MCQS and Answers no labour and pregnancy by Sir Dennis

Gravidity and Parity Quiz Questions

1.      Gravidity is defined as _______________________________.

A.     the number of completed pregnancies at 20 weeks or greater.

B.     the number of pregnancies greater than 20 weeks.

C.     the number of times a woman has been pregnant regardless of the outcome.

D.     the number of births regardless of the outcome.

The answer is C. Gravidity is defined as the number of pregnancies or how many times a woman has been pregnant, regardless of the outcome. Parity is the number of BIRTHS (or completed pregnancies) at 20 weeks or greater.

2.      Parity is defined as ______________________________.

A.     the number of babies born at 20 weeks or greater.

B.     the number of pregnancies greater than 36 weeks.

C.     the number of births at 20 weeks or less.

D.     the number of completed pregnancies at 20 weeks or greater.

The answer is D. Parity is defined as the number of completed pregnancies at 20 weeks or greater. Option A is wrong because it says the number of BABIES (remember twins or multiples count as one). It’s not the number of babies but the number of completed pregnancies at 20 weeks or greater.

3.      A woman who has never given birth or completed a pregnancy at 20 weeks gestation or greater is termed as?

A.     Primigravida

B.     Nullipara

C.     Nulligravida

D.     Primipara

The answer is B. Nullipara means that the woman has never given birth or completed a pregnancy at greater than 20 weeks or greater.

4.      A patient says she has never been pregnant before. You would chart this as?

A.     Nullipara

B.     Primigravida

C.     Nulligravida

D.     Multigravida

The answer is C. Nulligravida means that a woman has never been pregnant before.

5.      A patient is currently 32 weeks pregnant. She reports being pregnant 2 other times before this current pregnancy, and had 2 live births at 39 and 40 weeks. Which option below best describes the patient’s gravidity and parity?

A.     Gravida 3, para 2

B.     Gravida 2, para 3

C.     Gravida 2, para 2

D.     Gravida 4, para 2

The answer is A. Gravida represents the NUMBER of times the woman has been PREGNANT (it INCLUDES the current pregnancy). The woman’s gravida is 3. Parity represents the NUMBER OF BIRTHS or completed pregnancies (this includes babies that lived or died) at greater than 20 weeks. The parity is 2 for this scenario.

6.      In a patient’s chart you note in the physician’s progress note that the term primigravida was used. How do you interpret this term?

A.     The patient had one completed pregnancy or birth at 20 weeks gestation or greater.

B.     The patient has never been pregnant before.

C.     The patient has been pregnant more than once.

D.     The patient is pregnant for the first time or has been pregnant once in the past.

The answer is D. Primigravida means that either the patient is currently pregnant or has been pregnant once in the past.

7.      During a medical history collection the patient states she has been pregnant six times and has delivered 2 babies at 38 and 39 weeks. She reports losing 4 pregnancies at 5, 7, 8, and 10 weeks gestation. Which option below best describes the patient’s gravidity and parity?

A.     Gravida 6, para 6

B.     Gravida 6, para 2

C.     Gravida 8, para 2

D.     Gravida, 2, para 6

The answer is B: Gravida 6 and para 2….Gravida is the number of times the woman has been pregnant, regardless the outcome. The patient has been pregnant a total of 6 times. Parity is the number of births (hence completed pregnancies) that occurred at 20 weeks gestation or greater. The patient’s parity is 2 (she has two completed pregnancies at 38 and 39 weeks). The other 4 pregnancies completed BEFORE 20 weeks gestation.

8.      A 28-year-old female gives birth to twins at 38 weeks gestation. This is her first pregnancy. Which option below best describes the patient’s gravidity and parity?

A.     Gravida 1, para 1

B.     Gravida 1, para 2

C.     Gravida 2, para 2

D.     Gravida 1, para 0

The answer is A: Gravida 1, para 1… Gravida is the number of times the woman has been pregnant, regardless the outcome. The patient has been pregnant just once (twins or multiples count as ONE). Parity is the number of births (hence completed pregnancies) that occurred at greater than 20 weeks gestation. The patient’s parity is 1 (twins or multiples count as ONE).

9.      A 32-year-old is pregnant with twins at 32 weeks gestation. This is her first pregnancy. Which option below best describes the patient’s gravidity and parity?

A.     Gravida 2, para 2

B.     Gravida 1, para 1

C.     Gravida 2, para 0

D.     Gravida 1, para 0

The answer is D: Gravida 1, para 0… Gravida is the number of times the woman has been pregnant, regardless the outcome. The patient has been pregnant just once (twins or multiples count as ONE). Parity is the number of births (hence completed pregnancies) that occurred at 20 weeks or greater gestation. The patient’s parity is 0. She has not currently completed this pregnancy. If this pregnancy is completed at 20 weeks or greater (regardless if the babies survive or die at 20 weeks or greater), parity will be 1 then.

10.   A patient who has been pregnant more than once is termed?

A.     Multipara

B.     Multigravida

C.     Primipara

D.     Primigravida

The answer is B. Multigravida is the term used when a woman has been PREGNANT more than once. The current pregnancy is included in this count. The current pregnancy is included in this gravida count.

Preeclampsia and Eclampsia  Questions

1. The nurse knows that preeclampsia tends to occur during what time in a pregnancy?

A. before 20 weeks

B. in the third trimester and postpartum

C. after 20 weeks

D. in the first and second trimester

The answer is C. Preeclampsia tends to occur AFTER 20 weeks gestation.

2. A patient is currently 34 weeks pregnant with her first baby. Which findings below could indicate the development of preeclampsia in this patient that would need to be reported to the physician? Select all that apply:

A. 1600: blood pressure 144/100, 1700: blood pressure 120/80

B. 3+ dipstick urine protein

C. 1 hour glucose tolerance test 90 mg/dL

D. 0800: blood pressure 142/92, 1230: blood pressure: 144/98

E. <300 mg/dL 24-hour urine protein

The answers are B and D. Signs and symptoms of preeclampsia include: proteinuria (>1+ dipstick urine protein or >300 mg/dL 24 hour urine protein, hypertension >140/90…two reading at least 4-6 hours apart), swelling in face, eyes, extremities, headaches, vision changes, etc.

3. You’re providing an in-service to a group of new labor and delivery nurse graduates about the pathophysiology of preeclampsia. Which statement by one of the group participants demonstrates they understood how this condition develops?

A. “The basal arteries of the myometrium fail to widen to support blood flow to the placenta.”

B. “The placenta experiences ischemia because the spiral arteries of the uterus fail to reshape and increase in diameter.”

C. “The cardiovascular system of the mother fails to compensate for the increased blood flow from the fetus and placental ischemia occurs.”

D. “If the mother experience uncontrolled hypertension and proteinuria, it compromises blood flow to the placenta and leads to preeclampsia.”

The answer is B. This is the only correct statement. When preeclampsia occurs it is because the spiral arteries of the uterus failed to widen in diameter due to poor trophoblast invasion during the beginning of the pregnancy. Overtime, this causes problems (usually after 20 weeks gestation) and the placenta experiences ischemia. When the placenta becomes ischemic is releases substances into mom’s circulation that are very toxic to her endothelial cells, which causes all the signs and symptoms seen in preeclampsia. Severity varies in patients.

4. A 37-year-old female patient who is 36 weeks pregnant is diagnosed with mild preeclampsia. The nurse will include what information in the patient’s education? Select all that apply:

A. Report weight gain of >4 lbs in one week to physician

B. Incorporate foods like eggs, nuts, fish, meat in your diet

C. Follow a no salt diet

D. Headache and vision changes are expected side effects of this condition and cause no reason for concern.

E. Importance of monitoring urine protein at home

F. Lying on left-side is recommended along with rest

G. Report a decrease in fetal activity immediately

The answers are: B, E, F, and G. These options are topics the nurse wants to include in the patient’s teaching with preeclampsia. Option A is wrong because the patient should report a weight gain of >2 lbs (NOT 4 lbs) in one week. Option C is wrong become it is no longer recommended the patient restrict salt in diet but limit it. Option D is wrong because a headache and vision changes are serious complications that may indicate the development of eclampsia, and the patient should report it immediately.

5. Fill-in-the-blank: The signs and symptoms of preeclampsia are mainly occurring because substances released by the ischemic placenta cause damage to the _________________ in mom’s body, which injuries organs.

A. spiral arteries

B. epithelial cells

C. endothelial cells

D. juxtaglomerular cells

The answer is C: The signs and symptoms of preeclampsia are mainly occurring because substances released by the ischemic placenta cause damage to the ENDOTHELIAL CELLS in mom’s body, which injuries organs.

6. Select all the risk factors below that increases a woman’s risk for developing preeclampsia:

A. Nulligravida

B. Primigravida

C. BMI 34

D. Pregnant with twins

E. Maternal history of preeclampsia

F. Age: 25-years-old

G. History of Lupus and Diabetes

The answers are: B, C, D, E, and G. Risk factors for preeclampsia include: History of preeclampsia or family history, first pregnancy (primigravida), significant health history prior to pregnancy: diabetes, lupus, high blood pressure, kidney disease, Obese: BMI >30, having more than one baby (twins, triplets etc.), age (young <18 or advanced >35).

7. Your patient is 36 weeks pregnant with severe preeclampsia. The physician has ordered lab work to assess for HELLP Syndrome. Which findings on the patient’s lab results correlate with HELLP Syndrome?

A. Hemoglobin 12 g/dL

B. Platelets 90,000 μL

C. ALT 100 IU/L

D. AST 90 IU/L

E. Glucose 350 mg/dL

F. Abnormal RBC peripheral smear

The answers are: B, C, D, and F. HELLP Syndrome causes of Hemolysis of RBCs (abnormal RBC peripheral smear), Elevated Liver enzymes (>70 IU/L for AST or ALT), Low Platelets (<100,000 μL ).

8. Your patient with preeclampsia is started on Magnesium Sulfate. The nurse knows to have what medication on standby?

A. Acetylcysteine

B. Calcium carbonate

C. Oxytocin

D. Calcium gluconate

The answer is D: The antidote for Magnesium Sulfate is Calcium Gluconate. The nurse should have this on hand in case Magnesium toxicity occurs.

9. A 39 week pregnant patient is in labor. The patient has preeclampsia. The patient is receiving IV Magnesium Sulfate. Which finding below indicates Magnesium Sulfate toxicity and requires you to notify the physician?

A. Deep tendon reflex 4+

B. Respiratory rate of 13 breaths per minute

C. Urinary output of 600 mL over 12 hours

D. Clonus presenting in the lower extremities

E. Patient reports flushing or feeling hot

The answer is E. The nurse should monitor for Magnesium Sulfate toxicity. Signs of this include: EARLY: flushing or feeling hot/warm, later on: decreased or absent reflexes (finding of 4+ Deep tendon reflex is considered HYPERreflexia), Respiratory rate less than 12 breaths per minute, Urinary output of less than 30 mL/hr, EKG changes.

10. In a patient with preeclampsia, what signs and symptoms indicate that the patient has a high risk of experiencing a seizure due to central nervous system irritability?  Select all that apply:

A. You note bouncing of the foot when it is quickly dorsiflexed.

B. Patellar and bicep deep tendon reflexes are graded 4+.

C. Platelet count 200,000

D. Patient reports a decrease in headache pain.

The answers are A and B. Option A indicates positive clonus and Option B is indicative of hyperreflexia. If these findings are present it demonstrates that the central nervous system is irritated and there is a high risk of potential seizure activity. Seizure precautions should be initiated and the physician notified.

11. How would the nurse check for clonus in a patient with preeclampsia?

A. Assess the patellar and bicep tendon with a reflex hammer and grade the reaction.

B. Assess for muscular rigidity by having the patient extend the arms and place resistance against the arms.

C. Assess for beating of the foot when the foot is quickly dorsiflexed.

D. Assess for dorsiflexion of the foot by quickly plantar flexing the foot.

The answer is C: To check for clonus the nurse will have the patient dangle the leg and support the patient’s lower leg. Then the nurse will quickly dorsiflex the foot. The nurse is assessing for bouncing or beating of the foot (hence the foot attempts to plantarflex). If the foot attempts to bounce or beat 3 or more times, it is positive for clonus.

12. A 37 week pregnant patient is admitted with severe preeclampsia. The patient begins to experiences a tonic-clonic seizure. Which of the following would the nurse AVOID during the seizure?

A. Placing the patient in a supine position

B. Holding down the patient’s head to prevent injury

C. Staying with the patient and activating the emergency response team

D. Timing the seizure

E. Providing 8 to 10 L of oxygen

APGAR MCQ Practice Questions

1.  You’re assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 130, pink body and hands with cyanotic feet, weak cry, flexion of the arms and legs, active movement and crying when stimulated. What is your patient’s APGAR score?

A.      APGAR 9

B.      APGAR 10

C.      APGAR 8

D.      APGAR 5

2.       You’re assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 101, cyanotic body and extremities, no response to stimulation, no flexion of extremities, and strong cry. What is your patient’s APGAR score?

A.      APGAR 4

B.      APGAR 6

C.      APGAR 3

D.      APGAR 2

3.       You’re assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: weak cry, some flexion of the arm and legs, active movement and cries to stimulation, heart rate 145, and pallor all over the body and extremities. What is your patient’s APGAR score?

A.      APGAR  5

B.      APGAR 9

C.      APGAR 12

D.      APGAR 6

4. A newborn’s five minute APGAR score is 5. Which of the following nursing interventions will you provide to this newborn?

A. Routine post-delivery care

B. Continue to monitor and reassess the APGAR score in 10 minutes.

C. Some resuscitation assistance such as oxygen and rubbing baby’s back and reassess APGAR score.

D. Full resuscitation assistance is needed and reassess APGAR score.

5. Regarding the scenario in the question above, when would you reassess the APGAR score?

A. 2 minutes

B. 10 minutes

C. 5 minutes

D. No reassessment of the APGAR score is needed.

6. You’re assessing the five minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: pink body and hand with cyanotic feet, heart rate 109, grimace to stimulation, flaccid, and irregular cry. What is your patient’s APGAR score?

A. APGAR 2

B. APGAR 5

C. APGAR 4

D. APGAR 8

7. You’re assessing the five minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 97, no response to stimulation, flaccid, absent respirations, cyanotic throughout. What is your patient’s APGAR score?

A. APGAR 2

B. APGAR 3

C. APGAR 0

D. APGAR 1

8. A newborn’s one minute APGAR score is 8. Which of the following nursing interventions will you provide to this newborn?

A. Routine post-delivery care

B. Full resuscitation assistance is needed and reassess APGAR score

C. Continue to monitor and reassess the APGAR score in 10 minutes

D. Some resuscitation assistance such as oxygen

Answer Key:

1. C
2. A
3. D
4. C
5. B
6. B
7. D
8. A

Pregnancy Signs Quiz

1. Which category of pregnancy signs are subjective and can only be reported by the patient?

A. Positive Signs

B. Probable Signs

C. Presumptive Signs

D. Proven Signs

The answer is C. Presumptive signs are subjective and are only reported by the patient.

2. Which of the following are NOT considered presumptive signs of pregnancy? Select all that apply:

A. Positive pregnancy test

B. Amenorrhea

C. Fatigue

D. Ballottement

E. Increased urination

F. Quickening

The answers are A and D. Positive pregnancy test and ballottement are probable signs of pregnancy.

3. A 35-year-old female suspects she may be pregnant. The physician notes in chart that the lower uterine segment is soft. As the nurse you know this is known as:

A. Ballottement

B. Hegar’s Sign

C. Goodell’s Sign

D. Chadwick’s Sign

The answer is B: Hegar’s Sign. This is the softening of the lower uterine segment (LUS).

4. Which statement below correctly describes Chadwick’s Sign?

A. “This sign is present when there is softening of the cervix.”

B. “Chadwick’s Sign is the rebounding of the fetus against the examiner fingers when the uterus is pushed during palpation.”

C. “This can be noted when the lower segment of the uterus softens.”

D. “Chadwick’s Sign occurs when there is a bluish color to the vulva, cervix and vagina.”

The answer is D: Chadwick’s Sign occurs when there is a bluish color to the vulva, cervix and vagina.

5. Select all the probable signs of pregnancy:

A. Enlarged uterus

B. Ultrasound detecting fetus

C. Goodell’s Sign

D. Braxton Hick’s contractions

E. Fetal movement felt by the examiner

The answers are A, C, and D. Option B and E are positive signs of pregnancy.

6. The examiner notes there is softening of the cervix. This is known as?

A. Goodell’s Sign

B. Hegar’s Sign

C. Chadwick’s Sign

D. Palmer’s Sign

The answer is A: Goodell’s Sign

7. During physical assessment of a pregnant female, it is noted that there is movement and recoil of the fetus against the examiner’s fingers when the uterus is palpated. This is termed as?

A. Palmer’s Sign

B. Ballottement

C. Hegar’s Sign

D. Chadwick’s Sign

The answer is B: Ballottement

8. Select below the positive signs of pregnancy:

A. Ultrasound detecting fetus

B. Visible movement of baby seen by the examiner

C. The delivery of the baby

D. Doppler detects fetal heart tones

E. Fetal movement felt by examiner

F. Braxton Hicks Contractions

The answers are A, B, C, D, and E. Option F is a probable sign of pregnancy.

9. A 25-year-old female, who is 18 weeks pregnant, reports feeling fluttering in her lower abdomen. She states it feels like the baby is moving. This is known as:

A. Ballottement

B. Quickening

C. Hegar’s Sign

D. Goodell’s Sign

The answer is B. This is known as quickening.

Stages of Labor  Quiz

1. Stage 1 of labor includes which phases in the correct order?

A. Transition, Latent, Active

B. Active, Latent, Transition

C. Active, Transition, Latent

D. Latent, Active, Transition

2. True or False: Stage 2 of labor begins with the delivery of the baby and ends with the delivery of the placenta.

3. You’re performing a routine assessment on a mother post-delivery. The uterus is soft and displaced to the left of the umbilicus. What is your next nursing action?

A. Perform fundal massage and assist the patient to the bathroom.

B. Continue to monitor the mother. This is a normal finding post-delivery.

C. Notify the physician.

D. Administer PRN dose of Pitocin as ordered by the physician.

4. In stage 1 of labor, during the active phase, the cervix dilates?

A. 1-3 cm

B. 7-10 cm

C. 4-7 cm

D. 8-10 cm

5. What statement is FALSE about the transition phase of stage 1?

A. The mother may experience intense pain, irritation, nausea, and deep concentration.

B. The transition phase is the longest phase of stage 1 and contractions are very intense and long in duration.

C. The cervix will dilate from 8 to 10 cm.

D. The transition phase ends and progresses to stage 2 of labor when the cervix has dilated to 10 cm.

6. Your laboring patient has transitioned to stage 2 of labor. What changes in the perineum indicate the birth of the baby is imminent?

A. Increase in meconium-stained fluid and retracting perineum

B. Retracting perineum and anus with an increase of bloody show

C. Rapid and intense contractions

D. Bulging perineum and rectum with an increase in bloody show

7. True or False: Stage 4 of labor starts with the full delivery of the baby and ends with the full delivery of the placenta.

8. The mother has delivered the placenta. You note that the shiny surface of the placenta was delivered first. What delivery mechanism is this known as AND is this the maternal or baby’s surface of the placenta?

A. Duncan mechanism, maternal

B. Schultze mechanism, maternal

C. Schultze mechanism, baby

D. Duncan mechanism, baby

9. After birth, where do you expect to assess fundal height?

A. At the xiphoid process

B. 5 cm below the umbilicus

C. 2 cm above the pubic symphysis

D. At or near the umbilicus

10. During stage 3 of labor, you note a gush of blood and that the uterus changes shape from an oval shape to globular shape. This indicates?

A. Postpartum hemorrhage

B. Imminent delivery of the baby

C. Signs of placental separation

D. Answers B and C

Answer Key:

1. D
2. False
3. A
4. C
5. B
6. D
7. False
8. C
9. D
10. C 

Menstrual Cycle Questions

1. The _________ is responsible for secreting gonadotropin-releasing hormone.

A. Thalamus

B. Hypothalamus

C. Anterior pituitary gland

D. Posterior pituitary gland

2. During which cycle day of a typical 28 day menstrual cycle does the follicular phase occur?

A. Cycle days 7-14

B. Cycle days 14-28

C. Cycle days 1-6

D. Cycle days 1-13

3. As the graafian follicle matures, a massive amount of estrogen is released by the follicle which causes a luteinizing hormone surge. Approximately, what cycle day does the LH surge occur?

A. Cycle day 11-13

B. Cycle Day 14

C. Cycle day 5-8

D. Cycle day 1-6

4. Select all the functions of the luteinizing hormone:

A. Forming the corpus luteum

B. Thickening the endometrium layer for implantation

C. Breaking down the wall of the graffian follicle to allow for release of the ovum

D. Thinning cervical mucous

5. During which stage of the menstrual cycle does the endometrium layer thicken?

A. Secretory Phase

B. Luteal Phase

C. Ovulation Phase

D. Proliferative Phase

6. What cycle day does the proliferative stage occur?

A. Cycle day 7-14

B. Cycle day 14-28

C. Cycle day 1-6

D. Cycle day 1-14

7. Which statement is TRUE about the ovulation phase?

A. The newly released egg will live for 72 hours and disintegrate if not fertilized.

B. The woman will have a low basal body temperature before ovulation and then a temperature increase of 0.4-1’F degrees around ovulation.

C. The ovum is directly released into the fallopian tube.

D. Fertilization most commonly occurs at the fimbria.

8. If the ovum is to be fertilized, where is the most common site of fertilization?

A. Uterine wall

B. Fimbria

C. Ampulla of the Fallopian Tube

D. Isthmus of the Fallopian Tube

9. In what stage does the corpus luteum form?

A. Luteal Phase

B. Follicular Phase

C. Proliferative Phase

D. None of the above

10. What cycle day does the luteal phase occur?

A. Cycle days 15-28

B. Cycle days 5-13

C. Cycle day 14

D. Cycle days 7-14

11. The corpus luteum secretes (select-all-that-apply)?

A. Progesterone

B. Estrogen

C. FSH

D. LH

12. During the menstrual phase the _________ layer of the endometrium is shed.

A. Stratum basalis

B. Stratum functionalis

C. Stratum compactum

D. Myometrium

13. A patient is trying to prevent pregnancy by using the rhythm method. At what time during a woman’s cycle is she the most fertile?

A. Cycle days 21-28

B. Cycle days 1-6

C. Cycle days 9-16

D. Cycle days 6-9

14. ___________ is released from the anterior pituitary gland and stimulates the follicles in the ovary to mature.

A. Progesterone

B. Follicle-stimulating hormone

C. Estrogen

D. Human chorionic gonadotropin

15. If pregnancy does not occur, the corpus luteum will disintegrate and turn into what is called the?

A. Corpus Albicans

B. Corpus Callosum

C. Corpus Cavernosum

D. Corpus Allatum

16. Select all the following that is NOT a function of progesterone and estrogen:

A. Inhibits the production of LH and FSH

B. Causes the hypothalamus to release gonadotropin releasing hormone

C. Maintains the endometrium for pregnancy

D. Causes the follicle to mature into a graafian follicle

17. True or False: One of the many functions of progesterone is to maintain the endometrium for the fertilized ovum.

18. If fertilization occurs the corpus luteum will act as a temporary endocrine structure to release hormones. It will do this until the placenta is fully developed to take over with hormone secretion and this occurs at approximately?

A. 4 weeks gestation

B. 8 weeks gestation

C. 20 weeks gestation

D. 2 weeks gestation

Answer Key:

1. B
2. D
3. A
4. A, C
5. D
6. A
7. B
8. C
9. A
10. A
11. A, B
12. B
13. C
14. B
15. A
16. B, D
17. True
18. B

Abruptio Placentae and Placenta Previa MCQ Questions

1. A woman, who is 22 weeks pregnant, has a routine ultrasound performed. The ultrasound shows that the placenta is located at the edge of the cervical opening. As the nurse you know that which statement is FALSE about this finding:

A. This is known as marginal placenta previa.

B. The placenta may move upward as the pregnancy progresses and needs to be re-evaluated with another ultrasound at about 32 weeks gestation.

C. The patient will need to have a c-section and cannot deliver vaginally.

D. The woman should report any bleeding immediately to the doctor.

The answer is C. All the other options are CORRECT. Option C is FALSE. This is a type of placenta previa called marginal (or low-lying). There is a chance the woman can delivery vaginally, but if the placenta was completely over the cervix or partially covering it a c-section would be required. At the 20 week ultrasound the location of the placenta is detected. The location will be re-evaluated at about 32 weeks. If a placenta is found to be low lying there is a chance the placenta will move upward (away from the cervix) as the uterus grows to accommodate the baby.

2. Your patient who is 34 weeks pregnant is diagnosed with total placenta previa. The patient is A positive. What nursing interventions below will you include in the patient’s care? Select all that apply:

A. Routine vaginal examinations

B. Monitoring vital signs

C. Administer RhoGAM per MD order

D. Assess internal fetal monitoring

E. Placing patient on side-lying position

F. Monitoring pad count

G. Monitoring CBC and clotting levels

The answers are: B, E, F, and G. Option A is WRONG because vaginal exams are avoided to prevent causing damage to the placenta presenting at the cervical opening. Option C is WRONG because the patient is A positive and does NOT need RhoGAM, which is for patients who are RH negative. Option D is WRONG because external monitoring should be used NOT internal, which can damage the placenta at the cervical opening.

3. A 28 year old female, who is 33 weeks pregnant with her second child, has uncontrolled hypertension. What risk factor below found in the patient’s health history places her at risk for abruptio placentae?

A. childhood polio

B. preeclampisa

C. c-section

D. her age

The answer is B. Preeclampisa is a risk factor for experiencing abruptio placentae. The patient is at risk for developing this condition again since she is currently experiencing uncontrolled hypertension with this pregnancy.

 

4. A 36 year old woman, who is 38 weeks pregnant, reports having dark red bleeding. The patient experienced abruptio placentae with her last pregnancy at 29 weeks. What other signs and symptoms can present with abruptio placentae? Select all that apply:

A. Decrease in fundal height

B. Hard abdomen

C. Fetal distress

D. Abnormal fetal position

E. Tender uterus

The answers are: B, C, and E. Option A is wrong because there may be an INCREASE in fundal height (not decrease) due to concealed bleeding. Option D is wrong because this tends to occur in placenta previa because the placenta attaches too low in the uterus at the cervical opening.

5. Select all the patients below who are at risk for developing placenta previa:

A. A 37 year old woman who is pregnant with her 7th child.

B. A 28 year old pregnant female with chronic hypertension.

C. A 25 year old female who is 36 weeks pregnant that has experienced trauma to abdomen.

D. A 20 year old pregnant female who is a cocaine user.

The answer is A and D. Risk factors for developing placenta previa include: Maternal age >35 years old, multiples (twins etc.), already had a baby, drug use: cocaine or smoking, surgery to the uterus that will leave scarring: fibroid removal, c-section etc.

6. You’re performing a head-to-toe assessment on a patient admitted with abruptio placentae. Which of the following assessment findings would you immediately report to the physician?

A. Oozing around the IV site

B. Tender uterus

C. Hard abdomen

D. Vaginal bleeding

The answer is A. Oozing around the IV site can indicate the patient is entering into DIC (disseminated intravascular coagulation) because clotting levels have been depleted. Therefore, the MD should be notified. Option B, C, and D are findings found in this condition, but Option A is a SEVERE complication that can develop from it.

7. Which statement is TRUE regarding abruptio placenta?

A. This condition occurs due to an abnormal attachment of the placenta in the uterus near or over the cervical opening.

B. A marginal abruptio placenta occurs when the placenta is located near the edge of the cervical opening.

C. Nursing interventions for this condition includes measuring the fundal height.

D. Fetal distress is not common in this condition as it is in placenta previa.

The answer is C. All the other options are INCORRECT.

8. Select all the signs and symptoms associated with placenta previa:

A. Painless bright red bleeding

B. Concealed bleeding

C. Hard, tender uterus

D. Normal fetal heart rate

E. Abnormal fetal position

F. Rigid abdomen

The answer is A, D, and E. These are all sign and symptoms of placenta previa. The other options are associated abruptio placentae.

9. Disseminated intravascular coagulation (DIC) can occur in __________________. This happens because when the placenta becomes damaged and detaches from the uterine wall, large amounts of _____________  are released into mom’s circulation, leading to clot formation and then clotting factor depletion.

A. Placenta previa, fibrinogen

B. Placenta previa, platelets

C. Abruptio placentae, fibrinogen

D. Abruptio placentae, thromboplastin

The answer is D.

10. A patient who is 25 weeks pregnant has partial placenta previa. As the nurse you’re educating the patient about the condition and self-care. Which statement by the patient requires you to re-educate the patient?

A. “I will avoid sexual intercourse and douching throughout the rest of the pregnancy.”

B. “I may start to experience dark red bleeding with pain.”

C. “I will have another ultrasound at 32 weeks to re-assess the placenta’s location.”

D. “My uterus should be soft and non-tender.”

The answer is B. All the other options are CORRECT about partial placenta previa. Option B is WRONG because this condition will present with PAINLESS, bright red bleeding NOT with pain and dark red bleeding, which happens in abruptio placentae.