Nokea
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.
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What term describes a spontaneous abortion with no expulsion of the products of conception and a closed cervix?
- A. incomplete abortion
- B. threatened abortion
- C. missed abortion
- D. recurrent abortion
Correct Answer: C
Rationale: The correct answer is C: missed abortion. In a missed abortion, the fetus has died but has not been expelled. The cervix remains closed, and there are no signs of active miscarriage. This term specifically describes the scenario where the pregnancy is no longer viable, but the body has not recognized it yet.
A: Incomplete abortion involves partial expulsion of the products of conception.
B: Threatened abortion signifies a possible miscarriage with ongoing pregnancy.
D: Recurrent abortion refers to multiple consecutive miscarriages.
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.
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 finding would indicate concealed hemorrhage in abruptio placentae?
- A. Bradycardia
- B. Hard boardlike abdomen
- C. Decrease in fundal height
- D. Decrease in abdominal pain
Correct Answer: B
Rationale: The correct answer is B: Hard boardlike abdomen. This finding indicates concealed hemorrhage in abruptio placentae because it suggests intra-abdominal bleeding causing rigidity and firmness. This is due to blood pooling in the abdomen, leading to a tense, boardlike feeling upon palpation. The other choices are incorrect because: A) Bradycardia is not a specific indicator of concealed hemorrhage in this context; C) Decrease in fundal height is more characteristic of a missed miscarriage or intrauterine fetal demise; D) Decrease in abdominal pain is not typically associated with concealed hemorrhage, which often presents with severe abdominal pain.
The nurse admits a client with preeclampsia to the high-risk prenatal unit. Which is the next nursing action after the vital signs have been obtained?
- A. Calling the primary health care provider
- B. Checking the client's reflexes
- C. Determining the client's blood type
- D. Establishing an intravenous (IV) line
Correct Answer: B
Rationale: The correct answer is B: Checking the client's reflexes. This is important in assessing for signs of worsening preeclampsia, such as hyperreflexia. It helps determine the severity of the condition and guides further interventions. Calling the primary health care provider (A) may be necessary but not the immediate next step. Determining the client's blood type (C) is important but not urgent in this situation. Establishing an IV line (D) is important for treatment but assessing reflexes takes priority in preeclampsia management.