Ch. 5-7

methods of distract from pain

music, TV, imagery

A nurse is caring for a client in the prenatal clinic who has a possible at topic pregnancy at eight weeks of gestation period which of the following findings should the nurse expect

Pelvic pain

A nurse in a providers office is reinforcing teaching about home care with a client who has mild preeclampsia. Which of the following information should the nurse include in the teaching

Perform daily fetal movement counts

4 "P's"

Power, Passage, Passenger, Psyche

teaching a new LVN about common complication for newborn from maternal gestational diabetes

newborn hypogylcemia

test to confirm rupture of amniotic fluid

nitrazine strip

placenta previa

painless, bright red vaginal blood

ectopic pregnancy at 8 weeks expected finding

pelvic pain

epidural anesthesia block during early labor

place patient in lateral position to relive pressure to improve BP

umbilical cord protruding from vagina

place pt in knee-chest or trendelenberg

fetal heart rate decelerates

place pt in lateral position

late deceleration's on fetal monitoring

position pt on her side then place oxygen

if patient is 39 weeks and heavy vaginal bleeding

prepare for cesarean birth

37 weeks and has placenta previa, why should nurse avoid pelvic exam

profound bleeding

A client has been admitted with a diagnosis of hyperemesis gravid arum. Which of the following order is written by the primary healthcare provider is highest priority for the nurse to complete

Start intravenous electrolyte replacement with multivitamins

prior to onset of labor

"you will experience a surge of energy"

amniocentisis

maturity of lungs

32 weeks, and in labor, medication contraindications

misoprostol

A 39-year-old, 16-week-gravid woman has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences any of the following side effects? Select all that apply. 1. Fever or chills. 2. Lack of fetal movement. 3. Abdominal pain. 4. Rash or pruritus. 5. Vaginal bleeding.

1. Fever or chills 2. Lack of fetal movement 3. Abdominal pain 5. Vaginal bleeding

100mL/60min 60gtt/mL

100gtt/min

A nurse is caring for a client who has gestational diabetes and reports feeling shaky, sweaty, and having blurred vision. The clients blood glucose level is 48. Which of the following foods should the nurse give to the client

120 ML of unsweetened fruit juice, 1 teaspoon honey, five hard candies

how many blood vessels in newborns umbilical cord

2 arteries and 1 vein

math Q 20mg/40mg x 5 mL

2.5mL

expulsion of the placenta occurs during what stage of labor

3rd

which degree of laceration goes through all layers and into rectal mucosa

4th dgree

100mL/200mL x hr

5 hrs

A nurse is counseling a pre eclamptic client about her diet. Which should the nurse encourage the woman to do

Eat a well-balanced diet

A nurse is caring for a client who has just learned that she is pregnant. The nurse should reinforce with the client to call her provider if she experiences which of the following manifestations

Facial edema

A woman eight weeks pregnant is admitted to the obstetric unit with a diagnosis of threatened abortion. Which of the following test would help to determine whether the woman is carrying a viable or non-viable pregnancy

HCG

A client has just been diagnosed with gestational diabetes. She cries, " oh no, I will never be able to give myself shots ", which of the following responses by the nurse is appropriate at this time

If you follow your diet and exercise you will probably need no insulin

A nurse in a prenatal client is caring for a client who is at 38 weeks of gestation and has heavy red vaginal bleeding, without contractions, that started spontaneously. She is in no distress and states that she can feel the baby moving. The client should undergo an ultrasound to determine which of the following findings

Location of placenta

A nurse is assisting with the care of a client who is expecting preterm labor and is scheduled to undergo amniocentesis. The client needs an amniocentesis to determine which of the following findings

Maturity of lungs

A nurse is reinforcing teaching with a client who is pregnant and has a prescription for our Rho(D) immune globulin. Which of the following information should the nurse include

This medication prevents the formation of our RH antibodies by a woman who is RH negative

A nurse is reinforcing teaching with a client who is at 17 weeks of gestation and is scheduled to have a maternal serum alpha-fetiprotein (MSAFFP) determination. Which of the following information should the nurse include

This test will screen for neural tube defect's

A clients 32 week clinic assessment was BP 90/60, temperature 98.6, pulse 92, RR 20, weight 145 LB, and urine negative for proteins. Which of the following findings at the 34 week appointment should the nurse highlight for the certified nurse midwife

Weight 155lb, urine protein +2

patterned paced breathing during 1st stage of labor

assist the client to breath into paper bag

RSA position

breech

amniotomy now in active phase 1st stage labor priority

monitor for a prolapse of umbilical cord

reversal agent for magnesium sulfate

calcium

42 week and primigravidia what will confirm pts in labor

cervical dilation

vaginal exam by doctor: 3cm 30%

cervix is dilated 3cm, effaced 30% and presenting part is 1cm above ischial spine

Immediate by RN

client who has preeclampsia and reports epigastric pain and unresolved headache

true labor

contractions develop a regular pattern that are more intense and frequent, progressive effacement and dilation of cervix occurs, true labor cannot be stopped

Pt with immediate chills postpartum period

cover with warm blankets

meperidine for pain expect and prepare for

decreased respirations in newborn

reduce evaporation heat loss

dry the newborn

natural pain reliever during labor

endorphins

amnitomy whats nurses priority

fetal heart rate pattern, check before and immediately after to detect any changes in feta; status

assess newborn for respiratory distress s/s (select all apply)

grunting, flairing of nostrils, persistent cyanosis, retractions

most desired pelvic structure

gynecoid

to prevent thrombophlebitis after (VBAC) birth

have the pt ambulate frequently in hallway

Severe preeclampsia causes

headache

placenta previa

large amount of bright red vaginal bleeding with no pain

fetal lung maturity

lecithin /sphingomyelin (L/S) ratio 2:1

most common risk for placental abruption

maternal hypertention

side effect of magnesium sulfate=stops labor

pt will notice a warm flush

the initial discharge is called

rubra

firmly pressing on lower back for comfort technique

sacral pressure

preterm labor risks

smoking, substance abuse, chronic illness such as DM, pregnancy induced hypertension

nurses main priority

support infant during birth

cesarean birth (VBAC)

the primary consideration is what type of incision you had

measure frequency of contractions

the time between beginning of one contraction until beginning of the next contraction

teaching of Rho(D) immune globulin

this med prevents formation of RH antibodies by woman who is Rh negative

Cause of variable decelerations in fetal heart rate

umbilical cord compression

assist doctor with (select all that apply)

vacuum extraction, epistomy

intrapartum care (select all)

vitals, monitor contractions, assess response to labor, monitor progress of labor