Pregnancy Complications
A patient at 10 weeks gestation reports mild cramping and slight spotting. On examination, the nurse notes the cervix is closed and no tissue has been passed. How should the nurse document this type of miscarriage?
What is a threatened miscarriage?
mild cramping/ cervix closed/ no tissue passed
A patient receiving Magnesium Sulfate for preeclampsia has a respiratory rate of 10 breaths per minute, absent patellar reflexes, and urine output of 20 mL/hr. Which action should the nurse take first?
Stop the magnesium sulfate infusion
You may remember the antidote is calcium glucognate, but remember this is a priority question.
To enhance absorption, the nurse should instruct a woman with iron-deficiency anemia to take her iron supplement with?
Orange juice
-Vitamin C found in orange juice significantly increases the absorption of iron
A patient with a positive history of human papillomavirus (HPV) is at 35 weeks gestation. The nurse explains that the route of delivery will be determined based on which factor?
The presence of active lesions
-Route of delivery is influenced by the presence of lesions that might obstruct the birth canal or infect the infant.
The nurse is planning care for a pregnant adolescent. Which goal should be a priority for this specific vulnerable population?
Developing a plan for returning to school or job counseling
-The most important impact lies in the psychosocial area: it contributes to a loss of self-esteem, a destruction of life projects, and the maintenance of the circle of poverty
What clinical finding should the nurse prioritize as a sign of a ruptured ectopic pregnancy?
(Two options I have listed as correct answers)
B. Cullen’s sign and sharp pain unilaterally in lower abdomen
-Rupture causes internal bleeding that irritates the diaphragm, leading to sharp stabbing pain and bluish discoloration around the umbilicus indicating severe internal bleeding
During the first trimester of pregnancy, the nurse should expect a woman with pregestational diabetes to have which change in her insulin requirements?
Insulin need is reduced because of increased insulin production by pancreas and increased peripheral sensitivity to insulin; nausea, vomiting, and decreased food intake by mother and glucose transfer to embryo or fetus contribute to hypoglycemia
What is the first diagnostic step when assessing a woman for primary amenorrhea?
Performing a pregnancy test
-Pregnancy is the most common cause of missed menses and must be ruled out first before investigating other etiologies
Which laboratory tests are commonly used to determine the presence of antibodies in a high-risk client screened for HIV?
ELISA and Western blot
-The ELISA is the initial screening test, followed by the Western blot to confirm the diagnosis of HIV antibodies.
Which diagnostic screening is routinely recommended for an 'older woman' (age 35 or older) due to increased risks associated with advanced maternal age?
Amniocentesis and quadruple blood test screen
-These tests screen for chromosomal abnormalities and genetic disorders, which increase in frequency with maternal age.
A nurse is providing discharge instructions to a patient following the evacuation of a gestational trophoblastic disease (molar pregnancy). What would you instruct your client to do in regards to this diagnosis?
Avoid pregnancy for 1 year using contraception
-Pregnancy must be avoided to ensure that rising hCG levels are not misinterpreted, as molar pregnancies can lead to choriocarcinoma.
In preeclampsia, this widespread constriction of maternal blood vessels increases blood pressure and decreases blood flow to organs such as the kidneys, liver, and brain. What causes the multi-organ failure/ causes the hypertension?
Generalized vasospasm
-Preeclampsia → vasospasm → hypertension + decreased organ perfusion → organ damage
Which complication is an obese pregnant woman at a significantly higher risk for compared to a woman of normal weight?
Postpartum thromboembolism
-Obesity is a major risk factor for venous thromboembolic events, as well as hypertension and gestational diabetes.
The Venereal Disease Research Laboratory (VDRL) and Rapid Plasma Reagin (RPR) tests are screening tools for which condition?
Syphilis
-These serologic tests are standard pre-natal screens used to detect syphilis in all pregnant clients.
For a pregnant woman with an opioid addiction, which treatment approach is recommended to reduce fetal withdrawal symptoms and illicit drug use?
Oral methadone maintenance program
-Methadone provides a steady state that blocks euphoria and reduces cravings, making it safer for the fetus than abrupt withdrawal
-Naloxone can trigger acute withdrawal, which is hazardous to the fetus; maintenance is the preferred steady-state approach.
-Cold turkey withdrawal is dangerous to the fetus and lead to severe distress or death
The nurse is assessing a patient at 32 weeks gestation who presents with sudden, dark red vaginal bleeding and a rigid, board-like abdomen that is highly tender to touch. Which condition is the patient likely experiencing?
Placental abruption
-Abruption is characterized by dark bleeding, sudden sharp pain, and uterine rigidity due to concealed or overt hemorrhage.
A pregnant patient is suspected of having HELLP syndrome. Which laboratory findings would support this diagnosis?
Elevated Liver Enzymes, low platelet count
-The 'EL' in HELLP stands for Elevated Liver enzymes, resulting from hepatic blood flow obstruction and liver ischemia.
HELLP: Hemolysis Elevated Liver enzymes Low Platelets
LOW H&H, LOW platelet count, HIGH AST/ ALT
According to the functional classification system for heart disease, a patient who is comfortable at rest but experiences palpitations and dyspnea with 'less than ordinary' activity falls into which category?
Class III
-Class III involves a marked limitation of physical activity where even minor movement causes symptoms, although the patient is okay at rest
Class I: asymptomatic
Class II: dyspnea with ORDINARY activity
Class IV: dyspnea/ palpitations even while at rest
A pregnant client is exposed to a child diagnosed with Fifth disease (parvovirus B19). Which fetal complication is the nurse most concerned about?
Fetal anemia and hydrops fetalis
-Parvovirus B19 can cross the placenta and infect the fetus. Because it suppresses red blood cell production, the fetus can develop severe anemia, which may lead to hydrops fetalis and, in severe cases, fetal death
hydrops fetalis: serious, life-threatening condition where fluid builds up in at least 2 compartments of an unborn babyA newborn is exhibiting hypertonicity, a high-pitched cry, excessive sneezing, and poor sucking. The nurse recognizes these as classic signs of which condition?
Neonatal Abstinence Syndrome (NAS)
-These symptoms represent the central nervous system and gastrointestinal irritability common in infants withdrawing from drugs like opiates.
A patient with severe hyperemesis gravidarum is found to have positive ketonuria. The nurse understands that this finding is primarily due to which process?
Breakdown of fat and muscle because the body has depleted carbohydrates for fuel, which releases ketones into the urine. This can be highly toxic to fetal development
Chronic hypertension in pregnancy is defined as blood pressure exceeding 140/90 mmHg that is first identified at which point?
Before the 20th week
-Hypertension diagnosed before 20 weeks or before pregnancy is classified as chronic rather than gestational
A pregnant woman with Systemic Lupus Erythematosus (SLE) is taking Prednisone. The nurse should be particularly alert for which secondary effect of this medication?
Masking of signs of infection
-Corticosteroids like Prednisone suppress the inflammatory response, which can hide early signs of urinary or respiratory infections
A pregnant client at 20 weeks' gestation is diagnosed with bacterial vaginosis (BV) after reporting a thin, grayish-white vaginal discharge with a fishy odor. Which prescription should the nurse anticipate?
Metronidazole
-Symptomatic bacterial vaginosis should be treated during pregnancy. Metronidazole is a recommended treatment and is considered safe for use during pregnancy
When is the standard screening for Group B Streptococcus (GBS) performed during pregnancy?
At 35 to 37 weeks gestation
-All pregnant women are screened late in the third trimester because GBS can colonize the birth canal and infect the newborn.