Chapter 16 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Chapter 16 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Chapter 16_LO01_Q01

The nurse is supervising care in the Emergency Department. Which situation most requires an intervention?

1. Moderate vaginal bleeding at 36 weeks’ gestation; client 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; client reports an absence of fetal movement.

Correct Answer: 3

Rationale:

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.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 16-1 Relate the etiology, medical therapy, and cultural perspectives to community-based and hospital-based nursing care management of women with a bleeding problem associated with pregnancy.

Chapter 16_LO02 _Q02

The prenatal clinic nurse is caring for a client 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 client.
2. Give 1 liter of lactated Ringer’s solution IV.
3. Administer 30 ml Maalox (magnesium hydroxide) orally.
4. Encourage clear liquids orally.

Correct Answer: 2

Rationale:

1. Weighing the client provides information on weight gain or loss, but is not the top priority in a client 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 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.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 16-2 Describe the maternal and fetal/neonatal risks and medical therapy in community-based and hospital-based nursing care management of the woman with hyperemesis gravidarum.

Chapter 16_LO03 _Q03

The nurse on the high-risk antepartal unit has received shift change report. Which client should the nurse see first?

1. Primip at 26 weeks with prolonged premature rupture of membranes experiencing chills
2. Multip at 28 weeks with premature rupture of membranes reporting leakage of clear vaginal fluid
3. Primip at 30 weeks with premature rupture of membranes due for a betamethasone injection
4. Multip at 32 weeks with prolonged premature rupture of membranes and a hemoglobin of 11.0

Correct Answer: 1

Rationale:

1. Chills indicate fever, which in turn indicates infection. Prolonged premature rupture of membranes increases the risk of maternal infection, specifically chorioamnionitis. Intrauterine infection can be life-threatening to the fetus or to a neonate. This client requires immediate intervention, including contacting the physician.
2. Premature rupture of membranes is the leakage of amniotic fluid; continued leaking of clear fluid does not indicate the development of further complications.
3. Scheduled medications are important, but when a client is experiencing complications, medications are less important.
4. Although this client has prolonged premature rupture of membranes, there is no indication of any further complications. This client is a low priority.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 16-3 Delineate the nursing care needs of a woman experiencing premature rupture of the membranes or preterm labor.

Chapter 16_LO03 _Q04

A woman is being treated for preterm labor with magnesium sulfate. The nurse is concerned that the client is experiencing early drug toxicity. What assessment finding by the nurse indicates early magnesium sulfate toxicity?

1. Patellar reflexes are weak or absent.
2. complaints by the client of feeling flushed and warm
3. Respiratory rate of 16
4. Fetal heart rate of 120

Answer: 1

Rationale:

1. Early signs of magnesium sulfate toxicity are related to a decrease in deep tendon reflexes.
2. The peripheral vasodilation will cause flushing and a feeling of warmth; this is a side effect, not a toxic effect.
3. Late signs of toxicity are a respiratory rate less than 12, urine output less than 30 cc/hr, and confusion.
4. Magnesium typically has no effect on fetal heart rate.

Cognitive Level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome 16-3 Delineate the nursing care needs of a woman experiencing premature rupture of the membranes or preterm labor.