Chapter 7: High-Risk Antepartum Nursing Care Nursing School Test Banks

Chapter 7: High-Risk Antepartum Nursing Care

Multiple Choice

1. A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety.a. Assess uterine contractions continuously.b. Assess fetal heart rate continuously.c. Assess urinary output.d. Assess respiratory rate.

ANS: d
Feedback
a. Monitoring contractions does not indicate magnesium toxicity.
b. Magnesium sulfate will decrease fetal variability and not provide an accurate assessment of magnesium toxicity.
c. Urinary output does not correlate to decreased deep tendon reflexes.
d. Correct. Respiratory effort and deep tendon reflexes (DTRs) are involuntary, and a decrease in DTRs could indicate the risk of magnesium sulfate toxicity and the risk for decreased respiratory effort.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Pharmacological/Parenteral Therapies | Difficulty Level: Moderate

2. A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications:a. Premature rupture of membranesb. Gestational diabetesc. Ectopic pregnancyd. Pregnancy-induced hypertension

ANS: c
Feedback
a. Multiple partners do not increase a womans risk of premature rupture of membranes.
b. Genetics and client diet and weight are contributing factors to gestational diabetes.
c. Correct. A history of multiple sexual partners places the client at a higher risk of having contracted a sexually transmitted disease that could have ascended the uterus to the fallopian tubes and caused fallopian tube blockage, placing the client at high risk for an ectopic pregnancy.
d. Multiple sexual partners are not a risk factor for pregnancy-induced hypertension.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate
3. Identify the hallmark of placenta previa that differentiates it from abruptio placenta.a. Sudden onset of painless vaginal bleedingb. Board-like abdomen with severe painc. Sudden onset of bright red vaginal bleedingd. Severe vaginal pain with bright red bleeding

ANS: a
Feedback
a. Correct. When the placenta attaches to the lower uterine segment near or over the cervical os, bleeding may occur without the onset of contractions or pain.
b. The hallmark for abruptio placenta is pain and a board-like abdomen.
c. Bright red bleeding could be related to abruptio placenta, placenta previa, or other complications of pregnancy.
d. Pain is not a hallmark of placenta previa.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

4. Which of the following assessments would indicate instability in the client hospitalized for placenta previa?a. BP <90/60 mm/Hg, Pulse <60 BPM or >120 BPMb. FHR moderate variability without accelerationsc. Dark brown vaginal discharge when voidingd. Oral temperature of 99.9F

ANS: a
Feedback
a. A decrease in BP accompanied by bradycardia or tachycardia is an indication of hypovolemic shock.
b. FHR with moderate variability can be absent of accelerations during fetal sleep cycles or after maternal sedation.
c. Bright red vaginal bleeding is an indication of current bleeding.
d. Oral temperature may fluctuate based on the clients hydration status. It should be reassessed. Cause for concern is a temperature of 100.4F or more.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

5. During pregnancy, poorly controlled asthma can place the fetus at risk for:a. Hyperglycemiab. IUGRc. Hypoglycemiad. Macrosomia
ANS: b
Feedback
a. Maternal asthma does not place the fetus at risk for hyperglycemia.
b. Compromised pulmonary function can lead to decompensation and hypoxia that decrease oxygen flow to the fetus and can cause intrauterine growth restriction (IUGR).
c. Asthma does not directly affect glycemic control.
d. A fetus experiencing hypoxia would be small for gestational age, not large for gestational age.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: AnalysisContent Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate
6. Which of the following nursing diagnoses is of highest priority for a client with an ectopic pregnancy who has developed disseminated intravascular coagulation (DIC)?a. Risk for deficient fluid volumeb. Risk for family process interruptedc. Risk for disturbed identityd. High risk for injury

ANS: a
Feedback
a. Correct. The client is at high risk for hypovolemia which is life threatening and takes precedence over any psychosocial or less pressing diagnoses.
b. This is a psychosocial diagnosis and is not life threatening.
c. This is a psychosocial diagnosis and is not life threatening.
d. The client is at risk for injury; however, the diagnosis of deficient fluid volume is more descriptive and has clearly defined goals and interventions.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Difficult

7. Which of the following laboratory values is most concerning in a client with pregnancy-induced hypertension?a. Total urine protein of 200 mg/dLb. Total platelet count of 40,000 mm c. Uric acid level of 8 mg/dLd. Blood urea nitrogen 24 mg/dL

ANS: b
Feedback
a. The clients urine protein is elevated. A urine protein of 300 mg/dL in a 24-hour collection is considered concerning.
b. Correct. A platelet count of 50,000 is a critical value and should be reported to the health-care provider immediately. This client is at increased risk of hemorrhage.
c. The uric acid level is only slightly elevated.
d. The BUN is only slightly elevated.
KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Difficult
8. Which of the following medications administered to the pregnant client with GDM and experiencing preterm labor requires close monitoring of the clients blood glucose levels?a. Nifedipineb. Betamethasone c. Magnesium sulfated. Indomethacin

ANS: b
Feedback
a. Nifedipine does not affect maternal blood glucose levels.
b. Beta-sympathomimetics may stimulate hyperglycemia which will require an increased need for insulin.
c. Magnesium sulfate does not affect blood glucose levels.
d. Indomethacin does not affect blood glucose levels.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Pharmacological/Parenteral Therapies | Difficulty Level: Difficult
9. While educating the client with class II cardiac disease, at 28 weeks gestation, the nurse instructs the client to notify the physician if she experiences which of the following conditions? a. Emotional stress at workb. Increased dyspnea while restingc. Mild pedal and ankle edemad. Weight gain of 1 pound in 1 week

ANS: b
Feedback
a. Emotional stress increases cardiac workload; however, without symptoms of cardiac decompensation, this is not immediately concerning.
b. Increasing dyspnea, at rest, can be a sign of cardiac decompensation leading to increased congestive heart failure.
c. Mild edema during the third trimester is normal. However, increasing edema and pitting edema should be reported as they can be a sign of increasing CHF.
d. A weight gain of 1 pound per week is expected during the third trimester.
KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

10. The nurse working in a prenatal clinic is providing care to three primigravida patients. Which of the patient findings would the nurse highlight for the physician?
a. 15 weeks, denies feeling fetal movement
b. 20 weeks, fundal height at the umbilicus
c. 25 weeks, complains of excess salivation
d. 30 weeks, states that her vision is blurry

ANS: d
Feedback
a. This finding is normal. Quickening is usually felt between 16 and 20 weeks gestation.
b. This finding is normal. The fundal height at 20 weeks gestation is usually at the level of the umbilicus.
c. Excess salivation is a normal, albeit annoying, finding.
d. Blurred vision is a sign of pregnancy-induced hypertension (PIH). This finding should be reported to the womans health-care practitioner.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

11. The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks gestation in her first pregnancy. She is worried about having her baby too soon, and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be:
a. Preterm labor
b. Term labor
c. Back labor
d. Braxton-Hicks contractions

ANS: d
Feedback
a. Preterm labor (PTL) is defined as regular uterine contractions and cervical dilation before the end of the 36th week of gestation. Many patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor.
b. Term labor occurs after 37 weeks gestation.
c. There is no indication in this scenario that this is back labor.
d. Braxton-Hicks contractions are regular contractions occurring after the third month of pregnancy. They may be mistaken for regular labor, but unlike true labor, the contractions do not grow consistently longer, stronger, and closer together, and the cervix is not dilated. Some patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Difficult

12. The perinatal nurse knows that the term to describe a woman at 26 weeks gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is:
a. Preeclampsia
b. Chronic hypertension
c. Gestational hypertension
d. Chronic hypertension with superimposed preeclampsia

ANS: d
Feedback
a. Preeclampsia is a multisystem, vasopressive disease process that targets the cardiovascular, hematologic, hepatic, and renal and central nervous systems.
b. Chronic hypertension is hypertension that is present and observable prior to pregnancy or hypertension that is diagnosed before the 20th week of gestation.
c. Gestational hypertension is a nonspecific term used to describe the woman who has a blood pressure elevation detected for the first time during pregnancy, without proteinuria.
d. The following criteria are necessary to establish a diagnosis of superimposed preeclampsia: hypertension and no proteinuria early in pregnancy (prior to 20 weeks gestation) and new-onset proteinuria, a sudden increase in proteinurinary excretion of 0.3 g protein or more in a 24-hour specimen, or two dipstick test results of 2+ (100 mg/dL), with the values recorded at least 4 hours apart, with no evidence of urinary tract infection; a sudden increase in blood pressure in a woman whose blood pressure has been well controlled; thrombocytopenia (platelet count lower than 100,000/mmC); and an increase in the liver enzymes alanine transaminase (ALT) or aspartate transaminase (AST) to abnormal levels.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

13. A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following findings?
a. Patellar and biceps reflexes of +4
b. Urinary output of 50 mL/hr
c. Respiratory rate of 10 rpm
d. Serum magnesium level of 5 mg/dL

ANS: c
Feedback
a. The magnesium sulfate has been ordered because the patient has severe pregnancy-induced hypertension. Patellar and biceps reflexes of +4 are symptoms of the disease.
b. The urinary output must be above 25 mL/hr.
c. The drop in respiratory rate may indicate that the patient is suffering from magnesium toxicity. The nurse should report the finding to the physician.
d. The therapeutic range of magnesium is 4 to 7 mg/dL.

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation | Cognitive Level: Application | Content Area: Adverse Effects/Contraindications; Antepartum Care; Potential for Alterations in Body Systems; Reduction of Risk Potential: Diagnostic Tests | Client Need: Health Promotion and Maintenance; Pharmacological and Parenteral Therapies; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

14. A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother?
a. Serum potassium level increases
b. Diarrhea
c. Urticaria
d. Complaints of nervousness

ANS: d
Feedback
a. The nurse would not expect to see a rise in the mothers serum potassium levels.
b. The beta agonists are not associated with diarrhea.
c. The beta agonists are not associated with urticaria.
d. Complaints of nervousness are commonly made by women receiving subcutaneous beta agonists.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Intrapartum Care; Pharmacological and Parenteral Therapies: Adverse Effects/Contraindications and Side Effects | Client Need: Health Promotion and Maintenance; Physiological Integrity: Pharmacological and Parenteral Therapies | Difficulty Level: Moderate

15. Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae?
a. Increasing abdominal girth measurements
b. Profuse vaginal bleeding
c. Bradycardia with an aortic thrill
d. Hypothermia with chills

ANS: a
Feedback
a. The nurse would expect to see increasing abdominal girth measurements.
b. Profuse vaginal bleeding is rarely seen in placental abruption and is never seen when the abruption is concealed.
c. With excessive blood loss, the nurse would expect to see tachycardia.
d. The nurse would expect to see a stable temperature.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Moderate

16. A woman who has had no prenatal care was assessed and found to have hydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings?
a. Pyelonephritis
b. Pregnancy-induced hypertension
c. Gestational diabetes
d. Abruptio placentae

ANS: c
Feedback
a. Pyelonephritis does not lead to the development of hydramnios or macrosomia.
b. Pregnancy-induced hypertension does not lead to the development of hydramnios or macrosomia.
c. Untreated gestational diabetics often have hydramnios and often deliver macrosomic babies.
d. Abruptio placentae does not lead to the development of hydramnios or macrosomia.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Difficult

17. For the patient with which of the following medical problems should the nurse question a physicians order for beta agonist tocolytics?
a. Type 1 diabetes mellitus
b. Cerebral palsy
c. Myelomeningocele
d. Positive group B streptococci culture

ANS: a
Feedback
a. Beta agonists often elevate serum glucose levels. The nurse should question the order.
b. Beta agonists are not contraindicated for patients with cerebral palsy.
c. Beta agonists are not contraindicated for patients with myelomeningocele.
d. Beta agonists are not contraindicated for patients with group B streptococci.

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation | Cognitive Level: Application | Content Area: Intrapartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

18. The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption?
a. The patient with placenta previa
b. The patient whose vagina is colonized with group B streptococci
c. The patient who is hepatitis B surface antigen positive
d. The patient with eclampsia

ANS: d
Feedback
a. Patients with placenta previa are not especially high risk for placental abruption.
b. Patients colonized with group B streptococci are not especially high risk for placental abruption.
c. Patients who are hepatitis B surface antigen positive are not especially high risk for placental abruption.
d. Patients with eclampsia are high risk for placental abruption.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Intrapartum Care; Reduction of Risk Potential: Potential for Complications | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

19. The nurse is caring for a woman at 28 weeks gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis?
a. Human relaxin levels
b. Amniotic fluid levels
c. Alpha-fetoprotein levels
d. Fetal fibronectin levels

ANS: d
Feedback
a. Relaxin levels are rarely assessed. In addition, they are unrelated to the incidence of preterm labor.
b. Amniotic fluid levels are not directly related to the incidence of preterm labor.
c. Alpha-fetoprotein levels are not related to the incidence of preterm labor.
d. A rise in the fetal fibronectin levels in cervical secretions has been associated with preterm labor.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Laboratory Values | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Moderate

20. Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa?
a. During the second stage of labor you will need to bear down.
b. You should ambulate in the halls at least twice each day.
c. The doctor will likely induce your labor with oxytocin.
d. Please promptly report if you experience any bleeding or feel any back discomfort.

ANS: d
Feedback
a. This response is inappropriate. This patient will be delivered by cesarean section.
b. This response is inappropriate. Patients with placenta previa are usually on bed rest.
c. This response is inappropriate. This patient will be delivered by cesarean section.
d. Labor often begins with back pain. Labor is contraindicated for a patient with complete placenta previa.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

21. A woman at 32 weeks gestation is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will identify which of the following as a positive patient care outcome?
a. Rise in serum creatinine
b. Drop in serum protein
c. Resolution of thrombocytopenia
d. Resolution of polycythemia

ANS: c
Feedback
a. A rise in serum creatinine indicates that the kidneys are not effectively excreting creatinine. It is a negative outcome.
b. A drop in serum protein indicates that the kidneys are allowing protein to be excreted. This is a negative outcome.
c. Resolution of thrombocytopenia is a positive sign. It indicates that the platelet count is returning to normal.
d. Polycythemia is not related to HELLP syndrome. Rather one sees a drop in red cell and platelet counts with HELLP. A positive sign, therefore, would be a rise in the RBC count.

KEY: Integrated Process: Nursing Process: Evaluation | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Illness Management | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Difficult

22. A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following?
a. High leukocyte count
b. Explosive diarrhea
c. Fractured pelvis
d. Low platelet count

ANS: d
Feedback
a. High leukocyte count is not associated with severe pregnancy-induced hypertension (PIH) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.
b. Explosive diarrhea is not associated with severe PIH or HELLP syndrome.
c. A fractured pelvis is not associated with severe PIH or HELLP syndrome.
d. Low platelet count is one of the signs associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Diagnostic Tests; Reduction of Risk Potential: Laboratory Data | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

23. A woman at 10 weeks gestation is diagnosed with gestational trophoblastic disease (hydatiform mole). Which of the following findings would the nurse expect to see?
a. Platelet count of 550,000/ mm3
b. Dark brown vaginal bleeding
c. White blood cell count 17,000/ mm3
d. Macular papular rash

ANS: b
Feedback
a. The nurse would not expect to see an elevated platelet count.
b. The nurse would expect to see dark brown vaginal discharge
c. The nurse would not expect to see an elevated white blood cell count.
d. The nurse would not expect to see a rash.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Difficult

24. After an education class, the nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that additional teaching about sexually transmitted infection (STI) control issues is needed?
a. I could get an STI even if I just have oral sex.
b. Girls over 16 are less likely to get STDs than younger girls.
c. The best way to prevent an STI is to use a diaphragm.
d. Girls get human immunodeficiency virus (HIV) easier than boys do.

ANS: c
Feedback
a. This statement is true. Organisms that cause sexually transmitted infections can invade the respiratory and gastrointestinal tracts.
b. This statement is true. Young women are especially high risk for becoming infected with sexually transmitted diseases.
c. This statement is untrue. The young woman needs further teaching. Condoms protect against STDs and pregnancy. In addition, condoms can be kept in readiness for whenever sex may occur spontaneously. Using condoms does not require the teen to plan to have sex. A diaphragm is not an effective infection-control method. Plus, it would require the teen to plan for intercourse.
d. This statement is true. Young women are higher risk for becoming infected with HIV than are young men.

KEY: Integrated Process: Nursing Process: Evaluation; Teaching and Learning | Cognitive Level: Application | Content Area: Disease Prevention; High Risk Behaviors; Human Sexuality | Client Need: Health Promotion and Maintenance: High Risk Behaviors; Human Sexuality | Difficulty Level: Moderate

25. A woman who is admitted to labor and delivery at 30 weeks gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour?
a. Temperature
b. Pulse
c. Respiratory rate
d. Blood pressure

ANS: c
Feedback
a. The temperature should be monitored, but it is not the most important vital sign.
b. The pulse rate should be monitored, but it is not the most important vital sign.
c. The respiratory rate is the most important vital sign. Respiratory depression is a sign of magnesium toxicity.
d. The blood pressure should be monitored, but it is not the most important vital sign.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Intrapartum Care; Potential for Complications from Pharmacological Therapies: Adverse Effects/Contraindications | Client Need: Health Promotion and Maintenance; Physiological Integrity: Pharmacological and Parenteral Therapies | Difficulty Level: Moderate

26. You are caring for a patient who was admitted to labor and delivery at 32 weeks gestation and diagnosed with preterm labor. She is currently on magnesium sulfate, 2 gm per hour. Upon your initial assessment you note that she has a respiratory rate of 8 with absent deep tendon reflexes. What will be your first nursing intervention?
a. Elevate head of the bed
b. Notify the MD
c. Discontinue magnesium sulfate
d. Draw a serum magnesium level

ANS: c
Initial nursing intervention needs to be discontinuing magnesium sulfate because the patient is exhibiting signs of magnesium toxicity with absent deep tendon reflexes and decreased respiratory rate.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application and Comprehension | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Hard

27. A 34-weeks gestation multigravida, G3 P1 is admitted to the labor suite. She is contracting every 7 minutes and 40 seconds. The woman has several medical problems. Which of the following of her comorbidities is most consistent with the clinical picture?
a. Kyphosis
b. Urinary tract infection
c. Congestive heart failure
d. Cerebral palsy

ANS: b
Feedback
a. Kyphosis is unrelated to preterm labor.
b. Urinary tract infections often precipitate preterm labor.
c. It is unlikely that the congestive heart failure precipitated the preterm labor.
d. Cerebral palsy is unrelated to preterm labor.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance: Antepartum Care; Physiological Integrity: Physiological Adaptation | Difficulty Level: Difficult

28. A primiparous woman has been admitted at 35 weeks gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis?
a. Hematocrit dropped to 28%.
b. Platelets increased to 300,000 cells/mm3.
c. Red blood cells increased to 5.1 million cells/mm3.
d. Sodium dropped to 132 mEq/dL.

ANS: a
Feedback
a. The nurse would expect to see a drop in the hematocrit: The H in HELLP stands for hemolysis.
b. The nurse would expect to see low platelets.
c. The nurse would expect to see hemolysis.
d. The sodium is usually unaffected in HELLP syndrome.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Intrapartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Moderate

29. A labor nurse is caring for a patient, 39 weeks gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question?
a. Type and cross-match her blood.
b. Insert an internal fetal monitor electrode.
c. Administer an oral stool softener.
d. Assess her complete blood count.

ANS: b
Feedback
a. It would be appropriate to type and cross-match the patient for a blood transfusion.
b. This action is inappropriate. When a patient has a placenta previa, nothing should be inserted into the vagina.
c. To prevent constipation, it is appropriate for a patient to take a stool softener.
d. It is appropriate to monitor the patient for signs of anemia.

KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care; Patient Advocacy; Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential; Safe and Effective Care Environment: Management of Care | Difficulty Level: Moderate

30. A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see?
a. Postpartum hemorrhage
b. Neonatal hyperglycemia
c. Postpartum oliguria
d. Neonatal macrosomia

ANS: d
Feedback
a. The patient is not especially high risk for a postpartum hemorrhage.
b. The nurse would expect to see neonatal hypoglycemia, not hyperglycemia.
c. The nurse would expect to see postpartum polyuria.
d. The nurse would expect to see neonatal macrosomia.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Antepartum Care; Physiological Adaptation: Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Physiological Adaptation | Difficulty Level: Difficult

31. According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia:
a. Take the patients blood pressure every 6 hours
b. Encourage the patient to rest on her back
c. Notify the physician of a urine output greater than 30 mL/hr
d. Administer magnesium sulfate according to agency policy

ANS: d
Feedback
a. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The blood pressure is taken every 1 hour or more frequently according to physician orders or institutional protocol.
b. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The patient should be encouraged to assume a side-lying position to enhance uterine perfusion.
c. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. A urine output less than 30 mL/hr is indicative of oliguria and the physician must be notified.
d. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

32. The perinatal nurse is providing care to Marilyn, a 25-year-old G1 TPAL 0000 woman hospitalized with severe hypertension at 33 weeks gestation. The nurse is preparing to administer the second dose of beta-methasone prescribed by the physician. Marilyn asks: What is this injection for again? The nurses best response is:
a. This is to help your babys lungs to mature.
b. This is to prepare your body to begin the labor process.
c. This is to help stabilize your blood pressure.
d. This is to help your baby grow and develop in preparation for birth.

ANS: a
Feedback
a. Antenatal glucocorticoids such as beta-methasone may be given (12 mg IM 24 hours apart) to promote fetal lung maturity if the gestational age is less than 34 weeks and childbirth can be delayed for 48 hours.
b. Antenatal glucocorticoids such as beta-methasone may be given (12 mg IM 24 hours apart) to promote fetal lung maturity if the gestational age is less than 34 weeks and childbirth can be delayed for 48 hours.
c. Antenatal glucocorticoids such as beta-methasone may be given (12 mg IM 24 hours apart) to promote fetal lung maturity if the gestational age is less than 34 weeks and childbirth can be delayed for 48 hours.
d. Antenatal glucocorticoids such as beta-methasone may be given (12 mg IM 24 hours apart) to promote fetal lung maturity if the gestational age is less than 34 weeks and childbirth can be delayed for 48 hours.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

33. A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner?
a. Presence of chloasma
b. Presence of severe heartburn
c. 10-pound weight gain in a month
d. Patellar reflexes +1

ANS: c
Feedback
a. Chloasma is a normal pregnancy finding.
b. Heartburn is an expected finding during the third trimester.
c. The weight gain may be due to fluid retention. Fluid retention may occur in patients with pregnancy-induced hypertension and in patients with congestive heart failure. The physician should be notified.
d. Although slightly hyporeflexic, patellar reflexes of +1 are within normal limits.

KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Difficult

34. The single most important risk factor for preterm birth includes:
a. Uterine and cervical anomalies
b. Infection
c. Increased BMI
d. Prior preterm birth

ANS: d
The single most important factor is prior preterm birth with a reoccurrence rate of up to 40%.

KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

35. Your antepartal patient is 38 weeks gestation, has a history of thrombosis, and has been on strict bed rest for the last 12 hours. She is now experiencing shortness of breath. What about the patient may be a contributing factor for her shortness of breath?
a. Physiologic changes in pregnancy result in vasodilation, which increases the tendency to form blood clots.
b. Physiologic changes in pregnancy result in vasoconstriction, which increases the tendency to form blood clots.
c. Physiologic changes in pregnancy result in anemia, which increases the tendency to form blood clots.
d. Physiologic changes in pregnancy result in decreased perfusion to the lungs, which increases the tendency to form blood clots.

ANS: a
The patients shortness of breath, bed rest, and history of thrombosis indicate possible pulmonary embolism. Her pregnant state also increases the potential for thrombosis resulting from increased levels of coagulation factors and decreased fibrinolysis, venous dilation, and obstruction of the venous system by the gravid uterus. Thromboembolitic diseases occurring most frequently in pregnancy include deep vein thrombosis and pulmonary embolism.

KEY: Integrated Process: Critical Thinking | Cognitive Level: Complication | Content Area: Physiologic Adaptation: Alteration in Body Systems | Client Need: Physiologic Adaptation | Difficulty Level: Hard

36. Metabolic changes during pregnancy __________ glucose tolerance.
a. lower
b. increase
c. maintain
d. alter

ANS: a
Metabolic changes during pregnancy lower glucose tolerance.

KEY: Integrated Process: Knowledge | Cognitive Level: Synthesis | Content Area: Maternity
| Client Need: Physiologic Adaptation | Difficulty Level: Hard

True/False

37. Immediately postpartum, the insulin needs in diabetic women increase dramatically.

ANS: FalseThere is a significant decrease in the need for insulin immediately after delivery related to the loss of antagonistic placental hormones and suppression of the anterior pituitary growth hormone.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy

38. The perinatal nurse observes the placental inspection by the health-care provider after birth. This examination may help to determine whether an abruption has occurred prior to or during labor.

ANS: True
Fifty percent of abruptions occur before labor and after the 30th week, 15% occur during labor, and 30% are identified only upon inspection of the placenta after delivery.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

39. It is critical for the perinatal nurse to learn, as part of the facilitys policies and procedures, to immediately perform a vaginal examination on a woman who presents with vaginal bleeding after 24 weeks gestation.

ANS: False
Placenta previa should be suspected in all patients who present with bleeding after 24 completed weeks of gestation. Because of the risk of placental perforation, vaginal examinations are not performed.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

40. The perinatal nurse knows that the survival rate for infants born at or greater than 28 to 29 gestational weeks is greater than 90%.

ANS: True
With appropriate medical care, neonatal survival dramatically improves as the gestational age increases, with over 50% of neonates surviving at 25 weeks gestation, and over 90% surviving at 28 to 29 weeks of gestation.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

41. A patient with hypertension who is receiving intravenous magnesium sulfate therapy has requested an epidural anesthetic. The perinatal nurse should first review the patients complete blood count results for evidence of a decreased platelet count.

ANS: True
Baseline information, including complete blood count (CBC), clotting studies, serum electrolytes, and renal function tests, is used to alert the care providers to changes in the patients condition as additional laboratory tests are obtained.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Integrity | Difficulty Level: Difficult

42. The perinatal nurse knows that the laboring diabetic patients blood glucose level should always be less than 120 mg/dL.

ANS: True
Blood glucose levels are assessed every hour, and fluid/insulin adjustments are made as needed to maintain maternal blood glucose levels between 80 and 120 mg/dL.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

Multiple Response

43. The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include (select all that apply):
a. Cocaine use
b. Tobacco use
c. Previous caesarean birth
d. Previous use of medroxyprogesterone (Depo-Provera)

ANS: a, b, c
Feedback
a. Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years.
b. Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years.
c. Placenta previa may be associated with conditions that cause scarring of the uterus such as a prior cesarean section, multiparity, or increased maternal age.
d. Previous use of medroxyprogesterone (Depo-Provera) is not a risk factor for placenta previa.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

44. Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks gestation. An appropriate nursing action would be to (select all that apply):
a. Assess the fetal heart rate
b. Obtain urine for culture and sensitivity
c. Assess Kerrys blood pressure and pulse
d. Palpate Kerrys abdomen for contractions

ANS: a, b, d
Feedback
a. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patients abdomen should be palpated to assess for contractions, and the fetuss heart rate should be monitored.
b. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. A urinalysis and urine culture and sensitivity (C & S) should be obtained on all patients who present with signs of preterm labor, and the nurse must remember that signs of UTI often mimic normal pregnancy complaints (i.e., urgency, frequency). The patients abdomen should be palpated to assess for contractions, and the fetuss heart rate should be monitored.
c. Assessment of blood pressure and pulse is not an important nursing action in this scenario.
d. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patients abdomen should be palpated to assess for contractions and the fetuss heart rate should be monitored.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

45. The perinatal nurse knows that tocolytic agents are most often used to (select all that apply):
a. Prevent maternal infection
b. Prolong pregnancy to 40 weeks gestation
c. Prolong pregnancy to facilitate administration of antenatal corticosteroids
d. Allow for transport of the woman to a tertiary care facility

ANS: c, d
Feedback
a. Tocolytics are not used to treat maternal infection.
b. Tocolytics are generally only effective in delaying delivery for several days.
c. Presently, it is believed that the best reason to use tocolytic drugs is to allow an opportunity to begin the administration of antenatal corticosteroids to accelerate fetal lung maturity.
d. Delaying the birth provides time for maternal transport to a facility equipped with a neonatal intensive care unit.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

46. The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes (select all that apply):
a. Encouraging regular, ongoing prenatal care
b. Reporting symptoms of urinary frequency and burning to the health-care provider
c. Coming to the labor triage unit if back pain or cramping persist or become regular
d. Lying on the right side, withholding fluids, and counting fetal movements if contractions occur every 5 minutes

ANS: a, b, c
Feedback
a. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur.
b. Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur.
c. Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider if symptoms of preterm labor occur.
d. Lying on the right side; drinking fluids, not withholding fluids; and counting fetal movements if contractions occur every 5 minutes are recommended if a woman thinks she is contracting.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

47. The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes. These risks include (select all that apply):
a. Chorioamnionitis
b. Abruptio placentae
c. Operative birth
d. Cord prolapse

ANS: a, b, d
Even though maintaining the pregnancy to gain further fetal maturity can be beneficial, prolonged PPROM has been correlated with an increased risk of chorioamnionitis, placental abruption, and cord prolapse.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

48. Betamethasone is a steroid that is given to a pregnant woman with signs of preterm labor. The purpose of giving steroids is to (select all that apply):
a. Stimulate the production of surfactant in the preterm infant
b. Be given between 24 and 34 weeks gestation
c. Increase the severity of respiratory distress
d. Accelerate fetal lung maturity

ANS: a, b, d
Betamethasone is a steroid that is given to pregnant women with signs of preterm labor between 24 and 34 weeks gestation. It stimulates the production of surfactant in the preterm infant and accelerates fetal lung maturity.

KEY: Integrated Process: Knowledge | Cognitive Level: Comprehension | Content Area: Pharmacological and Parenteral Therapies: Expected Effects/Outcomes | Client Need: Pharmacologic and Parenteral Therapies | Difficulty Level: Hard

49. Marked hemodynamic changes in pregnancy can impact the pregnant woman with cardiac disease. Signs and symptoms of deteriorating cardiac status include (select all that apply):
a. Orthopnea
b. Nocturnal dyspnea
c. Palpitations
d. Irritation

ANS: a, b, c
Signs and symptoms of deteriorating cardiac status with cardiac disease include orthopnea, nocturnal dyspnea, and palpitations, but do not include irritation.

KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Synthesis | Content Area: Reduction of Risk Potential-Potential for Complications | Client Need: Physiologic Adaptation | Difficulty Level: Hard

Short Answer

50. A condition where the placenta attaches to the lower uterine segment of the uterus

ANS: Placenta previa
Refer To: Maternity Nursing Terms and Definitions; Ref. 7

KEY: Integrated Process: Teaching/Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

51. A pregnancy that ends before 20 weeks gestation

ANS: Miscarriage
Refer To: Maternity Nursing Terms and Definitions; Ref. 7

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

52. Birth prior to 37 completed weeks of pregnancy

ANS: Preterm birth
Refer To: Glossary; Perinatal Nursing Terms and Definitions

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

53. Specks or spots in the vision where the patient cannot see; blind spots

ANS: Scotoma
Refer To: Maternity Nursing Terms and Definitions; Ref. 7

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

54. A disease characterized by an abnormal placental development that results in the production of fluid-filled grapelike clusters and a vast proliferation of trophoblastic tissue

ANS: Hydatidiform mole/Gestational trophoblastic disease
Refer To: Perinatal Nursing Terms and Definitions; Ref. 7

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

55. No expulsion of the products of conception, but bleeding and dilation of the cervix such that a pregnancy is unlikely

ANS: Inevitable abortion
Refer To: Maternity Nursing Terms and Definitions; Ref. 7

KEY: Integrated Processes: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

56. Placement of suture to mechanically close a weak cervix

ANS: Cervical cerclage
Refer To: Maternity Nursing Terms and Definitions; Ref. 7

KEY: Integrated Process: Teaching and Learning | | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

Fill-in-the-Blank

57. The perinatal nurse knows that an early pregnancy loss occurs before __________ weeks, and a late pregnancy loss is one that occurs between 12 and __________ weeks.

ANS: 12; 20
Not all conceptions result in a live-born infant. Of all clinically recognized pregnancies, 10% to 20% are lost, and approximately 22% of pregnancies detected on the basis of hCG assays are lost before the appearance of any clinical signs or symptoms. By definition, an early pregnancy loss occurs before 12 weeks of gestation; a late pregnancy loss is one that occurs between 12 and 20 weeks.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

58. Mary, a G3 TPAL 0020 woman at 20 weeks gestation, has had a transvaginal ultrasound. Mary has been informed that she has cervical incompetence. The perinatal nurse explains that this diagnosis means that her cervix has __________ without __________ contractions.

ANS: dilated; regular
Patients with cervical incompetence usually present with painless dilation and effacement of the cervix, often during the second trimester of pregnancy. The patient frequently gives a history of repeated second trimester losses with no apparent etiology. Incompetent cervix is estimated to cause approximately 15% of all second trimester losses.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

59. The perinatal nurse knows that nausea and vomiting are common in pregnancy and usually resolve by __________ weeks gestation. The severe form of this condition is __________.

ANS: 16; hyperemesis gravidarum
Feedback 1: Nausea and vomiting are a common condition of pregnancy which affect 70% to 85% of pregnant women and usually resolve by the 16th week of gestation.
Feedback 2: Hyperemesis gravidarum represents the extreme end of the nausea/vomiting spectrum in terms of severity. Criteria for the diagnosis of hyperemesis gravidarum include persistent vomiting unrelated to other causes, a measure of acute starvation (usually large ketonuria), and some discrete weight loss, most often 5% of the prepregnancy weight.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

60. The perinatal nurse explains to the student nurse who is assessing the abdomen of a 32-week pregnant woman with placenta previa that it would not be unusual to find the fetus in a __________ or __________ position.

ANS: breech; transverse
Placenta previa is an implantation of the placenta in the lower uterine segment, near or over the internal cervical os. This condition accounts for 20% of all antepartal hemorrhages. Leopold maneuvers often reveal the fetus to be in a breech or oblique position or transverse lie because of the abnormal location of the placenta.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

61. The perinatal nurse knows that a __________ hemorrhage is limited to the uterus, and a __________ hemorrhage moves blood toward and through the cervix.

ANS: concealed; revealed
Feedback 1: A concealed hemorrhage occurs in 20% of cases and describes an abruption in which the bleeding is confined within the uterine cavity. The most common abruption is associated with a revealed or external hemorrhage, where the blood dissects downward toward the cervix.
Feedback 2: The most common abruption is associated with a revealed or external hemorrhage, where the blood dissects downward toward the cervix.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

62. The perinatal nurse encourages Colleen, who has just been discharged from the hospital for intravenous therapy for severe nausea and vomiting, to ensure that she __________ often, eats frequent, __________ meals and avoids __________ odors.

ANS: rests; small; cooking
The nurse should counsel the woman with nausea and vomiting to avoid foods and sensory stimuli that provoke symptoms (i.e., some women become nauseous when they smell certain foods being prepared) and also to eat small, frequent meals of dry, bland foods and include high-protein snacks in their diet.

KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

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