Chapter 15 Pregnancy at Risk: Gestational Onset

Chapter 15   Pregnancy at Risk: Gestational Onset

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is supervising care in the emergency department. Which situation most requires an intervention?

1. Moderate vaginal bleeding at 36 weeks’ gestation; patient has an IV of lactated Ringer’s solution running at 125 mL/hour
2. Spotting of pinkish-brown discharge at 6 weeks’ gestation and abdominal cramping; ultrasound scheduled in one hour
3. Bright red bleeding with clots at 32 weeks’ gestation; pulse = 110, blood pressure 90/50, respirations = 20
4. Dark red bleeding at 30 weeks’ gestation with normal vital signs; patient reports an absence of fetal movement

Answer:  3

Explanation:  1. Bleeding in the third trimester is usually a placenta previa or placental abruption. Blood loss can be heavy and rapid, so having an IV stabilizes the client’s vascular volume.

2. Bleeding in the first trimester can be indicative of spontaneous abortion beginning or of an ectopic pregnancy. An ultrasound will diagnose which situation is occurring and will determine care. Because this client is very early in the pregnancy and only experiencing spotting, it is not appropriate to have an IV at this time.
3. Bleeding in the third trimester is usually a placenta previa or placental abruption. Blood loss can be heavy and rapid. This client has a low blood pressure with an increased pulse rate, which indicates hypovolemic shock, which can be fatal to the mother and therefore the baby. Both lives are at risk in this situation. Since there is no information given that the client has an IV started, this client is the least stable, and therefore the highest priority.
4. Watery, dark red bleeding in the third trimester can indicate placental abruption with ruptured membranes. Normal vital signs indicate a normal vascular volume. A lack of fetal movement could indicate fetal hypoxia or fetal demise. The fetus is at greatest risk in this situation; the mother is stable.

Page Ref: 280

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Leadership

Learning Outcome:  LO 15.1-Contrast the etiology, medical therapy, and nursing interventions for the various bleeding problems associated with pregnancy.

MNL LO:  Contrast the bleeding disorders of late pregnancy and their implications for nursing care.

 

2) The prenatal clinic nurse is caring for a patient with hyperemesis gravidarum at 14 weeks’ gestation. The vital signs are: blood pressure 95/48, pulse 114, respirations 24. Which order should the nurse implement first?

1. Weigh the patient.
2. Give 1 liter of lactated Ringer’s solution IV.
3. Administer 30 ml Maalox (magnesium hydroxide) orally.
4. Encourage clear liquids orally.

Answer:  2

Explanation:  1. Weighing the client provides information on weight gain or loss, but it is not the top priority in a patient with excessive vomiting during pregnancy. The vital signs indicate hypovolemia. The client needs IV fluids.

2. The vital signs indicate hypovolemia. Giving this client a liter of lactated Ringer’s solution intravenously will re-establish vascular volume and bring the blood pressure up, and the pulse and respiratory rate down.
3. The vital signs indicate hypovolemia. There is no indication that the client has dyspepsia. The client needs IV fluids.
4. The client needs IV fluids because of the vital signs indicating hypovolemia. Oral fluids are not likely to be tolerated well by a client with hyperemesis. Lack of tolerance of oral fluids through excessive vomiting is what has led to the hypovolemia.

Page Ref: 285-286

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 15.2-Discuss the medical therapy and nursing care for a woman with hyperemesis gravidarum.

MNL LO:  Discuss the effects of hyperemesis gravidarum on pregnancy.

 

3) A 28-year-old woman who is at 16 weeks’ gestation has just undergone screening for ABO incompatibility. She asks the nurse why her blood contains anti-A antibodies. What is the nurse’s best response?

1. “Anti-A antibodies occur naturally, as a result of exposure to foods and different infections.”
2. “It’s most likely that you contracted anti-A antibodies through sexual activity.”
3. “Anti-A antibodies are inherited; usually, they are genetically passed down from father to daughter.”
4. “You may have contracted anti-A antibodies as a result of a viral infection.”

Answer:  1

Explanation:  1. Anti-A and anti-B antibodies are naturally occurring; that is, women are naturally exposed to the A and B antigens through the foods they eat and through exposure to infection by gram negative bacteria.

2. Anti-A and anti-B antibodies are naturally occurring; that is, women are naturally exposed to the A and B antigens through the foods they eat and through exposure to infection by gram negative bacteria.
3. Women develop anti-A and anti-B antibodies naturally as a result of exposure to the A and B antigens through the foods they eat and through exposure to infection by gram negative bacteria.
4. Women develop anti-A and anti-B antibodies as a result of exposure to the A and B antigens through infection by gram negative bacteria, as well as through exposure to the foods they eat.

Page Ref: 306

Cognitive Level:  Understanding

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 15.10-Compare Rh incompatibility to ABO incompatibility with regard to occurrence, clinical treatment, and implications for the fetus or newborn.

MNL LO:  Assess maternal data for potential risk factors.

 

4) While preparing a class on maternal-fetal ABO incompatibility for antepartum patients, the nurse is creating a brochure. Which statement should be included in the brochure information?

1. In most cases, ABO incompatibility is limited to Type A mothers with a Type B or O fetus.
2. Group A infants, because they have no antigenic sites on the red blood cells (RBCs), are never affected regardless of the mother’s blood type.
3. In most cases, ABO incompatibility is limited to Type O mothers with a Type A or B fetus.
4. ABO incompatibility occurs as a result of the fetal serum antibodies present and interaction between the antigen sites on the maternal RBCs.

Answer:  3

Explanation:  1. In most cases, ABO incompatibility is limited to Type O mothers with a Type A or B fetus. The group B fetus of a group A mother and the group A fetus of a group B mother are only occasionally affected.

2. Group O infants, because they have no antigenic sites on the red blood cells (RBCs), are never affected regardless of the mother’s blood type.
3. In most cases, ABO incompatibility is limited to Type O mothers with a Type A or B fetus. The group B fetus of a group A mother and the group A fetus of a group B mother are only occasionally affected.
4. The incompatibility occurs as a result of the maternal antibodies present in her serum and interaction between the antigen sites on the fetal RBCs.

Page Ref: 306

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Health teaching and health promotion

Learning Outcome:  LO 15.10-Compare Rh incompatibility to ABO incompatibility with regard to occurrence, clinical treatment, and implications for the fetus or newborn.

MNL LO:  Explore the role of the nurse in maternity care delivery.