Diabetes: Nursing Care Management

Antepartum care
Diet and exercise
Monitoring blood glucose levels
Insulin therapy
Complications requiring hospitalization
Determination of birth date and mode of delivery

Intrapartum care
Close monitoring of blood glucose levels and dehydration

Postpartum care
Insulin requirements decrease substantially in immediate postpartum period.
Breastfeeding
Family planning and contraception
Diabetes mellitus interventions
Early recognition
Preconception counselling
Folic acid supplementation
Obesity complications
Increased risk of shoulder dystocia
Caesarean birth (& decrease success)
Difficulty with breastfeeding
Risk for postpartum hemorrhage
Spontaneous Abortion
HTP
Gestational diabetes
Venous thromboembolism
Macrosomia & dystocia
Anaesthesia
gestational hypertension
gestational diabetes
obstructive sleep apnea
congenital abnormalities
Nursing care management:
Weight loss before conception (BMI Obese < 30 kg/m, ideally < 25 kg/m)
Regular exercise > reduce some of these risks.
Appropriate screening (increase risk for congenital abnormalities)
Take BMI into consideration during fetal anatomic assessment in the 2
trimester
Anatomic assessment (20 to 22 weeks) better choice
Consultation with an anaesthesiologist
Risk of venous thromboembolism >thromboprophylaxis
Anemia
Common/uncommon during preg?
Types?
Current guidelines as outlined by the Association of Ontario Midwives?
Most common medical disorder of pregnancy

Iron-deficiency anemia
Folic acid-deficiency anemia

Sickle cell hemoglobinopathy

Thalassemia
HIV and AIDS
Perinatal transmission

Obstetrical complications
HIV and AIDS
Nursing care management
Pregnancy does not accelerate the condition.
Treated with antiretroviral therapy (ART) during pregnancy.
Testing for other STIs
Opportunistic infections
Decrease the newborn's exposure to blood and secretions
(Wiped free of all body fluids, infection control techniques)
Substance Use:
Smoking during pregnancy has serious health risks
Bleeding complications
Miscarriage
Stillbirth
Prematurity
Low birth weight
Sudden infant death syndrome
Substance Use :
Barriers to treatment
Legal considerations
Guilt, fear, shame
Delay seeking prenatal care
Substance-use treatment programs usually do not address issues affecting
pregnant women.
Long waiting lists for treatment
lack of women-only recovery spaces

Drug testing during pregnancy not legal requirement in Canada

Substance Use
Nursing care management:
decrease substance use, abstinence recommended
Consequences of drug use should be clearly communicated
Women are more receptive to making lifestyle changes during pregnancy than
at any other time
Alcoholics and/or Narcotics Anonymous
Methadone treatment for pregnant women
Increase cocaine and crystal methamphetamine use during pregnancy
Encourage Maternal-infant attachment & Breastfeeding
Nonjudgemental and women-centred approach
Harm reduction model
Anemia in pregnancy
-1st trimester: Hg<11
-2nd trimester: Hg <10.5
-3rd trimester: Hg <10.5-11
-PP: Hg <10
Differentiate from physiological (dilutional) anemia by ordering ferritin and TSAT
iron deficiency anemia
-Ddx: anemia of chronic d/o, Hg cc/dd, lead poisoning, microcytic anemia, hemolytic
anemia, beta thalassemia
-Dx: CBC at prenatal visit w/ repeat CBC at 24-28 weeks
-Tx: prevention w/ 30mg/day of iron; may have to increase to 200mg/day or IV if not
able to absorb orally
-Risk factors: pregnancy, previous dx, DM, smoking, HIV, IBD, multiparas, h/o
abnormal uterine bleeding, underweight/obese, vegetarian, back to back
pregnancies
Chronic hypertension
-HTN that antecedes pregnancy or is present on at least 2 occasions before the 20th
week of gestation or persists longer than 12 weeks PP
-reproductive age + proteinuria = likely chronic kidney disease or preeclampsia
-Dx: order creat and urine protein to r/o preeclampsia
-Tx: meds not recommended for mild HTN, only for SBP >160 or DBP >100
-Education: need for screening fetal growth restriction, test to monitor fetal well
being, and timing of delivery
goal is to prevent CVA and coronary events
Pregestational diabetes
-DM 1 & 2, DI
-refer for DI
-Dx: self monitoring of blood glucose
-Tx: target a1c levels <6; insulin = best tx
-Education: fetal well being, fetal size, macrosomia, NST, fetal demise, biophysical
profile
Opioid use
Tx: methadone, suboxone, psychosocial therapy
Maternal/neonatal effects: overdose, NAS
Cocaine use
Urge to stop taking
Maternal/neonatal effects: placental abruption, CV-arterial vasoconstriction,
increased thrombus formation, CVA, fetal demise, spontaneous abortion,
prematurity, fetal growth restriction, behavioral abnormalities, NAS
ETOH use
Tx: measure blood etoh levels
Maternal/neonatal effects: fetal alcohol syndrome
Cigarette/cannabis smoking
Tx: referral to counseling, do not recommend nicotine patches
Maternal/neonatal effects: SGA, increased risk for preterm delivery, poor apgar
scores, congenital abnormalities (CNS, cardiac, trisomy 21)
Types of Diabetes in Pregnancy
Type 1- low insulin production
Type II- high insulin reistance
Type III- Gestational diabetes-just like gestational HTN, diagnosed in the back half of
pregnancy

Whites Classifcation (A1 and A2- gestational diabetes) B, C, D, F, R, T (pregestational

diabetest that gets progressively worse)
Insulin needs in Pregnancy-(early and later)
Due to placenta!!!
early pregnancy-in 1st trimester, eating less because of N/V. tend to be
hypoglycemic (need to decrease insulin)-up to 20 weeks

late pregnancy- tend to be hyperglycemic. (need to increase insulin)- late 2nd and
3rd trimesteR. Placenta begins to grow beginning at 20 weeks, and increased need
for insulin because of release of placental hormones (human placental lactogen) at
delivery, get rid of placenta! so just by that, their insulin requirements are cut in half.
less insulin while she's breastfeeding because she's putting out sugar. Women must
eat ON TIME too!! Insulin readjustments needed when weaning!
maternal risks of pregestational diabetes
ketoacidosis-most in 2nd and 3rd trimester. DKA can even happen at 200! (why it's
so important to keep them post-prandial at 120! insulin doesn't cross the placenta.
PIH and preeclampsia, HTN
PROM and PTL, R/T Polyhydramnios- r/t fetal anomalies and hyperglycemia.
Infections d/t reduced resistance, high sugar, which can cause PTL! (vaginal, UTI and
PP)
Progression of vascular disease R/T altered control
(retinopathy, nephropathy, neuropathy)
Increased risk of maternal mortality
(heart disease, vascular disease, DKA, hypoglycemia, labor disturbances, PPH)hi
Fetal risks of pregestational diabetes
Macrosomia > 9 lbs r/t fetal hyperinsulinemia (insulin is a growth hormone, >4000g
at term OR above 90% percentile for their gestational age).
IUGR-R/T Mom having vascular problems (CV issues) and decreased placental
perfusion.
Hyperbili r/t polycythemia
Respiratory distress syndrome r/t delayed fetal lung maturity and PTB (surfactant
production is not there. PTB may be necessary).
Congenital Anomalies***
Hypoglycemia at birth: newborns have profound hypoglycemia, pancreas is working
fine but baby doesn't have glucose to match it. *why BF is critical to get them
glucose
Still birth
Tx of pregestational diabetes
TIGHT GLUCOSE CONTROL Euglycemia (65-fasting -120 1 hr post-prandial)
Glucose (65-120)
65-95 (fasting)
postmeal (1hr) 100-120
Hgb A1c- reflects mean blood glucose during previous 4-6 weeks. desire <6%
renal evaluation
eye exam
CV assessment
thyroid function tests
**increased frequency prenatal visits. at 28 weeks start NST, BPP. need to keep a
closer eye on them, bc of risk of stillbirth!!
INDUCE by due date d/t increased risk of IUFD with postdates
Gestational Diabetes (type III)
90% of all diabetic pregnancies!
Occurs later pregnancy (d/t placenta)
insulin antagonism by placental hormones (cortisol and insulinase) leads to increased
blood glucose levels.
Risk factors for GDM
AMA >30
Obesity
family hx Type II diabetes
Hx macrosomic infant, unexplained loss, infant with congenital anomalies
Latina, NA, africans, asian increased risk bc of horrible american diet
Maternal risks associated with GDM
Hypertensive disorders
PTL
*Infections
Birth complications r/t macrosomia (lacerations, c/s, epis)
Fetal risks associated with GDM
Hypoglycemia
same rate of congenital anomalies as regular population (GDM develops after
organogenesis in early pregnancy)

Glucose tolerance Test

Screening at 24-28 weeks
if mom fails 1 hour GCT (>140 is positive result-fails)
order GTT.
3 DAYS of carb rich diet and nothing after midnight the night before. in the morning
check fasting BG, then she drinks 100g drink
fasting < 95
1 hour <180
2 hour<155
3 hour <140
GDM during L&D
manage glucose control, can have IV with D5NS-sugar needed for energy in
labor. or LR (to prevent hypoglycemia), monitor blood sugars every hour.
should be under 140!!

*continuous FHM!!
If C/S: NPO, no AM insulin.schedule early. if over 4000g, offered a C/S,
fasting and no insulin in AM!!!
The nurse is preparing to discharge a 30-year-old woman who has
experienced a miscarriage at 10 weeks of gestation. Which statement by the
woman would indicate a correct understanding of the discharge instructions?

A. "I will not experience mood swings since I was only at 10 weeks of
gestation."
B. "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months."
C. "I should eat foods that are high in iron and protein to help my body heal."
D. "I should expect the bleeding to be heavy and bright red for at least 1
week."
C

("I should eat foods that are high in iron and protein to help my body heal."

After a miscarriage a woman may experience mood swings and depression

from the reduction of hormones and the grieving process. Sexual intercourse
should be avoided for 2 weeks or until the bleeding has stopped and should
avoid pregnancy for 2 months. A woman who has experienced a miscarriage
should be advised to eat foods that are high in iron and protein to help
replenish her body after the loss. The woman should not experience bright
red, heavy, profuse bleeding; this should be reported to the health care
provider.)
A woman with severe preeclampsia is receiving a magnesium sulfate infusion.
The nurse becomes concerned after assessment when the woman exhibits:

A. a sleepy, sedated affect.

B. a respiratory rate of 10 breaths/min.
C. deep tendon reflexes of 2+.
D. absent ankle clonus.
B

(a respiratory rate of 10 breaths/min.

Because magnesium sulfate is a central nervous system (CNS) depressant,

the client will most likely become sedated when the infusion is initiated. A
respiratory rate of 10 breaths/min indicates that the client is experiencing
respiratory depression (bradypnea) from magnesium toxicity. Deep tendon
reflexes of 2+ are a normal finding. Absent ankle clonus is a normal finding.)
A woman with severe preeclampsia is being treated with an IV infusion of
magnesium sulfate. This treatment is considered successful if:

A. blood pressure is reduced to prepregnant baseline.

B. seizures do not occur.
C. deep tendon reflexes become hypotonic.
D. diuresis reduces fluid retention.
B

(seizures do not occur.

A temporary decrease in blood pressure can occur; however, this is not the
purpose of administering this medication. Magnesium sulfate is a central
nervous system (CNS) depressant given primarily to prevent seizures.
Hypotonia is a sign of an excessive serum level of magnesium. It is critical
that calcium gluconate be on hand to counteract the depressant effects of
magnesium toxicity. Diuresis is not an expected outcome of magnesium
sulfate administration.)
A woman with severe preeclampsia has been receiving magnesium sulfate by
IV infusion for 8 hours. The nurse assesses the woman and documents the
following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory
rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon
reflexes, and no ankle clonus. The nurse calls the physician, anticipating an
order for:

A. hydralazine.
B. magnesium sulfate bolus .
C. diazepam.
D. calcium gluconate.
A

(hydralazine.

Hydralazine is an antihypertensive commonly used to treat hypertension in

severe preeclampsia. An additional bolus of magnesium sulfate may be
ordered for increasing signs of central nervous system irritability related to
severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam
sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate
is used as the antidote for magnesium sulfate toxicity. The client is not
currently displaying any signs or symptoms of magnesium toxicity.)
The most prevalent clinical manifestation of abruptio placentae (as opposed to
placenta previa) is:

A. bleeding.
B. intense abdominal pain.
C. uterine activity.
D. cramping.
B

(intense abdominal pain.

Bleeding may be present in varying degrees for both placental conditions.

Pain is absent with placenta previa and may be agonizing with abruptio
placentae. Uterine activity may be present with both placental conditions.
Cramping is a form of uterine activity that may be present in both placental
conditions.)
A woman at 39 weeks of gestation with a history of preeclampsia is admitted
to the labor and birth unit. She suddenly experiences increased contraction
frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense,
painful abdomen. The nurse suspects the onset of:

A. eclamptic seizure.
B. rupture of the uterus.
C. placenta previa.
D. placental abruption.
D

(placental abruption.

Eclamptic seizures are evidenced by the presence of generalized tonic-clonic

convulsions. Uterine rupture presents as hypotonic uterine activity, signs of
hypovolemia, and in many cases the absence of pain. Placenta previa
presents with bright red, painless vaginal bleeding. Uterine tenderness in the
presence of increasing tone may be the earliest finding of premature
separation of the placenta (abruptio placentae or placental abruption). Women
with hypertension are at increased risk for an abruption.)
In caring for the woman with disseminated intravascular coagulation (DIC),
what order should the nurse anticipate?

A. Administration of blood
B. Preparation of the woman for invasive hemodynamic monitoring
C. Restriction of intravascular fluids
D. Administration of steroids
A

(Administration of blood

Primary medical management in all cases of DIC involves correction of the

underlying cause, volume replacement, blood component therapy,
optimization of oxygenation and perfusion status, and continued
reassessment of laboratory parameters. Central monitoring would not be
ordered initially in a woman with DIC because this can contribute to more
areas of bleeding. Management of DIC includes volume replacement, not
volume restriction. Steroids are not indicated for the management of DIC.)
Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks
of gestation. What is an appropriate management approach for this type of
abortion?

A. Prepare the woman for a dilation and curettage (D&C).

B. Place the woman on bed rest for at least 1 week and reevaluate.
C. Prepare the woman for an ultrasound and blood work.
D. Comfort the woman by telling her that if she loses this baby, she may
attempt to get pregnant again in 1 month.
C

(Prepare the woman for an ultrasound and blood work.

D&C is not considered until signs of the progress to an inevitable abortion are
noted or the contents are expelled and incomplete. Bed rest is recommended
for 48 hours initially. Repetitive transvaginal ultrasounds and measurement of
human chorionic gonadotropin (hCG) and progesterone levels may be
performed to determine if the fetus is alive and within the uterus. If the
pregnancy is lost, the woman should be guided through the grieving process.
Telling the client that she can get pregnant again soon is not a therapeutic
response because it discounts the importance of this pregnancy.)
A woman diagnosed with marginal placenta previa gave birth vaginally 15
minutes ago. At the present time she is at the greatest risk for:

A. hemorrhage.
B. infection.
C. urinary retention.
D. thrombophlebitis.
A

(hemorrhage.

Hemorrhage is the most immediate risk because the lower uterine segment
has limited ability to contract to reduce blood loss. Infection is a risk because
of the location of the placental attachment site; however, it is not a priority
concern at this time. Placenta previa poses no greater risk for urinary
retention than with a normally implanted placenta. There is no greater risk for
thrombophlebitis than with a normally implanted placenta.)
The nurse is caring for a woman who is at 24 weeks of gestation with
suspected severe preeclampsia. Which signs and symptoms would the nurse
expect to observe? (Select all that apply.)

A. Decreased urinary output and irritability

B. Transient headache and +1 proteinuria
C. Ankle clonus and epigastric pain
D. Platelet count of less than 100,000/mm3 and visual problems
E. Seizure activity and hypotension
A, C, D

(Decreased urinary output and irritability are signs of severe eclampsia. Ankle
clonus and epigastric pain are signs of severe eclampsia. Platelet count of
less than 100,000/mm3 and visual problems are signs of severe
preeclampsia. A transient headache and +1 proteinuria are signs of
preeclampsia and should be monitored. Seizure activity and hyperreflexia are
signs of eclampsia.)
The emergency department nurse is assessing a pregnant trauma victim who
just arrived at the hospital. What are the nurse's MOST appropriate actions?
(Select all that apply.)

A. Place the patient in a supine position.

B. Assess for point of maximal impulse at fourth intercostal space.
C. Collect urine for urinalysis and culture.
D. Frequent vital sign monitoring.
E. Assist with ambulation to decrease risk of thrombosis.
B, C, D

(Passive regurgitation may occur if patient is supine, leading to high risk for
aspiration. Placental perfusion is decreased when the patient is in a supine
position as well. The heart is displaced upward and to the left in pregnant
patients. During pregnancy, there is dilation of the ureters and urethra, and
the bladder is displaced forward placing the pregnant trauma patient at higher
risk for urinary stasis, infection, and bladder trauma. The trauma patient can
suffer blood loss and other complications, necessitating frequent monitoring of
vital signs. While the pregnant patient is at risk for thrombus formation, the
patient must be cleared by the health care provider before ambulating. The
pregnant trauma patient is at higher risk for pelvic fracture, and therefore this
condition must be ruled out first as well.)
A pregnant woman presents to the emergency department complaining of
persistent nausea and vomiting. She is diagnosed with hyperemesis
gravidarum. The nurse should include which information when teaching about
diet for hyperemesis? (Select all that apply.)

A. Eat three larger meals a day.

B. Eat a high-protein snack at bedtime.
C. Ice cream may stay down better than other foods.
D. Avoid ginger tea or sweet drinks.
E. Eat what sounds good to you even if your meals are not well-balanced.
B, C, E

(The diet for hyperemesis includes:

• Avoid an empty stomach. Eat frequently, at least every 2 to 3 hours.

Separate liquids from solids and alternate every 2 to 3 hours.
• Eat a high-protein snack at bedtime.
• Eat dry, bland, low-fat, and high-protein foods. Cold foods may be better
tolerated than those served at a warm temperature.
• In general eat what sounds good to you rather than trying to balance your
meals.
• Follow the salty and sweet approach; even so-called junk foods are okay.
• Eat protein after sweets.
• Dairy products may stay down more easily than other foods.
• If you vomit even when your stomach is empty, try sucking on a Popsicle.
• Try ginger tea. Peel and finely dice a knuckle-sized piece of ginger and
place it in a mug of boiling water. Steep for 5 to 8 minutes and add brown
sugar to taste.
• Try warm ginger ale (with sugar, not artificial sweetener) or water with a slice
of lemon.
• Drink liquids from a cup with a lid.)
A pregnant patient has a systolic blood pressure that exceeds 160 mm Hg.
Which action should the nurse take for this patient?

A. Administer magnesium sulfate intravenously.

B. Obtain a prescription for antihypertensive medications.
C. Restrict intravenous and oral fluids to 125 mL/hr.
D. Monitor fetal heart rate (FHR) and uterine contractions (UCs).
B

(Systolic blood pressure exceeding 160 mm Hg indicates severe hypertension

in the patient. The nurse should alert the health care provider and obtain a
prescription for antihypertensive medications, such as nifedipine (Adalat) and
labetalol hydrochloride (Normodyne). Magnesium sulfate would be
administered if the patient was experiencing eclamptic seizures. Oral and
intravenous fluids are restricted when the patient is at risk for pulmonary
edema. Monitoring FHR and UCs is a priority when the patient experiences a
trauma so that any complications can be addressed immediately.)
The nurse observes that maternal hypotension has decreased uterine and
fetal perfusion in a pregnant patient. What does the nurse need to assess
further to understand the maternal status?

A. D-dimer blood test

B. Kleihauer-Betke (KB) test
C. Electronic fetal monitoring
D. Electrocardiogram reading
C

(Electronic fetal monitoring reflects fetal cardiac responses to hypoxia and

hypoperfusion and helps to assess maternal status after a trauma. The D-
dimer blood test is used to rule out the presence of a thrombus. The KB test is
used to evaluate transplacental hemorrhage. Electrocardiogram reading is
more useful to assess the cardiac functions in nonpregnant cardiac patients.)
What does the nurse advise a pregnant patient who is prescribed
phenazopyridine (Pyridium) for cystitis?

A. "Avoid sweet foods in diet."

B. "Limit exposure to sunlight."
C. "Do not wear contact lenses."
D. "Restrict oral fluids to 125 mL per hour."
C

(Phenazopyridine (Pyridium) colors the tears orange. Therefore the nurse

instructs the patient to avoid wearing contact lenses. Sweet foods are avoided
in patients with diabetes mellitus, because they can cause fluctuating glucose
levels, which may harm the fetus. Exposure to sunlight is avoided when the
patient is receiving methotrexate therapy, because it causes photosensitivity.
Oral fluids are restricted in patients who are at risk for pulmonary edema.)
A patient reports excessive vomiting in the first trimester of the pregnancy,
which has resulted in nutritional deficiency and weight loss. The urinalysis
report of the patient indicates ketonuria. Which disorder does the patient
have?

A. Preeclampsia
B. Hyperthyroid disorder
C. Gestational hypertension
D. Hyperemesis gravidarum
D

(Hyperemesis gravidarum is characterized by excessive vomiting during

pregnancy, which causes nutritional deficiency and weight loss. The presence
of ketonuria is another indication of this disorder. Preeclampsia refers to
hypertension and proteinuria in patients after 20 weeks' gestation.
Hyperthyroid disorder may be one of the causes of hyperemesis gravidarum.
Gestational hypertension also develops after 20 weeks' gestation.)
Which hypertensive disorders can occur during pregnancy? Select all that
apply.

A. Chronic hypertension
B. Preeclampsia-eclampsia
C. Hyperemesis gravidarum
D. Gestational hypertension
E. Gestational trophoblastic disease
A, B, D

(Chronic hypertension refers to hypertension that developed in the pregnant

patient before 20 weeks' gestation. Preeclampsia refers to hypertension and
proteinuria that develops after 20 weeks' gestation. Eclampsia is the onset of
seizure activity in a pregnant patient with preeclampsia. Gestational
hypertension is the onset of hypertension after 20 weeks' gestation.
Gestational trophoblastic disease and hyperemesis gravidarum are not
hypertensive disorders. Gestational trophoblastic disease refers to a disorder
without a viable fetus that is caused by abnormal fertilization. Hyperemesis
gravidarum is excessive vomiting during pregnancy that may result in weight
loss and electrolyte imbalance.)
A pregnant patient in the first trimester reports spotting of blood with the
cervical os closed and mild uterine cramping. What does the nurse need to
assess? Select all that apply.

A. Progesterone levels
B. Transvaginal ultrasounds
C. Human chorionic gonadotropin (hCG) measurement
D. Blood pressure
E. Kleihauer-Betke (KB) test reports
A, B, C

(The spotting of blood with the cervical os closed and mild uterine cramping in
the first trimester indicates a threatened miscarriage. Therefore the nurse
needs to assess progesterone levels, transvaginal ultrasounds, and
measurement of hCG to determine whether the fetus is alive and within the
uterus. Blood pressure measurements do not help determine the fetal status.
KB assay is prescribed to identify fetal-to-maternal bleeding, usually after a
trauma.)
Which conditions during pregnancy can result in preeclampsia in the patient?
Select all that apply.

A. Genetic abnormalities
B. Dietary deficiencies
C. Abnormal trophoblast invasion
D. Cardiovascular changes
E. Maternal hypotension
A, B, C, D

(Current theories consider that genetic abnormalities and dietary deficiencies

can result in preeclampsia. Abnormal trophoblast invasion causes fetal
hypoxia and results in maternal hypertension. Cardiovascular changes
stimulate the inflammatory system and result in preeclampsia in the pregnant
patient. Maternal hypertension, and not hypotension, after 20 weeks' gestation
is known as preeclampsia.)
Which condition is seen in a pregnant patient if uterine artery Doppler
measurements in the second trimester of pregnancy are abnormal?

A. Preeclampsia
B. HELLP syndrome
C. Molar pregnancy
D. Gestational hypertension
A

(Preeclampsia is a condition in which patients develop hypertension and

proteinuria after 20 weeks' gestation. It can be diagnosed if uterine artery
Doppler measurements in the second trimester of pregnancy are abnormal.
HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes
(EL), and low platelet count (LP) in a patient with preeclampsia. Molar
pregnancy refers to the growth of the placental trophoblast due to abnormal
fertilization. Gestational hypertension is a condition in which hypertension
develops in a patient after 20 weeks' gestation.)
A woman with severe preeclampsia has been receiving magnesium sulfate by
intravenous infusion for 8 hours. The nurse assesses the woman and
documents the following findings: temperature 37.1° C, pulse rate 96
beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg,
3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician,
anticipating an order for:

A. hydralazine.
B. magnesium sulfate bolus.
C. diazepam.
D. morphine
A

(Hydralazine is an antihypertensive commonly used to treat hypertension in

severe preeclampsia. An additional bolus of magnesium sulfate may be
ordered for increasing signs of central nervous system irritability related to
severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam
sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate
is used as the antidote for magnesium sulfate toxicity. The patient is not
currently displaying any signs or symptoms of magnesium toxicity.)
After being rehydrated in the emergency department, a 24 year-old primipara
in her 18th week of pregnancy is at home and is to rest at home for the next
two days and take in small but frequent fluids and food as possible. Discharge
teaching at the hospital by the nurse has been effective if the patient makes
which statement?
"A. I'm going to eat five to six small servings per day, which contain such
foods and fluids as tea, crackers, or a few bites of baked potato."
B. "A strip of bacon and a fried egg will really taste good as long as I eat them
slowly."
C. "As long as I eat small amounts and allow enough time for digestion, I can
eat almost anything, like barbequed chicken or spaghetti."
D. "I'm going to stay only on clear fluids for the next 24 hours and then add
dairy products like eggs and milk."
A

(Once the vomiting has stopped, feedings are started in small amounts at
frequent intervals. In the beginning, limited amounts of oral fluids and bland
foods such as crackers, toast, or baked chicken are offered. Clear fluids alone
do not contain enough calories and contain no protein. Most women are able
to take nourishment by mouth after several days of treatment. They should be
encouraged to eat small, frequent meals and foods that sound appealing
(e.g., nongreasy, dry, sweet, and salty foods).

Test-Taking Tip: Many times the correct answer is the longest alternative
given, but do not count on it. NCLEX item writers (those who write the
questions) are also aware of this and attempt to avoid offering you such
"helpful hints.")
Which intervention does the nurse implement for a patient immediately after a
severe abdominal trauma?

A. Prep the patient for cesarean birth.

B. Send the patient for pelvic computed tomography (CT) scanning.
C. Provide fluids to the patient as part of the protocol for ultrasound
examination.
D. Prepare to administer Rho(D) immunoglobulin.
B

(Pelvic CT scanning helps visualize extraperitoneal and retroperitoneal

structures and the genitourinary tract. The nurse needs to prepare the patient
for cesarean birth if there is no evidence of a maternal pulse. Ultrasound
examination is not as effective as electronic fetal monitoring for determining
placental abruption in the patient after the trauma. Therefore the nurse
prepares the patient for a CT scan after a severe abdominal trauma. The
nurse needs to administer Rho(D) immunoglobulin in an Rh-negative
pregnant trauma patient. This helps protect the patient from isoimmunization.)
A woman at 37 weeks of gestation is admitted with a placental abruption after
a motor vehicle accident. Which assessment data are most indicative of her
condition worsening?

A. Pulse (P) 112, respiration (R) 32, blood pressure (BP) 108/60; fetal heart
rate (FHR) 166--178
B. P 98, R 22, BP 110/74; FHR 150--162
C. P 88, R 20, BP 114/70; FHR 140--158
D. P 80, R 18, BP 120/78; FHR 138--150
A

(Bleeding is the most dangerous problem, which impacts the mother's well-
being as well as that of her fetus. The decreasing blood volume would cause
increases in pulse and respirations and a decrease in blood pressure. The
fetus often responds to decreased oxygenation as a result of bleeding,
causing a decrease in perfusion. This causes the fetus' heart rate to increase
above the normal range of 120--160 beats per minute. The other options have
measurements that are in the "normal" range and would not reflect a
deterioration of the patient's physical status.

Test-Taking Tip: Do not worry if you select the same numbered answer
repeatedly, because there usually is no pattern to the answers.)
The nurse is caring for a woman who is at 24 weeks of gestation with
suspected severe preeclampsia. Which signs and symptoms should the nurse
expect to observe? Select all that apply.

A. Decreased urinary output and irritability

B. Transient headache and +1 proteinuria
C. Ankle clonus and epigastric pain
D. Platelet count of less than 100,000/mm3 and visual problems
E. Seizure activity and hypotension
A, C, D

(Decreased urinary output and irritability are signs of severe eclampsia. Ankle
clonus and epigastric pain are signs of severe eclampsia. Platelet count of
less than 100,000/mm3 and visual problems are signs of severe
preeclampsia. A transient headache and +1 proteinuria are signs of
preeclampsia and should be monitored.Seizure activity and hyperreflexia are
signs of eclampsia.

Test-Taking Tip: Do not worry if you select the same numbered answer
repeatedly, because there usually is no pattern to the answers.)
A pregnant patient reports abdominal pain in the right lower quadrant, along
with nausea and vomiting. The patient's urinalysis report shows an absence of
any urinary tract infection in the patient. A chest x-ray also rules out lower-
lobe pneumonia. Which condition does the nurse suspect in the patient?

A. Appendicitis
B. Cholelithiasis
C. Placenta previa
D. Uterine rupture
A

(Abdominal pain in the right lower quadrant, accompanied by nausea and

vomiting, indicates appendicitis in a pregnant patient. Cholelithiasis is
characterized by right upper quadrant pain. Placenta previa is a condition
wherein the placenta is implanted in the lower uterine segment covering the
cervix, which causes bleeding when the cervix dilates. Uterine rupture is seen
in a pregnant patient as a result of trauma, which may cause fetal death.)
The nurse observes that a pregnant patient with gestational hypertension who
is on magnesium sulfate therapy is prescribed nifedipine (Adalat). What action
does the nurse take?

A. Evaluates the patient's renal function test

B. Obtains a prescription for a change of drug
C. Reduces the nifedipine (Adalat) dose by 50%
D. Administers both medications simultaneously
B

(Concurrent use of nifedipine (Adalat) and magnesium sulfate can result in

skeletal muscle blockade in the patient. Therefore the nurse needs to report
immediately to the primary health care provider (PHP) and obtain a
prescription for a change of drug. The nurse assesses the patient's renal
function to determine the risk for toxicity after administering any drug.
However, it is not a priority in this case. Reducing the nifedipine (Adalat) dose
is not likely to prevent the drug interaction in the patient. The nurse does not
administer both drugs simultaneously because it may be harmful for the
patient.)
A pregnant woman presents to the emergency department complaining of
persistent nausea and vomiting. She is diagnosed with hyperemesis
gravidarum. The nurse should include which information when teaching about
diet for hyperemesis? Select all that apply.

A. Eat three larger meals a day.

B. Eat a high-protein snack at bedtime.
C. Ice cream may stay down better than other foods.
D. Avoid ginger tea or sweet drinks.
E. Eat what sounds good to you even if your meals are not well-balanced.
B, C, E

(The diet for hyperemesis includes: (1) Avoid an empty stomach. Eat
frequently, at least every 2 to 3 hours. Separate liquids from solids and
alternate every 2 to 3 hours. (2) Eat a high-protein snack at bedtime. (3) Eat
dry, bland, low-fat, and high-protein foods. Cold foods may be better tolerated
than those served at a warm temperature. (4) In general eat what sounds
good to you rather than trying to balance your meals. (5) Follow the salty and
sweet approach; even so-called junk foods are okay. (6) Eat protein after
sweets. (7) Dairy products may stay down more easily than other foods. (8) If
you vomit even when your stomach is empty, try sucking on a Popsicle. (9)
Try ginger tea. Peel and finely dice a knuckle-sized piece of ginger and place
it in a mug of boiling water. Steep for 5 to 8 minutes and add brown sugar to
taste. (10) Try warm ginger ale (with sugar, not artificial sweetener) or water
with a slice of lemon. (11) Drink liquids from a cup with a lid.)
A woman diagnosed with marginal placenta previa gave birth vaginally 15
minutes ago. At the present time, she is at the greatest risk for:

A. hemorrhage.
B. infection.
C. urinary retention.
D. thrombophlebitis.
A

(Hemorrhage is the most immediate risk because the lower uterine segment
has limited ability to contract to reduce blood loss. Infection is a risk because
of the location of the placental attachment site; however, it is not a priority
concern at this time. Placenta previa poses no greater risk for urinary
retention than with a normally implanted placenta. There is no greater risk for
thrombophlebitis than with a normally implanted placenta.)
Which condition in a pregnant patient with severe preeclampsia is an
indication for administering magnesium sulfate?

A. Seizure activity
B. Renal dysfunction
C. Pulmonary edema
D. Low blood pressure (BP)
A

(Severe preeclampsia may cause seizure activity or eclampsia in the patient,

which is treated with magnesium sulfate. Magnesium sulfate is not
administered for renal dysfunction and can cause magnesium toxicity in the
patient. Pulmonary enema can be prevented by restricting the patient's fluid
intake to 125 mL/hr. Increasing magnesium toxicity can cause low BP in the
patient.)
What action does the nurse take to relieve choking in a pregnant patient who
is in the third trimester?

A. Administering anesthesia
B. Administering chest thrusts
C. Placing a towel under the hips
D. Positioning the patient onto one side
B

(Choking is often relieved in patients by administering abdominal thrusts.

However if the patient is in the third trimester of pregnancy, chest thrusts are
administered to prevent injury to the uterus. Administering anesthesia or
positioning the patient onto one side will not help dislodge the object and
relieve choking. The nurse needs to place a towel under the hips to displace
the uterus while administering cardiopulmonary resuscitation (CPR).)
Which clinical reports does the nurse evaluate to identify ectopic pregnancy in
a patient? Select all that apply.

A. Quantitative human chorionic gonadotropin (β-hCG) levels

B. Transvaginal ultrasound
C. Progesterone level
D. Thyroid test reports
E. Kleihauer-Betke (KB) test
A, B, C
(An ectopic pregnancy is indicated when β-hCG levels are >1500 milli-
international units/mL but no intrauterine pregnancy is seen on the
transvaginal ultrasound. A transvaginal ultrasound is repeated to verify if the
pregnancy is inside the uterus. A progesterone level <5 ng/mL indicates
ectopic pregnancy. Thyroid test reports need to be evaluated in case the
patient has hyperemesis gravidarum, as hyperthyroidism is associated with
this disorder. The KB test is used to determine transplacental hemorrhage.)
The nurse is caring for a pregnant patient who is receiving antibiotic therapy
to treat a urinary tract infection (UTI). Which dietary changes does the nurse
suggest for the pregnant patient who is receiving antibiotic therapy for UTI?

A. "Include yogurt, cheese, and milk in your diet."

B. "Avoid folic acid supplements until the end of therapy."
C. "Include vitamins C and E supplementation in your diet."
D. "Reduce your dietary fat intake by 40 to 50 g per day.
A

(The antibiotic therapy kills normal flora in the genitourinary tract, as well as
pathologic organisms. Therefore the nurse instructs the patient to include
yogurt, cheese, and milk in daily diet because they contain active acidophilus
cultures. Folic acid should not be avoided, because it may affect the fetal
development. Vitamins C and E supplementation is usually included in the
diet to treat preeclampsia in a patient. Dietary fat is reduced in patients with
cholecystitis or cholelithiasis, because it may cause epigastric pain.)
A pregnant patient with severe preeclampsia who is being transported to a
tertiary care center needs to be administered magnesium sulfate injection for
seizure activity. What actions does the nurse take when administering the
drug? Select all that apply.

A. A 10-g dose is administered in the buttock.

B. A local anesthetic is added to the solution.
C. The Z-track technique is used to inject the drug.
D. The injection site is massaged after the injection.
E. The subcutaneous route is used to inject the drug.
B, C, D

(The nurse adds a local anesthetic to the solution to reduce pain that is
caused by the injection. The Z-track technique is used to inject the drug so
that the drug is injected in the intramuscular (IM) tissue safely. The nurse
gently massages the site after administering the injection to reduce pain. The
nurse administers two separate injections of 5 g in each buttock. Magnesium
sulfate injections are administered in the IM layer and not the subcutaneous
layer.)
At 37 weeks of gestation, the patient is in a severe automobile crash where
her abdomen was hit by the steering wheel and her seat belt. What actions
would the emergency room nurse expect to perform upon the patient's arrival
at the hospital?

A. Stay with the patient, assure a patent airway is present, and keep the
patient as calm as possible.
B. Move the patient's skirt to determine if any vaginal bleeding is present, find
out who to call, and monitor the level of consciousness.
C. Assess the patient's vital signs, determine location and severity of pain,
and establish continual fetal heart rate monitoring.
D. Obtain arterial blood gases, obtain a hemoglobin and hematocrit, and
oxygen saturation rate.
C

(Full assessment of the patient and her fetus are essential and include vital
signs, continual fetal heart rate monitoring, determining the location and
severity of pain, whether any vaginal bleeding is dark red or bright red, and
the status of the abdomen, which would be expected to be rigid or "board
like." Staying with the patient, assuring a patent airway is present, and
keeping the patient as calm as possible would be appropriate at the crash site
before the arrival of emergency medical services (EMS). The current status of
the patient and fetus are thepriority. The health care provider would prescribe
the arterial blood gases and other laboratory work after the patient is
assessed and stabilized.)
A 24-year-old primipara, who is 18 weeks pregnant, has been having
increasing vomiting since she was 8 weeks pregnant. Upon arrival at the
emergency department, her skin turgor is diminished, temperature is 99.2F
(o), pulse is 102, respiration is 18, blood pressure is 102/68, and she has
deep furrows on her tongue. What would the nurse expect to do to care for
her? Select all that apply.

A. Start an intravenous infusion.

B. Check her urine for ketones
C. Cross match blood for a transfusion.
D. Obtain a complete history.
E. Obtain blood for a complete blood count
A, B, D, E

(Whenever a pregnant woman has nausea and vomiting, the first priority is a
thorough assessment to determine the severity of the problem. In most cases
the woman should be told to come immediately to the health care provider's
office or the emergency department because the severity of the illness often is
difficult to determine by telephone conversation. The assessment should
include frequency, severity, and duration of episodes of nausea and vomiting.
If the woman reports vomiting, the assessment also should include the
approximate amount and color of the vomitus. The woman is asked to report
any precipitating factors relating to the onset of her symptoms. Any
pharmacologic or nonpharmacologic treatment measures used should be
recorded. Prepregnancy weight and documented weight gain or loss during
pregnancy are important to note. The woman's weight and vital signs are
measured, and a complete physical examination is performed, with attention
to signs of fluid and electrolyte imbalance and nutritional status. The most
important initial laboratory test to be obtained is a determination of ketonuria.
Other laboratory tests that may be prescribed are a urinalysis, a complete
blood cell count, electrolytes, liver enzymes, and bilirubin levels. At this time,
there is no supportive evidence that a blood transfusion is required. Based on
provided objective data that the patient has deep furrows on her tongue, this
may suggest a vitamin B deficiency which should be investigated further.)
A pregnant patient is at risk for cardiac arrest as a result of profound
hypovolemia after a trauma. Which action does the nurse take? The nurse:

A. Assesses airway, breathing, and pulse rate.

B. Administers warmed crystalloid solutions.
C. Administers calcium gluconate intravenously.
D. Obtains a prescription for magnesium sulfate.
B

(The nurse administers warmed crystalloid solutions for massive fluid

resuscitation in the patient who has profound hypovolemia after a trauma. The
nurse needs to assess the airway, breathing, and pulse in a patient after a
convulsion so that prompt actions can be taken to stabilize the patient. The
nurse administers calcium gluconate as an antidote to a patient who has
magnesium toxicity. The nurse may administer magnesium sulfate for the
treatment of eclamptic seizures in a patient with preeclampsia.)
Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks
of gestation. What is an appropriate management approach for this type of
abortion?

A. Prepare the woman for a dilation and curettage (D&C).

B. Place the woman on bed rest for at least 1 week and reevaluate.
C. Prepare the woman for an ultrasound and bloodwork.
D. Comfort the woman by telling her that if she loses this baby, she may
attempt to get pregnant again in 1 month.
C

(Repetitive transvaginal ultrasounds and measurement of human chorionic

gonadotropin (hCG) and progesterone levels may be performed to determine
if the fetus is alive and within the uterus. If the pregnancy is lost , the woman
should be guided through the grieving process. D&C is not considered until
signs of the progress to an inevitable abortion are noted or the contents are
expelled and incomplete. Bed rest is recommended for 48 hours initially.
Telling the woman that she can get pregnant again soon is not a therapeutic
response because it discounts the importance of this pregnancy.)
Which intervention will help prevent the risk of pulmonary edema in a
pregnant patient with severe preeclampsia?

A. Assess fetal heart rate (FHR) abnormalities regularly.

B. Place the patient on bed rest in a darkened environment.
C. Restrict total intravenous (I.V.) and oral fluids to 125 mL/hr.
D. Ensure that magnesium sulfate is administered as prescribed.
C

(Pulmonary edema may be seen in patients with severe preeclampsia.

Therefore the nurse needs to restrict total intravenous (I.V.) and oral fluids to
125 mL/hr. FHR monitoring helps assess any fetal complications. The patient
is placed on bed rest in a darkened environment to prevent stress.
Magnesium sulfate is administered to prevent eclamptic seizures.)
A blunt abdominal trauma causes fetal hemorrhage in a pregnant patient. The
nurse finds that the patient is Rh negative. What action does the nurse take?

A. Initiate magnesium sulfate per protocol.

B. Administer oxytocin (pitocin).
C. Administer prescribed Rho (D) immunoglobulin.
D. Prepare the patient for magnetic resonance imaging (MRI).
C

(The nurse administers the prescribed Rho(D) immunoglobulin to the patient

to protect the patient from isoimmunization. The nurse needs to obtain a
prescription for magnesium sulfate if there are eclamptic seizures in a patient
with preeclampsia. Oxytocin (Pitocin) is administered to prevent bleeding after
birth or the evacuation of the uterus. Magnetic resonance imaging (MRI) is
used to assess injuries in a patient after trauma.)
Which is an important nursing intervention when a patient has an incomplete
miscarriage with heavy bleeding?

A. Initiate expectant management at once.

B. Prepare the patient for dilation and curettage.
C. Administer the prescribed oxytocin (Pitocin).
D. Obtain a prescription for ergonovine (Methergine).
B

(In the case of an incomplete miscarriage, sometimes there is heavy bleeding

and excessive cramping and some part of fetal tissue remains in the uterus.
Therefore the nurse needs to prepare the patient for dilation and curettage for
the removal of the fetal tissue. Expectant management is initiated if the
pregnancy continues after a threatened miscarriage. Oxytocin (Pitocin) is
administered to prevent hemorrhage after evacuation of the uterus.
Ergonovine (Methergine) is administered to contract the uterus.)
What does the nurse include in the plan of care of a pregnant patient with mild
preeclampsia? Select all that apply.

A. Ensure prolonged bed rest.

B. Provide diversionary activities.
C. Encourage the intake of more fluids.
D. Restrict sodium and zinc in the diet.
E. Refer to Internet-based support group
B, C, E

(Activity is restricted in patients with preeclampsia, so it is necessary to

provide diversionary activities to such patients to prevent boredom. The nurse
encourages the patient to increase fluid intake to enhance renal perfusion and
bowel function. The nurse can suggest Internet-based support groups to
reduce boredom and stress in the patient. Patients need to restrict activity, but
complete bed rest is not advised because it may cause cardiovascular
deconditioning, muscle atrophy, and psychological stress. The patient needs
to include adequate zinc and sodium in the diet for proper fetal development.)
The quantitative human chorionic gonadotropin (β-hCG) levels are high in a
patient who is on methotrexate therapy for dissolving abdominal pregnancy.
Which instruction does the nurse give to this patient?

A. "Avoid sexual activity."

B. "Avoid next pregnancy."
C. "Avoid feeling sad and low."
D. "Take folic acid without fail."
A

(High β-hCG levels indicate that the abdominal pregnancy is not yet
dissolved. Therefore the nurse advises the patient to avoid sexual activity until
the β-hCG levels drop and the pregnancy is dissolved completely. If the
patient engages in vaginal intercourse, the pelvic pressure may rupture the
mass and cause pain. Abdominal pregnancy increases the chances of
infertility or recurrent ectopic pregnancy in patients. However, the nurse need
not instruct the patient to avoid further pregnancy, because it may increase
the feelings of sadness and guilt in the patient. The nurse encourages the
patient to share feelings of guilt or sadness related to pregnancy loss. Folic
acid is contraindicated with methotrexate therapy, because it may exacerbate
ectopic rupture.)
A pregnant patient with chronic hypertension is at risk for placental abruption.
Which symptoms of abruption does the nurse instruct the patient to be alert
for? Select all that apply.

A. Weight loss
B. Abdominal pain
C. Vaginal bleeding
D. Shortness of breath
E. Uterine tenderness
B, C, E

(The nurse instructs the pregnant patient to be alert for abdominal pain,
vaginal bleeding, and uterine tenderness as these indicates placental
abruption. Weight loss indicates fluid and electrolyte loss and not placental
abruption. Shortness of breath indicates inadequate oxygen, which is usually
seen in a patient who is having cardiac arrest.)
Which is a priority nursing action when a pregnant patient with severe
gestational hypertension is admitted to the health care facility?

A. Prepare the patient for cesarean delivery.

B. Administer intravenous (I.V.) and oral fluids.
C. Provide diversionary activities during bed rest.
D. Administer the prescribed magnesium sulfate.
D

(The nurse administers the prescribed magnesium sulfate to the patient to

prevent eclamptic seizures. I.V. oral fluids are indicated when there is severe
dehydration in the patient. It is important to provide diversionary activities
during bed rest, but it is secondary in this case. A patient who has
experienced a multisystem trauma is prepared for cesarean delivery if there is
no evidence of a maternal pulse, which increases the chance of maternal
survival.)
What are the possible causes of miscarriage during early pregnancy? Select
all that apply.

A. Premature dilation of cervix

B. Chromosomal abnormalities
C. Endocrine imbalance
D. Hypothyroidism
E. Antiphospholipid antibodies
B, C, D, E

(Chromosomal abnormalities account for 50% of all early pregnancy losses.

Endocrine imbalance is caused by luteal phase defects, hypothyroidism, and
diabetes mellitus in pregnant patients and results in miscarriage.
Antiphospholipid antibodies also increase the chances of miscarriage in
pregnant patients. Premature dilation of the cervix may cause a second-
trimester loss and is usually seen in patients between 12 and 20 weeks'
gestation.)
A patient with gestational hypertension is prescribed labetalol hydrochloride
(Normodyne) therapy, which is continued after giving birth. What does the
nurse instruct the patient about breastfeeding?

A. "You may breastfeed the infant if you desire."

B. "Breastfeeding may cause convulsions in the infant."
C. "Breastfeed only once a day and use infant formulas."
D. "There may be high levels of the drug in the breast milk."
A

(Labetalol hydrochloride (Normodyne) has a low concentration in breast milk,

so the patient can breastfeed the infant. Breastfeeding is safe and will not
cause convulsions or any side effects in the infant. Infant formulas are used
only if the mother is unable to breastfeed the infant or if the mother does not
desire to breastfeed.)
What does the nurse assess to detect the presence of a hypertensive disorder
in a pregnant patient? Select all that apply.

A. Proteinuria
B. Epigastric pain
C. Placenta previa
D. Presence of edema
E. Blood pressure (BP)
A, B, D, E

(Proteinuria indicates hypertension in a pregnant patient. Proteinuria is

concentration ≥300 mg/24 hours in a 24-hour urine collection. The nurse
needs to assess the patient for epigastric pain because it indicates severe
preeclampsia. Hypertension is likely to cause edema or swollen ankles as a
result of greater hydrostatic pressure in the lower parts of the body. Therefore
the nurse needs to assess the patient for the presence of edema. Accurate
measurement of BP will help detect the presence of any hypertensive
disorder. A systolic BP greater than 140 mm Hg or a diastolic BP greater than
90 mm Hg will indicate hypertension. Placenta previa is a condition wherein
the placenta is implanted in the lower uterine segment covering the cervix,
which causes bleeding when the cervix dilates.)
The nurse is preparing to discharge a 30-year-old woman who has
experienced a miscarriage at 10 weeks of gestation. Which statement by the
woman indicates a correct understanding of the discharge instructions?

A. "I will not experience mood swings since I was only at 10 weeks of
gestation."
B. "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months."
C. "I should eat foods that are high in iron and protein to help my body heal."
D. "I should expect the bleeding to be heavy and bright red for at least 1
week."
C

(A woman who has experienced a miscarriage should be advised to eat foods

that are high in iron and protein to help replenish her body after the loss. After
a miscarriage, a woman may experience mood swings and depression from
the reduction of hormones and the grieving process. Sexual intercourse
should be avoided for 2 weeks or until the bleeding has stopped and should
avoid pregnancy for 2 months. The woman should not experience bright red,
heavy, profuse bleeding; this should be reported to the health care provider.)
A 24-year-old primipara, 10 weeks pregnant, who has been experiencing
vomiting every morning for the past few weeks, asks the nurse at her check-
up how long this "morning sickness" will continue. Which statement by the
nurse is most accurate?

A. "It will end by the 15th week of pregnancy."

B. "It usually subsides by the 20th week of pregnancy."
C. "It's a very common but not serious problem."
D. "In some women, it can last throughout the pregnancy and become
serious."
B

(This discomfort of pregnancy usually subsides by the 20th week of

pregnancy. An absolute definite end of vomiting during pregnancy can never
be stated.

Test-Taking Tip: Identifying content and what is being asked about that
content is critical to your choosing the correct response. Be alert for words in
the stem of the item that are the same or similar in nature to those in one or
two of the options. Example: If the item relates to and identifies stroke
rehabilitation as its focus and only one of the options contains the word stroke
in relation to rehabilitation, you are safe in identifying this choice as the
correct response.)
What does the nurse administer to a patient if there is excessive bleeding
after suction curettage?

A. Nifedipine (Procardia)
B. Methyldopa (Aldomet)
C. Hydralazine (Apresoline)
D. Ergonovine (Methergine)
D

(Ergonovine (Methergine) is an ergot product, which is administered to

contract the uterus when there is excessive bleeding after suction curettage.
Nifedipine (Procardia) is prescribed for gestational hypertension or severe
preeclampsia. Methyldopa (Aldomet) is an antihypertensive medication
indicated for pregnant patients with hypertension. Hydralazine (Apresoline) is
also an antihypertensive medication used for treating hypertension
intrapartum.)
What instruction does the nurse provide to a pregnant patient with mild
preeclampsia?

A. "You need to be hospitalized for fetal evaluation."

B. "Nonstress testing can be done once every month."
C. "Fetal movement counts need to be evaluated daily."
D. "Take complete bed rest during the entire pregnancy."
C

(Preeclampsia can affect the fetus and may cause fetal growth restrictions,
decreased amniotic fluid volume, abnormal fetal oxygenation, low birth weight,
and preterm birth. Therefore the fetal movements need to be evaluated daily.
Patients with mild preeclampsia can be managed at home effectively and
need not be hospitalized. Nonstress testing is performed once or twice per
week to determine fetal well-being. Patients need to restrict activity, but
complete bed rest is not advised because it may cause cardiovascular
deconditioning, muscle atrophy, and psychological stress.)
Which fetal risk is associated with an ectopic pregnancy?

A. Miscarriage
B. Fetal anemia
C. Preterm birth
D. Fetal deformity
D

(In an ectopic pregnancy, the risk for fetal deformity is high because of the
pressure deformities caused by oligohydramnios. There may be facial or
cranial asymmetry, various joint deformities, limb deficiency, and central
nervous system (CNS) anomalies. Miscarriage is not likely to happen in an
ectopic pregnancy. Instead, the patient is at risk for pregnancy-related death
resulting from ectopic rupture. Fetal anemia is a risk associated with placenta
previa. Preterm birth is not possible because the pregnancy is dissolved when
it is diagnosed or a surgery is performed to remove the fetus.)
Which instructions does the nurse give to a patient who is prescribed
methotrexate therapy for dissolving the tubal pregnancy?

A. "Discontinue folic acid supplements."

B. "Get adequate exposure to sunlight."
C. "Take stronger analgesics for severe pain."
D. "Vaginal intercourse is safe during the therapy."
A

(The nurse advises the patient to discontinue folic acid supplements as they
interact with methotrexate and may exacerbate ectopic rupture in the patient.
Exposure to sunlight is avoided as the therapy makes the patient
photosensitive. Analgesics stronger than acetaminophen are avoided,
because they may mask symptoms of tubal rupture. Vaginal intercourse is
avoided until the pregnancy is dissolved completely.)
A woman with severe preeclampsia is being treated with an intravenous
infusion of magnesium sulfate. This treatment is considered successful if:

A. blood pressure is reduced to prepregnant baseline.

B. seizures do not occur.
C. deep tendon reflexes become hypotonic.
D. diuresis reduces fluid retention
B

(Magnesium sulfate is a central nervous system (CNS) depressant given

primarily to prevent seizures . A temporary decrease in blood pressure can
occur; however, this is not the purpose of administering this medication.
Hypotonia is a sign of an excessive serum level of magnesium. It is critical
that calcium gluconate be on hand to counteract the depressant effects of
magnesium toxicity. Diuresis is not an expected outcome of magnesium
sulfate administration.)
The most prevalent clinical manifestation of abruptio placentae (as opposed to
placenta previa) is:

A. bleeding.
B. intense abdominal pain.
C. uterine activity.
D. cramping
B

(Pain is absent with placenta previa but may be agonizing with abruptio
placentae. Bleeding may be present in varying degrees for both placental
conditions. Uterine activity may be present with both placental conditions.
Cramping is a form of uterine activity that may be present in both placental
conditions.)