Question

A nurse is caring for a client who has been diagnosed with hyperemesis gravidarum. Which of the following conditions are risk factors for hyperemesis gravidarum?

Answer 1

Correct Answers:

Twin gestations.
Molar pregnancy.
History of hyperemesis.

Rationale :

Twin gestations

✔️ Twin or multiple gestations result in higher levels of human chorionic gonadotropin (hCG) and estrogen, both of which are strongly associated with the development of hyperemesis gravidarum.

✔️ The increased placental mass in multifetal pregnancies contributes to hormonal surges that intensify nausea and vomiting.

✔️ Clients with twins are more prone to early and more severe symptoms of pregnancy-related nausea and vomiting.

✔️ This is a well-documented risk factor recognized in prenatal screening.

✔️ Early recognition in these pregnancies can lead to proactive hydration and antiemetic therapy.

Molar pregnancy

✔️ A molar pregnancy, or gestational trophoblastic disease, causes abnormally high levels of hCG, far exceeding those in normal pregnancy.

✔️ This abnormal trophoblastic proliferation is directly linked to severe nausea and vomiting, often refractory to standard treatment.

✔️ Hyperemesis may be one of the first clinical clues to suspect a molar pregnancy, especially when paired with uterine size greater than dates.

✔️ These patients may also experience hyperthyroidism and early-onset preeclampsia, further complicating care.

✔️ Molar pregnancy is a classic cause of exaggerated pregnancy symptoms.

History of hyperemesis

✔️ A previous history of hyperemesis gravidarum is a strong predictor of recurrence in future pregnancies.

✔️ Studies show that clients who experienced hyperemesis once are significantly more likely to experience it again, often with increased severity or earlier onset.

✔️ This risk is linked to genetic, hormonal, and gastrointestinal factors that may persist between pregnancies.

✔️ Nurses should use this history to initiate early interventions and client education.

✔️ Proactive planning may include prescribing antiemetics early and monitoring hydration status closely.

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Answer 2

Correct Answers:

50

Rationale :

🧮 To deliver 2 g/hr from a solution of 20 g in 500 mL,

🧮Use the ratio:

(2g/20g)×500mL

50mL/hr

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Answer 3

Correct Answers:

Increases risk for infection.

Rationale :

👌 In clients with Preterm Premature Rupture of Membranes (PPROM), repeated vaginal exams are strictly limited because they significantly increase the risk of ascending bacterial infection.

👌 The cervix is already compromised, and every exam introduces external flora into the uterine cavity, especially after amniotic sac rupture.

👌 The major complication of PPROM is chorioamnionitis, which can lead to preterm birth, neonatal sepsis, and uterine infection.

👌 Once the initial vaginal exam confirms cervical dilation, further assessment is performed via non-invasive methods (e.g., sterile speculum exams or ultrasound).

👌 The nurse should educate the client that protecting the intrauterine environment from infection takes precedence over frequent checks.

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Answer 4

Correct Answers:

I will position the lap belt under my abdomen and the shoulder belt between my breasts and above my abdomen to minimize the risk of abdominal trauma.

Rationale :

🟣 The proper positioning of seat belts during pregnancy is essential for maternal and fetal safety in the event of an accident.

🟣 The lap belt should be placed low across the hips and under the belly, not over it, to avoid uterine trauma.

🟣 The shoulder strap should go between the breasts and above the belly, not behind the back or under the arm.

🟣 Misplacement of the belt, such as placing it above the uterus or removing it, dramatically increases the risk of abdominal trauma, uterine rupture, placental abruption, and fetal demise during even minor collisions.

🟣 Current recommendations from ACOG and NHTSA emphasize consistent seatbelt use throughout pregnancy with correct positioning.

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Answer 5

Correct Answers:

A vaginal exam could cause vaginal bleeding.

Rationale :

🩸 In a patient with a known complete placenta previa, performing a vaginal exam is contraindicated unless location of placenta has been cleared by recent ultrasound.

🩸 Placenta previa means the placenta is covering the cervical os, and inserting a finger could rupture placental vessels, causing catastrophic hemorrhage.

🩸 Vaginal bleeding from placenta previa is painless but heavy and may lead to maternal hypovolemia or fetal distress.

🩸 This is why all clients with known or suspected previa are examined abdominally or with imaging, not digitally.

🩸 The nurse must educate the client that the lack of vaginal exam is intentional to protect both maternal and fetal health.

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Answer 6

Correct Answers:

Cytomegalovirus.

Rationale :

🧬 TORCH infections include Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes Simplex Virus (HSV)—each with the potential to cause fetal anomalies.

🧬 Cytomegalovirus is the most common congenital viral infection, often asymptomatic in the mother but associated with hearing loss, microcephaly, hepatosplenomegaly, and developmental delays in the newborn.

🧬 It spreads via saliva, urine, and other bodily fluids, and pregnant women should avoid contact with toddlers’ secretions.

🧬 Routine CMV screening is not performed, but awareness and hygiene precautions are critical for prevention.

🧬 Although rubella and HSV are also TORCH infections, CMV is uniquely common and severe, making it a high-priority risk in pregnancy.

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Answer 7

Correct Answers:

Cerclage.

Rationale :

♦️Cerclage is the placement of sutures in the cervix to prevent premature dilation, indicated in cases of incompetent cervix, often diagnosed after recurrent second-trimester losses or cervical shortening seen on ultrasound.

♦️ It is performed prophylactically around 12–14 weeks, or emergently if cervix changes are discovered during pregnancy.

♦️ The goal is to maintain cervical integrity and reduce the risk of spontaneous abortion or early preterm birth.

♦️ The client's comment “sew my cervix shut” directly references this procedure in layman’s terms, and the nurse should provide factual reassurance and terminology.

♦️ Post-cerclage, clients are monitored for preterm contractions, bleeding, or signs of infection.

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Answer 8

Correct Answers:

50 mg Pyridoxine (vitamin B6) PO.

Rationale :

🎯 Pyridoxine (Vitamin B6) is a first-line pharmacologic treatment for nausea and vomiting in pregnancy, especially in cases progressing toward hyperemesis gravidarum.

🎯 It is considered safe, inexpensive, and effective with minimal side effects, and may be combined with doxylamine for increased effectiveness.

🎯 Unlike antiemetics that carry risk, vitamin B6 is well-tolerated in pregnancy and can reduce hospitalizations when started early.

🎯 IV fluids may be needed for dehydration, but the cornerstone of treatment is nutritional support and anti-nausea therapy.

🎯 The nurse should anticipate B6 and educate the client on adherence and dietary support.

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Answer 9

Correct Answers:

Calcium gluconate.

Rationale :

🛑 Calcium gluconate is the antidote for magnesium sulfate toxicity, which presents with respiratory depression (<12/min), hypotension, decreased urine output, and eventually loss of deep tendon reflexes.

🛑 Magnesium sulfate acts as a CNS depressant, and toxic levels can lead to cardiac or respiratory arrest if not reversed.

🛑 The first response is to discontinue the infusion, then administer 1g of calcium gluconate IV slowly over 2–3 minutes.

🛑 Magnesium levels should be monitored every 6 hours and kept between 4.8–8.4 mg/dL during therapy.

🛑 Nurses must always keep calcium gluconate readily available when magnesium sulfate is in use.

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Answer 10

Correct Answers:

Vaginal spotting.
Regular contractions occurring every 10 minutes or less.
Lower back pain or pelvic pressure.

Rationale :

Vaginal spotting

✔️ Light vaginal spotting or bleeding may indicate early cervical changes, such as effacement or dilation, which can precede preterm labor.

✔️ Cervical friability in pregnancy increases the likelihood of spotting as the cervix begins to thin, stretch, and open.

✔️ While not always present, spotting with other symptoms (like contractions or pelvic pressure) increases clinical suspicion.

✔️ This finding warrants further evaluation, especially when paired with uterine activity or fetal descent.

✔️ Spotting is a red flag and should not be dismissed in a client less than 37 weeks gestation.

Regular contractions occurring every 10 minutes or less

✔️ The hallmark sign of preterm labor is regular uterine contractions—often defined as more than 4 in 20 minutes or 8 or more in 60 minutes.

✔️ When contractions occur every 10 minutes or less, especially when rhythmic and painful, they suggest coordinated uterine activity that may be advancing cervical change.

✔️ If accompanied by effacement or dilation, this finding confirms preterm labor and requires intervention.

✔️ Timely detection is essential to initiate tocolytics, corticosteroids, or magnesium sulfate depending on gestational age.

✔️ Monitoring frequency, duration, and intensity of contractions is critical in triage assessment.

Lower back pain or pelvic pressure

✔️ Low dull back pain, especially when rhythmic or unrelieved by rest, often reflects referred pain from uterine contractions.

✔️ Pelvic pressure may result from fetal descent or early cervical dilation and is frequently reported before preterm labor progresses.

✔️ These symptoms may be subtle, particularly in multiparous clients, and are easily confused with normal pregnancy discomforts.

✔️ Nurses must differentiate between non-labor discomforts and labor-inducing pressure or pain by assessing contraction patterns and cervical status.

✔️ Back pain and pelvic pressure are among the most common presenting symptoms of preterm labor.

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QLexNursing

1 :
A nurse is caring for a client who has been diagnosed with hyperemesis gravidarum. Which of the following conditions are risk factors for hyperemesis gravidarum?

2 :
A laboring client with preeclampsia is prescribed magnesium sulfate 2g/h IVPB. The pharmacy sent the IV to the unit labeled magnesium sulfate 20g/500mL normal saline. To administer the correct dose, the nurse should set the pump to deliver how many milliliters per hour?

3 :
A nurse is admitting a client at 33 weeks’ gestation who experienced PPROM 4 hours ago. The client is asking when her next vaginal exam will be since her first exam revealed she is 2 cm dilated. Which of the following reasons does the nurse explain for not performing another vaginal exam?

4 :
A nurse is educating a client at the end of her second trimester about car safety. Which statement by the client indicates a correct understanding of the nurse's education?

6 :
A nurse is providing education about TORCH infections to a pregnant client and her partner. The nurse identifies that the client is at risk for which infection?

8 :
A nurse is caring for a client who was recently diagnosed with Hyperemesis Gravidarum. Which of the following medications should the nurse anticipate administering?

9 :
A nurse is caring for a client receiving Magnesium Sulfate therapy IV for preterm labor. Which of the following medications should the nurse anticipate administering if the client exhibits hypotension, decreased urine output, and a respiratory rate of 10/min?

10 :
A client at 34 weeks’ gestation arrives to 0B triage and is concerned she may be in preterm labor. Which of the following are signs and symptoms of preterm labor? (Select all that apply.)

QLexNursing

1 : A nurse is caring for a client who has been diagnosed with hyperemesis gravidarum. Which of the following conditions are risk factors for hyperemesis gravidarum?

2 : A laboring client with preeclampsia is prescribed magnesium sulfate 2g/h IVPB. The pharmacy sent the IV to the unit labeled magnesium sulfate 20g/500mL normal saline. To administer the correct dose, the nurse should set the pump to deliver how many milliliters per hour?

3 : A nurse is admitting a client at 33 weeks’ gestation who experienced PPROM 4 hours ago. The client is asking when her next vaginal exam will be since her first exam revealed she is 2 cm dilated. Which of the following reasons does the nurse explain for not performing another vaginal exam?

4 : A nurse is educating a client at the end of her second trimester about car safety. Which statement by the client indicates a correct understanding of the nurse's education?

6 : A nurse is providing education about TORCH infections to a pregnant client and her partner. The nurse identifies that the client is at risk for which infection?

8 : A nurse is caring for a client who was recently diagnosed with Hyperemesis Gravidarum. Which of the following medications should the nurse anticipate administering?

9 : A nurse is caring for a client receiving Magnesium Sulfate therapy IV for preterm labor. Which of the following medications should the nurse anticipate administering if the client exhibits hypotension, decreased urine output, and a respiratory rate of 10/min?

10 : A client at 34 weeks’ gestation arrives to 0B triage and is concerned she may be in preterm labor. Which of the following are signs and symptoms of preterm labor? (Select all that apply.)

1 :
A nurse is caring for a client who has been diagnosed with hyperemesis gravidarum. Which of the following conditions are risk factors for hyperemesis gravidarum?

2 :
A laboring client with preeclampsia is prescribed magnesium sulfate 2g/h IVPB. The pharmacy sent the IV to the unit labeled magnesium sulfate 20g/500mL normal saline. To administer the correct dose, the nurse should set the pump to deliver how many milliliters per hour?

3 :
A nurse is admitting a client at 33 weeks’ gestation who experienced PPROM 4 hours ago. The client is asking when her next vaginal exam will be since her first exam revealed she is 2 cm dilated. Which of the following reasons does the nurse explain for not performing another vaginal exam?

4 :
A nurse is educating a client at the end of her second trimester about car safety. Which statement by the client indicates a correct understanding of the nurse's education?

6 :
A nurse is providing education about TORCH infections to a pregnant client and her partner. The nurse identifies that the client is at risk for which infection?

8 :
A nurse is caring for a client who was recently diagnosed with Hyperemesis Gravidarum. Which of the following medications should the nurse anticipate administering?

9 :
A nurse is caring for a client receiving Magnesium Sulfate therapy IV for preterm labor. Which of the following medications should the nurse anticipate administering if the client exhibits hypotension, decreased urine output, and a respiratory rate of 10/min?

10 :
A client at 34 weeks’ gestation arrives to 0B triage and is concerned she may be in preterm labor. Which of the following are signs and symptoms of preterm labor? (Select all that apply.)