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WorksheetsExam 2 (OB) Part 2
Total questions: 95
Worksheet time: 50mins
SATA: Pregnant patients with type 1 diabetes may be affected by this condition in which of the following ways?
increased likelihood of preeclampsia
increased likelihood of fetal macrosomia
increased likelihood of fetal shoulder dystocia
maternal insulin requirements will increase during pregnancy
maternal insulin requirements will increase after birth
When does a fetus have a functioning pancreas to secrete insulin to combat high blood glucose levels that are crossing the placenta?
10-15 weeks gestation.
4-6 weeks gestation.
20-24 weeks gestation.
After birth.
A newborn of a diabetic patient may be LGA (Large for Gestational Age) due to which physiologic process?
Fetal hyperinsulinemia caused by maternal hyperglycemia
Increased fetal growth due to high levels of glucose crossing the placenta
Fetal hypoglycemia after disconnection from the placenta
Decreased placental perfusion
If a patient with type 1 diabetes required insulin during pregnancy, what change to her care will be needed during the Postpartum period?
After delivery, REDUCE insulin dosage based on BG monitoring.
After delivery, INCREASE insulin dosage based on BG monitoring.
Continue the same insulin dosage as during pregnancy.
Discontinue insulin therapy immediately after delivery.
If a patient has preexisting heart disease, can they get pregnant?
They can get pregnant, but their heart may not physiologically cope with added plasma volume and increased cardiac output.
They cannot get pregnant under any circumstances.
They can get pregnant and will have no additional risks compared to healthy individuals.
They can get pregnant, but their heart may not physiologically cope with reduced plasma volume and decreased cardiac output.
SATA: What are some interventions that will help ensure a healthy pregnancy for patients with cardiac conditions?
limit strenuous activities
avoid excessive weight gain
monitor VS and FHR frequently
promote need for adequate rest and sleep
reduce dosage of prescribed medications
What would be the best lab test to gather objective data of how bad a patient's bleeding is?
CBC
CMP
BG
BMP
Which of the following are symptoms that would indicate a patient is miscarrying?
Vaginal bleeding, abdominal pain, and passage of tissue
Increased appetite, weight gain, and frequent urination
Headache, blurred vision, and high blood pressure
Fever, cough, and sore throat
Excessive weight gain during pregnancy increases stress on the heart.
True
False
Fill in the blank: Abnormally slow increase or a decrease in ________ levels may indicate miscarriage.
hCG
TSH
FSH
LH
Threatened miscarriage is characterized by spotting and cramping without cervical change.
True
False
Incomplete miscarriage involves loss of some products of conception. Some portion of the products of conception are retained, most often the ________.
placenta
fetus
amniotic sac
umbilical cord
Missed miscarriage means products of conception are retained in-utero after fetal death.
True
False
SATA: What interventions could be performed for a patient who has miscarried?
Count and weigh peri pads (to approximate blood/tissue loss)
Assess cramping and spotting, assess for s/s of shock
Monitor VS, maintain bedrest, save expelled tissue
Administer Rhogam for Rh negative moms for same reason as misoprostol
Administer misoprostol as prescribed (to induce “labor”)
Is there a possibility that even though there is vaginal bleeding that a miscarriage will not occur?
Yes, although spotting and cramping is an ominous sign. If bleeding is severe, the likelihood of fetal survival is very low.
No, vaginal bleeding always means miscarriage will occur.
SATA: What symptoms would indicate the patient potentially has an ectopic pregnancy?
Cullen’s sign
Referred lower extremity pain
Dark red or brown spotting
Severe suprapubic pain
Referred shoulder pain
95% of ectopic pregnancies occur in which location?
Fallopian tube
Cervix
Abdominal cavity
Ovary
Habitual miscarriages occur in how many or more successive pregnancies?
Three or more successive pregnancies
Two or more successive pregnancies
Four or more successive pregnancies
Five or more successive pregnancies
Symptoms that would indicate the fallopian tube has ruptured include:
Sudden severe abdominal pain, shoulder pain, and signs of shock
Gradual onset of mild abdominal discomfort
Frequent urination and burning sensation
Mild headache and sore throat
A molar pregnancy is:
an abnormal growth of trophoblastic tissue
a type of ectopic pregnancy where the embryo implants outside the uterus
a condition in which maternal HTN can lead to seizures
a pregnancy that results in premature birth
The priority nursing education after a molar pregnancy has been delivered is:
The importance of follow-up to monitor for increased hCG levels
The importance of follow-up to monitor for increased luteinizing hormone levels
The importance of follow-up to monitor for increased estradiol levels
The importance of follow-up to monitor for spotting
Cervical insufficiency is:
a condition where the cervix weakens and opens too early during pregnancy
an infection of the cervix causing pain and discharge
a condition where the cervix weakens and refuses to dilate during labor
a condition where the cervix weakens and falls off
Premature dilation of the cervix is diagnosed by:
Ultrasound
CT scan
Urine analysis
X-ray
Which of the following is NOT a method to diagnose premature dilation of the cervix?
A) History of progressively earlier loss (GA) with each miscarriage
B) Sterile speculum exam: looking for fetal membranes
C) Ultrasound for abnormal anatomy: looking for short cervix
D) CMP: looking for high serum hCG levels in the bloodstream
For patients with cervical insufficiency, a cervical cerclage is placed at ______ weeks.
10-14
6-8
16-20
22-26
A cerclage is removed at what time and for what reason?
At 37 weeks of gestation to allow for natural labor
At 20 weeks to prevent infection
Immediately after placement to check for complications
After delivery to prevent preterm labor
Placenta previa is:
a condition where the placenta completely covers the cervix
a condition where the placenta completely detaches from the uterus
a condition where the placenta improperly implants in the lower portion of the uterus
a condition where the placenta improperly implants in the upper portion of the uterus
Which of the following is NOT a degree of placenta previa?
Marginal
Partial
Total
Central
Symptoms that would indicate placenta previa include:
Painless vaginal bleeding in the second or third trimester
Severe abdominal pain with no bleeding
Blood pressure of 160/110 or greater
Frequent urination with burning sensation
Ultrasound may discover placenta previa before any signs or symptoms are evident.
True
False
Placental abruption is:
the premature separation of the placenta from the uterus
a condition where the placenta completely covers the cervix
the fusion of the placenta with the fetus
the delayed delivery of the placenta after birth
explosion of the placenta
Interventions needed for a severe placental abruption include:
Immediate Caesarean delivery, isotonic IV fluids, and blood transfusions
Immediate vaginal delivery, isotonic IV fluids, and blood transfusions
Immediate vaginal delivery, hypertonic IV fluids, and blood transfusions
Immediate Caesarean delivery, hypertonic IV fluids, and blood transfusions
When during the pregnancy is a patient screened for gestational diabetes?
24-28 weeks gestation
8-12 weeks gestation
32-36 weeks gestation
At delivery
How do we SCREEN for gestational diabetes?
50g of oral glucose ingested, draw BG after 1hr
Fasting blood glucose every morning for a week
HbA1c measurement at 24 weeks gestation
Urine dipstick for glucose at every prenatal visit
3 hour oral glucose tolerance test
A score of 140 mg/dL or more is considered positive for gestational diabetes screening. What should be done if the screening is positive?
Double check with 3hr OGTT
Start insulin immediately
Repeat the same test after a week
Notify the HCP that the patient is diagnosed with gestational diabetes
Gestational diabetes can increase the risk of complications to the pregnancy/fetus. What is the MOST important factor to prevent these complications?
Monitor and control maternal BG levels
Increase maternal caloric intake
Restrict all physical activity during pregnancy
Delay prenatal care until the third trimester
If a patient has preeclampsia, the nurse should assess for worsening of the condition. What potential symptoms would show preeclampsia without severe features is getting worse?
Proteinuria, thrombocytopenia, elevated AST/ALT, pulmonary edema, visual symptoms, intense headache
Severe headache that cannot be treated with acetaminophen, increased appetite, weight loss, improved vision, decreased blood pressure
Bradycardia, hypothermia, decreased urine output, dry skin, severe hypotension
Hyperglycemia, polyuria, polydipsia, weight gain, elevated AST/ALT
A regular headache while pregnant is not necessarily cause for concern. HOWEVER, they should be monitored, ESPECIALLY IF SEVERE, WON'T GO AWAY, COMES WITH VISUAL DISTURBANCES, OR CAN'T BE RESOLVED WITH ACETAMINOPHEN!
True
False
The interventions that need to be performed frequently if the patient is being treated with magnesium sulfate include:
Monitoring deep tendon reflexes
Administering potassium supplements
Encouraging high fluid intake
Applying heat packs to the abdomen
SATA: Magnesium sulfate is administered to a patient by which of the following methods?
PO
IV
IM
SQ
SL
Magnesium sulfate therapy is used for preeclampsia because:
it prevents seizures
it enhances muscle contraction and excitability
it increases uterine contractions
it increases blood pressure
What would indicate the patient has magnesium toxicity?
Respiratory rate less than 12/min.
Increased urine output.
Elevated blood pressure.
Hyperactive deep tendon reflexes.
Interventions that should be performed for magnesium toxicity include:
Administering calcium gluconate
Increasing magnesium intake
Providing potassium supplements
Encouraging high-magnesium foods
HELLP stands for:
Hemolysis, Elevated Liver enzymes, Low Platelet count
High Enzyme, Low Platelet, Liver Problem
Hepatic Enzyme, Low Protein, Leukocyte Proliferation
Hemoglobin, Electrolyte, Lipid, Protein
DIC is:
Disseminated Intravascular Coagulation
Diabetes Insipidus Condition
Diffuse Ischemic Cardiomyopathy
Direct Immune Complex
Fill in the blank: Urine output less than 30 ml/hr is a sign of ________ toxicity.
magnesium
potassium
calcium
sodium
Fill in the blank: Serum mag levels over ________ is a sign of magnesium toxicity.
9.6
7.0
5.5
8.2
Fill in the blank: A nurse should monitor VS, assess bleeding and S/S of ________ in a patient with DIC.
shock
infection
dehydration
hypothermia
Fill in the blank: In the management of DIC, the nurse should provide ________ therapy PRN.
oxygen
antibiotic
insulin
antacid
Fill in the blank: The nurse should administer ________ as prescribed by HCP for DIC.
heparin
magnesium sulfate
aspirin
misoprostol
Fill in the blank: The nurse should monitor urine output because ________ failure is a complication of DIC.
renal
hepatic
cardiac
respiratory
For cardiac patients during labor, bed rest should be maintained in a ______ position with the HOB _______.
prone, lowered
supine, flat
lateral, elevated
supine, elevated
The increased demand on the heart from pregnancy in cardiac patients can cause blood to be shunted from the _____ to the _____.
brain, uterus
uterus, brain
extremities, uterus
uterus, extremeties
Gestational diabetes completely stops production of insulin, similar to T1DM.
True
False
When do we SCREEN for gestational diabetes?
10-12 weeks gestation
30-36 weeks gestation
24-28 weeks gestation
After a glucola test reading of 140 mg/dL or more
A patient with gestational diabetes has given birth. How long will it take for the neonate's insulin-glucose regulatory mechanism to stabilize?
1 hour
6 hours
12 hours
24 hours
36 hours
Using controlled pushing efforts during labor ______ cardiac stress.
increases
decreases
eliminates
induces
When using a CBC to determine extent of blood loss in a pregnant patient, which values should the RN examine FIRST?
WBC and RBC count
Platelet count and hematocrit
RBC count and hemoglobin
hemoglobin and hematocrit
A sudden loss of pregnancy symptoms, like morning sickness, may indicate what?
imminent labor
standard progression of pregnancy
miscarriage
preterm delivery
An inevitable miscarriage is characterized as spotting, cramping, and ________ during a pregnancy.
cessation of cervical change
presence of cervical dilation and effacement
endogenous cerclage formation in the cervix
placentia abruptio and placenta previa
What is Cullen's sign and which condition is this symptom a hallmark of?
superficial edema and bruising in the subcutaneous fatty tissue around umbilicus, ectopic pregnancy
BP over 140/90, headache, generalized edema, preeclampsia
massive proteinuria, hyperreactive DTRs, clonus, preeclampsia
Decreased neuromuscular irritability and decreased CNS irritability, magnesium toxicity
SATA: What methods can be used to verify presence of an ectopic pregnancy?
rule out all other causes of symptoms
transvaginal U/S
lab tests (CBC, hCG)
laparotomy
lithostropy
What is the primary reason a D&C (dilation and cutterage) would be performed?
to stop maternal seizures
to save a fetus from miscarriage
to remove aborted tissue
to stop maternal hemorrhage
In a molar pregnancy, the embryoblast becomes fluid filled and an embryo does NOT form.
True
False
What is a molar pregnancy?
fertilization of an empty ovum
group of sperm implanting into the uterine wall, forming a "mole"
fertilization that occurs within the ovaries
when a woman gives birth to a mole
During a molar pregnancy, vaginal spotting and discharge may look like:
Lemonade
Prune Juice
Orange Juice
Dr. Pepper
Rumplemintz
A patient should try again for pregnancy shortly after the mole has been delivered, as this gives the greatest chance for a viable fetus.
True
False
How long should a patient with a molar pregnancy wait to get pregnant again after the mole has been delivered?
2-4 weeks
2-4 months
6-8 months
12+ months
SATA: What are the guidelines for serum hCG monitoring in a patient with a recent molar pregnancy?
initial monitoring every 1-2 weeks until pre-pregnancy levels obtained
initial monitoring every 4-6 weeks until pre-pregnancy levels obtained
once pre-pregnancy levels obtained, monitor every 1-2 months for a total of 1 year
once pre-pregnancy levels obtained, monitor every 4-6 months for a total of 2 years
once pre-pregnancy levels obtained, monitor every 1-2 months for a total of 2 year
For patient with cervical insufficiency, their cerclage is removed prior to a C-section delivery.
True
False
In which condition could hemorrhage be "concealed"?
placenta previa
cervical insufficiency
miscarriage
abruptio placentea
SATA: What should the RN AVOID when treating a patient with placenta previa?
vaginal exams
anything that could stimulate contractions
acetaminophen for pain management
monitoring FHTs
performing C-sections
A placental abruption will always occur after ____ weeks. If this occurs before this time period, the condition is instead considered a spontaneous abortion.
10
20
24
36
A placental abruption can occur during pregnancy AND during labor.
True
False
Abrupt onset dark red vaginal bleeding, severe uterine pain, and uterine rigidity are all indicators of which condition?
placenta previa
HELLP syndrome
abruptio placentae
cervical insufficiency
What is the leading cause of non-obstetric fetal death?
maternal alcohol use
maternal cigarette smoking
maternal trauma
maternal opiate use
preeclampsia
If a pregnant patient experiences a trauma, the immediate priority is to STABILIZE THE MOM FIRST!
True
False
SATA: Select the signs and symptoms of preeclampsia WITHOUT severe features.
BP over 140/90
headache
generalized edema
massive proteinuria
clonus
SATA: Select the signs and symptoms of preeclampsia WITH severe features.
massive proteinuria
hyperreactive DTRs and clonus
BP over 160/110
elevated BUN, uric acid, and AST/ALT
severe RUQ pain
SATA: What interventions need to be performed to provide quality/safe care for the patient with severe feature preeclampsia?
treat hypertension (Labetalol, Hydralazine, ect)
initiate seizure prophylaxis (Magnesium sulfate)
treat hypotension (volume expanders, vasopressors, ect)
closely monitor FHTs, kick counts, and obtain fetal U/S
assess neurological status frequently
For patients with severe preeclampsia, it is preferred they have an indwelling catheter inserted to obtain accurate I/Os.
True
False
For seizure prophylaxis, magnesium sulfate is given first as a bolus/loading dose of ____g, and then as a maintenance dose of ____ g/hr.
1-2, 0.5-0.8
9-10, 4-6
4-6, 1-2
20-30, 10-15
The therapeutic range of magnesium sulfate is:
wide
narrow
SATA: Why is magnesium sulfate used for preeclampsia?
Causes smooth muscle relaxation
Blocks Ach at synapses
Decreases cardiac conduction
Pulls fluid back into vasculature
Increases blood pressure
It is IMPERATIVE to monitor respiratory rate in a patient receiving magnesium sulfate, as this medication can induce respiratory depression.
True
False
What interventions should be performed FIRST for magnesium toxicity?
administer calcium gluconate
call HCP
administer misoprostol or rhogam
stop the magnesium infusion at once
HELLP is a variant of preeclampsia that presents with severe _____ dysfunction.
renal
hepatic
respiratory
cardiovascular
What does HELLP stand for?
H: hemolysis
EL: elevated liver enzymes
LP: low platelet count
H: hypertension
EL: elevated liver enzymes
LP: low protein count
H: hemorrhage
EL: elevated lung enzymes
LP: low protein count
H: hypotension
EL: elevated liver enzymes
LP: low platelet count
DIC is a condition in which the body's __________ is activated and can be life threatening.
endogenous diuresis
endogenous opiate reception
inflammatory mediation
clotting cascade
DIC can cause a patient to bleed to death.
True
False
A patient with HELLP syndrome always presents with classic preeclampsia symptoms.
True
False
SATA: What are some frequent assessments the RN should perform on a patient receiving magnesium sulfate for preeclampsia?
monitor I/Os
assess DTRs
perform GCS
monitor for headache and increased ICP
monitor VS and ECG
What is clonus?
extreme hyporeflexia
a short seizure
"beats" that occur when a foot returns from extension
the speed in which DTRs are performed
Corticosteroids are a treatment option for placental abruption.
True
False
In a molar pregnancy, all trophoblast villi will look like ___________ on imaging studies.
a cluster of grapes
one giant prune
everything bagel seeds
2-3 pulsating masses
