1. A patient presents to the perinatal clinic with abdominal pain. She has missed one period
and, following a transvaginal ultrasound, pregnancy is confirmed. However, implantation
has occurred in the right fallopian tube. The ectopic mass is 3 cm and has not ruptured.
The nurse prepares the patient for which therapy?
a. Laparoscopic salpingostomy
b. Methotrexate
c. Partial salpingectomy
d. Salpingectomy by laparotomy
ANS: B
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
Pregnancy Objective: #1. Plan nursing assessments and interventions for the woman
experiencing com- plications of pregnancy.
Page: 146
Heading: Management
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies
Cognitive Level: Application [Applying]
Concept: Pregnancy; Assessment
Difficulty: Moderate
Feedback
A. Laparoscopic salpingostomy would not be needed.
B. Methotrexate, a chemotherapeutic drug and folic acid inhibitor that stops cell
production and destroys remaining trophoblastic tissue, is used in the
management of uncomplicated, non-life-threatening ectopic pregnancies.
Patients are eligible for methotrexate therapy if the ectopic mass is unruptured
and measures 4 cm or less on ultrasound examination.
C. Partial salpingectomy would not be needed.
D. Salpingectomy by laparotomy would not be needed.
2. The perinatal nurse is assessing a patient who is at 35 weeks’ gestation in her first
pregnancy. She is worried about having her baby “too soon,” and she is experiencing
uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats/minute. A
vaginal examination performed by the health-care provider reveals no cervical changes
since her last examination. Ultrasound examination reveals the presence of V-shaped
cervical funneling. Which action by the nurse is most appropriate?
, a. Educate the patient on benefits of corticosteroids.
b. Facilitate admission to the high-risk OB unit.
c. Prepare to administer a dose of magnesium sulfate.
d. Reassure the patient that she is not in preterm labor.
ANS: D
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
Pregnancy Objective: #3. Identify complications of pregnancy that require fetal and/or
maternal surveil- lance.
Page: 152
Heading: Preterm Labor
Integrated Processes: Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
Cognitive Level: Analysis [Analyzing]
Concept: Pregnancy; Assessment; Critical Thinking
Difficulty: Difficult
Feedback
A. The patient does not require corticosteroids.
B. The patient does not require admission to the high-risk OB unit.
C. The patient does not require magnesium sulfate.
D. Preterm labor is defined as regular uterine contractions and cervical changes
before the end of the 37th week of gestation. Many patients present with
preterm contractions, but only those who demonstrate changes in the cervix are
diagnosed with preterm labor. Because this patient has no demonstrated
cervical changes, she does not have the diagnosis. Also reassuring is the
infrequency of her contractions; a defining characteristic of preterm labor is
persistent uterine contractions (four every 20 minutes or eight per hour).
Another reassuring finding is the presence of V-shaped cervical funneling; a
change to U-shaped cervical funneling in a patient with a shortened cervix is
associated with preterm labor in high-risk women with a prior spontaneous
preterm birth.
3. The perinatal nurse is caring for a patient at 26 weeks’ gestation who has a history of
hypertension that has been well controlled. Today she presents with a blood pressure of
156/102 mm Hg, and she has 2+ protein on urine dipstick. Which initial action by the
nurse is most appropriate?
a. Arrange admission to the high-risk OB unit.
b. Instruct the patient on strict bedrest.
c. Obtain a clean-catch urine sample.
d. Prepare to administer IV antihypertensives.
ANS: C
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
, Pregnancy Objective: #3. Identify complications of pregnancy that require fetal and/or
maternal surveil- lance.
Page: 156
Heading: Pre-Eclampsia>Pathophysiology
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Pregnancy; Assessment; Critical Thinking
Difficulty: Difficult
Feedback
A. The patient does not need admission to the high-risk OB unit at this point.
B. The patient does not need strict bedrest at this point.
C. Pre-eclampsia can occur in a pregnant person who has chronic hypertension.
This patient has the characteristics of hypertension after a period of good
control and proteinuria of at least 2+ on dipstick (100 mg/dL). The nurse needs
to ensure protein levels are assessed in two samples at least 4 hours apart and
ensure the patient has no signs of a urinary tract infection, as protein can occur
in a sample of infected urine. The nurse should obtain a clean-catch urine
sample to send to the laboratory for analysis. Asymptomatic UTI can occur in
up to 11% of pregnant people, so assessing for signs and symptoms may not be
accurate.
D. The patient does not need IV antihypertensives at this point.
4. A 22-year-old patient presents to the emergency department with abdominal pain and
vaginal bleeding. Her blood pressure is 90/58 mm Hg, her pulse is 120 beats/minute, and
she complains of dizziness. Which action by the nurse takes priority?
a. Assess the patient for sexually transmitted infections.
b. Collect a urine sample for pregnancy testing.
c. Obtain informed consent for a salpingectomy.
d. Start two large-bore IVs for fluid replacement.
ANS: D
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
Pregnancy Objective: #3. Identify complications of pregnancy that require fetal and/or
maternal surveil- lance.
Page: 145
Heading: Ectopic Pregnancy
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Analysis [Analyzing]
Concept: Pregnancy; Assessment; Critical Thinking
Difficulty: Difficult
Feedback
, A. Assessing for sexually transmitted infections is not a priority.
B. Collecting a urine sample for pregnancy testing is not a priority.
C. The nurse may need to obtain informed consent for an operative procedure
once a definitive diagnosis is made, but this is not the priority.
D. This patient has both signs (hypotension, tachycardia) and symptoms
(complaints of dizziness) of acute volume loss. The priority is starting large-
bore IV lines for fluid resuscitation.
5. A patient in her second trimester of pregnancy presents to the perinatal clinic with
complaints of scant vaginal bleeding, abdominal pain, and shoulder pain. What action
should the nurse perform first?
a. Assess her for a history of preterm labor.
b. Obtain a blood sample for a b-hCG test.
c. Prepare the patient for a pelvic exam.
d. Request an order for methotrexate (Rheumatrex).
ANS: B
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
Pregnancy Objective: #1. Plan nursing assessments and interventions for the woman
experiencing com- plications of pregnancy.
Page: 145
Heading: Ectopic Pregnancy
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Pregnancy; Assessment; Critical Thinking
Difficulty: Difficult
Feedback
A. Preterm labor is not a risk factor for this patient.
B. This patient is displaying symptoms of a possible ruptured ectopic pregnancy
(vaginal bleeding, abdominal pain, shoulder pain). Shoulder pain can occur
from nerve irritation due to the presence of blood in the pelvic cavity. A b-hCG
test finding will be lower than expected for the gestational age. To facilitate a
rapid diagnosis, the nurse should first obtain and send a blood sample for b-
hCG test.
C. The patient will most likely need a pelvic exam, but this is not the priority.
D. Methotrexate is used for uncomplicated, non-life-threatening ectopic
pregnancies. It would not be indicated in this patient because she has
manifestations of rupture.
6. A nurse is caring for a patient who has been diagnosed with an incomplete molar
pregnancy. Which action by the nurse is most appropriate?
a. Advise the patient that she can try to get pregnant in 3 months.
and, following a transvaginal ultrasound, pregnancy is confirmed. However, implantation
has occurred in the right fallopian tube. The ectopic mass is 3 cm and has not ruptured.
The nurse prepares the patient for which therapy?
a. Laparoscopic salpingostomy
b. Methotrexate
c. Partial salpingectomy
d. Salpingectomy by laparotomy
ANS: B
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
Pregnancy Objective: #1. Plan nursing assessments and interventions for the woman
experiencing com- plications of pregnancy.
Page: 146
Heading: Management
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies
Cognitive Level: Application [Applying]
Concept: Pregnancy; Assessment
Difficulty: Moderate
Feedback
A. Laparoscopic salpingostomy would not be needed.
B. Methotrexate, a chemotherapeutic drug and folic acid inhibitor that stops cell
production and destroys remaining trophoblastic tissue, is used in the
management of uncomplicated, non-life-threatening ectopic pregnancies.
Patients are eligible for methotrexate therapy if the ectopic mass is unruptured
and measures 4 cm or less on ultrasound examination.
C. Partial salpingectomy would not be needed.
D. Salpingectomy by laparotomy would not be needed.
2. The perinatal nurse is assessing a patient who is at 35 weeks’ gestation in her first
pregnancy. She is worried about having her baby “too soon,” and she is experiencing
uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats/minute. A
vaginal examination performed by the health-care provider reveals no cervical changes
since her last examination. Ultrasound examination reveals the presence of V-shaped
cervical funneling. Which action by the nurse is most appropriate?
, a. Educate the patient on benefits of corticosteroids.
b. Facilitate admission to the high-risk OB unit.
c. Prepare to administer a dose of magnesium sulfate.
d. Reassure the patient that she is not in preterm labor.
ANS: D
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
Pregnancy Objective: #3. Identify complications of pregnancy that require fetal and/or
maternal surveil- lance.
Page: 152
Heading: Preterm Labor
Integrated Processes: Nursing Process: Implementation
Client Need: Health Promotion and Maintenance
Cognitive Level: Analysis [Analyzing]
Concept: Pregnancy; Assessment; Critical Thinking
Difficulty: Difficult
Feedback
A. The patient does not require corticosteroids.
B. The patient does not require admission to the high-risk OB unit.
C. The patient does not require magnesium sulfate.
D. Preterm labor is defined as regular uterine contractions and cervical changes
before the end of the 37th week of gestation. Many patients present with
preterm contractions, but only those who demonstrate changes in the cervix are
diagnosed with preterm labor. Because this patient has no demonstrated
cervical changes, she does not have the diagnosis. Also reassuring is the
infrequency of her contractions; a defining characteristic of preterm labor is
persistent uterine contractions (four every 20 minutes or eight per hour).
Another reassuring finding is the presence of V-shaped cervical funneling; a
change to U-shaped cervical funneling in a patient with a shortened cervix is
associated with preterm labor in high-risk women with a prior spontaneous
preterm birth.
3. The perinatal nurse is caring for a patient at 26 weeks’ gestation who has a history of
hypertension that has been well controlled. Today she presents with a blood pressure of
156/102 mm Hg, and she has 2+ protein on urine dipstick. Which initial action by the
nurse is most appropriate?
a. Arrange admission to the high-risk OB unit.
b. Instruct the patient on strict bedrest.
c. Obtain a clean-catch urine sample.
d. Prepare to administer IV antihypertensives.
ANS: C
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
, Pregnancy Objective: #3. Identify complications of pregnancy that require fetal and/or
maternal surveil- lance.
Page: 156
Heading: Pre-Eclampsia>Pathophysiology
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Pregnancy; Assessment; Critical Thinking
Difficulty: Difficult
Feedback
A. The patient does not need admission to the high-risk OB unit at this point.
B. The patient does not need strict bedrest at this point.
C. Pre-eclampsia can occur in a pregnant person who has chronic hypertension.
This patient has the characteristics of hypertension after a period of good
control and proteinuria of at least 2+ on dipstick (100 mg/dL). The nurse needs
to ensure protein levels are assessed in two samples at least 4 hours apart and
ensure the patient has no signs of a urinary tract infection, as protein can occur
in a sample of infected urine. The nurse should obtain a clean-catch urine
sample to send to the laboratory for analysis. Asymptomatic UTI can occur in
up to 11% of pregnant people, so assessing for signs and symptoms may not be
accurate.
D. The patient does not need IV antihypertensives at this point.
4. A 22-year-old patient presents to the emergency department with abdominal pain and
vaginal bleeding. Her blood pressure is 90/58 mm Hg, her pulse is 120 beats/minute, and
she complains of dizziness. Which action by the nurse takes priority?
a. Assess the patient for sexually transmitted infections.
b. Collect a urine sample for pregnancy testing.
c. Obtain informed consent for a salpingectomy.
d. Start two large-bore IVs for fluid replacement.
ANS: D
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
Pregnancy Objective: #3. Identify complications of pregnancy that require fetal and/or
maternal surveil- lance.
Page: 145
Heading: Ectopic Pregnancy
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Analysis [Analyzing]
Concept: Pregnancy; Assessment; Critical Thinking
Difficulty: Difficult
Feedback
, A. Assessing for sexually transmitted infections is not a priority.
B. Collecting a urine sample for pregnancy testing is not a priority.
C. The nurse may need to obtain informed consent for an operative procedure
once a definitive diagnosis is made, but this is not the priority.
D. This patient has both signs (hypotension, tachycardia) and symptoms
(complaints of dizziness) of acute volume loss. The priority is starting large-
bore IV lines for fluid resuscitation.
5. A patient in her second trimester of pregnancy presents to the perinatal clinic with
complaints of scant vaginal bleeding, abdominal pain, and shoulder pain. What action
should the nurse perform first?
a. Assess her for a history of preterm labor.
b. Obtain a blood sample for a b-hCG test.
c. Prepare the patient for a pelvic exam.
d. Request an order for methotrexate (Rheumatrex).
ANS: B
Chapter: Chapter 6 – Caring for the Woman Experiencing Complications During
Pregnancy Objective: #1. Plan nursing assessments and interventions for the woman
experiencing com- plications of pregnancy.
Page: 145
Heading: Ectopic Pregnancy
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Pregnancy; Assessment; Critical Thinking
Difficulty: Difficult
Feedback
A. Preterm labor is not a risk factor for this patient.
B. This patient is displaying symptoms of a possible ruptured ectopic pregnancy
(vaginal bleeding, abdominal pain, shoulder pain). Shoulder pain can occur
from nerve irritation due to the presence of blood in the pelvic cavity. A b-hCG
test finding will be lower than expected for the gestational age. To facilitate a
rapid diagnosis, the nurse should first obtain and send a blood sample for b-
hCG test.
C. The patient will most likely need a pelvic exam, but this is not the priority.
D. Methotrexate is used for uncomplicated, non-life-threatening ectopic
pregnancies. It would not be indicated in this patient because she has
manifestations of rupture.
6. A nurse is caring for a patient who has been diagnosed with an incomplete molar
pregnancy. Which action by the nurse is most appropriate?
a. Advise the patient that she can try to get pregnant in 3 months.
