A 12-week pregnant client presents for a routine checkup. She reports no vaginal bleeding or cramping, but her last fetal heartbeat detected on ultrasound is absent. The cervix is closed, and the client feels no fetal movement. Which type of miscarriage does the nurse suspect?

Threatened miscarriage

Incomplete miscarriage

Missed miscarriage

Inevitable miscarriage

Answer and Explanation

The Correct Answer is C

A. A threatened miscarriage is characterized by vaginal bleeding, mild cramping, and a closed cervix, but the fetus is still viable with a detectable heartbeat. In this case, the fetal heartbeat is absent, making a threatened miscarriage unlikely.

B. An incomplete miscarriage occurs when some products of conception have been expelled while others remain in the uterus. It is usually accompanied by heavy bleeding, cramping, and an open cervix. This client has a closed cervix and no bleeding, ruling out an incomplete miscarriage.

C. A missed miscarriage occurs when the fetus has died in utero but has not been expelled. The client may have no symptoms—no bleeding or cramping—and the cervix remains closed. Ultrasound confirms the absence of fetal cardiac activity, which matches this presentation. Missed miscarriages often require medical or surgical management to prevent complications such as infection or coagulopathy.

D. An inevitable miscarriage is indicated by vaginal bleeding, cramping, and cervical dilation, suggesting that miscarriage is in progress and cannot be prevented. Since this client has a closed cervix and no active bleeding, an inevitable miscarriage is unlikely.

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Correct Answer is ["A"]

Explanation

A. The client shows signs of magnesium sulfate toxicity: oliguria (urine output <30 mL/hr) and absent deep-tendon reflexes. These are potentially life-threatening signs that require immediate intervention, including preparing for emergent delivery if maternal or fetal status is unstable. Stopping the magnesium infusion and preparing for emergency interventions is critical.

B. Administering Vitamin K is not indicated in this scenario. Vitamin K is used to treat or prevent coagulopathy, such as in newborns or clients on certain anticoagulants, but it does not counteract magnesium toxicity.

C. Increasing the magnesium sulfate infusion would worsen toxicity. The correct action is to stop the infusion immediately and prepare to administer calcium gluconate as an antidote if prescribed.

D. Assessing maternal glucose levels is unrelated to the immediate concern of magnesium toxicity. While glucose monitoring may be part of overall prenatal care, it is not a priority in this emergent situation.

E. Placing the client in Trendelenburg position is not indicated. Positioning does not treat magnesium toxicity and could worsen respiratory compromise in a client with severe preeclampsia. The priority is stopping magnesium, assessing maternal and fetal status, and preparing for emergency delivery if necessary.

A. Repeat the 1-hour test tomorrow B. Schedule a 3-hour oral glucose tolerance test for diagnostic confirmation C. Begin insulin therapy immediately D. Reassure the patient that the result is normal; no further testing is needed

Correct Answer is B

Explanation

A. Repeating the screening test is not standard practice. A screening value above the threshold requires a diagnostic test, not a repeat screening.

B. The 1-hour 50-gram glucose challenge is a screening test for gestational diabetes mellitus (GDM). A blood glucose level of ≥140 mg/dL (some guidelines use 130 mg/dL) indicates a positive screen. The next step is a 3-hour, 100-gram OGTT, which is the diagnostic test to confirm or rule out GDM.

C. Initiating insulin therapy is premature. Diagnosis of GDM requires confirmation by the 3-hour OGTT. Treatment decisions, including diet, exercise, or insulin therapy, are based on confirmed diagnosis and blood glucose patterns.

D. A 1-hour glucose level of 150 mg/dL exceeds the normal screening threshold, so further diagnostic testing is required. Reassuring without follow-up could miss a diagnosis of GDM, increasing maternal and fetal risks.

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A 12-week pregnant client presents for a routine checkup. She reports no vaginal bleeding or cramping, but her last fetal heartbeat detected on ultrasound is absent. The cervix is closed, and the client feels no fetal movement. Which type of miscarriage does the nurse suspect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has preeclampsia and is being treated with magnesium sulfate IV. The client's urine output for the past hour is 25 mL and deep-tendon reflexes are absent. Which of the following actions should the nurse take? (Select all that apply)

Correct Answer is ["A"]

Explanation

A 26-year-old pregnant woman at 26 weeks gestation is undergoing a 1-hour glucose challenge screening. She drinks the 50-gram glucose solution, and her blood glucose is measured 1 hour later at 150 mg/dL. Which of the following is the most appropriate next step?

Correct Answer is B

Explanation

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