Advanced Maternal Age Monitoring

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A nurse is educating a pregnant patient about warning signs to report during pregnancy. Which of the following statements indicates that the teaching has been effective?

  • A. I should report any sudden increase in swelling, especially in my hands and face.
  • B. I should wait until after my due date to report any concerns.
  • C. I should only report changes in fetal movement after the third trimester.
  • D. I don't need to report headaches or blurry vision unless they are severe.
Correct Answer: A

Rationale: The correct answer is A because sudden increase in swelling, especially in hands and face, can indicate preeclampsia, a serious condition during pregnancy. Swelling in these areas can be a sign of fluid retention and increased blood pressure. Prompt reporting and intervention are crucial to prevent complications for both the mother and the baby.

Choices B, C, and D are incorrect because:
B: Waiting until after the due date to report concerns can lead to missed opportunities for early intervention and can be dangerous for both the mother and the baby.
C: Changes in fetal movement should be reported immediately, not just after the third trimester, as they can indicate fetal distress.
D: Headaches and blurry vision, even if not severe, can be symptoms of preeclampsia or other serious conditions that require immediate attention. Waiting for symptoms to worsen can be harmful.

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A nurse is assisting with a vaginal delivery. What is the most important action to take when the fetal head crowns?

  • A. apply gentle downward pressure
  • B. assist with shoulder delivery
  • C. assist with perineal massage
  • D. administer pain relief
Correct Answer: A

Rationale: The correct answer is A: apply gentle downward pressure. This action helps prevent rapid delivery, reducing the risk of perineal tearing and ensuring a controlled birth. Applying too much pressure can cause trauma to the mother and baby. Incorrect choices: B is premature, as shoulder delivery should only be done after the head and shoulders are delivered. C is not the most important action at crowning. D is not necessary at this specific stage of delivery.

A nurse is assessing a pregnant patient at 34 weeks gestation who reports feeling itchy and has noticed jaundice. Which of the following conditions should the nurse suspect?

  • A. Gestational diabetes
  • B. Preeclampsia
  • C. Cholestasis of pregnancy
  • D. Hyperthyroidism
Correct Answer: C

Rationale: The correct answer is C: Cholestasis of pregnancy. This condition presents with itching, especially on the palms and soles, and jaundice. It is more common in the third trimester. Cholestasis of pregnancy is a liver condition that can lead to complications for both the mother and the baby if not managed promptly. Gestational diabetes (Choice A) presents with high blood sugar levels. Preeclampsia (Choice B) is characterized by high blood pressure and protein in the urine. Hyperthyroidism (Choice D) involves an overactive thyroid gland, which can present with symptoms such as weight loss and palpitations.

Which of the following is the most appropriate nursing action for a patient who has been administered an epidural block and is now experiencing hypotension?

  • A. Administer a bolus of IV fluids
  • B. Place the patient in a Trendelenburg position
  • C. Administer oxygen via mask
  • D. Raise the head of the bed slightly
Correct Answer: A

Rationale: The correct answer is A: Administer a bolus of IV fluids. Hypotension after an epidural block is often due to vasodilation caused by the block. Administering IV fluids can help increase blood volume and improve blood pressure. This action is crucial in maintaining perfusion to vital organs.

Choice B: Placing the patient in a Trendelenburg position can potentially worsen hypotension by increasing venous return to the heart, leading to further vasodilation and reduced blood pressure.

Choice C: Administering oxygen via mask may be important in some situations but is not the primary intervention for hypotension caused by epidural block.

Choice D: Raising the head of the bed slightly is not the best option for treating hypotension as it does not address the underlying cause of vasodilation and decreased blood pressure.

The nurse discusses sexual intimacy with a pregnant couple. Which of the following should be included in the teaching plan?

  • A. Vaginal intercourse should cease by the beginning of the third trimester.
  • B. Breast fondling should be discouraged because of the potential for preterm labor.
  • C. The couple may find it necessary to experiment with alternate positions.
  • D. Vaginal lubricant should be used sparingly throughout the pregnancy.
Correct Answer: C

Rationale: Experimenting with alternate positions is often necessary due to changing body dynamics during pregnancy. Vaginal intercourse does not need to stop unless medically advised, breast fondling is unlikely to induce labor, and vaginal lubricants can be used as needed.

A pregnant patient is at 34 weeks gestation and reports sudden sharp abdominal pain and difficulty breathing. What is the nurse's priority action?

  • A. Encourage the patient to lie down and monitor the symptoms.
  • B. Administer pain medication and schedule an ultrasound.
  • C. Call the healthcare provider immediately and prepare for possible preterm labor.
  • D. Assess the fetal heart rate and monitor for contractions.
Correct Answer: C

Rationale: The correct answer is C - Call the healthcare provider immediately and prepare for possible preterm labor. At 34 weeks gestation, sudden sharp abdominal pain and difficulty breathing could indicate a serious complication such as placental abruption or pulmonary embolism. Calling the healthcare provider ensures prompt assessment and appropriate intervention to prevent harm to the mother and baby. Encouraging the patient to lie down may delay necessary intervention. Administering pain medication before determining the cause of pain could mask important symptoms. Assessing the fetal heart rate and monitoring for contractions are important but secondary actions to calling the healthcare provider in this urgent situation.

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