Individual Activity #3: CHAPTER STUDY QUESTIONS

Answer Chapter the following Study Questions accordingly.

Rubric for Short Answer:

5- CORRECT ANSWER and EXPLANATION/ RATIONALE, with complete details.
3- CORRECT ANSWER and EXPLANATION/ RATIONALE, but lacking details.
1- INCORRECT ANSWER and NO EXPLANATION/ RATIONALE.

I. Bleeding During Pregnancy

Abortion
1. What are the leading causes of maternal mortality?
- Thromboembolism
- Hemorrhage
- Infection
- Hypertension of pregnancy
- Ectopic pregnancy

2. What are the common causes of bleeding on the 1st Trimester? 2nd Trimester? 3rd
Trimester?
a. FIRST TRIMESTER:
- The normal hormone production during pregnancy can cause changes to the
cervix, rendering it softer and more prone to bleeding. A vaginal infection may
cause spontaneous vaginal bleeding during pregnancy. The bleeding may be
accompanied by an abnormal vaginal discharge. While early bleeding may indicate
the presence of a serious problem, this is frequently not the case. In fact,
approximately 20% of pregnant women experience light bleeding or spotting during
the first trimester of pregnancy. Serious causes of bleeding in pregnancy include:
miscarriage, molar pregnancy, ectopic pregnancy, and subchorionic hemorrhage.

b. SECOND AND THIRD TRIMESTERS

- Bleeding or spotting later in pregnancy can be due to a number of causes.
Sometimes, having sex or even having an internal (pelvic) examination by your
OB/GYN or midwife can cause light bleeding during pregnancy. Problems with the
cervix, including cervical insufficiency (when the cervix opens too early in
pregnancy) or infection of the cervix, can lead to bleeding. More serious causes of
bleeding in later pregnancy include placenta previa, preterm labor, uterine rupture,
or placental abruption.

3. What is the age of viability? What is miscarriage?

- The age of viability is the age a premature baby can survive outside the uterus.
This is usually after 23 weeks of gestation; however the survival rate for infants
born this prematurely is low with an increase chance of developing medical
problems.
 - A miscarriage is the spontaneous loss of a fetus before the 20th week of
pregnancy (pregnancy losses after the 20th week are called stillbirths).
Miscarriage is a naturally occurring event, unlike medical or surgical abortions.

4. What are the 5 types of abortion/ miscarriage?

a. Threatened Miscarriage - begin as vaginal bleeding, initially only scant and
usually bright red; no cervical dilatation present on vaginal examination.
b. Imminent (Inevitable) Miscarriage - uterine contractions and cervical dilation
occur as, with cervical dilation, the loss of the products of conception cannot be
halted.
c. Complete Miscarriage - the entire products of conception (fetus, membranes,
placenta) are expelled spontaneously without any assistance
d. Incomplete Miscarriage - part of the conceptus (usually the fetus) is expelled,
but the membranes or placenta are retained in the uterus
e. Missed Miscarriage - also commonly referred to as early pregnancy failure, the
fetus dies in the utero but is not expelled
f. Recurrent Pregnancy Loss - miscarriage pattern of multiple spontaneous
miscarriages

5. How does Methotrexate works as treatment for elective abortion?

- It stops embryonic cells from dividing and multiplying and is a non-surgical
method of ending pregnancy in its early stages. Within a few days or weeks of
receiving an injection of Methotrexate (MTX) at the clinic, the pregnancy ends
through an experience similar to an early miscarriage.

6. What are the different causes of spontaneous abortion?

- The most frequent cause in the first trimester is abnormal fetal development
due to either a teratogenic factor or to a chromosomal aberration. In some,
immunologic factors may be present or rejection of the embryo through an
immune response.
- Implantation abnormalities due to inadequate endometrial formation or
inappropriate site of implantation.
- Corpus luteum fail to produce enough progesterone to maintain decidua
basalis.
- Ingestion of alcohol
- Urinary tract infections (more associated with preterm births)
- Systemic infections such as rubella, syphilis, poliomyelitis

7. What are the different stages/types of spontaneous abortion? Differentiate each

type.
- Threatened: client experiences vaginal bleeding but the cervix remains
closed: there may be some mild cramping.
- Inevitable: client experience cramping and bleeding. Cervix dilates and
membranes may rupture.
- Incomplete: clients experiences bleeding, cramping, and expulsion of part
of the products of conception. Tissue remains in the uterus and the cervix
is dilated. Hemorrhage is possible.
 - Complete: client experiences bleeding, cramping, and expulsion of all the
products of conception. The cervix is closed and the uterus contracts.
- Missed: client experiences decreasing signs of pregnancy as the fetus had
died in utero but has not been expelled. The client may be at risk for DIC if
the products of conception are not removed.

8. What is missed abortion?

- It is more commonly referred to early pregnancy failure, where the fetus dies in
utero but is not expelled. It is usually discovered at a prenatal examination
when the fundal height is measured and no increase in size can be
demonstrated or when previously heard fetal heart sounds can no longer be
heard. A woman may have had symptoms of threatened miscarriage (e.g.
painless vaginal bleeding) or she may have had no prior clinical symptoms.

9. When do you give RhoGAM?

- RhoGAM is a prescription medicine that is used to prevent Rh immunization, a
condition in which an individual with Rh-negative blood develops antibodies
after exposure to Rh-positive blood. To offset problems, the doctor can give a
shot of RhoGAM — generic: Rho(D) immune globulin — at about 28 weeks of
pregnancy and whenever the mother’s blood may mix with her baby’s, like
during prenatal tests or delivery. Additionally, after a miscarriage, because the
blood type of the new conceptus is unknown, all women with Rh-negative blood
should receive Rh (D antigen) immune globulin (RhIG) to prevent buildup of
antibodies in the event conceptus was Rh positive.

10. This is unintended termination of pregnancy at any time before the fetus has
attained viability. (20-24 wks gestational or fetal weight of <500g (1lb).
Spontaneous abortion.

11. What is the most common cause of spontaneous miscarriage? Abnormal Fetal
Development

12. Early miscarriage occurs before the 16th week.

13. Late miscarriage between the 16th and 20th week.

14. Pregnant treated with DES for threatened abortion have female babies with clear
cell adenocarcinoma, reproductive tract structural differences, pregnancy
complications, and infertility as adverse effects of the drug.

15. The earliest sign of hypovolemic shock in the heart, as complication of abortion, is
rapid heart rate or being tachycardic.

Ectopic Pregnancy
16. The most common type of ectopic pregnancy is tubal pregnancy (occurs
when the egg has implanted in the fallopian tube).
 17. The confirmatory test for a ruptured ectopic pregnancy is a transvaginal ultrasound
will demonstrate the ruptured tube and blood collecting in the peritoneum.

18. The drug of choice if the patient desire for future fertility and the ectopic pregnancy
is not ruptured is methotrexate.

19. The surgery of choice to preserve future fertility is salpingectomy.

20. Administer RhIG/RhoGAM (for isoimmunization protection in future childbearing)

if woman is RH-

21. Select all that apply. Predisposing factors are: (5 points)

1. Pelvic/tubal hx or sx
2. History of previous ectopic pregnancy (2 to)
3. Tumors that distort the fallopian tube
4. Women with IUD
5. Altered tubal motility

22. What does a positive Cullen’s sign indicate?

- The umbilicus develops a bluish-tinged hue. It is named for gynecologist
Thomas Stephen Cullen (1869–1953), who first described the sign in ruptured
ectopic pregnancy in 1916.

23. What are the usual laboratory test results of a woman with ectopic pregnancy?
- During the week after treatment for an ectopic pregnancy, your hCG (human
chorionic gonadotropin) blood levels are tested several times. Your doctor will
look for a drop in hCG levels, which is a sign that the pregnancy is ending (hCG
levels sometimes rise during the first few days of treatment, then drop).

24. What is the priority nursing diagnosis for a client with an ectopic pregnancy?
- Risk for fluid volume deficit r/t blood loss from ruptured tube
- Pain r/t ectopic pregnancy or rupture bleeding into the peritoneal cavity
- Anticipatory grieving r/t loss of pregnancy and potential loss of childbearing
capacity

25. How is Ectopic pregnancy diagnosed using culdocentesis?

- Culdocentesis confirms the presence of intra‐abdominal bleeding. Dilation of
the cervical os and curettage of the endometrial lining can be used to establish
the diagnosis of ectopic pregnancy if no chorionic villi are found. If decidua
without chorionic villi is found, it may indicate an ectopic pregnancy.

H-MOLE
26. This type of mole has no embryo is present but fetal blood maybe present, has 69
chromosomes (triploid formation) partial mole.
 27. This type of mole has a normal number of chromosomes, all trophoblastic villi swell
and become cystic. If an embryo forms, it does early 2 1-2 mm in size with no fetal
blood present in the villi complete mole.

28. This type of mole has higher incidence of malignancy. Complete mole.

29. Symptoms of pregnancy occur before 20 weeks gestation.

30. The client with Hmole is instructed not to get pregnant for 1 year/s

31. What contraceptive method is contradicted for this client?

- oral estrogen/progesterone

32. Select all that apply: Predisposing factors are: (5 points)

1. >17 y.o below and 35 y.o above
2. Low socioeconomic status
3. High protein intake
4. Fertility pills to induce ovulation
5. Previous mole

33. Prophylactic course of methotrexate and dactinomycin is considered if B-hCG

levels rise or begin to plateau or there is evidenced of metastasis (as management)

34. hCG levels is measured every 2 to 3 weeks until normal- then monthly testing for
6 months, then every 2 months for a total of 1 year.

Premature Cervical Dilatation

35. Select all that apply. Predisposing factors are: (3 points)
1. Increased age
2. Congenital maldevelopment of cervix- short cervix
3. Repeated D&C

36. Cervical cerclage is done at 12 to 14 weeks gestational under rehional anesthesia.

37. Cervical cerclage is removed 37 to 38 wks AOG before of labor.

38. After surgery, place patient Slight or modified Trendelenburg position to prevent
pressure on suture area of cervix.

39. McDonald procedure is a temporary cerclage and client delivers through NVSD.

40. Shirodkar procedure is a permanent cerclage and the client delivers through CS.

41. Following placement of cerclage monitor for signs of preterm labor, infection and
vital signs (heart rate, blood pressure).
Placenta Previa
42. Type of placenta wherein implantation totally the cervical os.
- Total placenta previa

43. Type of placenta previa wherein implantation partially obstructs the cervical os.
- Partial placenta previa

44. Type of placenta wherein the placenta edge approaches the cervical os.
- Marginal placenta previa

45. Type of placenta wherein the implantation is in the lower part of uterus rather than
upper.
- Low-lying placenta

46. Cardinal sign of placenta previa is vaginal bleeding (abrupt, painless, bright red).

47. The painless bleeding in placenta previa is caused by placenta’s inability to stretch
to accommodate the differing shape of the lower uterine segment or the cervix.

48. CS is often indicated if the degree of previa is >30% or if there is excessive

bleeding.

49. Select all that apply. Predisposing factors are: (7 points)

1. Multiparity
2. Advanced maternal age
3. Multiple pregnancy
4. Uterine tumor
5. Cigarette smoking (vasoconstriction)
6. Scarring from previous CS
7. Decrease vascularity of upper uterine segment

50. In placenta previa nursing care, the nurse knows that pelvic and rectal procedures
are contradicted.

51. Patient is positioned in a side-lying position to allow the weight of fetus to compress
the placenta and decrease bleeding.

Abruptio Placenta
52. Select all that apply. Predisposing factors are:
1. Maternal HPN (PIH)
2. Advanced maternal age
3. Grand multiparity
4. Trauma to uterus
5. Short umbilical cord
6. Cigarette smoking, alcohol and cocaine abuse or amphetamine abuse
 53. The patient is positioned in left lateral position, with head elevated to enhance
placental perfusion.

54. Check all that apply. The following are signs of hypovolemic shock, complication
os abruption placenta, EXCEPT: (7 points)
1. Increased BP
2. Increased HR
3. Decreased RR
4. Decreased urine output
5. Pallor
6. Decreased LOC
7. Restlessness

Preterm Labor
55. A nurse know that if a pregnant woman is treated with indomethacin for preterm
labor the possibility of fetal adverse effects (Indomethacin is given cautiously to
preterm infants because it has been associated with adverse effects such as
decreased renal function, decreased platelet count, and gastric irritation) may
exist.

56. To enhance fetal lung maturity, what drug is administer?

- Corticosteroid such as betamethasone

57. All but one are predisposing factors of PTL. (4 points)

1. Strenuous activities
2. Long cervix
3. African-American
4. Early adolescents

58. Hydralazine, labetalol, and nifedipine are the drug of choice of PIH.

59. Indomethacin is a tocolytic administered for PTL. The nurse knows that the
administration of this drug cause premature closure of this fetal accessory
structure which is the patent ductus arteriosus.

Premature Rupture of Membranes

60. Premature rupture of membranes refers to amniotic membrane rupture before
labor begins; labor will usually begin spontaneously within 24H of membrane
rupture.

61. Preterm rupture of membranes refers to rupture prior to term gestational of before
38 wks; risk factors; infection, incompetent, cervix and trauma.

62. Prolonged rupture of membranes refers to membranes ruptured more than 12H
before birth; many caregivers will induce labor rather than risk prolonged rupture
with possible ascending infection.
 63. Amniotic fluid turns nitrazine paper blue indicating an alkaline pH.

64. Amniotic fluid shows characteristics ferning pattern on microscopic examination of

a slide with dried fluid on it; which uterine and vaginal secretions do not.

65. The unengaged fetus is at risk for a prolapsed cord when the membranes rupture.

66. Priority nursing intervention in PROM is to assess Fetal heart rate (FHR). This is
to rule out prolapsed cord, note time, color, and amount of fluid.

67. In PROM, evaluate client’s temperature every 2 hours other vital signs may be
routine.

PIH
1. Which increases risk of preeclampsia?
- Primigravid clients younger than 20 years or older than 40 years, clients with
five or more pregnancies, women of color, women with multifetal pregnancies,
women with diabetes or heart disease and women with polyhydramnios

2. Preeclampsia cannot lead to which of the following: (hydrocephalus, abruption

placenta, IUGR, poor placental perfusion)
- Hydrocephalus

3. Diet for mild preeclampsia

- Regular diet with ample protein and calories / Usual pregnancy nutrition

4. Which is not associated condition with preeclampsia: (multifetal pregnancy,

diabetes mellitus, age older than 35 years, iron deficiency)
- iron deficiency

5. The client should contact the healthcare provider immediately if she

experiences which: (blurred vision, ankle edema, increase energy levels, mild
backache)
- blurred vision

6. When preparing for the admission of a client with severe preeclampsia, the
nurse must prepare for which: (oxytocin infusion solution, disposable tongue
blades, portable ultrasound machine, padding for the side rails).
- padding for the side rails

7. When administering MgSO4 for severe preeclampsia, the drug acts as a what?
- Central Nervous System Depressant, Prophylaxis for seizures

8. While giving MgSO4 to a client, which of the signs must a nurse report: (RR 12
bpm, patellar reflex 2+, BP 160/88 mm Hg, urinary output exceeding intake)
- RR 12 bpm
 9. Shortly after a client had eclamptic seizures, the nurse should assess the client
for which: (polyuria, facial flushing, hypotension, uterine contractions)
- uterine contractions

preeclampsia Mild preeclampsia Severe preeclampsia

BP 140/90, SBP 130 10. >160/110
mmHg & DBP mmHg
of 15mmHg
Proteinuria +1 to +2; 300 mg in 11. 3+ to 4+ on a
24 H UO random sample; 5 g/24H
UO
Edema Digital edema (+1 to Pitting (+3 to 4);
2) facial; anasarca
Dependent edema
Weight gain 2 lb/wk 2nd tri; 1 lb/wk More than 12.2
rd
3 tri lbs/wk on
3rd tri
Urine output 13. >500 ml/24H <500 mL/24H
Headache Severe
17.absent
Reflexes Hypereflexia (3+ to
14.normal/not 4+)
affected
Visual disturbance Photophobia,
15. none blurring
Epigastric pain Absent
16. severe
epigastric pain is
present
17-18. The warning signs of preeclampsia are hypertension and proteinuria, indicating
impending seizure (eclampsia).

19. Select all that apply. Predisposing factors to preeclampsia are: (8 points)
◻ Primiparas <20 & <40
◻ Low socioeconomic status
◻ Multiparity
◻ Women in color- Black
◻ Multiple gestation
◻ Women in hydramnios
◻ Women with underlying disease like DM
◻ Renal and cardiac disease

20. The triad symptoms of PIH are: hypertension, edema, and proteinuria.
21. Of the three classic symptoms of PIH, the two may be absent except hypertension or
elevated blood pressure.

22. What is the number one vital sign to be monitored when client is given Apresoline for
preeclampsia? - blood pressure

23. The antidote for MgSO4 toxicity which must be kept ready at bedside is a solution of
10 mL of a 10% calcium gluconate solution (1g).

24. The dangers of convulsion is present the how many hours postpartum? - 48 hours

25. At least 18 months should elapse for the next pregnancy to decrease likelihood of PIH
recurrence.

26. The only cure for preeclampsia is medications or delivery of a baby.

27-28. S/sx of MgSO$ toxicity are loss of deep tendon reflexes and respiratory
depression.

29. Symptoms of PIH rarely occur 20 wks AOG.

30. What is the most common complication of eclampsia? - seizures

OPEN-ENDED QUESTIONS:
68. What if Lynn were to tell you she’s glad her pregnancy is ending early because the
baby probably wasn’t going to be perfect? How would you respond to her?
- I'm worried about how she says she's happy that her pregnancy is ending early,
as the baby probably won't be "perfect." It’s as though she’s implying that she
would only accept a "perfect" child. I would explain to her that an early
miscarriage cannot be prevented because it is caused by something beyond
her control, such as abnormal chromosome formation or poor uterine
implantation. I will then listen to her without passing judgment and encourage
her to express herself.

69. What if Lynn asks you if her prepregnancy exercise routine could have caused the
placenta to implant so low? How would you answer her?
- I will explain to her why and how placenta previa happens. This occurs when
implantation occurs in the lower half of the uterus and this happens in about 1
in 500 pregnant women. Risk factors include the baby's atypical position
(breech or transverse), past uterine procedures such as cesarean birth, surgery
to remove uterine fibroids, dilatation and curettage (D&C), and multiparity.
Thus, I'll explain to her that her workout could not have caused this problem.