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Questions and Answers
A client presents with vaginal bleeding and is diagnosed with a threatened abortion. Which finding would the nurse anticipate?
A client presents with vaginal bleeding and is diagnosed with a threatened abortion. Which finding would the nurse anticipate?
- Rupture of membranes
- Cervical dilatation
- Passage of tissue
- Mild uterine cramping (correct)
A patient at 10 weeks gestation experiences a spontaneous abortion with dilation and passage of some, but not all, products of conception. Which type of abortion is this?
A patient at 10 weeks gestation experiences a spontaneous abortion with dilation and passage of some, but not all, products of conception. Which type of abortion is this?
- Threatened
- Inevitable
- Incomplete (correct)
- Complete
A woman experiences a spontaneous abortion. What nursing intervention takes priority?
A woman experiences a spontaneous abortion. What nursing intervention takes priority?
- Preparing the client for a D&C
- Administering oxytocin to halt bleeding
- Providing emotional support and comfort (correct)
- Encouraging early ambulation
Which statement indicates that a client understands the discharge instructions after a spontaneous abortion?
Which statement indicates that a client understands the discharge instructions after a spontaneous abortion?
What is the primary risk factor for an ectopic pregnancy?
What is the primary risk factor for an ectopic pregnancy?
A client is diagnosed with an unruptured ectopic pregnancy. Which medication might the nurse administer?
A client is diagnosed with an unruptured ectopic pregnancy. Which medication might the nurse administer?
A client presents with unilateral stabbing pain and scant, dark red vaginal spotting. What should the nurse suspect?
A client presents with unilateral stabbing pain and scant, dark red vaginal spotting. What should the nurse suspect?
What education should the nurse provide to a client receiving education about methotrexate for an ectopic pregnancy?
What education should the nurse provide to a client receiving education about methotrexate for an ectopic pregnancy?
A client experiencing abnormally high hCG levels, rapid uterine growth, and dark red vaginal bleeding may be experiencing which condition?
A client experiencing abnormally high hCG levels, rapid uterine growth, and dark red vaginal bleeding may be experiencing which condition?
What follow-up care is essential for a client following the evacuation of a hydatidiform mole?
What follow-up care is essential for a client following the evacuation of a hydatidiform mole?
A client diagnosed with gestational trophoblastic disease (GTD) asks the nurse about future pregnancies. What should the nurse advise?
A client diagnosed with gestational trophoblastic disease (GTD) asks the nurse about future pregnancies. What should the nurse advise?
A client reports painless, bright red vaginal bleeding during the second trimester. What condition is likely?
A client reports painless, bright red vaginal bleeding during the second trimester. What condition is likely?
A client with placenta previa is actively bleeding. What medication should the nurse anticipate the provider will prescribe?
A client with placenta previa is actively bleeding. What medication should the nurse anticipate the provider will prescribe?
Which assessment finding differentiates abruptio placentae from placenta previa?
Which assessment finding differentiates abruptio placentae from placenta previa?
A client is diagnosed with abruptio placentae. What action should the nurse immediately implement?
A client is diagnosed with abruptio placentae. What action should the nurse immediately implement?
Which of the following clients is at highest risk for abruptio placentae?
Which of the following clients is at highest risk for abruptio placentae?
Which assessment finding would lead the nurse suspect a uterine rupture?
Which assessment finding would lead the nurse suspect a uterine rupture?
Besides preparing the client for an emergency C/S, what other intervention is most important in uterine rupture?
Besides preparing the client for an emergency C/S, what other intervention is most important in uterine rupture?
During labor, a client who had a previous cesarean birth suddenly complains of a ripping sensation and constant abdominal pain. What should the nurse suspect?
During labor, a client who had a previous cesarean birth suddenly complains of a ripping sensation and constant abdominal pain. What should the nurse suspect?
Which type of cord insertion is characterized by fetal vessels running through the membranes before entering the placenta?
Which type of cord insertion is characterized by fetal vessels running through the membranes before entering the placenta?
A nurse is caring for a client who is at 32 weeks of gestation and has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following medications should the nurse expect the provider to prescribe?
A nurse is caring for a client who is at 32 weeks of gestation and has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following medications should the nurse expect the provider to prescribe?
A nurse in the ED is caring for a a client who reports abrupt sharp right sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states “I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device", the nurse should suspect which of the following?
A nurse in the ED is caring for a a client who reports abrupt sharp right sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states “I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device", the nurse should suspect which of the following?
For a client who is experiencing a ruptured ectopic pregnancy, which of the following findings is expected with this condition?
For a client who is experiencing a ruptured ectopic pregnancy, which of the following findings is expected with this condition?
A nurse at an antepartum clinic is caring for a client who is at four months of gestation. The client reports continued nausea, vomiting, and scant, colored discharge. The client has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse expect?
A nurse at an antepartum clinic is caring for a client who is at four months of gestation. The client reports continued nausea, vomiting, and scant, colored discharge. The client has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse expect?
Which of the following is the most common site for an ectopic pregnancy?
Which of the following is the most common site for an ectopic pregnancy?
A nurse is reviewing the lab results for a client with a suspected ectopic pregnancy. Which of the following findings would the nurse expect to see?
A nurse is reviewing the lab results for a client with a suspected ectopic pregnancy. Which of the following findings would the nurse expect to see?
A nurse is providing care to a client with a known placenta previa. Which of the following interventions should the nurse implement when the client reports vaginal bleeding?
A nurse is providing care to a client with a known placenta previa. Which of the following interventions should the nurse implement when the client reports vaginal bleeding?
A nurse is teaching a group of pregnant women about the risk factors associated with placental abruption. Which of the following statements should the nurse include in the teaching?
A nurse is teaching a group of pregnant women about the risk factors associated with placental abruption. Which of the following statements should the nurse include in the teaching?
A nurse is providing care to a client who has experienced a complete spontaneous abortion. Which of the following findings would the nurse expect to observe?
A nurse is providing care to a client who has experienced a complete spontaneous abortion. Which of the following findings would the nurse expect to observe?
A client experiencing a missed abortion is prescribed misoprostol. What should the nurse monitor for following administration?
A client experiencing a missed abortion is prescribed misoprostol. What should the nurse monitor for following administration?
A nurse is caring for a client with a known ectopic pregnancy who reports severe abdominal pain and dizziness. Which action should the nurse take?
A nurse is caring for a client with a known ectopic pregnancy who reports severe abdominal pain and dizziness. Which action should the nurse take?
Following a D&C for a molar pregnancy, what instructions are most essential for the nurse to provide for follow-up care?
Following a D&C for a molar pregnancy, what instructions are most essential for the nurse to provide for follow-up care?
A client at 35 weeks gestation presents with sudden onset of intense, localized uterine pain and dark red vaginal bleeding. What condition should the nurse suspect?
A client at 35 weeks gestation presents with sudden onset of intense, localized uterine pain and dark red vaginal bleeding. What condition should the nurse suspect?
A nurse is assessing laboring clients. Which client is at highest risk for uterine rupture?
A nurse is assessing laboring clients. Which client is at highest risk for uterine rupture?
A client is diagnosed with vasa previa. What fetal complication is the greatest risk?
A client is diagnosed with vasa previa. What fetal complication is the greatest risk?
A nurse is caring for a client diagnosed with a threatened abortion. Which of the following findings would the nurse expect?
A nurse is caring for a client diagnosed with a threatened abortion. Which of the following findings would the nurse expect?
A client experiencing a missed abortion is scheduled for a D&C. What is the nurse's role in preparing the client for the procedure?
A client experiencing a missed abortion is scheduled for a D&C. What is the nurse's role in preparing the client for the procedure?
A nurse is assessing a pregnant client with a history of ectopic pregnancy. Which assessment finding would be most concerning?
A nurse is assessing a pregnant client with a history of ectopic pregnancy. Which assessment finding would be most concerning?
A client is being discharged following the evacuation of a hydatidiform mole. The nurse provides instructions about follow up care. Which statement by the client indicates understanding of the teaching?
A client is being discharged following the evacuation of a hydatidiform mole. The nurse provides instructions about follow up care. Which statement by the client indicates understanding of the teaching?
A client at 9 weeks gestation is diagnosed with an ectopic pregnancy. She has no signs of rupture. Considering the typical treatment options, which of the following should the nurse anticipate?
A client at 9 weeks gestation is diagnosed with an ectopic pregnancy. She has no signs of rupture. Considering the typical treatment options, which of the following should the nurse anticipate?
A client at 10 weeks gestation has been diagnosed with a hydatidiform mole. She is scheduled for a dilation and curettage (D&C). What information is most important for the nurse to include in the pre-operative teaching?
A client at 10 weeks gestation has been diagnosed with a hydatidiform mole. She is scheduled for a dilation and curettage (D&C). What information is most important for the nurse to include in the pre-operative teaching?
A client at 35 weeks gestation presents to the emergency department reporting painless, bright red vaginal bleeding. Based on these findings, what should the nurse suspect?
A client at 35 weeks gestation presents to the emergency department reporting painless, bright red vaginal bleeding. Based on these findings, what should the nurse suspect?
A client at 28 weeks gestation is diagnosed with abruptio placentae after presenting with sudden-onset abdominal pain and dark red vaginal bleeding. The client's abdomen is rigid and tender to the touch. Which of the following interventions would be the highest priority for the nurse?
A client at 28 weeks gestation is diagnosed with abruptio placentae after presenting with sudden-onset abdominal pain and dark red vaginal bleeding. The client's abdomen is rigid and tender to the touch. Which of the following interventions would be the highest priority for the nurse?
During a prenatal visit at 30 weeks gestation, a client with a history of previous cesarean section complains of sudden, severe abdominal pain and a tearing sensation. The fetal heart rate tracing shows prolonged bradycardia. What complication should the nurse suspect, and what is the immediate nursing intervention?
During a prenatal visit at 30 weeks gestation, a client with a history of previous cesarean section complains of sudden, severe abdominal pain and a tearing sensation. The fetal heart rate tracing shows prolonged bradycardia. What complication should the nurse suspect, and what is the immediate nursing intervention?
Flashcards
Spontaneous Abortion
Spontaneous Abortion
End of pregnancy due to natural causes before 20 weeks gestation.
Threatened Abortion
Threatened Abortion
A type of spontaneous abortion with bleeding but no cervical dilation.
Inevitable Abortion
Inevitable Abortion
A type of spontaneous abortion with bleeding and cervical dilation.
Incomplete Abortion
Incomplete Abortion
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Complete Abortion
Complete Abortion
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Missed Abortion
Missed Abortion
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Ectopic Pregnancy
Ectopic Pregnancy
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Ectopic Pregnancy
Ectopic Pregnancy
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Ectopic Pregnancy Pain
Ectopic Pregnancy Pain
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Ectopic Pregnancy Spotting
Ectopic Pregnancy Spotting
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Ruptured Ectopic Pregnancy
Ruptured Ectopic Pregnancy
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Ruptured Ectopic Shock
Ruptured Ectopic Shock
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Gestational Trophoblastic Disease
Gestational Trophoblastic Disease
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Choriocarcinoma
Choriocarcinoma
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GTD Clinical Findings
GTD Clinical Findings
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GTD Lab Work
GTD Lab Work
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Kleihauer-Betke Test
Kleihauer-Betke Test
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Placenta Previa
Placenta Previa
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Placenta Previa Bleeding
Placenta Previa Bleeding
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Abruptio Placentae
Abruptio Placentae
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Abruptio Placentae Findings
Abruptio Placentae Findings
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Rigid, Board-like Abdomen
Rigid, Board-like Abdomen
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Uterine Rupture
Uterine Rupture
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Uterine Rupture Pain
Uterine Rupture Pain
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BANDL Ring
BANDL Ring
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Velamentous Cord Insertion
Velamentous Cord Insertion
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Vasa Previa Treatment
Vasa Previa Treatment
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Study Notes
- Bleeding during pregnancy, see ATI chapter 7
Spontaneous abortion
- This is the end of pregnancy caused by natural events before 20 weeks of gestation
- There are five types of spontaneous abortion: threatened, inevitable, incomplete, complete, and missed
Risk Factors for Spontaneous Abortion
- Chromosomal abnormalities account for 25%
- Maternal illness may increase the risk
- AMA (Advanced Maternal Age) is a risk factor
- Preterm cervical dilatation (PTL) may cause it
- Chronic maternal infections may have an impact
- Maternal malnutrition is a risk
- Trauma and injury can cause it
- Fetal or placental abnormalities may cause it
- Substance abuse can increase risk
- Antiphospholipid syndrome is a risk factor
Spontaneous Abortion Findings
- Abdominal cramping or pain can be a sign
- Rupture of membranes (ROM) is a sign
- Dilated cervix may occur
- Fever may occur
- Signs and symptoms of hemorrhage include hypotension and tachycardia
Spontaneous Abortion Lab Work
- Complete blood count (CBC) with differential should be done
- Hemoglobin and hematocrit (H&H) levels should be checked
- White blood cell count (WBC) levels should be checked
- Clotting factors like PT/PTT should be tested
- HCG levels should be measured
Diagnostic and Therapeutic Procedures for Spontaneous Abortion
- Ultrasound (U/S) may be conducted
- Cervical exam may be done
- Dilatation and curettage (D&C) can be performed
- Administer uterine stimulants, such as oxytocin or prostaglandins
Nursing Care for Spontaneous Abortion
- Refer to the loss as a miscarriage, not an abortion
- Observe for bleeding and passed tissue, and document findings
- Provide bed rest, especially if the client is at risk for falls
- Avoid excessive vaginal exams
- Offer assistance with ultrasound or D&C
- Administer prescribed medications and blood products
- Provide comfort, education, and support group information
Spontaneous Abortion Medications
- Pain medications may be prescribed
- Prostaglandins such as misoprostol (Cytotec) or carboprost (Hemabate) may be given
- Oxytocin is used to help with uterine contraction
- Antibiotics (ABX) may be administered
- Rhogam is given to Rh-negative mothers
Client Education for Spontaneous Abortion
- If client experiences heavy, bright red vaginal bleeding, elevated temperature, or foul-smelling vaginal discharge, the provider must be notified
- A small amount of vaginal bleeding is normal for 1-2 weeks
- Take medications as prescribed
- Avoid baths, intercourse, or placing anything in the vagina for two weeks
- Discuss loss with provider before attempting another pregnancy
Ectopic Pregnancy
- This is an abnormal implantation of a fertilized egg outside the uterine cavity
- The most common site for it to occur is in the fallopian tube
- The second most frequent cause of bleeding in early pregnancy and leading cause of infertility
Ectopic Pregnancy Risk Factors
- History of sexually transmitted infections (STIs)
- Assisted reproduction can increase the risk
- Prior tubal ligation or surgery
- Presence of an intrauterine device (IUD)
Ectopic Pregnancy Clinical Findings
- Unilateral stabbing pain in the lower abdomen region
- Late menses for 1-2 weeks
- Scant, dark red, brown spotting for 6-8 weeks after last menses may occur
- If ruptured, red bleeding and referred shoulder pain (r/t nerve irritation) occurs
- There is a risk for hemorrhagic shock, indicated by hypotension, pallor, tachycardia, and dizziness
Ectopic Pregnancy Treatment
- If unruptured, methotrexate or salpingostomy can be administered
- If ruptured, laparoscopic salpingectomy
Nursing Care for Ectopic Pregnancy
- Replace fluids
- Comfort care should be taken
- Administer medications as ordered
- Prepare the client for a procedure/surgery
- Draw labs, including CBC, liver & renal studies, HCG/progesterone, type & cross
- If the client receives methotrexate, advise avoiding vitamins containing folic acid and to protect against sun exposure
Gestational Trophoblastic Disease
- This involves the proliferation and degeneration of cells that would normally form the placenta
- Cells form into grape-like clusters
- Associated with choriocarcinoma
- There are 2 types of growths: complete and partial
Gestational Trophoblastic Disease Risk Factors
- History of molar pregnancy
- Early teen or over 40 years of age
Gestational Trophoblastic Disease Clinical Findings
- Rapid uterine growth larger than expected for gestational age
- Dark red vaginal bleeding (prune juice) or bright red bleeding
- Passage of vesicles may occur
- Anemia may occur
- Signs and symptoms of preeclampsia could occur before 24 weeks gestation
- Hyperemesis may occur
Gestational Trophoblastic Disease Lab Work
- Often presents with abnormally high HCG levels
Gestational Trophoblastic Disease Diagnostic and Therapeutic Procedures
- Ultrasound (U/S)
- Dilatation and curettage (D&C)
- Follow-up serial serum HCG levels to detect regrowth weekly for 3 weeks, then monthly for 1 year
Nursing Considerations for Gestational Trophoblastic Disease
- Fundal height assessment
- Assess vaginal bleeding and discharge
- Assess appetite and nausea/vomiting (N/V)
- Give Rhogam after the procedure if indicated
- Refer for chemotherapy if malignancy is found
- Advise the client to save any tissue expelled for evaluation
Education for Gestational Trophoblastic Disease
- Birth control should be used for at least 1 year following GTD
- Avoid IUDs
- Schedule and keep follow-up appointments
Placenta Previa
- It is a condition where the placenta covers some or all of the internal os
- Bleeding occurs when the cervix begins to dilate and efface
- There are 4 types: complete, incomplete/partial, marginal, and low-lying
Placenta Previa Risk Factors
- Previous placenta previa
- Uterine scarring may occur
- Maternal age >35
- Multi-fetal pregnancy
- Multiple gestations
- Smoking
- Male fetus
Placenta Previa Clinical Findings
- Painless, bright red bleeding during the 2nd or 3rd trimester
Placenta Previa Lab test
- HgB/HCT decreases with blood loss
- Complete blood count (CBC) levels checked
- Blood type/Rh
- Partial thromboplastin time (Pt/PTT)
- Kleihauer-Betke test may indicate maternal-fetal blood mixing
Placenta Previa Diagnostics
- Diagnosed with Ultrasound (U/S)
- A complete placenta previa condition will likely require a cesarean section
Abruptio Placentae
- Premature separation of the placenta from the uterus
- Can be partial or complete, and may be concealed
- Significant maternal and fetal mortality occurs
- May lead to Disseminated Intravascular Coagulation (DIC)
Abruptio Placentae Risk Factors
- Maternal hypertension
- Blunt abdominal trauma
- Cocaine use
- History of abruption
- Cigarette smoking
- Premature rupture of membranes (PROM)
- Multifetal gestation
Abruptio Placentae Clinical Findings
- Experience a sudden onset of intense localized uterine pain with dark red vaginal bleeding
- Area of tenderness is localized or diffuse
- Rigid, board-like abdomen
- Contractions with hypertonicity
- May experience fetal distress
- May experience Signs and Symptoms of hypovolemic shock
Abruptio Placentae Lab work
- CBC: HgB & HCT, PLTS should be checked
- Draw for clotting factors
- Blood type and cross
- Kleihauer-Betke test
Abruptio Placentae Diagnostic and Procedures
- U/S for confirmation
- Delivery!
Nursing Considerations for Abruptio Placentae
- Palpate the uterus for tone and tenderness
- Perform serial monitoring of fundal height
- Prepare for an emergent birth
- Intravenous fluids (IVF)
- Oxygen as ordered
- Continual fetal monitoring
- Urinary output monitoring
- Prepare ordered blood products
- Ensure the availability of resuscitative equipment
- Provide emotional support
Uterine Rupture
- Involves a rupture of the layers of the uterine wall
- There are three types:
- Window: a thinning of myometrium
- Dehiscence: a tear in both the endometrium and myometrium
- Complete: a tear through all layers; Rare but a medical emergency
Uterine Rupture Risk Factors
- Uterine abnormalities
- Scars or trauma to the uterus
- Over distention of the uterus
- Tachysystole of the uterus
- Pregnancies close together
- Forceps-assisted birth
Uterine Rupture Assessment findings
- A ripping or tearing feeling in the abdomen
- Pain and tenderness in the abdomen
- Presence of a Bandl Ring sign: A narrowing in the lower segment of the uterus due to the upper segment thickening and pushing against a thinning lower segment
- Infant may return to a higher station of labor
- Imminent sign of a dystocia of labor
- Requires Cesarean section with classical incision
- Signs of fetal distress as indicated by decreased HR and decelerations
- Palpable fetal parts may be present
- Maternal vital sign changes, manifesting as shock with tachypnea, hypotension, pallor, and cool, clammy skin
Nursing Care for Uterine Rupture
- Prepare for cesarean section and possible hysterectomy
- Obtain labs, including CBC and type and cross
- Call the blood bank
- Give oxygen and intravenous fluids if not already infusing
- Consider tocolytics to stop contractions
- Inform the client and family
- Stay calm and reassuring
Vasa Previa
- Occurs when fetal blood vessels from the placenta or umbilical cord cross the entrance to the birth canal in front of the baby
- Rarely reported; occurs in 1 in 2,500 births, with a fetal mortality rate estimated as high as 50% if not diagnosed prenatally
- There is no known cause; it is an anomaly of placental attachment Pregnancies resulting from in vitro fertilization or multiple pregnancies are risk factors for the anomaly
- Vasa previa can be asymptomatic but can also present with sudden onset of abnormally heavy or small amounts of painless vaginal bleeding in the second or third trimester of pregnancy
- The source of the blood should always be investigated to determine whether it is maternal or fetal to ascertain whether the baby is in distress
3 Vasa Previa Types
- Velamentous: parts of the umbilical cord are exposed due to lack of Wharton’s Jelly
- Succenturiate: two or more lobes of the placenta have grown and are attached by umbilical vessels
- Battledore: marginal cord, vessels grow from the end of the placenta
Risk with Vasa Previa
- Fetal nutrients/O2 limited or restricted
- Decreased fetal growth
- Bleeding with ROM/contractions
Vasa Previa Treatment
- Monitor fetal growth and wellbeing with serial U/S; schedule C/S if internal os is not obstructed
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