Complications of Pregnancy

Chapter 13: Pregnancy at Risk: Gestational Conditions
Test Bank
MULTIPLE CHOICE
1. Which statement is true about women who experience hyperemesis gravidarum?

a. Seventy percent of all pregnant women suffer from it at some point in pregnancy.
b. Such women have vomiting severe and persistent enough to cause weight loss,
dehydration, and electrolyte imbalance.
c. They need intravenous (IV) fluid and nutrition for most of their pregnancy.
d. They often inspire similar, milder symptoms in their male partners and mothers.
ANS: B
Women with hyperemesis gravidarum have severe vomiting; however, treatment for several days sets things right in most cases.
Although 70% of pregnant women experience nausea and vomiting, fewer than 1% proceed to this severe level. IV administration
may be used at first to restore fluid levels, but they are seldom needed for very long. Women suffering from this condition want
sympathy, because some authorities believe that difficult relationships with mothers or partners may be the cause.
DIF: Cognitive Level: Comprehension REF: page 310 OBJ: 6

TOP: Nursing Process: Assessment MSC: CRNE: CH-8
2. What should the nurse be aware of in relation to women who may need surgery during pregnancy?
a. The diagnosis of appendicitis may be difficult, because the normal signs and
symptoms mimic some normal changes in pregnancy.
b. Rupture of the appendix is less likely in pregnant women because of the close
monitoring.
c. Surgery for intestinal obstructions should be delayed as long as possible because it
usually affects the pregnancy.
d. When pregnancy takes over, a woman is less likely to have ovarian problems that
require invasive responses.
ANS: A
Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count. Rupture of the appendix is
two to three times more likely in pregnant women. Surgery to remove obstructions should be done right away. It usually does not
affect the pregnancy. Pregnancy predisposes a woman to ovarian problems.

3. Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)?

a. Bleeding time of 10 minutes
b. Presence of fibrin split products
c. Thrombocytopenia
d. Hyperfibrinogenemia
ANS: B
Degradation of fibrin leads to the accumulation of fibrin split products in the blood. Bleeding time in DIC is normal. Low platelets
may occur with, but are not indicative of, DIC because they may result from other coagulopathies. Hypofibrinogenemia would not
occur with DIC.
DIF: Cognitive Level: Knowledge REF: page 329 OBJ: 9

4. In caring for an immediate postpartum patient, you note petechiae and oozing from her IV site. Based on this assessment, what
clotting disorder would the nurse monitor her closely for?
a. Disseminated intravascular coagulation (DIC)
b. Amniotic fluid embolism (AFE)
c. Hemorrhage
d. HELLP syndrome
ANS: A
The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding.
Petechiae may appear around a blood pressure cuff on the woman’s arm. Excessive bleeding may occur from the site of a slight
trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage
occurs for a variety of reasons in the postpartum patient. These symptoms are associated with DIC. Hemorrhage would be a finding
associated with DIC and is not a clotting disorder in and of itself. HELLP is not a clotting disorder, but it may contribute to the
clotting disorder DIC.

TOP: Nursing Process: Planning MSC: CRNE: CH-1
Copyright © 2013 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 1
5. In caring for the woman with disseminated intravascular coagulation (DIC), which order should the nurse anticipate?
a. Administration of blood
b. Preparation of the patient for invasive hemodynamic monitoring
c. Restriction of intravascular fluids
d. Administration of steroids
ANS: A
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 patient with DIC because this can contribute to more areas of bleeding. Management
of DIC would include volume replacement, not volume restriction. Steroids are not indicated for the management of DIC.

6. A primigravida is being monitored in her prenatal clinic for pre-eclampsia. Which finding should concern her nurse?
a. Blood pressure (BP) increase to 138/86 mm Hg
b. Weight gain of 0.5 kg during the past 2 weeks
c. Urine protein reading of 0.05 g/L on two occasions
d. Pitting pedal edema at the end of the day
ANS: C
Proteinuria is defined as a concentration of 0.03 g/L or more in at least two random urine specimens and should alert the nurse that
additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or an increase in systolic
pressure of 30 mm Hg or 15 mm Hg diastolic pressure. Pre-eclampsia may manifest as a rapid weight gain of more than 2 kg in 1
week. Edema occurs in many normal pregnancies and in women with pre-eclampsia. Therefore, the presence of edema is no longer
considered diagnostic of pre-eclampsia.
DIF: Cognitive Level: Analysis REF: page 296 OBJ: 2

TOP: Nursing Process: Diagnosis MSC: CRNE: CH-6
7. The labour of a pregnant woman with pre-eclampsia is going to be induced. Before initiating the oxytocin infusion, the nurse
reviews the woman’s latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase
(AST) level, and a falling hematocrit. These findings are indicative of which of the following?
a. Eclampsia
b. Disseminated intravascular coagulation (DIC)
c. HELLP syndrome
d. Idiopathic thrombocytopenia
ANS: C
HELLP syndrome is a laboratory diagnosis for a variant of severe pre-eclampsia that involves hepatic dysfunction characterized by
hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a
potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown
cause and is not associated with pre-eclampsia.
DIF: Cognitive Level: Comprehension REF: pages 298-299

OBJ: 4 TOP: Nursing Process: Diagnosis MSC: CRNE: CH-6
8. A woman with pre-eclampsia has a seizure. What is the nurse’s priority intervention?
a. Ensure a patent airway.
b. Suction the mouth to prevent aspiration.
c. Administer oxygen by mask.
d. Stay with the patient to provide emotional support.
ANS: A
If a patient becomes eclamptic, the priority intervention is to ensure a patent airway. The nurse should attempt to keep the airway
patent by turning the patient’s head to the side to prevent aspiration. The nurse should stay with her and call for help, not to provide
emotional support. Once the seizure has ended, it may be necessary to suction the patient’s mouth. Oxygen would be administered
after the convulsion has ended.
DIF: Cognitive Level: Application REF: page 306 OBJ: 3

TOP: Nursing Process: Implementation MSC: CRNE: CH-65
9. A pregnant woman has been receiving a magnesium sulphate infusion for treatment of severe pre-eclampsia for 24 hours. On
assessment the nurse finds the following vital signs: temperature of 37.3°C, pulse rate of 88 beats/min, respiratory rate of 10
breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The patient complains, “I’m
so thirsty and warm.” What is the nurse’s initial intervention?
a. Call for a stat magnesium sulphate level.
b. Administer oxygen.
c. Discontinue the magnesium sulphate infusion.
d. Prepare to administer hydralazine.
ANS: C
The patient is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In
addition, calcium gluconate, the antidote for magnesium, may be administered. Hydralazine is an antihypertensive commonly used
to treat hypertension in severe pre-eclampsia. Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over
110 mm Hg.

10. A woman with severe pre-eclampsia has been receiving magnesium sulfphate by intravenous infusion for 8 hours. The nurse
assesses the woman and documents the following findings: temperature of 37.1°C, pulse rate of 96 beats/min, respiratory rate of 24
breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse should anticipate a
doctor’s order for which of the following?
a. Hydralazine
b. Magnesium sulphate bolus
c. Diazepam
d. Calcium gluconate
ANS: A
Hydralazine is an antihypertensive commonly used to treat hypertension in severe pre-eclampsia. Typically it is administered for a
systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg. An additional bolus of magnesium sulphate may be ordered for
increasing signs of central nervous system irritability related to severe pre-eclampsia (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
sulphate toxicity. The patient is not currently displaying any signs or symptoms of magnesium toxicity.

11. A woman at 39 weeks of gestation with a history of pre-eclampsia is admitted to the labour 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 which of the following?
a. Eclamptic seizure
b. Rupture of the uterus
c. Placenta previa
d. Placental abruption
ANS: D
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. 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.
DIF: Cognitive Level: Comprehension REF: page 324, Table 13-8

12. A woman with severe pre-eclampsia is receiving a magnesium sulphate infusion. Which finding should the nurse be concerned
about?
a. A sleepy, sedated affect
b. A respiratory rate of 10 breaths/min
c. Deep tendon reflexes of 2
d. Absent ankle clonus
ANS: B
A respiratory rate of 10 breaths/min indicates that the patient is experiencing respiratory depression from magnesium toxicity.
Because magnesium sulphate is a central nervous system depressant, the patient will most likely become sedated when the infusion
is initiated. Deep tendon reflexes of 2 and absent ankle clonus are normal findings.

13. Your patient has been on magnesium sulphate for 20 hours for treatment of pre-eclampsia. She just delivered a viable infant girl 30
minutes ago. What uterine findings would you expect to assess in this patient?
a. Absence of uterine bleeding in the postpartum period
b. A fundus firm below the level of the umbilicus
c. Scant lochia flow
d. A boggy uterus with heavy lochia flow
ANS: D
Because of the tocolytic effects of magnesium sulphate, this patient most likely would have a boggy uterus with increased amounts
of bleeding and a heavy lochia flow in the postpartum period.
DIF: Cognitive Level: Analysis REF: page 307, Nursing Alert

OBJ: 3 TOP: Nursing Process: Assessment MSC: CRNE: CH-6
14. Your patient is being induced because of her worsening pre-eclampsia. She is also receiving magnesium sulphate. It appears that her
labour has not become active, despite several hours of oxytocin administration. She asks the nurse, “Why is it taking so long?”
What is the most appropriate response by the nurse?
a. “The magnesium is relaxing your uterus and competing with the oxytocin. It may
increase the duration of your labour.”
b. “I don’t know why it is taking so long. Maybe we can stop the magnesium
sulphate administration.”
c. “The length of labour varies for different women.”
d. “Your baby is just being stubborn.”
ANS: A
Because magnesium sulphate is a tocolytic agent, its use may increase the duration of labour. The amount of oxytocin needed to
stimulate labour may be more than that needed for the woman who is not receiving magnesium sulphate. “I don’t know why it is
taking so long.” is not an appropriate statement for the nurse to make. Although the length of labour does vary for different women,
the most likely reason that this woman’s labour is protracted is the tocolytic effects of magnesium sulphate. The behaviour of the
fetus has no bearing on the length of labour.
DIF: Cognitive Level: Application REF: page 305, Nursing Alert

OBJ: 3 TOP: Nursing Process: Planning MSC: CRNE: CH-65
15. What nursing diagnosis would be most appropriate for a woman experiencing severe pre-eclampsia?
a. Risk for injury to the fetus related to uteroplacental insufficiency
b. Risk for eclampsia
c. Risk for deficient fluid volume related to increased sodium retention secondary to
administration of MgSO4
d. Risk for increased cardiac output related to use of antihypertensive drugs
ANS: A
Risk for injury to the fetus related to uteroplacental insufficiency is the most appropriate nursing diagnosis for this patient scenario.
Other diagnoses include risk to the fetus related to preterm birth and abruptio placentae. Eclampsia is a medical, not a nursing,
diagnosis. There would be a risk for excess, not deficient, fluid volume related to increased sodium retention. There would be a risk
for decreased, not increased, cardiac output related to the use of antihypertensive drugs.
DIF: Cognitive Level: Application REF: page 300, Nursing Process: Mild Pre-Eclampsia
OBJ: 3 TOP: Nursing Process: Diagnosis MSC: CRNE: PP-11
16. The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is which of the
following?
a. Hypertension
b. Hyperemesis gravidarum
c. Hemorrhagic complications
d. Infections
ANS: A
Pre-eclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women have nausea and
vomiting, but relatively few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most
common medical complication of pregnancy; hypertension is the most common. Hypertension is the most common medical
complication of pregnancy.

TOP: Nursing Process: Diagnosis | Nursing Process: Planning MSC: CRNE: CH-8
17. Which of the following is true in relation to HELLP syndrome?

a. It is a mild form of pre-eclampsia.
b. It can be diagnosed by a nurse alert to its symptoms.
c. It is characterized by hemolysis, elevated liver enzymes, and low platelets.
d. It is associated with preterm labour but not perinatal mortality.
ANS: C
The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant
of severe pre-eclampsia. HELLP syndrome is difficult to identify because the symptoms often are not obvious. It must be diagnosed
in the laboratory. Preterm labour is greatly increased and so is perinatal mortality.

18. Which statement is true of pre-existing hypertension?
a. It is defined as hypertension that begins during pregnancy and lasts for the
duration of pregnancy.
b. It is considered severe when the systolic blood pressure (BP) is greater than 140
mm Hg or the diastolic BP is greater than 90 mm Hg.
c. It is general hypertension plus proteinuria.
d. It can be accompanied by preeclampsia during pregnancy.
ANS: D
Pre-existing hypertension is present before pregnancy or diagnosed before 20 weeks of gestation and persists longer than 6 weeks
postpartum. It can occur with pre-eclampsia as well as other comorbid conditions. The range for hypertension is systolic BP greater
than 140 mm Hg or diastolic BP greater than 90 mm Hg. It becomes severe with a diastolic BP of 110 mm Hg or higher.
Proteinuria is an excessive concentration of protein in the urine. It is a complication of hypertension, not a defining characteristic.

19. In planning care for women with pre-eclampsia, what should the nurse be aware of?
a. Induction of labour is likely, as near term as possible.
b. If at home, the woman should be confined to her bed, even with mild
pre-eclampsia.
c. A special diet low in protein and salt should be initiated.
d. Vaginal birth is still an option, even in severe cases.
ANS: A
Induction of labour is likely, as near term as possible; however, at less than 37 weeks of gestation, immediate delivery may not be in
the best interest of the fetus. Strict bed rest is becoming controversial for mild cases; some women in the hospital are even allowed
to move around. Diet and fluid recommendations are much the same as those for healthy pregnant women, although some
authorities have suggested a diet high in protein. Women with severe pre-eclampsia should expect a Caesarean delivery.

20. What is the purpose of administering magnesium sulphate to women with pre-eclampsia and eclampsia?
a. It improves patellar reflexes and increases respiratory efficiency.
b. It shortens the duration of labour.
c. It prevents and treats convulsions.
d. It prevents a boggy uterus and lessens lochial flow.
ANS: C
Magnesium sulphate is the drug of choice to prevent convulsions, although it can generate other problems. Loss of patellar reflexes
and respiratory depression are signs of magnesium toxicity. Magnesium sulphate can increase the duration of labour. Women are at
risk for a boggy uterus and heavy lochial flow as a result of magnesium sulphate therapy.

21. Which patient exhibits the greatest number of the risk factors associated with pre-eclampsia?
a. A 30-year-old obese White woman with her third pregnancy
b. A 41-year-old White primigravida
c. An Inuit patient who is 19 years old, weighs 92 kg, and is pregnant with twins
d. A 25-year-old Métis woman whose pregnancy is the result of donor insemination
ANS: C
Three risk factors are present for this woman. She is obese, is at the young end of the age distribution, and has a multiple pregnancy.
In planning care for this patient, the nurse must monitor blood pressure frequently and teach the woman about early warning signs.
The 30-year-old patient only has one known risk factor: obesity. Age distribution appears to be U-shaped, with women less than 20
years and more than 40 years of age being at greatest risk. Pre-eclampsia continues to be seen more frequently in primigravidas; this
patient is a multigravida woman. Two risk factors are present for the 41-year-old patient. Her age and status as a primigravida put
her at increased risk for pre-eclampsia. The Métis patient exhibits only one risk factor. Pregnancies that result from donor
insemination, oocyte donation, and embryo donation are at an increased risk of developing pre-eclampsia.

TOP: Nursing Process: Planning MSC: CRNE: HW-2
22. A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for
a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The
anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?
a. Incomplete
b. Inevitable
c. Threatened
d. Septic
ANS: C
A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete
abortion would present with heavy bleeding, mild-to-severe cramping, and cervical dilation. An inevitable abortion presents with
the same symptoms as an incomplete abortion: heavy bleeding, mild-to-severe cramping, and cervical dilation. A woman with a
septic abortion presents with malodorous bleeding and typically a dilated cervix.

23. The perinatal nurse is giving discharge instructions to a woman, status postsuction curettage secondary to a hydatidiform mole. The
woman asks why she must take oral contraceptives for the next 12 months. What is the best response from the nurse?
a. “If you get pregnant within 1 year, the chance of a successful pregnancy is very
small. Therefore, if you desire a future pregnancy, it would be better for you to use
the most reliable method of contraception available.”
b. “The major risk to you after a molar pregnancy is a type of cancer that can be
diagnosed only by measuring the same hormone that your body produces during
pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer
more difficult.”
c. “If you can avoid a pregnancy for the next year, the chance of developing a second
molar pregnancy is rare. Therefore, to improve your chance of a successful
pregnancy, it is better not to get pregnant at this time.”
d. “Oral contraceptives are the only form of birth control that will prevent a
recurrence of a molar pregnancy.”
ANS: B
This is an accurate statement. -Human chorionic gonadotropin (hCG) levels will be drawn for 1 year to ensure that the mole is
completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The
goal is to achieve a “zero” hCG level. If the woman were to become pregnant, it might obscure the presence of the potentially
carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. The rationale
for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an
intrauterine device is acceptable.

TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: CRNE: CH-44
24. What is the most prevalent clinical manifestation of abruptio placentae, as opposed to placenta previa?
a. Bleeding
b. Intense abdominal pain
c. Uterine activity
d. Cramping
ANS: B
Pain is absent with placenta previa and may be agonizing with abruptio placentae, especially grade 3. Bleeding may be present in
varying degrees for both placental conditions. Uterine activity and cramping may be present with both placental conditions.
DIF: Cognitive Level: Knowledge REF: page 324, Table 13-8

25. Methotrexate is recommended as part of the treatment plan for which obstetrical complication?
a. Complete hydatidiform mole
b. Missed abortion
c. Unruptured ectopic pregnancy
d. Abruptio placentae
ANS: C
Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is
unruptured. Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole, missed abortion,
or abruptio placentae.
DIF: Cognitive Level: Knowledge REF: page 319, Medication Guide

OBJ: 7 TOP: Nursing Process: Planning MSC: CRNE: CH-44
26. A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal
bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure?
a. Amniocentesis for fetal lung maturity
b. Ultrasound for placental location
c. Contraction stress test (CST)
d. Internal fetal monitoring
ANS: B
The presence of painless bleeding should always alert the health care team to the possibility of placenta previa. This can be
confirmed through ultrasonography. Amniocentesis would not be performed on a woman who is experiencing bleeding. In the event
of an imminent delivery, the fetus would be presumed to have immature lungs at this gestational age, and the mother would be
given corticosteroids to aid in fetal lung maturity. A CST would not be performed at a preterm gestational age. Furthermore,
bleeding would be a contraindication to this test. Internal fetal monitoring would be contraindicated in the presence of bleeding.
DIF: Cognitive Level: Application REF: page 322, Fig. 13-11

OBJ: 8 TOP: Nursing Process: Assessment MSC: CRNE: CH-5
27. What is occurring when some of the umbilical vessels cross the cervical os below the presenting part?
a. Placenta previa
b. Vasa previa
c. Severe abruptio placentae
d. Disseminated intravascular coagulation (DIC)
ANS: B
Vasa previa is occurring when some of the umbilical vessels cross the cervical os below the presenting part. The umbilical vessels
are not surrounded by Wharton jelly and have no supportive tissue. The presence of placenta previa most likely would be
ascertained before labour and would be considered a risk factor for this pregnancy. With the presence of severe abruptio placentae,
the uterine tonicity would typically be tetanus (i.e., a boardlike uterus). DIC is a pathological form of diffuse clotting that consumes
large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both.

TOP: Nursing Process: Diagnosis MSC: CRNE: CH-8
28. A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal
bleeding. On examination the nurse notices an ecchymotic blueness around the woman’s umbilicus. How should the nurse interpret
this assessment finding?
a. This is a normal integumentary change associated with pregnancy.
b. This is Turner’s sign, associated with appendicitis.
c. This is Cullen’s sign, associated with a ruptured ectopic pregnancy.
d. This is Chadwick’s sign, associated with early pregnancy.
ANS: C
Cullen’s sign, the blue ecchymosis seen in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured
intra-abdominal ectopic pregnancy. Linea nigra on the abdomen is the normal integumentary change associated with pregnancy. It
presents as a brown, pigmented, vertical line on the lower abdomen. Turner’s sign is ecchymosis in the flank area, often associated
with pancreatitis. Chadwick’s sign is the blue–purple colour of the cervix that may be seen during or around the eighth week of
pregnancy.

29. What should nurses be aware of regarding miscarriage?

a. It is a natural pregnancy loss before labour begins.
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
c. It often can be attributed to careless maternal behaviour, such as poor nutrition or
excessive exercise.
d. If it occurs before the twelfth week of pregnancy, it may present only as moderate
discomfort and blood loss.
ANS: D
Before the sixth week the only evidence might be a heavy menstrual flow. After the twelfth week more severe pain, similar to that
of labour, is likely. Miscarriage is a natural pregnancy loss, but by definition it occurs before 20 weeks of gestation, before the fetus
is viable. Miscarriages occur in approximately 15% of all clinically recognized pregnancies. Miscarriage can be caused by a number
of disorders or illnesses outside of the mother’s control or knowledge.

30. Which of the following is NOT a bleeding disorder in late pregnancy?

a. Placenta previa
b. Abruptio placentae
c. Spontaneous abortion
d. Cord insertion
ANS: C
Spontaneous abortion is another name for miscarriage; by definition it occurs early in pregnancy and is not considered a bleeding
disorder. Placenta previa is a cause of bleeding disorders in later pregnancy. Abruptio placentae is a cause of bleeding disorders in
later pregnancy. Cord insertion is a cause of bleeding disorders in later pregnancy.
DIF: Cognitive Level: Knowledge REF: page 313 OBJ: 7

31. A patient who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. Her vital
signs are stable, bleeding has been controlled, and she has a low-normal hemoglobin level. To promote an optimal recovery, which
of the following should be part of discharge teaching for this woman?
a. Iron supplementation
b. Resumption of intercourse at 6 weeks following the procedure
c. Can resume normal activity level with no restrictions
d. Expectation of heavy bleeding for at least 2 weeks
ANS: A
The woman should be advised to consume a diet high in iron and protein. For many women iron supplementation also is necessary.
Discharge teaching should emphasize the need for rest rather than an immediate return to normal activity level. Nothing should be
placed in the vagina for 2 weeks after the procedure. This includes tampons and vaginal intercourse. The purpose of this
recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The patient should expect a scant,
dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur, she should be instructed to contact her health care
provider.

TOP: Nursing Process: Implementation MSC: CRNE: NCP-14

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Chapter 13: Pregnancy at Risk: Gestational Conditions

1. Which statement is true about women who experience hyperemesis gravidarum?

DIF: Cognitive Level: Comprehension REF: page 310 OBJ: 6

DIF: Cognitive Level: Comprehension REF: page 330 OBJ: 10

3. Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)?

DIF: Cognitive Level: Knowledge REF: page 329 OBJ: 9

DIF: Cognitive Level: Comprehension REF: page 330 OBJ: 9

DIF: Cognitive Level: Comprehension REF: page 329 OBJ: 9

DIF: Cognitive Level: Analysis REF: page 296 OBJ: 2

DIF: Cognitive Level: Comprehension REF: pages 298-299

DIF: Cognitive Level: Application REF: page 306 OBJ: 3

DIF: Cognitive Level: Application REF: page 305 OBJ: 3

DIF: Cognitive Level: Analysis REF: page 305 OBJ: 3

DIF: Cognitive Level: Comprehension REF: page 324, Table 13-8

DIF: Cognitive Level: Application REF: page 305 OBJ: 3

DIF: Cognitive Level: Analysis REF: page 307, Nursing Alert

DIF: Cognitive Level: Application REF: page 305, Nursing Alert

DIF: Cognitive Level: Comprehension REF: page 294 OBJ: 2

17. Which of the following is true in relation to HELLP syndrome?

DIF: Cognitive Level: Comprehension REF: page 299 OBJ: 4

DIF: Cognitive Level: Comprehension REF: page 294 OBJ: 1

DIF: Cognitive Level: Comprehension REF: page 303 OBJ: 3

DIF: Cognitive Level: Comprehension REF: page 304 OBJ: 3

DIF: Cognitive Level: Analysis REF: page 296 OBJ: 2

DIF: Cognitive Level: Comprehension REF: page 314 OBJ: 7

DIF: Cognitive Level: Application REF: page 321 OBJ: 7

DIF: Cognitive Level: Knowledge REF: page 324, Table 13-8

DIF: Cognitive Level: Knowledge REF: page 319, Medication Guide

DIF: Cognitive Level: Application REF: page 322, Fig. 13-11

DIF: Cognitive Level: Analysis REF: page 328 OBJ: 8

DIF: Cognitive Level: Analysis REF: page 318 OBJ: 7

29. What should nurses be aware of regarding miscarriage?

DIF: Cognitive Level: Comprehension REF: page 314 OBJ: 7

30. Which of the following is NOT a bleeding disorder in late pregnancy?

DIF: Cognitive Level: Knowledge REF: page 313 OBJ: 7

DIF: Cognitive Level: Application REF: page 316 OBJ: 7

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