Antepartum Complications AQ
1.A nurse is assessing the effectiveness of a teaching plan regarding self-care and conservative
management of gestational hypertension. The nurse confirms that the teaching has been
understood when the client notes the importance of what?
Eating a low-protein diet
Ensuring adequate sodium intake
Joining a weight-reduction program
Following the prescribed diuretic regimen
(Sodium is not restricted, because restriction decreases blood volume, which in turn reduces
placental perfusion. Women at risk for preeclampsia are advised to eat a high-protein diet.
Losing weight is contraindicated during pregnancy and does not reduce the risk of preeclampsia.
Diuretic therapy is contraindicated because it decreases blood volume, which in turn reduces
placental perfusion.)
2.A client who is in preterm labor at 34 weeks' gestation is receiving intravenous tocolytic
therapy. The frequency of her contractions increases to every 10 minutes, and her cervix dilates
to 4 cm. The infusion is discontinued. Toward what outcome should the priority nursing care be
directed at this time?
Reduction of anxiety associated with preterm labor
Promotion of maternal and fetal well-being during labor
Supportive communication with the client and her partner
Helping the family cope with the impending preterm birth
(Labor is continuing, and promotion of the well-being of both client and fetus is the priority
nursing care during this period. Reduction of anxiety associated with preterm labor, supportive
communication with the client and her partner, and helping the family cope with the impending
preterm birth each address just one aspect of this client's needs and must be dealt with in the
context of the priority need.)
3.The nurse is caring for a client who has had a spontaneous abortion. Which complication
should the nurse assess this client for?
Hemorrhage
Dehydration
,Hypertension
Subinvolution
(Hemorrhage may result if placental tissue is retained or uterine atony occurs. There is no
indication that the client has been deprived of fluids. Hypotension, not hypertension, may occur
with postabortion hemorrhage. Subinvolution is more likely to occur after a full-term birth.)
4.What should the plan of care for a client with a tentative diagnosis of partial abruptio placentae
include?
Bed rest with sedation
Trendelenburg position and hydration
Preparation for emergency cesarean birth
External fetal monitoring and oxygenation
(Fetal monitoring and oxygen administration should be instituted to protect the fetus. Some
placental separation has occurred, and it may progress further. Sedation is contraindicated; it
may further stress an already compromised fetus. The Trendelenburg position may shift the
heavy uterus against the diaphragm and lead to compromised maternal respiratory function,
further depriving the fetus of oxygen. Hydration is not a priority at this time. Further assessment
of fetal status and progression of abruption placentae is needed before a cesarean birth is
considered.)
5.While mopping the kitchen floor, a client at 37 weeks' gestation experiences a sudden sharp
pain in her abdomen with a period of fetal hyperactivity. When the client arrives at the prenatal
clinic, the nurse examines her and detects fundal tenderness and a small amount of dark-red
bleeding. What does the nurse conclude is the probable cause of these clinical manifestations?
True labor
Placenta previa
Partial abruptio placentae
Abdominal muscular injury
(Typical manifestations of abruptio placentae are sudden sharp localized pain and small amounts
of dark-red bleeding caused by some degree of placental separation. True labor begins with
regular contractions, not sharp localized pain. There is no pain with placenta previa, just the
presence of bright-red bleeding. There are no data to indicate that the client sustained an injury.)
,6.What is the optimal method for the nurse to use to assess blood loss in a client with placenta
previa?
Count or weigh perineal pads
Monitor pulse and blood pressure
Check hemoglobin and hematocrit values
Measure or estimate the height of the fundus
(An accurate measurement of the amount of blood loss may be obtained by counting or weighing
perineal pads. The vital signs will reflect the effects of the blood loss rather than the amount.
Laboratory results demonstrate the effects of the blood loss rather than the amount. The fundus
may be higher than expected, because the low-lying placenta prevents the descent of the fetus
into the pelvis, but the height cannot be used to estimate blood loss.)
7.A pregnant client with type 1 diabetes is visiting the prenatal clinic for the first time. What is
the primary long-term goal for this client?
Insulin dosages will decrease
Dietary fluctuations will be minimized
The blood glucose level will remain stable
Pregnancy will end with the birth of a healthy infant
(In any prenatal situation, the goal is an optimally healthy mother and newborn, no matter what
other factors are involved. Insulin is given as necessary to maintain an acceptable glucose level.
Minimizing dietary fluctuations is important, but it is not the priority. Stabilizing the blood
glucose level is an ongoing goal, not a long-term goal.)
8.A nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those
born to women who do not have diabetes. On what information about pregnant women with
diabetes should the nurse base the response?
Taking exogenous insulin stimulates fetal growth.
Consuming more calories covers the insulin secreted by the fetus.
Extra circulating glucose causes the fetus to acquire fatty deposits.
Fetal weight gain increases as a result of the common response of maternal overeating.
, (It is difficult to maintain maternal normoglycemia throughout pregnancy; excess glucose passes
into the fetus, where it is converted to fat. The problem is excess glucose, which is why
exogenous insulin must be administered. Although all pregnant women consume extra calories to
meet the increased metabolism associated with pregnancy, fetal insulin does not pass from the
fetus to the mother. Stating that fetal weight gain increases because pregnant women commonly
overeat is a stereotypical statement; not all clients with diabetes overeat.)
9.A client who is in the first trimester is being discharged after a week of hospitalization for
hyperemesis gravidarum. She is to be maintained at home with rehydration infusion therapy.
What is the priority nursing activity for the home health nurse?
Determining fetal well-being
Monitoring for signs of infection
Monitoring the client for signs of electrolyte imbalances
Teaching about changes in nutritional needs during pregnancy
(Rehydration fluids contain only saline and dextrose; if the client continues to vomit, she will
lose electrolytes. Monitoring the fetus is not the priority at this time. Although there is a danger
of infection when an intravenous line is in place, monitoring for it is not the priority. Teaching
about nutritional needs is a nontherapeutic nursing action while the client is still vomiting.)
10.A pregnant client is admitted with abdominal pain and heavy vaginal bleeding. What is the
priority nursing action?
Administering oxygen
Elevating the head of the bed
Drawing blood for a hematocrit level
Giving an intramuscular analgesic
(Abdominal pain and heavy vaginal bleeding indicate significant blood loss. To compensate for
decreased cardiac output, oxygen is given to maintain the well-being of both mother and fetus.
Elevating the head of the bed will decrease blood flow to vital centers in the brain. Drawing
blood for a hematocrit level is not the priority. Giving an intramuscular analgesic may mask
abdominal pain and sedate an already compromised fetus; also, it requires a primary healthcare
provider's prescription.)
11.A client is admitted with a marginal placenta previa. Which item should the nurse have
readily available?
One unit of freeze-dried plasma
1.A nurse is assessing the effectiveness of a teaching plan regarding self-care and conservative
management of gestational hypertension. The nurse confirms that the teaching has been
understood when the client notes the importance of what?
Eating a low-protein diet
Ensuring adequate sodium intake
Joining a weight-reduction program
Following the prescribed diuretic regimen
(Sodium is not restricted, because restriction decreases blood volume, which in turn reduces
placental perfusion. Women at risk for preeclampsia are advised to eat a high-protein diet.
Losing weight is contraindicated during pregnancy and does not reduce the risk of preeclampsia.
Diuretic therapy is contraindicated because it decreases blood volume, which in turn reduces
placental perfusion.)
2.A client who is in preterm labor at 34 weeks' gestation is receiving intravenous tocolytic
therapy. The frequency of her contractions increases to every 10 minutes, and her cervix dilates
to 4 cm. The infusion is discontinued. Toward what outcome should the priority nursing care be
directed at this time?
Reduction of anxiety associated with preterm labor
Promotion of maternal and fetal well-being during labor
Supportive communication with the client and her partner
Helping the family cope with the impending preterm birth
(Labor is continuing, and promotion of the well-being of both client and fetus is the priority
nursing care during this period. Reduction of anxiety associated with preterm labor, supportive
communication with the client and her partner, and helping the family cope with the impending
preterm birth each address just one aspect of this client's needs and must be dealt with in the
context of the priority need.)
3.The nurse is caring for a client who has had a spontaneous abortion. Which complication
should the nurse assess this client for?
Hemorrhage
Dehydration
,Hypertension
Subinvolution
(Hemorrhage may result if placental tissue is retained or uterine atony occurs. There is no
indication that the client has been deprived of fluids. Hypotension, not hypertension, may occur
with postabortion hemorrhage. Subinvolution is more likely to occur after a full-term birth.)
4.What should the plan of care for a client with a tentative diagnosis of partial abruptio placentae
include?
Bed rest with sedation
Trendelenburg position and hydration
Preparation for emergency cesarean birth
External fetal monitoring and oxygenation
(Fetal monitoring and oxygen administration should be instituted to protect the fetus. Some
placental separation has occurred, and it may progress further. Sedation is contraindicated; it
may further stress an already compromised fetus. The Trendelenburg position may shift the
heavy uterus against the diaphragm and lead to compromised maternal respiratory function,
further depriving the fetus of oxygen. Hydration is not a priority at this time. Further assessment
of fetal status and progression of abruption placentae is needed before a cesarean birth is
considered.)
5.While mopping the kitchen floor, a client at 37 weeks' gestation experiences a sudden sharp
pain in her abdomen with a period of fetal hyperactivity. When the client arrives at the prenatal
clinic, the nurse examines her and detects fundal tenderness and a small amount of dark-red
bleeding. What does the nurse conclude is the probable cause of these clinical manifestations?
True labor
Placenta previa
Partial abruptio placentae
Abdominal muscular injury
(Typical manifestations of abruptio placentae are sudden sharp localized pain and small amounts
of dark-red bleeding caused by some degree of placental separation. True labor begins with
regular contractions, not sharp localized pain. There is no pain with placenta previa, just the
presence of bright-red bleeding. There are no data to indicate that the client sustained an injury.)
,6.What is the optimal method for the nurse to use to assess blood loss in a client with placenta
previa?
Count or weigh perineal pads
Monitor pulse and blood pressure
Check hemoglobin and hematocrit values
Measure or estimate the height of the fundus
(An accurate measurement of the amount of blood loss may be obtained by counting or weighing
perineal pads. The vital signs will reflect the effects of the blood loss rather than the amount.
Laboratory results demonstrate the effects of the blood loss rather than the amount. The fundus
may be higher than expected, because the low-lying placenta prevents the descent of the fetus
into the pelvis, but the height cannot be used to estimate blood loss.)
7.A pregnant client with type 1 diabetes is visiting the prenatal clinic for the first time. What is
the primary long-term goal for this client?
Insulin dosages will decrease
Dietary fluctuations will be minimized
The blood glucose level will remain stable
Pregnancy will end with the birth of a healthy infant
(In any prenatal situation, the goal is an optimally healthy mother and newborn, no matter what
other factors are involved. Insulin is given as necessary to maintain an acceptable glucose level.
Minimizing dietary fluctuations is important, but it is not the priority. Stabilizing the blood
glucose level is an ongoing goal, not a long-term goal.)
8.A nurse teaching a prenatal class is asked why infants of diabetic mothers are larger than those
born to women who do not have diabetes. On what information about pregnant women with
diabetes should the nurse base the response?
Taking exogenous insulin stimulates fetal growth.
Consuming more calories covers the insulin secreted by the fetus.
Extra circulating glucose causes the fetus to acquire fatty deposits.
Fetal weight gain increases as a result of the common response of maternal overeating.
, (It is difficult to maintain maternal normoglycemia throughout pregnancy; excess glucose passes
into the fetus, where it is converted to fat. The problem is excess glucose, which is why
exogenous insulin must be administered. Although all pregnant women consume extra calories to
meet the increased metabolism associated with pregnancy, fetal insulin does not pass from the
fetus to the mother. Stating that fetal weight gain increases because pregnant women commonly
overeat is a stereotypical statement; not all clients with diabetes overeat.)
9.A client who is in the first trimester is being discharged after a week of hospitalization for
hyperemesis gravidarum. She is to be maintained at home with rehydration infusion therapy.
What is the priority nursing activity for the home health nurse?
Determining fetal well-being
Monitoring for signs of infection
Monitoring the client for signs of electrolyte imbalances
Teaching about changes in nutritional needs during pregnancy
(Rehydration fluids contain only saline and dextrose; if the client continues to vomit, she will
lose electrolytes. Monitoring the fetus is not the priority at this time. Although there is a danger
of infection when an intravenous line is in place, monitoring for it is not the priority. Teaching
about nutritional needs is a nontherapeutic nursing action while the client is still vomiting.)
10.A pregnant client is admitted with abdominal pain and heavy vaginal bleeding. What is the
priority nursing action?
Administering oxygen
Elevating the head of the bed
Drawing blood for a hematocrit level
Giving an intramuscular analgesic
(Abdominal pain and heavy vaginal bleeding indicate significant blood loss. To compensate for
decreased cardiac output, oxygen is given to maintain the well-being of both mother and fetus.
Elevating the head of the bed will decrease blood flow to vital centers in the brain. Drawing
blood for a hematocrit level is not the priority. Giving an intramuscular analgesic may mask
abdominal pain and sedate an already compromised fetus; also, it requires a primary healthcare
provider's prescription.)
11.A client is admitted with a marginal placenta previa. Which item should the nurse have
readily available?
One unit of freeze-dried plasma
