Unit 2 Maternity Exam Eves Greater Lowell Technical School
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Free Unit 2 Maternity Exam Eves Greater Lowell Technical School Questions
Rh incompatibility occurs in which of the following situations:
- Rh-negative mother, Rh-positive fetus
- Rh-negative mother, Rh-negative fetus
- Rh-positive mother, Rh-negative fetus
- Rh-positive mother, Rh-positive fetus
Explanation
Explanation:
Correct Answer: (A) Rh-negative mother, Rh-positive fetus
Rh incompatibility occurs when an Rh-negative mother carries an Rh-positive fetus. If fetal Rh-positive blood enters the maternal circulation, the mother's immune system recognizes the Rh antigen as foreign and produces antibodies against it. In subsequent pregnancies, these antibodies can cross the placenta and destroy fetal red blood cells, causing hemolytic disease of the newborn.
Why Other Options are Incorrect:
B. Rh-negative mother, Rh-negative fetus — Both mother and fetus share the same Rh factor, so no immune reaction occurs and incompatibility does not develop.
C. Rh-positive mother, Rh-negative fetus — An Rh-positive mother does not produce antibodies against the Rh antigen because she already carries it. No incompatibility results from this combination.
D. Rh-positive mother, Rh-positive fetus — Both mother and fetus are Rh-positive, so there is no antigenic difference to trigger an immune response.
The nurse educates prenatal patients about the threat of TORCH infections. These infections include (Select all that apply.)
- Herpes simplex
- Toxoplasmosis
- Rubella
- Toxemia
- Cytomegalovirus
Explanation
Explanation:
Correct Answer: (A) Herpes simplex, (B) Toxoplasmosis, (C) Rubella, and (E) Cytomegalovirus
TORCH is an acronym representing a group of infections that can be transmitted from mother to fetus and cause serious congenital complications. T — Toxoplasmosis, O — Other infections, R — Rubella, C — Cytomegalovirus, H — Herpes simplex. All four of these are classic TORCH infections known to cause significant fetal harm including neurological damage, vision and hearing loss, and developmental disabilities.
Why Other Options are Incorrect:
D. Toxemia — Toxemia is an outdated term for preeclampsia, which is a hypertensive disorder of pregnancy, not an infectious disease. It is not part of the TORCH acronym or classification.
The nurse is collecting a patient's personal information for the client history. How should the nurse question the woman regarding physical abuse and safety in her living situation?
- "Does your partner ever hit you?"
- "Tell me about your home life."
- "Are you happily married?"
- "Tell me about your husband."
Explanation
Explanation:
Correct Answer: (B) "Tell me about your home life."
This open-ended, non-threatening question creates a safe and comfortable space for the patient to share information about her living situation at her own pace. It avoids assumptions about relationship status, does not use alarming language, and allows the woman to disclose concerns about abuse or safety without feeling directly confronted or judged.
Why Other Options are Incorrect:
A. "Does your partner ever hit you?" — While direct screening for abuse is important, this phrasing is too abrupt and confrontational as an opening question. It may cause the patient to become defensive and deny abuse before trust has been established.
C. "Are you happily married?" — This question assumes the patient is married, is closed-ended, and does not effectively screen for abuse or assess the safety of her living situation.
D. "Tell me about your husband." — This assumes the patient is married and heterosexual, which is presumptuous and excludes patients in other types of relationships. It also does not directly address safety concerns.
A nursing assessment reveals heavy vaginal bleeding, a firm, board-like abdomen, contractions lasting 3 minutes with less than 30 seconds between them, and uterine tenderness in a woman last assessed to be 3 cm dilated and in early labor. Which is the nurse's priority of care?
- Frequent vital signs and fetal heart tones
- Assessment and documentation of pain
- Notification of the healthcare provider
- Providing patient with emotional support
Explanation
Explanation:
Correct Answer: (C) Notification of the healthcare provider
The clinical presentation — heavy vaginal bleeding, a rigid board-like abdomen, tetanic contractions with minimal rest intervals, and uterine tenderness — is highly indicative of abruptio placentae, which is a life-threatening obstetric emergency. The nurse's priority is to immediately notify the healthcare provider so that emergency intervention can be initiated without delay to prevent maternal and fetal death.
Why Other Options are Incorrect:
A. Frequent vital signs and fetal heart tones — While continuous monitoring of vital signs and fetal heart tones is critical and will be done simultaneously, it cannot take priority over immediately notifying the provider about a suspected obstetric emergency requiring urgent intervention.
B. Assessment and documentation of pain — Pain assessment is an ongoing nursing responsibility but is not the priority when the patient is showing signs of a potentially fatal complication requiring immediate medical intervention.
D. Providing patient with emotional support — Emotional support is an important aspect of holistic nursing care but is not the priority in an acute, life-threatening emergency situation such as suspected abruptio placentae.
The distinguishing symptom between severe preeclampsia and eclampsia is:
- Epigastric pain
- Oliguria
- Blurred vision
- Seizures
Explanation
Explanation:
Correct Answer: (D) Seizures
Eclampsia is defined by the occurrence of seizures (convulsions) in a patient with preeclampsia, in the absence of other neurological conditions. Severe preeclampsia can present with many serious symptoms, but it is specifically the development of seizures that marks the transition from severe preeclampsia to eclampsia. This is the key distinguishing feature between the two conditions.
Why Other Options are Incorrect:
- A. Epigastric pain — This can occur in severe preeclampsia due to liver capsule distension or HELLP syndrome, but it does not distinguish eclampsia from severe preeclampsia.
- B. Oliguria — Reduced urine output is a feature of severe preeclampsia reflecting renal involvement, but it is present before eclampsia develops and does not distinguish the two.
- C. Blurred vision — Visual disturbances, including blurred vision, are a symptom of severe preeclampsia due to cerebral and retinal changes, but they do not define eclampsia.
When monitoring the signs of DIC, the nurse would suspect a woman had developed DIC if he or she observes:
- Pain and swelling of the calf of one leg
- Laboratory values indicating increased platelets
- Rapid clotting times
- Petechiae, oozing from injection sites, and hematuria
Explanation
Explanation:
Correct Answer: (D) Petechiae, oozing from injection sites, and hematuria
Disseminated intravascular coagulation (DIC) is a serious coagulopathy characterized by widespread activation of the clotting cascade, which paradoxically leads to simultaneous clotting and bleeding. Clinical signs include petechiae, spontaneous bleeding from injection sites, and hematuria, reflecting the consumption of clotting factors and platelets and the inability to form stable clots.
Why Other Options are Incorrect:
A. Pain and swelling of the calf of one leg — This is a classic sign of deep vein thrombosis, not DIC. DVT involves localized clot formation, whereas DIC is a systemic coagulopathy.
B. Laboratory values indicating increased platelets — In DIC, platelets are consumed in the clotting process, resulting in thrombocytopenia (decreased platelets), not an increase.
C. Rapid clotting times — DIC is associated with prolonged clotting times due to the depletion of clotting factors, not rapid or shortened clotting times.
The nurse would suspect abruptio placentae when the pregnant woman presents with:
- Painless vaginal bleeding
- Vaginal bleeding and back pain
- Uterine irritability with contractions
- Premature rupture of membranes
Explanation
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.
The nurse explains that pregnancy affects glucose metabolism because:
- Placental hormones increase the resistance of cells to insulin.
- There is a decreased production of insulin during pregnancy.
- Insulin cells cannot meet the body's demands as the woman's weight increases.
- The speed of insulin breakdown is decreased during pregnancy.
Explanation
Explanation:
Correct Answer: (A) Placental hormones increase the resistance of cells to insulin.
During pregnancy, hormones produced by the placenta — including human placental lactogen, progesterone, and cortisol — create a state of insulin resistance in maternal cells. This ensures a continuous supply of glucose to the developing fetus. However, in women who cannot compensate with increased insulin production, this resistance leads to gestational diabetes mellitus.
Why Other Options are Incorrect:
B. There is a decreased production of insulin during pregnancy — The pancreas actually increases insulin production during pregnancy in response to rising insulin resistance. A decrease in production is not the primary mechanism affecting glucose metabolism.
C. Insulin cells cannot meet the body's demands as the woman's weight increases — While weight gain can contribute to insulin resistance, it is not the primary physiological explanation for how pregnancy specifically affects glucose metabolism.
D. The speed of insulin breakdown is decreased during pregnancy — Altered insulin breakdown is not the primary mechanism. The central issue is placental hormone-induced insulin resistance, not changes in insulin degradation.
A patient who is 30 weeks pregnant delivers a stillborn infant. What should the nurse offer the patient? (Select all that apply.)
- Materials about support groups
- An opportunity to hold the infant
- A memento (footprint or lock of hair)
- A warm beverage E. Privacy
Explanation
Explanation:
Correct Answer: (A) Materials about support groups, (B) An opportunity to hold the infant, (C) A memento (footprint or lock of hair), and (E) Privacy
These interventions are all evidence-based components of bereavement care for parents experiencing stillbirth. Providing information about support groups connects the family to ongoing grief resources. Offering the opportunity to hold the infant allows the parents to bond, grieve, and create memories. A memento such as a footprint or lock of hair provides a tangible remembrance of the baby. Privacy allows the family to grieve without interruption in a safe, respectful space.
Why Other Options are Incorrect:
D. A warm beverage — While offering comfort is kind, providing a warm beverage is not a recognized evidence-based bereavement intervention and is not an appropriate priority offering in this context compared to the emotional and psychological support needs of the family.
The pregnant woman comes to the clinic stating that she has been exposed to hepatitis B. She is afraid that her baby will also contract hepatitis B. The nurse counsels that the baby:
- Will be given a single dose of hepatitis immune globulin at birth after the first bath .
- Will not have hepatitis B because the virus does not pass through the placental barrier
- Will be able to use the antibodies from the immunizations given to the patient before delivery
- Will be immune to hepatitis B because of the mother's infection
Explanation
Explanation:
Correct Answer: (A) Will be given a single dose of hepatitis immune globulin at birth after the first bath
Neonates born to hepatitis B surface antigen-positive mothers should receive hepatitis B immune globulin (HBIG) along with the first dose of the hepatitis B vaccine within 12 hours of birth, typically after the first bath to remove maternal blood and secretions. This passive-active immunization strategy is highly effective in preventing perinatal transmission of hepatitis B.
Why Other Options are Incorrect:
B. Will not have hepatitis B because the virus does not pass through the placental barrier — Hepatitis B can be transmitted perinatally, primarily during delivery through exposure to infected blood and body fluids, making prophylactic treatment essential.
C. Will be able to use the antibodies from the immunizations given to the patient before delivery — Maternal antibodies from prior immunization can provide some passive protection, but this is not reliable enough to protect the neonate, and active prophylaxis with HBIG and vaccine is still required.
D. Will be immune to hepatitis B because of the mother's infection — Maternal hepatitis B infection does not confer immunity to the newborn. Without prophylaxis, the infant is at significant risk of acquiring chronic hepatitis B infection.
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