Ch 29 Care High Risk Mother/Newborn & Ch 39 Drugs used in OB

A patient is admitted to the hospital with hyperemesis gravidarum. The patient is malnourished and severely dehydrated. The care plan should be altered to include which interventions?

• Hyperalimentation

• IV fluids and electrolyte replacement

• Hormone replacement therapy

• Vitamin supplements

Answer explanation

Medical treatment is aimed at meeting fluid and electrolyte replacement.

A patient with hyperemesis gravidarum asks the nurse what would have happened if she had not come to the hospital. What result is the best response by the nurse?

• A large for gestational age infant

• Anorexia nervosa

• Preterm delivery

• Maternal or fetal death

Answer explanation

If untreated, hyperemesis gravidarum can result in maternal or fetal death.

How should twins who share a placenta and come from one fertilized ovum be identified?

• Dizygotic

• Trizygotic

• Genetically different

• Monozygotic

Answer explanation

Monozygotic twins, also known as identical twins, originate from one fertilized ovum and share a placenta. Monozygotic twins carry the same genetic code. Dizygotic twins are the result of two separate ova being fertilized at the same time.

What complication of delivery should the nurse expect with the birth of multiple fetuses?

• An ectopic tendency

• Difficulty with breast-feeding

• A vaginal delivery

• Loss of uterine tone

Answer explanation

Delivery of multiple fetuses is often complicated by loss of uterine tone. Oftentimes multiple fetuses are delivered by cesarean. An ectopic tendency would present before delivery. While it can be difficult to breastfeed multiple infants, this does not relate to the delivery.

A patient is admitted to the hospital with signs of an ectopic pregnancy. What should the plan of care include for the patient?

• Long-term bed rest

• Episodes of extreme hypertension

• Surgery to remove the embryo/fetus

• Treatment for dehydration

Answer explanation

An ectopic implantation occurs somewhere outside the uterus and either resolves itself in a spontaneous abortion or requires surgical intervention.

What percent of first-trimester pregnancies spontaneously abort?

• 5% to 10%

• 10% to 15%

• 20% to 25%

• 40% to 50%

Answer explanation

It is estimated that 10% to 15% of first-trimester pregnancies end in spontaneous abortion.

What symptom, no matter what stage of pregnancy, should be reported immediately?

• Backache

• Urinary frequency

• Vaginal bleeding

• Uterine tightening

Answer explanation

Women should be instructed to contact their health care provider if any bleeding occurs during pregnancy.

A patient in her second trimester of pregnancy arrives at the hospital complaining of bright red, painless vaginal bleeding. What condition should the nurse immediately suspect?

• Abruptio placentae

• Hemorrhage

• Placenta previa

• Placentitis

Answer explanation

Placenta previa is a serious condition that consists of bright red painless vaginal bleeding occurring after 20 weeks of pregnancy. The major symptoms of abruptio placentae are severe abdominal pain and uterine rigidity.

A pregnant woman comes to the hospital 3 weeks before her estimated date of birth (EDB) complaining of severe pain and a rigid abdomen. What should the nurse immediately suspect as the cause of the pain?

• Placenta previa

• Appendicitis

• Ectopic pregnancy

• Abruptio placentae

Answer explanation

The major symptoms of abruptio placentae are severe pain and a rigid abdomen. Placenta previa consists of painless bleeding. Appendicitis is not usually accompanied by a rigid abdomen. Symptoms of an ectopic pregnancy would usually occur in the first trimester.

A patient presents with symptoms of abruptio placentae. To facilitate uterine-placental perfusion, in what position would the nurse place the patient?

• Prone position

• Trendelenburg’s position

• Supine position

• Modified side-lying position

Answer explanation

A modified side-lying position facilitates uterine-placental perfusion.