NCM 109A:WEEK 4

NCM 109A:

MATERNAL PRENATAL HIGH RISK COMPLICATIONS​

WEEK 4

By Michelle Flores

Review/Rationalized

Pre Test​

Week 4​

Multiple Choice

Answer: C. Uterine tenderness/pain.

In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompany placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by the failure of the uterus to relax in an attempt to constrict blood vessels and control bleeding.

• an empty gestational sac.

• grapelike clusters.

• a severely malformed fetus.

• an extrauterine pregnancy.

Answer: B. Abruptio placentae

The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion first, not third, trimester abortion and abruptio placentae.

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Multiple Choice

Which of the following is the most common kind of placental adherence seen in pregnant women?

• A. Accreta

• B. Placenta previa

• C. Percreta

• D. Increta

Answer: A. Accreta

Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium. In placenta previa, the placenta does not embed correctly and results in what is known as a low-lying placenta. It can be marginal, partial, or complete in how it covers the cervical os, and it increases the patient’s risk for painless vaginal bleeding during the pregnancy and/or delivery process. Placenta percreta leads to perforation of the uterus and is the most serious and invasive of all types of accrete. Placenta increta leads to deep penetration of the myometrium.

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Multiple Choice

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa?

• A. Disseminated intravascular coagulation

• B. Chronic hypertension

• C. Infection

• D. Hemorrhage

Answer: D. Hemorrhage.

Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding.

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Multiple Choice

Maureen in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected?

• a. Placenta previa

• b. Abruptio placentae

• c. Premature labor

• d. Sexually transmitted disease

Answer: A. Placenta previa

Placenta previa with painless vaginal bleeding.

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Multiple Choice

Tina experienced painless vaginal bleeding has just been diagnosed as having a placenta previa. Which of the following procedures is usually performed to diagnose placenta previa?

• a. Amniocentesis

• b. Digital or speculum examination

• c. External fetal monitoring

• d. Ultrasound

Answer: D. Ultrasound

Rationale: Once the mother and the fetus are stabilized, ultrasound evaluation  of the placenta should be done to determine the cause of the bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldn’t be done as this may lead to severe bleeding or hemorrhage. External fetal monitoring won’t detect a placenta previa, although it will detect fetal distress, which may result from blood loss or placenta separation.

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Multiple Choice

The common normal site of nidation/implantation in the uterus is:

• A. Upper uterine portion

• B. Mid-uterine area

• C. Lower uterine segment

• D. Lower cervical segment

Answer: A. Upper uterine portion

The embryo’s normal nidation site is the upper portion of the uterus. If the implantation is in the lower segment, this is an abnormal condition called placenta previa.

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Multiple Choice

A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding?

• A. Placenta previa

• B. Abruptio placentae

• C. Ectopic pregnancy

• D. Spontaneous abortion

Answer: B. Abruptio placentae

The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion first, not third, trimester abortion and abruptio placentae.

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Multiple Choice

A pregnant woman arrives at the emergency department with abruptio placentae at 34 weeks’ gestation. She’s at risk for which of the following blood dyscrasias?

• A. Thrombocytopenia.

• B. Idiopathic thrombocytopenic purpura (ITP).

• C. Disseminated intravascular coagulation (DIC).

• D. Heparin-associated thrombosis and thrombocytopenia (HATT).

Answer: C. Disseminated intravascular coagulation (DIC).

Abruptio placentae is a cause of DIC because it activates the clotting cascade after hemorrhage.

Option A: Thrombocytopenia results from decreased production of platelets. Option B: ITP doesn’t have a definitive cause. Option D: A patient with abruptio placentae wouldn’t get heparin and, as a result, wouldn’t be at risk for HATT.

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Multiple Choice

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present?

• Absence of abdominal pain

• B. A soft abdomen

• C. Uterine tenderness/pain

• D. Painless, bright red vaginal bleeding

Answer: C. Uterine tenderness/pain.

In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompany placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by the failure of the uterus to relax in an attempt to constrict blood vessels and control bleeding.

Some text here about the topic of discussion