ATI RN
Antenatal complications Questions
Question 1 of 5
Which maternal condition always necessitates delivery by cesarean birth?
Correct Answer: B
Rationale: The correct answer is B: Total placenta previa. In total placenta previa, the placenta completely covers the opening of the cervix, posing a risk of severe bleeding during vaginal delivery. Cesarean birth is necessary to prevent maternal hemorrhage and ensure a safe delivery. Partial abruptio placentae (A) may require cesarean birth if there is significant bleeding or fetal distress, but it's not an absolute indication for cesarean section. Ectopic pregnancy (C) and eclampsia (D) do not always necessitate cesarean birth unless there are other obstetric indications.
Question 2 of 5
In which situation would a dilation and curettage (D&C) be indicated?
Correct Answer: D
Rationale: A dilation and curettage (D&C) is indicated for an incomplete abortion at 10 weeks because it involves dilating the cervix and removing remaining products of conception from the uterus to prevent infection or excessive bleeding. Incomplete abortion at 16 weeks (Choice B) would be too advanced for a D&C and may require a different procedure. A complete abortion at 8 weeks (Choice A) does not require a D&C as all products of conception have already been expelled. Threatened abortion at 6 weeks (Choice C) indicates a possible miscarriage, but a D&C is not necessary unless the miscarriage is confirmed and incomplete.
Question 3 of 5
Which laboratory finding is indicative of DIC?
Correct Answer: A
Rationale: The correct answer is A: Decreased fibrinogen. In DIC, there is widespread activation of the coagulation cascade, leading to consumption of clotting factors like fibrinogen. This results in decreased levels of fibrinogen in the blood. Increased platelets (B) are seen in early stages, but they decrease as consumption continues. Increased hematocrit (C) is a nonspecific finding. Decreased thromboplastin time (D) is not indicative of DIC, as it would typically be prolonged due to consumption of clotting factors.
Question 4 of 5
A patient who was pregnant had a spontaneous abortion at approximately 4 weeks' gestation. At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the patient presents at the clinic office complaining of “crampy†abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100°F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/minute (bpm), and respirations, 20 breaths per minute. Based on this assessment data, what does the nurse anticipate as a clinical diagnosis?
Correct Answer: B
Rationale: The correct answer is B: Uterine infection. The patient's presentation with crampy abdominal pain, scant serosanguineous vaginal drainage, negative pregnancy test, and vital signs indicating fever, hypotension, and tachycardia are indicative of a uterine infection, most likely post-miscarriage. The timing of symptoms 2 weeks after miscarriage aligns with the typical onset of infection. The absence of products of conception being expelled completely could have led to retained tissue causing infection. Ectopic pregnancy (A) would typically present with severe abdominal pain, vaginal bleeding, and positive pregnancy test. Gestational trophoblastic disease (C) would present with irregular vaginal bleeding and elevated hCG levels. Endometriosis (D) is a chronic condition characterized by pelvic pain and abnormal menstrual bleeding, not an acute post-miscarriage complication.
Question 5 of 5
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.