is a risk factor for cervical insufficiency?

Cold knife conization

Vacuum delivery

Collagen anomaly 

Uterine surgery requiring cervical dilation

Forceps delivery

Braxton Hicks contractions

Tightening in the abdomen of a pregnant client that comes and goes, contraction of uterus preparing body for labor, not intensely painful and does not cause cervix to dilate. 

Which of the following clients is likely to be diagnosed with cervical insufficiency?

A 24-year-old client with three prior 14-week pregnancy losses without labor

A client who had a 22-week pregnancy loss without labor and whose current 20-week ultrasound shows a shortened cervix

A client who is 26 weeks pregnant with no contractions or any other complications and a vaginal exam of 6 cm

A nurse is caring for a client who has a cervical cerclage in place. Which of the following findings indicate that the cerclage should be removed?

Gestational age of 36 weeks

Onset of preterm labor at 33 weeks

Spontaneous rupture of membranes

Manifestations of intrauterine infection

Which of the following are manifestations of cervical insufficiency? 

Pelvic pressure 

Cramping

Backache

The nurse is teaching Casey about physical findings that indicate a cerclage is recommended. Which of the following should the nurse include in the teaching about candidates who are eligible for a cerclage?

A client who has physical examination-indicated cervical insufficiency prior to 24 weeks of gestation

A client who has ultrasound-indicated cerclage with transvaginal ultrasound cervical length less than 25 mm prior to 24 weeks of gestation

A client who has a history-indicated cerclage between 12 to 14 weeks of gestation for clients who have experienced recurrent second trimester spontaneous abortions preceded by painless cervical dilation

The nurse is teaching Casey about the risks of cerclage placement. Which of the following should the nurse include in the teaching? 

Premature preterm rupture of membranes

Suture migration

Cervical dystocia

Cervical trauma

Which of the following statements demonstrates the client's understanding of discharge instructions? 

“Some spotting is normal for several days after the cerclage.” 

hysterotomy

An incision made into the uterus during a medical procedure. 

A nurse is teaching a group of nursing students about ectopic pregnancy implantation. Which of the following should the nurse include as potential ectopic implantation sites?

Ovary

Cervix

Fallopian tube

endometriosis

A condition where endometrial tissue is found growing outside of the uterus. 

pelvic inflammatory disease

Infection of the female reproductive organs. 

Which of the following clients has the highest risk of ectopic pregnancy?

A white client who got pregnant with an IUD in place

syncope

Fainting

ovarian torsion

The ovary and possibly fallopian tube twist, cutting off blood supply. 

A nurse is caring for a client who is suspected of having an ectopic pregnancy. Which of the following manifestations should the nurse anticipate with this client? 

Abdominal pain

Vaginal bleeding

Urinary frequency

A nurse is caring for a client who has an ectopic pregnancy. Which of the following treatments should the nurse understand is expectant management of this condition? 

The client will be monitored while waiting for the ectopic pregnancy to resolve on its own. 

Methotrexate

Although the use of methotrexate for the medical management of ectopic pregnancy is supported by the American College of Obstetricians and Gynecologists, it is considered an off-label use by the Food and Drug Administration.

salpingectomy

Surgical removal of the fallopian tube.  

salpingostomy

Incision into the fallopian tube without removing the tube. 

A nurse is caring for a client who has had an ectopic pregnancy in the past. The client asked if there are any modifiable risk factors for ectopic pregnancy. Which of the following should the nurse inform the client of?

Vaginal douching

A nurse is teaching a client who has an ectopic pregnancy about methotrexate. Which of the following should the nurse include in the teaching?

Avoid foods and supplements containing folic acid.

Do not take nonsteroidal anti-inflammatory medications.

Avoid sunlight while on this medication.             

Which of the following puts Eileen at risk for an ectopic pregnancy? 

Endometriosis 

A nurse is educating the client about taking methotrexate for ectopic pregnancy. Which of the following statements by the client demonstrates effective teaching?

“I will stop taking my prenatal vitamins.”

marginal placenta previa

Placenta lies near the cervix but does not cover the opening. 

partial placenta previa

The placenta covers a portion of the cervix. 

complete placenta previa

Placenta completely covers the cervical opening. 

myomectomy

Surgical removal of fibroids. 

A nurse is caring for a client who has placenta previa. Which of the following are considered risk factors for placenta previa? 

Previous cesarean births

Multiple gestation 

38 years of age

History of fertility treatment

placenta previa-accreta spectrum

Unexpected implantation of the placenta that is too deep within the uterus. 

vasa previa

Some of the umbilical cord blood vessels run near or across the internal cervical orifice.