Name: Angelica Jane Suan Block: CCC Date: 2/22/24

Individual Activity #3: CHAPTER STUDY

QUESTIONS Answer Chapter the following Study Questions
accordingly.

Rubric for Short Answer:

5- CORRECT ANSWER and EXPLANATION/ RATIONALE, with complete details.
3- CORRECT ANSWER and EXPLANATION/ RATIONALE, but lacking details. 1-
INCORRECT ANSWER and NO EXPLANATION/ RATIONALE.

I. Bleeding During Pregnancy

Abortion
1. What are the leading causes of maternal mortality?
The leading complications related directly to pregnancy are:
● Thromboembolism - During pregnancy, there is an increased risk of blood clot
formation due to changes in blood composition and circulation.
● Hemorrhage - Bleeding during pregnancy can occur due to various reasons
such as placenta previa, placental abruption, or trauma.
● Infection - Pregnancy can weaken the immune system, making pregnant
women more susceptible to infections.
● Hypertension of pregnancy - High blood pressure during pregnancy can be a
sign of a serious condition called preeclampsia.
● Ectopic pregnancy - This occurs when the fertilized egg implants outside the
uterus, usually in the fallopian tube.

All of these have the potential to threaten both the life of the mother and the fetus.

2. What are the common causes of bleeding on the 1st Trimester? 2nd Trimester? 3rd
Trimester?
● First trimester and second trimester: Abortion and Ectopic pregnancy;
possibly chromosomal or uterine abnormalities, possibly poor placental
attachment, Implantation of zygote at site other than in uterus, associated with
tubal constrictors
● Second trimester: Hydatidiform Mole, Premature Cervical Dilatation, and
Disseminated intravascular coagulation (DIC); Abnormal proliferation of
trophoblast cells; fertilization or division defect, Cervix begins to dilate and
pregnancy is lost at about 20 weeks; unknown cause but cervical trauma from
dilatation and curettage (D&C) may be associated. Hydatidiform Mole, Premature
Cervical Dilatation and Disseminated Intravascular Coagulation (DIC)
● Third Trimester: Placena Previa, Abruptio Placenta, Preterm Labor; Low
implantation of placenta possibly because of uterine abnormality, hypertension;
placenta separates from uterus before birth of fetus, etiologic factors such as
 trauma, substance abuse, hypertension of pregnancy, or cervicitis; increased
chance in multiple gestation, maternal illness
3. What is the age of viability? What is miscarriage?
Age of viability, also called fetal viability, refers to the period of time when the
developing fetus is able to survive outside of its mother’s womb. A viable fetus is
usually defined as a fetus of more than 20 to 24 weeks of gestation or one that
weighs at least 500 grams. A fetus born before this point is considered a
miscarriage or is termed a premature or immature birth. In other words,
miscarriage, also known in medical terms as a spontaneous abortion and
pregnancy loss, is the natural death of an embryo or fetus before it is able to
survive independently or in short the termination of pregnancy before
viability.

4. What are the 5 types of abortion/ miscarriage?

(1) Elective or therapeutic: These types of abortions are performed by choice,
either because the pregnancy is unwanted, or because continuing the pregnancy
poses a threat to the health of the mother or the fetus.
(2) Spontaneous: Also known as a miscarriage, a spontaneous abortion occurs
when a pregnancy ends on its own, without any medical intervention. This can
happen for a variety of reasons, such as chromosomal abnormalities, hormonal
imbalances, or problems with the uterus or cervix.
(3) Missed: A missed abortion, also known as a missed miscarriage, occurs
when the embryo or fetus dies but is not expelled from the uterus. The woman
may not experience any symptoms, and the pregnancy may be detected only
during a routine ultrasound or prenatal exam.
(4) Habitual Abortion/Recurrent Pregnancy Loss: This type of abortion occurs
when a woman experiences three or more spontaneous abortions in a row.
Recurrent pregnancy loss can be caused by a variety of factors, including genetic
abnormalities, hormonal imbalances, and problems with the uterus or cervix.
(5) Septic abortion: A septic abortion occurs when an infection develops in the
uterus after an unsafe or incomplete abortion. This can lead to a life-threatening
condition and requires urgent medical attention. Septic abortions are most
common in developing countries, where access to safe and legal abortion is
limited.

5. How does Methotrexate works as treatment for elective abortion? This medication
works as a treatment for elective abortion by causing trophoblastic cell death.
Methotrexate is a folic acid antagonist that causes destruction and sloughing of
the implantation site, leaving the tube intact and the woman fully fertile

6. What are the different causes of spontaneous abortion?

• Fetal factors
- Genetic/chromosomal defects
• Maternal factors
- Advanced maternal age
 - Autoimmune disease
- Structural abnormalities of reproductive tract
- Infection
- Endocrine dysfunction
- Coagulation problem
• Environmental factors:
- Poor nutrition
- Exposure to tobacco, chemicals, radiation
- Use of alcohol, street drugs

7. What are the different stages/types of spontaneous abortion? Differentiate each

type.
(1) Threatened miscarriage - begin as vaginal bleeding, initially only scant and
usually bright red
- client experiences vaginal bleeding but the cervix remains closed: -
there may be some mild cramping
(2) Imminent (inevitable) miscarriage - uterine contractions and cervical
dilation occur as, with cervical dilation, the loss of the products of conception
cannot be halted.
- client experience cramping and bleeding.
- Cervix dilates and membranes may rupture
(3) Complete miscarriage - entire products of conception (fetus, membranes,
and placenta) are expelled spontaneously without any assistance. - clients
experiences bleeding, cramping, and expulsion of part of the - products of
conception.
- Tissue remains in the uterus and the cervix is dilated.
- Hemorrhage is possible
(4) Incomplete miscarriage - part of the conceptus (usually the fetus) is
expelled, but the membranes or placenta are retained in then uterus. - client
experiences bleeding, cramping, and expulsion of all the products of conception.
- The cervix is closed and the uterus contracts
(5) Missed miscarriage - also known as early pregnancy failure, the fetus dies
in the utero but is not expelled.
- client experiences decreasing signs of pregnancy as the fetus had died in utero
but has not been expelled.
- The client may be at risk for DIC if the products of conception are not removed.

8. What is missed abortion?

A missed abortion is a miscarriage where the fetus dies in utero but is not
expelled. It is usually discovered at a prenatal examination when the fundal
height is measured and no increase in size can be demonstrated or when
previously heard fetal heart sounds can no longer be heard.

9. When do you give RhoGAM?

 ● As with miscarriage, women with Rh-negative blood should receive RhIG or
RhoGAM after an ectopic pregnancy for isoimmunization protection in future
childbearing.
● Also, All women with Rh-negative blood should receive Rh (D antigen)
immunoglobulin (RhIG) to prevent the buildup of antibodies in the event the
conceptus is Rh positive often given both during and following pregnancy.

10.This is unintended termination of pregnancy at any time before the fetus has
attained viability. (20-24 wks gestational or fetal weight of <500g (1lb).
Spontaneous Miscarriage. R: Spontaneous miscarriage, also known as
pregnancy loss or miscarriage, is the natural and unintended termination of a
pregnancy before the 20th week of gestation. It is a common occurrence, with
approximately 10-20% of all recognized pregnancies ending in miscarriage.

11.What is the most common cause of spontaneous miscarriage?

Genetic/chromosomal defects R: Genetic and chromosomal defects can lead to
developmental abnormalities in the fetus that are incompatible with life, resulting
in spontaneous miscarriage. These defects are responsible for up to 60% of
miscarriages that occur in the first trimester of pregnancy.

12.Early miscarriage occurs before the 16th week. R: Miscarriage before week 16 of
pregnancy is called early miscarriage because it occurs during the first trimester
of pregnancy, which spans from conception to week 13 or 14 of gestation

13.Late miscarriage between the 16th and 24th week. R: Miscarriage that occurs
between weeks 16 and 24 of pregnancy is called late miscarriage because it
occurs during the second trimester of pregnancy. The second trimester spans
from week 14 to week 27 of gestation, and during this time, the fetus is more
developed and closer to the stage of viability (when it could survive outside the
womb with medical assistance).

14.Pregnant treated with DES for threatened abortion have female babies
with_______________ as adverse effects of the drug.
Diethylstilbestrol- the first synthetic form of estrogen
∙ DES Daughters are defined as women born between 1938 and 1971 who
were exposed to DES before birth (in the womb). Research has confirmed
that DES Daughters are at an increased risk for: Clear cell
adenocarcinoma (CCA), a rare kind of vaginal and cervical cancer.
∙ And women who took DES while pregnant face a slightly higher risk of
breast cancer”. Daughters exposed to diethylstilbestrol also have a higher
risk of infertility, vaginal adenosis, and abnormalities of the fallopian tubes,
cervix, and uterus.
∙ Associated with many reproductive problems and an increased risk of
certain cancers and pre-cancerous conditions
 ∙ Maternal diethylstilbestrol (DES) exposure or congenital uterine anomalies
may be associated with incompetent cervix

15.The earliest sign of hypovolemic shock in the heart , as complication of abortion,

is tachycardia hypertension
R: Tachycardia (fast heart rate) and hypertension (high blood pressure) are early
signs of hypovolemic shock in the heart following an abortion because the body is
trying to compensate for the loss of blood volume. The heart beats faster to
maintain blood pressure and perfusion to vital organs, while blood vessels
constrict to raise blood pressure. These compensatory mechanisms are the
body's way of trying to maintain adequate oxygen delivery to tissues, but if left
untreated, hypovolemic shock can progress and lead to organ failure and even
death. Therefore, recognizing and treating these early signs of shock is crucial in
preventing severe complications in patients who have undergone abortions.

Ectopic Pregnancy
16.The most common type of ectopic pregnancy is tubal pregnancy R: Tubal
pregnancy is the most common type of ectopic pregnancy because the fallopian
tube provides a suitable environment for fertilization and early embryo
development. However, if the fertilized egg fails to travel down to the uterus and
becomes implanted within the tube, it can cause an ectopic pregnancy

17.The confirmatory test for a ruptured ectopic pregnancy is Culdocentesis. R: In

cases of a ruptured ectopic pregnancy, blood and fluid may accumulate in the
cul-de-sac, which can be detected through culdocentesis.

18.The drug of choice if the patient desire for future fertility and the ectopic
pregnancy is not ruptured is Conservative therapy-methotrexate IM.
R: The drug works by inhibiting the growth of rapidly dividing cells, including those
in the developing embryo. Methotrexate is typically given as a single injection and
can often eliminate the ectopic pregnancy without the need for surgery. This can
help preserve the patient's fertility by avoiding the need for surgical removal of the
affected fallopian tube.

19.The surgery of choice to preserve future fertility is Salpingostomy. R: While

removing a fallopian tube may seem like it could negatively impact fertility, in
many cases, it can actually improve the chances of future pregnancy. This is
because an ectopic pregnancy in one tube increases the risk of future ectopic
pregnancies and can also cause scarring or blockages in the remaining tube

20.Administer RhoGAM if woman is RH

R: This medication contains antibodies that target and destroy Rh-positive cells in
the bloodstream, preventing the mother's immune system from developing an
immune response to the baby's blood cells.
21.Select all that apply. Predisposing factors are: (5 points)
a. Pelvic/tubal hx or sx
R: Ectopic tubal pregnancy may occur in a blocked tube with contralateral tubal
patency, although this association was found to be weaker for those with two
blocked tubes.
b. History of previous ectopic pregnancy
R: Same as having a previous ectopic pregnancy increases the risk for further
ectopic pregnancies, having an intrauterine pregnancy decreases this risk.

c. Tumors that distort the fallopian tube

R: They can cause physical blockages or abnormalities in the fallopian tube,
which can impede the normal movement of the fertilized egg towards the uterus.
This can result in the egg implanting and developing outside of the uterus,
leading to an ectopic pregnancy.

d. Women with IUD

R: It is thought that IUD-induced inflammation may result in deciliation of the
endosalpinx and then delays ovum transport, altough, the exact mechanism is not
fully understood

e. Altered tubal motility

R: Abnormalities in the movement of the fallopian tubes, such as decreased or
increased motility, can impair the ability of the fertilized egg to travel through the
tube and implant in the uterus. This can increase the risk of the fertilized egg
implanting and developing outside of the uterus, resulting in an ectopic
pregnancy.

22.What does a positive Cullen’s sign indicate?

Cullen's sign is a term used in medicine to describe bruising or a bluish
discoloration of the umbilicus (belly button) which indicates internal hemorrhage.
A positive Cullen's sign in the setting of an ectopic pregnancy may mean that
there is bleeding into the abdominal cavity as a result of an ectopic pregnancy
that has burst. Internal bleeding brought on by the rupture of an ectopic
pregnancy may result in blood clots and bruises in the abdominal area. Then,
when the blood clots move toward the umbilicus, the area around the belly button
may become discolored or bruised.

23.What are the usual laboratory test results of a woman with ectopic pregnancy? (1)
Beta-hCG (human chorionic gonadotropin) levels: Beta-hCG is a hormone
produced during pregnancy and levels of this hormone are typically lower in
ectopic pregnancies than in normal pregnancies. Additionally, beta-hCG levels
may not rise as quickly as expected in ectopic pregnancies.
(2) Culdocentesis - In cases of suspected ectopic pregnancy, culdocentesis can
detect the presence of blood or fluid in the pouch of Douglas, which is the space
 behind the uterus and in front of the rectum. Blood or fluid in this space can be a
sign of a ruptured ectopic pregnancy or other pelvic pathology.
(3) Laparotomy- indication for surgery if there any question about the diagnosis
(4) Laparoscopy- visualization of tubal pregnancy
(5) Ultrasound - A frequent diagnostic method for determining whether an
ectopic pregnancy is present is ultrasound. It can determine the size and location
of the pregnancy as well as the fetus' gestational age. The absence of a
gestational
sac in the uterus, a gestational sac in the fallopian tube or another inappropriate
site, the absence of a fetal pole, an irregular form of the gestational sac, fluid in
the pelvis, and increased blood flow surrounding the gestational sac are some
common symptoms in ectopic pregnancy.

24.What is the priority nursing diagnosis for a client with an ectopic pregnancy?
● Risk for fluid volume deficit r/t blood loss from ruptured tube
● Pain r/t ectopic pregnancy or rupture bleeding into the peritoneal cavity ●
Anticipatory grieving r/t loss of pregnancy and potential loss of childbearing
capacity
● Powerlessness related to early loss of pregnancy secondary to ectopic
pregnancy

25.How is Ectopic pregnancy diagnosed using culdocentesis?

Culdocentesis is a procedure in which a needle is inserted into the space behind
the vagina and in front of the rectum to check for the presence of blood or fluid.
This test may be done if other tests are inconclusive or if there is a high suspicion
of a ruptured ectopic pregnancy

H-MOLE
26.This type of mole has no embryo is present but fetal blood maybe present, has
69 chromosomes (triploid formation) Partial mole.
R: A partial mole, some villi form normally. It is a triploid formation in which there
are three chromosomes instead of two for every pair of chromosomes to be
fertilized. A set of chromosomes (23 chromosomes) supplied by an ovum was
fertilized by two sperm sperm (23+23 chromosomes) or an ovum fertilized by one
sperm in which meiosis or reduction did not occur.

27.This type of mole has a normal number of chromosomes, all trophoblastic villi
swell and become cystic. If an embryo forms, it does early 2 1-2 mm in size with
no fetal blood present in the villi. Complete mole. R: A complete mole has a
normal 46XX or 46 XY karyotype, this chromosome component was contributed
only by the father or an “empty ovum”, the chromosome material was duplicated
and fertilized.

28.This type of mole has higher incidence of malignancy. Complete mole. R: Partial
 moles rarely lead to choriocarcinoma since hCG titers are lower in partial than in
complete moles; titers also return to normal faster after gestational trophoblast
evacuation.

29.Symptoms of pregnancy occur before 20 weeks gestation.

R: In h-mole pregnancy, the uterus tends to expand faster than usual or the
uterus reaches its landmarks before the usual time, especially 12 weeks.These
symptoms may also include missed periods, vaginal bleeding or spotting,
nausea, vomiting, and breast tenderness.

30.The client with Hmole is instructed not to get pregnant for 1-2 year/s
R: Hmole is associated with a higher risk of developing gestational trophoblastic
neoplasia, a type of cancer that can develop from the abnormal placental tissue.
The monitoring of hCG levels will help ensure that everything goes back to normal
and in stability.

31.What contraceptive method is contradicted for this client? IUD R: An intrauterine

device (IUD) is contraindicated for a client with a hydatidiform mole (H-mole)
because an H-mole is a type of gestational trophoblastic disease that involves
the abnormal growth of placental tissue. The use of an IUD in this condition can
increase the risk of complications such as bleeding and infection, and may also
interfere with the diagnosis and treatment of the H-mole. Additionally, the
presence of an IUD in the uterus can cause trauma to the gestational
trophoblastic tissue, which can result in further growth of abnormal tissue and
delay the diagnosis and treatment of the H-mole.

32.Select all that apply: Predisposing factors are: (5 points)

a. >17 y.o below and 35 y.o above
b. Low socioeconomic status
c. High protein intake
d. Fertility pills to induce ovulation
e. Previous mole
R: Women who are younger than 17 years old and older than 35 years old have
higher risk of developing Hmole as they either did not develop their eggs
sufficiently or has experienced Hmole pregnancy. With low socioeconomic status,
women will not be able to get the nutrients needed to have a healthy pregnancy
and risk not getting enough protein. Thus, The risk of recurrence is approximately
1-2% for women who have had one molar pregnancy, but can increase to 15-20%
for women who have had two or more molar pregnancies. Moreover, fertility pills
can stimulate abnormal growth of placental tissue.

33.Chemotherapy (Methotrexate) and or hysterectomy is considered if B-hCG

levels rise or begin to plateau or there is evidenced of metastasis (as
management)
R: Chemotherapy, such as Methotrexate, or hysterectomy may be considered as
 management options in cases of gestational trophoblastic disease (GTD) if B
hCG levels rise or begin to plateau, or there is evidence of metastasis. These
treatments are necessary to control the cancer and prevent further complications
in GTD, which is a rare group of tumors that develop from abnormal growth of
placental cells.

34.hCG levels is measured every 2 to 3 weeks until normal- then monthly testing for
6 months, then every 2 months for a total of 1 year.
R: Regular monitoring of hCG levels every 2 to 3 weeks until normal, followed by
monthly testing for 6 months and then every 2 months for a total of one year, is
recommended to ensure complete resolution of the disease and to detect any
potential recurrence.
Premature Cervical Dilatation
35.Select all that apply. Predisposing factors are: (3 points)
a. Increased age
b. Congenital maldevelopment of cervix- short cervix
c. Repeated D&C
R: The cause of premature cervical dilation is often difficult to explain. The
predisposing factors stated above are just the common factors that women that
experience PCD share. Although commonly it may be diagnosed by an early
ultrasound before symptoms occur, it is usually diagnosed only after the
pregnancy is lost.

36.Cervical cerclage is done at 12 to 14 weeks gestational under regional

anesthesia. R: Prior to giving cervical cerclage, assessment through ultrasound
confirmation that the fetus of a second pregnancy at approximately 12 to 14
weeks, which suits the requirement for placing purse-string sutures in the cervix

37.Cervical cerclage is removed 37 to 38 wks AOG before of labor. R: This ensures

that the fetus is developed in full term and can be born vaginally. However, when
a transabdominal approach is used, the sutures must be left in place and a CS
birth is performed.

38.After surgery, place patient in a slight or modified Trendelenburg position to

prevent pressure on suture area of cervix. R: The position helps to decrease
pressure on the new sutures. Hence, the ADLs and sexual relations can be
continued after the rest period.

39.McDonald’s suture is a temporary cerclage and client delivers through NVSD. R:

The nylon sutures are placed horizontally and vertically across the cervix and pulled
tight to reduce the cervical canal to a few millimeters in diameter, hold it closed and
provide additional support to prevent the cervix from opening too early.

40. Shirodkar suture is a permanent cerclage and the client delivers through CS. R:
The sterile tape is threaded in a purse string manner under the submucosal layer
 of the cervix and sutured in place to achieve a closed cervix which is suitable for
CS delivery.

41.Following placement of cerclage monitor for uterine contractions, bleeding, and

rupture of bag of water R: The monitoring of bleeding, uterine contractions, and
rupture of the bag of waters following placement of a cerclage helps to identify
any potential complications early and initiate prompt interventions to prevent
preterm labor, miscarriage, or infection.
Placenta Previa
42.Type of placenta wherein implantation totally the cervical os. Total Placental
Previa R: In a total placenta previa, the placenta attaches to the lower part of the
uterus and completely covers the cervix, which can lead to potentially life
threatening bleeding during labor and delivery

43.Type of placenta previa wherein implantation partially obstructs the cervical os.
Partial Placenta Previa R: In a partial placenta previa, the placenta attaches to
the lower part of the uterus and partially covers the cervix, which can lead to
bleeding during labor and delivery

44.Type of placenta wherein the placenta edge approaches the cervical os. Marginal
Placenta Previa R: In a marginal placenta previa, the placenta is located near
the edge of the cervix, which can lead to bleeding during labor and delivery.

45.Type of placenta wherein the implantation is in the lower part of uterus rather than
upper. Low Placenta Lying R: In a low-lying placenta, the placenta is located
near the cervix and can cause bleeding during pregnancy

46.Cardinal sign of placenta previa is painless, abrupt, bright red vaginal bleeding
which usually appears near the end of the second trimester or later.

47.The painless bleeding in placenta previa is caused by the bleeding (painless) in

the intervillous spaces in the placenta. R: The placenta that is unable to
stretch to accommodate the differing shape of the lower uterine segment or the
cervix, a small portion loosens and damaged blood vessels begin to bleed .

48.CS is often indicated if the degree of previa is >30% or if there is excessive

bleeding. R: If the degree of placenta previa is greater than 30%, there is an
increased risk of severe bleeding during vaginal delivery, which can be life
threatening for both the mother and the baby.

49.Select all that apply. Predisposing factors are: (7 points)

a. Multiparity
b. Advanced maternal age
c. Multiple pregnancy
d. Uterine tumor
 e. Cigarette smoking (vasoconstriction)
f. Scarring from previous CS
g. Decrease vascularity of upper uterine segment

R: These factors are considered predisposing factors for placenta previa because
they can lead to abnormalities in the placental implantation and growth, which
increases the likelihood of the placenta attaching to the lower uterine segment
and partially or completely covering the cervical os. Multiparity and advanced
maternal age can lead to changes in the uterine environment that can affect
placental implantation. Multiple pregnancy can increase the risk of abnormal
placental implantation due to competition for space and resources. Uterine
tumors and scarring from previous cesarean sections can also disrupt the normal
placental
implantation process. Cigarette smoking can cause vasoconstriction and
decrease blood flow to the placenta, which can lead to abnormal implantation.
Finally, a decrease in vascularity of the upper uterine segment can lead to
inadequate blood flow to the upper portion of the uterus, forcing the placenta to
implant in the lower uterine segment.

50.In placenta previa nursing care, the nurse knows that IE, pelvic exam or
internal monitor and rectal procedures are contradicted. R: These procedures
can cause trauma or damage to the placenta, which can result in significant
bleeding and potentially harm the mother and the baby.

51.Patient is positioned in a sitting position to allow the weight of fetus to compress

the placenta and decrease bleeding.

Abruptio Placenta
52.Select all that apply. Predisposing factors are:
a. Maternal HPN (PIH)
b. Advanced maternal age
c. Grand multiparity
d. Trauma to uterus
e. Short umbilical cord
f. Cigarette smoking, alcohol and cocaine abuse or amphetamine abuse

R: a. Maternal HPN (PIH): Women with hypertension during pregnancy,

especially those with severe or uncontrolled hypertension, are at increased
risk for abruption placenta due to the damage to blood vessels in the uterus.
b. Advanced maternal age: Women who are older than 35 years are at
increased risk for abruption placenta because of age-related changes in the
placenta and blood vessels.
c. Grand multiparity: Women who have had five or more pregnancies are at
increased risk for abruption placenta due to the strain on the uterus and
changes in the blood vessels.
 d. Trauma to uterus: Any trauma to the uterus, such as a car accident or a
fall, can cause abruption placenta due to the damage to blood vessels. e.
Short umbilical cord: A short umbilical cord can increase the risk of
abruption placenta because it can cause tension on the placenta and lead to
detachment.
f. Cigarette smoking, alcohol, and cocaine or amphetamine abuse: These
substances can damage the blood vessels in the uterus, leading to an
increased risk of abruption placenta.

53.The patient is positioned in left lateral position, with head elevated to enhance
placental perfusion. R: This position helps to improve blood flow and oxygenation
to the fetus and placenta, which can reduce the risk of complications such as fetal
distress, intrauterine growth restriction, and placental insufficiency
54.Check all that apply. The following are signs of hypovolemic shock, complication
os abruption placenta, EXCEPT: (7 points)
a. Increased BP
b. Increased HR
c. Decreased RR
d. Decreased urine output
e. Pallor
f. Decreased LOC
g. Restlessness
R: Decreased RR - In hypovolemic shock, the body tries to compensate for the
decreased blood volume by increasing the heart rate and respiratory rate.
Therefore, a decreased respiratory rate is not a typical sign of hypovolemic shock
during abruptio placenta.

Preterm Labor
55.A nurse know that if a pregnant woman is treated with indomethacin for preterm
labor the possibility of fetal renal impairment or kidney dysfunction and
constriction of the ductus arteriosus may exist.

R: Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits the

production of prostaglandins, which are hormones that play a role in regulating
blood flow to the kidneys and maintaining normal renal function. When
indomethacin is administered to a pregnant woman to treat preterm labor, the
drug can cross the placenta and reach the fetal circulation, where it can interfere
with the normal development and function of the fetal kidneys. It promotes
closure of the PDA and generally has an onset of action within minutes. Thus,
inhibition of prostaglandin synthesis by indomethacin results in constriction of the
ductus arteriosus.

56.To enhance fetal lung maturity, what drug is administered? Betamethasone and
Dexamethasone
 R: A corticosteroid, specially betamethasone or dexamethasone , is administered
to hasten fetal lung maturity. These drugs are synthetic versions of the hormones
produced by the fetal adrenal glands, and they work by accelerating the
production of surfactant, a substance that helps keep the air sacs in the lungs
open and prevents them from collapsing

57. All but one are predisposing factors of PTL. (4 points)

a. Strenuous activities
b. Long cervix
c. African-American
d. Early adolescents
R: Long cervix is a predisposing factor of preterm labor (PTL), while strenuous
activities, African-American ethnicity, and early adolescents are risk factors but
not necessarily predisposing factors. A long cervix, which is a cervix that
measures less than 2.5 cm in length during pregnancy, is a predisposing factor of
preterm
labor because it is associated with an increased risk of premature cervical dilation
and labor.

58.Magnesium Sulfate, Diazepam, Diuretic, Hydralazine (Apresoline) are the

drug of choice of PIH.
R: Magnesium sulfate is used in cases of preeclampsia to prevent seizures and
reduce the risk of maternal and fetal complications, while hydralazine, diazepam,
and diuretics are used to manage high blood pressure and associated symptoms
in women with preeclampsia or gestational hypertension

59.Indomethacin is a tocolytic administered for PTL. The nurse knows that the
administration of this drug cause premature closure of this fetal accessory
structure which is the ductus arteriosus
R: Indomethacin or ibuprofen may be used to cause closure of a patent ductus
arteriosus, making ventilation more efficient. It promotes closure of the PDA and
generally has an onset of action within minutes. Thus, inhibition of prostaglandin
synthesis by indomethacin results in constriction of the ductus arteriosus.

Premature Rupture Of Membranes

60. Premature rupture of membranes refers to amniotic membrane rupture before
labor begins; labor will usually begin spontaneously within 24H of membrane
rupture.
R: PROM is defined as the rupture of the amniotic sac before the onset of labor,
and it can occur at any gestational age. PROM can be spontaneous or induced,
and it is typically diagnosed by performing a sterile speculum examination and
testing the vaginal fluid for the presence of amniotic fluid.

61. Preterm premature rupture of membranes refers to rupture prior to term

 gestational of before 38 wks; risk factors; infection, incompetent, cervix and
trauma.
R: Preterm premature rupture of membranes (PPROM) refers to the rupture of
the amniotic sac before the 37th week of gestation, which is considered
premature.

62. Prolonged rupture of membranes (PROM) refers to membranes ruptured

more than 12H before birth; many caregivers will induce labor rather than risk
prolonged rupture with possible ascending infection.
R: Inducing labor in cases of prolonged rupture of membranes can reduce the
risk of infection, fetal distress, and preterm delivery, while providing patients with
greater control over the timing of delivery and reducing anxiety.

63. Amniotic fluid turns nitrazine paper blue (yellow to blue) indicating an alkaline
pH.
R: The amniotic fluid is typically alkaline, with a pH range of 7.0 to 7.5.
64.Amniotic fluid shows characteristics fern like pattern on microscopic
examination of a slide with dried fluid on it; which uterine and vaginal secretions
do not.
R: The ferning pattern is created by the presence of salt crystals in the amniotic
fluid, which form a distinctive branching or fern-like pattern when the fluid dries
on a slide.

65.The unengaged fetus is at risk for a prolapsed umbilical cord when the
membranes rupture.
R: This is because when the membranes rupture, there is a sudden release of
amniotic fluid which can cause the umbilical cord to slip down into the birth canal
in front of the baby's head. If this happens, the pressure of the baby's head on
the cord can compress it and reduce or cut off the flow of oxygen and nutrients to
the baby.

66.Priority nursing intervention in PROM is to assess FHR. This is to rule out

prolapsed cord, note time, color, and amount of fluid.
R: Monitoring the FHR is a priority nursing intervention in PROM because it
allows for the detection of potential complications, assessment of fetal well-being,
and determination of the appropriate timing of delivery to minimize the risk of
harm to the fetus.

67.In PROM, evaluate client’s temperature every 2 hours other vital signs may be
routine.
R: Frequent monitoring of temperature is important because an elevated
temperature (fever) is often the first sign of infection. In cases of PROM, there is
a risk of ascending infection, which occurs when bacteria from the vagina or
cervix ascend into the uterus and amniotic fluid, leading to infection. Frequent
monitoring of temperature every 2 hours can help to identify any increases in
 temperature that may indicate the onset of infection.
PIH
__________1. Which increases risk of preeclampsia?

∙ Pre-existing hypertension: Women who have high blood pressure before

becoming pregnant are at a higher risk of developing preeclampsia. ∙ Kidney
disease: Women with pre-existing kidney disease are at a higher risk of
developing preeclampsia, as their kidneys may not be functioning properly,
which can lead to high blood pressure.
∙ Previous pregnancy-induced hypertension (PIH): Women who have had
PIH in a previous pregnancy are at a higher risk of developing
preeclampsia in subsequent pregnancies.
∙ Age <20 or >40: Women who are younger than 20 or older than 40 are at a
higher risk of developing preeclampsia
∙ Multiple fetuses: Women carrying more than one fetus, such as twins or
triplets, are at a higher risk of developing preeclampsia due to the
increased demands on the mother's body.
∙ Diabetes: Women with pre-existing diabetes are at a higher risk of
developing preeclampsia, as diabetes can damage blood vessels and
affect the functioning of the kidneys.

Hydrocephalus 2. Preeclampsia cannot lead to which of the following:

(hydrocephalus, abruption placenta, IUGR, poor placental perfusion)

R:Placental dysfunction, intrauterine growth restriction (IUGR), and placental

abruption are complications that occur because preeclampsia affects the blood
vessels in the placenta, which can lead to poor placental perfusion and reduced
blood flow to the baby. Hydrocephalus is not caused by preeclampsia and is not
directly related to the condition

High protein diet 3. Diet for mild preeclampsia

R: Eating a diet high in protein can help increase blood flow and support the
growth of the placenta. In addition, a high protein diet can also help reduce blood
pressure. This is because protein can help dilate blood vessels and improve the
flexibility of the arteries, which can reduce the resistance to blood flow and lower
blood pressure.

Iron deficiency 4. Which is not associated condition with preeclampsia:

(multifetal pregnancy, diabetes mellitus, age older than 35 years, iron
deficiency)
R: Several factors can increase the risk of developing preeclampsia, including
multifetal pregnancy, diabetes mellitus, and advanced maternal age (older than
35 years). Iron deficiency, on the other hand, is a common condition during
pregnancy but has not been identified as a risk factor for preeclampsia.

Blurred vision 5. The client should contact the healthcare provider immediately
if she experiences which: (blurred vision, ankle edema, increase energy levels,
mild backache)

R: Blurred vision is one of the common symptoms of severe preeclampsia and

can indicate that the condition is worsening. Ankle edema and mild backache are
common symptoms during pregnancy and may not necessarily indicate a
problem, but should still be reported to the healthcare provider. Increase in
energy levels is also not typically associated with preeclampsia.

Padding for the side rails 6. When preparing for the admission of a client with
severe preeclampsia, the nurse must prepare for which: (oxytocin infusion
solution, disposable tongue blades, portable ultrasound machine, padding for the
side rails)

R: Padding for side rails is an important safety measure to protect patients with
severe preeclampsia from injury during seizures or falls.

Anticonvulsant, reduces bp, and act as a muscle relaxant 7. When

administering MgSO4 for severe preeclampsia, the drug acts as a
what?

R: MgSO4 works by blocking the action of calcium in the nervous system, which
helps to prevent seizures in women with severe preeclampsia or eclampsia.
Magnesium is a natural calcium antagonist and leads to relaxation and dilation of
blood vessels, which can help lower blood pressureIn addition, MgSO4 can also
act as a muscle relaxant, which can help to prevent and reduce the severity of
seizures.

Respiratory rate of 12 bpm 8. While giving MgSO4 to a client, which of the

signs must a nurse report: (RR 12 bpm, patellar reflex 2+, BP 160/88 mm Hg,
urinary output exceeding intake)

R: One of the signs of magnesium toxicity is a decrease in respiratory rate, which

can progress to respiratory arrest if not promptly identified and treated. Patellar
reflex 2+, BP 160/88 mm Hg, and urinary output exceeding intake are not
necessarily concerning signs during MgSO4 administration and do not typically
indicate magnesium toxicity.
Uterine contractions 9. Shortly after a client had eclamptic seizures, the nurse
should assess the client for which: (polyuria, facial flushing, hypotension, uterine
contractions)

R: After a client has eclamptic seizures, it is important for the nurse to assess the
client for uterine contractions because seizures can cause changes in the uterine
muscle tone.
preeclampsia Mild preeclampsia Severe preeclampsia

BP 140/90, SBP 130 mmHg 10. 160/110 mmHg

& DBP Rationale: Elevated
of 15mmHg blood pressure in
severe
preeclampsia is caused
by vasoconstriction, or
narrowing of the
blood vessels, which
reduces blood flow
and oxygen supply
to the
organs.

Proteinuria +1 to +2; 300 mg in 24 11. +3 to +4; 5 g/24H

H UO UO Rationale:
Proteinuria
levels are higher and are
often accompanied by
other signs of organ
damage, such as
elevated liver enzymes or
low platelet counts

Edema Digital edema (+1 to Pitting (+3 to 4);

2) Dependent facial; anasarca
edema
Weight gain 2 lb/wk 2nd tri; 1 lb/wk 3rd tri More than 12.2 lb/week
on 3rd tri
Rationale: A weight gain
of more than 2 pounds
per week in the third
trimester of pregnancy
in severe preeclampsia
may indicate the
development of fluid
retention, which is a
common symptom of
the condition

Urine output 13.Not < than 500 <500 mL/24H

ml/24H Rationale: In
mild
preeclampsia, the
kidney function is
usually not
significantly affected, and
urine output remains
within normal limits.

Headache 17.Mild or Severe

Occasional
headache
Rationale: Mild headache
is a common symptom in
mild preeclampsia and is
typically not a cause
for concern.

Reflexes 14. +1 or +2 or Hypereflexia (3+ to 4+)

Normal Rationale: In
mild
preeclampsia, reflexes
of +1 to +2 are
typically
considered normal and
not a cause for concern.
Visual disturbance 15.None Photophobia,
Rationale: In mild cases blurring
of preeclampsia, blood
pressure may not be as
high, and the other
organs

may not be affected yet.

As a result, visual
disturbances may not
occur.

Epigastric pain Absent 16.Right upper

quadrant pain due to
hepatic
capsule
Rationale: Abnormal
function of the blood
vessels in the placenta
can cause constriction
and
reduced blood flow to
the liver, leading to
liver
ischemia and injury.
This can manifest as
severe epigastric pain,
nausea, and vomiting.

17-18. The warning signs of preeclampsia are hypertension and

proteinuria, indicating impending seizure (eclampsia).

R: Elevated blood pressure can reduce blood flow to the brain, which can
lead to neurological symptoms such as headaches, visual changes, and
seizures. Proteinuria is a sign of kidney damage and can indicate that the
woman's kidneys are not functioning properly, which can lead to the
accumulation of toxic waste products in the body. These waste products can
affect the brain and other organs, increasing the risk of seizures and other
complications.

19. Select all that apply. Predisposing factors to preeclampsia are: (8

 points)
◻ Primiparas <20 & <40
◻ Low socioeconomic status
◻ Multiparity
◻ Women in color- Black
◻ Multiple gestation
◻ Women in hydramnios
◻ Women with underlying disease like DM
◻ Renal and cardiac disease

R: ● Low socioeconomic status: Women with low socioeconomic status are

more likely to have poor nutrition and limited access to healthcare, which can
increase the risk of preeclampsia. They may also have higher levels of stress,
which can contribute to hypertension and other risk factors for preeclampsia.
● Women of color, especially Black women: Black women have a higher risk
of preeclampsia than women of other racial and ethnic groups, possibly due to
genetic, environmental, and socioeconomic factors.

● Multiple gestation: Women carrying more than one fetus are at higher risk of
developing preeclampsia, as the increased demand on the placenta can lead to
reduced blood flow and other complications.

● Women with hydramnios: Excessive amniotic fluid (hydramnios) can increase

the risk of preeclampsia, possibly due to increased pressure on blood vessels
and reduced blood flow to the placenta.

● Women with underlying medical conditions like DM, renal and cardiac
disease: Women with pre-existing medical conditions such as diabetes, renal
disease, or cardiac disease are at increased risk of developing preeclampsia due
to the impact of these conditions on the cardiovascular system and blood flow to
the placenta

20. The triad symptoms of PIH are: hypertension, proteinuria, edema R:●
Hypertension: High blood pressure is a hallmark symptom of PIH. This means
that the systolic blood pressure is equal to or greater than 140 mmHg, and the
diastolic blood pressure is equal to or greater than 90 mmHg, measured on at
least two occasions, six hours apart.
● Proteinuria: Excess protein in the urine is another common symptom of PIH.
This occurs when the kidneys become damaged due to high blood pressure,
causing them to leak protein into the urine.
● Edema: Swelling of the feet, ankles, and hands can occur in women with PIH
due to the buildup of excess fluid in the tissues.
 21. Of the three classic symptoms of PIH, the two may be absent except
hypertension
R: Although proteinuria and edema are commonly associated with PIH, they may
not always be present. In some cases, a woman with PIH may have hypertension
as the only symptom. It is important to note, however, that the absence of
proteinuria or edema does not rule out the diagnosis of PIH, and careful
monitoring of blood pressure is still necessary

22. What is the number one vital sign to be monitored when client is given
Apresoline for preeclampsia? Blood pressure
R: Apresoline (hydralazine) is an antihypertensive medication commonly used to
treat high blood pressure associated with preeclampsia. It works by relaxing the
blood vessels, which leads to a decrease in blood pressure. However, it is
important to monitor blood pressure closely when Apresoline is administered, as it
can cause a rapid drop in blood pressure, especially if given too quickly or in high
doses.
23.The antidote for MgSO4 toxicity which must be kept ready at bedside is
Calcium gluconate
R: Calcium gluconate is the antidote for MgSO4 toxicity, and it works by
antagonizing the effects of magnesium on the neuromuscular system and heart. It
is important to have calcium gluconate readily available at the bedside when
administering MgSO4 to women with preeclampsia, as prompt treatment can
prevent or minimize the severity of magnesium toxicity

24. The dangers of convulsion is present the how many hours postpartum?
48 hours postpartum
R: The risk of seizures is highest in the first 24 hours postpartum, but it can
persist for up to 48 hours. Women with a history of preeclampsia are at higher
risk of developing postpartum eclampsia, and careful monitoring for signs of
seizures is important during this time.

25. At least 18-24 months should elapse for the next pregnancy to
decrease likelihood of PIH recurrence.
R: This waiting period allows the woman's body to recover from the physical and
hormonal changes of the previous pregnancy and childbirth, and to replenish
nutrient stores. Additionally, waiting for 18-24 months between pregnancies can
help reduce the risk of preterm birth, low birth weight, and other adverse
outcomes in the subsequent pregnancy

26. The only cure for preeclampsia is Delivery of a baby or a placenta of

a baby.
R: The only definitive cure for preeclampsia is delivery of the baby and placenta.
This is because the placenta is the source of the problem, and delivery of the
 placenta removes the cause of the disorder. After delivery, the mother's blood
pressure usually returns to normal, and the symptoms of preeclampsia typically
resolve within a few days to a few weeks.

27-28. S/sx of MgSO$ toxicity are Decreased or absent deep tendon

reflexes (hyporeflexia or areflexia) and respiratory depression. R: Decreased
or absent deep tendon reflexes (hyporeflexia or areflexia) are a hallmark sign of
MgSO4 toxicity and may be detected during routine monitoring of the patient.
Respiratory depression, which can manifest as a decreased respiratory rate,
shallow breathing, or difficulty breathing, can occur as a result of the medication's
effects on the central nervous system.

29. Symptoms of PIH rarely occur 20 wks AOG

R: PIH typically develops after 20 weeks of pregnancy and is characterized by
high blood pressure and proteinuria (excessive protein in the urine) in a
previously normotensive woman. It can progress to a more severe form called
preeclampsia, which may also involve other organ systems and can be life-
threatening for both the mother and the baby.
30. What is the most common complication of eclampsia? HELLP
syndrome
R: Women with eclampsia are at an increased risk of developing HELLP
syndrome because both conditions are related to the abnormal functioning of the
placenta. In eclampsia, the high blood pressure and other changes associated
with preeclampsia can lead to damage to the blood vessels in the placenta. This
damage can cause the release of substances into the mother's bloodstream that
can lead to the development of HELLP syndrome.

OPEN-ENDED QUESTIONS:
68.What if Lynn were to tell you she’s glad her pregnancy is ending early because
the baby probably wasn’t going to be perfect? How would you respond to her?

ANS: As a nurse, I would respond to Lynn with empathy and support while also
addressing her concerns and misconceptions. I would first acknowledge that
pregnancy can be a challenging and emotional experience, and that it's
understandable to have fears and worries about the health of the baby. However,
I would also gently challenge the idea that the baby may not be "perfect", as this
can be a stigmatizing and harmful view that perpetuates ableism and negative
attitudes towards disability.

I would emphasize that all babies are unique and have their own strengths and
challenges, and that having a disability or special need does not diminish their
value or potential. I would also reassure Lynn that our healthcare team is
committed to providing the best possible care for both her and her baby, and that
we will work together to address any concerns or issues that may arise.
 Additionally, I would offer Lynn resources and support services, such as
counseling or support groups, that can help her process her feelings and connect
with other parents who may be facing similar situations. Overall, my goal would
be to provide Lynn with compassionate, nonjudgmental care that respects her
dignity and autonomy while also promoting the well-being of both her and her
baby.

69.What if Lynn asks you if her prepregnancy exercise routine could have caused
the placenta to implant so low? How would you answer her?

ANS: As a nurse, I would explain to Lynn that her prepregnancy exercise routine
is unlikely to have caused the placenta to implant low. Placenta previa is thought
to be caused by a combination of genetic, environmental, and obstetric factors.

While there are some risk factors that may increase the likelihood of placenta
previa, such as multiple pregnancies, advanced maternal age, and a history of
cesarean delivery or other uterine surgeries, there is no clear evidence to
suggest that exercise plays a role in placenta previa. In fact, exercise is generally
recommended during pregnancy as a way to promote maternal and fetal health,
reduce the risk of gestational diabetes and hypertension, and prepare the body
for labor and delivery. However, it's important to follow safe exercise guidelines
and avoid activities that may be too strenuous or pose a risk of falls or other
injuries.

I would reassure Lynn that she should not blame herself for the placenta previa
and that our healthcare team is committed to providing the best possible care for
both her and her baby. I would encourage her to continue to prioritize her health
and well-being through safe exercise and other healthy habits, and to ask any
questions or share any concerns that she may have throughout her pregnancy.