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Study Guide Answer Key Chapter 51

chapter

Study Guide Answer Key


5

Learning Activities 5. fallopian tube


1. b, f, e, d, a, c 6. hypovolemic shock secondary to blood loss
2. Maintain adequate intake and output. 7. a. Bleeding, possibly accompanied by cramp-
Avoid cooking odors. ing, that varies from spotting to hemor-
Carbohydrates are best tolerated. rhage
Drink liquids between meals. b. Larger than usual
Eat frequently in small quantities. c. Absent fetal heart activity
Sit upright after meals to reduce gastric reflux. d. Early and severe hyperemesis gravidarum
Keep visual reminders of nausea, such as em- e. Elevated, with other signs of pregnancy-
esis basins, out of sight. related hypertension
Provide emotional support. f. hCG levels higher than expected for gesta-
3. h, b, a, e, f, g, c, d tion
4. a. Report increased bleeding. g. Snowstorm appearance on ultrasound
b. Report temperature of 38 C (100.4 F) or h. Increased risk for choriocarcinoma if all
higher. abnormal tissue is not removed
c. Take iron supplement as recommended to 8. a. Within 23 cm of the cervical opening, but
correct anemia. not covering any part of it
d. Resume sexual activity as directed. b. Partially covering the cervical opening
e. Return to physician for checkup and con- c. Totally covering the cervical opening
traceptive information and emphasize that
pregnancy can occur before the first men-
strual period.

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2Study Guide Answer Key Chapter 5

9.
Placenta Previa Abruptio Placentae
a. Pain No unusual pain Bleeding is accompanied by pain; low
uterine tenderness
b. Characteristics Bright red, obvious Often concealed behind placenta, with
of bleeding little external bleeding
c. Fetal anemia Fetus may lose some blood as vessels Some blood behind placenta is often
and/or are disrupted with cervical dilation and fetal blood; maternal hypovolemia may
hypoxia effacement; maternal hypovolemia may reduce oxygen delivery to the fetus
reduce oxygen delivery to the fetus
d. Consistency of No unusual contractions or irritability Frequent cramplike contractions
the uterus
e. Blood No blood clotting abnormalities are DIC may occur due to large clot behind
coagulation expected placenta with consumption of clotting
factors
f. Risk for Higher because lower uterus does not Higher because injured muscle at
postpartum have as much muscle to compress open placenta site may not contract as well
hemorrhage vessels
g. Risk for Higher because placenta is implanted Higher because injured tissue is more
postpartum near vagina and organisms can easily susceptible to microbial invasion
infection ascend and infect it

10. Signs that suggest a possible seizure include: previously normotensive woman after 20
a. Abdominal and/or epigastric pain (related weeks; blood pressure returns to normal by
to liver edema, ischemia, and necrosis; 6 weeks postpartum)
precedes seizure; abruptio placentae is also b. Preeclampsia (includes proteinuria with
more likely and may be cause of pain) hypertension)
b. Persistent vomiting (may occur with hy- c. Eclampsia (hypertension with 1 seizure)
peremesis gravidarum, but may also be d. HELLP (includes proteinuria plus abnor-
caused by same mechanisms noted above) malities of coagulation and liver studies)
c. Edema of face and hands (large excess of e. Chronic hypertension (existence of hyper-
tissue fluid, although edema is not essen- tension before 20 weeks of gestation or
tial to diagnosis and may occur for many persistence for 6 weeks after birth, when
different reasons) gestational hypertension is expected to be
d. Severe persistent headache (brain edema resolved)
and small hemorrhages; often precedes sei- f. Preeclampsia with superimposed chronic
zure) hypertension (chronic hypertension that
e. Blurred vision or dizziness (arterial spasm has a new occurrence of proteinuria,
and edema near retina; often precedes a thrombocytopenia, and increased liver en-
convulsion) zymes)
11. See Box 5-4. 13. 140/90 mm Hg or higher
First pregnancy 14. a. Hypertension (vasospasm)
Obesity b. Edema (fluid leaves blood vessels abnor-
Family history of gestational hypertension mally and enters tissue spaces)
Age younger than 19 or older than 40 years c. Proteinuria (reduced blood flow to the kid-
Multifetal pregnancy neys)
Chronic hypertension d. Central nervous system changes such as
Chronic renal disease severe headache or hyperactive reflexes
Diabetes mellitus (brain edema and small cerebral hemor-
12. See Table 5-5. rhages [severe])
a. Gestational hypertension (development e. Visual disturbances (arterial spasm and
of blood pressure 140/90 mm Hg in a edema around retina [severe])

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Study Guide Answer Key Chapter 53

f. Reduced urine output (reduced blood flow 25. Each labor contraction shifts 300500 mL of
to the kidneys) blood from the uterus and placenta into the
g. Pulmonary edema (movement of fluid womans general circulation, possibly over-
from vessels to lung tissue [severe]) loading her heart. Interstitial fluid returns to
h. Epigastric pain or nausea (liver edema, the circulation after birth and also may increase
ischemia, and necrosis [severe]) the risk for congestive heart failure.
i. Lab studies (liver enzymes elevated be- 26. a. Increased blood volume
cause of decreased circulation, edema, and b. Iron transfer to the fetus
small hemorrhages [severe]); coagulation c. Cushion against the blood lost naturally at
abnormalities due to low platelet levels birth
and accumulation of platelets at sites of 27. While 10.5 g/dL is the minimum acceptable
vessel damage [severe] value for the womans hematocrit during the
15. Reduces blood flow to mothers skeletal mus- second trimester, she will soon be entering the
cles, making more available to her vital organs third trimester when her hemoglobin should
and for perfusion of the placenta be 11 g/dL or higher. The nurse might initially
16. a. Reduce central nervous system irritability determine whether the woman is now taking
to prevent seizures iron supplements; her most common foods
b. Urine output < 30 mL/hour, depression or during an average day; and if she has specific
loss of deep tendon reflexes, respiratory dietary needs such as food allergies, foods that
depression, serum levels above 8 mg/dL, she does not eat (specific meats or vegetables),
observation for uterine atony after birth or a therapeutic diet. Additional iron may be
c. Calcium gluconate indicated as she enters the third trimester.
d. 48 mg/dL 28. Refer to Nutrition Considerations box, p. 103,
17. a. negative; positive green leafy vegetables, whole or enriched grain
b. Rh immune globulin (RhoGAM or products, nuts, blackstrap molasses, tofu, eggs,
HypRho-D) dried fruits
c. i. 28 weeks of gestation b. Folic acid: green leafy vegetables, aspara-
ii. Within 72 hours of birth gus, green beans, fruits, whole grains, liver,
iii. After spontaneous abortion legumes, yeast
iv. Bleeding during pregnancy c. Vitamin C: citrus, strawberries, cantaloupe,
18. Gestational cabbage, green and red peppers, tomatoes,
19. The woman drinks 50 g of an oral glucose so- potatoes, green leafy vegetables
lution and fasting is not needed. In 1 hour, a 29. a. Foods containing vitamin C may enhance
blood sample is analyzed for glucose level. The iron absorption.
result should be less than 140 mg/dL. The test b. Milk and high-calcium products such as
is done at 2428 weeks gestation. antacids or calcium supplements inhibit
20. a. To keep levels as near normal as possible absorption of the iron.
over the day 30. Preventive folic acid should be 400 mcg (0.4
b. To test for ketones, which might require an mg)/day. Treatment of folic acid anemia or pre-
adjustment in diet or signal onset of infec- vention of neural tube defects in the infant of
tion a woman who has previously had an affected
21. Insulin; does not cross the placenta infant should be at least 1 mg/day. The supple-
22. Insulin needs may be less during the first tri- ment dose may be higher than 1 mg/day to
mester due to the effect of nausea and vomit- prevent recurrent neural tube defects in the
ing on food intake. Insulin needs rise steadily fetus.
throughout pregnancy but then fall dramati- 31. Sickle cell crises may cause erythrocyte de-
cally after birth, often below the prepregnancy struction with occlusion of small blood ves-
requirements. sels, including those supplying the placenta.
23. Some women with preexisting diabetes have This may result in preterm birth, intrauterine
vascular impairment and exercise would re- growth restriction, and fetal death.
duce circulation to the placenta, resulting in 32. f, c, a, b, e, d
poor oxygen and nutrient delivery to the fetus. 33. The CDC recommends routine immunization
In gestational diabetes, exercise often helps re- at birth, 12 months, and 618 months. If moth-
duce the need for insulin. er is positive for hepatitis B, newborn should
24. Higher heart rate, blood volume, and cardiac have a single dose of hepatitis B immune glob-
output increase the hearts workload, possibly ulin followed by hepatitis B vaccine
resulting in congestive heart failure.

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4Study Guide Answer Key Chapter 5

34. a. Transplacentally creas secretes added insulin during pregnancy


b. Through contact with infected maternal (except in women who have type 1 diabetes),
secretions at birth but its effectiveness is less (1 and 4). The fetus
c. Through breast milk secretes his or her own insulin for glucose me-
35. a. Avoid drug use or do not share needles if tabolism because the hormone does not cross
the habit is continued. the placenta (3).
b. Use a latex condom. 2. Answer: 3
c. Avoid oral sex. Rationale: The biophysical profile includes five
36. Incomplete bladder emptying due to pressure evaluations associated with placental function
on the bladder and reduced motility of the ure- (3): nonstress test, fetal breathing movements,
ters; retained urine becomes more alkaline and fetal body movements, fetal tone, and volume
favors growth of microorganisms. of amniotic fluid. Rising antibody titers in labo-
37. a. Clean the vaginal-perineal area in a front- ratory tests, as well as noninvasive DNA test-
to-back direction. ing of maternal plasma, can determine fetal Rh
b. Drink at least eight glasses of liquids each status (1). Fetal lung maturity requires tests on
day, excluding caffeinated ones. Cranberry amniotic fluid (2) obtained by amniocentesis.
juice makes the urine more acidic and less Amniocentesis and/or ultrasound are often
favorable to bacterial growth. used to identify serious fetal anomalies (4).
c. Urinate before and after intercourse; use a 3. Answer: 2
water-soluble lubricant to reduce irritation. Rationale: Rubella vaccine can cross the placen-
38. Standard precautions to reduce spread by con- ta and could adversely affect the fetus. It can
tact be given in the immediate postpartum period
Safe food and water supply to ensure adequate (2) and the woman should be advised not to
nutrition and hydration become pregnant for at least 3 months. Limit-
Safe air supply to reduce further transmission ing her contact with other pregnant women is
Vaccines or antibiotics if benefits outweigh unnecessary unless they have an infection (1).
risks to fetus Nonimmunity does not mean infected and au-
39. a. Growth retardation, facial abnormalities, tomatic birth defects (3). It only means that her
mental retardation risk for infection with a virus that could cause
b. Avoid alcohol intake from conception. anomalies is present. It is not possible to say
40. e, f, i, c, a, b, g, h, d that there is little risk for infection (4) because
41. The physician or nurse-midwife will prescribe the risk depends on whether the woman is in-
the drug that is least harmful yet is therapeutic fected with rubella. Minimizing the risk to her
for her condition and will prescribe it in the may cause her to ignore steps to prevent infec-
lowest possible effective dose and at the best tion in this or another pregnancy.
time(s) to take the drug. The physician who 4. Answer: 1
prescribed the drug or a pharmacist may also Rationale: Wiping front to back after toilet-
be consulted. ing (1) reduces introduction of anal organisms
42. a. Increased risk for spontaneous abortion into the bladder. Foods high in fiber, iron,
(miscarriage), stillbirth, low-birthweight and vitamin C (2) would reduce the risk for
baby constipation and help prevent iron deficiency
b. Late prenatal care anemia, but not UTIs specifically. Citrus fruits
c. Increased risk for homicide and juices (3) may add fiber and liquids, which
43. Late or erratic prenatal care; injuries in various reduce constipation, not UTIs. Not adding
stages of healing; old fractures; tendency to lubricant during vaginal intercourse (4) if one
minimize injury or its severity; assumption of is needed can increasenot reducethe risk
responsibility for the trauma. The abuser may for urinary tract infection by irritation of the
be extremely attentive after a battering episode. vaginal-perineal area.
5. Answer: 1
Rationale: If the mothers heart cannot meet
Review Questions the demands of her own body, placental blood
1. Answer: 2 flow will be reduced, leading to fetal hypoxia
Rationale: The placenta secretes substances (es- (1). Preterm birth (2) by cesarean may become
trogen, progesterone, insulinase) that decrease necessary if the womans condition worsens,
the effectiveness of insulin or break it down but this is not the primary risk because a term
more quickly (2). This action makes more avail- baby is always the goal. Maternal infection (3)
able to the fetus. (See also Chapter 4.) The pan- is a risk to both mother and fetus/newborn,

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Study Guide Answer Key Chapter 55

but steps are taken throughout the pregnancy 10. Answer: 1


to avoid it. The fetus may have a greater risk Rationale: Abruptio placentae is characterized
for congenital heart defects if the mother has by dark or concealed bleeding (1), while pla-
one (4), but this is still not the primary risk and centa previa is marked by profuse bleeding (4).
the risk is usually small. Both placenta previa and abruptio placentae
6. Answer: 3 are associated with some uterine irritation (2)
Rationale: Continual vomiting reduces calo- and infection (3), so these are not distinguish-
ries available to the fetus. Overall small size ing features. Vomiting (4) does not characterize
is a greater risk with persistent hyperemesis either condition.
gravidarum (3) than are multiple vitamin and 11. Answer: 4
mineral deficiencies (1). Many factors may be Rationale: Percutaneous umbilical blood sam-
at the root of inadequate birth attachment. The pling (4) serves to obtain a fetal blood sample
woman with hyperemesis gravidarum has from a placental vessel or from the umbilical
no more or less risk for poor bonding (2) than cord; this may be used to give a blood transfu-
other women simply because of her disorder. sion to an anemic fetus. Ultrasound exami-
Neonatal sepsis (4) is not a characteristic asso- nation identifies placental location, which is
ciated with hyperemesis gravidarum. important because third trimester bleeding is
7. Answer: 4 often due to placenta previa or abruptio pla-
Rationale: A rising pulse (4) and falling blood centae. Placenta previa can be diagnosed with
pressure are characteristic in a woman with ultrasound, although it is not as reliable for
hypovolemic shock from blood loss. If she abruptio placentae. An x-ray (1) is avoided if
is pregnant, the fetal heart rate often rises possible during pregnancy and is unlikely to
initially. Fever, as opposed to low temp (1) is determine a source of bleeding. Vaginal exams
characteristic of infection. Abnormal uterine (2) are avoided in the bleeding woman until
contractions (2) are characteristic of abruptio the source of the bleeding is identified to avoid
placentae or other conditions. Urine output (3) increasing hemorrhage. Alpha-fetoprotein (3) is
usually falls or ceases with hypovolemic shock. used to identify open fetal defects such as neu-
8. Answer: 4 ral tube defects.
Rationale: Signs of hypovolemia from ectopic 12. Answer: 1
pregnancy, characterized by initially reduced Rationale: Severe preeclampsia may progress
urine output (4) and tachycardia with little or to eclampsia, manifested by occurrence of one
no external bleeding suggest intraabdominal or more seizures (1). Decreased uric acid levels
bleeding consistent with ectopic pregnancy. (2) and polyuria (4) are not associated with
Falling blood pressure, not hypertension (1), either severe preeclampsia or eclampsia. The
with shallow (not deep) respirations (1) are blood pressure will be high rather than low (3)
later signs of hypovolemia. Vaginal bleeding unless another complication occurs, such as
without cramping (2) may occur during early bleeding with abruptio placentae.
pregnancy (threatened abortion) or later preg- 13. Answer: 2
nancy (placenta previa); in ectopic pregnancy Rationale: Herpesvirus infection rarely crosses
vaginal bleeding is accompanied by severe ab- the placenta, but the fetus can acquire infection
dominal pain. Tachycardia, not bradycardia (3), if born when lesions are in or near the vagina.
with pale skin (not cyanosis) is another sign of Thus, cesarean birth (2) may be done for active
the hypovolemic shock encountered in ectopic herpesvirus infection at the time of birth. An-
pregnancy. tiviral (not antibiotic [1]) drugs may be given
9. Answer: 2 to the fetus who was exposed to the virus.
Rationale: Vesicles of hydatidiform mole may Spontaneous abortion, intrauterine growth
undergo malignant change, leading to chorio- restriction, and preterm labor may occur with
carcinoma (2). The physician will discourage initial infection during early pregnancy. Dis-
getting pregnant, not monitor for recurrent seminated, rather than local (3), infection has
pregnancy (1), within a year of hydatidiform a high newborn mortality and survivors may
mole because doing so does not allow proper have neurologic complications. The virus be-
follow-up with hCG levels. If elevated, the comes dormant and can be reactivated at any
blood pressure usually returns to normal after time. There is no immunity (4) at this time.
evacuation of the mole (3). Continued bleeding 14. Answer: 1
(4) would be assessed and treated, but is not Rationale: The pregnant woman must check
the primary reason for long-term follow-up. blood glucose levels several times each day (1)
to keep her glucose levels as close to normal

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6Study Guide Answer Key Chapter 5

as possible. Urine glucose (2) is not reliable for ternal and fetal glucose as close to normal
diabetic glucose control, especially in preg- values as possible. She will also need to
nancy. Urine testing is used to identify ketonu- know how to perform her glucose tests and
ria that may need treatment. The glycosylated a urine ketone if ordered.
hemoglobin levels (3) help identify long-term c. If Amys diabetes is not gestational but
glucose control but are not done for daily man- type 2, it is likely to be evident by her
agement. Recording hypoglycemic symptoms 6-week postpartum visit and she should
(4) would be relevant, but would not objec- be referred to an appropriate physician for
tively identify the success or need for change in care.
a womans insulin. d. Basic teaching and care continue with the
15. Answer: 3 diabetes care, monitoring how Amy ob-
Rationale: To eradicate the organism that tains blood samples for testing with a hos-
causes tuberculosis, the woman must take all pital glucometer, and how she gives herself
her medication (3), which extends over sev- insulin drawn up by the nurse, usually an
eral months. Increasing fluid (1) helps prevent RN. In addition, observing for worsening
urinary tract infections and prevent or relieve hypertension and cerebral irritability are
constipation. Cesarean birth (2) is not required essential because of onset of hypertension.
specifically for the tuberculosis infection. Mod- On high-risk antepartum units, RNs usu-
ern antitubercular drugs usually render the ally provide most patient care. However,
sputum culture negative within 2 weeks; thus the LPN/LVN may identify the problem in
home care, not hospitalization (4) is the proto- prenatal care.
col, with health department follow-up.
16. Answer: 4
Rationale: Placing a pillow or similar object Thinking Critically
under one hip tilts her uterus off the great ves- 1. When a person has significant anemia, the
sels, improving blood return to her heart and heart must work harder by beating faster to
circulation to the placenta (4). (See also Supine circulate the remaining erythrocytes (red blood
Hypotension in Chapter 4.) A head-dependent cells) to deliver oxygen to the tissues and re-
position (1) is likely to compromise her breath- move carbon dioxide. Any pregnant woman
ing because of the added pressure of her heavy has extra demands on her heart related to a
uterus on her diaphragm. Fluid overload (2) higher blood volume to circulate blood to more
is rarely a problem in the otherwise-healthy tissue (such as uterine and breast tissue). If sig-
woman who is a victim of trauma. Frequent nificant anemia is added, the already-stressed
vital signs and pulse oximetry are the norm if heart must beat faster in an attempt to deliver
trauma occurs in any patient (3), but do noth- oxygen and remove carbon dioxide. The ad-
ing to improve circulation to the placenta as ditive effects of these demands can exceed the
the question asked. capacity of a diseased heart.
2. Magnesium is excreted by the kidneys. If ad-
ministration continues, yet the kidneys are not
Case Study excreting the drug, a buildup to toxic levels
1. a. Factors predisposing Amy to complication: may occur. The early manifestations of a too-
(1) Three pregnancy losses, two spontane- high magnesium level is depressed reflexes,
ous abortions or miscarriages and one late followed by depressed respirations. If not
loss at 35 weeks gestation. (2) Prior large- corrected, collapse and death may occur from
for-gestational-age baby. (3) Two pregnan- depression of cardiac function. An LPN/LVN
cies complicated by hypertension. (4) Late should promptly bring the low urine output
prenatal care. (5) Overweight or obese but to the attention of an RN so that the adminis-
cannot determine without height to deter- tration of magnesium can be stopped and the
mine BMI. blood level, reflexes, and respiratory status can
b. Teaching includes correct withdrawal of be assessed.
ordered insulin(s) and injection. Dose, 3. Many women and their partners grieve over an
frequency, and type of insulin(s) are likely early pregnancy loss, whether the pregnancy
to vary during pregnancy. Because Amy was planned or not. Examples of therapeutic
began prenatal care past midpregnancy, approaches would be to suggest that they may
the early lowering of dose is unlikely but feel grief and loss to invite expression of their
a dose change up or down is likely with feelings, use of open-ended questions rather
pregnancy progression to maintain ma- than closed-ended ones, explaining that they

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Study Guide Answer Key Chapter 57

may feel grief for longer than expected or that Applying Knowledge
men may express grief differently from wom- Answers will vary.
en. Some nontherapeutic approaches would
be to say, I know just how you feel, using
closed-ended questions that can be answered
with a yes or no, ignoring that they feel any
grief, or saying something like, At least you
did not yet know you were pregnant, or You
can always have another baby.

Elsevier items and derived items 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.