Unit 2 Maternity Exam Eves Greater Lowell Technical School
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Free Unit 2 Maternity Exam Eves Greater Lowell Technical School Questions
A prenatal client at 14 weeks complains of continuous nausea, vomiting, and a severe headache. Her blood pressure is elevated and her fundal height is 21 centimeters. Which diagnostic test does the nurse anticipate will be ordered to confirm a hydatidiform mole?
- Biophysical profile
- Maternal serum alpha-fetoprotein
- Human chorionic gonadotropin
- Ultrasound
Explanation
Explanation:
Correct Answer: (D) Ultrasound
Ultrasound is the definitive diagnostic test for confirming a hydatidiform mole. It reveals the classic "snowstorm" appearance of the uterus due to the proliferating trophoblastic tissue replacing normal pregnancy structures. It also confirms the absence of a viable fetus and the presence of abnormal uterine contents consistent with molar pregnancy.
Why Other Options are Incorrect:
A. Biophysical profile — A biophysical profile is used to assess fetal wellbeing in viable pregnancies and is not applicable in the evaluation of a suspected hydatidiform mole.
B. Maternal serum alpha-fetoprotein — AFP screening is used to detect neural tube defects and chromosomal abnormalities in a viable fetus. It is not the confirmatory test for hydatidiform mole.
C. Human chorionic gonadotropin — While hCG levels are markedly elevated in hydatidiform mole and are used as a supporting finding, elevated hCG alone is not diagnostic. Ultrasound is required for definitive confirmation of the diagnosis.
What will be the nurse's highest priority of care for the woman about to undergo an amniocentesis?
- Risk of aspiration related to anesthesia
- Maternal anxiety related to concern for fetal well-being
- Risk of fluid deficit secondary to removal of amniotic fluid
- Nutritional status related to being NPO
Explanation
Explanation:
Correct Answer: (B) Maternal anxiety related to concern for fetal well-being
Amniocentesis is an invasive prenatal procedure that carries risks such as fetal injury, infection, and pregnancy loss. The highest priority nursing concern before the procedure is addressing the mother's anxiety related to the safety and well-being of her fetus. Providing emotional support, education, and reassurance is essential to prepare the patient physically and psychologically and ensures informed consent and cooperation during the procedure.
Why Other Options are Incorrect:
A. Risk of aspiration related to anesthesia — Amniocentesis is typically performed under local anesthesia only, making general anesthesia-related aspiration risk not applicable in this context.
C. Risk of fluid deficit secondary to removal of amniotic fluid — Only a small amount of amniotic fluid is removed during amniocentesis, which is not sufficient to cause a clinically significant fluid deficit in the mother.
D. Nutritional status related to being NPO — Amniocentesis does not require the patient to be NPO, as it is a minimally invasive procedure performed under local anesthesia. Therefore, nutritional status related to NPO status is not a relevant concern.
A pregnant client is at risk to toxoplasmosis. The nurse would teach the client which of the following to prevent exposure to this disease?
- Wash hands only before meals
- Avoid exposure to litter boxes used by cats
- Eat raw meats
- Use topical corticosteroid treatments prophylactically
Explanation
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.
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.
The nurse caring for a pregnant woman who is receiving an intravenous infusion with magnesium sulfate will:
- Count respirations and report a rate of less than 12 breaths per minute
- Check blood pressure and report a rate of less than 100/60
- Count respirations and report a rate of more than 20 breaths per minute
- Monitor urinary output and report a rate of less than 100 ml per hour
Explanation
Explanation:
Correct Answer: (A) Count respirations and report a rate of less than 12 breaths per minute
Magnesium sulfate toxicity causes respiratory depression, which is one of the most dangerous and potentially fatal complications. The nurse must closely monitor the respiratory rate and immediately report a rate below 12 breaths per minute, as this is a critical sign of magnesium toxicity requiring prompt intervention including administration of calcium gluconate.
Why Other Options are Incorrect:
B. Check blood pressure and report a rate of less than 100/60 — While blood pressure monitoring is important in pre-eclampsia management, hypotension at 100/60 is not the primary toxicity concern with magnesium sulfate infusion.
C. Count respirations and report a rate of more than 20 breaths per minute — A respiratory rate above 20 is not a sign of magnesium toxicity. The concern is respiratory depression, indicated by a rate below 12.
D. Monitor urinary output and report a rate of less than 100 ml per hour — While urinary output should be monitored (and output below 30 ml/hour is concerning), the threshold of less than 100 ml/hour is not the standard reporting parameter, and respiratory status remains the priority toxicity concern.
The young prenatal patient with gestational diabetes mellitus (GDM) says, "I am frightened that I will have to deal with insulin injections for the rest of my life." What is the best response by the nurse?
- "After delivery your doctor will prescribe oral hypoglycemic medication."
- "After a while the insulin injections won't seem so bad."
- "Have you considered an insulin pump?"
- "GDM usually resolves by 6 weeks after the baby is born."
Explanation
Explanation:
Correct Answer: (D) "GDM usually resolves by 6 weeks after the baby is born."
This response is accurate, reassuring, and directly addresses the patient's fear about lifelong insulin dependence. Gestational diabetes mellitus is typically a temporary condition that resolves after delivery, usually by 6 weeks postpartum. Providing this factual information alleviates the patient's anxiety and promotes understanding of her condition.
Why Other Options are Incorrect:
A. "After delivery your doctor will prescribe oral hypoglycemic medication." — This is inaccurate. GDM typically resolves after delivery and does not routinely require ongoing oral hypoglycemic medication postpartum.
B. "After a while the insulin injections won't seem so bad." — This response dismisses the patient's concern and does not address the underlying misconception that she will need insulin for life. It is not therapeutic or informative.
C. "Have you considered an insulin pump?" — This response is irrelevant to the patient's concern and does not address her fear of lifelong insulin dependence. It may also increase her anxiety by suggesting a more invasive long-term treatment.
A woman who is 4 weeks pregnant becomes concerned when she has light vaginal bleeding accompanied by abdominal pain. An ectopic pregnancy is confirmed by ultrasound. The statement that indicated that the woman understands the explanation of an ectopic pregnancy is:
- The chorionic villi develop vesicles within the uterus.
- The fetus dies in the uterus during the first half of the pregnancy.
- The placenta develops in the lower part of the uterus.
- The embryo is implanted in the fallopian tube.
Explanation
Explanation:
Correct Answer: (D) The embryo is implanted in the fallopian tube.
An ectopic pregnancy most commonly occurs when the fertilized egg implants in the fallopian tube rather than the uterine cavity. This statement correctly reflects the patient's understanding of what an ectopic pregnancy means and why it causes pain and bleeding, as the fallopian tube cannot support fetal growth.
Why Other Options are Incorrect:
A. The chorionic villi develop vesicles within the uterus — This describes a hydatidiform mole, a gestational trophoblastic disease, not an ectopic pregnancy.
B. The fetus dies in the uterus during the first half of the pregnancy — This describes a missed abortion or intrauterine fetal demise, not an ectopic pregnancy.
C. The placenta develops in the lower part of the uterus — This describes placenta previa, a condition where the placenta partially or fully covers the cervical os, which is unrelated to ectopic pregnancy.
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.
The drug the nurse plans to have available for immediate IV administration whenever magnesium sulfate is administered to a maternity patient is:
- Ferrous sulfate
- Calcium gluconate
- Oxytocin
- Nifedipine
Explanation
Explanation:
Correct Answer: (B) Calcium gluconate
Calcium gluconate is the antidote for magnesium sulfate toxicity. Whenever magnesium sulfate is administered — typically for seizure prophylaxis in preeclampsia or as a tocolytic — calcium gluconate must be kept at the bedside for immediate IV administration in the event of magnesium toxicity, which can cause respiratory depression, cardiac arrest, and neuromuscular blockade.
Why Other Options are Incorrect:
A. Ferrous sulfate — Ferrous sulfate is an iron supplement used to treat anemia and has no role as an antidote for magnesium sulfate toxicity.
C. Oxytocin — Oxytocin is used to stimulate uterine contractions and is not related to the management of magnesium sulfate toxicity.
D. Nifedipine — Nifedipine is a calcium channel blocker used as a tocolytic or antihypertensive in pregnancy but is not the antidote for magnesium sulfate toxicity.
The nurse emphasizes to a patient with a high-risk pregnancy that the impact of such a pregnancy might result in which problems? (Select all that apply.)
- Excessive attachment to infant
- Financial pressures
- Frustration with activity restriction
- Alteration in child care practices
- Disruption of family roles
Explanation
Explanation:
Correct Answer: (B) Financial pressures, (C) Frustration with activity restriction, (D) Alteration in child care practices, and (E) Disruption of family roles
A high-risk pregnancy commonly creates financial strain due to increased medical costs, emotional frustration from necessary activity limitations, challenges in caring for other children, and significant disruption to established family dynamics and roles. These are well-recognized psychosocial and practical impacts of high-risk pregnancies.
Why Other Options are Incorrect:
A. Excessive attachment to infant — Excessive attachment is not a recognized problem resulting from a high-risk pregnancy. In fact, high-risk pregnancies may sometimes complicate bonding due to anxiety, prolonged hospitalization, or NICU admission, but excessive attachment is not a standard identified concern.
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