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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.
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Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant patient with diabetes?
- A. Evaluation of retinopathy by an ophthalmologist
- B. The patient's stable emotional and psychological status
- C. Degree of glycemic control before and during the pregnancy
- D. Total protein excretion and creatinine clearance within normal limits
Correct Answer: C
Rationale: The correct answer is C, the degree of glycemic control before and during the pregnancy. Proper management of blood sugar levels is crucial in reducing complications in pregnant patients with diabetes. Uncontrolled blood sugar levels can lead to adverse outcomes for both the mother and the baby. Monitoring and maintaining optimal glycemic control before and during pregnancy can help prevent complications such as birth defects, preterm birth, macrosomia, and neonatal hypoglycemia.
Choice A, evaluation of retinopathy by an ophthalmologist, is important for diabetic patients but is not the most critical factor in reducing maternal, fetal, and neonatal complications.
Choice B, the patient's stable emotional and psychological status, is important for overall well-being but does not directly impact maternal, fetal, and neonatal complications in the same way as glycemic control.
Choice D, total protein excretion and creatinine clearance within normal limits, is important for assessing kidney function in diabetic patients but is not as directly related to
Which condition is most commonly associated with late decelerations of the fetal heart rate?
- A. Head compression
- B. Maternal hypothyroidism
- C. Uteroplacental insufficiency
- D. Umbilical cord compression
Correct Answer: C
Rationale: Late decelerations of the fetal heart rate are most commonly associated with uteroplacental insufficiency. During contractions, there is reduced blood flow to the placenta, leading to hypoxia and acidosis in the fetus, resulting in late decelerations. Head compression (A) typically causes early decelerations. Maternal hypothyroidism (B) does not directly affect fetal heart rate. Umbilical cord compression (D) can cause variable decelerations, not late decelerations. Therefore, the correct answer is C.
Fraternal twins are delivered by your Rh-negative patient. Twin A is Rh-positive and twin B is Rh-negative. Prior to administering Rho(D) immune globulin (RhoGAM), the nurse should determine the results of the
- A. direct Coombs test of twin A.
- B. direct Coombs test of twin B.
- C. indirect Coombs test of the mother.
- D. transcutaneous bilirubin level for both twins.
Correct Answer: C
Rationale: The correct answer is C, indirect Coombs test of the mother. This test is crucial to determine if the mother has developed antibodies against the Rh-positive blood of twin A. If the test is positive, it indicates sensitization has occurred, making RhoGAM necessary to prevent hemolytic disease in future pregnancies. Direct Coombs tests of the twins (choices A and B) are not relevant in this scenario as they assess for antibodies already attached to the red blood cells. Transcutaneous bilirubin levels (choice D) are used to monitor jaundice, not Rh incompatibility.
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.