Test Bank Ricci - Essentials of Maternity, Newborn, and Women's Health Nursing (4th Edition) chpt 19. 100% correct answers with rationales

Test Bank - Essentials of Maternity, Newborn, and Women's Health Nursing (4th Edition) Chapter 19: Nursing Management of Pregnancy at Risk- Pregnancy 1. After teaching a woman who has had an evacuation for a hydatidiform mole (molar pregnancy) about her condition, which of the following statements indicates that the nurses teaching was successful? A) I will be sure to avoid getting pregnant for at least 1 year. B) My intake of iron will have to be closely monitored for 6 months. C) My blood pressure will continue to be increased for about 6 more months. D) I won't use my birth control pills for at least a year or two. Answer: A Explanation: As a result of the increased risk for cancer, the client is advised to receive extensive follow-up therapy for the next 12 months. Strong recommendation to avoid pregnancy for 1 year because the pregnancy can interfere with the monitoring of hCG levels. Use of a reliable contraceptive for at least 1 year. 2. Which of the following findings on a prenatal visit at 10 weeks might lead the nurse to suspect a hydatidiform mole? A) Complaint of frequent mild nausea B) Blood pressure of 120/84 mm Hg C) History of bright red spotting 6 weeks ago D) Fundal height measurement of 18 cm Answer: D Explanation: 3. A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication? A) Urinary output of 20 mL per hour B) Respiratory rate of 10 breaths/minute C) Deep tendons reflexes 2+ D) Difficulty in arousing Answer: C Explanation: Diminished or absent reflexes occur when the client develops magnesium toxicity. Because magnesium is a potent neuromuscular blockade, the afferent and efferent nerve pathways do not relay messages properly and hyporeflexia develops. Common sites used to assess DTRs are biceps reflex, triceps reflex, patellar reflex, Achilles reflex, and plantar reflex. It grades reflexes from 0 to 4+. Grades 2+ and 3+ are considered normal, whereas grades 0 and 4 may indicate pathology. 4. Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which of the following responses by the nurse would be most appropriate? A) Why are you crying? B) Will a pill help your pain? C) I'm sorry you lost your baby. D) A baby still wasn't formed in your uterus. Answer: C Explanation: 5. Which of the following data on a client’s health history would the nurse identify as contributing to the clients risk for an ectopic pregnancy? A) Use of oral contraceptives for 5 years B) Ovarian cyst 2 years ago C) Recurrent pelvic infections D) Heavy, irregular menses Answer: C Explanation: In the general population, most cases are the result of tubal scarring secondary to pelvic inflammatory disease (PID). Organisms such as Neisseria gonorrhea and Chlamydia trachomatis preferentially attack the fallopian tubes, producing silent infections. A recent study reported a twofold increased risk for ectopic pregnancy in women with a history of a chlamydia infection, secondary to tubal damage. Other associated risk factors for ectopic pregnancy include previous tubal surgery, infertility, PID, previous pregnancy loss (induced or spontaneous, use of an intrauterine contraceptive system, previous ectopic pregnancy, uterine fibroids, sterilization, smoking (which alters tubal motility), history of multiple sexual partners, use of progestin-only oral contraceptives, douching, and exposure to diethylstilbestrol (DES). 6. In a woman who is suspected of having a ruptured ectopic pregnancy, the nurse would expect to assess for which of the following as a priority? A) Hemorrhage B) Jaundice C) Edema D) Infection Answer: A Explanation: Signs and symptoms of ectopic rupture are severe, sharp, stabbing, unilateral abdominal pain; vertigo/fainting; hypotension; and increased pulse 7. Which of the following findings would the nurse interpret as suggesting a diagnosis of gestational trophoblastic disease? A) Elevated hCG levels, enlarged abdomen, quickening B) Vaginal bleeding, absence of FHR, decreased hPL levels C) Visible fetal skeleton on ultrasound, absence of quickening, enlarged abdomen D) Gestational hypertension, hyperemesis gravidarum, absence of FHR Answer: D This study source was downloaded by from CourseH on :29:03 GMT -05:00 Explanation: 8. It is determined that a client’s blood Rh is negative and her partners is positive. To help prevent Rh isoimmunization, the nurse anticipates that the client will receive RhoGAM at which time? A) At 34 weeks gestation and immediately before discharge B) 24 hours before delivery and 24 hours after delivery C) In the first trimester and within 2 hours of delivery D) At 28 weeks gestation and again within 72 hours after delivery Answer: D Explanation: The current recommendation is for every Rh-negative nonimmunized woman to receive RhoGAM at some point between 28 and 32 weeks’ gestation and again within 72 hours after giving birth. 9. The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse includes interventions focusing on which of the following because of the woman's increased risk? A) Oligohydramnios B) Preeclampsia C) Post-term labor D) Chorioamnionitis Answer: B Explanation: The increasing number of multiple gestations is a concern because women who are expecting more than one infant are at high risk for preterm labor, polyhydramnios, hyperemesis gravidarum, anemia, preeclampsia, and antepartum hemorrhage. 10. A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would lead the nurse to suspect that the client is having an adverse effect associated with this drug? A) Gastrointestinal bleeding B) Blurred vision C) Tachycardia D) Sweating Answer: C Explanation: Hydralazine hydrochloride (Apresoline) is used to reduce blood pressure. Adverse effects of hydralazine are palpitations, headache, tachycardia, anorexia, nausea, vomiting, and diarrhea. 11. After reviewing a client’s history, which factor would the nurse identify as placing her at risk for gestational hypertension? A) Mother had gestational hypertension during pregnancy. B) Client has a twin sister. C) Sister-in-law had gestational hypertension. D) This is the client’s second pregnancy. Answer: A Explanation: 12. A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the clients plan of care? A) Clear liquid diet B) Total parenteral nutrition C) Nothing by mouth D) Administration of labetalol Answer: C Explanation: Hyperemesis gravidarum is nausea and vomiting in early pregnancy that prevents the woman from ingesting adequate nutrition. IV fluids may be required for rehydration, but the priority is to stop all intake of food and fluid for a period of time until vomiting has stopped. 13. The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome? A) Hyperglycemia B) Elevated platelet count C) Leukocytosis D) Elevated liver enzymes Answer: D Explanation: HELLP syndrome is an acronym for hemolysis, elevated liver enzymes, and low platelet count 14. Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia? A) Calcium gluconate B) Potassium chloride C) Ferrous sulfate D) Calcium carbonate Answer: A Explanation: 15. Which assessment finding would lead the nurse to suspect infection as the cause of a clients PROM? A) Yellow-green fluid B) Blue color on Nitrazine testing C) Ferning D) Foul odor Answer: D Explanation: 16. While assessing a pregnant woman, the nurse suspects that the client may be at risk for hydramnios based on which of the following? (Select all that apply.) A) History of diabetes B) Complaints of shortness of breath C) Identifiable fetal parts on abdominal palpation D) Difficulty obtaining fetal heart rate E) Fundal height below that for expected gestational age This study source was downloaded by from CourseH on :29:03 GMT -05:00