Pregnancy Complications: NCLEX

Pregnancy Complications: NCLEX

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OB: Labor and Birth Complications ...

38 terms nelvehjemPreview NCM 109 Care of Mother & Child at-...50 terms lilpigboiPreview High Ri 14 terms brit A woman who's 36 weeks pregnant comes into the labor & delivery unit with mild contracts. Which of the following complications should the nurse watch out for when the client informs her that she has placenta prevue?

• sudden rupture of membranes
• vaginal bleeding
• emesis
• fever
• vaginal bleeding

contractions may disrupt the microvascular network in the placenta of a client with placenta prevue and result in bleeding. If the separation of the placenta occurs at the margin of the placenta, the blood will escape vaginally.Sudden rupture of the membranes isn't related to placenta prevue. Fever would indicate an infectious process, and emesis isn't related to placenta previa The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic pregnancy?

• Painless vaginal bleeding
• Abdominal cramping
• Throbbing pain in the upper quadrant
• Sudden, stabbing pain in the lower quadrant

Answer D is correct. The signs of an ectopic pregnancy are vague until the fallopian tube ruptures. The client will complain of sudden, stabbing pain in the lower quadrant that radiates down the leg or up into the chest. Painless vaginal bleeding is a sign of placenta previa, abdominal cramping is a sign of labor, and throbbing pain in the upper quadrant is not a sign of an ectopic pregnancy, making answers A, B, and C incorrect.A 21y.o. client has been diagnosed with hydatidiform mole. Which of the following factors is considered a risk factor for developing hydatidiform mole?

• age in 20s or 30s
• high in SES
• Primigravida
• prior molar gestation

4.previous molar gestation increases risk for developing subsequent molar gestation by 4-5 times. Adolescents and women ages 40+ are at increased risk for molar pregs. MULTIGRAVIDAS, esp women with prior preg loss, and women with LOWER SES are at increased risk for this problem.

A 21 y.o. has arrives to the ER with c/o cramping abdominal pain and mild vaginal bleeding. Pelvic exam shows a left adnexal mass that's tender when palpated.Culdocentesis shows blood in the culdesac. This client probably has which of the following conditions?

• Abruptio placentae
• Ecoptic pregnancy
• Hydatidiform mole
• Pelvic Inflammatory Disease
• Ecoptic pregnancy

most ecoptic pregnancies dont appear as obvious life threatening med emergencies. THey must be considered in any sexually active woman of childbearing age who c/o menstrual irregularity, cramping abdominal pain, and mild vaginal bleeding.PID, abruptio placentae and hydatidiform moles wont show blood in the cul de sac A client, 34 weeks pregnant, arrives at the ER with SEVERE abdominal pain, uterine tenderness and an increased uterine tone. The client denies vaginal bleeding. The external fetal monitor shows fetal distress with severe, variable decels. The client most likely has which of the following?

• Abruptio Plantae
• Placenta Previa
• Molar Pregnancy
• Ectopic Pregnancy
• Abruptio placentae

a client w/ severe abruptio placentae will often have SEVERE abdominal pain. The uterus will have increased tone w/ little to no return to resting tone btw/ contractions.The fetus will start to show signs of distress, with decels in the HR or even fetal death w/ large placental separation.Placenta previa usually involves PAINLESS vaginal bleeding w/out UCs.A molar preg. generally would be detected before 34 weeks gestation.An ecoptic preg. which usually occurs in the FALLOPIAN TUBES, would rupture well before 34 weeks gestation a 21 y.o. client, 6 weeks pregnant, is diagnosed with hyperemesis gravidum. This excessive vomiting during pregnancy will often result in which of the following?

• bowel perforation
• electrolyte imbalance
• miscarriage

4. PIH

2. ELECTROLYTE IMBALANCE

Excessive vomiting in clients with hyperemesis grav often causes weight loss / fluid and electrolyte, acid base imbalance.PIH and bowel perforation arent r/t hyper grav the effects of hyper grav on the fetus depend on the severity of the disorder.clients w/ severe hyper grav may have low birth weight infant, but the disorder isnt life threatening to the fetus.a client is being admitted to the antepartum unit for hypovolemia secondary to hyperemesis gravidarum.WHich of the following factors predisposes a client to the development of this?

• trophoblastic disease
• maternal age > 35 y.o.
• malnourished or underweight clients
• low levels of HCG
• Trophoblastic disease

is associated w/ hyperemesis grav obesity and maternal age younger than 20 y.o. are risk factors too.High levels of estrogen HCG have also been associated with the development.

Clients with gestational diabetes are usually managed by which of the following therapies?

• diet
• long acting insulin
• oral hypoglycemic drugs
• oral hypoglycemic drugs/insulin
• diet

oral hypoglycemics are contraindicated in preg.long acting insulin usually inst needed for blood glucose control in the client with GDM Which of the following factors would contribute to a high risk pregnancy?

• Blood type O positive
• first pregnancy at age 33y.o.
• Hx of allergy to honey bee pollen
• Hx of insulin dependent DM
• a woman w/ a hx of diabetes has an increased risk for perinatal complications,

including HTN, preeclampsia, and neonatal hypoglycemia.The age of 33 years w/out other risk factors doesn't increase risk, nor does type O positive blood or environmental allergens.Which of the following complications can be potentially life threatening and can occur in a client receiving a tocolytic agent?

• diabetic ketoacidosis
• hyperemesis gravidarum
• pulmonary edema
• sickle cell anemia
• pulmonary edema

Tocolytics are used to stop labor contractions.The most common adverse effect associated with the use of these drugs is pulmonary edema.Clients who dont have diabetes dont need to be observed for diabetic ketoacidosis.Hyperemesis gravidium doesnt result from tocolytic use.Sickle cell anemia is an inherited genetic condition and doesnt develop spontaneously Because uteroplacental circulation is compromised in clients with preeclampsia, a NST is performed to detect which conditions?

• Anemia
• Fetal well being

3. IUGR

• oligohydarminos

An NST is based on the theory that a healthy fetus will have transient fetal heart rate accelerations with fetal movement.A fetus with compromised uteroplacental circulation usually wont have these accelerations, which indicate a nonreactive NST.Serial US wil detect IUGR and oligohydramnios in a fetus.An NST cant detect anemia in a fetus A client is 33 weeks pregnant and has had diabetes since she was 21. When checking her fasting blood sugar level, which values indicate the clients disease was controlled.

• 45 mg/dl
• 85 mg/dl
• 120 mg/dl
• 136 mg/dl
• 85 mg/dl

recommended fasting blood sugar levels in pregnant clients w/ dm are 60-90 mg/dl a fasting blood sugar level of 45mg/dl is low and may result in hypoglyecemia a bs level below 120mg/dl is recommeded for 1hour postprandial values a bs level above 136 mg/dl in a pregnant client indicates hyperglycemia

Which of the following is best to monitor a fetus of a client with diabetes in her 3rd trimester

• US exam weekly
• NST 2x/week
• Daily contraction stress test at 32 weeks
• monitoring fetal activity by client weekly
• NST 2X/week

NST is the preferred antepartum HR screening test for pregnant clients with diabetes.NSTs should be done at least 2x per week staring at 32 weeks gestation, as fetal deaths in clients w/ diabetes have been noted within 1 week of a reactive NST.US should be done ever 4-6 weeks to monitor fetal growth.CST wouldnt be initiated at 32 weeks Maternal fetal activity monitoring should be done daily The nurse receives an order to start an infusion for a client whos hemorrhaging due to a placenta previa. What supplies will be needed?

• Y tubing, normal saline solution, and 20G cathether
• Ytubing, lactated Ringers solution and 18G cath
• Y tubing, normal saline, 18G cath
• Y tubing, lactated RIngers, 20G cath
• Y tubing, normal saline, 18G cath

blood transfusions require Y tubing Normal Saline solution to mix with the blood product and an 18G cath to avoid lysing breaking the RBCs.A 20G cath lumen isnt large enough for a blood transfusion.Lactated RIngers solutions isnt the IV solution of choice for blood transfusions Which of the following conditions isnt dx by abdominal US during the prenatal period?

• fetal presentation
• fetal heart activity
• maternal diabetes
• amniotic fluid volume
• maternal diabetes

abdominal US evals fetal presentation, fetal heart activity, amniotic fluid volume although it may show increased amnitoic flud, thus helping to diagnose maternal diabetes, it isnt used for that purpose.A client who is 32 weeks pregnant is being monitored in the antepartum unit for PIH. She suddenly complains of continuous abdominal pain and vaginal bleeding. Which of the following nursing internventions should be included in the care of this client? Check all that apply

• Evaluate VS
• Prepare for vaginal delivery
• Reassure client that she'll be able to continue

pregnancy

• Evaluate FHT
• Monitor amt of vaginal bleed
• Monitor I&O
• Evaluate VS
• Evaluate FHT
• Monitor amt of vaginal bleed
• Monitor I&O

The clients Sx indicate that she's experiencing abruptio placenta.The nurse must immed eval the moms well being by eval VS, FWB, by auscultation of heart tones, monitoring amt of blood loss and eval the vol status by measuring I&O.After the severity of the abruption has been determined and blood and fluid have been replaced, prompt C-SECTION delivery of the fetus (not vaginal) is indicated if the fetus is in distress