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.
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A patient who had premature rupture of the membranes (PROM) earlier in the pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she is now in labor. The labor and birth nurse performs the following assessments. The vaginal exam is deferred until the physician is in attendance. The patient is placed on electronic fetal monitoring (EFM) and a baseline FHR of 130 bpm is noted. No contraction pattern is observed. The patient is then transferred to the antepartum unit for continued observation. Several hours later, the patient complains that she does not feel the baby move. Examination of the abdomen reveals a fundal height of 34 cm. Muscle tone is no different from earlier in the hospital admission. The patient is placed on the EFM and no fetal heart tones are observed. What does the nurse suspect is occurring?
- A. Placental previa
- B. Active labor has started
- C. Placental abruption
- D. Hidden placental abruption
Correct Answer: D
Rationale: The correct answer is D: Hidden placental abruption. In this scenario, the patient had a history of PROM at 28 weeks, which puts her at risk for placental abruption due to the weakened membranes. The sudden onset of decreased fetal movement and absence of fetal heart tones on EFM indicate a potential emergency. The fundal height of 34 cm suggests the baby is at term, ruling out placental previa or preterm labor. Active labor typically presents with contractions, which are not observed in this case. Placental abruption can be concealed, leading to a sudden decrease in fetal well-being. The nurse should suspect hidden placental abruption and notify the physician immediately for further evaluation and intervention.
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.
In which situation would a dilation and curettage (D&C) be indicated?
- A. Complete abortion at 8 weeks
- B. Incomplete abortion at 16 weeks
- C. Threatened abortion at 6 weeks
- D. Incomplete abortion at 10 weeks
Correct Answer: D
Rationale: A dilation and curettage (D&C) is indicated for an incomplete abortion at 10 weeks because it involves dilating the cervix and removing remaining products of conception from the uterus to prevent infection or excessive bleeding. Incomplete abortion at 16 weeks (Choice B) would be too advanced for a D&C and may require a different procedure. A complete abortion at 8 weeks (Choice A) does not require a D&C as all products of conception have already been expelled. Threatened abortion at 6 weeks (Choice C) indicates a possible miscarriage, but a D&C is not necessary unless the miscarriage is confirmed and incomplete.
A blood-soaked peripad weighs 900 g. The nurse would document a blood loss of _____ mL.
- A. 1800
- B. 450
- C. 900
- D. 90
Correct Answer: C
Rationale: The correct answer is C (900 mL). To calculate blood loss, divide the weight of the blood-soaked pad (900 g) by the specific gravity of blood (1 g/mL). This gives 900 mL. Choice A (1800 mL) is incorrect as it doubles the correct amount. Choice B (450 mL) is incorrect as it halves the correct amount. Choice D (90 mL) is incorrect as it divides the correct amount by 10. The key is to convert the weight to volume using the specific gravity of blood to determine the correct blood loss measurement.
A patient, who delivered her third child yesterday, has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her?
- A. Her two children should be treated with acyclovir before she goes home from the hospital.
- B. The baby will acquire immunity from her and will not be susceptible to chickenpox.
- C. The children can visit their mother and baby in the hospital as planned but must wear gowns and masks.
- D. She must make arrangements to stay somewhere other than her home until the children are no longer contagious.
Correct Answer: D
Rationale: The correct answer is D because the patient, having just given birth, is at a higher risk of complications from chickenpox. By staying away from her home until her children are no longer contagious, she reduces the risk of contracting the illness and potentially passing it on to her newborn. This is crucial for the safety of both the mother and the baby.
Choice A is incorrect because treating the children with acyclovir does not prevent the mother from contracting chickenpox. Choice B is incorrect as immunity is not transferred from the children to the mother or newborn. Choice C is incorrect because even with gowns and masks, the risk of transmission is still present, especially for a postpartum mother and a newborn.