A patient who had premature rupture of the membranes (PROM) earlier in the pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she is now in labor. The labor and birth nurse performs the following assessments. The vaginal exam is deferred until the physician is in attendance. The patient is placed on electronic fetal monitoring (EFM) and a baseline FHR of 130 bpm is noted. No contraction pattern is observed. The patient is then transferred to the antepartum unit for continued observation. Several hours later, the patient complains that she does not feel the baby move. Examination of the abdomen reveals a fundal height of 34 cm. Muscle tone is no different from earlier in the hospital admission. The patient is placed on the EFM and no fetal heart tones are observed. What does the nurse suspect is occurring?

Correct Answer: D

Rationale: The correct answer is D: Hidden placental abruption. In this scenario, the patient had a history of PROM at 28 weeks, which puts her at risk for placental abruption due to the weakened membranes. The sudden onset of decreased fetal movement and absence of fetal heart tones on EFM indicate a potential emergency. The fundal height of 34 cm suggests the baby is at term, ruling out placental previa or preterm labor. Active labor typically presents with contractions, which are not observed in this case. Placental abruption can be concealed, leading to a sudden decrease in fetal well-being. The nurse should suspect hidden placental abruption and notify the physician immediately for further evaluation and intervention.

Correct Answer: C

Rationale: The correct answer is C, indirect Coombs test of the mother. This test is crucial to determine if the mother has developed antibodies against the Rh-positive blood of twin A. If the test is positive, it indicates sensitization has occurred, making RhoGAM necessary to prevent hemolytic disease in future pregnancies. Direct Coombs tests of the twins (choices A and B) are not relevant in this scenario as they assess for antibodies already attached to the red blood cells. Transcutaneous bilirubin levels (choice D) are used to monitor jaundice, not Rh incompatibility.

Correct Answer: C

Rationale: The correct answer is C, the degree of glycemic control before and during the pregnancy. Proper management of blood sugar levels is crucial in reducing complications in pregnant patients with diabetes. Uncontrolled blood sugar levels can lead to adverse outcomes for both the mother and the baby. Monitoring and maintaining optimal glycemic control before and during pregnancy can help prevent complications such as birth defects, preterm birth, macrosomia, and neonatal hypoglycemia. Choice A, evaluation of retinopathy by an ophthalmologist, is important for diabetic patients but is not the most critical factor in reducing maternal, fetal, and neonatal complications. Choice B, the patient's stable emotional and psychological status, is important for overall well-being but does not directly impact maternal, fetal, and neonatal complications in the same way as glycemic control. Choice D, total protein excretion and creatinine clearance within normal limits, is important for assessing kidney function in diabetic patients but is not as directly related to

Correct Answer: A

Rationale: The correct answer is A because insulin needs vary during pregnancy due to hormonal changes affecting insulin sensitivity. In early pregnancy, insulin needs may decrease due to increased insulin sensitivity, but in late pregnancy, insulin needs may increase due to insulin resistance. Choice B is incorrect as insulin needs do not consistently increase throughout pregnancy and postpartum. Choice C is incorrect as insulin needs typically increase rather than decrease during pregnancy. Choice D is incorrect as the fetus does not produce its own insulin to regulate the mother's blood sugar levels.

Correct Answer: D

Rationale: The correct answer is D because the patient, having just given birth, is at a higher risk of complications from chickenpox. By staying away from her home until her children are no longer contagious, she reduces the risk of contracting the illness and potentially passing it on to her newborn. This is crucial for the safety of both the mother and the baby. Choice A is incorrect because treating the children with acyclovir does not prevent the mother from contracting chickenpox. Choice B is incorrect as immunity is not transferred from the children to the mother or newborn. Choice C is incorrect because even with gowns and masks, the risk of transmission is still present, especially for a postpartum mother and a newborn.