Pregnancy Math & Language
A currently pregnant patient previously delivered twins at 35 weeks, delivered one child at 39 weeks, and experienced a pregnancy loss at 10 weeks. All three children are living. Identify the patient’s GTPAL.
What is G4 T1 P1 A1 L3?
Rationale
The current pregnancy makes four total pregnancies. The singleton was term, the twin pregnancy was one preterm delivery, the loss occurred before 20 weeks, and there are three living children.
A patient at 10 weeks reports mild morning nausea but is able to eat small meals and retain fluids. Classify this finding.
What is an expected pregnancy discomfort?
Rationale
Mild nausea is common during early pregnancy. Persistent vomiting, weight loss, dehydration, or inability to retain fluids would be concerning.
A patient states, “My cell-free DNA result is abnormal, so my baby definitely has a chromosome disorder.” Give the nurse’s best response.
What is, “This is a screening result that estimates risk; diagnostic testing would be needed for more definitive information”?
Rationale
Screening identifies increased risk but does not establish a diagnosis. The patient may be offered genetic counseling and diagnostic testing.
A patient at 35 weeks reports a severe headache, blurred vision, and right upper-quadrant pain. Identify the complication the nurse should suspect.
What is preeclampsia with severe features?
Rationale
Neurologic symptoms and right upper-quadrant or epigastric pain indicate possible severe end-organ involvement and require immediate evaluation.
This is the primary purpose of magnesium sulfate for a patient with severe preeclampsia.
What is seizure prevention?
Rationale
Magnesium sulfate is an anticonvulsant used to prevent or treat eclamptic seizures. It is not the primary medication for treating hypertension.
The nurse is preparing to screen a pregnant patient for intimate partner violence. Identify the appropriate setting.
What is privately, without the partner or family present?
Rationale
Private, respectful, and nonjudgmental screening improves safety and allows the patient to respond confidentially.
A patient’s last menstrual period began November 9. Using Naegele’s rule, identify the estimated date of delivery.
What is August 16 of the following year?
Rationale
Subtract three months from November 9 to obtain August 9, add seven days to obtain August 16, and add one year.
A patient at 30 weeks becomes pale, dizzy, and nauseated while lying flat during an ultrasound. Identify the nurse’s first action.
What is reposition the patient to the left side?
Rationale
The gravid uterus may compress the vena cava when the patient is supine, reducing venous return and cardiac output. Lateral positioning relieves the compression.
At 32 weeks, the fetal heart rate has two accelerations that rise 15 beats/minute above baseline and last 15 seconds within 20 minutes. Interpret this nonstress test.
What is a reactive and reassuring NST?
Rationale
At 32 weeks or later, at least two 15-by-15 accelerations within approximately 20 minutes generally meet reactive criteria.
A pregnant patient has hemolysis, an elevated AST level, and a platelet count of 72,000/mm³. Identify the syndrome
What is HELLP syndrome?
Rationale
HELLP stands for hemolysis, elevated liver enzymes, and low platelets. It is a serious hypertensive complication of pregnancy.
A patient receiving magnesium sulfate has a respiratory rate of 9 breaths/minute, absent patellar reflexes, and urine output of 20 mL/hour. Identify the nurse’s first action.
What is stop the magnesium sulfate infusion?
Rationale
Respiratory depression, absent reflexes, and decreased urine output suggest magnesium toxicity. The infusion must be stopped immediately.
A patient at 33 weeks reports pelvic pressure, menstrual-like cramping, constant low back pain, and increased vaginal discharge. Identify the nurse’s priority concern.
What is preterm labor?
Rationale
Pelvic pressure, cramping, back pain, discharge changes, and contractions before 37 weeks require assessment for preterm labor and cervical change.
A pregnant patient reports nausea, breast tenderness, urinary frequency, and feeling fetal movement. The nurse explains that all these findings belong to this category of pregnancy signs.
What are presumptive signs of pregnancy?
Rationale
Presumptive signs are experienced or reported by the patient. They suggest pregnancy but do not confirm the presence of a fetus.
A patient at 31 weeks reports irregular contractions after a busy day. The contractions resolve with hydration and rest, and there is no fluid leakage. Identify the likely cause.
What are Braxton Hicks contractions?
Rationale
Braxton Hicks contractions are typically irregular and do not cause progressive cervical change. Regular contractions, pelvic pressure, bleeding, or fluid leakage require evaluation for preterm labor.
A 32-week fetus has a nonreactive NST. The fetal heart rate baseline and variability are otherwise acceptable. The nurse should understand this about the result.
What is the fetus requires additional evaluation, but fetal distress is not automatically confirmed?
Rationale
Fetal sleep, medications, prematurity, or compromise can produce a nonreactive NST. The test may be extended or followed by a BPP or modified BPP.
A patient at 8 weeks reports unilateral pelvic pain, light vaginal bleeding, shoulder pain, and dizziness. Identify the priority hypothesis.
What is a ruptured ectopic pregnancy?
Rationale
Shoulder pain, dizziness, weakness, or syncope can indicate intra-abdominal bleeding from ectopic rupture.
his medication should be readily available when a patient receives magnesium sulfate.
What is calcium gluconate?
Rationale
Calcium gluconate is the antidote used to reverse serious magnesium sulfate toxicity.
A patient presents with painless bright-red bleeding and a soft, nontender uterus. Identify the action the nurse must avoid.
What is a digital vaginal examination?
Rationale
These findings suggest placenta previa. A digital examination could disrupt the placenta and cause severe hemorrhage before placental location is confirmed.
At 28 weeks, a patient’s fundal height measures 23 cm. The nurse should take this action.
What is report the discrepancy and anticipate additional evaluation?
Rationale
Between approximately 20 and 36 weeks, fundal height in centimeters generally approximates gestational age in weeks. A 5-cm discrepancy warrants evaluation for incorrect dates, altered fetal growth, multiple gestation, or abnormal amniotic fluid.
A patient at 28 weeks reports unilateral calf warmth, swelling, and pain. State the priority nursing response.
What is limit ambulation and arrange immediate evaluation for a possible deep vein thrombosis?
Rationale
Unilateral warmth, swelling, and pain may indicate thrombosis. The leg should not be massaged, and the patient requires prompt evaluation.
A biophysical profile is scored 6 out of 10, and the amniotic fluid volume is decreased. Identify the priority interpretation.
What is a concerning result requiring prompt provider notification and further evaluation?
Rationale
A score of 6 is equivocal, and reduced amniotic fluid remains concerning even when other components are reassuring.
A patient at 36 weeks has sudden abdominal pain, a firm boardlike uterus, fetal heart-rate abnormalities, and only a small amount of visible bleeding. Identify the most likely condition.
What is placental abruption with possible concealed hemorrhage?
Rationale
Abruption is generally painful and may produce a firm or boardlike uterus. Blood can remain concealed behind the placenta.
An unsensitized Rh-negative patient experiences abdominal trauma at 26 weeks. The nurse should anticipate administration of this medication.
What is Rho(D) immune globulin?
Rationale
Abdominal trauma can cause fetomaternal blood exposure. Rho(D) immune globulin prevents antibody formation in an unsensitized Rh-negative patient.
Four patients require attention. Select the patient the nurse should assess first:
A. A patient at 10 weeks with mild nausea who can drink fluids
B. A patient at 28 weeks requesting fetal-movement teaching
C. A patient at 34 weeks with blurred vision and epigastric pain
D. A patient at 24 weeks with uncomplicated urinary frequency
What is Patient C?
Rationale
Blurred vision and epigastric pain are severe preeclampsia cues and indicate possible neurologic and hepatic involvement.
Laboratory results show a mildly decreased hematocrit during pregnancy despite adequate iron intake. Explain the physiological cause.
What is plasma volume increasing more than red blood cell mass?
Rationale
The disproportionate increase in plasma volume produces hemodilution, sometimes called physiological or dilutional anemia of pregnancy.
A patient at 32 weeks reports persistent vomiting, a 7-pound weight loss, dizziness, and inability to retain fluids. Urinalysis reveals ketones. Identify the most likely condition.
What is hyperemesis gravidarum?
Rationale
Persistent vomiting accompanied by dehydration, weight loss, ketonuria, and electrolyte abnormalities is not routine morning sickness.
After an amniocentesis, an unsensitized Rh-negative patient has a reassuring fetal heart rate. Identify one additional medication the nurse should anticipate.
What is Rho(D) immune globulin?
Rationale
Amniocentesis can expose an Rh-negative patient to fetal Rh-positive blood. Rho(D) immune globulin helps prevent maternal sensitization.
A patient with PPROM develops a temperature of 38.5°C, uterine tenderness, foul-smelling fluid, and fetal tachycardia. State the priority concern.
What is an intra-amniotic infection requiring immediate evaluation and treatment?
Rationale
Fever, uterine tenderness, fetal tachycardia, and foul-smelling fluid are major infection cues. Maternal sepsis and fetal compromise can develop.
A patient receiving magnesium sulfate continues to have a blood pressure of 172/114 mm Hg. The fetal tracing is currently reassuring. Identify the most appropriate interpretation and anticipated action.
What is magnesium sulfate does not treat the severe hypertension, so prescribed rapid-acting antihypertensive therapy and immediate provider management are required?
Rationale
Magnesium prevents seizures. Persistent severe-range blood pressure places the patient at risk for stroke and requires prompt antihypertensive treatment.
A patient at 35 weeks has a blood pressure of 168/112 mm Hg, hyperreflexia, severe headache, decreased urine output, and decreased fetal movement. Name four immediate nursing actions.
What are place the patient laterally, initiate seizure precautions, reduce stimulation, assess maternal and fetal status, establish IV access, notify the obstetric provider, and anticipate prescribed treatment?
Rationale
The findings indicate preeclampsia with severe features. Immediate maternal stabilization, seizure prevention, fetal assessment, and escalation are required.