Antenatal care for complicated pregnancies

Antenatal care for complicated pregnancies Related

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As the triage nurse in the emergency room, you are reviewing results for the high-risk obstetric patient who is in labor because of traumatic injury experienced as a result of a motor vehicle accident (MVA). You note that the Kleihauer–Betke test is positive. Based on this information, you anticipate that

  • A. immediate birth is required.
  • B. the patient should be transferred to the critical care unit for closer observation.
  • C. RhoGAM should be administered.
  • D. a tetanus shot should be administered.
Correct Answer: A

Rationale: The correct answer is A: immediate birth is required. The positive Kleihauer–Betke test indicates fetal-maternal hemorrhage, where fetal blood enters the maternal circulation. This can lead to fetal-maternal transfusion, causing fetal anemia. Immediate birth is necessary to assess and manage potential fetal distress, such as anemia and hypoxia, due to the trauma from the MVA.

Choices B, C, and D are incorrect:
B: Transferring to critical care unit is not the immediate priority. The focus should be on addressing the fetal distress.
C: RhoGAM is given to Rh-negative mothers to prevent Rh sensitization, but it is not directly related to the positive Kleihauer–Betke test result.
D: Tetanus shot administration is important for tetanus prevention, but it is not the priority in this case where immediate birth is required due to fetal-maternal hemorrhage.

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Examination of a newborn in the birth room reveals bilateral cataracts. Which disease process in the maternal history would likely cause this abnormality?

  • A. Rubella
  • B. Cytomegalovirus (CMV)
  • C. Syphilis
  • D. HIV
Correct Answer: A

Rationale: The correct answer is A: Rubella. Rubella infection during pregnancy can lead to congenital rubella syndrome, which includes bilateral cataracts in newborns. Rubella virus can cross the placenta and affect the developing fetus, leading to various congenital abnormalities. The other choices, B: CMV, C: Syphilis, and D: HIV, can also cause congenital abnormalities but are not specifically associated with bilateral cataracts in newborns. Rubella is the most likely cause in this scenario based on the clinical presentation.

Rh incompatibility can occur if the patient is Rh-negative and the

  • A. fetus is Rh-negative.
  • B. fetus is Rh-positive.
  • C. father is Rh-positive.
  • D. father and fetus are both Rh-negative.
Correct Answer: B

Rationale: The correct answer is B because Rh incompatibility occurs when an Rh-negative mother carries an Rh-positive fetus. During pregnancy or birth, some fetal Rh-positive blood may enter the mother's bloodstream, leading to the production of Rh antibodies. These antibodies can then cause complications in future pregnancies if the fetus is Rh-positive again. Choices A, C, and D are incorrect because Rh incompatibility specifically involves the Rh factor of the fetus, not the mother's own Rh status, the father's Rh status, or both being Rh-negative.

A patient at 10 weeks' gestation informs the nurse they are having vaginal bleeding and cramping. After completing a speculum examination, the health-care provider (HCP) informs the patient their cervix is open. What does the nurse anticipate the HCP will inform the patient they are experiencing?

  • A. complete abortion
  • B. incomplete abortion
  • C. inevitable abortion
  • D. spontaneous abortion
Correct Answer: C

Rationale: The correct answer is C: inevitable abortion. At 10 weeks' gestation, an open cervix with vaginal bleeding and cramping indicates an inevitable abortion, where the miscarriage is unavoidable and the process is ongoing. The open cervix suggests that the pregnancy is not viable and will not continue. The other options are incorrect because: A. Complete abortion refers to the expulsion of all products of conception, B. Incomplete abortion involves partial expulsion of products of conception, and D. Spontaneous abortion is a general term for any non-induced abortion.

Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?

  • A. Determining cervical dilation and effacement
  • B. Monitoring FHR and maternal vital signs
  • C. Observing vaginal bleeding or leakage of amniotic fluid
  • D. Determining frequency, duration, and intensity of contractions
Correct Answer: A

Rationale: The correct answer is A: Determining cervical dilation and effacement. This assessment is contraindicated for a patient with suspected placenta previa because it can lead to further disruption of the placenta and potentially cause severe bleeding. Monitoring FHR and vital signs (B) is important for assessing fetal well-being and maternal status. Observing vaginal bleeding or amniotic fluid leakage (C) is crucial in identifying complications. Determining the frequency, duration, and intensity of contractions (D) is essential for monitoring labor progression but is not appropriate for a patient with suspected placenta previa due to the risk of placental disruption.

A pregnant client with a history of preterm labor is at home on bed rest. Which instruction would be included in this client's teaching plan?

  • A. Place blocks under the foot of the bed.
  • B. Sit upright with several pillows behind the back.
  • C. Lie on the side with the head raised on a small pillow.
  • D. Assume the knee-chest position at regular intervals throughout the day.
Correct Answer: C

Rationale: The correct answer is C: Lie on the side with the head raised on a small pillow. This position helps improve circulation to the uterus and placenta, reducing the risk of preterm labor. Lying on the left side also promotes optimal blood flow. Option A is incorrect as elevating the foot of the bed can decrease blood flow to the placenta. Option B may cause discomfort and increase pressure on the cervix. Option D is not suitable for bed rest as it involves being on all fours, which is not conducive to rest and relaxation.

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