Chapter 30: Medical Surgical Disorders - Lowdermilk Maternity & Women’s Health Care

When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition?

A. regular heart rate and hypertension

B. increased urinary output, tachycardia, and dry cough

C. shortness of breath, bradycardia, and hypertension

D. edema, crackles, and cyanosis of nails and lips

D. edema, crackles, and cyanosis of nails and lips

Which information should the nurse take into consideration when planning care for a postpartum client with cardiac disease?

A. the plan of care for a postpartum client is the same as the plan for any pregnant woman.

B. the plan of care includes rest, stool softeners, and monitoring of the effect of activity.

C. the plan of care includes frequent ambulating, alternating with active range-of-motion exercises.

D. the plan of care includes limiting visits with the infant to once per day.

B. the plan of care includes rest, stool softeners, and monitoring of the effect of activity.

A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma?

a. oxytocin (Pitocin)

b. nonsteroidal anti-inflammatory drugs (NSAIDs)

c. 15-methyl PGF2α

d. fentanyl

C. 15-methyl PGF2α

Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis?

A. assess the woman's dietary history for adequate calories and proteins.

B. teach the woman that the bulk of calories should come from proteins.

C. instruct the woman to eat a low-fat diet and to avoid fried foods.

D. instruct the woman to eat a low-cholesterol, low-salt diet.

C. instruct the woman to eat a low-fat diet and to avoid fried foods.

Postoperative care of the pregnant woman who requires abdominal surgery for appendicitis includes which additional assessment?

A. intake and output (I&O) and intravenous (IV) site

B. signs and symptoms of infection

C. vital signs and incision

D. fetal heart rate (FHR) and uterine activity

D. fetal heart rate (FHR) and uterine activity

Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to the most recent statistics, how often does cystic fibrosis occur in Caucasian live births?

A. 1 in 100

B. 1 in 1000

C. 1 in 2000

D. 1 in 3200

D. 1 in 3200

Which neurologic condition would require preconception counseling, if possible?

A. eclampsia

B. bell palsy

C. epilepsy

D. multiple sclerosis

C. epilepsy

The client makes an appointment for preconception counseling. The woman has a known heart condition and is unsure if she should become pregnant. Which is the only cardiac condition that would cause concern?

A. marfan syndrome

B. eisenmenger syndrome

C. heart transplant

D. ventricular septal defect (VSD)

B. eisenmenger syndrome

What form of heart disease in women of childbearing years generally has a benign effect on pregnancy?

A. cardiomyopathy

B. rheumatic heart disease

C. congenital heart disease

D. mitral valve prolapse

D. mitral valve prolapse

A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the fetal heart rate (FHR) is 132 beats per minute with variability. What is the nurse's highest priority?

A. monitoring the woman for a ruptured spleen

B. obtaining a physician's order to discharge her home

C. monitoring her for 24 hours

D. using continuous electronic fetal monitoring (EFM) for a minimum of 4 hours

D. using continuous electronic fetal monitoring (EFM) for a minimum of 4 hours

Bell palsy is an acute idiopathic facial paralysis, the cause for which remains unknown. Which statement regarding this condition is correct?

A. bell palsy is the sudden development of bilateral facial weakness.

B. women with Bell palsy have an increased risk for hypertension.

C. pregnant women are affected twice as often as nonpregnant women.

D. bell palsy occurs most frequently in the first trimester.

B. women with Bell palsy have an increased risk for hypertension.

A pregnant woman at term is transported to the emergency department (ED) after a severe vehicular accident. The obstetric nurse responds and rushes to the ED with a fetal monitor. Cardiopulmonary arrest occurs as the obstetric nurse arrives. What is the highest priority for the trauma team?

A. obtaining IV access, and starting aggressive fluid resuscitation

B. quickly applying the fetal monitor to determine whether the fetus viability

C. starting cardiopulmonary resuscitation (CPR)

D. transferring the woman to the surgical unit for an emergency cesarean delivery in case the fetus is still alive

C. starting cardiopulmonary resuscitation (CPR)

Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP). A client asks the nurse why she has developed this condition and what can be done. What is the nurse's best response?

A. PUPPP is associated with decreased maternal weight gain.

B. the rate of hypertension decreases with PUPPP.

C. this common pregnancy-specific condition is associated with a poor fetal outcome.

D. the goal of therapy is to relieve discomfort.

D. the goal of therapy is to relieve discomfort.

It is extremely rare for a woman to die in childbirth; however, it can happen. In the United States, the annual occurrence of maternal death is 12 per 100,000 cases of live birth. What are the leading causes of maternal death?

A. embolism and preeclampsia

B. falls and motor vehicle accidents (MVAs)

C. hemorrhage and infection

D. underlying chronic conditions

B. falls and motor vehicle accidents (MVAs)

Which congenital anomalies can occur because of the use of antiepileptic drugs (AEDs) in pregnancy? (Select all that apply.)

A. cleft lip

B. congenital heart disease

C. neural tube defects

D. gastroschisis

E. diaphragmatic hernia

A.,B.,C. cleft lip, congenital heart disease and neural tube defects

In caring for a pregnant woman diagnosed with sickle cell anemia, the nurse must be aware of the signs and symptoms of a sickle cell crisis. What do these include? (Select all that apply.)

A. fever

B. endometritis

C. abdominal pain

D. joint pain

E. urinary tract infection (UTI)

A.,C.,D. fever, abdominal pain and joint pain

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Which disorders fall into the category of collagen vascular disease? (Select all that apply.)

A. multiple sclerosis

B. systemic lupus erythematosus (SLE)

C. antiphospholipid syndrome

D. rheumatoid arthritis

E. myasthenia gravis

B.,C.,D.,E. systemic lupus erythematosus (SLE), antiphospholipid syndrome, rheumatoid arthritis and myasthenia gravis

Increased risk of thrombus formation

Increase in clotting factors

Decreased placental perfusion in the supine position

Increased heart rate

Altered pain referral

Displacement of abdominal viscera

Increased risk of acidosis

Increased oxygen consumption

Increased risk of aspiration

Decreased gastric motility