Review Practice Exercise 6

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Practice Exercise 6

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Total Questions : 5

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Question 1:

A nurse is assessing a patient with vaginal bleeding at 7 weeks gestation. Which finding warrants immediate escalation to the obstetric team?

A. Light spotting with no pain B. Hypotension and pulse 130 bpm C. Mild cramping relieved by rest D. Passage of small clots

Answer and Explanation

Choice A:

Light spotting with no pain is common in early pregnancy and often benign, related to implantation or cervical irritation. It does not indicate active bleeding or instability. Without pain or systemic signs, observation and routine follow-up are appropriate.

Choice B:

Hypotension and pulse 130 bpm indicate hemodynamic instability, which is a medical emergency. These findings suggest significant blood loss, possibly from ruptured ectopic pregnancy or hemorrhagic miscarriage. Immediate escalation is required to prevent cardiovascular collapse and initiate resuscitation, imaging, and surgical management.

Choice C:

Mild cramping relieved by rest is nonspecific and may reflect uterine stretching or early pregnancy changes. It lacks signs of tissue passage, hemodynamic compromise, or acute pathology. No escalation is needed unless symptoms worsen or bleeding increases.

Choice D:

Passage of small clots can occur in threatened miscarriage, but without pain or instability, it does not warrant immediate escalation. Monitoring and ultrasound evaluation are appropriate. Clots alone do not confirm complete miscarriage or rupture.

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Question 2:

What is the primary purpose of administering crystalloid fluids in a patient with pregnancy-related bleeding?

A. To induce uterine contractions B. To restore intravascular volume C. To prevent infection D. To reduce pain

Answer and Explanation

Choice A:

Inducing uterine contractions is achieved pharmacologically using oxytocin, misoprostol, or ergometrine, not crystalloid fluids. Fluids do not stimulate myometrial activity. Their role is volume expansion, not uterine tone modulation.

Choice B:

Crystalloid fluids restore intravascular volume by expanding plasma compartment and improving circulatory stability. In pregnancy-related bleeding, rapid volume replacement is essential to maintain perfusion and prevent hypovolemic shock. Crystalloids are first-line due to availability, low cost, and compatibility with blood products.

Choice C:

Preventing infection requires antibiotics, sterile technique, and wound care. Crystalloid fluids do not possess antimicrobial properties. They do not alter immune response or reduce microbial load.

Choice D:

Reducing pain involves analgesics such as acetaminophen, NSAIDs, or opioids. Crystalloids do not affect nociceptive pathways or pain perception. Their use is hemodynamic, not analgesic.

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Question 3:

A nurse is preparing to administer RhoGAM to a patient with a miscarriage. Within what timeframe must this medication be given to prevent Rh isoimmunization?

A. Within 24 hours B. Within 72 hours C. Within 7 days D. Within 14 days

Answer and Explanation

Choice A:

Within 24 hours is unnecessarily restrictive. While earlier administration is ideal, the immune response takes time to develop. The validated window for effective prophylaxis is up to 72 hours. Limiting to 24 hours may delay appropriate care if logistics prevent immediate administration.

Choice B:

RhoGAM must be administered within 72 hours of a miscarriage, delivery, or any event involving fetomaternal hemorrhage. This timeframe ensures neutralization of fetal Rh-positive cells before maternal sensitization occurs. Beyond 72 hours, the risk of antibody formation increases, compromising future pregnancies.

Choice C:

Within 7 days exceeds the recommended prophylactic window. After 72 hours, maternal B-cell activation and IgG production may begin, rendering RhoGAM ineffective. Delayed administration increases the risk of alloimmunization and fetal complications in future Rh-positive pregnancies.

Choice D:

Within 14 days is clinically unsafe. By this time, sensitization is likely complete, and RhoGAM cannot reverse the immune response. Administering beyond 72 hours offers no protective benefit and falsely reassures providers and patients.

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Question 4:

Which interventions are appropriate for a patient with hemodynamic instability due to pregnancy bleeding? Select all that apply.

A. Administering high-flow oxygen B. Encouraging oral fluid intake C. Establishing large-bore IV access D. Monitoring vital signs every 15 minutes E. Administering oral analgesics

Answer and Explanation

Choice A:

High-flow oxygen improves tissue perfusion and compensates for reduced oxygen-carrying capacity due to hemorrhage. It supports maternal and fetal oxygenation during circulatory compromise. The stem indicates hemodynamic instability, which requires immediate oxygen supplementation.

Choice B:

Oral fluid intake is contraindicated in hemodynamic instability due to risk of aspiration and delayed absorption. In acute bleeding, IV fluids are required for rapid volume expansion. Oral intake is insufficient and unsafe in compromised patients.

Choice C:

Large-bore IV access enables rapid fluid resuscitation and blood product administration. In hemorrhagic shock, restoring intravascular volume is critical. Peripheral 16G or 18G cannulas are preferred for high-flow infusion.

Choice D:

Monitoring vital signs every 15 minutes detects deterioration and guides intervention timing. Frequent checks allow early recognition of worsening hypotension or tachycardia, which are markers of ongoing bleeding or inadequate resuscitation.

Choice E:

Oral analgesics are inappropriate in unstable patients due to delayed onset and potential hypotension. Parenteral analgesia is preferred if pain control is needed, but only after stabilization. Oral route is contraindicated in shock states.

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Question 5:

Which components should be included in discharge teaching for a patient post-miscarriage? Select all that apply.

A. Report fever or heavy bleeding immediately B. Resume intercourse within 24 hours C. Avoid heavy lifting for 1 week D. Expect persistent pregnancy symptoms E. Attend follow-up for hCG monitoring

Answer and Explanation

Choice A:

Fever and heavy bleeding are signs of infection or retained products. Immediate reporting allows prompt evaluation and intervention. Post-miscarriage patients are at risk for endometritis and hemorrhage.

Choice B:

Intercourse within 24 hours is contraindicated due to infection risk and cervical vulnerability. The cervix remains open post-miscarriage, increasing susceptibility to ascending pathogens. Sexual activity should resume only after bleeding stops and cervix closes.

Choice C:

Avoiding heavy lifting reduces abdominal strain and supports uterine healing. Physical exertion may increase bleeding or delay recovery. One week of rest is standard unless complications arise.

Choice D:

Persistent pregnancy symptoms are not expected post-miscarriage. Continued symptoms may suggest incomplete miscarriage or ectopic pregnancy. hCG levels should fall, resolving nausea, breast tenderness, and fatigue. Ongoing symptoms warrant evaluation.

Choice E:

hCG monitoring confirms complete resolution and excludes gestational trophoblastic disease. Serial measurements should show a consistent decline to <5 mIU/mL. Persistent elevation may indicate retained tissue or molar pregnancy.

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Practice Exercise 6

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