NUR 402 Final Exam Review - High Risk Antepartum

The nurse is assessing all assigned patients and notes that one patient is at risk for preterm labor. Which of the following meets the criteria for preterm labor? 1. G2P0 at 35 0/7 weeks reporting four contractions in one hour 2. G6P5 at 37 5/7 weeks with cervical dilation of 3 cm 3. G1P0 at 32 3/7 weeks with regular contractions and a change in cervical dilation 4. G3P2 at 28 0/7 weeks complaining of increased vaginal discharge and low back ache - 3 A woman in preterm labor has an order for nifedipine (Procardia). Which assessment finding should alert the nurse to withhold the medication? 1. Fetal heart rate (FHR) 155 beats per minute 2. Breath sounds clear to auscultation 3. The patient reports nausea 4. Blood pressure 88/50 mm Hg - 4 Calcium channel blockers may cause maternal hypotension and should not be given if already hypotensive The nurse is teaching a patient with preterm contractions about a fetal fibronectin (fFN) test that was ordered. Which statement indicates that the patient requires further education? 1. This test will help predict if I will not deliver preterm. 2. I need to give a blood sample for this test. 3. This test is collected from my vagina. 4. This test can't predict for sure if I will deliver preterm. - 2 This test is collected from vaginal fluid The nurse is caring for a woman with preterm premature rupture of membranes, not in active labor. Which of the following nursing actions would be included in the plan of care for this patient? Select all that apply. 1. Digital vaginal exams every four hours 2. Assess for signs of infection 3. Assess fetal heart rate with internal fetal scalp electrode 4. Report maternal fever to provider 5. Placement of a Foley catheter - 2, 4 Vaginal exams and internal monitors should be avoided to prevent infection, patient should be on bedrest and uses a bedside commode or bed pan A patient has just had a cerclage procedure for cervical insufficiency. which anticipatory guidance should the nurse provide prior to discharge? 1. "A cesarean delivery will be necessary for your birth, due to the cerclage." 2. "The stitch in your cervix should be removed if you go into labor." 3. "The stitch in your cervix should be removed no later than 20 weeks' gestation." 4. "The cerclage will prevent you from delivering a preterm baby." - 2 A cerclage is removed at 36 to 37 weeks or when labor ensues to prevent cervical tearing The nurse is providing prenatal education to patient expecting twins. Which statement by the patient indicates the need for further teaching? 1. "My babies might be born too early." 2. "If my babies are both girls, they must be identical twins." 3. "I need to eat well because I'm at risk for anemia." 4. "I might have pregnancy complications." - 2 Fraternal can be either same or different genders A patient experiencing hyperemesis gravidarum has just been admitted with vomiting and severe dehydration. Which of the following orders would be carried out first by the nurse? 1. Weigh the patient. 2. Administer an oral prenatal vitamin. 3. Provide intravenous hydration. 4. Assist the patient with oral hygiene. - 3 Correcting fluid balance is the highest priority A patient with hyperemesis gravidarum says to the nurse, "I am so worried that all this vomiting will cause me to miscarry my baby." Which is the appropriate therapeutic response from the nurse? 1. "Tell me what makes you concerned about this." 2. "As long as you don't lose more than 5% of your weight, you will probably have a normal pregnancy." 3. "It is estimated that around 25% of all pregnancies end in miscarriage." 4. "I will do everything I can to try to prevent that from happening." - 1 Therapeutic communication The nurse is assessing a patient who at 32 weeks gestation is being evaluated for intrahepatic cholestasis of pregnancy. Which laboratory findings would be most indicative of this diagnosis? 1. Decreased bilirubin level 2. Elevated bile acids 3. Decreased platelets 4. Proteinuria - 2 Increased bilirubin and bible acids The nurse is monitoring a patient who is receiving magnesium sulfate for preeclampsia. Which assessment findings might indicate magnesium toxicity? Select all that apply. 1. Deep Tendon Reflex (DTR) +4 2. Respiratory rate 10 breaths/minute 3. Urine output 15 mL/hour 4. Patient reports nausea 5. Patient reports feeling flushed - 2,3 Diminished or absent DTR might indicate toxicity, nausea and feeling flushed are expected side effects A patient receiving magnesium sulfate for preeclampsia is found to be unresponsive with a respiratory rate of 8 breaths/minute. Which nursing action is the highest priority? 1. Notify the provider. 2. Prepare to administer calcium gluconate. 3. Discontinue the magnesium sulfate infusion. 4. Administer oxygen via face mask. - 3 Prevent further increase A postpartum woman is suspected of having HELLP syndrome. Which laboratory finding would support this diagnosis? 1. Decreased liver enzymes 2. Thrombocytopenia 3. Decreased bilirubin 4. Elevated white blood count (WBC) - 2 The nurse is caring for a patient with placenta previa. Which would be included in the plan of care? Select all that apply. 1. Promptly report any increase in vaginal bleeding. 2. Assess fetal heart rate continuously with fetal scalp electrode. 3. Limit vaginal exams to once a shift. 4. Establish and maintain intravenous (IV) access. 5. Ensure the availability of blood products. - 1,4,5 Internal exams and monitoring is contraindicated There are four women admitted to the labor and delivery unit. Which patient is at highest risk of placental abruption? 1. G1P0 at 41 weeks with labor induction 2. G4P1 at 28 weeks in preterm labor 3. G2P0 at 40 weeks with gestational diabetes 4. G3P2 at 39 weeks with history of prior cesarean deliveries and a smoker - 4 A gravid woman at 34 weeks gestation presents to labor and delivery after a motor vehicle accident. She is admitted for suspected abruption. Which assessment findings are consistent with placental abruption? Select all that apply. 1. Uterus is tense and firm to palpation between contractions 2. Painless vaginal bleeding 3. Hypertension 4. Abdominal pain 5. Pale and moist skin - 1,4,5 abruption causes hypertonus of the uterus, hypotension due to hemorrhage and shock A gravid patient just had an ultrasound, which showed a placenta accreta. Which is the best explanation by the nurse? 1. "Your placenta has partially separated from the wall of the uterus." 2. "Your placenta is covering your cervix." 3. "Your placenta has invaded the uterine wall." 4. "Your placenta has grown through the uterine wall and attached to other organs." - 3 The nurse is teaching a childbirth preparation class about pregnancy complications after cesarean (c-section) births. Which pregnancy complications can result from prior cesarean births? Select all that apply. 1. Preeclampsia 2. Placenta previa 3. Placenta accreta 4. Placenta abruption 5. Hyperemesis gravidarum - 2,3,4 All due to prior uterine scar The nurse is caring for a woman who had a spontaneous abortion. Which of the following statements made by the nurse is most appropriate after early pregnancy loss? 1. "Most miscarriages occur because there is something wrong with the baby." 2. "You can try to get pregnant again." 3. "This is probably a difficult time for you. Would you like to talk about it?" 4. "I know how sad you must feel. I miscarried once." - 3 A gravid patient at 8 weeks gestation presents to the emergency department reporting unilateral sharp lower abdominal pain, shoulder pain, and light vaginal bleeding. The nurse knows these signs and symptoms are associated with which pregnancy complication? 1. Ectopic pregnancy 2. Hydatidiform mole 3. Spontaneous abortion 4. Therapeutic abortion - 1 The nurse is providing anticipatory guidance to a patient who has had surgery to evacuate a molar pregnancy. Which statement from the patient indicates teaching has been effective? 1. "I can try to get pregnant again as soon as I have a period." 2. "If I get pregnant again, I won't be at a higher risk of this happening." 3. "If my human chorionic gonadotropin (hCG) levels rise, I'll know I'm getting better." 4. "I am at an increased risk of cancer." - 4 Molar pregnancy can develop into choriocarcinoma A gravid woman who is HIV seropositive asks how her Human Immunodeficiency Virus (HIV) will affect the baby. Which is the best response by the nurse? 1. "The baby will be born with HIV." 2. "The risk of transmission to the fetus decreases if you continue taking your antiretroviral medications." 3. "Since you do not have Acquired Immunodeficiency Syndrome (AIDS) yet, the baby is not at risk." 4. "Breastfeeding your baby will help decrease the risk of transmission." - 2 A patient who is positive for Human Immunodeficiency Virus (HIV) is in active labor. Which would be included in the nursing plan of care? Select all that apply. 1. Early amniotomy to augment labor 2. Fetal heart rate monitoring with fetal scalp electrode 3. Maintain strict isolation precautions 4. Provide emotional support 5. External fetal heart rate monitoring - 4,5 A gravid patient at 30 weeks gestation has a urinary tract infection (UTI), and the clinic nurse is teaching her about UTIs in pregnancy. Which statement made by the patient indicates the teaching was effective? 1. "I should call my doctor if I begin to have regular contractions." 2. "I should take the antibiotics until the pain is gone." 3. "The baby might get the infection." 4. "I might pass the stone when I urinate." - 1 A gravid woman in her third trimester is admitted following blunt force trauma to her abdomen. Which lab test does the nurse anticipate being ordered? 1. Fetal fibronectin test 2. Group B Strep culture 3. Kleihauer-Betke test 4. Urine culture - 3 Detects fetal blood in maternal circulation A gravid patient is experiencing pregnancy complications and the nurse is constructing a plan of care. Which are examples of patient-centered pregnancy care? Select all that apply. 1. Elicit the patient's values and preferences. 2. Recognize the patient may be emotionally and spiritually vulnerable. 3. Recommend treatments to the patient which are based on the latest research. 4. Make decisions for the patient, as she does not have the expertise. 5. Encourage the patient's family to be active participants in the care process. - 1,2,5 The nurse is caring for a patient with congenital heart disease who is beginning her prenatal care. Which normal cardiac changes during pregnancy can exacerbate cardiac disease during pregnancy? Select all that apply. 1. Increase in total blood volume from 30 to 50% 2. Decrease in heart rate by 10 to 20 beats per minute 3. The weight of the gravid uterus can lie on the inferior vena cava 4. Increased peripheral vascular resistance 5. Increased cardiac output - 1,3,5 The nurse is caring for a gravid patient with iron-deficiency anemia. Which assessment findings are associated with this diagnosis? Select all that apply. 1. Pallor 2. Fatigue 3. Rales heard on auscultation 4. Hemoglobin below 10 to 11 g/dL 5. Bruising easily - 1,2,4 A pregnant patient at 30 weeks gestation with asthma is scheduled for serial sonograms. which is the primary reason for the serial sonograms? 1. To determine the sex of the fetus 2. To measure the lung capacity of the fetus 3. To monitor the growth of the fetus 4. To confirm there are no birth defects due to the asthma medications - 3 A gravid patient with severe asthma asks the nurse if she should stop taking her asthma medications because she is worried they may harm her fetus. Which response by the nurse is most appropriate? 1. "Medications commonly used for asthma management are considered safe during pregnancy. Let's talk with your provider about them." 2. "You should take your bronchodilators, but do not take any steroid medications while pregnant." 3. "If you can't breathe, the baby can't breathe, so you should take the medicine." 4. "There is really no medication that is safe during pregnancy." - 1 The nurse is caring for a gravid patient with cholelithiasis in acute pain. Which is the most likely medical treatment for acute cholelithiasis? 1. Bed rest and fluids 2. Laparoscopic cholecystectomy 3. Cesarean delivery 4. Lithotripsy - 2 A patient who is obese is planning a pregnancy and asks the clinic nurse what the risks are if she were to get pregnant now. Which pregnancy complications are related to obesity? Select all that apply. 1. Preeclampsia 2. Gestational diabetes 3. Congenital anomalies 4. Cystic fibrosis of the newborn 5. Sickle cell trait of the newborn - 1,2,3 A gravid patient is being evaluated for a thyroid disorder. Assessment findings are fatigue, cold intolerance, dry skin, and an abnormally high TSH level. The nurse knows these findings are consistent with which of the following? 1. Hyperthyroidism 2. Hypothyroidism 3. Systemic lupus erythematosus 4. Polycystic ovarian syndrome (PCOS) - 2 The nurse is teaching a gravid patient in her second trimester about smoking during pregnancy. Which statements would be included? Select all that apply. 1. "Since fetal development is most important during the first 8 weeks, it won't really do any good to quit smoking now." 2. "Each time you smoke, there is less oxygen to the baby. So, any amount of smoking you can reduce will be better for the baby." 3. "Smoking increases your risk of a preterm delivery and a low birth weight baby." 4. "Smoking increases your risk of placenta problems, such as placenta previa and placental abruption." 5. "Once the baby is born you can resume smoking." - 2,3,4 The nurse is teaching a prenatal class. A patient asks, "Isn't it OK to have an occasional glass of wine during pregnancy?" Which is the best response by the nurse? 1. "If you limit it to one glass of wine, it is probably OK." 2. "If you wait until after your first trimester, you can have an occasional drink." 3. "Since we don't know what the safe limit is, it is best not to consume any alcohol at all while pregnant." 4. "Fetal alcohol spectrum disorder (FASD) occurs from binge drinking." - 3 The nurse is teaching a group of high-risk antepartum patients about the effects of substance abuse on pregnancy. Which substance does the nurse discuss as having the highest risk for causing placental abruption? 1. Marijuana 2. Opioids 3. Alcohol 4. Cocaine - 4 Cocaine is a powerful vasoconstrictor The nurse is advocating for policy change to improve services to pregnant women using substances. Which statements would the nurse include? Select all that apply. 1. Women are more receptive to treatment and lifestyle changes during pregnancy. 2. The consequences of drug use during pregnancy comes as a substantial cost to society. 3. Women who fail to seek treatment should be subject to criminal prosecution. 4. Substance abuse treatment programs designed for pregnant women can improve recovery, pregnancy outcomes, and parenting skills. 5. Mandatory drug testing during pregnancy would improve perinatal outcomes. - 1,2,4 The nurse is caring for several gravid patients on the antepartum unit. Which patient would the nurse see first? 1. G1P0 at 12 weeks gestation with hyperemesis gravidarum who is receiving IV fluids 2. G3P2 at 30 weeks gestation with sudden onset dyspnea, tachypnea, tachycardia, and anxiety 3. G3P1 at 26 weeks gestation admitted for premature rupture of membranes 4. G4P0 at 33 weeks gestation with placenta previa, not actively bleeding - 2 PE A gravid patient with preeclampsia is due for an assessment. Which correctly describes how to assess deep tendon reflexes (DTRs)? 1. Asking the patient to dorsiflex the foot against the nurse's hand and then releasing it suddenly 2. Striking the tendon of a partially stretched muscle briskly with a reflex hammer 3. Shining a light in the patient's eye, and noting the constriction of the pupil 4. Stimulating the sole of the foot with a blunt instrument - 2 The nurse is caring for a gravid woman with preeclampsia. Which finding would indicate worsening condition and should be reported to the physician? 1. Proteinuria 2. Platelet count 120,000/mm3 3. Blood pressure 158/98 mmHg 4. Increased respiratory rate and report of shortness of breath - 4 Signs of pulomnary edema The nurse is providing anticipatory guidance to a gravid patient with cardiomyopathy. Which assessment finding by the nurse indicates deteriorating cardiac function? 1. Shortness of breath while climbing stairs 2. Feeling tired at the end of the day 3. Edema in ankles that improves when putting feet up 4. Syncope during or after exertion - 4 The nurse is educating a group of pregnant women on anemia in pregnancy. Which statement correctly describes the difference between physiological anemia and iron-deficiency anemia? 1. An increase in blood volume larger than the increase in RBCs results in irondeficiency anemia. 2. Anemia is present if the hemoglobin level drops below 13 g/dL. 3. Physiological anemia of pregnancy should be treated with additional iron supplementation. 4. A diet low in iron content and insufficient iron stores results in iron-deficiency anemia. - 2 The nurse is teaching a group of pregnant women about the risks of venous thromboembolism (VTE). Which statements would the nurse include in the education? Select all that apply. 1. All pregnant women are at an increased risk because pregnancy is a state of hypercoagulability. 2. Women should report any abrupt unilateral leg pain right away. 3. Heparin is not considered safe during pregnancy, so it should be avoided. 4. Pregnant women should avoid sitting for long periods of time to avoid venous stasis in the lower extremities. 5. A prior history of having a blood clot is not significant and does not put a patient at higher risk during pregnancy. - 1,2,4 A woman with Type I diabetes presents for her first prenatal appointment. Which anticipatory guidance would the nurse provide this patient? 1. "Insulin needs will most likely decrease over the course of the pregnancy." 2. "The risk of diabetic ketoacidosis (DKA) is highest in the first trimester." 3. "Watch for signs and symptoms of preterm labor." 4. "If your fasting blood glucose is under 95, you don't need to check it again." - 3 Diabetes increases the risk for preterm labor The nurse is caring for a patient at risk for preterm labor. Which are risk factors for preterm labor? Select all that apply. 1. Multiple gestation 2. History of preterm birth 3. Maternal smoking 4. Maternal age of 18 to 25 5. Decreased fetal movement - 1,2,3