EXAM-5-RATIO-PRETEM-LABOR-TO-ANESTHESIA PDF

PREMATURE LABOR Question 1: A nurse is caring for a patient experiencing premature labor at 34 weeks gestation. Which of the following medications should the nurse anticipate administering to accelerate fetal lung maturity? A) Oxytocin B) Betamethasone C) Ibuprofen D) Magnesium sulfate Answer: B) Betamethasone. Reasons for the Correct Answer: Betamethasone: This corticosteroid is given to pregnant women at risk of preterm birth to help accelerate fetal lung maturity. It significantly reduces the risk of neonatal respiratory distress syndrome, intraventricular hemorrhage, and other complications associated with premature birth. Reasons Why Other Options are Incorrect: Oxytocin: This medication is used to induce labor, not to accelerate fetal lung maturity. Ibuprofen: This is a nonsteroidal anti-inflammatory drug (NSAID) and is not used for accelerating fetal lung maturity. Magnesium sulfate: This medication is often used for neuroprotection in preterm infants and to prevent seizures in women with preeclampsia, but it does not accelerate fetal lung maturity. Question 2: Which of the following signs and symptoms would MOST likely indicate premature labor? A) Braxton Hicks contractions B) Decreased fetal movement C) Regular uterine contractions D) Increased energy levels Answer: C) Regular uterine contractions. Reasons for the Correct Answer: Regular Uterine Contractions: Contractions occurring at regular intervals, especially if they become more frequent, intense, and don't go away with rest, are strong indicators of premature labor. These contractions may cause cervical changes, such as dilation and effacement, leading to preterm birth if not managed. Reasons Why Other Options are Incorrect: Braxton Hicks contractions: These are usually irregular, infrequent, and often referred to as "false labor" contractions. They don't typically indicate the onset of labor. Decreased fetal movement: While this is a concern and should be reported, it is not a primary sign of premature labor. Increased energy levels: This is not associated with premature labor and could be due to various other reasons. Question 3: A nurse is providing education to a patient at risk for premature labor. Which of the following instructions is MOST important? A) Limit physical activity and rest as much as possible. B) Drink at least eight glasses of water per day. C) Ignore mild contractions unless they become painful. D) Perform daily fetal kick counts. Answer: A) Limit physical activity and rest as much as possible. Reasons for the Correct Answer: Limit Physical Activity and Rest as Much as Possible: Rest and reducing physical activity can help decrease the risk of triggering premature labor. It's essential for the patient to take it easy and avoid activities that could induce contractions or other complications. Reasons Why Other Options are Incorrect: Drink at least eight glasses of water per day: Staying hydrated is important, but it does not specifically address the risk of premature labor. Ignore mild contractions unless they become painful: It's important to report any contractions, as they could indicate the start of premature labor. Ignoring them could delay necessary medical intervention. Perform daily fetal kick counts: While monitoring fetal movements is important, it does not directly prevent premature labor. Question 4: During an assessment of a patient in premature labor, the nurse notes a bulging amniotic sac. What is the nurse’s PRIORITY action? A) Instruct the patient to push. B) Prepare for immediate delivery. C) Place the patient in the Trendelenburg position. D) Administer tocolytic medication as prescribed. Answer: C) Place the patient in the Trendelenburg position. Reasons for the Correct Answer: Place the Patient in the Trendelenburg Position: Positioning the patient with her head lower than her pelvis can help reduce pressure on the cervix and potentially prevent or delay further prolapse of the membranes. This is a critical step to manage the immediate risk and prevent complications. Reasons Why Other Options are Incorrect: Instruct the patient to push: This action could worsen the situation by increasing the risk of rupturing the amniotic sac and advancing labor. Prepare for immediate delivery: While preparation is important, the immediate priority is to manage the bulging membranes to prevent preterm birth if possible. Administer tocolytic medication as prescribed: This may be part of the management plan, but the initial priority is to address the physical position of the patient to manage the immediate risk. Question 5: A patient in premature labor is prescribed nifedipine. What is the PRIMARY purpose of this medication? A) To relieve pain B) To reduce blood pressure C) To suppress contractions D) To prevent infection Answer: C) To suppress contractions. Reasons for the Correct Answer: Suppress Contractions: Nifedipine is a calcium channel blocker that works by preventing calcium from entering the muscle cells of the uterus, which helps to relax the uterine muscles and suppress contractions. This can delay preterm labor and provide time for other interventions, such as administering corticosteroids to accelerate fetal lung maturity1. Reasons Why Other Options are Incorrect: Relieve pain: While nifedipine may indirectly help reduce pain by stopping contractions, its primary purpose is not pain relief. Reduce blood pressure: Although nifedipine is also used to treat high blood pressure, its use in premature labor is specifically for tocolysis (suppressing contractions). Prevent infection: Nifedipine does not have any properties that would prevent infection. Question 6: Which of the following risk factors is MOST associated with premature labor? A) Advanced maternal age B) Multiparity C) History of cervical conization D) Gestational diabetes Answer: C) History of cervical conization. Reasons for the Correct Answer: History of Cervical Conization: Women who have undergone cervical conization (a surgical procedure to remove a portion of the cervix) are at a higher risk of premature labor due to cervical insufficiency, which can lead to early dilation and effacement of the cervix. Reasons Why Other Options are Incorrect: Advanced maternal age: While advanced maternal age (over 35) is a risk factor for various pregnancy complications, it is not the most associated with premature labor. Multiparity: Having multiple pregnancies (twins, triplets, etc.) is a significant risk factor, but cervical conization poses a more direct risk. Gestational diabetes: While gestational diabetes can lead to complications, it is not the most associated risk factor for premature labor compared to cervical conization. Question 7: A nurse is monitoring a patient for signs of preterm labor. Which of the following symptoms should prompt the nurse to contact the healthcare provider? A) Occasional nausea B) Frequent urination C) Low backache D) Pelvic pressure Answer: D) Pelvic pressure. Reasons for the Correct Answer: Pelvic Pressure: This symptom can indicate changes in the cervix, such as dilation and effacement, which are signs of preterm labor. It is important to notify the healthcare provider immediately to assess and manage the situation appropriately. Reasons Why Other Options are Incorrect: Occasional nausea: While this can occur during pregnancy, it is not a specific sign of preterm labor. Frequent urination: This is common in pregnancy due to increased pressure on the bladder and is not a direct indicator of preterm labor. Low backache: This can be a symptom of preterm labor but is less specific than pelvic pressure. However, if combined with other symptoms, it should be reported. Question 8: A patient at 32 weeks gestation with a history of premature labor is experiencing contractions every 10 minutes. What is the nurse’s BEST response? A) Advise the patient to take a warm bath. B) Instruct the patient to lie down on her left side. C) Tell the patient to wait until the contractions are 5 minutes apart. D) Prepare to administer tocolytic therapy as prescribed. Answer: D) Prepare to administer tocolytic therapy as prescribed. Reasons for the Correct Answer: Prepare to Administer Tocolytic Therapy: Tocolytics are medications used to suppress premature labor. Administering these medications can help delay delivery, providing more time for fetal development and the administration of corticosteroids to enhance fetal lung maturity. Reasons Why Other Options are Incorrect: Advise the patient to take a warm bath: While this might help relax the patient, it does not address the medical need to suppress contractions. Instruct the patient to lie down on her left side: This can help improve blood flow to the uterus and placenta but is not sufficient on its own to manage preterm labor. Tell the patient to wait until the contractions are 5 minutes apart: Waiting could result in progressing labor and reducing the effectiveness of interventions to delay delivery. Question 9: Which of the following assessments is MOST important for a nurse to perform on a patient at risk for premature labor? A) Daily weight measurement B) Vaginal pH testing C) Fetal heart rate monitoring D) Measurement of fundal height Answer: C) Fetal heart rate monitoring. Reasons for the Correct Answer: Fetal Heart Rate Monitoring: Continuous or frequent monitoring of the fetal heart rate is crucial to ensure that the fetus is not in distress. It provides vital information about the well-being of the fetus and can help in making timely decisions if there are any signs of complications. Reasons Why Other Options are Incorrect: Daily weight measurement: While monitoring weight is important, it is not the most critical assessment for managing premature labor risk. Vaginal pH testing: This can help detect infections, but it is not the primary assessment for preterm labor. Measurement of fundal height: Fundal height is useful for assessing fetal growth, but it does not provide immediate information on the risk of premature labor or fetal distress. Question 10: A nurse is caring for a patient who delivered prematurely. Which of the following postpartum complications should the nurse monitor for? A) Postpartum hemorrhage B) Postpartum depression C) Subinvolution of the uterus D) All of the above Answer: D) All of the above. Reasons for the Correct Answer: Postpartum Hemorrhage: Women who deliver prematurely are at increased risk of postpartum hemorrhage due to the possibility of uterine atony and other complications. Postpartum Depression: Premature delivery can be a stressful and emotional experience, increasing the risk of postpartum depression. Subinvolution of the Uterus: The uterus may take longer to return to its pre-pregnancy size and condition, which can lead to complications such as prolonged bleeding. HEMOLYTIC DISEASE DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient with a known risk for hemolytic disease of the fetus and newborn (HDFN). Which of the following laboratory tests is MOST important to monitor? A) Maternal serum alpha-fetoprotein B) Maternal serum indirect bilirubin C) Fetal umbilical cord blood hemoglobin D) Fetal scalp blood pH Answer: B) Maternal serum indirect bilirubin. Reasons for the Correct Answer: Maternal Serum Indirect Bilirubin: Monitoring maternal serum indirect bilirubin levels is crucial in HDFN as it helps assess the extent of hemolysis (breakdown of red blood cells) and the risk of severe hyperbilirubinemia in the newborn. Elevated bilirubin levels can lead to complications such as kernicterus in the newborn. Reasons Why Other Options are Incorrect: Maternal serum alpha-fetoprotein: This test is used primarily for screening neural tube defects and other fetal abnormalities, not for monitoring HDFN. Fetal umbilical cord blood hemoglobin: While this can provide information about fetal anemia, it is not the primary test for monitoring HDFN. Fetal scalp blood pH: This test is used to assess fetal well-being during labor but is not specific to monitoring HDFN. Question 2: Which of the following interventions is MOST appropriate for a newborn with HDFN? A) Immediate breastfeeding initiation B) Phototherapy C) Oral iron supplementation D) Routine vaccination Answer: B) Phototherapy. Reasons for the Correct Answer: Phototherapy: This is a primary treatment for managing hyperbilirubinemia in newborns with HDFN. Phototherapy helps to break down bilirubin in the skin, reducing the risk of severe jaundice and kernicterus. Reasons Why Other Options are Incorrect: Immediate breastfeeding initiation: While breastfeeding is important for the overall health of the newborn, it does not specifically address the bilirubin levels in HDFN. Oral iron supplementation: Iron supplementation is not typically used in the immediate management of HDFN; it is more relevant for addressing iron deficiency anemia. Routine vaccination: While important for overall health, routine vaccinations do not address the acute condition of HDFN. Question 3: A nurse is providing education to a Rh-negative mother who has just given birth to an Rh-positive baby. Which of the following medications should the nurse prepare to administer? A) Rho(D) immune globulin B) Intravenous immunoglobulin C) Erythropoietin D) Folic acid Answer: A) Rho(D) immune globulin. Reasons for the Correct Answer: Rho(D) Immune Globulin: This medication is given to Rh-negative mothers who have given birth to an Rh-positive baby to prevent the mother's immune system from producing antibodies against Rh- positive blood cells. This is crucial to prevent hemolytic disease in future pregnancies. Reasons Why Other Options are Incorrect: Intravenous Immunoglobulin: This is used for various immune deficiencies and autoimmune conditions, not specifically for preventing Rh sensitization. Erythropoietin: This is used to stimulate red blood cell production, not for Rh incompatibility. Folic Acid: This is important for preventing neural tube defects during pregnancy but does not address Rh sensitization. Question 4: During a prenatal visit, a patient with a history of a child with HDFN asks about the risk to her current pregnancy. Which of the following factors MOST influences the risk? A) Maternal blood type B) Paternal blood type C) Presence of maternal antibodies D) Gestational age Answer: C) Presence of maternal antibodies. Reasons for the Correct Answer: Presence of Maternal Antibodies: If the mother has developed antibodies against Rh-positive blood cells (due to previous sensitization), these antibodies can cross the placenta and attack the red blood cells of an Rh-positive fetus, leading to hemolytic disease of the fetus and newborn (HDFN). Reasons Why Other Options are Incorrect: Maternal blood type: While maternal Rh-negative blood type is a risk factor, the presence of antibodies is a more direct indicator of risk. Paternal blood type: The father's Rh-positive blood type contributes to the risk, but it is the maternal antibodies that directly affect the fetus. Gestational age: While gestational age can affect the severity and timing of HDFN, the primary factor is the presence of maternal antibodies. Question 5: A nurse is assessing a newborn for signs of HDFN. Which of the following findings would be a cause for concern? A) Pale skin color B) Jaundice within the first 24 hours of life C) A high-pitched cry D) All of the above Answer: D) All of the above. Reasons for the Correct Answer: Pale Skin Color: This may indicate anemia, which is a common complication of HDFN due to the destruction of red blood cells. Jaundice Within the First 24 Hours of Life: Early onset jaundice is a significant concern as it suggests high levels of bilirubin resulting from the breakdown of red blood cells, a hallmark of HDFN. A High-Pitched Cry: This can be a sign of neurological irritability, possibly due to hyperbilirubinemia or other complications associated with HDFN. GONORRHEA DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient diagnosed with gonorrhea. Which of the following complications should the nurse monitor for in the newborn? A) Cleft lip B) Ophthalmia neonatorum C) Congenital heart defect D) Talipes equinovarus (clubfoot) Answer: B) Ophthalmia neonatorum. Reasons for the Correct Answer: Ophthalmia Neonatorum: This is a severe eye infection in newborns caused by Neisseria gonorrhoeae, which can be contracted during delivery if the mother is infected. It can lead to serious complications such as blindness if not treated promptly. Reasons Why Other Options are Incorrect: Cleft lip: This is a congenital condition and is not related to gonorrhea. Congenital heart defect: This is also a congenital condition and is not associated with gonorrhea. Talipes equinovarus (clubfoot): This is a congenital deformity of the foot and is not related to gonorrhea. Question 2: During a prenatal visit, a patient tests positive for gonorrhea. Which of the following treatments should the nurse expect to be prescribed? A) Oral metronidazole B) Intramuscular ceftriaxone C) Oral acyclovir D) Topical miconazole Answer: B) Intramuscular ceftriaxone. Reasons for the Correct Answer: Intramuscular Ceftriaxone: The Centers for Disease Control and Prevention (CDC) recommends a single 500 mg intramuscular dose of ceftriaxone for the treatment of uncomplicated gonorrhea in pregnant patients. Reasons Why Other Options are Incorrect: Oral metronidazole: This is used to treat bacterial vaginosis and trichomoniasis, not gonorrhea. Oral acyclovir: This is an antiviral medication used to treat herpes infections, not bacterial infections like gonorrhea. Topical miconazole: This is an antifungal medication used to treat fungal infections, not bacterial infections like gonorrhea. CHLAMYDIA DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient diagnosed with chlamydia. Which of the following complications should the nurse monitor for in the newborn? A) Cleft palate B) Neonatal conjunctivitis C) Congenital heart disease D) Umbilical hernia Answer: B) Neonatal conjunctivitis. Reasons for the Correct Answer: Neonatal Conjunctivitis: Chlamydia can be transmitted to the newborn during delivery, leading to eye infections known as neonatal conjunctivitis (or ophthalmia neonatorum). This condition can cause redness, swelling, and discharge from the eyes and requires prompt treatment to prevent complications. Reasons Why Other Options are Incorrect: Cleft palate: This is a congenital condition and is not related to chlamydia. Congenital heart disease: This is also a congenital condition and is not associated with chlamydia. Umbilical hernia: This is a condition where part of the intestine protrudes through the abdominal wall near the umbilicus and is not related to chlamydia. Question 2: During a prenatal visit, a patient tests positive for chlamydia. Which of the following treatments should the nurse expect to be prescribed? A) Oral metronidazole B) Intramuscular penicillin C) Oral azithromycin D) Topical antifungal cream Answer: C) Oral azithromycin. Reasons for the Correct Answer: Oral Azithromycin: The Centers for Disease Control and Prevention (CDC) recommends a single 1-g dose of oral azithromycin as the first-line treatment for chlamydia during pregnancy. Reasons Why Other Options are Incorrect: Oral metronidazole: This is used to treat bacterial vaginosis and trichomoniasis, not chlamydia. Intramuscular penicillin: This is not the recommended treatment for chlamydia. Topical antifungal cream: This is used for fungal infections, not bacterial infections like chlamydia. SYPHILIS DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient diagnosed with syphilis. Which of the following interventions is MOST important to prevent congenital syphilis in the newborn? A) Administering penicillin to the mother during pregnancy B) Performing a cesarean section C) Giving the newborn hepatitis B vaccine D) Treating the newborn with antiviral medication Answer: A) Administering penicillin to the mother during pregnancy. Reasons for the Correct Answer: Administering Penicillin: Penicillin is the recommended treatment for syphilis during pregnancy. Administering penicillin to the mother can effectively treat the infection and prevent transmission to the baby, thereby preventing congenital syphilis. Reasons Why Other Options are Incorrect: Performing a cesarean section: This does not prevent congenital syphilis, as the infection is transmitted through the placenta. Giving the newborn hepatitis B vaccine: This vaccine is for hepatitis B, not syphilis. Treating the newborn with antiviral medication: Congenital syphilis is a bacterial infection, not a viral one, so antiviral medications are not effective. Question 2: During a prenatal visit, a patient tests positive for syphilis. Which of the following findings should the nurse anticipate in the newborn if congenital syphilis occurs? A) Cleft lip and palate B) Hepatosplenomegaly and rash C) Polydactyly D) Congenital heart disease Answer: B) Hepatosplenomegaly and rash. Reasons for the Correct Answer: Hepatosplenomegaly and Rash: Congenital syphilis can cause hepatosplenomegaly (enlargement of the liver and spleen) and a rash, which are common signs of the infection in newborns. Reasons Why Other Options are Incorrect: Cleft lip and palate: These are congenital conditions and are not typically associated with congenital syphilis. Polydactyly: This is a congenital condition where the newborn has extra fingers or toes and is not related to congenital syphilis. Congenital heart disease: While congenital syphilis can cause various health issues, congenital heart disease is not a primary symptom of congenital syphilis. CANDIDIASIS DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient who presents with a thick, white vaginal discharge and pruritus. Which of the following treatments should the nurse anticipate to be prescribed? A) Oral fluconazole B) Intravenous acyclovir C) Topical clotrimazole D) Oral metronidazole Answer: A) Oral fluconazole. Reasons for the Correct Answer: Oral Fluconazole: This is an antifungal medication commonly used to treat yeast infections, which often present with thick, white, cottage cheese-like discharge and itching. Reasons Why Other Options are Incorrect: Intravenous acyclovir: This is an antiviral medication used to treat herpes infections, not yeast infections. Topical clotrimazole: While clotrimazole is an antifungal treatment, it is usually applied topically and may not be the first choice for pregnant patients. Oral metronidazole: This is used to treat bacterial infections like bacterial vaginosis, not yeast infections. Question 2: During a prenatal visit, a patient reports symptoms suggestive of vaginal candidiasis. Which of the following is an important nursing intervention to help prevent recurrence? A) Advise the patient to wear tight-fitting synthetic underwear. B) Recommend the use of scented feminine hygiene products. C) Suggest dietary changes such as reducing sugar intake. D) Instruct the patient to take warm baths daily. Answer: C) Suggest dietary changes such as reducing sugar intake. Reasons for the Correct Answer: Suggest Dietary Changes Such as Reducing Sugar Intake: High sugar intake can contribute to yeast overgrowth. Reducing sugar in the diet can help maintain a healthier balance of yeast and bacteria in the body, thus reducing the risk of recurrent infections. Reasons Why Other Options are Incorrect: Advise the patient to wear tight-fitting synthetic underwear: Tight-fitting synthetic underwear can create a warm, moist environment that encourages yeast growth. It's better to recommend loose-fitting, breathable cotton underwear. Recommend the use of scented feminine hygiene products: Scented products can irritate the vaginal area and disrupt the natural balance of bacteria and yeast, increasing the risk of infection. Instruct the patient to take warm baths daily: While maintaining good hygiene is important, taking frequent warm baths can disrupt the natural flora and may not necessarily help in preventing candidiasis. In some cases, it might even increase the risk. TRICHOMONIASIS DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient diagnosed with trichomoniasis. Which of the following symptoms should the nurse expect the patient to report? A) Abdominal cramping B) Profuse, frothy, greenish-yellow vaginal discharge C) Absence of vaginal discharge D) Fever and chills Answer: B) Profuse, frothy, greenish-yellow vaginal discharge. Reasons for the Correct Answer: Profuse, Frothy, Greenish-Yellow Vaginal Discharge: This is a common symptom of trichomoniasis, often accompanied by an unpleasant odor and irritation. Reasons Why Other Options are Incorrect: Abdominal Cramping: While lower abdominal discomfort can occur, it is less common. Absence of Vaginal Discharge: This is not typical of trichomoniasis, as the infection usually causes noticeable discharge. Fever and Chills: These are not typical symptoms of trichomoniasis. Question 2: During a prenatal visit, a patient tests positive for trichomoniasis. Which of the following treatments should the nurse expect to be prescribed? A) Oral metronidazole B) Topical antifungal cream C) Intravenous acyclovir D) Oral fluconazole Answer: A) Oral metronidazole. Reasons for the Correct Answer: Oral Metronidazole: This is the recommended antibiotic treatment for trichomoniasis, including during pregnancy. It is effective in clearing the infection and relieving symptoms2. Reasons Why Other Options are Incorrect: Topical antifungal cream: This is used for fungal infections, not bacterial infections like trichomoniasis. Intravenous acyclovir: This is an antiviral medication used to treat herpes infections, not trichomoniasis. Oral fluconazole: This is an antifungal medication used to treat yeast infections, not trichomoniasis. BACTERIAL VAGINOSIS DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient diagnosed with bacterial vaginosis. Which of the following symptoms is the patient MOST likely to report? A) Itching and redness around the vulva B) Pain during urination C) Fishy vaginal odor and thin, gray discharge D) Lesions on the external genitalia Answer: C) Fishy vaginal odor and thin, gray discharge. Reasons for the Correct Answer: Fishy Vaginal Odor and Thin, Gray Discharge: Bacterial vaginosis typically presents with a strong fishy odor and a thin, grayish discharge. These symptoms are characteristic of the imbalance of vaginal bacteria causing the condition. Reasons Why Other Options are Incorrect: Itching and Redness around the Vulva: These symptoms are more commonly associated with yeast infections, not bacterial vaginosis. Pain during Urination: While this can occur with bacterial vaginosis, it is not the most common or defining symptom. Lesions on the External Genitalia: These are typically associated with sexually transmitted infections like herpes, not bacterial vaginosis. Question 2: During a prenatal visit, a patient is found to have bacterial vaginosis. Which of the following treatments should the nurse expect to be prescribed? A) Oral fluconazole B) Intravenous acyclovir C) Oral metronidazole or clindamycin D) Topical antifungal cream Answer: C) Oral metronidazole or clindamycin. Reasons for the Correct Answer: Oral Metronidazole or Clindamycin: These antibiotics are commonly used to treat bacterial vaginosis. They help restore the normal balance of bacteria in the vagina. Reasons Why Other Options are Incorrect: Oral fluconazole: This is an antifungal medication used to treat yeast infections, not bacterial vaginosis. Intravenous acyclovir: This is an antiviral medication used to treat herpes infections, not bacterial vaginosis. Topical antifungal cream: This is used for fungal infections and is not appropriate for treating bacterial vaginosis. HUMAN PAPILLOMAVIRUS DURING PREGNANCY Question 1: A nurse is providing care to a pregnant patient diagnosed with HPV. Which of the following fetal risks should the nurse discuss with the patient? A) Increased risk of fetal macrosomia B) Potential for respiratory papillomatosis in the newborn C) High likelihood of congenital heart defects D) Increased chance of preterm labor Answer: B) Potential for respiratory papillomatosis in the newborn. Reasons for the Correct Answer: Potential for Respiratory Papillomatosis: Although rare, HPV can be transmitted to the newborn during delivery, potentially causing respiratory papillomatosis, which is characterized by the growth of warts in the airways and can lead to breathing difficulties. Reasons Why Other Options are Incorrect: Increased risk of fetal macrosomia: This is not typically associated with HPV. High likelihood of congenital heart defects: There is no established link between HPV and congenital heart defects. Increased chance of preterm labor: While HPV can cause some complications, it is not directly linked to an increased chance of preterm labor. Question 2: During a prenatal visit, a patient with HPV expresses concern about the mode of delivery. Which of the following is the MOST appropriate response by the nurse? A) “HPV has no impact on the mode of delivery; you can proceed with a vaginal birth.” B) “A cesarean section is necessary for all HPV-positive mothers to prevent transmission.” C) “The mode of delivery will be determined by the type of HPV and presence of genital warts.” D) “You should consider only elective cesarean section to eliminate the risk of transmission.” Answer: C) “The mode of delivery will be determined by the type of HPV and presence of genital warts.” Reasons for the Correct Answer: Type of HPV and Presence of Genital Warts: The decision on the mode of delivery depends on whether the patient has active genital warts caused by HPV. If genital warts are present and obstruct the birth canal, a cesarean section might be recommended to prevent complications and potential transmission to the newborn. Reasons Why Other Options are Incorrect: HPV has no impact on the mode of delivery: This is not entirely true, as the presence of genital warts can impact the decision. A cesarean section is necessary for all HPV-positive mothers: This is not accurate. A cesarean section is only necessary if there are active genital warts that could obstruct the birth canal. You should consider only elective cesarean section: This is not always necessary and depends on the presence of genital warts and other factors. HIV AIDS INFECTION DURING PREGNANCY Question 1: A nurse is providing prenatal care to a patient with HIV. Which of the following antiretroviral regimens should the nurse expect to be prescribed to reduce the risk of mother-to-child transmission? A) Zidovudine (AZT) monotherapy B) Highly active antiretroviral therapy (HAART) C) Intermittent short-course therapy D) No antiretroviral therapy during pregnancy Answer: B) Highly active antiretroviral therapy (HAART). Reasons for the Correct Answer: Highly Active Antiretroviral Therapy (HAART): HAART, also known as combination antiretroviral therapy (cART), is the standard treatment for HIV infection during pregnancy. It involves using a combination of antiretroviral drugs to effectively suppress the virus, reducing the risk of mother-to-child transmission. Reasons Why Other Options are Incorrect: Zidovudine (AZT) monotherapy: While zidovudine is used in some regimens, monotherapy is not sufficient to effectively reduce the risk of transmission. Intermittent short-course therapy: Continuous and consistent antiretroviral therapy is necessary to maintain viral suppression and prevent transmission. No antiretroviral therapy during pregnancy: This would significantly increase the risk of mother-to- child transmission and is not recommended. Question 2: Which of the following is a recommended method to reduce the risk of HIV transmission from mother to baby during the birthing process? A) Vaginal delivery with episiotomy B) Elective cesarean section before the onset of labor C) Natural water birth D) Home birth with a midwife Answer: B) Elective cesarean section before the onset of labor. Reasons for the Correct Answer: Elective Cesarean Section: For HIV-positive mothers with a high viral load (more than 1,000 copies/mL) or an unknown viral load near the time of delivery, a scheduled cesarean section before the onset of labor can significantly reduce the risk of perinatal transmission of HIV. Reasons Why Other Options are Incorrect: Vaginal delivery with episiotomy: This does not reduce the risk of HIV transmission compared to a scheduled cesarean section. Natural water birth: This is not a recommended method to reduce the risk of HIV transmission. Home birth with a midwife: This does not provide the controlled environment necessary to reduce the risk of HIV transmission during delivery. Question 3: A pregnant patient with HIV presents with a CD4 count of 250 cells/mm³. What is the nurse’s PRIORITY concern? A) The patient is at increased risk for opportunistic infections. B) The patient is likely to transmit HIV to the baby. C) The patient will require immediate initiation of antiretroviral therapy postpartum. D) The patient’s CD4 count indicates an immediate need for cesarean delivery. Answer: A) The patient is at increased risk for opportunistic infections. Reasons for the Correct Answer: Increased Risk for Opportunistic Infections: A CD4 count below 300 cells/mm³ indicates a weakened immune system, making the patient more susceptible to opportunistic infections, which can pose significant health risks during pregnancy. Reasons Why Other Options are Incorrect: The patient is likely to transmit HIV to the baby: While mother-to-child transmission is a concern, it is not the immediate priority with a CD4 count of 250 cells/mm³. The patient will require immediate initiation of antiretroviral therapy postpartum: Antiretroviral therapy should be initiated during pregnancy to manage the patient's health and reduce the risk of transmission. The patient’s CD4 count indicates an immediate need for cesarean delivery: The mode of delivery is determined by factors such as viral load and presence of genital warts, not solely by CD4 count. Question 4: During labor, a nurse notes that a patient with HIV has a ruptured membrane for over 4 hours. Which of the following actions should the nurse take? A) Continue to monitor the patient as this is a normal finding. B) Prepare for an immediate vaginal delivery. C) Administer intravenous antibiotics as prescribed. D) Notify the healthcare provider to consider an emergency cesarean section. Answer: D) Notify the healthcare provider to consider an emergency cesarean section. Reasons for the Correct Answer: Notify the Healthcare Provider: Prolonged rupture of membranes (over 4 hours) in an HIV-positive patient increases the risk of transmitting the virus to the baby. The healthcare provider should be notified to assess the situation and consider an emergency cesarean section to minimize this risk. Reasons Why Other Options are Incorrect: Continue to Monitor the Patient: This is not sufficient given the increased risk of transmission with prolonged rupture of membranes. Prepare for an Immediate Vaginal Delivery: This does not address the increased risk of transmission associated with prolonged rupture of membranes. Administer Intravenous Antibiotics: While antibiotics may be used to prevent infection, they do not address the risk of HIV transmission. Question 5: A nurse is counseling a patient with HIV on infant feeding options. Which of the following is the MOST appropriate recommendation? A) Breastfeeding exclusively for the first 6 months B) Mixed feeding with breast milk and formula C) Exclusive formula feeding from birth D) Pumping and discarding breast milk to stimulate supply Answer: C) Exclusive formula feeding from birth. Reasons for the Correct Answer: Exclusive Formula Feeding: In settings where safe and affordable alternatives to breastfeeding are available, exclusive formula feeding from birth is recommended to eliminate the risk of HIV transmission through breast milk. Reasons Why Other Options are Incorrect: Breastfeeding exclusively for the first 6 months: While exclusive breastfeeding is recommended in some settings with proper antiretroviral therapy (ART), it may not be the safest option in all contexts. Mixed feeding with breast milk and formula: Mixed feeding can increase the risk of HIV transmission compared to exclusive formula feeding. Pumping and discarding breast milk to stimulate supply: This is not recommended as it does not eliminate the risk of HIV transmission. Question 6: Which of the following is an important consideration for a nurse when caring for a newborn whose mother is HIV-positive? A) Delaying the first bath to preserve maternal antibodies B) Administering zidovudine (AZT) prophylaxis to the newborn C) Encouraging immediate skin-to-skin contact to promote bonding D) Initiating breastfeeding within the first hour of life Answer: B) Administering zidovudine (AZT) prophylaxis to the newborn. Reasons for the Correct Answer: Administering Zidovudine (AZT) Prophylaxis: AZT prophylaxis is recommended to reduce the risk of mother-to-child transmission of HIV. This antiretroviral medication is given to the newborn to help prevent the virus from establishing infection. Reasons Why Other Options are Incorrect: Delaying the first bath to preserve maternal antibodies: This is not relevant in the context of HIV transmission. Encouraging immediate skin-to-skin contact to promote bonding: While beneficial for bonding, it does not specifically address the risk of HIV transmission. Initiating breastfeeding within the first hour of life: Breastfeeding is not recommended for HIV- positive mothers in settings where safe alternatives are available due to the risk of transmission through breast milk. Question 7: A pregnant patient with HIV is experiencing preterm labor. Which of the following factors should the nurse consider when planning care? A) The use of tocolytics may be contraindicated due to potential drug interactions. B) Preterm labor is unrelated to the patient’s HIV status. C) Immediate delivery is preferred regardless of gestational age. D) Antiretroviral therapy should be discontinued during preterm labor. Answer: A) The use of tocolytics may be contraindicated due to potential drug interactions. Reasons for the Correct Answer: Potential Drug Interactions: Tocolytics, which are medications used to suppress preterm labor, may interact with antiretroviral drugs, potentially causing adverse effects or reducing the effectiveness of treatment. Reasons Why Other Options are Incorrect: Preterm labor is unrelated to the patient’s HIV status: Preterm labor can be influenced by various factors, including infections and other complications, but it is not directly caused by HIV. Immediate delivery is preferred regardless of gestational age: The decision for immediate delivery depends on the clinical situation and gestational age, not solely on the presence of HIV. Antiretroviral therapy should be discontinued during preterm labor: Continuing antiretroviral therapy is crucial to manage the mother's health and reduce the risk of transmission to the baby. Question 8: A nurse is reviewing the laboratory results of a pregnant patient with HIV. Which of the following viral load results would indicate the greatest risk for perinatal transmission? A) Undetectable viral load B) Viral load of 200 copies/mL C) Viral load of 1,000 copies/mL D) Viral load of 10,000 copies/mL Answer: D) Viral load of 10,000 copies/mL. Reasons for the Correct Answer: High Viral Load (10,000 copies/mL): A higher viral load significantly increases the risk of transmitting HIV from mother to baby. Effective antiretroviral therapy aims to reduce the viral load to undetectable levels, thereby minimizing the risk of transmission. Reasons Why Other Options are Incorrect: Undetectable Viral Load: An undetectable viral load greatly reduces the risk of transmission and is the goal of antiretroviral therapy. Viral Load of 200 copies/mL: This is relatively low and indicates effective viral suppression, though not as safe as an undetectable viral load. Viral Load of 1,000 copies/mL: While higher than 200 copies/mL, it still poses less risk compared to 10,000 copies/mL. Question 9: Which of the following statements by a pregnant patient with HIV indicates a need for further education? A) “I will need to take antiretroviral medication throughout my pregnancy.” B) “I can reduce the risk of transmitting HIV to my baby by having a vaginal delivery.” C) “I should not breastfeed my baby to prevent transmission of HIV.” D) “My baby will receive medication after birth to prevent HIV infection.” Answer: B) “I can reduce the risk of transmitting HIV to my baby by having a vaginal delivery.” Reasons for the Correct Answer: Reducing the Risk of HIV Transmission: A vaginal delivery is not typically the recommended method to reduce the risk of HIV transmission. In fact, a cesarean section is often preferred in certain cases, especially if the viral load is high or not well controlled, to minimize the risk of perinatal transmission. Reasons Why Other Options are Correct: A) “I will need to take antiretroviral medication throughout my pregnancy.” This is correct as consistent antiretroviral therapy is crucial to manage the mother's health and reduce the risk of transmission. C) “I should not breastfeed my baby to prevent transmission of HIV.” This is correct as breastfeeding can transmit the virus to the baby, and alternatives like formula feeding are recommended in settings where they are safe and accessible. D) “My baby will receive medication after birth to prevent HIV infection.” This is correct as newborns typically receive antiretroviral medication to reduce the risk of HIV transmission from the mother. Question 10: A nurse is planning postpartum care for a patient with HIV. Which of the following is the MOST important aspect of care? A) Encouraging the patient to express emotions about her diagnosis B) Coordinating care with a multidisciplinary team for ongoing management C) Advising the patient to avoid future pregnancies D) Recommending natural remedies to boost the immune system Answer: B) Coordinating care with a multidisciplinary team for ongoing management. Reasons for the Correct Answer: Coordinating Care with a Multidisciplinary Team: Ongoing management of HIV requires a comprehensive approach involving various healthcare professionals. This includes physicians, nurses, social workers, and other specialists who can provide medical, psychological, and social support to ensure the best outcomes for both the mother and the baby. Reasons Why Other Options are Incorrect: Encouraging the patient to express emotions about her diagnosis: While emotional support is important, it is not the most critical aspect of postpartum care. Advising the patient to avoid future pregnancies: This is not necessarily appropriate or required. The patient should receive counseling on family planning options. Recommending natural remedies to boost the immune system: There is no scientific evidence supporting the efficacy of natural remedies in managing HIV, and medical treatment should not be replaced with unproven alternatives. HEPATITIS B INFECTION DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient with hepatitis B. Which of the following is the MOST effective way to prevent perinatal transmission of hepatitis B to the newborn? A) Administer hepatitis B vaccine to the newborn within 12 hours of birth. B) Give the newborn hepatitis B immune globulin (HBIG) within 24 hours of birth. C) Both A and B. D) Avoid breastfeeding. Answer: C) Both A and B. Reasons for the Correct Answer: Administer Hepatitis B Vaccine Within 12 Hours of Birth: This provides the newborn with active immunity against the hepatitis B virus. Give Hepatitis B Immune Globulin (HBIG) Within 24 Hours of Birth: This provides the newborn with immediate passive immunity by giving them antibodies to fight the virus. Reasons Why Other Options are Incorrect: Administer hepatitis B vaccine to the newborn within 12 hours of birth (Option A): While important, this alone is not as effective as combined treatment with HBIG. Give the newborn hepatitis B immune globulin (HBIG) within 24 hours of birth (Option B): While crucial, this alone is not sufficient without the vaccine. Avoid breastfeeding (Option D): Breastfeeding is not contraindicated for mothers with hepatitis B, especially if the newborn has received both the vaccine and HBIG. ------- Question 2: A nurse is assessing a newborn whose mother has hepatitis B. Which of the following findings would be a cause for concern? A) Jaundice within the first 24 hours of life B) Weight within the normal range for gestational age C) Hepatitis B vaccination given at birth D) HBIG administration within 12 hours of birth Answer: A) Jaundice within the first 24 hours of life. Reasons for the Correct Answer: Jaundice within the First 24 Hours of Life: Jaundice occurring within the first 24 hours is unusual and may indicate a serious underlying condition, such as hemolytic disease or an infection. In the context of a newborn whose mother has hepatitis B, this could be a sign of liver dysfunction or other complications that need immediate medical attention. Reasons Why Other Options are Incorrect: Weight within the normal range for gestational age: This is a normal and expected finding. Hepatitis B vaccination given at birth: This is part of the standard protocol to prevent hepatitis B transmission. HBIG administration within 12 hours of birth: This is also part of the standard preventive measures for newborns at risk of hepatitis B transmission. Question 3: Which of the following is an important nursing intervention for a newborn of a hepatitis B positive mother? A) Delay the first dose of the hepatitis B vaccine until the baby is 6 months old. B) Administer the first dose of the hepatitis B vaccine within 12 hours of birth. C) Wait for confirmation of HBsAg status in the newborn before administering the vaccine. D) Provide the hepatitis B vaccine only if the mother’s viral load is high. Answer: B) Administer the first dose of the hepatitis B vaccine within 12 hours of birth. Reasons for the Correct Answer: Administering the First Dose of the Hepatitis B Vaccine: Giving the newborn the hepatitis B vaccine within 12 hours of birth provides active immunity and is crucial in preventing perinatal transmission of hepatitis B from the mother to the baby. Reasons Why Other Options are Incorrect: Delay the first dose of the hepatitis B vaccine until the baby is 6 months old: This would significantly increase the risk of hepatitis B transmission and is not recommended. Wait for confirmation of HBsAg status in the newborn before administering the vaccine: The vaccine should be given promptly to prevent infection, regardless of the newborn's HBsAg status. Provide the hepatitis B vaccine only if the mother’s viral load is high: The vaccine should be administered to all newborns of hepatitis B positive mothers, regardless of the mother's viral load, to ensure protection. CHORIOAMNIONITIS Question 1: A nurse is caring for a patient in labor who has developed a fever, tachycardia, and uterine tenderness. Which of the following conditions should the nurse suspect? A) Urinary tract infection B) Chorioamnionitis C) Preeclampsia D) Endometritis Answer: B) Chorioamnionitis. Chorioamnionitis is a bacterial infection of the amniotic fluid, membranes, and placenta that can cause fever, tachycardia (rapid heart rate), and uterine tenderness during labor. Reasons why other options are incorrect: Urinary tract infection (UTI): While a UTI can cause fever and tachycardia, it is less likely to cause uterine tenderness. Preeclampsia: This condition typically presents with high blood pressure and proteinuria, not necessarily with fever and uterine tenderness. Endometritis: This is an infection of the uterine lining that can cause fever and uterine tenderness, but it is less common during labor compared to chorioamnionitis. Question 2: Which of the following interventions is MOST appropriate for a patient diagnosed with chorioamnionitis? A) Immediate cesarean delivery B) Administration of intravenous antibiotics C) Oral administration of antipyretics only D) Expectant management with close monitoring Answer: B) Administration of intravenous antibiotics. Administering intravenous antibiotics is crucial to treat the infection and reduce the risk of complications for both the mother and the baby. Reasons why other options are incorrect: Immediate cesarean delivery: While sometimes necessary, the primary treatment is antibiotics to control the infection. The decision for cesarean delivery depends on other clinical factors. Oral administration of antipyretics only: Antipyretics can help manage fever, but they do not treat the underlying infection. Expectant management with close monitoring: This approach alone is not sufficient for treating the infection and can increase the risk of complications. Question 3: A nurse is reviewing the risk factors for developing chorioamnionitis with a pregnant patient. Which of the following should the nurse include as a risk factor? A) Multiple gestation pregnancy B) Maternal diabetes C) Prolonged rupture of membranes D) Advanced maternal age Answer: C) Prolonged rupture of membranes. Prolonged rupture of membranes (PROM) is a significant risk factor for developing chorioamnionitis because it provides an entry point for bacteria to ascend from the vagina into the amniotic sac, increasing the risk of infection. Reasons why other options are incorrect: Multiple gestation pregnancy: While it has its own set of complications, it is not specifically a risk factor for chorioamnionitis. Maternal diabetes: This condition can complicate pregnancy in various ways, but it is not a direct risk factor for chorioamnionitis. Advanced maternal age: This can be associated with various pregnancy complications, but it is not specifically linked to an increased risk of chorioamnionitis. DISSEMINATED INTRAVASCULAR COAGULATION DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient with suspected DIC. Which of the following laboratory findings should the nurse expect? A) Elevated platelet count B) Prolonged prothrombin time (PT) C) Decreased fibrin degradation products (FDP) D) Shortened activated partial thromboplastin time (aPTT) Answer: B) Prolonged prothrombin time (PT) Reasons for the Correct Answer: Prolonged Prothrombin Time (PT): In DIC, there is widespread activation of the coagulation system, leading to consumption of clotting factors and resulting in prolonged PT. Reasons Why Other Options are Incorrect: Elevated platelet count: DIC typically causes a decreased platelet count due to consumption of platelets. Decreased fibrin degradation products (FDP): In DIC, there is an increase in FDPs due to excessive fibrinolysis. Shortened activated partial thromboplastin time (aPTT): DIC usually results in a prolonged aPTT due to the consumption of clotting factors. Question 2: The nurse concludes that both clotting and bleeding occur during DIC due to which process? A) Tissue damage from bleeding uses up clotting factors quicker than they can be replaced. B) Activation of intrinsic pathways results in release of excess clotting factors. C) Only clotting occurs during DIC, as clotting factors are replaced and available to prevent excess bleeding. D) Excess release of thrombin uses up clotting factors quicker than they can be replaced. Answer: D) Excess release of thrombin uses up clotting factors quicker than they can be replaced. Reasons for the Correct Answer: Excess Release of Thrombin: In DIC, there is an excessive release of thrombin, which leads to widespread clotting throughout the body. This widespread clotting uses up clotting factors and platelets faster than they can be replaced, leading to a simultaneous risk of bleeding. Reasons Why Other Options are Incorrect: Tissue damage from bleeding uses up clotting factors quicker than they can be replaced (A): This option does not accurately describe the systemic nature of DIC, where clotting occurs throughout the body, not just at sites of bleeding. Activation of intrinsic pathways results in release of excess clotting factors (B): This does not fully capture the consumption and depletion of clotting factors characteristic of DIC. Only clotting occurs during DIC, as clotting factors are replaced and available to prevent excess bleeding (C): Question 3: A patient with DIC during pregnancy is exhibiting signs of microvascular thrombosis. Which of the following interventions should the nurse prioritize? A) Administration of clotting factors B) Administration of anticoagulants C) Application of a tourniquet to affected limbs D) Immediate initiation of thrombolytic therapy Answer: B) Administration of anticoagulants. Reasons for the Correct Answer: Administration of Anticoagulants: In cases of DIC with microvascular thrombosis, anticoagulants help to prevent further clot formation and improve blood flow, reducing the risk of organ damage. Reasons Why Other Options are Incorrect: Administration of clotting factors (A): While clotting factors may be necessary in cases of significant bleeding, they are not the primary intervention for microvascular thrombosis. Application of a tourniquet to affected limbs (C): This is not appropriate for managing DIC and could potentially worsen the condition by restricting blood flow. Immediate initiation of thrombolytic therapy (D): Question 4: Which condition should the nurse identify as a trigger for the clotting cascade in DIC during pregnancy? A) Aortic aneurysm B) Gunshot wound to the distal arm C) Third-degree burns and septic shock D) Bacterial pneumonia treated with antibiotics Answer: C) Third-degree burns and septic shock. Reasons for the Correct Answer: Third-degree burns and septic shock: These conditions can lead to systemic inflammation and widespread activation of the coagulation system, which can trigger DIC. Reasons Why Other Options are Incorrect: Aortic aneurysm: While serious, it is not typically associated with triggering DIC. Gunshot wound to the distal arm: This can cause localized trauma but is less likely to trigger systemic DIC. Bacterial pneumonia treated with antibiotics: While bacterial infections can contribute to sepsis, the treatment with antibiotics should help control the infection and reduce the risk of DIC. FETAL DEATH IN UTERO Question 1: A nurse is caring for a patient at 32 weeks gestation who has not felt fetal movement for the past 12 hours. Which of the following actions should the nurse take FIRST? A) Perform a non-stress test. B) Provide reassurance that this is normal in late pregnancy. C) Schedule an immediate ultrasound. D) Instruct the patient to drink cold water to stimulate fetal movement. Answer: C) Schedule an immediate ultrasound. Scheduling an immediate ultrasound is critical to promptly assess the baby's condition and ensure timely medical intervention if needed. This approach helps determine the baby's well-being and identify any potential complications. Reasons why other options are incorrect: Perform a non-stress test (A): While useful for assessing fetal well-being, an immediate ultrasound provides a more comprehensive assessment in this urgent situation. Provide reassurance that this is normal in late pregnancy (B): While fetal movements can be less noticeable in late pregnancy, any decrease in movement should not be dismissed without proper assessment. Instruct the patient to drink cold water to stimulate fetal movement (D): Although this may sometimes help stimulate movement, it is not the first recommended action in a clinical setting where fetal well-being is in question. Question 2: Which of the following risk factors is MOST associated with fetal death in utero? A) Maternal age over 40 B) History of preterm labor C) Maternal hypertension D) Gestational diabetes well-controlled with diet Answer: C) Maternal hypertension. Reasons for the Correct Answer: Maternal Hypertension: High blood pressure during pregnancy can significantly increase the risk of fetal death due to complications such as placental abruption and reduced blood flow to the fetus. Reasons Why Other Options are Incorrect: Maternal age over 40 (A): While advanced maternal age is a risk factor for various pregnancy complications, it is not the most associated with fetal death in utero. History of preterm labor (B): A history of preterm labor can increase the risk of complications, but it is not the most significant factor for fetal death in utero. Gestational diabetes well-controlled with diet (D): Well-controlled gestational diabetes typically does not pose a high risk for fetal death compared to uncontrolled diabetes or other complications. Question 3: A nurse finds no fetal heart tones on Doppler auscultation during a routine prenatal visit. What is the nurse’s NEXT step? A) Reassure the patient that the fetus is likely in a position that makes heart tones difficult to detect. B) Refer the patient for a biophysical profile. C) Attempt to locate the fetal heart tones with a fetoscope. D) Arrange for an expedited obstetric evaluation. Answer: D) Arrange for an expedited obstetric evaluation. Reasons for the Correct Answer: Expedited Obstetric Evaluation: If no fetal heart tones are detected, it is critical to arrange for an immediate and thorough evaluation to assess fetal well-being and determine the appropriate next steps. Reasons Why Other Options are Incorrect: A) Reassure the patient that the fetus is likely in a position that makes heart tones difficult to detect: While this may sometimes be the case, it is important to rule out any serious concerns first. B) Refer the patient for a biophysical profile: This might be done as part of the evaluation, but it is not the immediate next step. C) Attempt to locate the fetal heart tones with a fetoscope: This may not provide additional useful information, and a more urgent and thorough evaluation is needed. Question 4: During the management of a patient with a confirmed fetal death in utero, which of the following nursing interventions is MOST important? A) Preparing for immediate induction of labor B) Providing emotional support and grief counseling C) Administering Rho(D) immune globulin if the patient is Rh-negative D) All of the above Answer: D) All of the above. Reasons for the Correct Answer: Preparing for Immediate Induction of Labor: Induction is often necessary to manage the delivery process after a confirmed fetal death. Providing Emotional Support and Grief Counseling: Emotional support is crucial for helping the patient cope with the loss and navigate through the grieving process. Administering Rho(D) Immune Globulin if the Patient is Rh-Negative: This is important to prevent Rh sensitization in future pregnancies, which can cause complications. By addressing all these aspects, the nurse ensures comprehensive care for the patient, both medically and emotionally. Reasons why these interventions are important: A) Preparing for immediate induction of labor: Helps safely manage the delivery process. B) Providing emotional support and grief counseling: Assists the patient in coping with the emotional impact of the loss. C) Administering Rho(D) immune globulin if the patient is Rh-negative: Prevents potential complications in future pregnancies. Question 5: A patient who has experienced a fetal death in utero asks about the cause. Which of the following responses by the nurse is MOST appropriate? A) “It’s likely due to something you did or didn’t do during the pregnancy.” B) “Most fetal deaths in utero are caused by genetic abnormalities.” C) “The exact cause is often unknown, but we can perform tests to try to determine the reason.” D) “Fetal death in utero is usually preventable with proper prenatal care.” Answer: C) “The exact cause is often unknown, but we can perform tests to try to determine the reason.” Reasons for the Correct Answer: The Exact Cause is Often Unknown: This response is truthful and acknowledges that, in many cases, the precise cause of fetal death in utero may not be immediately clear. Offering to Perform Tests: This provides a constructive way forward, offering the possibility of finding an explanation through further investigation, which can be comforting for the patient. Reasons Why Other Options are Incorrect: A) “It’s likely due to something you did or didn’t do during the pregnancy.” This response can cause unnecessary guilt and distress to the patient and is not typically accurate or helpful. B) “Most fetal deaths in utero are caused by genetic abnormalities.” While genetic abnormalities are one possible cause, it is not accurate to generalize this as the most common cause without specific evidence. D) “Fetal death in utero is usually preventable with proper prenatal care.” This statement is not accurate and can be misleading and hurtful. Fetal death in utero can occur despite proper prenatal care. POSTPARTUM HEMATOMA Question 1: A nurse is assessing a patient 12 hours postpartum who reports severe perineal pain unrelieved by analgesics. On examination, the nurse notes swelling and discoloration in the perineal area. Which of the following actions should the nurse take FIRST? A) Apply an ice pack to the perineal area. B) Administer additional analgesics as prescribed. C) Notify the healthcare provider immediately. D) Encourage the patient to use a sitz bath. Answer: C) Notify the healthcare provider immediately. Reasons for the Correct Answer: Notify the Healthcare Provider Immediately: Severe perineal pain, swelling, and discoloration may indicate a hematoma, which requires prompt medical evaluation and possible intervention to prevent complications. Reasons Why Other Options are Incorrect: A) Apply an ice pack to the perineal area: While this can help reduce swelling and provide some pain relief, it does not address the underlying issue that may require medical intervention. B) Administer additional analgesics as prescribed: Additional analgesics may provide temporary pain relief but do not address the potential cause of the severe pain and swelling. D) Encourage the patient to use a sitz bath: Sitz baths can provide comfort and aid healing, but they do not address the urgent need for medical evaluation in this scenario. Question 2: Which of the following risk factors is MOST associated with the development of a postpartum hematoma? A) Prolonged second stage of labor B) History of chronic hypertension C) Maternal age below 20 years D) Gestational diabetes Answer: A) Prolonged second stage of labor. Reasons for the Correct Answer: Prolonged Second Stage of Labor: This increases the risk of trauma and blood vessel injury, which can lead to the formation of a hematoma. Reasons Why Other Options are Incorrect: History of chronic hypertension (B): While hypertension can lead to other complications, it is not the most associated risk factor for postpartum hematoma. Maternal age below 20 years (C): Young maternal age is not typically associated with an increased risk of postpartum hematoma. Gestational diabetes (D): While gestational diabetes can lead to other pregnancy complications, it is not the most associated risk factor for postpartum hematoma. Question 3: A patient develops a vulvar hematoma after a vaginal delivery. Which of the following nursing interventions is MOST appropriate to manage the patient’s pain and promote healing? A) Encourage frequent ambulation. B) Apply warm compresses to the affected area. C) Administer prescribed pain medication and apply ice packs. D) Instruct the patient to perform Kegel exercises every hour. Answer: C) Administer prescribed pain medication and apply ice packs. Reasons for the Correct Answer: Administer Prescribed Pain Medication and Apply Ice Packs: Pain medication will help manage the patient's discomfort, and applying ice packs can reduce swelling and provide pain relief, promoting healing of the hematoma. Reasons Why Other Options are Incorrect: A) Encourage frequent ambulation: Frequent ambulation is not advisable as it can increase discomfort and may exacerbate the condition. B) Apply warm compresses to the affected area: Warm compresses can increase blood flow and potentially worsen the swelling and pain associated with a hematoma. D) Instruct the patient to perform Kegel exercises every hour: Kegel exercises strengthen the pelvic floor muscles but are not appropriate for managing acute pain and swelling from a hematoma. TORCH COMPLEX Question 1: A nurse is caring for a pregnant patient who has been diagnosed with a TORCH infection. Which of the following is the MOST likely cause of this diagnosis? A) Trauma during a previous delivery B) A group of infections that can cause congenital anomalies C) Exposure to teratogenic medications D) Genetic abnormalities in the fetus Answer: B) A group of infections that can cause congenital anomalies. Reasons for the Correct Answer: A Group of Infections: TORCH infections refer to a group of infections that can affect a developing fetus and cause congenital anomalies. The acronym TORCH stands for Toxoplasmosis, Other infections (such as syphilis, varicella-zoster, and parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes Simplex Virus (HSV). Reasons Why Other Options are Incorrect: Trauma during a previous delivery (A): This is not related to TORCH infections. Exposure to teratogenic medications (C): While certain medications can cause congenital anomalies, they are not part of the TORCH group of infections. Genetic abnormalities in the fetus (D): Genetic abnormalities are different from infections and are not included in the TORCH acronym. Question 2: Which of the following infections is NOT typically included in the TORCH complex? A) Toxoplasmosis B) Rubella C) Hepatitis B D) Cytomegalovirus Answer: C) Hepatitis B. Reasons for the Correct Answer: Hepatitis B: While Hepatitis B is a significant infection that can affect pregnancy, it is not part of the TORCH complex. Reasons why other options are incorrect: Toxoplasmosis (A): This infection is part of the TORCH complex and can cause congenital infections. Rubella (B): Rubella is included in the TORCH complex and is known to cause congenital anomalies. Cytomegalovirus (D): CMV is also part of the TORCH complex and can lead to congenital infections. Question 3: A newborn exhibits signs of a TORCH infection. Which of the following symptoms would the nurse expect to find? (Select all that apply.) A) Jaundice B) Purpuric rash C) Microcephaly D) Cardiac murmurs E) Hepatosplenomegaly Answer: The nurse would expect to find the following symptoms in a newborn with a TORCH infection: A) Jaundice B) Purpuric rash C) Microcephaly E) Hepatosplenomegaly These symptoms are commonly associated with TORCH infections and can indicate the presence of one or more of these infections in the newborn. Question 4: A pregnant patient is concerned about the risk of contracting a TORCH infection. Which of the following measures should the nurse advise to prevent Toxoplasmosis? A) Avoid changing cat litter B) Receive the annual flu vaccine C) Practice safe sex D) Wash hands frequently Answer: A) Avoid changing cat litter. Reasons for the Correct Answer: Avoid Changing Cat Litter: Toxoplasmosis is often transmitted through contact with cat feces. Pregnant individuals should avoid changing cat litter to reduce the risk of contracting the infection. Reasons Why Other Options are Incorrect: Receive the annual flu vaccine (B): While important for preventing influenza, it does not prevent Toxoplasmosis. Practice safe sex (C): This is important for preventing sexually transmitted infections but not specifically related to preventing Toxoplasmosis. Wash hands frequently (D): Good hygiene is crucial, but avoiding cat litter is more specific to preventing Toxoplasmosis. Question 5: During a prenatal visit, a patient tests positive for a TORCH infection. Which of the following treatments should the nurse expect to be prescribed? A) Antibiotics, antivirals, or other specific treatments depending on the infection B) Corticosteroids to reduce inflammation C) No treatment, as TORCH infections are self-limiting D) Immediate delivery regardless of gestational age Answer: A) Antibiotics, antivirals, or other specific treatments depending on the infection. Reasons for the Correct Answer: Antibiotics, Antivirals, or Other Specific Treatments: TORCH infections are caused by different pathogens (bacteria, viruses, and parasites), so treatment needs to be tailored to the specific infection. For instance, antibiotics for bacterial infections, antivirals for viral infections, and other specific treatments as needed. Reasons Why Other Options are Incorrect: B) Corticosteroids to reduce inflammation: Corticosteroids are not the primary treatment for TORCH infections, though they may be used in conjunction with other treatments in some cases. C) No treatment, as TORCH infections are self-limiting: TORCH infections are not typically self- limiting and can have serious consequences for the fetus if not properly treated. D) Immediate delivery regardless of gestational age: Immediate delivery is not always the appropriate response and depends on the gestational age and the severity of the infection's impact on the fetus and the mother. Question 6: Which of the following statements by a patient indicates a need for further education about TORCH infections? A) “I can get vaccinated against Rubella to prevent infection.” B) “I should avoid eating undercooked meat to prevent Toxoplasmosis.” C) “If I contract a TORCH infection, my baby will definitely have birth defects.” D) “I need to practice good hygiene to reduce the risk of contracting a TORCH infection.” Answer: C) “If I contract a TORCH infection, my baby will definitely have birth defects.” Reasons for the Correct Answer: Need for Further Education: While TORCH infections can increase the risk of congenital anomalies, it is not certain that the baby will definitely have birth defects. The outcome depends on various factors such as the type of infection, the timing of the infection during pregnancy, and the effectiveness of the treatment. Reasons why other options are correct: A) “I can get vaccinated against Rubella to prevent infection.”: Rubella vaccination is an important preventive measure. B) “I should avoid eating undercooked meat to prevent Toxoplasmosis.”: Avoiding undercooked meat helps prevent Toxoplasmosis. D) “I need to practice good hygiene to reduce the risk of contracting a TORCH infection.”: Good hygiene practices can reduce the risk of many infections, including those in the TORCH complex. TUBERCULOSIS DURING PREGNANCY Question 1: A nurse is caring for a pregnant patient diagnosed with TB. Which of the following medications is considered safe to continue during pregnancy? A) Rifampin B) Pyrazinamide C) Ethambutol D) Isoniazid Answer: D) Isoniazid. Isoniazid (INH) is commonly used to treat tuberculosis (TB) during pregnancy and is considered safe when accompanied by vitamin B6 supplementation to prevent potential side effects. Reasons why other options are incorrect: Rifampin: While rifampin is used to treat TB, it is not typically the first choice during pregnancy due to potential risks. Pyrazinamide: This medication is generally not recommended during pregnancy due to unknown effects on the fetus. Ethambutol: Ethambutol is used in TB treatment but is not the preferred medication during pregnancy. Question 2: Which of the following is a priority nursing intervention for a pregnant patient with active TB? A) Placing the patient in airborne isolation B) Encouraging increased fluid intake C) Administering a bacillus Calmette-Guérin (BCG) vaccine D) Recommending bed rest throughout the pregnancy Answer: A) Placing the patient in airborne isolation. Reasons for the Correct Answer: Placing the Patient in Airborne Isolation: Tuberculosis is an airborne disease, so placing the patient in airborne isolation is crucial to prevent the spread of the infection to others, including healthcare staff and other patients. Reasons why other options are incorrect: Encouraging increased fluid intake (B): While hydration is important, it is not the priority intervention for preventing the spread of TB. Administering a bacillus Calmette-Guérin (BCG) vaccine (C): The BCG vaccine is used for prevention in certain populations but is not a treatment for active TB. Recommending bed rest throughout the pregnancy (D): Bed rest is not specific to managing TB and does not address the critical need to control the infection and prevent its spread. Question 3: A pregnant patient with TB is concerned about the risk of transmission to the fetus. Which of the following statements by the nurse is MOST accurate? A) “TB can cross the placenta and infect the fetus during pregnancy.” B) “TB does not cross the placenta, but your baby can be infected during delivery.” C) “There is no risk of transmitting TB to your baby during pregnancy or delivery.” D) “The risk of transmission is high, but taking your medications can reduce this risk.” Answer: A) "TB can cross the placenta and infect the fetus during pregnancy." Explanation: Tuberculosis (TB) can, although rarely, cross the placenta and infect the fetus during pregnancy, leading to congenital tuberculosis. This occurs when Mycobacterium tuberculosis spreads through the mother's bloodstream to the placenta and then to the fetus. While congenital TB is uncommon, it is important for the patient to understand this potential risk so appropriate precautions and treatments can be maintained. References supporting this include: Clinical Guidelines: Medical literature, including recommendations from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), acknowledges that transplacental transmission of TB can occur, although it is rare. Textbooks on Obstetrics and Infectious Diseases: These resources detail cases and mechanisms of congenital TB resulting from maternal infection. Reasons why other options are incorrect: B) "TB does not cross the placenta, but your baby can be infected during delivery." This statement is inaccurate because TB can cross the placenta. Additionally, TB is not typically transmitted to the baby during delivery since it is spread through airborne droplets, not through the birth canal. C) "There is no risk of transmitting TB to your baby during pregnancy or delivery." This is incorrect because there is a risk, albeit low, of transmission both during pregnancy (through the placenta) and after birth through close contact if the mother is contagious. D) "The risk of transmission is high, but taking your medications can reduce this risk." While taking medications does reduce the risk of transmission, stating that the risk is high may cause unnecessary alarm. With proper treatment and adherence to medication, the risk of congenital TB is significantly reduced. Question 4: During a prenatal visit, a nurse identifies a patient at high risk for TB. Which of the following actions should the nurse take FIRST? A) Administer a tuberculin skin test (TST) B) Start the patient on prophylactic TB treatment C) Schedule the patient for a chest X-ray D) Isolate the patient immediately Answer: A) Administer a tuberculin skin test (TST). Administering a tuberculin skin test (TST) is the initial step to determine if the patient has been exposed to Mycobacterium tuberculosis. This screening test helps identify latent TB infection, which is crucial for timely intervention and prevention of disease progression. Reasons why other options are incorrect: B) Start the patient on prophylactic TB treatment: Initiating treatment without confirming infection is not appropriate. The nurse should first perform the TST to determine if the patient has latent TB before any treatment is considered. C) Schedule the patient for a chest X-ray: A chest X-ray may be necessary if the TST result is positive or if the patient exhibits symptoms of active TB. However, it's not the first step due to concerns about fetal exposure to radiation. D) Isolate the patient immediately: Isolation is required if the patient has active TB disease with symptoms like coughing. In this case, the patient is at high risk but doesn't necessarily have active TB requiring immediate isolation. Question 5: A nurse is educating a pregnant patient on how to prevent TB transmission to family members. Which of the following instructions should the nurse include? (Select all that apply.) A) Wear a surgical mask when around others B) Take all TB medications as prescribed C) Keep the home well-ventilated D) Breastfeed to provide the baby with antibodies E) Avoid public transportation Answer: A) Wear a surgical mask when around others. B) Take all TB medications as prescribed. C) Keep the home well-ventilated. E) Avoid public transportation. Reasons for Each Instruction: A) Wear a surgical mask when around others: This helps to prevent the spread of TB bacteria through airborne droplets when the patient coughs, sneezes, or talks. B) Take all TB medications as prescribed: Adhering to the prescribed medication regimen is crucial to effectively treat the infection and reduce the risk of spreading TB to others. C) Keep the home well-ventilated: Proper ventilation helps to disperse and dilute any airborne TB bacteria, reducing the likelihood of transmission. E) Avoid public transportation: Limiting exposure to others in crowded settings can help prevent the spread of TB. Reason Why Option D is Incorrect: D) Breastfeed to provide the baby with antibodies: While breastfeeding has many benefits, it does not provide specific antibodies to prevent TB transmission. TB prevention focuses on infection control measures and medication adherence. Question 6: Which of the following symptoms in a pregnant patient would MOST likely suggest TB and warrant further investigation? A) Intermittent nausea and vomiting B) Persistent cough lasting more than three weeks C) Occasional shortness of breath after activity D) Frequent urination Answer: B) Persistent cough lasting more than three weeks. Reasons for the Correct Answer: Persistent Cough: A cough that lasts for more than three weeks is a classic symptom of active tuberculosis (TB). It is one of the primary indicators that warrant further investigation and testing for TB. Reasons Why Other Options are Less Likely: A) Intermittent nausea and vomiting: These symptoms are more commonly associated with other conditions, such as gastrointestinal issues or pregnancy-related nausea (morning sickness). C) Occasional shortness of breath after activity: While shortness of breath can be a symptom of TB, it is less specific and can be caused by other conditions, especially during pregnancy. D) Frequent urination: This is typically related to pregnancy itself or conditions like gestational diabetes, rather than TB. OBESITY IN PREGNANCY Question 1: Which of the following complications is a pregnant patient with obesity at an increased risk for? A) Gestational diabetes B) Oligohydramnios C) Fetal growth restriction D) Low birth weight Answer: A) Gestational diabetes. Reasons for the Correct Answer: Gestational Diabetes: Pregnant patients with obesity are at a higher risk of developing gestational diabetes due to insulin resistance associated with excess body weight. Reasons Why Other Options are Less Likely: B) Oligohydramnios: This condition, characterized by low amniotic fluid, is not commonly associated with obesity. C) Fetal growth restriction: While obesity can lead to complications, fetal growth restriction is more commonly associated with other factors. D) Low birth weight: Obesity is actually associated with a higher risk of having a larger baby (macrosomia) rather than low birth weight. Question 2: A nurse is assessing a pregnant patient with obesity. Which of the following findings would warrant further investigation for preeclampsia? A) Blood pressure of 120/80 mmHg B) Trace proteinuria C) Sudden weight gain and edema D) Fasting blood glucose of 90 mg/dL Answer: C) Sudden weight gain and edema. Reasons for the Correct Answer: Sudden Weight Gain and Edema: These are classic signs of preeclampsia, a serious condition characterized by high blood pressure and often proteinuria, leading to potential complications for both the mother and baby. Sudden weight gain and swelling, especially in the face and hands, are significant symptoms that require prompt medical evaluation. Reasons Why Other Options are Less Likely: A) Blood pressure of 120/80 mmHg: This is considered normal and does not indicate preeclampsia. B) Trace proteinuria: While proteinuria can be a sign of preeclampsia, trace amounts alone are not definitive without other symptoms like high blood pressure or significant edema. D) Fasting blood glucose of 90 mg/dL: This is within the normal range and does not indicate preeclampsia. Question 3: Which of the following is an important consideration for postpartum care in a patient with obesity? A) Encouraging rapid weight loss immediately after delivery B) Monitoring for signs of postpartum hemorrhage C) Recommending a strict diet to return to pre-pregnancy weight D) Discontinuing blood glucose monitoring after delivery Answer: B) Monitoring for signs of postpartum hemorrhage. Reasons for the Correct Answer: Monitoring for Signs of Postpartum Hemorrhage: Obesity is a significant risk factor for postpartum hemorrhage, which is a leading cause of maternal morbidity and mortality. Close monitoring is essential to ensure timely intervention if bleeding occurs. Reasons Why Other Options are Incorrect: A) Encouraging rapid weight loss immediately after delivery: Rapid weight loss is not recommended as it can be unsafe and unrealistic. A gradual and healthy approach to weight loss is preferred. C) Recommending a strict diet to return to pre-pregnancy weight: A strict diet may not provide adequate nutrition, especially during the postpartum period when the body needs to heal and possibly support breastfeeding. D) Discontinuing blood glucose monitoring after delivery: If the patient had gestational diabetes, it's important to continue monitoring blood glucose levels postpartum, as there is a risk of developing type 2 diabetes. UNIT 2: PROBLEMS WITH LABOR AND BIRTH (ABNORMAL INTRANATAL PERIOD) PREMATURE RUPTURE OF MEMBRANES (PROM) 1. A nurse is caring for a patient at 34 weeks gestation who reports a sudden gush of fluid from the vagina. What is the nurse’s FIRST action? o A) Perform a sterile speculum examination. o B) Prepare for immediate delivery. o C) Administer tocolytics. o D) Confirm fluid is amniotic fluid using a Nitrazine test. The nurse’s first action should be: D) Confirm fluid is amniotic fluid using a Nitrazine test. Reasons for the Correct Answer: Confirming Fluid is Amniotic Fluid: The Nitrazine test helps to determine if the fluid is indeed amniotic fluid. This is a critical first step to assess whether the patient has experienced preterm premature rupture of membranes (PPROM). Reasons Why Other Options are Incorrect: A) Perform a sterile speculum examination: While this may be part of the assessment, confirming the nature of the fluid is the priority before conducting further examinations. B) Prepare for immediate delivery: Immediate delivery is not necessarily indicated at this point without further assessment and confirmation. C) Administer tocolytics: Tocolytics may be used to manage preterm labor, but the first step is to confirm if the fluid is amniotic fluid. 2. Which of the following maternal conditions is associated with an increased risk of PROM? o A) Chronic hypertension o B) Gestational diabetes o C) Intrauterine infection o D) Pre-existing renal disease The maternal condition associated with an increased risk of premature rupture of membranes (PROM) is: C) Intrauterine infection. Reasons for the Correct Answer: Intrauterine Infection: Infections within the uterus, such as bacterial vaginosis, urinary tract infections, and sexually transmitted infections, can weaken the membranes and increase the risk of PROM. Reasons Why Other Options are Less Likely: A) Chronic hypertension: While chronic hypertension is a risk factor for other pregnancy complications, it is not specifically associated with an increased risk of PROM. B) Gestational diabetes: Gestational diabetes is associated with other complications but not specifically with PROM. D) Pre-existing renal disease: Pre-existing renal disease is not typically linked to an increased risk of PROM. 3. Following PROM, the nurse should prioritize monitoring for which of the following complications? o A) Maternal hypotension o B) Fetal bradycardia o C) Signs of maternal infection o D) Immediate onset of labor C) Signs of maternal infection. Reasons for the Correct Answer: Signs of Maternal Infection: Once the membranes rupture, there is an increased risk of infection, such as chorioamnionitis, due to the entry of bacteria into the amniotic sac. Monitoring for maternal infection is crucial to ensure timely intervention and prevent complications for both the mother and the baby. Reasons Why Other Options are Less Likely: A) Maternal hypotension: While monitoring blood pressure is always important, hypotension is not a direct complication of PROM. B) Fetal bradycardia: Fetal heart rate monitoring is essential, but bradycardia is not a primary complication of PROM itself. It may result from other complications that need to be addressed if they arise. D) Immediate onset of labor: Although PROM can lead to the onset of labor, it is not guaranteed, and the immediate concern is the risk of infection. 4. A patient with PROM at 36 weeks gestation has no signs of labor. What is the MOST appropriate nursing intervention? o A) Encourage ambulation to induce labor. o B) Administer corticosteroids for fetal lung maturity. o C) Prepare for cesarean delivery. o D) Monitor for signs of placental abruption. o Answer: B) Administer corticosteroids for fetal lung maturity. o Rationale: If labor has not begun spontaneously after PROM, administering corticosteroids can help accelerate fetal lung maturity in preparation for a potential preterm delivery 1. 5. The nurse is reviewing orders on a patient admitted for PROM. Which physician order will the nurse question? o A) Perform a vaginal exam every shift. o B) Monitor maternal temperature every 4 hours. o C) Continuous fetal heart rate monitoring. o D) Ampicillin 1 gm IVPB q 6 hours. o Answer: A) Perform a vaginal exam every shift. o Rationale: Frequent vaginal exams can increase the risk of introducing infection following PROM and should be avoided unless absolutely necessary2. PROLAPSED UMBILICAL CORD 1. Upon suspicion of a prolapsed umbilical cord, what is the nurse’s FIRST action? o A) Prepare for a cesarean section. o B) Place the patient in the knee-chest position. o C) Administer oxygen at 10 L/min. o D) Perform a vaginal exam. o Answer: B) Place the patient in the knee-chest position. o Rationale: The knee-chest position helps relieve pressure on the prolapsed cord, improving fetal oxygenation until medical intervention can occur3. 2. Which fetal heart rate pattern is MOST concerning for a prolapsed umbilical cord? o A) Tachycardia. o B) Bradycardia. o C) Variable decelerations. o D) Late decelerations. o Answer: B) Bradycardia. o Rationale: Fetal bradycardia may indicate significant cord compression and fetal hypoxia, which is an emergency situation in the case of a prolapsed cord3. 3. A patient’s water breaks and the umbilical cord is visible at the vaginal opening. What should the nurse do IMMEDIATELY? o A) Push the cord back into the uterus. o B) Cover the cord with a warm, moist sterile saline gauze. o C) Instruct the patient to pant and avoid pushing. o D) Elevate the presenting fetal part off the cord manually. o Answer: D) Elevate the presenting fetal part off the cord manually. o Rationale: Manually elevating the presenting part off the cord can help alleviate pressure and improve fetal oxygenation until delivery can be facilitated3. 4. Which maternal position is recommended to reduce the risk of umbilical cord compression in the event of a prolapsed cord? o A) Supine. o B) Trendelenburg. o C) Left lateral. o D) Sitting upright. o Answer: B) Trendelenburg. o Rationale: The Trendelenburg position uses gravity to relieve pressure on the cord by displacing the fetal presenting part upward3. 5. During delivery, the umbilical cord prolapses. Which medication might the nurse administer to relieve cord compression? o A) Oxytocin. o B) Tocolytics. o C) Magnesium sulfate. o D) Methylergonovine. o Answer: B) Tocolytics. o Rationale: Tocolytics may be used to relax the uterus and reduce contractions, thereby decreasing pressure on the prolapsed cord until delivery can be achieved3. SUPINE HYPOTENSION SYNDROME (VENA CAVA SYNDROME) 1. What is the primary cause of supine hypotension syndrome in pregnancy? o A) Dehydration. o B) Compression of the vena cava. o C) Gestational diabetes. o D) Preeclampsia. o Answer: B) Compression of the vena cava. o Rationale: Supine hypotension syndrome is caused by the gravid uterus compressing the inferior vena cava when the woman lies supine, reducing venous return and causing hypotension4. 2. Which symptom is MOST indicative of supine hypotension syndrome? o A) Epigastric pain. o B) Dizziness when lying on the back. o C) Swelling in the legs. o D) Shortness of breath. o Answer: B) Dizziness when lying on the back. o Rationale: Dizziness when lying on the back is a common symptom of supine hypotension syndrome due to decreased cardiac output and cerebral perfusion4. 3. What is the BEST nursing intervention for a patient experiencing supine hypotension syndrome? o A) Elevate the head of the bed. o B) Have the patient lie on her left side. o C) Increase intravenous fluid rate. o D) Administer oxygen. o Answer: B) Have the patient lie on her left side. o Rationale: Lying on the left side relieves pressure on the vena cava, improving venous return and alleviating symptoms of supine hypotension syndrome4. 4. Which complication is associated with untreated supine hypotension syndrome? o A) Fetal tachycardia. o B) Maternal hypoxia. o C) Decreased fetal movement. o D) Maternal bradycardia. o Answer: B) Maternal hypoxia. o Rationale: Untreated supine hypotension syndrome can lead to maternal hypoxia due to decreased cardiac output and

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