Quiz 12: Pregnancy at Risk: Gestational Conditions

Maternal Child-Nursing Care

Nursing
45
Questions
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True/False
43
Choices
2
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Questions

Q1
Free

Women with hyperemesis gravidarum:

Multiple Choice
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A) Are a majority, because 80% of all pregnant women suffer from it at some time.
B) Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.
C) Need intravenous (IV) fluid and nutrition for most of their pregnancy.
D) Often inspire similar, milder symptoms in their male partners and mothers.
Answer:
B) Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.

Explanation:

Women with hyperemesis gravidarum have severe vomiting; however, treatment for several days sets things right in most cases. Although 80% of pregnant women experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe level. IV administration may be used at first to restore fluid levels, but it is seldom needed for very long. Women suffering from this condition want sympathy because some authorities believe that difficult relationships with mothers and/or partners may be the cause.

Q2
Free

Because pregnant women may need surgery during pregnancy, nurses should be aware that:

Multiple Choice
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A) The diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy.
B) Rupture of the appendix is less likely in pregnant women because of the close monitoring.
C) Surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy.
D) When pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses.
Answer:
A) The diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy.

Explanation:

Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count. Rupture of the appendix is two to three times more likely in pregnant women. Surgery to remove obstructions should be done right away. It usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian problems.

Q3
Free

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)?

Multiple Choice
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A) Bleeding time of 10 minutes
B) Thrombocytopenia
C) Presence of fibrin split products
D) Hyperfibrinogenemia
Answer:
B) Thrombocytopenia

Explanation:

Degradation of fibrin leads to the accumulation of fibrin split products in the blood. Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC.

Q4

In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder:

Multiple Choice
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A) Disseminated intravascular coagulation (DIC)
B) Amniotic fluid embolism (AFE)
C) Hemorrhage
D) HELLP syndrome
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Q5

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate?

Multiple Choice
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A) Administration of blood
B) Preparation of the client for invasive hemodynamic monitoring
C) Restriction of intravascular fluids
D) Administration of steroids
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Q6

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?

Multiple Choice
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A) Blood pressure (BP) increase to 138/86 mm Hg
B) Weight gain of 0.5 kg during the past 2 weeks
C) A dipstick value of 3+ for protein in her urine
D) Pitting pedal edema at the end of the day
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Q7

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the womans latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of:

Multiple Choice
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A) Eclampsia.
B) Disseminated intravascular coagulation (DIC).
C) HELLP syndrome.
D) Idiopathic thrombocytopenia.
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Q8

A woman with preeclampsia has a seizure. The nurses primary duty during the seizure is to:

Multiple Choice
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A) Insert an oral airway.
B) Suction the mouth to prevent aspiration.
C) Administer oxygen by mask.
D) Stay with the client and call for help.
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Q9

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3 C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, Im so thirsty and warm. The nurse:

Multiple Choice
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A) Calls for a stat magnesium sulfate level.
B) Administers oxygen.
C) Discontinues the magnesium sulfate infusion.
D) Prepares to administer hydralazine.
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Q10

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1 C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

Multiple Choice
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A) Hydralazine.
B) Diazepam.
C) Magnesium sulfate bolus.
D) Calcium gluconate.
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Q11

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:

Multiple Choice
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A) Eclamptic seizure.
B) Placenta previa.
C) Rupture of the uterus.
D) Placental abruption.
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Q12

The patient that you are caring for has severe preeclampsia and is receiving a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits:

Multiple Choice
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A) A sleepy, sedated affect.
B) Deep tendon reflexes of 2.
C) A respiratory rate of 10 breaths/min.
D) Absent ankle clonus.
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Q13

Your patient has been receiving magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client?

Multiple Choice
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A) Absence of uterine bleeding in the postpartum period
B) A fundus firm below the level of the umbilicus
C) Scant lochia flow
D) A boggy uterus with heavy lochia flow
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Q14

Your patient is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse, Why is it taking so long? The most appropriate response by the nurse would be:

Multiple Choice
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A) The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.
B) I dont know why it is taking so long.
C) The length of labor varies for different women.
D) Your baby is just being stubborn.
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Q15

What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia?

Multiple Choice
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A) Risk for injury to the fetus related to uteroplacental insufficiency
B) Risk for eclampsia
C) Risk for deficient fluid volume related to increased sodium retention secondary to administration of MgSO4
D) Risk for increased cardiac output related to use of antihypertensive drugs
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Q16

The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:

Multiple Choice
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A) Hypertension.
B) Hemorrhagic complications.
C) Hyperemesis gravidarum.
D) Infections.
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Q17

Nurses should be aware that HELLP syndrome:

Multiple Choice
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A) Is a mild form of preeclampsia.
B) Can be diagnosed by a nurse alert to its symptoms.
C) Is characterized by hemolysis, elevated liver enzymes, and low platelets.
D) Is associated with preterm labor but not perinatal mortality.
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Q18

Nurses should be aware that chronic hypertension:

Multiple Choice
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A) Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy.
B) Is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg.
C) Is general hypertension plus proteinuria.
D) Can occur independently of or simultaneously with gestational hypertension.
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Q19

In planning care for women with preeclampsia, nurses should be aware that:

Multiple Choice
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A) Induction of labor is likely, as near term as possible.
B) If at home, the woman should be confined to her bed, even with mild preeclampsia.
C) A special diet low in protein and salt should be initiated.
D) Vaginal birth is still an option, even in severe cases.
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Q20

Magnesium sulfate is given to women with preeclampsia and eclampsia to:

Multiple Choice
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A) Improve patellar reflexes and increase respiratory efficiency.
B) Shorten the duration of labor.
C) Prevent and treat convulsions.
D) Prevent a boggy uterus and lessen lochial flow.
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Q21

Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors?

Multiple Choice
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A) A 30-year-old obese Caucasian with her third pregnancy
B) A 41-year-old Caucasian primigravida
C) An African-American client who is 19 years old and pregnant with twins
D) A 25-year-old Asian-American whose pregnancy is the result of donor insemination
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Q22

A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?

Multiple Choice
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A) Incomplete
B) Threatened
C) Inevitable
D) Septic
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Q23

The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse would be:

Multiple Choice
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A) If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available.
B) The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult.
C) If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time.
D) Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy.
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Q24

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is:

Multiple Choice
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A) Bleeding.
B) Uterine activity.
C) Intense abdominal pain.
D) Cramping.
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Q25

Methotrexate is recommended as part of the treatment plan for which obstetric complication?

Multiple Choice
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A) Complete hydatidiform mole
B) Unruptured ectopic pregnancy
C) Missed abortion
D) Abruptio placentae
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Q26

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure?

Multiple Choice
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A) Amniocentesis for fetal lung maturity
B) Ultrasound for placental location
C) Contraction stress test (CST)
D) Internal fetal monitoring
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Q27

A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of:

Multiple Choice
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A) Placenta previa.
B) Vasa previa.
C) Severe abruptio placentae.
D) Disseminated intravascular coagulation (DIC).
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Q28

A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the womans umbilicus and recognizes this assessment finding as:

Multiple Choice
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A) Normal integumentary changes associated with pregnancy.
B) Turners sign associated with appendicitis.
C) Cullens sign associated with a ruptured ectopic pregnancy.
D) Chadwicks sign associated with early pregnancy.
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Q29

As related to the care of the patient with miscarriage, nurses should be aware that:

Multiple Choice
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A) It is a natural pregnancy loss before labor begins.
B) It occurs in fewer than 5% of all clinically recognized pregnancies.
C) It often can be attributed to careless maternal behavior such as poor nutrition or excessive exercise.
D) If it occurs before the twelfth week of pregnancy, it may manifest only as moderate discomfort and blood loss.
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Q30

Which condition would not be classified as a bleeding disorder in late pregnancy?

Multiple Choice
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A) Placenta previa.
B) Spontaneous abortion.
C) Abruptio placentae.
D) Cord insertion.
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Q31

In providing nutritional counseling for the pregnant woman experiencing cholecystitis, the nurse would:

Multiple Choice
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A) Assess the womans dietary history for adequate calories and proteins.
B) Instruct the woman that the bulk of calories should come from proteins.
C) Instruct the woman to eat a low-fat diet and avoid fried foods.
D) Instruct the woman to eat a low-cholesterol, low-salt diet.
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Q32

Which maternal condition always necessitates delivery by cesarean section?

Multiple Choice
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A) Partial abruptio placentae
B) Ectopic pregnancy
C) Total placenta previa
D) Eclampsia
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Q33

Spontaneous termination of a pregnancy is considered to be an abortion if:

Multiple Choice
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A) The pregnancy is less than 20 weeks.
B) The fetus weighs less than 1000 g.
C) The products of conception are passed intact.
D) No evidence exists of intrauterine infection.
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Q34

An abortion in which the fetus dies but is retained within the uterus is called a(n):

Multiple Choice
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A) Inevitable abortion
B) Incomplete abortion
C) Missed abortion
D) Threatened abortion
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Q35

A placenta previa in which the placental edge just reaches the internal os is more commonly known as:

Multiple Choice
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A) Total
B) Complete
C) Partial
D) Marginal
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Q36

What condition indicates concealed hemorrhage when the patient experiences an abruptio placentae?

Multiple Choice
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A) Decrease in abdominal pain
B) Hard, boardlike abdomen
C) Bradycardia
D) Decrease in fundal height
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Q37

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to:

Multiple Choice
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A) Assess fetal heart rate (FHR) and maternal vital signs
B) Perform a venipuncture for hemoglobin and hematocrit levels
C) Place clean disposable pads to collect any drainage
D) Monitor uterine contractions
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Q38

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of:

Multiple Choice
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A) Anxiety due to hospitalization.
B) Worsening disease and impending convulsion.
C) Effects of magnesium sulfate.
D) Gastrointestinal upset.
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Q39

Which order should the nurse expect for a patient admitted with a threatened abortion?

Multiple Choice
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A) Bed rest
B) Ritodrine IV
C) NPO
D) Narcotic analgesia every 3 hours, prn
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Q40

What finding on a prenatal visit at 10 weeks could suggest a hydatidiform mole?

Multiple Choice
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A) Complaint of frequent mild nausea
B) Blood pressure of 120/80 mm Hg
C) Fundal height measurement of 18 cm
D) History of bright red spotting for 1 day, weeks ago
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Q41

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that:

Multiple Choice
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A) Bed rest and analgesics are the recommended treatment.
B) She will be unable to conceive in the future.
C) A D&C will be performed to remove the products of conception.
D) Hemorrhage is the major concern.
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Q42

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion?

Multiple Choice
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A) Chromosomal abnormalities
B) Endocrine imbalance
C) Infections
D) Immunologic factors
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Q43

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve:

Multiple Choice
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A) Corticosteroids to reduce inflammation.
B) IV therapy to correct fluid and electrolyte imbalances.
C) An antiemetic, such as pyridoxine, to control nausea and vomiting.
D) Enteral nutrition to correct nutritional deficits.
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Q44

[Multiple Response] A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include (Select all that apply):
a. Iron supplementation.
b. Resumption of intercourse at 6 weeks following the procedure.
c. Referral to a support group if necessary.
d. Expectation of heavy bleeding for at least 2 weeks.
e. Emphasizing the need for rest.

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Q45

[Multiple Response] The reported incidence of ectopic pregnancy in the United States has risen steadily over the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (Select all that apply):
a. Pelvic pain
b. Abdominal pain
c. Unanticipated heavy bleeding
d. Vaginal spotting or light bleeding
e. Missed period

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