Unit 2 Maternity Exam Eves Greater Lowell Technical School

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.

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: (D) Sudden weight gain

Sudden, rapid weight gain is the earliest and most sensitive indicator of fluid retention in gestational hypertension. It precedes visible edema and reflects the accumulation of excess fluid in the tissues. A weight gain of more than 2 pounds per week or 6 pounds per month in the third trimester is a warning sign that warrants further assessment.

Why Other Options are Incorrect:

A. Abdominal enlargement — This is a normal finding of advancing pregnancy and is not specific to fluid retention from gestational hypertension.

B. Blurred vision — Blurred vision is a later sign of severe preeclampsia related to cerebral involvement, not the first sign of fluid retention.

C. Dyspnea — Shortness of breath may occur with severe fluid overload but is not the earliest indicator of fluid retention in gestational hypertension.

E. Swelling of the feet and ankles — Peripheral edema is a visible sign of fluid retention that typically appears after significant fluid has already accumulated, making it a later finding than sudden weight gain.

F. Facial swelling — Facial edema, particularly periorbital swelling, is a more advanced sign associated with significant fluid retention and preeclampsia, not the earliest indicator.

G. Backache — Backache is a common pregnancy complaint and is not a specific indicator of fluid retention or gestational hypertension.

Explanation:

Correct Answer: (B) Encourage the patient to drink 1 to 2 quarts of water before the test.

At 8 weeks gestation, the uterus is still a pelvic organ. A full bladder is required for a transabdominal ultrasound at this early gestational age because it displaces the bowel, provides an acoustic window, and lifts the uterus into a better position for visualization of the fetus and uterine structures.

Why Other Options are Incorrect:

A. Instruct the patient to take nothing by mouth the night before the test — NPO status is not required for an abdominal ultrasound. There is no sedation or anesthesia involved in this procedure.

C. Initiate IV access — IV access is not required for a routine diagnostic abdominal ultrasound in pregnancy.

D. Instruct the patient to remove all jewelry just prior to the test — Removing jewelry is a preparation for procedures such as MRI or surgery. It is not necessary for an abdominal ultrasound.

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.

Explanation:

Correct Answer: (D) Active genital herpes

Active genital herpes (HSV) lesions at the time of labor are an indication for cesarean birth to prevent neonatal herpes infection, which can be life-threatening to the newborn. Vaginal delivery through an active herpes outbreak exposes the infant to the virus, making cesarean delivery the standard of care in this situation.

Why Other Options are Incorrect:

A. Gonorrhea — Gonorrhea does not require cesarean delivery. It is managed with antibiotic treatment, and the standard preventive measure for the newborn is prophylactic eye drops administered after birth.

B. Chronic Hepatitis — Chronic hepatitis B does not require cesarean delivery. Neonatal transmission is prevented through hepatitis B immune globulin and vaccination administered to the newborn after birth.

C. Chlamydia — Chlamydia does not necessitate cesarean delivery. It is treated with antibiotics during pregnancy, and neonatal eye prophylaxis is administered after vaginal delivery.

Explanation:

Correct Answer: (B) Avoid exposure to litter boxes used by cats

Toxoplasmosis is caused by the parasite Toxoplasma gondii, which is commonly found in cat feces. Pregnant women must avoid cleaning or handling cat litter boxes, as exposure to infected feces is one of the primary routes of transmission. Congenital toxoplasmosis can cause serious fetal complications including neurological damage, blindness, and stillbirth.

Why Other Options are Incorrect:

A. Wash hands only before meals — Handwashing should be performed frequently and thoroughly throughout the day, not only before meals. Limiting handwashing increases the risk of inadvertent ingestion of the parasite.

C. Eat raw meats — This is a direct risk factor for toxoplasmosis, not a preventive measure. Pregnant women must avoid consuming raw or undercooked meats as they can harbor the Toxoplasma parasite.

D. Use topical corticosteroid treatments prophylactically — Corticosteroids have no role in the prevention of toxoplasmosis and are not an appropriate prophylactic measure for this infection.

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.

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.