Nokea
The nurse is caring for a patient admitted with vaginal bleeding and cramping who delivered a stillborn infant at 22 weeks' gestation. What data in the patient's health history are associated with this complication of pregnancy?
- A. motor vehicle accident 1 year ago
- B. hypertension times 4 years
- C. appendectomy 2 years ago
- D. nausea every day for the past 16 weeks
Correct Answer: B
Rationale: The correct answer is B: hypertension times 4 years. Hypertension is a risk factor for complications during pregnancy, such as preterm birth and stillbirth. The patient's history of chronic hypertension increases the likelihood of developing conditions like preeclampsia, which can lead to fetal complications like stillbirth. The other choices (A, C, and D) are not directly associated with the complication of pregnancy described in the scenario. A motor vehicle accident, appendectomy, and nausea do not have a direct causal relationship with the patient's current condition of vaginal bleeding and cramping after delivering a stillborn infant at 22 weeks' gestation.
You may also like to solve these questions
A patient who was pregnant had a spontaneous abortion at approximately 4 weeks' gestation. At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the patient presents at the clinic office complaining of “crampy†abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100°F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/minute (bpm), and respirations, 20 breaths per minute. Based on this assessment data, what does the nurse anticipate as a clinical diagnosis?
- A. Ectopic pregnancy
- B. Uterine infection
- C. Gestational trophoblastic disease
- D. Endometriosis
Correct Answer: B
Rationale: The correct answer is B: Uterine infection. The patient's presentation with crampy abdominal pain, scant serosanguineous vaginal drainage, negative pregnancy test, and vital signs indicating fever, hypotension, and tachycardia are indicative of a uterine infection, most likely post-miscarriage. The timing of symptoms 2 weeks after miscarriage aligns with the typical onset of infection. The absence of products of conception being expelled completely could have led to retained tissue causing infection. Ectopic pregnancy (A) would typically present with severe abdominal pain, vaginal bleeding, and positive pregnancy test. Gestational trophoblastic disease (C) would present with irregular vaginal bleeding and elevated hCG levels. Endometriosis (D) is a chronic condition characterized by pelvic pain and abnormal menstrual bleeding, not an acute post-miscarriage complication.
A patient at 25 weeks' gestation has just been diagnosed with gestational diabetes. What is the most important education for the nurse to provide the patient at this time?
- A. induction of labor
- B. nutrition
- C. potential fetal complications
- D. potential maternal complications
Correct Answer: B
Rationale: The correct answer is B: nutrition. At 25 weeks' gestation with gestational diabetes, nutrition education is crucial to manage blood sugar levels and prevent complications. Proper diet control can help regulate blood glucose levels, ensuring optimal fetal growth and reducing the risk of macrosomia. Educating the patient on a balanced diet, monitoring carbohydrate intake, and understanding the glycemic index are essential. Induction of labor (choice A) is not indicated at this stage and may lead to potential complications. While discussing potential fetal (choice C) and maternal (choice D) complications is important, addressing nutrition takes precedence as it directly impacts the health of both the mother and the fetus.
Which maternal condition always necessitates delivery by cesarean birth?
- A. Partial abruptio placentae
- B. Total placenta previa
- C. Ectopic pregnancy
- D. Eclampsia
Correct Answer: B
Rationale: The correct answer is B: Total placenta previa. In total placenta previa, the placenta completely covers the opening of the cervix, posing a risk of severe bleeding during vaginal delivery. Cesarean birth is necessary to prevent maternal hemorrhage and ensure a safe delivery.
Partial abruptio placentae (A) may require cesarean birth if there is significant bleeding or fetal distress, but it's not an absolute indication for cesarean section. Ectopic pregnancy (C) and eclampsia (D) do not always necessitate cesarean birth unless there are other obstetric indications.
Why is a multiple-gestation pregnancy considered a high risk?
- A. Postpartum hemorrhage is an expected complication.
- B. Perinatal mortality is two to three times more likely in multiple than in single births.
- C. Optimal psychological adjustment after a multiple birth requires 6 months to 1 year.
- D. Maternal mortality is higher during the prenatal period in the setting of multiple gestation.
Correct Answer: B
Rationale: The correct answer is B because perinatal mortality is two to three times more likely in multiple gestation pregnancies compared to single births. This is due to the increased risk of complications such as preterm birth, low birth weight, and other neonatal issues. Postpartum hemorrhage (A) is a potential complication but not specific to multiple gestation pregnancies. Optimal psychological adjustment (C) and maternal mortality during the prenatal period (D) are not directly related to the increased risks associated with multiple gestation pregnancies.
Which finding would indicate concealed hemorrhage in abruptio placentae?
- A. Bradycardia
- B. Hard boardlike abdomen
- C. Decrease in fundal height
- D. Decrease in abdominal pain
Correct Answer: B
Rationale: The correct answer is B: Hard boardlike abdomen. This finding indicates concealed hemorrhage in abruptio placentae because it suggests intra-abdominal bleeding causing rigidity and firmness. This is due to blood pooling in the abdomen, leading to a tense, boardlike feeling upon palpation. The other choices are incorrect because: A) Bradycardia is not a specific indicator of concealed hemorrhage in this context; C) Decrease in fundal height is more characteristic of a missed miscarriage or intrauterine fetal demise; D) Decrease in abdominal pain is not typically associated with concealed hemorrhage, which often presents with severe abdominal pain.