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Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank

Chapter 10: Complications of Pregnancy Foundations of Maternal-Newborn & Women’s Health Nursing, 7th Edition MULTIPLE CHOICE 1. A patient with preeclampsia is being treated with bed rest and intravenous magnesium sulfate.

The drug classification of this medication is a a. diuretic. b. tocolytic. c. anticonvulsant. d. antihypertensive. ANS: C

Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. Diuresis is a therapeutic response to magnesium sulfate. A tocolytic drug slows the frequency and intensity of uterine contractions but is not used for that purpose in this scenario. Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 2. Which clinical intervention is the only known cure for preeclampsia? a. Magnesium sulfate b. Delivery of the fetus c. Antihypertensive medications d. Administration of aspirin (ASA) every day of the pregnancy ANS: B

Delivery of the infant is the only known intervention to halt the progression of preeclampsia. Magnesium sulfate is one of the medications used to treat but not cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of aspirin (81 mg/day) have been administered to women at high risk for developing preeclampsia. This intervention appears to have little benefit. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 3. The clinic nurse is performing a prenatal assessment on a pregnant patient at risk for

preeclampsia. Which clinical sign would not present as a symptom of preeclampsia? a. Edema b. Proteinuria c. Glucosuria d. Hypertension ANS: C

Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank Glucose into the urine is not one of the three classic symptoms of preeclampsia. The first sign noted by the pregnant patient is rapid weight gain and edema of the hands and face. Proteinuria usually develops later than the edema and hypertension. The first indication of preeclampsia is usually an increase in the maternal blood pressure. DIF: Cognitive Level: Application OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 4. Which intrapartal assessment should be avoided when caring for a patient with HELLP

syndrome? a. Abdominal palpation b. Venous sample of blood c. Checking deep tendon reflexes d. Auscultation of the heart and lungs ANS: A

Palpation of the abdomen and liver could result in a sudden increase in intraabdominal pressure, leading to rupture of the subcapsular hematoma. Assessment of heart and lungs is performed on every patient. Checking reflexes is not contraindicated. Venous blood is checked frequently to observe for thrombocytopenia. DIF: Cognitive Level: Application OBJ: Nursing Process Step: Implementation MSC: Patient Needs: Physiologic Integrity 5. A nurse is explaining to the nursing students working on the antepartum unit how to assess for

edema. Which edema assessment score indicates edema of the lower extremities, face, hands, and sacral area? a. +1 b. +2 c. +3 d. +4 ANS: C

Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is +2 edema. Generalized massive edema (+4) includes the accumulation of fluid in the peritoneal cavity. DIF: Cognitive Level: Application OBJ: Nursing Process Step: Implementation MSC: Patient Needs: Physiologic Integrity 6. Which maternal condition always necessitates delivery by cesarean birth? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia ANS: B

Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal birth occurred. If the patient has stable vital signs and the fetus is alive, a vaginal birth can be attempted. If the fetus has already expired, a vaginal birth is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 7. Spontaneous termination of a pregnancy is considered to be an abortion if a. the pregnancy is less than 20 weeks. b. the fetus weighs less than 1000 g. c. the products of conception are passed intact. d. there is no evidence of intrauterine infection. ANS: A

An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of the fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Health Promotion and Maintenance 8. An abortion when the fetus dies but is retained in the uterus is called a. inevitable. b. missed. c. incomplete. d. threatened. ANS: B

A missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all the products of conception were expelled. With a threatened abortion, the patient has cramping and bleeding but not cervical dilation. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 9. A placenta previa when the placental edge just reaches the internal os is called a. total. b. partial. c. low-lying. d. marginal. ANS: D

A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa, the placenta completely covers the os. With a partial previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os. DIF: Cognitive Level: Understanding

OBJ: Nursing Process Step: Assessment

Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank MSC: Patient Needs: Physiologic Integrity 10. Which finding would indicate concealed hemorrhage in abruptio placentae? a. Bradycardia b. Hard boardlike abdomen c. Decrease in fundal height d. Decrease in abdominal pain ANS: B

Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. The patient will have shock symptoms that include tachycardia. The fundal height will increase as bleeding occurs. Abdominal pain may increase significantly. DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 11. The priority nursing intervention when admitting a pregnant patient who has experienced a

bleeding episode in late pregnancy is to a. monitor uterine contractions. b. assess fetal heart rate and maternal vital signs. c. place clean disposable pads to collect any drainage. d. perform a venipuncture for hemoglobin and hematocrit levels. ANS: B

Assessment of the fetal heart rate (FHR) and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the patient and fetus. Monitoring uterine contractions is important; however, not the top priority. It is important to assess future bleeding, but the top priority is patient and fetal well-being. The most important assessment is to check patient and fetal well-being. The blood levels can be obtained later. DIF: Cognitive Level: Application 12. A patient with preeclampsia is admitted complaining of pounding headache, visual changes,

and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. gastrointestinal upset. b. effects of magnesium sulfate. c. anxiety caused by hospitalization. d. worsening disease and impending convulsion. ANS: D

Headache and visual disturbances are caused by increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. Gastrointestinal upset is not an indication as severe as the headache and visual disturbance. She has not yet been started on magnesium sulfate as a treatment. The signs and symptoms do not describe anxiety. DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Evaluation MSC: Patient Needs: Physiologic Integrity 13. Rh incompatibility can occur if the patient is Rh-negative and the

Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank a. b. c. d.

fetus is Rh-negative. fetus is Rh-positive. father is Rh-positive. father and fetus are both Rh-negative.

ANS: B

For Rh incompatibility to occur, the mother must be Rh-negative and her fetus Rh-positive. If the fetus is Rh-negative, the blood types are compatible and no problems should occur. The father’s Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh-negative, the blood type with the mother is compatible. The father’s blood type does not enter into the problem. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 14. In which situation would a dilation and curettage (D&C) be indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks ANS: D

D&C is carried out to remove the products of conception from the uterus and can be performed safely until week 14 of gestation. If all the products of conception have been passed (complete abortion), a D&C is not necessary. If the pregnancy is still viable (threatened abortion), a D&C is not indicated. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 15. Which data found on a patient’s health history would place her at risk for an ectopic

pregnancy? a. Ovarian cyst 2 years ago b. Recurrent pelvic infections c. Use of oral contraceptives for 5 years d. Heavy menstrual flow of 4 days’ duration ANS: B

Infection and subsequent scarring of the fallopian tubes prevent normal movement of the fertilized ovum into the uterus for implantation. Ovarian cysts do not cause scarring of the fallopian tubes. Oral contraceptives do not increase the risk for ectopic pregnancies. Heavy menstrual flow of 4 days’ duration will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 16. Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Blood pressure of 120/80 mm Hg b. Complaint of frequent mild nausea c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day weeks ago

Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank ANS: C

The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. A patient with a molar pregnancy may have early-onset, pregnancy-induced hypertension. Nausea increases in a molar pregnancy because of the increased production of human chorionic gonadotropin (hCG). The history of bleeding is normally described as being of a brownish color. DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Health Promotion and Maintenance 17. Which routine nursing assessment is contraindicated for a patient admitted with suspected

placenta previa? Determining cervical dilation and effacement Monitoring FHR and maternal vital signs Observing vaginal bleeding or leakage of amniotic fluid Determining frequency, duration, and intensity of contractions

a. b. c. d.

ANS: A

Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this patient. Monitoring for bleeding and rupture of membranes is not contraindicated with this patient. Monitoring contractions is not contraindicated with this patient. DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 18. A laboratory finding indicative of DIC is one that shows a. decreased fibrinogen. b. increased platelets. c. increased hematocrit. d. decreased thromboplastin time. ANS: A

DIC develops when the blood-clotting factor thromboplastin is released into the maternal bloodstream as a result of placental bleeding. Thromboplastin activates widespread clotting, which uses the available fibrinogen, resulting in a decreased fibrinogen level. The platelet count will decrease. The hematocrit may decrease if bleeding is pronounced. The thromboplastin time is prolonged. DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 19. Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate

would indicate a therapeutic level of medication? a. Drowsiness b. Urinary output of 20 mL/hour c. Normal deep tendon reflexes d. Respiratory rate of 10 to 12 breaths per minute ANS: C

Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank Magnesium sulfate is administered for preeclampsia to reduce the risk of seizures from cerebral irritability. Hyperreflexia (deep tendon reflexes above normal) is a symptom of cerebral irritability. If the dosage of magnesium sulfate is effective, reflexes should decrease to normal or slightly below normal levels. Drowsiness is another sign of CNS depression from magnesium toxicity. A urinary output of 20 mL/hour is inadequate output. A respiratory rate of 10 to 12 breaths per minute is too slow and could be indicative of magnesium toxicity. DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 20. A patient taking magnesium sulfate has a respiratory rate of 10 breaths per minute. In addition

to discontinuing the medication, which action should the nurse take? Increase the patient’s IV fluids. Administer calcium gluconate. Vigorously stimulate the patient. Instruct the patient to take deep breaths.

a. b. c. d.

ANS: B

Calcium gluconate reverses the effects of magnesium sulfate. Increasing the patient’s IV fluids will not reverse the effects of the medication. Stimulation will not increase the respirations. Deep breaths will not be successful in reversing the effects of the magnesium sulfate. DIF: Cognitive Level: Application OBJ: Nursing Process Step: Implementation MSC: Patient Needs: Physiologic Integrity 21. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is

based on which of the following? Hemorrhage is the primary concern. She will be unable to conceive in the future. Bed rest and analgesics are the recommended treatment. A D&C will be performed to remove the products of conception.

a. b. c. d.

ANS: A

Severe bleeding occurs if the fallopian tube ruptures. If the tube must be removed, the patient’s fertility will decrease; however, she will be able to achieve a future pregnancy. The recommended treatment is to remove the pregnancy before hemorrhage occurs. A D&C is done on the inside of the uterine cavity. The ectopic is located within the tubes. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Planning MSC: Patient Needs: Physiologic Integrity 22. A patient who was pregnant had a spontaneous abortion at approximately 4 weeks’ gestation.

At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the patient presents at the clinic office complaining of “crampy” abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/minute (bpm), and respirations, 20 breaths per minute. Based on this assessment data, what does the nurse anticipate as a clinical diagnosis? a. Ectopic pregnancy b. Uterine infection

Foundations of Maternal-Newborn and Women's Health Nursing 7th Edition Murray Test Bank c. Gestational trophoblastic disease d. Endometriosis ANS: B

The patient is exhibiting signs of uterine infection, with elevated temperature, vaginal discharge with odor, abdominal pain, and blood pressure and pulse manifesting as shock-trended vitals. Because the pregnancy test is negative, an undiagnosed ectopic pregnancy and gestational trophoblastic disease are ruled out. There is no supportive evidence to indicate a clinical diagnosis of endometriosis at this time; however, it is more likely that this is an infectious process that must be aggressively treated. DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Diagnosis MSC: Patient Needs: Physiologic Integrity/Physiologic Adaptation 23. A patient with no prenatal care delivers a healthy male infant via the vaginal route, with

minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the patient is questioned, she relates that there is history of heart disease in her family; but, that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the patient is discharged. The patient returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension is the patient is exhibiting? a. Pregnancy-induced hypertension (PIH) b. Gestational hypertension c. Preeclampsia superimposed on chronic hypertension d. Undiagnosed chronic hypertension ANS: D

Even though the patient has no documented prenatal care or medical history, she does relate a family history that is positive for heart disease. Additionally, the patient’s blood pressure increased following birth and was treated in the hospital and resolved. Now the patient appears at the 6-week checkup with hypertension. Typically, gestational hypertension resolves by the end of the 6-week postpartum period. The fact that this has not resolved is suspicious for undiagnosed chronic hypertension. There is no evidence to suggest that the patient was preeclamptic prior to the birth. DIF: Cognitive Level: Analysis OBJ: Nursing Process Step: Diagnosis MSC: Patient Needs: Physiologic Integrity/Physiologic Adaptation 24. A high-risk labor patient progresses from preeclampsia to eclampsia. Aggressive management

is instituted, and the fetus is delivered via cesarean birth. Which finding in the immediate postoperative period indicates that the patient is at risk of developing HELLP syndrome? a. Platelet count of 50,000/mcL b. Liver enzyme levels within normal range c. Negative for edema d. No evidence of nausea or vomiting ANS: A

HELLP syndrome is characterized by Hemolysis, Elevated Liver enzyme levels, and a Low platelet count. A platelet count of 50,000/mcL indicates thrombocytopenia. DIF: Cognitive Level: Analysis

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