High Risk Pregnancy & Complications Review Questions

1. High Risk Pregnancy & Complications Review Questions Ana H. Corona, MSN, FNP-C Nursing Instructor November 2007 NCLEX RN-PN Review 2007

2. Q1 • The nurse is assessing a multigravida, 36 weeks gestation for symptoms of pregnancy-induced hypertension and preeclampsia. The nurse should give priority to assessing the client for: • Facial swelling • Pulse deficits • Ankle edema • Diminished reflexes

3. A1 • Answer A is correct. The nurse should pay close attention to swelling in the client with preeclampsia. Facial swelling indicates that the client’s condition is worsening and blood pressure will be increased. Answer B is not related to the question; therefore, it is incorrect. Answer C is incorrect because ankle edema is expected in pregnancy. Diminished reflexes are associated with the use of magnesium sulfate, which is the treatment of preeclampsia; therefore, answer D is incorrect

4. Q2 • The nurse has completed discharge instructions for a primigravida woman who is 29 weeks gestation and hospitalized for treatment of deep vein thrombosis. Which of the following statements, if made by the patient to the nurse, indicates that teaching has been successful? • “I should check my leg once a week.” • “I will message my leg nightly.” • “I can take Pepto-Bismol for diarrhea.” • “I will give myself heparin every day.”

5. A2 • D. • Explanation of Answer:Heparin doesn’t cross the placenta and is considered safe during pregnancy.

6. Q3 • The nurse is caring for a woman who is 37-weeks gestation. The nurse would be MOST concerned by which of the following findings? • B/P 150/95 • 4+ proteinuria. • The patient c/o right quadrant pain. • 3+ pitting edema of the ankles.

7. A3 • C. • Explanation of Answer:This indicates impaired liver function, sign of impending eclampsia.

8. Q4 • The nurse knows that which of the following patients has the lowest risk of developing a deep vein thrombosis (DVT)? • A 67-year-old carpenter undergoing a left total knee replacement. • A 22-year-old woman who weighs 230 lbs and is 2 months pregnant with her second child. • A 44-year-old woman with ovarian cancer experiencing vomiting from chemotherapy. • A 50-year-old executive following removal of cataracts.

9. A4 • D. • Explanation of Answer:Age increases risk but a patient is usually not immobile after cataract surgery.

10. Q5 • A 15-YEAR-OLD PRIMIGRAVIDA IS ADMITTED WITH A TENTATIVE DIAGNOSIS OF HELLP SYNDROME. WHICH LABORATORY FINDING IS ASSOCIATED WITH HELLP SYNDROME? • ELEVATED BLOOD GLUCOSE • ELEVATED PLATELET COUNT • ELEVATED CREATININE CLEARANCE • ELEVATED HEPATIC ENZYMES

11. A5 • Answer D is correct. The criteria for HELLP is hemolysis, elevated liver enzymes, and low platelet count. In answer A, an elevated blood glucose level is not associated with HELLP. Platelets are decreased, not elevated, in HELLP syndrome as stated in answer B. The creatinine levels are elevated in renal disease and are not associated with HELLP syndrome so answer C is incorrect.

12. Q6 • THE NURSE IS ASSESSING THE DEEP TENDON REFLEXES OF A CLIENT WITH PREECLAMPSIA. WHICH METHOD IS USED TO ELICIT THE BICEPS REFLEX? • THE NURSE PLACES HER THUMB ON THE MUSCLE INSET IN THE ANTECUBITAL SPACE AND TAPS THE THUMB BRISKLY WITH THE REFLEX HAMMER. • THE NURSE LOOSELY SUSPENDS THE CLIENT'S ARM IN AN OPEN HAND WHILE TAPPING THE BACK OF THE CLIENT'S ELBOW. • THE NURSE INSTRUCTS THE CLIENT TO DANGLE HER LEGS AS THE NURSE STRIKES THE AREA BELOW THE PATELLA WITH THE BLUNT SIDE OF THE REFLEX HAMMER. • THE NURSE INSTRUCTS THE CLIENT TO PLACE HER ARMS LOOSELY AT HER SIDE AS THE NURSE STRIKES THE MUSCLE INSERT JUST ABOVE THE WRIST.

13. A6 • Answer A is correct. Answer B elicits the triceps reflex, so it is incorrect. Answer C elicits the patella reflex, making it incorrect. Answer D elicits the radial nerve, so it is incorrect.

14. Q7 • A DIABETIC MULTIGRAVIDA IS SCHEDULED FOR AN AMNIOCENTESIS AT 32 WEEKS GESTATION TO DETERMINE THE L/S RATIO AND PHOSPHATIDYL GLYCEROL LEVEL. THE L/S RATIO IS 1:1 AND THE PRESENCE OF PHOSPHATIDYLGLYCEROL IS NOTED. THE NURSE'S ASSESSMENT OF THIS DATA IS: • THE INFANT IS AT LOW RISK FOR CONGENITAL ANOMALIES. • THE INFANT IS AT HIGH RISK FOR INTRAUTERINE GROWTH RETARDATION. • THE INFANT IS AT HIGH RISK FOR RESPIRATORY DISTRESS SYNDROME. • THE INFANT IS AT HIGH RISK FOR BIRTH TRAUMA.

15. A7 • Answer C is correct. When the L/S ratio reaches 2:1, the lungs are considered to be mature. The infant will most likely be small for gestational age and will not be at risk for birth trauma, so answer D is incorrect. The L/S ratio does not indicate congenital anomalies, as stated in answer A, and the infant is not at risk for intrauterine growth retardation, making answer B incorrect.

16. Q8 • WHICH OF THE FOLLOWING IS A CHARACTERISTIC OF A REASSURING FETAL HEART RATE PATTERN? • A FETAL HEART RATE OF 170–180BPM • A BASELINE VARIABILITY OF 25–35BPM • OMINOUS PERIODIC CHANGES • ACCELERATION OF FHR WITH FETAL MOVEMENTS

17. A8 • Answer D is correct. Accelerations with movement are normal. Answers A, B, and C indicate ominous findings on the fetal heart monitor.

18. Q9 • A CLIENT WITH DIABETES VISITS THE PRENATAL CLINIC AT 28 WEEKS GESTATION. WHICH STATEMENT IS TRUE REGARDING INSULIN NEEDS DURING PREGNANCY? • INSULIN REQUIREMENTS MODERATE AS THE PREGNANCY PROGRESSES. • A DECREASED NEED FOR INSULIN OCCURS DURING THE SECOND TRIMESTER. • ELEVATIONS IN HUMAN CHORIONIC GONADOTROPHIN DECREASE THE NEED FOR INSULIN. • FETAL DEVELOPMENT DEPENDS ON ADEQUATE INSULIN REGULATION.

19. A9 • Answer D is correct. Fetal development depends on adequate nutrition and insulin regulation. Insulin needs increase during the second and third trimesters, insulin requirements do not moderate as the pregnancy progresses, and elevated human chorionic gonadotrophin elevates insulin needs, not decreases them; therefore, answers A, B, and C are incorrect.

20. Q10 • A CLIENT IN THE PRENATAL CLINIC IS ASSESSED TO HAVE A BLOOD PRESSURE OF 180/96. THE NURSE SHOULD GIVE PRIORITY TO: • PROVIDING A CALM ENVIRONMENT • OBTAINING A DIET HISTORY • ADMINISTERING AN ANALGESIC • ASSESSING FETAL HEART TONES

21. A10 • Answer A is correct. A calm environment is needed to prevent seizure activity. Any stimulation can precipitate seizures. Obtaining a diet history should be done later, and administering an analgesic is not indicated because there is no data in the stem to indicate pain. Therefore, answers B and C are incorrect. Assessing the fetal heart tones is important, but this is not the highest priority in this situation as stated in answer D.

22. Q11 • A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse's response is based on the knowledge that: • THERE IS NO NEED TO TAKE THYROID MEDICATION BECAUSE THE FETUS'S THYROID PRODUCES A THYROID-STIMULATING HORMONE. • REGULATION OF THYROID MEDICATION IS MORE DIFFICULT BECAUSE THE THYROID GLAND INCREASES IN SIZE DURING PREGNANCY. • IT IS MORE DIFFICULT TO MAINTAIN THYROID REGULATION DURING PREGNANCY DUE TO A SLOWING OF METABOLISM. • FETAL GROWTH IS ARRESTED IF THYROID MEDICATION IS CONTINUED DURING PREGNANCY.

23. A11 • Answer B is correct. During pregnancy, the thyroid gland triples in size. This makes it more difficult to regulate thyroid medication. Answer A is incorrect because there could be a need for thyroid medication during pregnancy. Answer C is incorrect because the thyroid function does not slow. Fetal growth is not arrested if thyroid medication is continued, so answer D is incorrect.

24. Q12 • A pregnant client with diabetes has an order for ultrasonography. Preparation for an ultrasound includes: • INCREASING FLUID INTAKE • LIMITING AMBULATION • ADMINISTERING AN ENEMA • WITHHOLDING FOOD FOR 8 HOURS

25. A12 • Answer A is correct. Before ultrasonography, the client should be taught to drink plenty of fluids and not void. The client may ambulate, an enema is not needed, and there is no need to withhold food for 8 hours. Therefore, answers B, C, and D are incorrect

26. Q13 • Vicki F., 28 years old, has had diabetes mellitus since she was an adolescent. She is 8 weeks pregnant. Hyperglycemia during Vicki's first trimester will have what effect on the fetus? A) Excessive fetal size. B) Malformed organs. C) Abnormal positioning. D) Hyperinsulinemia.

27. A13 • B. Malformed organs • Major congenital malformations are noted in the insulin dependent mother with poor metabolic control. Excessive fetal size develops as a result of high maternal glucose levels over the course of the entire pregnancy. Abnormal positioning is not a common problem for the baby of a diabetic mother. Hyperinsulinemia occurs in the third trimester.

28. Q14 • A glycosylated hemoglobin level is ordered for a pregnant diabetic because it A) will predict how well the pancreas can respond to the stress of pregnancy. B) indicates mean glucose level over a 1- to 3-month period. C) gives diagnostic information related to the peripheral effects of diabetes. D) is the most accurate method of determining present insulin levels.

29. A14 • The correct answer is B. Glycosylated hemoglobin measurements can be used to assess prior glycemic control. They have no predictive capacity. They provide a more accurate clinical picture of diabetic control but not its complications. They are not used for current blood glucose levels.

30. Q15 • Ms. D., a diabetic, plans to breast-feed her baby. The nurse explains that, if she is hyperglycemic, A) her baby will receive insulin in the milk. B) the production of milk may be impaired. C) her blood sugar will be extremely difficult to manage. D) the glucose content of her breast milk may be high.

31. A15 • The correct answer is D. Glucose can be transferred from the serum to the breast, and hyperglycemia may be reflected in the breast milk. The production of milk will not be impaired because the mother is hyperglycemic. The baby will not receive insulin in the milk. If the mother is hyperglycemic her blood sugar will be no more difficult to manage. However, the nurse must stress the importance of keeping the blood sugar as close to normal as possible at all times.

32. Q16 • Which of the following matches the definition:  abnormal placenta development covering the cervix? • Placenta Previa • Abruptio Placentae • Multigravida • Proliferative phase

33. A16 • A. The right answer was Placenta Previa.

34. Q17 • What is the best antidote for magnesium sulfate toxicity?A: calcium glutonateB: magnesium glutonateC: radium sulfateD: barium extract

35. A17 • A. The preferred antidote for magnesium sulfate toxicity is calcium glutonate.

36. Q18 • Which of these is not considered a T.O.R.C.H. infection? • Rubella • Herpes • Cytomegalovirus • Croup

37. A18 • D. The right answer was Croup.

38. Q19 • A PRIMIGRAVIDA WITH DIABETES IS ADMITTED TO THE LABOR AND DELIVERY UNIT AT 34 WEEKS GESTATION. WHICH DOCTOR'S ORDER SHOULD THE NURSE QUESTION? • MAGNESIUM SULFATE 4GM (25%) IV • BRETHINE 10MCG IV • STADOL 1MG IV PUSH EVERY 4 HOURS AS NEEDED PRN FOR PAIN • ANCEF 2GM IVPB EVERY 6 HOURS

39. A19 • Answer B is correct. Brethine is used cautiously because it raises the blood glucose levels. Answers A, C, and D are all medications that are commonly used in the diabetic client, so they are incorrect

40. Q20 • WHICH OBSERVATION IN THE NEWBORN OF A DIABETIC MOTHER WOULD REQUIRE IMMEDIATE NURSING INTERVENTION? • CRYING • WAKEFULNESS • JITTERINESS • YAWNING

41. A20 • Answer C is correct. Jitteriness is a sign of seizure in the neonate. Crying, wakefulness, and yawning are expected in the newborn, so answers A, B, and D are incorrect.

42. Q21 • The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is: • DECREASED URINARY OUTPUT • HYPERSOMNOLENCE • ABSENCE OF KNEE JERK REFLEX • DECREASED RESPIRATORY RATE

43. A21 • Answer B is correct. The client is expected to become sleepy, have hot flashes, and be lethargic. A decreasing urinary output, absence of the knee-jerk reflex, and decreased respirations indicate toxicity, so answers A, C, and D are incorrect

44. Q22 • The client with preeclampsia is admitted to the unit with an order for magnesium sulfate. Which action by the nurse indicates understanding of the possible side effects of magnesium sulfate? • THE NURSE PLACES A SIGN OVER THE BED NOT TO CHECK BLOOD PRESSURE IN THE RIGHT ARM. • THE NURSE PLACES A PADDED TONGUE BLADE AT THE BEDSIDE. • THE NURSE INSERTS A FOLEY CATHETER. • THE NURSE DARKENS THE ROOM.

45. A22 • Answer C is correct. The client receiving magnesium sulfate should have a Foley catheter in place, and hourly intake and output should be checked. There is no need to refrain from checking the blood pressure in the right arm. A padded tongue blade should be kept in the room at the bedside, just in case of a seizure, but this is not related to the magnesium sulfate infusion. Darkening the room is unnecessary, so answers A, B, and D are incorrect.

46. Q23 • WHICH NURSE SHOULD BE ASSIGNED TO CARE FOR THE POSTPARTAL CLIENT WITH PREECLAMPSIA? • THE RN WITH 2 WEEKS OF EXPERIENCE IN POSTPARTUM • THE RN WITH 3 YEARS OF EXPERIENCE IN LABOR AND DELIVERY • THE RN WITH 10 YEARS OF EXPERIENCE IN SURGERY • THE RN WITH 1 YEAR OF EXPERIENCE IN THE NEONATAL INTENSIVE CARE UNIT

47. A23 • Answer B is correct. The nurse with 3 years of experience in labor and delivery knows the most about possible complications involving preeclampsia. The nurse in answer A is a new nurse to the unit, and the nurses in answers C and D have no experience with the postpartum client.

48. Q24 • The nurse is caring for a neonate whose mother is diabetic. The nurse will expect the neonate to be: • HYPOGLYCEMIC, SMALL FOR GESTATIONAL AGE • HYPERGLYCEMIC, LARGE FOR GESTATIONAL AGE • HYPOGLYCEMIC, LARGE FOR GESTATIONAL AGE • HYPERGLYCEMIC, SMALL FOR GESTATIONAL AGE

49. A24 • Answer C is correct. The infant of a diabetic mother is usually large for gestational age. After birth, glucose levels fall rapidly due to the absence of glucose from the mother. Answer A is incorrect because the infant will not be small for gestational age. Answer B is incorrect because the infant will not be hyperglycemic. Answer D is incorrect because the infant will be large, not small, and will be hypoglycemic, not hyperglycemic.

50. Q25 • A CLIENT IS ADMITTED TO THE LABOR AND DELIVERY UNIT COMPLAINING OF VAGINAL BLEEDING WITH VERY LITTLE DISCOMFORT. THE NURSE'S FIRST ACTION SHOULD BE TO: • ASSESS THE FETAL HEART TONES • CHECK FOR CERVICAL DILATION • CHECK FOR FIRMNESS OF THE UTERUS • OBTAIN A DETAILED HISTORY