N164 | Exam 3 EAQs

Which medication is preferred in the treatment of systemic lupus erythematosus (SLE) in a pregnant patient?

a) Aspirin

b) Corticosteroids

c) Prednisone

d) Hydroxychloroquine

d) Hydroxychloroquine

--> reduces SLE disease activity in a pregnant patient without any adverse effects on the fetus

When do the severity of symptoms in a pregnant asthmatic patient usually peak?

a) In the first trimester

b) Immediately postpartum

c) Between 17 to 24 weeks of gestation

d) During the last 4 weeks of pregnancy

c) Between 17 to 24 weeks of gestation

Which clinical finding in a pregnant patient will indicate proper fetal brain development?

a) Hemoglobin A1c levels greater than 6

b) Normal maternal thyroxine (T4) levels

c) 3% amniotic fluid phosphatidylglycerol

d) Fasting glucose levels less than 95 mg/dL

b) Normal maternal thyroxine (T4) levels

--> proper fetal brain development depends on normal maternal T4 levels early in pregnancy

Which is a metabolic change associated with pregnancy? Select all that apply.

a) Maternal insulin requirements increase during the first trimester

b) Maternal production of insulin increases during the first trimester

c) There is enough glucose for the fetus during the second trimester

d) Fasting blood glucose levels will decrease during the first trimester

e) The patient's tolerance to glucose increases in the second trimester

b) Maternal production of insulin increases during the first trimester

c) There is enough glucose for the fetus during the second trimester

d) Fasting blood glucose levels will decrease during the first trimester

Which condition is common in infants born to mothers with diabetes mellitus? Select all that apply.

a) Hypoglycemia

b) Marfan syndrome

c) Cephalohematoma

d) Shoulder dystocia

e) Brachial plexus palsy

a) Hypoglycemia

c) Cephalohematoma

d) Shoulder dystocia

e) Brachial plexus palsy

Which obstetric or medical complication is the pregnancy patient with diabetes mellitus at risk? Select all that apply.

a) Hydramnios

b) Preeclampsia

c) Hypoglycemia

d) Monilial vaginitis

e) Brachial plexus palsy

a) Hydramnios

b) Preeclampsia

c) Hypoglycemia

d) Monilial vaginitis

Which symptom is associated with systemic lupus erythematosus (SLE)? Select all that apply.

a) Fever

b) Hyperactivity

c) Hypotension

d) Muscle aches

e) Weight changes

a) Fever

d) Muscle aches

e) Weight changes

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes mellitus (GDM). Which education is important for this woman to understand?

a) Glucose levels are monitored by testing urine four times a day and at bedtime.

b) Dietary modifications and insulin are both required for adequate treatment.

c) Oral hypoglycemic agents should not be used if the woman is reluctant to give herself insulin.

d) Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

d) Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

--> decreases the risk for hypoglycemia and ketoacidosis

Which medication is administered to a pregnant patient to treat hyperthyroidism?

a) Isotretinoin

b) Methimazole

c) Levothyroxine

d) Sodium iodide-131

b) Methimazole

--> controls symptoms hyperthyroidism, improves weight gain, and reduces tachycardia

Which medication can be used for a gestational diabetic patient who is unwilling to take insulin?

a) Isotretinoin

b) Enoxaparin

c) Terbutaline

d) Glyburide

d) Glyburide

--> oral hypoglycemic therapy

--> minimal amounts of the medication cross the placenta to the fetus

Which condition can result after administering terbutaline to a pregnant patient with diabetes mellitus?

a) Infection

b) Dyspnea

c) Ketoacidosis

d) Hypoglycemia

c) Ketoacidosis

--> terbutaline may lead to hyperglycemia and cause ketoacidosis in the pregnant patient

A pregnant patient with diabetes mellitus and poor glycemic control in the early weeks of pregnancy is at risk for which condition?

a) Miscarriage

b) Ketoacidosis

c) Polyhydramnios

d) Fetal macrosomia

a) Miscarriage

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Pregnant women with untreated hypothyroidism are at risk for which condition? Select all that apply.

a) Stillbirth

b) Miscarriage

c) Macrosomia

d) Placental abruption

e) Gestational hypertension

a) Stillbirth

b) Miscarriage

d) Placental abruption

e) Gestational hypertension

Which clinical test evaluates the health status of a pregnant patient who abuses substances? Select all that apply.

a) Meconium testing

b) Complete blood count

c) Tuberculosis screening

d) Urine toxicologic testing

e) Glycosylated hemoglobin A1c

a) Meconium testing

b) Complete blood count

c) Tuberculosis screening

d) Urine toxicologic testing

When a pregnant woman with diabetes experiences hypoglycemia while hospitalized, which would the nurse have the woman do?

a) Eat a candy bar

b) Eat six saltine crackers or drink 8 oz of milk

c) Drink 4 oz of orange juice followed by 8 oz of milk

d) Drink 8 oz of orange juice with 2 teaspoons of sugar added

b) Eat six saltine crackers or drink 8 oz of milk

--> crackers provide carbohydrates in the form of polysaccharides

--> milk is a disaccharide

Which will the nurse inform a breastfeeding patient who is taking propylthiouracil for hyperthyroidism?

a) "The medication is likely to decrease milk production."

b) "Stop breastfeeding the child and start infant formula."

c) "It can adversely affect the neonate's thyroid function."

d) "Take the medication immediately after breastfeeding."

d) "Take the medication immediately after breastfeeding."

--> this is to allow a 3- to 4-hour period for the medication to absorb before nursing again

Which would the nurse recommend to a pregnant patient with diabetes who works long, irregular hours?

a) "Quit working for a while."

b) "Eat a snack hourly when at work."

c) "Keep fruits or fruit juice available."

d) "Try taking naps when you are free."

c) "Keep fruits or fruit juice available."

--> they contain simple carbohydrates that help control blood glucose levels

Which condition would the nurse ask the pregnant patient with a cardiac disorder to report immediately? Select all that apply.

a) Shortness of breath

b) Palpitations and pain

c) Hypoglycemia

d) Onset of constipation

e) Orthostatic hypotension

a) Shortness of breath

b) Palpitations and pain

d) Onset of constipation

The nurse is teaching a woman with gestational diabetes the technique to inject insulin. Which will the nurse include in the teaching session? Select all that apply.

a) Inject insulin slowly

b) Aspirate before injecting

c) Clean injection site with alcohol

d) After injection, cover site with sterile gauze

e) Insert the needle at a 45- to 90-degree angle

a) Inject insulin slowly

d) After injection, cover site with sterile gauze

e) Insert the needle at a 45- to 90-degree angle

Which would the nurse tell a pregnant patient with diabetes who asks about dietary management during pregnancy? Select all that apply.

a) "Eat meals at the same time every day."

b) "You need a large carbohydrate snack at bedtime."

c) "If you skip a meal, you should have a large snack."

d) "You need to stay away from any aerobic exercise."

e) "Remember to have more whole grains in your diet."

a) "Eat meals at the same time every day."

b) "You need a large carbohydrate snack at bedtime."

e) "Remember to have more whole grains in your diet."

Which dietary supplement would the primary health care provider prescriber for a pregnant patient who takes anticonvulsant medications? Select all that apply.

a) Iron

b) Vitamin K

c) Folic acid

d) Vitamin D

e) Vitamin B12

a) Iron

c) Folic acid

d) Vitamin D

A patient with gestational diabetes tells the nurse, "I'm extremely worried that my child will be diabetic, too." Which action would the nurse take to alleviate the patient's anxiety? Select all that apply.

a) Evaluate the test results to assess fetal growth

b) Use therapeutic communication with the patient

c) Listen to the feelings and concerns of the patient

d) Provide factual information of risks to the patient

e) Ask the patient to share any fears with the nurse

b) Use therapeutic communication with the patient

c) Listen to the feelings and concerns of the patient

d) Provide factual information of risks to the patient

e) Ask the patient to share any fears with the nurse

When providing preconception counseling, which instruction will the nurse give to a patient with diabetes mellitus? Select all that apply.

a) Inform the patient about the potential risks

b) Explain the need for frequent obstetrical visits

c) Instruct the patient about the expense involved

d) Advise the patient to use effective contraception

e) Advise the patient against trying to conceive a child

a) Inform the patient about the potential risks

b) Explain the need for frequent obstetrical visits

c) Instruct the patient about the expense involved

d) Advise the patient to use effective contraception

A pregnant woman in her first trimester with a history of epilepsy is transported to the hospital via ambulance after suffering a seizure. Which health care provider prescription would the nurse expect to be included in the plan of care? Select all that apply.

a) Valproate

b) Abdominal ultrasounds

c) Carbamazepine

d) Serum laboratory levels of medications

e) Prenatal vitamins with vitamin D

b) Abdominal ultrasounds

d) Serum laboratory levels of medications

e) Prenatal vitamins with vitamin D

Which nursing intervention would the nurse implement when assessing a patient with gestational diabetes? Select all that apply.

a) Tells the patient to follow a diabetic diet

b) Explains the importance of exercising daily

c) Demonstrates how to monitor blood glucose levels

d) Tells the patient to not take any oral hypoglycemics

e) Explains the effects of diabetes on the pregnancy and fetus

a) Tells the patient to follow a diabetic diet

c) Demonstrates how to monitor blood glucose levels

e) Explains the effects of diabetes on the pregnancy and fetus

Which fetal risk is associated with an ectopic pregnancy?

a) Miscarriage

b) Fetal anemia

c) Preterm birth

d) Fetal deformity

d) Fetal deformity

--> caused by oligohydramnios

--> ex: facial or cranial asymmetry, various joint deformities, limb deficiency, and CNS anomalies

Which hypertensive disorder can occur during pregnancy? Select all that apply.

a) Chronic hypertension

b) Preeclampsia-eclampsia

c) Gestational trophoblastic disease

d) Gestational hypertension

e) Hyperemesis gravidarum

a) Chronic hypertension

b) Preeclampsia-eclampsia

d) Gestational hypertension

Which condition during pregnancy can result in preeclampsia in the patient? Select all that apply.

a) Genetic abnormalities

b) Dietary deficiencies

c) Abnormal trophoblast invasion

d) Cardiovascular changes

e) Maternal hypotension

a) Genetic abnormalities

b) Dietary deficiencies

c) Abnormal trophoblast invasion

d) Cardiovascular changes

Which is a possible cause of miscarriage during early pregnancy? Select all that apply.

a) Premature dilation of cervix

b) Chromosomal abnormalities

c) Endocrine imbalance

d) Hypothyroidism

e) Antiphospholipid antibodies

b) Chromosomal abnormalities

c) Endocrine imbalance

d) Hypothyroidism

e) Antiphospholipid antibodies

A woman at 34 weeks of gestation presents with preeclampsia. Which clinical finding in the patient indicates that the disease has progressed to HELLP syndrome? Select all that apply.

a) Hepatic dysfunction

b) Elevated liver enzymes

c) Vaginal bleeding

d) Low platelet count

e) Chronic hypertension

a) Hepatic dysfunction

b) Elevated liver enzymes

d) Low platelet count

Which is a priority nursing action when a pregnant patient with severe gestational hypertension is admitted to the health care facility?

a) Administer intravenous (IV) and oral fluids

b) Provide diversionary activities during bed rest

c) Prepare the patient for cesarean delivery

d) Administer the prescribed magnesium sulfate

d) Administer the prescribed magnesium sulfate

--> to prevent eclamptic seizures

Which statement made by the nursing student about the management of molar pregnancy indicates effective learning?

a) "Methotrexate therapy is prescribed to abort molar pregnancy."

b) "Expectant management is initiated as per the amount of bleeding."

c) "Suction curettage is the safest way of terminating molar pregnancy."

d) "Induction of labor with oxytocic agents is one of the treatment options."

c) "Suction curettage is the safest way of terminating molar pregnancy."

Which is considered usual management for a patient with an incomplete miscarriage and heavy bleeding?

a) Expectant management

b) Dilation and curettage

c) Administration of oxytocin (Pitocin)

d) Prescription for ergonovine (Methergine)

b) Dilation and curettage

--> incomplete miscarriages are associated with heavy bleeding, excessive cramping, and some part of fetal tissue remains in the uterus

--> dilation and curettage is needed to remove any fetal tissue

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 37.1C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the health care provider, anticipating an order for which medication?

a) Hydralazine

b) Magnesium sulfate bolus

c) Diazepam

d) Calcium gluconate

a) Hydralazine

--> an antihypertensive commonly used to treat hypertension in severe preeclampsia

After being rehydrated in the emergency department for hyperemesis gravidarum, a 24-year-old primipara in her 18th week of pregnancy is discharged home. Discharge teaching at the hospital by the nurse has been effective if the patient makes which statement?

a) "I'm going to eat give to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato."

b) "I'm going to stay only on clear fluids for the next 2 hours and then add dairy products like eggs and milk."

c) "As long as I eat small amounts and allow enough time for digestion, I can eat almost anything, like barbequed chicken or spaghetti."

d) "A strip of bacon and a fried egg will really taste good as long as I eat them slowly."

a) "I'm going to eat give to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato."

The nurse observes that a pregnant patient with gestational hypertension who is on magnesium sulfate therapy is prescribed nifedipine. Which action does the nurse take?

a) Evaluates the patient's renal function test

b) Obtains an order for a change of drug

c) Reduces the nifedipine dose by 50%

d) Administers both medications simultaneously

b) Obtains an order for a change of drug

--> concurrent use of nifedipine and magnesium sulfate can result in skeletal muscle blockade in the patient

Which action will the nurse take when a pregnant patient has convulsions? Select all that apply.

a) Obtains a prescription for magnesium sulfate

b) Assesses the patient's airway, breathing, and pulse

c) Lowers the bed and turns the patient onto one side

d) Does not leave the patient for more than 10 minutes

e) Raises the side rails of the bed and pads with pillows

a) Obtains a prescription for magnesium sulfate

b) Assesses the patient's airway, breathing, and pulse

c) Lowers the bed and turns the patient onto one side

e) Raises the side rails of the bed and pads with pillows

A patient with gestational hypertension is prescribed labetalol hydrochloride therapy, which is continued after giving birth. Which instructions will the nurse provide about breastfeeding?

a) "You may breastfeed the infant if you desire."

b) "There may be high levels of the drug in the breast milk."

c) "Breastfeeding may cause convulsions in the infant."

d) "Breastfeed only once a day and use infant formulas."

a) "You may breastfeed the infant if you desire."

--> labetalol hydrochloride has a low concentration in breast milk, so the patient can breastfeed the infant

Which is a priority nursing action after administering magnesium sulfate to a pregnant patient?

a) Assess the patient's weight

b) Assess serum magnesium level

c) Restrict fluid intake to 250 mL/hr

d) Evaluate fetal movement counts hourly

b) Assess serum magnesium level

--> magnesium sulfate can cause toxicity in the patient if the renal system does not function properly

Which clinical screening tool does the nurse evaluate to identify ectopic pregnancy in a patient? Select all that apply.

a) Quantitative human chorionic gonadotropin (beta-hCG) levels

b) Transvaginal ultrasound

c) Progesterone level

d) Thyroid test reports

e) Kleihauer-Betke (KB) test

a) Quantitative human chorionic gonadotropin (beta-hCG) levels

b) Transvaginal ultrasound

c) Progesterone level

The nurse is caring for a woman who is at 24-weeks of gestation with suspected severe preeclampsia. Which sign and symptom will the nurse expect to observe? Select all that apply.

a) Decreased urinary output and irritability

b) Transient headache and +1 proteinuria

c) Ankle clonus and epigastric pain

d) Platelet count of less than 100,000/mm^3 and visual problems

e) Seizure activity and hypotension

a) Decreased urinary output and irritability

c) Ankle clonus and epigastric pain

d) Platelet count of less than 100,000/mm^3 and visual problems

A pregnant patient in the first trimester reports spotting of blood and mild uterine cramping. Which will the nurse assess? Select all that apply.

a) Progesterone levels

b) Transvaginal ultrasounds

c) Human chorionic gonadotropin (hCG) measurement

d) Blood pressure

e) Kleihauer-Betke (KB) test reports

a) Progesterone levels

b) Transvaginal ultrasounds

c) Human chorionic gonadotropin (hCG) measurement

A pregnant patient with severe preeclampsia who is being transported to a tertiary care center needs to be administered magnesium sulfate intramuscular injection for seizure activity. Which action will the nurse take when administering the drug? Select all that apply.

a) A 10-g dose is administered in the buttock

b) A local anesthetic is added to the solution

c) The Z-track technique is used to inject the drug

d) The injection site is massaged after the injection

e) The subcutaneous route is used to inject the drug

b) A local anesthetic is added to the solution

c) The Z-track technique is used to inject the drug

d) The injection site is massaged after the injection

Which will the nurse include in the plan of care of a pregnant patient with mild preeclampsia? Select all that apply.

a) Ensure prolonged bed rest

b) Provide diversionary activities

c) Encourage the intake of more fluids

d) Restrict sodium and zinc in the diet

e) Refer to Internet-based support group

b) Provide diversionary activities

c) Encourage the intake of more fluids

e) Refer to Internet-based support group

Which condition does the nurse remain alert for in a pregnant patient with preeclampsia? Select all that apply.

a) Seizures

b) Scotoma

c) Renal disease

d) Cerebral edema

e) Chronic hypertension

a) Seizures

b) Scotoma

d) Cerebral edema

A pregnant woman presents to the emergency department complaining of persistent nausea and vomiting. She is diagnosed with hyperemesis gravidarum. The nurse will include which information when teaching about diet for hyperemesis? Select all that apply.

a) Eat three larger meals a day

b) Eat a high-protein snack at bedtime

c) Ice cream may stay down better than other foods

d) Avoid ginger tea or sweet drinks

e) Eat what sounds good to you even if your meals are not well-balanced

b) Eat a high-protein snack at bedtime

c) Ice cream may stay down better than other foods

e) Eat what sounds good to you even if your meals are not well-balanced

A pregnant patient with chronic hypertension is at risk for placental abruption. Which symptom of abruption will the nurse instruct the patient to be alert for? Select all that apply.

a) Weight loss

b) Abdominal pain

c) Vaginal bleeding

d) Shortness of breath

e) Uterine tenderness

b) Abdominal pain

c) Vaginal bleeding

e) Uterine tenderness

Which pregnant patient is a likely candidate for expectant management?

a) A patient with a molar pregnancy that has a risk for vaginal bleeding

b) A patient who is 32 6/7 weeks of gestation and likely to deliver soon

c) A patient diagnosed with preeclampsia who is taking an antihypertensive medication

d) A patient with an incomplete miscarriage that has no bleeding or infection

d) A patient with an incomplete miscarriage that has no bleeding or infection

--> if bleeding and infection do not occur after a threatened miscarriage, then the patient is managed expectantly to continue the pregnancy successfully

Which clinical manifestation differentiates abruptio placentae from placenta previa?

a) Bleeding

b) Intense abdominal pain

c) Uterine activity

d) Cramping

b) Intense abdominal pain

--> pain is absent with placenta previa but may be agonizing with abruptio placentae

Which medication can be administered to a pregnant patient to prevent cerebral palsy in a preterm newborn?

a) Calcium gluconate to the pregnant patient

b) Magnesium sulfate to the pregnant patient

c) Glucocorticoid drugs to the pregnant patient

d) Antibiotic medications to the pregnant patient

b) Magnesium sulfate to the pregnant patient

--> can prevent the risk for cerebral palsy as it would delay delivery

Which tocolytic drug should be avoided in a pregnant patient with a history of migraine headaches?

a) Nitrous oxide

b) Magnesium sulfate

c) Terbutaline

d) Prednisolone

c) Terbutaline

--> beta-2 adrenergic agonists are contraindicated in patients with migraine headaches

--> terbutaline is a tocolytic agent and a beta-2 adrenergic agonist

Which is a risk factor for a prolapsed umbilical cord?

a) Oligohydramnios

b) Pregnancy at 38 weeks of gestation

c) Presenting part at a station of -3

d) Meconium-stained amniotic fluid

c) Presenting part at a station of -3

--> because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed cord could occur if the membranes rupture

Which is a cause of indicated preterm labor? Select all that apply.

a) Herpes infection

b) Multifetal gestation

c) Gestational diabetes

d) Chronic hypertension

e) Second trimester bleeding

a) Herpes infection

c) Gestational diabetes

d) Chronic hypertension

Which position is suitable for the patient who has a prolapsed cord following the rupture of membranes to promote fetal perfusion? Select all that apply.

a) Lithotomy

b) Recumbent

c) Trendelenburg

d) Lateral recumbent position

e) Knee-chest position

c) Trendelenburg

d) Lateral recumbent position

e) Knee-chest position

If a pregnant patient suspects signs and symptoms of preterm labor, which condition would lead the patient to go to the hospital immediately? Select all that apply.

a) Nausea and vomiting

b) Upper abdominal pain

c) Fluid leakage from vagina

d) Presence of vaginal bleeding

e) Contractions every 10 minutes

c) Fluid leakage from vagina

d) Presence of vaginal bleeding

e) Contractions every 10 minutes

The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. The nurse understands that the baby is at high risk for which condition?

a) Shoulder dystocia

b) Umbilical cord prolapse

c) Aspiration pneumonia

d) Brachial plexus injury

c) Aspiration pneumonia

--> the meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk for meconium aspiration syndrome, which may cause respiratory depression and aspiration pneumonia

Which postpartum nursing intervention should be taught to an obese patient who gave birth through a cesarean delivery?

a) Cleaning the stitches once a day with soapy water

b) Drying the wound by using a hair dryer at a low setting

c) Removing the sutures as soon as the wound starts healing

d) Keeping the wound covered at all times for better healing

b) Drying the wound by using a hair dryer at a low setting

--> the surgical wound should be kept dry at all times to prevent infections

Nurses should be aware of which factor regarding the use of tocolytic therapy to suppress uterine activity?

a) There are no important maternal (as opposed to fetal) contraindications)

b) Its most important function is to afford the opportunity to administer antenatal glucocorticoids

c) The drugs can be given efficaciously up to the designated beginning of term at 37 weeks

d) If the woman develops pulmonary edema while on tocolytics, intravenous (IV) fluids should be given

b) Its most important function is to afford the opportunity to administer antenatal glucocorticoids

--> after the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits

--> buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics

A nurse providing care to a woman in labor should be aware of which information about cesarean birth?

a) It is declining in frequency in the United States

b) It is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier patients do

c) It is performed primarily for the health of the mother and fetus

d) It can be either elected or refused by women as their absolute legal right

c) It is performed primarily for the health of the mother and fetus

--> the most common indications for cesarean birth are to preserve the health of the mother and fetus

Which intervention should the nurse perform during the McRoberts maneuver?

a) Apply fundal pressure to relieve the baby's shoulders

b) Instruct the patient to acquire a hands-and-knees position

c) Apply suprapubic pressure to the baby's anterior shoulder

d) Keep the patient's legs flexed apart with the knees on the abdomen

d) Keep the patient's legs flexed apart with the knees on the abdomen

--> this position decreases the pelvic inclination, allowing more space for the shoulders to be delivered

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factor may prohibit the woman from having a vaginal birth? Select all that apply.

a) Unstable coronary artery disease

b) Previous cesarean birth

c) Placenta previa

d) Initial blood pressure of 132/87 mm Hg

e) History of three spontaneous abortions

a) Unstable coronary artery disease

b) Previous cesarean birth

c) Placenta previa

While caring for a patient who is treated with terbutaline, the nurse tries to reduce pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant?

a) Suggesting that the patient lie on her side

b) Infusing Ringer's lactate solution intravenously

c) Increasing the terbutaline concentration

d) Encouraging drinking a full glass of water periodically

a) Suggesting that the patient lie on her side

--> this enhances placental perfusion and reduces the pressure on the cervix

The nurse is teaching a group of pregnant patients about preterm labor. Which patient statement indicates the need for further teaching?

a) "I will empty my bladder immediately."

b) "I will drink three to four glasses of water or juice."

c) "I will lie in the supine position for 1 hour."

d) "I will go to the hospital if symptoms continue."

c) "I will lie in the supine position for 1 hour."

--> the patient should lie down on her side for 1 hour to improve placental and fetal circulation

The nurse is instructed to administer 12 mg of betamethasone to a pregnant patient at 30 weeks of gestation. Which nursing intervention should be performed for the safe administration of the drug?

a) Give the medication by oral route

b) Assess platelet levels after drug administration

c) Administer increased doses of insulin with the drug

d) Follow a strict time interval of 24 hours between two doses

d) Follow a strict time interval of 24 hours between two doses

--> betamethasone is an antenatal glucocorticoid that is given IM to pregnant women between 24 and 34 weeks of gestation

--> it is administered to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome

--> optimal fetal benefits start 24 hours after the first injection

The primary health care provider (PHP) reports that the baby of a patient may have an injury resulting from a shoulder dystocia during birth. Which patient clinical condition would the nurse infer from the report?

a) Preterm labor

b) Post-term pregnancy

c) Secondary uterine inertia

d) Hypertonic uterine dysfunction

b) Post-term pregnancy

A patient in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect?

a) Buccal oxytocin

b) Terbutaline sulfate

c) Calcium gluconate

d) Magnesium sulfate

b) Terbutaline sulfate

Which nursing action should be initiated first when there is evidence of a prolapsed umbilical cord?

a) Notify the health care provider

b) Apply a scalp electrode

c) Prepare the woman for an emergency cesarean birth

d) Reposition the woman with her hips higher than her head

d) Reposition the woman with her hips higher than her head

--> the priority is to relieve pressure on the cord

The nurse hears the fetal heart tones by placing a fetoscope above the umbilicus of a pregnant patient. Which would the nurse infer from this assessment?

a) The head of the fetus will be observed initially during birth

b) The patient cannot be administered oxytocin during labor

c) The patient cannot be administered terbutaline during labor

d) The lower extremities of the fetus will be observed initially during birth

d) The lower extremities of the fetus will be observed initially during birth

--> the fetal heart tones are best heard above the umbilicus when the fetus is in a breech position

--> in the breech position, the lower extremities of the fetus are initially observed during birth

The fetal fibronectin test of a pregnant patient is positive, and her cervical length is found to be 32 mm. Which does the nurse interpret from these observations regarding the patient's pregnancy status?

a) Normal gestational labor

b) Indicated preterm labor

c) Spontaneous preterm labor

d) Miscarriage in the next week

a) Normal gestational labor

--> the cervical length and fibronectin test help to identify the risk of preterm delivery in the patient

--> if the cervical length is

The nurse is caring for a pregnant patient who is scheduled for an external cephalic version. Which intervention would the nurse do as part of the procedure?

a) Place the patient in a side position

b) Administer oxytocin intravenously

c) Place a pillow under the maternal abdomen

d) Administer terbutaline intravenously

d) Administer terbutaline intravenously

--> external cephalic version is the changing of the position of the fetus by the PHP

--> as part of the procedure, the PHP advises the nurse to administer terbutaline to soothe the muscle activity

--> patients are usually placed in supine position while performing the procedure

The nurse observes that a pregnant patient has a high temperature and foul smelling amniotic fluid during labor. Which possible complication might the nurse find in the patient and in the neonate after the delivery? Select all that apply.

a) The neonate may have pneumonia

b) The patient may have a pelvic abscess

c) The patient may have impaired lactation

d) The patient may have supine hypotension

e) The neonate may have bacteremia and sepsis

a) The neonate may have pneumonia

b) The patient may have a pelvic abscess

e) The neonate may have bacteremia and sepsis

The nurse is caring for a pregnant patient who had an onset of labor at 34 weeks of gestation. Which does the nurse expect the primary health care provider (PHP) to prescribe? Select all that apply.

a) Antibiotics

b) Glucocorticoids

c) Synthetic oxytocin

d) Magnesium sulfate

e) Progesterone supplementations

a) Antibiotics

b) Glucocorticoids

A pregnant patient reports severe pain in the midsection of the uterus. Following the assessment, the nurse finds that the patient has frequent uterine contractions (UCs) with cervical dilation up to 2 cm. Which nursing intervention does the nurse perform? Select all that apply.

a) Provides hydrotherapy to the patient

b) Administers an analgesic to the patient

c) Administers oxytocin to the patient

d) Encourages the patient to take a warm bath

e) Administers zolpidem to the patient

b) Administers an analgesic to the patient

d) Encourages the patient to take a warm bath

e) Administers zolpidem to the patient

Which question will the nurse ask a pregnant patient before administering terbutaline? Select all that apply.

a) "Do you experience urinary frequency?"

b) "Do you suffer from any cardiac disease?"

c) "Do you ever have migraine headaches?"

d) "Do you suffer from nausea and vomiting?"

e) "Do you have pregnancy-induced diabetes?"

b) "Do you suffer from any cardiac disease?"

c) "Do you ever have migraine headaches?"

e) "Do you have pregnancy-induced diabetes?"

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameter should the nurse assess in the patient to determine drug toxicity? Select all that apply.

a) Fluid intake

b) Respiratory status

c) Body temperature

d) Level of consciousness

e) Deep tendon reflexes

b) Respiratory status

d) Level of consciousness

e) Deep tendon reflexes

A pregnant patient is administered misoprostol to induce labor. After 8 hours of drug administration, the patient develops diarrhea and vomiting. Which will the nurse do to alleviate the symptoms?

a) Administer terbutaline

b) Increase the time between doses

c) Administer oxytocin infusion

d) Give a magnesium-containing antacid

a) Administer terbutaline

--> via SQ route

The nurse is caring for a pregnant patient who has been prescribed terbutaline to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline to the patient. Which patient condition leads the nurse to such a conclusion?

a) Blood pressure of 80/60 mm Hg

b) Short episode of hyperglycemia

c) Irregular episodes of dysrhythmias

d) Heart rate of less than 120 beats/min

a) Blood pressure of 80/60 mm Hg

--> terbutaline relaxes the smooth muscles and inhibits uterine activity

--> the drug can adversely affect the cardiovascular system, so the nurse should stop the treatment to prevent further damage

During the active phase of labor, the nurse prepares to insert an intrauterine pressure catheter (IUPC). Which patient clinical presentation would be the reason for this intervention?

a) Amniotic fluid of 300 mL

b) Cervical dilation of 6 cm

c) Complete deprivation of sleep in the patient

d) Reduced uterine contractions (UCs)

d) Reduced uterine contractions (UCs)

--> an IUPC is inserted into a pregnant patient in the active phase of labor to evaluate uterine activity accurately

--> intrauterine pressure of

During the first stage of labor, a pregnant patient complains of having severe back pain. Which does the nurse infer about the patient's clinical condition from the observation?

a) Oligohydramnios

b) Chorioamnionitis

c) Frank breech presentation

d) Occipitoposterior position of the fetus

d) Occipitoposterior position of the fetus

--> in this position, the fetal head (occiput) exerts pressure and presses against the sacrum of the patient

Which risk factor is associated with postpartum hemorrhage? Select all that apply.

a) Obesity

b) Maternal age

c) Chorioamnionitis

d) Cervical laceration

e) Placental abruption

a) Obesity

c) Chorioamnionitis

e) Placental abruption

For which symptom would the nurse monitor the postpartum patient with bipolar disorder? Select all that apply.

a) Constant worry

b) Increased energy

c) Changes in mood

d) Intrusive thoughts

e) Increased activity

b) Increased energy

c) Changes in mood

e) Increased activity

Which intrapartal factor can contribute to a postpartum infection? Select all that apply.

a) Hematomas

b) Prolonged labor

c) Diabetes mellitus

d) Epidural analgesia

e) Immunosuppression

a) Hematomas

b) Prolonged labor

d) Epidural analgesia

Which is a characteristic of postpartum venous thrombosis? Select all that apply.

a) Pain

b) Warmth

c) Redness

d) Chest pain

e) Calf tenderness

a) Pain

b) Warmth

c) Redness

A patient who has postpartum bleeding caused by uterine subinvolution has not recovered with drug therapy. Which procedure would be helpful in managing the bleeding when this patient is not willing to undergo surgery?

a) Massaging the abdomen

b) Inserting an indwelling urinary catheter

c) Using a nonrebreather mask

d) Inserting a fist into the vagina

d) Inserting a fist into the vagina

Which is a thromboembolic condition that is of concern during the postpartum period? Select all that apply.

a) Amniotic fluid embolism (AFE)

b) Superficial venous thrombosis

c) Deep vein thrombosis

d) Pulmonary embolism

e) Disseminated intravascular coagulation (DIC)

b) Superficial venous thrombosis

c) Deep vein thrombosis

d) Pulmonary embolism

What statement by the nurse would be included in the teaching for a patient prescribed sertraline for postpartum depression?

a) "Continue to take your prenatal vitamins."

b) "Your birth control pills will not be as effective."

c) "You will only need this medication for a short time."

d) "Discontinue breastfeeding while taking the medication."

a) "Continue to take your prenatal vitamins."

--> folate and vitamin B12 are needed for the synthesis of serotonin and other neurotransmitters

--> marginal or low folate levels increase the likelihood of a poor response to antidepressant medication

Which intervention would the nurse expect to be the most effective and least expensive for reducing the risk of urinary tract infections (UTIs) in the patient after the labor?

a) Providing good nutrition after labor

b) Providing antibiotic therapy before labor

c) Teaching comfort measures after labor

d) Maintaining aseptic conditions during labor

d) Maintaining aseptic conditions during labor

--> this helps reduce the invasion of microorganisms that may cause UTIs

Which is the most suitable surgical procedure to be performed by the obstetrician for a patient whose placenta has completely penetrated the myometrium on ultrasound, causing the patient to have persistent uterine bleeding?

a) Hysterectomy

b) Uterine tamponade

c) Uterine artery ligation

d) Uterine compression suturing

c) Uterine artery ligation

--> this patient has placenta accreta, which increases the risk for postpartum hemorrhage during childbirth

Which would the nurse infer about a postpartum patient's clinical condition of having spurts of blood with clots?

a) Partial separation of the placenta

b) Disseminated intravascular coagulation (DIC)

c) Bleeding from deep lacerations of the birth canal

d) Bleeding from superficial lacerations of the birth canal

a) Partial separation of the placenta

Which postpartum complication of pregnancy is the patient with submucosal uterine fibroids likely to have?

a) Placenta accreta

b) Impaired lactation

c) Vaginal hematomas

d) Postpartum hemorrhage

a) Placenta accreta

--> a slight penetration of the placenta into the myometrium of the uterus

Which discharge instruction would the nurse give a patient who had a postpartum hemorrhage? Select all that apply.

a) "Limit your physical activity."

b) "Alternate activity and rest periods."

c) "Increase the fat content in your diet."

d) "Increase dietary iron and protein."

e) "Increase caffeine content in your diet."

a) "Limit your physical activity."

b) "Alternate activity and rest periods."

d) "Increase dietary iron and protein."

Which is the best choice of treatment for a patient diagnosed with placenta accreta, who has uncontrolled bleeding, despite medications?

a) Perform a hysterectomy

b) Massage the uterus

c) Apply traction on the umbilical cord

d) Replace blood components as needed

a) Perform a hysterectomy

--> placenta accreta is an obstetric complication in which the placenta adheres to and penetrates the myometrium

Which would the nurse expect the postpartum patient to have when the primary health care provider prescribed desmopressin?

a) von Willebrand disease

b) Venous thromboembolism

c) Idiopathic thrombocytopenic purpura

d) Disseminated intravascular coagulation

a) von Willebrand disease

--> a type of hemophilia caused by a deficiency of blood clotting protein

A postpartum patient experiencing hemorrhagic shock has been administered an intravenous (IV) infusion of crystalloid solution. Which is the best treatment option for this patient whose platelet and clotting factor levels have not improved after IV infusion?

a) Infuse fresh frozen plasma

b) Administer packed red blood cells

c) Increase the dose of crystalloid solution

d) Provide supplemental oxygenation

a) Infuse fresh frozen plasma

--> fresh frozen plasma contains all of the coagulation factors and helps restore platelet counts

Which instruction given by the nurse needs to be corrected when teaching a pregnant patient with venous thromboembolism (VTE) about measures to prevent aggravation of her symptoms?

a) "Apply moist heat on the affected area."

b) "Change your position from time to time."

c) "Place your knees in a sharp flexed position."

d) "Feed the baby breast milk; it is not harmful."

c) "Place your knees in a sharp flexed position."

--> this position would cause pooling of the blood in the lower extremities, which would aggravate thromboembolism

Which action is indicated when the nurse is unable to obtain a firm fundus after massaging the boggy fundus of a patient who delivered a large baby after a prolonged labor with a forceps-assisted birth?

a) Increase the rate of the intravenous infusion

b) Massage the fundus while another nurse notifies the obstetrician

c) Change the peripad, replacing it with a double pad

d) Administer a half-dose of a uterine-contracting medication

b) Massage the fundus while another nurse notifies the obstetrician

--> fragments of the placenta can remain in the uterus after spontaneous separation of the placenta during the third stage of labor

--> in this case, the woman will have excessive bleeding and the uterus will feel boggy (soft) because of uterine atony

--> ultrasonography can be used to detect placental fragments

A patient has a hypotonic uterus and continuous bleeding despite the administration of oxytocin. The patient has hypertension, headache, and vomiting after the new medication to replace the oxytocin has been administered. Which new medication was most likely prescribed to the patient?

a) Misoprostol

b) Desmopressin

c) Warfarin sodium

d) Methyl prostaglandin F2-alpha

d) Methyl prostaglandin F2-alpha

--> this medication aggravates the blood pressure and is thus contraindicated in patients with a history of hypertension and cardiac disease

Which action would the nurse initially take for a 28-year-old multipara who delivered a 9-pound, 3-ounce baby girl an hour ago after a 22-hour labor with a forceps-assisted birth who keeps shifting position and is becoming increasingly irritable and annoyed with everyone in the room?

a) Assess her vital signs

b) Massage the fundus

c) Check her perineum

d) Check the tone of her fundus

c) Check her perineum

--> the patient is exhibiting increasing anxiety, which can signal the presence of postpartum hemorrhage

--> risk factors for postpartum hemorrhage include a large fetus, prolonged labor, and a forceps-assisted birth

--> the fastest way to see the amount of current hemorrhage is to check the perineum

Which postpartum complication would the nurse expect when finding the fetal head is exerting pressure on the patient's vaginal mucosa during labor?

a) Distention of the uterus

b) Loss of pelvic muscle strength

c) Deep vaginal lacerations and hematomas

d) Adherence of the placenta to the vagina

c) Deep vaginal lacerations and hematomas

--> when the fetal head exerts prolonged pressure on the vaginal mucosa during labor, it reduces blood flow to the vaginal tissue and causes ischemia

--> because of the reduced oxygen supply and tissue damage, the patient may have necrosis of the vaginal mucosa, leading to deep vaginal lacerations and vaginal hematomas

Which is the most important intervention when a nurse observes profuse postpartum bleeding?

a) Call the woman's primary health care provider

b) Administer the standing prescription for an oxytocic

c) Palpate the uterus and massage it if it is boggy

d) Assess maternal blood pressure and pulse for signs of hypovolemic shock

c) Palpate the uterus and massage it if it is boggy

--> the most important nursing intervention is to stop the bleeding