1
Q
What is the definition of a spontaneous abortion?
A
A pregnancy that ends as the result of natural causes before 20 weeks of gestation, with a fetal weight less than 500 g.
2
Q
Chromosomal abnormalities account for what percentage of spontaneous abortions?
A
0.25
3
Q
What diagnostic procedure uses sound waves to determine the presence of a viable fetus or retained products of conception?
A
An ultrasound.
4
Q
What surgical procedure is performed to dilate and scrape the uterine walls to remove its contents after an inevitable or incomplete abortion?
A
Dilation and curettage (D&C).
5
Q
In nursing care for a spontaneous abortion, what lay term should be used with clients instead of “abortion”?
A
Miscarriage.
6
Q
For a client who is Rh-negative and has experienced a spontaneous abortion, what medication is administered to suppress their immune response?
A
Rho(D) immune globulin.
7
Q
A client experiencing a _____ abortion might have mild cramps and slight spotting, but no tissue has passed and the cervix is closed.
A
threatened
8
Q
A client with an _____ abortion has mild to moderate cramping and moderate bleeding, but no tissue has passed.
A
inevitable
9
Q
Severe cramping, heavy, profuse bleeding, and passage of tissue are characteristic findings of what type of abortion?
A
Incomplete abortion.
10
Q
What is an ectopic pregnancy?
A
The abnormal implantation of a fertilized ovum outside of the uterine cavity, usually in the fallopian tube.
11
Q
Referred shoulder pain after a suspected tubal rupture in an ectopic pregnancy is caused by what?
A
Blood in the peritoneal cavity irritating the diaphragm or phrenic nerve.
12
Q
What medication inhibits cell division and dissolves the pregnancy in the medical management of an unruptured ectopic pregnancy?
A
Methotrexate.
13
Q
A client taking methotrexate for an ectopic pregnancy should be educated to avoid vitamins containing what substance?
A
Folic acid.
14
Q
What is a laparoscopic salpingectomy?
A
The surgical removal of the fallopian tube, performed when an ectopic pregnancy has ruptured.
15
Q
Gestational trophoblastic disease (GTD) is the proliferation and degeneration of trophoblastic villi in the placenta, taking on the appearance of _____.
A
grape-like clusters
16
Q
In a _____ mole, all genetic material is paternally derived, and there is no fetus, placenta, or amniotic fluid.
A
complete
17
Q
A key finding in gestational trophoblastic disease is a uterine size that is _____ than expected for the duration of the pregnancy.
A
larger (rapid uterine growth)
18
Q
What is the characteristic color of vaginal bleeding associated with gestational trophoblastic disease?
A
Dark brown, resembling prune juice.
19
Q
Why is serum hCG analysis performed for up to a year following the evacuation of a molar pregnancy?
A
To detect for gestational trophoblastic disease (GTD), due to the increased risk of choriocarcinoma.
20
Q
What condition occurs when the placenta abnormally implants in the lower segment of the uterus, near or over the cervical os?
A
Placenta previa.
21
Q
What is the hallmark symptom of placenta previa?
A
Painless, bright red vaginal bleeding during the second or third trimester.
22
Q
What nursing assessment is contraindicated in a client with known or suspected placenta previa?
A
Vaginal exams, as they can exacerbate bleeding.
23
Q
What corticosteroid is often prescribed for a client with placenta previa to promote fetal lung maturation if early delivery is anticipated?
A
Betamethasone.
24
Q
What is abruptio placentae?
A
The premature separation of the placenta from the uterus after 20 weeks of gestation.
25
What are the classic findings of abruptio placentae?
Sudden onset of intense localized uterine pain with dark red vaginal bleeding and a board-like uterus.
26
Cocaine use during pregnancy is a significant risk factor for what placental complication due to its vasoconstrictive effects?
Abruptio placentae.
27
The _____ test is used to detect fetal blood in maternal circulation, which can be helpful in cases of abruptio placentae.
Kleihauer-Betke
28
What condition is described as the fetal umbilical vessels implanting into the fetal membranes rather than the placenta?
Vasa previa.
29
For a client who is HIV-positive, what is the goal for their CD4 cell count during pregnancy?
To keep the CD4 cell count greater than 500 cells/mm3.
30
What IV medication is administered intrapartum to an HIV-positive client to prevent perinatal transmission?
Zidovudine.
31
Why should procedures like forceps, vacuum extraction, and internal fetal monitoring be avoided in an HIV-positive client during labor?
They increase the risk of fetal bleeding and maternal blood exposure to the fetus.
32
What is the most commonly reported STI in American women, which is often asymptomatic?
Chlamydia.
33
If chlamydia is transmitted to a neonate, it can cause conjunctivitis and what other serious condition?
Pneumonia.
34
What is the recommended single-dose oral antibiotic for treating chlamydia during pregnancy?
Azithromycin.
35
What medication is administered as an ointment to all newborns' eyes to provide prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis?
Erythromycin.
36
Ophthalmia neonatorum, which can cause blindness, is a potential complication for a newborn exposed to what STI during birth?
Gonorrhea.
37
What is the recommended antibiotic and route of administration for treating gonorrhea during pregnancy?
Ceftriaxone IM.
38
What is the characteristic lesion of the primary stage of syphilis?
A chancre, which is a painless papular lesion at the site of infection.
39
A skin rash on the palmar surface of the hands and soles of the feet is a finding in which stage of syphilis?
The secondary stage.
40
What is the medication of choice for treating syphilis during pregnancy?
Benzathine penicillin G IM.
41
When are pregnant clients screened for Group B streptococcus (GBS) via vaginal and rectal cultures?
Between 36 0/7 and 37 6/7 weeks of gestation.
42
What is the primary complication for a neonate if GBS is transmitted during labor and delivery?
Neonatal sepsis, pneumonia, or meningitis.
43
Intrapartum antibiotic prophylaxis for GBS is indicated for a client with a positive screen, a maternal fever of $38^{\circ}$ C or greater, or rupture of membranes for _____ hours or longer.
18
44
What is the most commonly prescribed antibiotic for intrapartum GBS prophylaxis?
Penicillin G.
45
A yellow-green, frothy vaginal discharge with a foul odor is a classic sign of what STI?
Trichomoniasis.
46
While taking metronidazole for trichomoniasis or bacterial vaginosis, what substance must the client avoid due to the risk of a disulfiram-like reaction?
Alcohol.
47
What is the hallmark finding on a wet mount for bacterial vaginosis (BV)?
The presence of clue cells.
48
What is the characteristic vaginal discharge associated with candidiasis?
Thick, creamy, white, cottage cheese-like discharge.
49
TORCH is an acronym for a group of infections that can cross the placenta and have teratogenic effects on the fetus. What does TORCH stand for?
Toxoplasmosis, Other infections (hepatitis), Rubella virus, Cytomegalovirus, and Herpes simplex virus.
50
How is toxoplasmosis commonly transmitted?
By consumption of raw or undercooked meat or handling cat feces.
51
To reduce the frequency of cesarean delivery, the CDC recommends initiating suppressive therapy at 36 weeks gestation for pregnant clients with what condition?
Herpes simplex virus (HSV).
52
What is cervical insufficiency?
A condition where painless dilation of the cervix occurs, leading to the expulsion of the products of conception.
53
What is a prophylactic cervical cerclage?
A surgical reinforcement of the cervix with a heavy ligature to prevent premature dilation.
54
A cervical cerclage is typically placed at 12 to 14 weeks of gestation and removed at _____ weeks of gestation.
36 to 38
55
What is hyperemesis gravidarum?
Excessive nausea and vomiting during pregnancy that leads to weight loss, dehydration, electrolyte imbalances, and ketonuria.
56
What is the most important initial laboratory test for a client with suspected hyperemesis gravidarum?
Urinalysis for ketones and acetones.
57
The American College of Obstetricians and Gynecologists recommends _____ as the initial medication for hyperemesis gravidarum.
pyridoxine (vitamin B6) alone or with doxylamine
58
During pregnancy, iron-deficiency anemia is diagnosed when Hgb is less than _____ mg/dL in the first and third trimesters.
11
59
Clients taking ferrous sulfate supplements should be educated to take them with what beverage to increase absorption?
Orange juice (or a source of vitamin C).
60
What is the ideal blood glucose level during pregnancy for a client with gestational diabetes mellitus (GDM) before meals or fasting?
Between 60 and 99 mg/dL.
61
A positive 1-hour glucose tolerance test is a blood glucose level of _____ mg/dL or greater.
130 to 140
62
What is the term for excessive fetal growth, a common risk for fetuses of clients with hyperglycemia?
Macrosomia.
63
Gestational hypertension (GH) is diagnosed when a client has an elevated blood pressure of _____ mm Hg or greater on two separate occasions at least 4 hours apart after the 20th week of pregnancy.
140/90
64
Severe preeclampsia is characterized by a blood pressure of _____ mm Hg or greater, along with other signs of end-organ damage.
160/110
65
What condition is defined as severe preeclampsia manifestations along with the onset of seizure activity or coma?
Eclampsia.
66
What does the 'LP' in HELLP syndrome stand for?
Low Platelets (less than 100,000/mm3).
67
What medication is the treatment of choice for seizure prophylaxis in clients with severe preeclampsia or eclampsia?
Magnesium sulfate.
68
What are two signs of magnesium sulfate toxicity?
Respirations less than 12/min, absence of patellar deep tendon reflexes, urine output less than 30 mL/hr, or decreased level of consciousness.
69
What is the antidote for magnesium sulfate toxicity?
Calcium gluconate or calcium chloride.
70
A client with an incomplete abortion will have what status regarding the passage of tissue and cervical dilation?
Tissue has been passed, and the cervix is dilated.
71
Which cause of first-trimester bleeding is characterized by abrupt unilateral lower-quadrant abdominal pain, with or without vaginal bleeding?
Ectopic pregnancy.
72
What is the term for a benign proliferative growth of the placental trophoblast?
Hydatidiform mole.
73
When counseling a client who has had a molar pregnancy, what is the key piece of education regarding future pregnancies?
To use reliable contraception and avoid pregnancy for the follow-up period (up to 1 year) due to the risk of choriocarcinoma.
74
What type of fetal positioning is common with placenta previa?
Breech, oblique, or transverse position.
75
A coagulation defect, such as _____, is often associated with moderate to severe abruptio placentae.
disseminated intravascular coagulopathy (DIC)
76
What is the immediate management for a client with abruptio placentae?
Immediate birth of the fetus.
77
Inconsistent breastfeeding by an HIV-positive mother _____ the risk of transmitting HIV to the infant.
increases
78
What is the term for postpartum uterine infection, which is a risk for clients with untreated chlamydia or gonorrhea?
Postpartum endometritis.
79
What is the term for a cauliflower-like appearance of warts in the genital area caused by certain strains of HPV?
Condyloma acuminata.
80
A physical finding of "strawberry spots" on the cervix is characteristic of what infection?
Trichomoniasis.
81
A positive "whiff test," where a fishy odor is detected when potassium hydroxide is added to vaginal secretions, indicates what condition?
Bacterial vaginosis (BV).
82
During pregnancy, candidiasis is treated primarily to relieve maternal discomfort and prevent what condition in the neonate?
Oral thrush.
83
In a client with hyperemesis gravidarum, an elevated hematocrit concentration is due to what physiological process?
Hemoconcentration resulting from dehydration.
84
The craving of unusual food, known as pica, can be a sign of what pregnancy-related condition?
Iron-deficiency anemia.
85
What are the three classic symptoms of hyperglycemia (the 3 P's)?
Polydipsia (excessive thirst), polyphagia (excessive hunger), and polyuria (excessive urination).
86
What is the underlying mechanism for the manifestations of hypertensive disorders in pregnancy?
Vasospasm contributing to poor tissue perfusion.
87
In HELLP syndrome, what does the 'H' and 'EL' stand for?
H: Hemolysis; EL: Elevated liver enzymes.
88
A client with preeclampsia reports severe continuous headache, blurring of vision, and _____ pain, which could indicate worsening liver involvement.
epigastric or right upper quadrant
89
What is the definition of a spontaneous abortion in terms of gestational age and fetal weight?
It is the end of a pregnancy from natural causes before 20 weeks of gestation, with a fetus weighing less than 500 g.
90
What is the most common cause of spontaneous abortion, accounting for 25% of cases?
Chromosomal abnormalities are the most common cause.
91
A Dilation and Curettage (D&C) is a procedure used to remove uterine contents for which two types of abortion?
D&C is used for inevitable and incomplete abortions.
92
During the first trimester, what are the two primary causes of bleeding during pregnancy?
The two primary causes are spontaneous abortion and ectopic pregnancy.
93
In a patient experiencing a spontaneous abortion, why is it important to save passed tissue?
Passed tissue should be saved for examination to determine the cause and completeness of the abortion.
94
What lay term should a nurse use with clients instead of the medical term "abortion" to avoid misunderstanding?
The nurse should use the lay term "miscarriage".
95
What is the definition of an ectopic pregnancy?
An ectopic pregnancy is the abnormal implantation of a fertilized ovum outside the uterine cavity, most commonly in the fallopian tube.
96
What is a classic symptom of a ruptured ectopic pregnancy caused by blood irritating the diaphragm or phrenic nerve?
Referred shoulder pain is a classic symptom.
97
Which medication is used in the medical management of an unruptured ectopic pregnancy to dissolve the pregnancy?
Methotrexate is used to inhibit cell division and dissolve the pregnancy.
98
What dietary supplement must be avoided when a client is taking methotrexate for an ectopic pregnancy?
Clients taking methotrexate should avoid vitamins containing folic acid to prevent a toxic response.
99
In the classification of spontaneous abortions, which type is characterized by mild to moderate cramps, moderate bleeding, but no tissue passed and an open cervix?
This describes an inevitable abortion.
100
Which type of spontaneous abortion involves severe cramps, heavy profuse bleeding, and the passage of some tissue, with a dilated cervix?
This describes an incomplete abortion.
101
A missed abortion is characterized by no cramps, no bleeding (or only spotting), and _____ of tissue.
prolonged retention
102
What is gestational trophoblastic disease (GTD)?
GTD is the proliferation and degeneration of trophoblastic villi in the placenta, which become swollen, fluid-filled, grape-like clusters.
103
In a _____ mole, all genetic material is paternally derived, and there is no fetus, placenta, or amniotic fluid.
complete
104
What is the characteristic vaginal bleeding associated with gestational trophoblastic disease described as resembling?
The bleeding is often dark brown, resembling prune juice.
105
What laboratory test is persistently high in a client with gestational trophoblastic disease?
The serum level of human chorionic gonadotropin (hCG) is persistently high.
106
What is the primary treatment for gestational trophoblastic disease?
A suction curettage is performed to aspirate and evacuate the mole.
107
Due to the increased risk of choriocarcinoma, what is the crucial follow-up protocol after a molar pregnancy evacuation?
Serum hCG analysis is done weekly for 3 weeks, then monthly for 6 months up to a year.
108
What is placenta previa?
Placenta previa is when the placenta abnormally implants in the lower segment of the uterus, near or over the cervical os.
109
What is the hallmark symptom of placenta previa?
The hallmark symptom is painless, bright red vaginal bleeding during the second or third trimester.
110
What nursing action is strictly contraindicated in a client with known or suspected placenta previa?
Performing vaginal exams is contraindicated as it can exacerbate bleeding.
111
What medication is often prescribed for a client with placenta previa to promote fetal lung maturation if early delivery is anticipated?
Corticosteroids, such as betamethasone, are prescribed.
112
What is abruptio placentae?
Abruptio placentae is the premature separation of the placenta from the uterus after 20 weeks of gestation.
113
What symptom combination is characteristic of abruptio placentae?
Sudden onset of intense localized uterine pain with dark red vaginal bleeding is characteristic.
114
On palpation, how does the uterus of a client with abruptio placentae typically feel?
The uterus may feel tender and board-like, with contractions showing hypertonicity.
115
A coagulation defect, such as _____, is often associated with moderate to severe abruptio placentae.
disseminated intravascular coagulopathy (DIC)
116
What is vasa previa?
Vasa previa is a condition where fetal umbilical vessels implant into the fetal membranes rather than the placenta.
117
What is the primary goal of care for a pregnant client who is HIV-positive?
The goal is to keep CD4 cell counts greater than 500 cells/mm3 and prevent transmission to the fetus.
118
For an HIV-positive client with a viral load greater than 1,000 copies/mL, what mode of delivery is planned?
A scheduled cesarean birth is planned to reduce the risk of transmission.
119
What intrapartum medication is administered to an HIV-positive client to prevent perinatal transmission?
IV zidovudine is administered 3 hours prior to a scheduled cesarean birth and continued until the cord is clamped.
120
Name two intrapartum procedures that should be avoided in an HIV-positive client due to the risk of fetal blood exposure.
Avoid artificial rupture of membranes, episiotomy, internal fetal monitors, and forceps/vacuum extractor.
121
Is breastfeeding recommended for clients who have HIV/AIDS in the U.S.?
No, to decrease the risk of transmission to the infant, breastfeeding is not recommended in the U.S.
122
What is the recommended medication for treating chlamydia during pregnancy?
A single dose of Azithromycin PO is the recommended treatment.
123
What medication is administered to all newborns following birth as prophylaxis against ophthalmia neonatorum caused by gonorrhea and chlamydia?
Erythromycin ointment is administered to all newborns.
124
A pregnant client diagnosed with gonorrhea will likely be treated with ceftriaxone IM and what other oral antibiotic, assuming chlamydia has not been excluded?
A single dose of Azithromycin PO is also given.
125
What is the primary stage of syphilis characterized by?
The primary stage is characterized by a chancre, which is a painless papular lesion at the site of infection.
126
What distinctive rash is associated with the secondary stage of syphilis?
A reddish-brown maculopapular rash on the palmar surface of the hands and the soles of the feet is distinctive.
127
What is the treatment of choice for syphilis during pregnancy?
Benzathine penicillin G administered via intramuscular injection.
128
When are pregnant clients screened for Group B streptococcus (GBS)?
Vaginal and rectal cultures are performed between 36 0/7 and 37 6/7 weeks of gestation.
129
Name two indications for administering intrapartum antibiotic prophylaxis for GBS.
Indications include a positive GBS screen, unknown status delivering <37 weeks, maternal fever, or rupture of membranes for 18 hours or longer.
130
What is the antibiotic of choice for intrapartum prophylaxis against GBS?
Penicillin G or ampicillin are the most prescribed antibiotics.
131
During pregnancy, genital warts caused by HPV can be treated with topical _____ or cryotherapy.
Trichloroacetic acid (TCA)
132
What is the characteristic vaginal discharge associated with Trichomoniasis?
A yellow-green, frothy vaginal discharge with a foul odor is characteristic.
133
What is the treatment for Trichomoniasis during pregnancy, and what substance must be avoided during therapy?
Metronidazole PO is the treatment, and alcohol must be avoided due to a disulfiram-like reaction.
134
Bacterial vaginosis (BV) is associated with a thin, milky (gray-white) discharge and a positive _____ test, which detects a fishy odor.
whiff
135
Microscopic examination of vaginal secretions from a client with bacterial vaginosis would reveal the presence of what type of cells?
The wet mount would be positive for clue cells.
136
What is the appearance of vaginal discharge in a client with candidiasis (yeast infection)?
The discharge is thick, creamy, white, and cottage cheese-like.
137
The acronym TORCH stands for infections that can have teratogenic effects on a fetus. What does TORCH stand for?
Toxoplasmosis, Other infections (hepatitis), Rubella virus, Cytomegalovirus, and Herpes simplex virus (HSV).
138
How is toxoplasmosis typically contracted?
Toxoplasmosis is contracted by consuming raw or undercooked meat or handling cat feces.
139
For a client with active genital herpes simplex virus (HSV) lesions, what mode of delivery is anticipated?
A cesarean birth is anticipated to prevent transmission to the fetus during a vaginal birth.
140
What is cervical insufficiency?
It is a condition involving premature, painless cervical dilation that leads to the expulsion of the products of conception.
141
A _____ is a surgical procedure to reinforce the cervix, typically performed at 12 to 14 weeks of gestation for cervical insufficiency.
prophylactic cervical cerclage
142
What is hyperemesis gravidarum?
It is excessive nausea and vomiting during pregnancy that leads to weight loss, dehydration, electrolyte imbalances, and ketonuria.
143
What is the most important initial laboratory test for a client with suspected hyperemesis gravidarum?
A urinalysis for ketones and acetones is the most important initial test.
144
What vitamin is often administered to clients with hyperemesis gravidarum?
Pyridoxine (vitamin B6) is often administered.
145
What is the diagnostic criterion for iron-deficiency anemia in the first and third trimesters of pregnancy?
A hemoglobin (Hgb) level less than 11 mg/dL.
146
To increase absorption, iron supplements should be taken on an empty stomach with what type of beverage?
Iron supplements should be taken with orange juice or another source of vitamin C.
147
What is the ideal blood glucose level for a pregnant client before meals or when fasting?
The ideal blood glucose level should be between 60 and 99 mg/dL.
148
A positive 1-hour glucose tolerance test is a blood glucose level of _____ or greater.
130 to 140 mg/dL
149
What is the primary risk to the fetus of a mother with uncontrolled gestational diabetes mellitus?
The primary risk is macrosomia (excessive fetal growth).
150
What defines gestational hypertension (GH)?
An elevated blood pressure of 140/90 mm Hg or greater on two occasions at least 4 hours apart, beginning after the 20th week of pregnancy, without proteinuria.
151
Severe preeclampsia is characterized by a blood pressure of _____ or greater, along with other signs of end-organ damage.
160/110 mm Hg
152
What condition is defined as severe preeclampsia manifestations along with the onset of seizure activity or coma?
This condition is eclampsia.
153
What does the 'LP' in HELLP syndrome stand for?
LP stands for Low Platelets (less than 100,000/mm3).
154
What is the medication of choice for seizure prophylaxis in a client with severe preeclampsia?
Magnesium sulfate is the medication of choice.
155
Name two signs of magnesium sulfate toxicity.
Signs include respirations less than 12/min, urine output less than 30 mL/hr, absence of deep tendon reflexes, or decreased level of consciousness.
156
What is the antidote for magnesium sulfate toxicity?
The antidote is calcium gluconate or calcium chloride.
157
A client with preeclampsia reports severe epigastric pain. What organ dysfunction does this symptom suggest?
Severe epigastric pain suggests hepatic dysfunction or liver involvement.
158
What is the recommended client position to enhance uterine perfusion and reduce pressure on the vena cava?
A lateral or side-lying position is recommended.
159
What is the definition of a spontaneous abortion in terms of gestational week and fetal weight?
It is the end of a pregnancy due to natural causes before 20 weeks of gestation, with a fetal weight of less than 500 g.
160
Chromosomal abnormalities account for what percentage of spontaneous abortions?
0.25
161
What diagnostic procedure is used to determine the presence of a viable or dead fetus in a suspected spontaneous abortion?
An ultrasound.
162
What surgical procedure involves dilating and scraping the uterine walls to remove uterine contents after an inevitable or incomplete abortion?
Dilation and curettage (D&C).
163
When communicating with a client who has experienced a spontaneous abortion, what lay term should a nurse use instead of 'abortion'?
The nurse should use the term 'miscarriage'.
164
A client who is Rh-negative and has experienced a spontaneous abortion should receive what medication to suppress her immune response?
Rho(D) immune globulin.
165
What are the characteristics of a 'threatened' abortion regarding cramps, bleeding, and tissue passage?
Possible mild cramps, slight spotting, and no tissue passed.
166
In which type of spontaneous abortion are there severe cramps, heavy profuse bleeding, and passage of tissue?
Incomplete abortion.
167
What is an ectopic pregnancy?
The abnormal implantation of a fertilized ovum outside of the uterine cavity, most commonly in the fallopian tube.
168
What is a classic symptom of a ruptured ectopic pregnancy related to pain referral?
Referred shoulder pain due to blood in the peritoneal cavity irritating the diaphragm or phrenic nerve.
169
What medication is used for medical management of an unruptured ectopic pregnancy to dissolve the pregnancy?
Methotrexate.
170
A client taking methotrexate for an ectopic pregnancy should be educated to avoid vitamins containing what substance?
Folic acid.
171
What is Gestational Trophoblastic Disease (GTD)?
The proliferation and degeneration of trophoblastic villi in the placenta, which become swollen, fluid-filled, and take on the appearance of grape-like clusters.
172
In a _____ mole, all genetic material is paternally derived, and it contains no fetus, placenta, or amniotic membranes.
complete
173
What is a characteristic finding of bleeding in a client with Gestational Trophoblastic Disease?
The bleeding is often dark brown, resembling prune juice.
174
What laboratory test is persistently high in a client with Gestational Trophoblastic Disease?
Serum level of human chorionic gonadotropin (hCG).
175
Why is long-term follow-up with serum hCG analysis crucial after the evacuation of a molar pregnancy?
To detect for Gestational Trophoblastic Disease (GTD) and the potential development of choriocarcinoma.
176
What is placenta previa?
A condition where the placenta abnormally implants in the lower segment of the uterus, near or over the cervical os.
177
What is the hallmark symptom of placenta previa?
Painless, bright red vaginal bleeding during the second or third trimester.
178
What nursing action is strictly contraindicated in a client with known or suspected placenta previa?
Performing vaginal exams, as they can exacerbate bleeding.
179
What medication is often prescribed for a client with placenta previa to promote fetal lung maturation if early delivery is anticipated?
Betamethasone, a corticosteroid.
180
What is abruptio placentae?
The premature separation of the placenta from the uterus after 20 weeks of gestation.
181
What are the classic findings of abruptio placentae?
Sudden onset of intense localized uterine pain with dark red vaginal bleeding and a board-like uterus.
182
What coagulation defect is often associated with moderate to severe abruptio placentae?
Disseminated intravascular coagulopathy (DIC).
183
Cocaine use is a significant risk factor for which pregnancy complication due to its vasoconstrictive effects?
Abruptio placentae.
184
What is vasa previa?
A condition where the fetal umbilical vessels implant into the fetal membranes rather than the placenta.
185
What is the goal for CD4 cell counts in a pregnant client with HIV?
To keep CD4 cell counts greater than 500 cells/mm3.
186
For a pregnant client with an HIV viral load greater than 1,000 copies/mL, what mode of delivery is planned?
A scheduled cesarean birth.
187
What are some procedures that should be avoided during the intrapartum period for a client with HIV?
Amniocentesis, episiotomy, internal fetal monitors, vacuum extraction, and forceps.
188
What medication is administered intravenously to an HIV-positive client during labor and delivery to prevent perinatal transmission?
Zidovudine.
189
Is breastfeeding recommended for clients with HIV in the U.S.?
No, to decrease the risk of transmission to the newborn, breastfeeding is not recommended.
190
What is the most commonly reported STI in American women, which is often asymptomatic?
Chlamydia.
191
If chlamydia is transmitted to a neonate during birth, what two conditions can it cause?
Conjunctivitis (ophthalmia neonatorum) and pneumonia.
192
What medication is administered to all newborns following birth as prophylaxis against ophthalmia neonatorum caused by gonorrhea and chlamydia?
Erythromycin ointment.
193
What is the recommended antibiotic treatment for chlamydia during pregnancy?
Azithromycin PO in a single dose.
194
What is the recommended treatment for gonorrhea during pregnancy?
Ceftriaxone IM and Azithromycin PO (if chlamydia is not excluded).
195
What is the characteristic lesion of the primary stage of syphilis?
A chancre, which is a painless papular lesion at the site of infection.
196
A client in the secondary stage of syphilis may present with a skin rash on what specific areas of the body?
The palmar surface of the hands and the soles of the feet.
197
What is the medication of choice for treating syphilis during pregnancy?
Benzathine penicillin G IM.
198
What is the timing for performing vaginal and rectal cultures to screen for Group B streptococcus (GBS) during pregnancy?
Between 36 0/7 and 37 6/7 weeks of gestation.
199
A client with a positive GBS culture in the current pregnancy will receive intrapartum antibiotic prophylaxis with what medication?
Penicillin G or ampicillin.
200
What are three indications for administering intrapartum antibiotic prophylaxis for GBS if the status is unknown?
Delivery at less than 37 weeks, rupture of membranes for 18 hours or longer, or maternal fever of 38° C (100.4° F) or greater.
201
Genital warts, or condyloma acuminata, are caused by which STI?
Human papilloma virus (HPV).
202
What is a recommended therapeutic procedure for treating HPV-related genital warts during pregnancy?
Cryotherapy.
203
What is the characteristic vaginal discharge associated with Trichomoniasis?
Yellow-green, frothy vaginal discharge with a foul odor.
204
A 'strawberry cervix' with tiny petechiae is a classic physical finding for which infection?
Trichomoniasis.
205
A client being treated with metronidazole for Trichomoniasis or bacterial vaginosis should be educated to avoid what substance?
Alcohol, due to the risk of a disulfiram-like reaction.
206
Bacterial vaginosis is characterized by a thin, white or gray vaginal discharge with what distinct odor?
A fishy odor.
207
What is the characteristic vaginal discharge in a client with vulvovaginal candidiasis (yeast infection)?
Thick, creamy, white, cottage cheese-like discharge.
208
The acronym TORCH stands for a group of infections that can cross the placenta and have teratogenic effects on the fetus. What does TORCH stand for?
Toxoplasmosis, Other infections (hepatitis), Rubella virus, Cytomegalovirus, and Herpes simplex virus.
209
How is toxoplasmosis contracted?
By consumption of raw or undercooked meat or handling cat feces.
210
For a pregnant client with a history of recurrent herpes simplex virus (HSV), when is suppressive therapy typically initiated?
At 36 weeks of gestation to reduce the frequency of active lesions at birth.
211
What is cervical insufficiency?
Premature, painless cervical dilation that can lead to the expulsion of the products of conception.
212
What is a prophylactic cervical cerclage?
A surgical reinforcement of the cervix with a heavy ligature to prevent premature dilation, typically placed at 12 to 14 weeks of gestation.
213
What is hyperemesis gravidarum?
Excessive nausea and vomiting during pregnancy that leads to weight loss, dehydration, electrolyte imbalances, and ketonuria.
214
What is the most important initial laboratory test for a client with suspected hyperemesis gravidarum?
A urinalysis for ketones and acetones.
215
For a client with hyperemesis gravidarum, the diet is advanced as tolerated, starting with _____.
clear liquids and bland foods (like dry toast or crackers)
216
A pregnant client is diagnosed with iron-deficiency anemia if her Hgb is less than _____ mg/dL in the first and third trimesters.
11
217
To increase absorption, ferrous sulfate supplements should be taken with a dietary source of what vitamin?
Vitamin C (e.g., orange juice).
218
What is gestational diabetes mellitus (GDM)?
An impaired tolerance to glucose with the first onset or recognition during pregnancy.
219
Excessive fetal growth, known as _____, is a significant risk for the fetus of a client with GDM.
macrosomia
220
At what point in pregnancy is the 1-hour glucose tolerance test typically performed?
At 24 to 28 weeks of gestation.
221
A positive 1-hour glucose screening test is a blood glucose level of _____ or greater.
130 to 140 mg/dL
222
What is the diagnostic criteria for gestational hypertension (GH)?
A blood pressure of 140/90 mm Hg or greater on two occasions at least 4 hours apart, after 20 weeks of gestation, without proteinuria.
223
What distinguishes severe preeclampsia from preeclampsia without severe features?
Blood pressure of 160/110 mm Hg or greater, plus evidence of end-organ damage such as proteinuria >3+, oliguria, cerebral disturbances, or hepatic dysfunction.
224
What is eclampsia?
Severe preeclampsia manifestations along with the onset of seizure activity or coma.
225
What does the 'HELLP' in HELLP syndrome stand for?
Hemolysis, Elevated Liver enzymes, and Low Platelets.
226
What is the medication of choice for seizure prophylaxis in a client with severe preeclampsia?
Magnesium sulfate.
227
What are the four classic signs of magnesium sulfate toxicity?
Absence of patellar deep tendon reflexes, respirations less than 12/min, urine output less than 30 mL/hr, and a decreased level of consciousness.
228
What is the antidote for magnesium sulfate toxicity?
Calcium gluconate or calcium chloride.
229
In a client with preeclampsia, what positioning is encouraged to maximize uterine and renal perfusion?
Lateral positioning (side-lying).
230
A surgical procedure to salvage a fallopian tube that has not ruptured in an ectopic pregnancy is called a _____.
salpingostomy
231
What is the term for the surgical removal of a fallopian tube, often performed when an ectopic pregnancy has ruptured?
Laparoscopic salpingectomy.
OB Proctor Exam ATI
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