Unit 2 Maternity Exam Eves Greater Lowell Technical School

Explanation:

Correct Answer: (B) "What over-the-counter and prescription drugs have you taken in the past 3 months?"

This question is the most therapeutically appropriate and non-judgmental way to begin a drug use history during a prenatal assessment. By starting with a broad, neutral question about all medications including over-the-counter and prescription drugs, the nurse creates a non-threatening environment that encourages honest disclosure. It normalizes the conversation and reduces the patient's defensiveness before moving to more sensitive topics.

Why Other Options are Incorrect:

A. "Do you smoke, drink alcohol, or use drugs?" — While this covers important areas, combining multiple sensitive topics in one question can feel accusatory and may cause the patient to become defensive, reducing the likelihood of honest responses.

C. "Do you ever use prescription or street drugs?" — The inclusion of "street drugs" early in the questioning can feel judgmental and confrontational, potentially shutting down communication before a trusting relationship is established.

D. "We need to know if you take drugs so we can help your baby." — While the intent is supportive, this phrasing implies guilt and can make the patient feel accused or shamed, which is not conducive to therapeutic communication.

Explanation:

Correct Answer: (A) Confusion

Confusion is a classic sign of hypovolemic shock resulting from decreased cerebral perfusion due to significant blood loss. In ectopic pregnancy, rupture of the fallopian tube causes internal hemorrhage, rapidly leading to hypovolemic shock. Altered mental status including confusion is an important clinical indicator of severe volume depletion and compromised end-organ perfusion.

Why Other Options are Incorrect:

B. Decreased heart rate — Hypovolemic shock causes tachycardia (increased heart rate), not a decreased heart rate, as the body compensates for reduced circulating volume by increasing cardiac output.

C. Lethargy — While lethargy can occur in later stages of shock, confusion is a more specific and earlier neurological indicator of hypovolemic shock from acute hemorrhage.

D. Elevated blood pressure — Hypovolemic shock causes hypotension, not elevated blood pressure. Blood pressure drops as circulating volume decreases and compensatory mechanisms are overwhelmed.

Explanation:

Correct Answer: (B) Vaginal bleeding and back pain

Abruptio placentae (placental abruption) classically presents with sudden, painful vaginal bleeding accompanied by abdominal or back pain and uterine rigidity. The pain results from blood accumulating behind the placenta and the resulting uterine irritation. Back pain is particularly associated with a posterior placental abruption.

Why Other Options are Incorrect:

A. Painless vaginal bleeding — Painless vaginal bleeding is the hallmark presentation of placenta previa, not abruptio placentae. The key distinguishing feature of abruption is the presence of pain.

C. Uterine irritability with contractions — While uterine irritability can be associated with abruption, contractions alone without the combination of painful bleeding are not the defining presentation of abruptio placentae.

D. Premature rupture of membranes — PROM involves the spontaneous rupture of the amniotic sac before the onset of labor and is not a characteristic sign of placental abruption.

Explanation:

Correct Answer: (B) "I want you to know I am here if you need to talk."

This response demonstrates therapeutic communication by offering presence, emotional support, and a non-judgmental space for the patient to express her grief. It validates her feelings without minimizing her loss or offering false reassurance, which is the most appropriate and compassionate approach in this emotionally vulnerable moment.

Why Other Options are Incorrect:

A. "There is usually something wrong when this happens early in pregnancy." — While this may be medically accurate, offering a clinical explanation to a grieving patient is dismissive of her emotional needs and is not appropriate in this moment.

C. "Everything will be okay. You can try to conceive on your next cycle." — This offers false reassurance and dismisses the patient's current grief by rushing her toward the future, which is not therapeutic.

D. "You are young and strong. I know you can have a healthy pregnancy." — This minimizes the patient's current loss and feelings by redirecting focus to future pregnancies, which is not empathetic or therapeutically appropriate.

Explanation:

Correct Answer: (A) Intellectual disability

Rubella infection during the first trimester is associated with congenital rubella syndrome, which classically causes intellectual disability, along with cataracts, congenital heart defects, and sensorineural hearing loss. Intellectual disability is one of the well-established and recognized consequences of rubella exposure during early fetal development.

Why Other Options are Incorrect:

B. Liver failure — Liver failure is not a recognized manifestation of congenital rubella syndrome. While some hepatic effects may occur, liver failure is not a characteristic outcome.

C. Limb deformities — Limb deformities are not a classic feature of congenital rubella syndrome. They are more commonly associated with other teratogens such as thalidomide.

D. Facial abnormalities — Facial abnormalities are not a hallmark of congenital rubella syndrome. The classic triad involves cardiac defects, cataracts, and hearing loss, along with neurological effects such as intellectual disability.

Explanation:

Correct Answer: (C) Hyperemesis gravidarum causes dehydration and electrolyte imbalances.

Hyperemesis gravidarum is distinguished from normal morning sickness by its severity and clinical consequences. Unlike typical nausea and vomiting of pregnancy, hyperemesis gravidarum involves severe, persistent vomiting that leads to dehydration, electrolyte imbalances, nutritional deficiencies, and significant weight loss, often requiring hospitalization and medical intervention.

Why Other Options are Incorrect:

A. Hyperemesis gravidarum usually lasts for the duration of the pregnancy — While it can persist beyond the first trimester in severe cases, hyperemesis gravidarum does not always last the entire pregnancy. This statement is not the defining distinguishing feature.

B. With hyperemesis gravidarum, sensitivity to smells is usually the cause of vomiting — Sensitivity to smells can trigger nausea in both normal morning sickness and hyperemesis gravidarum and is not specific to or distinguishing of hyperemesis gravidarum.

D. The women with hyperemesis gravidarum will have persistent vomiting without weight loss — This is incorrect. Significant weight loss of more than 5% of pre-pregnancy body weight is a hallmark feature of hyperemesis gravidarum, distinguishing it from ordinary morning sickness.

Explanation:

Correct Answer: (B) Physical abuse from partner

Circular bruises around both wrists are consistent with restraint injuries, and bruises above the umbilicus during pregnancy are a significant red flag for intimate partner violence, as abusers frequently target the abdomen during pregnancy. This pattern of injury is not consistent with accidental trauma and requires immediate assessment and intervention.

Why Other Options are Incorrect:

A. Clumsiness due to body changes — Accidental injuries from clumsiness during pregnancy typically occur on extremities from falls and do not produce bilateral circular wrist bruises or abdominal bruising in this pattern.

C. An attempt to induce a miscarriage — While abdominal trauma can threaten a pregnancy, the specific pattern of circular wrist and abdominal bruising is most consistent with physical abuse rather than a self-harm attempt.

D. A motor vehicle accident — MVA injuries tend to produce diffuse or seatbelt-pattern bruising and would not typically produce circular, bilateral wrist bruises consistent with restraint.

Explanation:

Correct Answer: (B) Clear and maintain an open airway

When a patient progresses to eclampsia and experiences a seizure, the nurse's first priority is to establish and maintain a patent airway. Airway management is always the primary intervention during any seizure activity, as it prevents aspiration and ensures adequate oxygenation. All other interventions follow after the airway is secured.

Why Other Options are Incorrect:

A. Prepare for the administration of IV magnesium sulfate — While magnesium sulfate is the treatment of choice for eclamptic seizures, airway management must be established first before any medication is administered.

C. Check the blood pressure and fetal heart tones — Assessment of vital signs and fetal status is important but is secondary to the immediate priority of maintaining the patient's airway during an active seizure.

D. Administer oxygen by facemask — Oxygen administration is an important supportive measure but cannot be effectively delivered until the airway is first cleared and maintained.

Explanation:

Correct Answer: (D) Diabetes mellitus

The combination of macrosomic (large for gestational age) infants, recurrent stillbirths, and polyhydramnios is a classic obstetric history highly suggestive of uncontrolled or undiagnosed diabetes mellitus. Elevated maternal glucose crosses the placenta, stimulating excess fetal insulin production and growth. Polyhydramnios occurs due to increased fetal urination from hyperglycemia, and the risk of stillbirth is significantly elevated in poorly controlled diabetic pregnancies.

Why Other Options are Incorrect:

A. Toxoplasmosis — Toxoplasmosis is a parasitic infection that can cause fetal neurological damage, but it is not associated with macrosomia, polyhydramnios, or a pattern of recurrent pregnancy complications of this nature.

B. Hydatidiform mole — A hydatidiform mole involves abnormal trophoblastic tissue growth and does not result in viable pregnancies with macrosomic infants or polyhydramnios.

C. Abruptio placentae — Placental abruption involves premature separation of the placenta and is associated with bleeding and fetal distress, not macrosomia or polyhydramnios as a recurrent pattern.