Chapter 18 Pregnancy at Risk: Gestational Onset

Chapter 18   Pregnancy at Risk: Gestational Onset

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is caring for a client who was just admitted to rule out ectopic pregnancy. Which orders are the most important for the nurse to perform?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Assess the client’s temperature.
2. Document the time of the client’s last meal.
3. Obtain urine for urinalysis and culture.
4. Report complaints of dizziness or weakness.
5. Have the lab draw blood for B-hCG level every 48 hours.

Answer:  4, 5

Explanation:  4. Reporting complaints of dizziness and weakness is important, as it can indicate hypovolemia from internal bleeding.

5. Having the lab draw blood for B-hCG levels every 48 hours is important, as the level rises much more slowly in ectopic pregnancy than in normal pregnancy.

Page Ref: 376, 377

Cognitive Level:  Analyzing

Client Need/Sub:  Physiological Integrity: Reduction of Risk Potential

Standards:  QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  2 Contrast the etiology, medical therapy, and nursing interventions for the various bleeding problems associated with pregnancy.

MNL LO:  2.7.2 Describe the causes of bleeding in early pregnancy and their implications for nursing care.

 

2) The nurse educator is presenting a class on the different kinds of miscarriages. Miscarriages, or spontaneous abortions, are classified clinically into which of the following different categories?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Threatened abortion
2. Incomplete abortion
3. Complete abortion
4. Missed abortion
5. Acute abortion

Answer:  1, 2, 3, 4

Explanation:  1. Unexplained cramping, bleeding, or backache indicates the fetus might be in jeopardy. This is a threatened abortion.

2. In an incomplete abortion, parts of the products of conception are retained, most often the placenta.
3. In a complete abortion, all the products of conception are expelled. The uterus is contracted and the cervical os may be closed.
4. In a missed abortion, the fetus dies in utero but is not expelled.

Page Ref: 374

Cognitive Level:  Understanding

Client Need/Sub:  Health Promotion and Maintenance: Management of Care

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and (a) quality and safe patient care, (b) excellence in nursing, and (c) advancement of the profession. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Delineate the bleeding problems associated with pregnancy.

MNL LO:  2.7.2 Describe the causes of bleeding in early pregnancy and their implications for nursing care.

 

3) The nurse is presenting a class on the pathophysiology of the different abortions. Some of the causes are which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Chromosomal abnormalities
2. Insufficient or excessive hormonal levels
3. Sexual intercourse in the first trimester
4. Infections in the first trimester
5. Cervical insufficiency

Answer:  1, 2, 4, 5

Explanation:  1. Chromosomal defects are generally seen as spontaneous abortions during weeks 4 to 8.

2. Insufficient or excessive hormonal levels usually will result in spontaneous abortion by 10 weeks’ gestation.
3. Infectious and environmental factors may also be seen in first trimester pregnancy loss.
4. In late spontaneous abortion, the cause is usually a maternal factor, for example, cervical insufficiency or maternal disease, and fetal death may not precede the onset of abortion.

Page Ref: 373

Cognitive Level:  Understanding

Client Need/Sub:  Health Promotion and Maintenance: Safety and Infection Control

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan and in all health care settings. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Delineate the bleeding problems associated with pregnancy.

MNL LO:  2.7.2 Describe the causes of bleeding in early pregnancy and their implications for nursing care.

 

 

4) A woman is hospitalized with severe preeclampsia. The nurse is meal-planning with the client and encourages a diet that is high in what?

1. Sodium
2. Carbohydrates
3. Protein
4. Fruits

Answer:  3

Explanation:  3. The client who experiences preeclampsia is losing protein.

Page Ref: 386

Cognitive Level:  Understanding

Client Need/Sub:  Physiological Integrity: Reduction of Risk Potential

Standards:  QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Relationship-Centered Care: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome:  4 Describe the maternal and fetal/neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO:  2.7.1 Contrast the various hypertensive disorders in pregnancy and appropriate nursing care.

5) The nurse is assessing a client who has severe preeclampsia. What assessment finding should be reported to the physician?

1. Excretion of less than 300 mg of protein in a 24-hour period
2. Platelet count of less than 100,000/mm3
3. Urine output of 50 mL per hour
4. 12 respirations

Answer:  2

Explanation:  2. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) complicates 10% to 20% of severe preeclampsia cases and develops prior to 37 weeks’ gestation 50% of the time. Vascular damage is associated with vasospasm, and platelets aggregate at sites of damage, resulting in low platelet count (less than 100,000/mm3).

Page Ref: 384

Cognitive Level:  Understanding

Client Need/Sub:  Physiological Integrity: Reduction of Risk Potential

Standards:  QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  4 Describe the maternal and fetal/neonatal risks, clinical manifestations, and nursing care of a pregnant woman with a hypertensive disorder.

MNL LO:  2.7.1 Contrast the various hypertensive disorders in pregnancy and appropriate nursing care.