Chapter 12: Pregnancy at Risk: Gestational Conditions

Women with hyperemesis gravidarum:Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.
Because pregnant women may need surgery during pregnancy, nurses should be aware that The diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy.

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? Presence of fibrin split products
Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC.

In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: Disseminated intravascular coagulation (DIC)
In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?
Administration of blood

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?A dipstick value of 3+ for protein in her urine
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman’s latest laboratory test findings, which reveal a platelet count of 90,000, an elevated

aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of: HELLP syndrome.
hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

A woman with preeclampsia has a seizure. The nurse’s primary duty during the seizure is to: Stay with the client and call for help.
A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88

beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, “I’m so thirsty and warm.”
The nurse Discontinues the magnesium sulfate infusion.

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96
beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: Hydralazine.

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a
tense, painful abdomen. The nurse suspects the onset of: Placental abruption.

The patient that you are caring for has severe preeclampsia and is receiving a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits: A respiratory rate of 10 breaths/min.
Your patient has been receiving magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client?

A boggy uterus with heavy lochia flow Because of the tocolytic effects of magnesium sulfate, this patient most likely would have a boggy uterus increased amounts of bleeding and a heavy lochia flow in the postpartum period.
Your patient is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the

nurse, “Why is it taking so long?” The most appropriate response by the nurse would be:”The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.”
What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia?
Risk for injury to the fetus related to uteroplacental insufficiency

The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:Hypertension.Preeclampsia and eclampsia are two noted deadly forms of hypertension
Nurses should be aware that HELLP syndrome Is characterized by hemolysis, elevated liver enzymes, and low platelets.

Nurses should be aware that chronic hypertension:Can occur independently of or simultaneously with gestational hypertension.
In planning care for women with preeclampsia, nurses should be aware that:Induction of labor is likely, as near term as possible.

Magnesium sulfate is given to women with preeclampsia and eclampsia to: Prevent and treat convulsions.
Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a

comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? An African-American client who is 19 years old and pregnant with twins
A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care

provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? Threatened
The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months.

The best response from the nurse would be:”The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy.
If you were to get pregnant, it would make the diagnosis of this cancer more difficult.” . Human chorionic gonadotropin (hCG) levels will be drawn for 1 year to ensure that the mole is completely gone

There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole Any contraceptive method except an intrauterine device is acceptable.
The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: Intense abdominal pain.

Methotrexate is recommended as part of the treatment plan for which obstetric complication?Unruptured ectopic pregnancy

Methotrexate is recommended as part of the treatment plan for which obstetric complication? Unruptured ectopic pregnancy
Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter.

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure?
Ultrasound for placental location

A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no
change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of: Vasa previa.

A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the woman’s
umbilicus and recognizes this assessment finding as:Cullen’s sign associated with a ruptured ectopic pregnancy.

As related to the care of the patient with miscarriage, nurses should be aware that:If it occurs before the twelfth week of pregnancy, it may manifest only as moderate discomfort and blood loss.
Which condition would not be classified as a bleeding disorder in late pregnancy? Spontaneous abortion.

In providing nutritional counseling for the pregnant woman experiencing cholecystitis, the nurse would: Instruct the woman to eat a low-fat diet and avoid fried foods.
Which maternal condition always necessitates delivery by cesarean section?Total placenta previa

Spontaneous termination of a pregnancy is considered to be an abortion if:The pregnancy is less than 20 weeks.
An abortion in which the fetus dies but is retained within the uterus is called a(n):Missed abortion

Missed abortion refers to retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions.
An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

A placenta previa in which the placental edge just reaches the internal os is more commonly known as: Marginal
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.

When the patient experiences a partial placenta previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os.
What condition indicates concealed hemorrhage when the patient experiences an abruptio placentae? Hard, boardlike abdomen

The patient will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height will increase.
The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to:Assess fetal heart rate (FHR) and maternal vital signs

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of:
Worsening disease and impending convulsion.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.

Which order should the nurse expect for a patient admitted with a threatened abortion?
Bed rest
What finding on a prenatal visit at 10 weeks could suggest a hydatidiform mole? Fundal height measurement of 18 cm

The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Nausea increases in a molar pregnancy because
of the increased production of hCG. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. In the patient’s history, bleeding is normally described as brownish.

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that: Hemorrhage is the major concern.
Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture in order to prevent hemorrhaging. If the tube must be

removed, the woman’s fertility will decrease; however, she will not be infertile.
D&C is performed on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes
Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? Chromosomal abnormalities

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve: IV therapy to correct fluid and electrolyte imbalances.
A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has

adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching includes Iron supplementation. Referral to a support group if necessary. Emphasizing the need for rest.
The woman should be advised to consume a diet high in iron and protein. For many women iron supplementation also is necessary

The reported incidence of ectopic pregnancy in the United States has risen steadily over the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and damage. The popularity of contraceptive
devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as

Pelvic pain
Abdominal pain
Vaginal spotting or light bleeding
Missed period
Decreased placental perfusion in supine position Increased heart rate

Increased risk of thrombus formation Increase in clotting factors
Altered pain referral Displacement of abdominal viscera

Increased risk of acidosis Increased oxygen consumption
Increased risk of aspiration Decreased gastric motility

Complications in First trimester Spontaneous Abortion Ectopic pregnancy What are s/s of spontaneous abortion Vaginal bleeding, uterine cramping, partial/complete expulsion of products of conception WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE …

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At 37 weeks of gestation, the patient is in a severe automobile crash where her abdomen was hit by the steering wheel and her seat belt. What priority action would the emergency room nurse expect to perform upon the patient’s …

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anticonvulsant. A woman with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is: Delivery of the fetus What is the only known cure for preeclampsia? WE WILL WRITE A CUSTOM ESSAY …

A pregnant woman asks the nurse about whether a medication is safe to take during pregnancy. The nurse notes that the drug has a low molecular weight. Based on this drug characteristic, the nurse understands that this drug a. can …

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