Acute wk 6 high risk pregnancy notes/practice questions

Nurses can advise their patients that which of these signs precede labor? Select all that apply. A return of urinary frequency as a result of increased bladder pressure Persistent low backache from relaxed pelvic joints Stronger and more frequent uterine (Braxton Hicks) contractions A decline in energy, as the body stores up for labor Uterus sinks downward and forward in first-time pregnancies.

A return of urinary frequency as a result of increased bladder pressure Persistent low backache from relaxed pelvic joints Stronger and more frequent uterine (Braxton Hicks) contractions

A client, 18 weeks pregnant, is concerned because she had a fever and rash about 2 ½ weeks ago. The RN's best response is A. "It's best to talk with the MD about that" B. "It's unlikely the fetus would be affected as the first trimester is the most important time" C. "What do you think the problems are with that?" D. "Are you thinking you may have to terminate the pregnancy?"

A. "It's best to talk with the MD about that" The MD is the best person to address it, because you're most likely only going to be able to provide possibilities ("it's maybe this, or maybe that"). You can do a little reassurance that most problems occur in the first trimester, but that's not true that no issues will happen in other trimesters, so B is wrong. C is not appropriate, and D is a stretch.

A 36 y/o female client has a hemoglobin level of 14 g/dL and a hematocrit of 42%, 24 hrs after a dilation and curettage (D&C). Which of the following findings should the RN expect to find when assessing the client? A. Capillary refill of less than 3 seconds B. Pale mucous membranes C. Respirations 36 breaths per minute D. Complains of fatigue with ambulation

A. Capillary refill of less than 3 seconds D&C: dilating of the cervix and then going in with a scooper and scooping everything out → they do this for women with retained placental parts after labor, OR for older women (instead of removing uterus and causing prolapse, they go in and destroy endometrium).

A primigravida client is 34 weeks' gestation is experiencing contractions every 3- 4 mins lasting 35 seconds. Her cervix is 2 cm dilated and 50% effaced. While the RN is assessing the client's VS, the client says, "I think my water just broke". Which of the following would the RN do first? A. Check the status of the fetal heart rate B. Turn the client to her right side C. Test the leaking fluid with nitrazine paper D. Perform a sterile vaginal examination

A. Check the status of the fetal heart rate This woman is in labor. Premature, but in labor. She's dilated and only effaced 50%. Are you worried about the fluid that is coming out? Would it be your priority to check the fluid coming out? No. Nitrazine paper is not very reliable. We already know she's in labor and she's going to have her baby, so the fluid coming out is not really a high priority. You want to check the baby! The gush of fluid coming out can cause cord prolapse and pressure change, which can affect the baby, so you want to check the baby. Vaginal exam would be ok but check the baby first. ● Aside: Sometimes when turning to the left side doesn't change anything, you could turn them to the right side. ● You usually wouldn't do a vaginal exam unless something has changed

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: uterine contractions occurring every 8 to 10 minutes a fetal heart rate (FHR) of 180 with absence of variability the client needing to void rupture of the client's amniotic membranes

a fetal heart rate (FHR) of 180 with absence of variability The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. This FHR is non-reassuring. The oxytocin should be immediately discontinued and the physician should be notified. This is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is non-reassuring or the client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.

pregnant women with asthma

have more exacerbations. need to weigh risk and benefit for steroid treatment

The nurse is reviewing the lab tests of four prenatal clients. Which lab finding would support the diagnosis of hyperemesis gravidarum? hypocalcemea hypokalemia hypercalcemia hyperkalemia

hypokalemia

The nurse is teaching a client with diabetes about insulin requirements during pregnancy. Which statement should the nurse include regarding insulin requirements? Insulin needs increase in the second trimester increase in the second trimester decrease early in the third trimester decrease late in the third trimester

increase in the second trimester Insulin needs in pregnancy increase after 12 weeks and continue to rise until delivery

Fetal well-being during labor is assessed by: the response of the fetal heart rate (FHR) to uterine contractions (UCs). maternal pain control. accelerations in the FHR. an FHR greater than 110 beats/min.

the response of the fetal heart rate (FHR) to uterine contractions (UCs). Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being.

The breasts of a bottle-feeding woman are engorged. The nurse should tell her to: wear a snug, supportive bra. allow warm water to soothe the breasts during a shower. express milk from breasts occasionally to relieve discomfort. place absorbent pads with plastic liners into her bra to absorb leakage.

wear a snug, supportive bra. A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners keep the nipples and areola moist, leading to excoriation and cracking.

An RN is caring for a client in labor who is receiving oxytocin (Pitocin) by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the RN that the infusion needs to be discontinued? A. 3 contractions occurring within a 10 minute period B. A fetal heart rate of 90 beats per minute C. Adequate resting tone of the uterus palpated between contractions D. Increased urinary output

B. A fetal heart rate of 90 beats per minute A is not right because it's >5, not 3. C is good to have. D doesn't tell you anything.

A client who is pre-eclamptic complains of blurred vision and scotomata to the RN. The RN should report this as indicating which of the following conditions? A. Glaucoma B. Cerebral edema C. Spinal cord injury D. Hydrocephalus

B. Cerebral edema

When reviewing the prenatal records of a 16 y/o primigravida client at 36 weeks' gestation dx with severe pre-eclampsia (PIH), the RN would interpret which of the following as most indicative of the client's dx? A. BP of 138/94 mm B. Severe blurring of vision C. Less than 2g protein in a 24 hr urine sample D. Wt gain of 0.5 pounds in 1 week

B. Severe blurring of vision "Severe" clues you in here. We didn't talk about 24 hr urine samples much, but here it with that answer choice it also includes "less than" and urine sample with less than 2g protein is nothing too concerning.

An RN is monitoring a client in labor. The RN suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction? A. Early deceleration B. Variable decelerations C. Late decelerations D. Short-term variability

B. Variable decelerations

A client in her 36th week of pregnancy is admitted to the maternity unit in effort to control the further development of eclampsia. She is assigned to a private room. The best rationale for this assignment is: A. The client is financially able to afford it B. The client would be distrubed if placed in a room where another mother was in active labor C. A quiet, darkened room is important to reduce external stimuli D. A rigid regimen is an important aspect of eclampsia care

C. A quiet, darkened room is important to reduce external stimuli Not A because do you need to know the body surface area? No. Also, a large body surface area would be a problem, not a small body surface area. ● Aside: They can be premature but not necessarily small for gestational age. ● What's very, very low weight? Less than 1,000 grams

While the client is in active labor with twins and the cervix is 5 cm dilates, the nurse observes contractions occurring at a rate of every 7 to 8 minutes in a 30-minute period. Which of the following would be the nurse's most appropriate action? Contact provider due to dystonic labor Direct patient to pant and blow during contractions Note the fetal heart patterns Apply O2 at 6 L via mask

Contact provider due to dystonic labor The nurse should contact the provider immediately because the client is most likely experiencing hypotonic uterine (dystonic labor) contractions. These contractions tend to be painful but ineffective. The usual treatment is oxytocin augmentation, unless cephalopelvic disproportion exist.

Rho(D) immune globulin (RhoGAM) is ordered for a client before she is discharged after a spontaneous abortion. The nurse understands that the rationale for administration is to prevent which of the following? A. Development of future Rh-positive fetus B. An antibody response to Rh-negative blood C. A future pregnancy resulting in abortion D. Development of Rh-positive antibodies

D. Development of Rh-positive antibodies RhoGAM is not given on an individual basis. They will always give it to you if you are negative and have a baby who is positive Rh.

A neonatal RN would be aware that a small-for-gestational-age (SGA) infant is more likely to develop which neonatal complication? A. Infantile seizures B. Hyperglycemia C. Respiratory distress D. Hypothermia

D. Hypothermia Another thing they're at risk for is respiratory distress, but often the cause of that is premature, not necessarily SGA.

An RN assists in the vaginal delivery of a newborn infant. After the delivery, the RN observes the umbilical cord lengthen and a spurt of blood from vagina. The RN documents these observations as signs of A. Hematoma B. Placenta previa C. Uterine atony D. Placental separation

D. Placental separation

An RN is caring for a client in labor. The RN determines that the client is beginning the second stage of labor when which of the following assessments is noted? A. The client begins to expel clear vaginal fluid B. The contractions are regular C. The membranes have ruptured D. The cervix is dilated completely

D. The cervix is dilated completely The only thing that is stage-related is the cervix is dilated and fully effaced.

Which of the following conditions would cause an insulin-dependent diabetic client the most difficult during her pregnancy? Rh incompatibility Placenta previa Pregnancy induced hypertension Hyperemesis gravidarum

Hyperemesis gravidarum Considering patients with DM 1 have a difficult enough time managing blood glucose when not pregnant, hyperemesis gravidum, which persists through pregnancy unlike "morning sickness" is a of major concern.

On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. What is a correct interpretation of the data? The fetal presenting part is 1 cm above the ischial spines. Effacement is 4 cm from completion. Dilation is 50% completed. The fetus has achieved passage through the ischial spines.

The fetal presenting part is 1 cm above the ischial spines. Station of -1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. Progress of effacement is referred to by percentages, with 100% indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation. Progress of effacement is referred to by percentages, with 100% indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation. Passage through the ischial spines with internal rotation would be indicated by a plus station such as +1.

cord prolapse steps

The usual priority is as follows:1. Change maternal position (side to side, knee chest).2. Discontinue oxytocin if infusing.3. Administer oxygen at 8 to 10 L/min by nonrebreather face mask.4. Notify physician or nurse-midwife.5. Assist with vaginal or speculum examination to assess for cord prolapse.6. Assist with amnioinfusion if ordered.7. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected

Which of the following would the nurse include when describing the pathophysiology of gestational diabetes? There is abnormal progressive resistance to the effects of insulin Glucose levels decrease to accommodate fetal growth Hypoinsulinemia develops early in the first trimester Pregnancy fosters the development of carbohydrate cravings

There is abnormal progressive resistance to the effects of insulin While some insulin resistance is a normal development in last term, theorized to allow growth of fetus, GDM features an abnormal progression.

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, the nurse includes which information? "Because this is a repeat procedure, you are at the lowest risk for complications." "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." "Because this is your second cesarean birth, you will recover faster." "You will not need preoperative teaching because this is your second cesarean birth."

"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." This statement is not accurate. Maternal and fetal risks are associated with every cesarean section. This statement is the most appropriate. This statement is not accurate. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours Lull: no contractions; dilation stable; duration of 20 to 60 minutes Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours. No official "lull" phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.

A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? Amnioinfusion Platelet infusion Immediate Csection Activity limited to bed rest

Activity limited to bed rest Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client's bleeding.

A nurse in the labor room is caring for a patient who is in the active phase of labor and is being induced with oxytocin. The nurse is assessing the fetal patterns and notes two late deceleration on the monitor strip within 20 minutes. The most appropriate nursing action is to: Have the patient move to supine position Increase the oxytocin rate per protocol Document the findings and continue to monitor the fetal patterns Administer oxygen via face mask and notify the provider

Administer oxygen via face mask and notify the provider Late decelerations are due to uteroplacental insufficiency as the result of decreased blood flow and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore oxygen is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The patient should be turned to her LEFT side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous Pitocin infusion is discontinued when a late deceleration is noted.

After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. The nurse should anticipate which actions in the patient's plan of care? Select all that apply. Keeping the head of bed elevated at all times Administration of oral analgesics Avoid caffeine Assisting with a blood patch procedure Frequent monitoring of vital signs

Administration of oral analgesics Assisting with a blood patch procedure Frequent monitoring of vital signs The nurse should suspect the patient is suffering from a postdural puncture headache (PDPH). Characteristically, assuming an upright position triggers or intensifies the headache, whereas assuming a supine position achieves relief (Hawkins and Bucklin, 2012). Conservative management for a PDPH includes administration of oral analgesics and methylxanthines (e.g., caffeine or theophylline). Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. Close monitoring of vital signs is essential.

When providing prenatal education to a pregnant woman with asthma, which of the following would be important for the nurse to do? Teach subcutaneous delivery of broncodilators Demonstrate how to assess capillary glucose Advise the patient seeks treatment for any exacerbation Explain why inhaled corticosteroids are absolutely contraindicated in pregnancy

Advise the patient seeks treatment for any exacerbation Immediate attention to exacerbation of asthma is no different during pregnancy. Bronchodilators are inhaled. Corticosteriod maintainence inhalers are not abandoned.

A Nurse is monitoring a client in labor who is receiving oxytocin (Pitocin) and notes that the client is experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse takes (#1 correlates to the first action). A. Stop the oxytocin B. Perform a vaginal examination C. Reposition the client D. Check the client's BP and HR E. Administer oxygen by face mask at 8-10 L/min

Answer: A, C, E, B, D. So we want to do all of these, but what is the order of priority? Hypertonic → strong contractions, too strong What do you have to know it's strong → high pressured → need intrauterine monitoring (superficial monitoring doesn't cut it) Absolutely stop the oxytocin. Then reposition to increase perfusion (perfusion is an issue because the uterus is contracting so much that it's not getting enough perfusion). Then put oxygen on → the uterus could be hypoxic and the baby could be squeezed as well (hypoxic) to oxygen. Then vaginal examination because you want to check on the baby (they might be in the process of labor). Then check the pt's BP and HR because that's less prioritized over the baby. Take VS AFTER you check the status of labor. Strong pushing contractions → you want to make sure effaced...damage to uterus, cervix, impact on baby if you squeeze too much, etc. You really have to assess what those strong contractions have done to all of that. VS won't tell you that.

After reinforcing the danger signs to report with a client, gravida 2 at 32 weeks' gestation with an elevated BP, which client statements would demonstrate her understanding of whether to call the MD's office? Select all that apply. A. "If I get up in the morning and feel dizzy, even if it goes away" B. "I need to call the hospital right away if I see bleeding, even if I have no pain" C. "I have a pounding headache that doesn't go away" D. "I notice the veins in my legs getting bigger" E. "The leg cramps at night are waking me up" F. "The baby seems to be more active than usual"

B. "I need to call the hospital right away if I see bleeding, even if I have no pain" C. "I have a pounding headache that doesn't go away" A is less concerning because of the fact that the dizziness did go away. B is correct because it's "bleeding" and not just spotting. D isn't it because enlarged superficial veins are not of concern. What is of concern is when there is edema (fluid shifting into intravascular space). E isn't specifically tied to pre-eclampsia or it getting worse to eclampsia, so you wouldn't pick this (although it's not necessarily normal either). F is not it either because babies can be active. Tinah, aside: D can be very variable...people who are darker skinned have easier, superficial veins to draw blood from? Fair skinned people have smaller veins that are deeper and harder to draw blood from?

An RN is preparing to care for a client in labor. The MD has prescribed an IV infusion of Pitocin. The RN ensures that which of the following is implemented before initiating the IV A. Place client on complete bed rest B. Continuous electronic fetal monitoring C. An IV infusion of antibiotics D. Code cart at bedside

B. Continuous electronic fetal monitoring

When caring for a multigravida client admitted to the hospital with vaginal bleeding at 38 weeks' gestation, which of the following would the RN anticipate administering intravenously if the client develops disseminated intravascular coagulation (DIC)? A. Ringer's lactate solution B. Fresh frozen plasma C. 5% dextrose solution D. Warfarin sodium (Coumadin)

B. Fresh frozen plasma They're going to bleed out so you need everything in plasma (has clotting factors and proteins, etc anything but RBCs). We know warfarin is wrong. LR is going to dilute things and not do anything, same with dextrose. So it's B, fresh frozen plasma. In DIC, all the clotting factors are used up, so you'll need to provide the clotting factors. Don't give platelets because that would exacerbate the situation?

An RN explains the purpose of effleurage to a client in early labor. The RN tells the client that effleurage is: A. A form of biofeedback to enhance bearing down efforts during delivery B. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus C. The application of pressure to the sacrum to relieve backache D. Performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest

B. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus It's good to know stuff about effleurage, doulas, and things that give women comfort during labor. C is a thing but that's not effleurage.

A 17 y/o pregnant client is being treated by a dermatologist for acne. The clinic RN asks the clinic RN asks the client about hte tx prescribed for acne, knowing that, which tx is contraindicated for acne? A. Exfoliation B. Oral isotretinoin C. Topical erythromycin ointment D. Cleansing antibacterial soap

B. Oral isotretinoin This is an absolute contraindication. Also, even if we don't know → all the other ones are external so you know they wouldn't affect the woman much. This treats severe acne, and actually they put you on birth control when on this to further prevent possibility of pregnancy.

A 28 y/o multigravid client at 37 weeks' gestation arrives at the ED via ambulance with a BP of 160/104 mmHg and 3+ reflexes without clonus. The client, who is dx with severe pre-eclampsia, asks the RN, "What is the cure for my high BP?" Which of the following would the RN ID as the primary cure? A. Administration of glucocorticoids (Betamethasone) B. Vaginal or cesarean delivery of the fetus C. Sedation with phenytoin (Dilantin) D. Reduction of fluid retention with thiazide diuretics

B. Vaginal or cesarean delivery of the fetus End the pregnancy! 3+ reflexes is hyper reflex response. Clonus means it's on and off (of contractions), not like a cramp.

A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? Increased maternal urinary output Baseline FHR is reduced to 90 BPM Variable accelerations on FHR graph 3 contractions lasting 60 seconds in 15 minutes

Baseline FHR is reduced to 90 BPM Bradycardia is a sign of significant fetal stress. The Oxytocin infusion must be stopped per protocol.

A woman is evaluated to be using an effective bearing-down effort if she: begins pushing as soon as she is told that her cervix is fully dilated and effaced. takes two deep, cleansing breaths at the onset of a uterine contraction and at the end of the contraction. uses the Valsalva maneuver by holding her breath and pushing vigorously for a count of 12. continues to push for short periods between uterine contractions throughout the second stage of labor.

Bearing-down efforts should begin during the active-descent phase of the second stage of labor when the urge to bear down (Fresno reflex) is perceived. Cleansing breaths at the onset of a contraction allow it to build to a peak before pushing begins. They also enhance gas exchange in the alveoli and help the woman relax after the uterine contraction subsides. Women should avoid closed-glottis pushing (Valsalva maneuver) since uteroplacental perfusion is usually reduced. Open-glottis pushing is recommended. The woman should push with contractions to combine the force of both powers of labor: uterine and abdominal. Pushing gently between contractions is only advised when the fetal head is being delivered. uses the Valsalva maneuver by holding her breath and pushing vigorously for a count of 12.Bearing-down efforts should begin during the active-descent phase of the second stage of labor when the urge to bear down (Fresno reflex) is perceived. Cleansing breaths at the onset of a contraction allow it to build to a peak before pushing begins. They also enhance gas exchange in the alveoli and help the woman relax after the uterine contraction subsides. Women should avoid closed-glottis pushing (Valsalva maneuver) since uteroplacental perfusion is usually reduced. Open-glottis pushing is recommended. The woman should push with contractions to combine the force of both powers of labor: uterine and abdominal. Pushing gently between contractions is only advised when the fetal head is being delivered.

An RN in the labor room is caring for a client in the active stage of labor. The RN is assessing the fetal patterns and notes late decelerations on the monitor strip. The most appropriate nursing action is to: A. Place the mother in a supine position B. Document the findings and continue to monitor the fetal patterns C. Administer oxygen via face mask D. Increase the rate of the oxytocin (Pitocin) IV infusion

C. Administer oxygen via face mask Fetal Heart Rate Monitoring → mnemonic to remember is VEAL CHOP Other things to do: turn mom to her side, give the mom a bolus,

The MD orders whole blood replacement for a multigravida client with abruptio placentae. Before administering the IV blood product, which of the following should the RN do first? A. Validate client information and the blood product with another RN. B. Check VS before transfusing over 5-6 hrs C. Ask the client if she has ever had any allergies D. Administer 100mL of 5% dextrose solutions IV

C. Ask the client if she has ever had any allergies Which one don't you ever do? D → dextrose cannot be used, use NS. B is wrong because you can only transfuse blood over a period of 4 hours (increases bacterial contamination risk if >4 hrs) How do you separate A & C? Which one comes first? You want to validate client information first. HOWEVER, in this choice, it's saying you already have the blood product at bedside so you're essentially positive and ready to give it at that point (remember: the process to get blood transfusion has many steps and if it's already at bedside you're giving it now). So C is correct because you need to verify for allergies before you give medications. Also it says "any allergies", so you want to know that at the beginning of the encounter, and so that step comes first. This is a sneaky question... ● Aside: Usually in peds we just premedicate with Benadryl and Tylenol as preventive measures for reactions (non-anaphylaxis).

The physician orders IV magnesium sulfate for a primigravida client at 38 weeks' gestation dx with severe pre-eclampsia (PIH). Which of the following medications would the RN have readily available at the client's bedside? A. Diazepam (Valium) B. Hydralazine (Apresoline) C. Calcium gluconate D. Phenytoin (dilantin)

C. Calcium gluconate C is the antidote for magnesium sulfate.

A multigravida client thought to be at 14 weeks' gestation reports that she is experiencing such severe morning sickness that she has not been able to keep anything down for a week". The RN should assess for signs and symptoms of which of the following? A. Hypercalcemia B. Hypobilirubinemia C. Hypokalemia D. Hyperglycemia

C. Hypokalemia That follows for anyone with severe vomiting.

For a multigravida client at 39 weeks' gestation with suggested HELLP syndrome, the RN would immediately notify the MD for which of the following lab test results A. Hyperfibrinogenemia B. Decreased liver enzymes C. Thrombocytopenia D. Hypernatremia

C. Thrombocytopenia HELLP says low platelet in the name...thrombocytopenia. Hypernatremia is not specific to HELLP.

A multigravida client at 32 weeks' gestation has experienced hemolytic disease of the newborn in a previous pregnancy. The RN would prepare the client for frequent antibody titer evaluation obtained from which of the following? A. Placental blood B. Amniotic fluid C. Fetal blood D. Maternal blood

D. Maternal blood

During a home visit to a 16 y/o client at 34 weeks' gestation dx with mild pre- eclampsia (PIH), assessment reveals that the client has gained 2 lbs in the past week and her current BP is 130/86 mmHg. Which of the following assessment findings would provide further evidence to support the client's dx? A. Pounding headache after reading B. Hx of UTI C. Frequent voiding in large amounts D. Mild edema in hands and face

D. Mild edema in hands and face Mild edema is okay, but because it's in her hands and face we know it's not dependent, so this is a preeclampsia sign. It's more systemic than dependent edema.

A nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate? Reposition the mother and check the fetal tracings after 2 minutes Take the mother's VS and the mother she must be on bedrest to conserve O2 Document the findings and tell the mother that the monitor indicates fetal well-being Notify the provider of these findings

Document the findings and tell the mother that the monitor indicates fetal well-being Accelerations and variability (episodic)

A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the following would the nurse be alert? Pelvic Inflammatory disease Endometritis Salpingitis Thrombophlebitis

Endometritis Endometritis is an infection of the uterine lining and can occur after prolonged rupture of membranes. Infection with pelvic involvement does not occur after a strong labor and prolonged rupture of membranes. Salpingitis is a tubal infection and could occur if endometritis is not treated. Pelvic thrombophlebitis involves a clot formation but it is not a complication specifically of prolonged rupture of membranes.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What findings indicate that preterm labor may be occurring? CORRECT Estriol is found in maternal saliva. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. Fetal fibronectin is present in vaginal secretions. The cervix is effacing and dilated to 2 cm. Fetal heart rate of 150 beats/minute

Estriol is found in maternal saliva. The cervix is effacing and dilated to 2 cm. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation.E. Fetal heart rate is normal.

When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider? Select all that apply. Maternal blood pressure of 108/79 Maternal heart rate of 98 Respiratory rate of 14 breaths/min Fetal heart rate of 100 beats/min Minimal variability on a fetal heart monitor

Fetal heart rate of 100 beats/min Minimal variability on a fetal heart monitor After induction of the anesthetic, maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. If signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given.

Which statement is most likely to be associated with a breech presentation? Least common malpresentation Descent is rapid Diagnosis by ultrasound only High rate of neuromuscular disorders

High rate of neuromuscular disorders Breech is the most common malpresentation affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as is the fetal head. Diagnosis is made by abdominal palpation and vaginal examination. It is confirmed by ultrasound. Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus.

A client with type 1 DM who is a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 DM: Nonstress testing is performed weekly until 32 weeks' gestation Induction of labor at 34 weeks' gestation. Weekly fetal movement counts are made by the mother Contraction stress testing is performed weekly

Nonstress testing is performed weekly until 32 weeks' gestation For most clients with type 1 DM non-stress testing is done weekly until 32 weeks' gestation and twice a week to assess fetal well-being.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? Notify nursery nurse of imminent delivery. Insert a Foley catheter. Start oxytocin (Pitocin). Notify the primary health care provider immediately (HCP).

Notify the primary health care provider immediately (HCP). This is not the most important nursing measure at this time. The patient needs to be evaluated by the HCP immediately to determine whether delivery is warranted at this time. If the FHR were to continue in an abnormal or non-reassuring pattern, a cesarean section may be warranted. This would require the insertion of a Foley catheter; however, the physician must make that determination. Oxytocin may put additional stress on the fetus. To relieve an FHR deceleration, the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? INCORRECT Fetal heart rate of 116 beats/min Cervix dilated 2 cm and 50% effaced Score of 8 on the biophysical profile One fetal movement noted in 1 hour of assessment by the mother

One fetal movement noted in 1 hour of assessment by the mother A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a 42-week gestation woman. A score of 8 on the BPP is a normal finding in a 42-week gestation pregnancy. Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? CORRECT Place the woman in the knee-chest position. Cover the cord in a sterile towel saturated with warm normal saline. . Prepare the woman for a cesarean birth. Start oxygen by face mask.

Place the woman in the knee-chest position. A. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. B. If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although this is an appropriate intervention, relieving pressure on the cord is the nursing priority. C. If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete. D. The nurse should administer O2 by facial mask at 8 to 10 L/min until delivery is complete. This intervention should be initiated after pressure is relieved on the cord. Not only should the woman be placed in knee-chest position, the nurse may also use her gloved hand or two fingers to lift the presenting part off the cord.

Gina, a 40-year-old multigravida with NYHA class III heart failure and Afib visits the clinic at 34 weeks' gestation. The nurse should instruct Gina to: Maintain absolute bed rest through the remainder of the pregnancy Contact the doctor if pulse is more that 80 beats per minute Plan for a cesarean section delivery before term Continue taking prescribed warfarin tablets daily

Plan for a cesarean section delivery before term This complex pregnancy will require Csection. Warfarin is contraindicated in pregnancy. Absolute b.edrest is not necessary. A pulse of 80 is not concerning for Afib nor pregnancy

The maternity nurse should notify the health care provider about which assessment findings during labor? Select all that apply. Positive urine drug screen Blood glucose level of 78 mg/dL Increased systolic blood pressure during first stage Elevated white blood cell count Oral temperature of 99.8° F Respiratory rate of 10 breaths/min

Positive urine drug screen Increased systolic blood pressure during first stage Respiratory rate of 10 breaths/min

A patient with pregnancy-induced hypertension exhibits which of the following symptoms alerting the nurse preeclampsia is a concern? Proteinuria, headaches, double vision Proteinuria, headaches, vaginal bleeding Proteinuria, double vision, uterine contractions Headaches, double vision, vaginal bleeding

Proteinuria, headaches, double vision A patient with pregnancy-induced hypertension complaining of headache, double vision, needs a urine specimen which could reveals proteinuria. Vaginal bleeding and uterine contractions are not associated with pregnancy-induces hypertension.

After completing a postpartum assessment on woman who delivered 20 hours ago, the nurse should report which assessment findings to the health care provider? Select all that apply. Temperature 100.0° F Pulse 110 beats/min Respiratory rate 12 breaths/min Blood pressure 125/78 Temperature 38° C

Pulse 110 beats/min Temperature 38° C During the first 24 hours postpartum, temperature may increase to 38° C (100.4° F) Pulse, remains elevated for the first hour or so after childbirth. It then begins to decrease to a nonpregnant rate. A rapid pulse may indicate hypovolemia. Respiratory rate is normal. Blood pressure is altered slightly if at all postpartum.

Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta? Premature rupture of membranes Excessive vaginal bleeding Tachysystolic contractions Rigid, boardlike abdomen

Rigid, boardlike abdomen The most common assessment finding in a client with abruption placenta is a rigid or boardlike abdomen. Pain, usually reported as a sharp stabbing sensation high in the uterine fundus with the initial separation, also is common. Bleeding is occult and not usually apparent.

Which description of postpartum restoration or healing times is accurate? The cervix shortens, becomes firm, and returns to form within a month postpartum. Rugae reappear within 3 to 4 weeks. Most episiotomies heal within a week. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

Rugae reappear within 3 to 4 weeks. The cervix regains its form within days; the cervical os may take longer. Rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? Semirecumbent Sitting Squatting Side-lying

Squatting A.A semirecumbent position does not assist in increasing the size of the pelvic outlet.B.Although sitting may assist with fetal descent, this position does not increase the size of the pelvic outlet.C.Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet.D.A side-lying position is unlikely to assist in increasing the size of the pelvic outlet.

For a patient in active labor, the nurse-midwife plans to use an internal electronic fetal monitoring (EFM) device. What must occur before the internal EFM can be applied? Fetal position must be 0 station Cervix must be completely effaced and dilated The membranes must rupture The patient must receive anesthesia

The membranes must rupture Internal EFM can be applied only after the patient's membranes have ruptures, when the fetus is at least at the -1 station, and when the cervix is dilated at least 2 cm. although the patient may receive anesthesia, it is not required before application of an internal EFM device.

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? Encourage her to empty her bladder. Decrease her intravenous (IV) rate to a keep vein-open rate. Turn the woman to the left lateral position or place a pillow under her hip. No action is necessary since a decrease in the woman's blood pressure is expected.

Turn the woman to the left lateral position or place a pillow under her hip. Encouraging the woman to empty her bladder will not help the hypotensive state and may cause her to faint if she ambulates to the bathroom. The IV rate should be kept at the current rate or increased to maintain the appropriate perfusion. Turning the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor's or nurse midwife's instruction. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken.

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth? CORRECT Unstable coronary artery disease Previous cesarean birth Placenta previa Initial blood pressure of 132/87 History of three spontaneous abortions

Unstable coronary artery disease Previous cesarean birth Placenta previa Indications for cesarean birth include: Maternal· Specific cardiac disease (e.g., Marfan syndrome, unstable coronary artery disease)· Specific respiratory disease (e.g., Guillain-Barré syndrome)· Conditions associated with increased intracranial pressure· Mechanical obstruction of the lower uterine segment (tumors, fibroids)· Mechanical vulvar obstruction (e.g., extensive condylomata)· History of previous cesarean birthFetal· Abnormal fetal heart rate (FHR) or pattern· Malpresentation (e.g., breech or transverse lie)· Active maternal herpes lesions· Maternal human immunodeficiency virus (HIV) with a viral load of more than 1000 copies/mL· Congenital anomaliesMaternal-Fetal· Dysfunctional labor (e.g., cephalopelvic disproportion, "failure to progress" in labor)· Placental abruption· Placenta previa· Elective cesarean birth (cesarean on maternal request)The blood pressure can be elevated because of pain and is not necessarily a contraindication to vaginal birth until further assessment is completed. Having a history of three spontaneous abortions is not a contraindication to vaginal birth.

Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern? FHR does not change as a result of fetal activity. Average baseline rate ranges between 100 and 140 beats/min. Mild late deceleration patterns occur with some contractions. Variability averages between 6 to 10 beats/min.

Variability averages between 6 to 10 beats/min. FHR should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats/min. Late deceleration patterns are never reassuring, although early and mild variable decelerations are expected, reassuring findings. Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system.

An amniocentesis is performed for a genetic cell analysis. The RN counsels the client that this test cannot be performed until 14 weeks gestation because A. This is when the heartbeat is best heard B. The fetus is not mature enough until this time C. There is not enough amniotic fluid until this time D. The genetic results will not be accurate until this time.

Why does amniocentesis have to wait until 14 weeks? Not enough fluid before that point → you don't want to poke the baby and you don't want to take fluids away from the baby. Amniocentesis is ultrasound-guided and they still poke the baby sometimes → you do not want to poke the baby! Increased risk for miscarriage as well, so some women may even not elect to do this test. If you are concerned about genetic defects or if you know you will abort if your child has a certain genetic defect, then go for it. Otherwise why do this test? Learn and know this information so you can help guide your patients to the answer that suits them best, don't just do the test for the sake of it.

A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse would be to: CORRECT assess the fetal heart rate (FHR) pattern. perform a vaginal examination. inspect the characteristics of the fluid. assess maternal temperature.

assess the fetal heart rate (FHR) pattern. The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy). These are all important and should be done after the FHR and pattern are assessed. These are all important and should be done after the FHR and pattern are assessed. These are all important and should be done after the FHR and pattern are assessed.

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe: weight gain of 1 to 3lbs. quickening. fatigue and lethargy. bloody show.

bloody show. Women usually experience a weight loss of 1 to 3 lbs. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks of gestation. Women usually experience a burst of energy or the nesting instinct. Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens.

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: change in position. oxytocin administration. regional anesthesia. intravenous analgesic.

change in position. Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman's heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position. Oxytocin administration may reduce maternal cardiac output. Regional anesthesia may reduce maternal cardiac output. Intravenous analgesic may reduce maternal cardiac output.

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's IMMEDIATE action would be to: change the woman's position. stop the Pitocin. elevate the woman's legs. administer oxygen via a tight mask at 8 to 10 L/min.

change the woman's position. The woman is already in an appropriate position for uteroplacental perfusion. Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion since Pitocin is an oxytocic that stimulates the uterus to contract. Elevation of her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.

On review of a fetal monitor tracing, the nurse notes that for several contractions, the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should: describe the finding in the nurse's notes. reposition the woman onto her side. call the physician for instructions. administer oxygen at 8 to 10 L/min with a tight face mask.

describe the finding in the nurse's notes. An early deceleration pattern from head compression is described. No action other than documentation of the finding is required since this is an expected reaction to compression of the fetal head as it passes through the cervix. These actions would be implemented when non-reassuring or ominous changes are noted. These actions would be implemented when non-reassuring or ominous changes are noted. These actions would be implemented when non-reassuring or ominous changes are noted.

With regard to systemic analgesics administered during labor, nurses should be aware that: systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. effects on the fetus and newborn can include decreased alertness and delayed sucking. IM administration is preferred over IV administration. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

effects on the fetus and newborn can include decreased alertness and delayed sucking. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is: urinary tract infection. excessive uterine bleeding. a ruptured bladder. bladder wall atony.

excessive uterine bleeding. A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. Excessive bleeding can occur immediately after birth if the bladder becomes distended, because it pushes the uterus up and to the side and prevents it from contracting firmly. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.

A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's MOST appropriate analgesic for pain control is: fentanyl (Sublimaze). promethazine (Phenergan). butorphanol tartrate (Stadol). nalbuphine (Nubain).

fentanyl (Sublimaze). Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Phenergan is not an analgesic. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. Stadol is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nubain is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use.

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that: kidney function returns to normal a few days after birth. diastasis recti abdominis is a common condition that alters the voiding reflex. fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. with adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Excess fluid loss through other means occurs as well. Bladder tone usually is restored 5 to 7 days after childbirth.

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: either hot or cold applications may provide relief, but they should never be used together in the same treatment. acupuncture can be performed by a skilled nurse with just a little training. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response would be to: encourage the woman to breathe more slowly. help the woman breathe into a paper bag. turn the woman on her side. administer a sedative.

help the woman breathe into a paper bag. Just telling her to breathe more slowly does not ensure a change in respirations. The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level. Turning her on her side will not solve this problem. Administration of a sedative could lead to neonatal depression since this woman, being in the transition phase, is near the birth process. The side-lying position would be appropriate for supine hypotension.

When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to: maternal hyperthyroidism. initiation of epidural anesthesia that resulted in maternal hypotension. maternal infection accompanied by fever. alteration in maternal position from semirecumbent to lateral.

initiation of epidural anesthesia that resulted in maternal hypotension. Hyperthyroidism would result in baseline tachycardia. Fetal bradycardia is the pattern described and results from the hypoxia that would occur when uteroplacental perfusion is reduced by maternal hypotension. The woman receiving epidural anesthesia needs to be well hydrated before and during induction of the anesthesia to maintain an adequate cardiac output and blood pressure. A maternal fever could cause fetal tachycardia. Assumption of a lateral position enhances placental perfusion and should result in a reassuring FHR pattern.

A nurse providing care to a woman in labor should be aware that cesarean birth: is declining in frequency in the United States. is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier clients do. is performed primarily for the benefit of the fetus. can be either elected or refused by women as their absolute legal right.

is performed primarily for the benefit of the fetus. Cesarean births are increasing in the United States. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: the drugs can be given efficaciously up to the designated beginning of term at 37 weeks. there are no important maternal (as opposed to fetal) contraindications its most important function is to afford the opportunity to administer antenatal glucocorticoids. if the client develops pulmonary edema while on tocolytics, IV fluids should be given.

its most important function is to afford the opportunity to administer antenatal glucocorticoids. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Tocolytic-induced edema can be caused by IV fluids.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1-day postpartum. Expected findings include: little if any change leakage of milk at let-down swollen, warm, and tender on palpation a few blisters and a bruise on each areola small amount of clear, yellow fluid expressed

little if any change Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used. E. Colostrum, or early milk, a clear, yellow fluid, may be expressed from the breasts during the first 24 hours.

A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: narcotics. barbiturates. methamphetamines. tranquilizers.

methamphetamines Maternal ingestion of narcotics may be the cause of decreased variability. The use of barbiturates may also result in a significant decrease in variability as these are known to cross the placental barrier. The use of illicit drugs, such as cocaine or methamphetamines, might cause increased variability. Tranquilizer use is a possible cause of decreased variability in the fetal heart rate.

With regard to afterbirth pains, nurses should be aware that these pains are: caused by mild, continual contractions for the duration of the postpartum period. more common in first-time mothers. more noticeable in births in which the uterus was overdistended. alleviated somewhat when the mother breastfeeds.

more noticeable in births in which the uterus was overdistended. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large baby or multiple babies overdistend the uterus. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

The nurse is caring for a laboring client with sickle-cell anemia. Which therapy should the nurse anticipate the physician ordering? magnesium sulfate diuretics bronchodilators oxygen

oxygen

The charge nurse on the maternity unit is orienting a new nurse to the unit and explains that the 5 Ps of labor and birth are: Select all that apply. passenger. placenta. passageway. psychologic response. powers. position.

passenger. passageway. psychologic response. powers. position.

What is the nurse's chief concern when a mother who delivered 2 hours ago has a blood pressure change from 112/70 to 142/94? postpartum preeclampsia postpartum psychosis Rh incompatability syndrome fluid overload

postpartum preeclampsia

The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be: progressive uterine contractions with cervical change. lightening. rupture of membranes. passage of the mucous plug (operculum).

progressive uterine contractions with cervical change. Regular, progressive uterine contractions that increase in intensity and frequency are the definitive sign of true labor along with cervical change. Lightening is a premonitory sign indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself. Passage of the mucous plug is a premonitory sign indicating that the onset of labor is getting closer

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: visceral. referred. somatic. afterpain.

referred Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

Nurses should be aware of the difference experience can make in labor pain, such as: sensory pain for nulliparous women often is greater than for multiparous women during early labor. affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. women with a history of substance abuse experience more pain during labor. multiparous women have more fatigue from labor and therefore experience more pain.

sensory pain for nulliparous women often is greater than for multiparous women during early labor. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

Postbirth uterine/vaginal discharge, called lochia: is similar to a light menstrual period for the first 6 to 12 hours. is usually greater after cesarean births. will usually decrease with ambulation and breastfeeding. should smell like normal menstrual flow unless an infection is present.

should smell like normal menstrual flow unless an infection is present. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding. An offensive odor usually indicates an infection.

Concerning the third stage of labor, nurses should be aware that: the placenta eventually detaches itself from a flaccid uterus the duration of the third stage may be as short as 3 to 5 minutes it is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface the major risk for women during the third stage is a rapid heart rate

the duration of the third stage may be as short as 3 to 5 minutes A.The placenta cannot detach itself from a flaccid (relaxed) uterus.B.The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits.C.Which surface of the placenta comes out first is not clinically important.D.The major risk for women during the third stage of labor is postpartum hemorrhage. The risk of hemorrhage increases as the length of the third stage increases.

In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that: the woman's blood pressure increases during contractions and falls back to prelabor normal between contractions. use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. having the woman point her toes reduces leg cramps. the endogenous endorphins released during labor raise the woman's pain threshold and produce sedation.

the endogenous endorphins released during labor raise the woman's pain threshold and produce sedation. Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second stage labor because of a number of potentially unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself. D. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain.

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: the examiner's hand should be placed over the fundus before, during, and after contractions. the frequency and duration of contractions are measured in seconds for consistency. contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. the resting tone between contractions is described as either placid or turbulent.

the examiner's hand should be placed over the fundus before, during, and after contractions. The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.

The nurse knows that the second stage of labor, the descent phase, has begun when: the amniotic membranes rupture. the cervix cannot be felt during a vaginal examination. the woman experiences a strong urge to bear down. the presenting part is below the ischial spines.

the woman experiences a strong urge to bear down. Rupture of membranes has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5 cm of dilation.

With regard to dysfunctional labor, nurses should be aware that: women who are underweight are more at risk. women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted. hypertonic uterine dysfunction is more common than hypotonic dysfunction. abnormal labor patterns are most common in older women.

women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted. Short women more than 30 lbs overweight are more at risk for dysfunctional labor. Precipitous labor lasts less than 3 hours. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women younger than 20 years of age.

The RN assesses the pregnant client who comes to the triage unit and determines that she is at 4/50/-1 and that the fetal HR is 148. What priority information should the RN collect before proceeding? A. Time and amount of last meal B. Number of weeks' gestation C. Who is attending the delivery D. History of previous illnesses.

B. Number of weeks' gestation

A primigravida client at 30 weeks' gestation has been admitted to the hospital with premature rupture of membranes without contractions. Her cervix is 2 cm dilated and 50% effaced. Which of the following would be a priority assessment for this client? A. RBC count B. Degree of discomfort C. Urinary output D. Temperature

D. Temperature Premature rupture of membrane without contractions → exposure! Cervix is open just a tiny bit but not closed. What is the risk that discomfort is going to tell you about? It's not a priority.

While the postpartum client is receiving herapin for thrombophlebitis, which of the following drugs would the nurse Mica expect to administer if the client develops complications related to heparin therapy? Methylegonovine (Methergine) Nitrofurantoin Calcium gluconate Protamine sulfate

Protamine sulfate

most common BP med in preg

labetalol