Which clinical intervention is the only known cure for preeclampsia?
- A. Magnesium sulfate
- B. Delivery of the fetus
- C. Antihypertensive medications
- D. Administration of aspirin (ASA) every day of the pregnancy
Correct Answer: B
Rationale: The correct answer is B: Delivery of the fetus. Preeclampsia is a serious condition that can only be cured by delivering the baby and placenta. This is because the placenta is the source of the problem in preeclampsia. Other options like magnesium sulfate, antihypertensive medications, and aspirin can help manage symptoms but do not cure the underlying condition. Magnesium sulfate is used to prevent seizures in severe cases, antihypertensive medications control high blood pressure, and aspirin may be used for prevention but not as a cure. Delivery is the definitive treatment to resolve preeclampsia and prevent further complications for both the mother and the baby.
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Which postpartum patient requires further assessment?
- A. G4 P4 who has had four saturated pads during the last 12 hours
- B. G1 P1 with Class II heart disease who complains of frequent coughing
- C. G2 P2 with gestational diabetes whose fasting blood sugar level is 100 mg/dL
- D. G3 P2 postcesarean patient who has active herpes lesions on the labia
Correct Answer: B
Rationale: The correct answer is B because a postpartum patient with Class II heart disease complaining of frequent coughing requires further assessment due to the risk of exacerbating heart failure. Coughing can increase cardiac workload, leading to potential complications. Choice A may indicate excessive postpartum bleeding, which would require immediate intervention. Choice C has a slightly elevated blood sugar level but is not immediately concerning. Choice D may require monitoring and possibly treatment for active herpes lesions, but it is not as urgent as assessing a patient with heart disease and coughing.
Nursing intervention for pregnant patients with diabetes is based on the knowledge that the need for insulin is
- A. varied depending on the stage of gestation.
- B. increased throughout pregnancy and the postpartum period.
- C. decreased throughout pregnancy and the postpartum period.
- D. should not change because the fetus produces its own insulin.
Correct Answer: A
Rationale: The correct answer is A because insulin needs vary during pregnancy due to hormonal changes affecting insulin sensitivity. In early pregnancy, insulin needs may decrease due to increased insulin sensitivity, but in late pregnancy, insulin needs may increase due to insulin resistance. Choice B is incorrect as insulin needs do not consistently increase throughout pregnancy and postpartum. Choice C is incorrect as insulin needs typically increase rather than decrease during pregnancy. Choice D is incorrect as the fetus does not produce its own insulin to regulate the mother's blood sugar levels.
Which laboratory finding is indicative of DIC?
- A. Decreased fibrinogen
- B. Increased platelets
- C. Increased hematocrit
- D. Decreased thromboplastin time
Correct Answer: A
Rationale: The correct answer is A: Decreased fibrinogen. In DIC, there is widespread activation of the coagulation cascade, leading to consumption of clotting factors like fibrinogen. This results in decreased levels of fibrinogen in the blood. Increased platelets (B) are seen in early stages, but they decrease as consumption continues. Increased hematocrit (C) is a nonspecific finding. Decreased thromboplastin time (D) is not indicative of DIC, as it would typically be prolonged due to consumption of clotting factors.
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.
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.