MSU 405 whole

Open Ended

Pregnancies can start off low risk and develop into high-risk situations, or they may start off as high-risk pregnancies to begin with.

What are some pre-existing conditions that would mean the pregnant person has a high-risk pregnancy?

Why might this pregnancy be considered high risk?
How do you think the couple may react on learning this information?

​Consider the following scenario: A couple has finally become pregnant after numerous attempts over the last 4 years. The woman is now 37 years old, and her partner is 40. The couple is informed that the pregnancy, for various reasons, is considered high risk.

Pregnancy Complications

• Cervical Insufficiency

• Bleeding during pregnancy

• Hyperemesis gravidarum

• Gestational hypertension

• HELLP syndrome

• Gestational diabetes

• Blood incompatibility

• Amniotic fluid imbalances

• Multiple gestation

• Premature rupture of membranes

(Spontaneous abortion, Ectopic pregnancy, and Gestational trophoblastic disease were covered in Previous Class)

Multiple Choice

A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states, "I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device." The nurse should suspect which of the following?

• Missed abortion

• Ectopic pregnancy

• Severe pre-eclampsia

• Hydatidiform mole

Cervical Insufficiency

Premature dilatation of cervix

• Cause unknown; possibly due to cervical damage

• Therapeutic management:

  • Bed rest, pelvic rest, avoidance of heavy lifting

  • Cervical cerclage

• Nursing assessment

  • Risk factors

  • Pink-tinged vaginal discharge or pelvic pressure

  • Cervical shortening via transvaginal ultrasound

• Nursing management

  • Continuing surveillance; close monitoring for preterm labor

  • Emotional support

  • Education

​

Hemorrhagic Disorders

OB Emergency

-> Leading cause of maternal death

-> Can occur during pregnancy, during labor, and/or after delivery antepartum, intrapartum, postpartum

Placenta Previa

when the placenta is inserted wholly or partly into the lower uterine segment of the uterus, partially or completely covering the internal cervical opening

Placental Abruption

​the early separation of a normally implanted placenta after the 20th week of gestation, prior to birth

​​Placenta Accreta, Increta, and Percreta

​placenta abnormally adherent to the myometrium; penetration of the myometrium; invasion of the myometrium to the peritoneal covering

Multiple Choice

A nurse is caring for a client who is at 32 weeks of gestation and has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following medications should the nurse expect the provider will prescribe?

• Betamethasone (Celestone)

• Indomethacin (Indocin)

• Nifedipine (Procardia)

• Methylergonovine (Methergine)

Therapeutic management: dependent on bleeding, amount of placenta over os, fetal development and position, maternal parity, labor signs and symptoms

Preparation for possible cesarean birth

​

​Placenta Previa

What is the nurse's role?

​Placenta Previa

What is the nurse's role?

​Placenta Previa

• Monitoring maternal-fetal status

  • vaginal bleeding / pad count

  • AVOID vaginal exams!

  • EFM

• Support and educate

• Prepare for C/S prn

Multiple Choice

 A client with placenta previa is being treated with expectant management.

The client and fetus are stable. The nurse is assessing the client for possible

discharge home. Which statement by the client suggests to the nurse that home

care might not be appropriate?

• "My parent lives next door and can drive me here if necessary"

• "I have a toddler and preschool-age child at home who need my attention."

• "I know to call my health care provider right away if I start to bleed again."

• "I realize the importance of following the instructions for my care."

Multiple Select

A nurse is providing care for a client who has a marginal abruptio placentae. Which of the following findings are risk factors for developing the condition? Select all that apply.

• Fetal Position

• Blunt abdominal trauma

• Cocaine use

• Maternal age

• Cigarette smoking

Multiple Choice

A client with hyperemesis gravidarum asks the nurse about suggestions to

minimize nausea and vomiting. Which suggestion will the nurse provide?

• "Make sure that anything around your waist is quite snug."

• "Try to eat three large meals a day with less snacking."

• "Drink fluids in between meals rather than with meals."

• "Lie down for about an hour after you eat."

Multiple Choice

 A client with hyperemesis gravidarum is admitted to the facility after being

cared for at home without success. Which order does the nurse expect to find in

the chart?

• nothing by mouth

• clear liquid diet

• total parenteral nutrition

• regular diet

Multiple Choice

A nurse is assessing a pregnant client with gestational hypertension. Which

finding leads the nurse to suspect that the client has developed preeclampsia

with severe features?

• urine protein 300 mg/24 hours

• blood pressure 150/96 mm Hg

• mild facial edema

• 4+ deep tendon reflexes

Multiple Choice

 A client with gestational hypertension develops eclampsia and experiences a

seizure. Which intervention is the priority?

• fluid replacement

• oxygenation

• control of hypertension

• birth of the fetus

Multiple Choice

A client is diagnosed with gestational hypertension and is receiving

magnesium sulfate. The nurse determines that the medication is at a therapeutic

level based on which finding?

• urinary output of 20 ml per hour

• respiratory rate of 10 breaths/min

• deep tendons reflexes 2+

• difficulty in arousing

Multiple Choice

A client with preeclampsia with severe features is receiving magnesium

sulfate as part of the treatment plan. To ensure the client's safety, which

compound does the nurse ensure is readily available?

• calcium gluconate

• potassium chloride

• ferrous sulfate

• calcium carbonate

Multiple Choice

It is determined that a client's blood Rh is negative and their partner's is Rh

positive. To help prevent Rh isoimmunization, the nurse expects to administer

Rho(D) immune globulin at which time?

• at 32 week's gestation and immediately before discharge after birth

• 24 hours before birth and 24 hours after birth

• in the first trimester and within 2 hours of birth

• at 28 week's gestation and again within 72 hours after birth

Multiple Choice

The nurse triages a patient with a high-risk pregnancy and notes this on the monitor. Which complication would the nurse suspect?

• Placenta previa

• Gestational hypertension

• Oligohydramnios

• Normal labor

​

Twins may have separate or share a placenta

​Twins may have separate sacs or share one.

​dichorionic

It's important to know what type of twin pregnancy it is to best assess its risks.

​

Multiple Choice

A client is 32 week's pregnant with twins and comes to the clinic for an

evaluation. Which assessment finding requires immediate follow-up?

• reports of intermittent blurry vision

• reports of urinary frequency

• +2 edema in bilateral lower extremities

• Leopold maneuvers shows breech presentation

Multiple Choice

A nurse is teaching a pregnant client with preterm premature rupture of

membranes (PPROM) about caring for themself after discharge to home (which is

to occur later this day). Which statement by the client indicates an

understanding of the teaching?

• "I can shower, but I should not take a tub bath."

• "I can resume my normal activities once I get home."

• "A greenish, yellow tint to my leaking fluid is normal."

• "It is okay for my spouse and I to have sexual intercourse."

Multiple Select

A pregnant client is admitted with premature rupture of the membranes. The

nurse is assessing the client closely for possible infection. Which finding(s) leads

the nurse to suspect that the client is developing an infection? Select all that

apply.

• fetal bradycardia

• abdominal tenderness

• elevated pulse rate of pregnant client

• decreased C-reactive protein levels

• cloudy, malodorous fluid

Multiple Choice

A pregnant client with iron-deficiency anemia is prescribed an iron

supplement. After teaching the client about using the supplement, the nurse determines that more teaching is needed based on which client statement?

• "I will take the iron with milk instead of orange juice or grapefruit juice."

• "Taking the iron supplement with food will help with the side effects."

• "I will need to avoid coffee and tea when I take this supplement."

• "If I happen to miss a dose, I will take it as soon as I remember."

Multiple Choice

The nurse is teaching a pregnant client with type 2 diabetes about diet during pregnancy. Which client statement indicates that the nurse's teaching was

successful?

• "Pregnancy affects insulin production, so I will need to make adjustments in

  my diet."

• "I will basically follow the same diet that I was following before I became

  pregnant."

• "I will basically follow the same diet that I was following before I became

  pregnant."

• "I will adjust my diet and insulin based on the results of my urine tests for

  glucose."

Multiple Choice

A pregnant client, G2P1, at 10 weeks gestation says to the nurse, "I have never urinated as often as I have for the past 3 weeks." How should the nurse respond?

• "Having to urinate so often is annoying. I suggest that you watch how much

  fluid you are drinking and limit it."

• "You should not be urinating this frequently now; it usually stops by the time you are 8 weeks pregnant. I bet you have diabetes."

• By the time you are 12 weeks pregnant, this frequent urination should really

  decrease, but it is likely to return toward the end of your pregnancy."

• "Clients having their second child generally do not have frequent urination. Are you experiencing any burning sensations?"

Multiple Choice

The nurse is discussing the insulin needs of a primiparous client with diabetes

who has been using insulin for the past few years. The nurse informs the client

that their insulin needs will increase during pregnancy based on the nurses

understanding that the placenta produces:

•  human chorionic gonadotropin (hCG), which increases glucose levels

• human placental lactogen (hPL), which decreases the effectiveness of insulin

• estriol, which interferes with insulin crossing the placenta

• relaxin, which decreases the amount of insulin produced

Multiple Choice

The nurse reviews the medical record of a client who has come to the clinic

for an evaluation. The client has a history of mitral valve prolapse and is listed as

risk class II. During the visit, the client states, "We want to have a baby, but I

know I am at higher risk. But what is my risk, really?" Which response by the

nurse is appropriate?

• "If you get pregnant, you will need to be seen by a cardiologist every other

  month for monitoring."

• "Your risk during pregnancy is small, but you should see your cardiologist

  before getting pregnant."

• "Your heart disease would put too much strain on your heart if you were to

  get pregnant."

• "Your pregnancy would be uneventful, but you would need specialized care for

  labor and birth."

Multiple Choice

A client with a history of asthma comes to the clinic for evaluation for

pregnancy. The client's pregnancy test is positive. When reviewing the client's

chart, which order requires follow-up?

• prednisone 40 mg daily

• ipratropium 1 puff every 6 hours as needed

• albuterol 2 puffs every 4 hours as needed

• salmeterol 1 puff every 12 hours as needed

Multiple Choice

A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching the client about the prescribed iron supplement, which statement indicates successful teaching?

• "I should take my iron with milk."

• "I should avoid drinking orange juice."

• "I need to drink plenty of fluids to prevent constipation"

• "I will call the health care provider if my stool is black and tarry."

Multiple Choice

 A client with a history of systemic lupus erythematosus comes to the clinic for

evaluation. The client tells the nurse that they and their partner would like to

have a baby but are afraid the client's lupus will be a problem. How will the

nurse respond?

• "It is probably not a good idea for you to get pregnant, because you have

  lupus."

• "Be sure that your lupus is stable or in remission for 6 months before getting

  pregnant."

• "Your lupus will not have any effect on your pregnancy."

• "If you get pregnant, we will have to add medications to your normal

  treatment plan"

Multiple Choice

A nurse is conducting a presentation for a group of pregnant clients about measures to prevent toxoplasmosis. Which statement should the nurse include in

the teaching?

• Drink bottled water if you travel to another country.

• Avoid eating raw fruits and vegetables.

• Cook all meat to an internal temperature of 140°F (60°C).

• Always wear gloves while changing a cat's litter box.

Multiple Choice

The nurse is caring for an infant born to a birth parent with group B

streptococcus who was not treated during labor. Which finding indicates the infant is developing a complication from the birth parent's infection?

• temperature: 102.1°F (38.9°C)

• blood glucose level: 160 mg/dl (8.88 mmol/l) (normal: 60 to 110 mg/dl; 3.33

  to 6.11 mmol/l)

• sunken fontanels (fontanelles)

• hyperactive moro reflex

Multiple Choice

A nurse is preparing a teaching program for a group of clients of child-

bearing age about preventing infections during pregnancy. When describing

measures for preventing cytomegalovirus infection, which measure will the nurse

stress?

• antibody titer screening

• prenatal screening

• immunization

•  frequent handwashing

Multiple Select

A nurse is teaching a pregnant client about ways to prevent the development

of the foodborne illness listeriosis. The nurse determines that the teaching was

successful when the client identifies the need to avoid which food(s)? Select all

that apply.

• soft cheeses

• refrigerated meat spreads

• canned tuna fish

• store-made chicken salad

• pasteurized milk

Multiple Choice

A client with genital herpes simplex infection asks the nurse, "Will I ever be cured of this infection?" Which response by the nurse is appropriate?

• "There is a new vaccine available that prevents the infection from returning."

• "All you need is a dose of penicillin and the infection will be gone."

• "There is no cure, but drug therapy helps to reduce symptoms and

  recurrences."

• "Once you have the infection, you develop an immunity to it."

Multiple Choice

A client who is HIV-positive is in their second trimester and remains

asymptomatic. The client voices concern about the newborn's risk for the infection. Which statement by the nurse is appropriate at this time?

• "You will probably have a cesarean birth to prevent exposing your newborn."

• "Antibodies cross the placenta and provide immunity to the newborn."

• "Wait until after the birth, and then something can be done."

• "Antiretroviral medications are available to help reduce the risk for

  transmission."

Multiple Choice

After teaching a group of nurses working at the women's health clinic about the impact of pregnancy on a client of advanced age for pregnancy, which statement by the group indicates the teaching was successful?

• "Clients aged 35 or older who become pregnant have an increased risk for

  postpartum hemorrhage."

• "The majority of clients who become pregnant at age 35 or older experience

  complications."

• "Clients aged 35 or older who become pregnant require a specialized type of

  assessment."

• "Clients aged 35 or older are more likely to have a substance use disorder."

Multiple Choice

When teaching a class for pregnant clients about the effects of substance use during pregnancy, the nurse will include which effect?

• low-birth-weight infants

• excessive weight gain

• higher pain tolerance

• longer gestational periods

Multiple Choice

The nurse manager is precepting a new nurse in an obstetrics office. Which action by the new nurse would cause the nurse manager to intervene?

• performing Leopold maneuvers on a client at 38 weeks gestation

• preparing to administer an injection of rho(D) immune globulin to a client who

  is Rh-negative

•  preparing to administer a measles, mumps, rubella vaccination to a client not

  immune to measles

• obtaining a blood draw for rapid plasma reagin (RPR) testing during a client's

  first prenatal appointment