CHAPTER 38: THE OBSTETRIC PATIENT {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 38: T HE O BSTETRIC P ATIENT
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. The treatment plan for management of an obstetric patient with peripartum
cardiom yopathy (PPCM) includes which interventions?
a. Oxygen therapy, pain management, and preload enhancemen t
b. Walking exercises, diuretics, and anticoagulants
c. Diuretics, digoxin, and anticoagulation
d. Fluid resuscitation, beta -blockers, and vasoconstrictors



ANS: C



Symptoms are identical to those of classic cardiac failure, but
treatment depends on the pregnancy status of the patient. Women who
present with peripartum cardiom yopathy (PPCM) during pregnancy
require joint cardiac and obstetric care, but as soon as the baby is born
and the patient is hemodynamicall y stable, standard therapy for heart
failure may be a pplied. This would include treatment with diuretics,
digoxin, beta-blockade, and afterload reduction. Angiotensin -
converting enz yme inhibitors, angiotensin receptor blockers, and renin
inhibitors are contraindicated during pregnancy because of fetotoxicit y
but may be used after the infant is born. After the bleeding has been
stopped after delivery, anticoagulation is commonl y used to prevent
thromboembolism and the formation of left ventricular thrombus,
which is associated with a worse prognosis.

, DIF: Cognitive Level: Appl ying REF: p. 927 OBJ:
Nursing Process Step: Intervention TOP: Obstetrics
MSC: NC LEX: Physiologic Integrit y



2. A patient who is 30 -weeks pregnant is admitted with severe asthma. The
nurse understands that sufficient fetal oxygenation re quires what minimum
level of maternal oxygenation?
a. PaO2 greater than 100 mm Hg
b. PaO2 greater than 70 mm Hg
c. Oxygen saturation of 100%
d. Oxygen saturation greater than 70%



ANS: C



Sufficient fetal ox ygenation requires a maternal arterial ox ygen tension
(PaO2) greater than 70 mm Hg, which corresponds to an oxygen
saturation of 95%.



DIF: Cognitive Level: Appl ying REF: p. 931
OBJ: Nursing Process Step: Diagnosis TOP:
Obstetrics MSC: NC LEX: Physiologic Integrit y



3. What is the most common cause of obstetric ca rdiac arrest in pregnancy?
a. Anesthetic complications
b. Idiopathic peripartum cardiom yopathy
c. Pregnancy-induced hypertension
d. Hemorrhage



ANS: D

, Obstetric causes for cardiac arrest in pregnancy are hemorrhage (17%),
pregnancy-induced hypertension (16%), idiopat hic peripartum
cardiom yopathy (8%), and anesthetic complications (2%).



DIF: Cognitive Level: Understanding REF: p. 928 | Table
38-6 OBJ: Nursing Process Step: Assessment TOP:
Obstetrics MSC: NC LEX: Physiologic Integrit y



4. What is the most common obste tric cause of disseminated intravascular
coagulopathy (DIC)?
a. Preeclampsia
b. Abruptio placentae
c. Dead fetus syndrome
d. Amniotic fluid embolism



ANS: B



Although all of these above conditions can cause disseminated
intravascular coagulopathy (DIC), abruptio place ntae is the most
common obstetric cause of DIC.



DIF: Cognitive Level: Understanding REF: p. 930 | Table
38-8 OBJ: Nursing Process Step: Diagnosis TOP:
Obstetrics MSC: NC LEX: Physiologic Integrit y



5. A multiparous woman was admitted at 36 weeks’ gestati on for nausea,
vomiting, and severe epigastric pain. The fetal heart rate was normal.