exam 4 ch 32 (1/2)

side effects of nifedipine

1. reflex tachycardia (greater than 120bpm). 2. dizziness. 3. faintness. 4. hypotension.

when should assisted delivery devices not be used?

1. severe fetal compromise. 2. umbilical cord prolapse. 3. high fetal station. 4. pulmonary edema.

obstetric conditions with high risk for preterm labor.

1. short cervical length. 2. previous preterm birth. 3. multifetal gestation. 4. preterm membrane rupture. 5. preeclampsia. 6. bleeding disorders.

oxytocin

1. synthetic hormone. 2. IV infusion. 3. titrate in milliunits/min/fetal response 4. monitor vital signs q60min. 5. fhr q15min. 6. RN ratio 1:1 for patient on oxytocin.

monitor maternal response to oxytocin

1. tachysystole for fetal hypoxia or uterine rupture. 2. contractions for frequency, duration, and intensity. 3. blood pressure and pulse. 4. temperature for infection. 5. intake and output. 6. postpartum hemorrhage.

types of forceps for assisted delivery

1. tucker-mclean. 2. piper (used for breech presentation)

complications from oligohydramnios

1. umbilical cord compression. 2. reduced lung volume. 3. deformities resulting from compression

contradiction of dinoprostone

1. unexplained vaginal bleeding. 2. previous uterine scarring. 3. fetal distress. 4. contradiction to vaginal birth

criteria to continue magnesium sulfate therapy

1. urine output more than 30mL/hr 2. presence of deep tendon reflexes. 3. more than 12 respirations per minute.

preterm labor signs and symptoms

1. uterine contractions. 2. sensation of fetus frequently balling up. 3. cramps similar to menstrual cramps. 4. constant low backache. 5. sensation of pelvic pressure. 6. pain, discomfort, or pressure in the vulva or thighs. 7. increase in vaginal discharge. 8. abdominal cramps. 9. sensation of feeling off/bad.

side effects for oxytocin

1. uterine tachysystole. 2 .fetal distress. 3. nausea, vomiting, and headache.

side effects for misoprostol

1. uterine tachysystole. 2. nausea, vomiting, and diarrhea.

side effects of dinoprostone

1. uterine tachysystole. 2. nausea, vomiting, diarrhea, and abdominal pain.

which drugs would the nurse anticipate administering for tocolysis during preterm labor? a. nifedipine. b. indomethacin. c. magnesium sulfate. d. labetalol. e. betamethasone.

a. nifedipine. b. indomethacin.

the nurse is providing care for a patient in labor, and the health care provider has just stated the patient's need for a forceps-assisted delivery. which action would the nurse's preparation include? a. obtaining a urinary catheter. b. establishing intravenous (IV) access. c. performing a head-to-toe assessment. d. educating the patient about the risk for lacerations. e. preparing for forceps using aseptic technique. f. monitoring the fetal heart rate for signs of distress.

a. obtaining a urinary catheter. b. establishing intravenous (IV) access. e. preparing for forceps using aseptic technique. f. monitoring the fetal heart rate for signs of distress.

36 week gestation patient presents with membranes grossly ruptured and is not contracting. which diagnosis does the nurse anticipate? a. preterm premature rupture of membranes (PPROM). b. preterm labor (PTL). c. premature rupture of membranes (PROM) d. AROM.

a. preterm premature rupture of membranes (PPROM).

when administering nifedipine for tocolysis, it is important for the nurse to monitor for which serious side effect? a. reflex tachycardia. b. hyperglycemia. c. change in fundal height. d. bradypnea.

a. reflex tachycardia.

the nurse is caring for a patient who has just been prescribed intravenous oxytocin for the induction of labor. the nurse's subsequent assessments should address the risk for which complication of oxytocin use? a. tachysystole. b. shoulder dystocia. c. fluid volume deficit. d. maternal hypertensive crisis.

a. tachysystole.

hyporeflexia

absence of a reflex

amniotomy

artificial rupture of membranes

when should you avoid indomethacin?

avoid after 32 weeks because it can constrict the ductus arteriousus and cause pulmonary hypertension

which medication would the nurse anticipate administering to promote fetal lung maturity? a. magnesium sulfate. b. betamethasone. c. nifedipine. d. indomethacin.

b. betamethasone

which risk factor identified by the nurse places the patient at risk for preterm labor (PTL)? a. family history of cervical cancer. b. homelessness. c. hypertension. d. history of birth of a child at 37 weeks.

b. homelessness.

a woman who is at 36 weeks gestation thinks she is experiencing labor. which signs or symptoms would support the woman's suspicion? a. headache. b. menstrual like cramps c. reports of constipation. d. reports of pelvic pressure. e. reports that something is wrong.

b. menstrual like cramps. d. reports of pelvic pressure. e. reports that something is wrong.

a patient is a G2/P0 at 32 weeks pregnant and experiencing regular contractions. she has multifetal gestation pregnancy, a history of preterm birth, and has had recurrent bacterial vaginosis throughout the pregnancy. her BMI is 22, she is 30 years' old, and she is a former smoker who quit two years ago. of the data provided, which are risk factors for preterm labor? a. age. b. multifetal gestation. c. recurrent bacterial vaginosis. d. former smoker status. e. BMI 22.

b. multifetal gestation. c. recurrent bacterial vaginosis.

when evaluating a patient with suspected preterm premature rupture of membranes and preterm labor, the nurse recognizes which cues as signs of preterm labor? a. dysuria and urinary frequency. b. pain and discomfort in the upper inner thighs. c. intermittent or constant lower back pain. d. a sensation that the fetus is frequently "balling up" e. the perception of decreased fetal movements. f. diarrhea.

b. pain and discomfort in the upper inner thighs. c. intermittent or constant lower back pain. d. a sensation that the fetus is frequently "balling up". f. diarrhea.

which conditions are contraindications to induction of labor? a. posterior placenta. b. placenta previa. c. previous classical cesarean delivery. d. transverse fetal lie. e. history of dilation and curettage (D&C). f. longitudinal fetal lie.

b. placenta previa. c. previous classical cesarean delivery. d. transverse fetal lie.

when administration corticosteroids to a patient in preterm labor, which information is relevant to the nurse regarding the patient's history? a. the patient is 33 weeks' gestation. b. the patient suffers from chronic hypertension. c. the patient's membranes are ruptured. d. the patient has type 1 diabetes.

d. the patient has type 1 diabetes.

what can cause a possible early delivery of a fetus to maternal obese patient?

difficult to evaluate. can possible have a macrosomic fetus.

fern test

estrogens in amniotic fluid cause crystallization of the salts ; crystals appear as a blade of fern

how often is the FHR recorded during the second stage of labor for a patient on oxytocin?

every 5 minutes

how far must the fetal head be to be able to perform an episiotomy?

fetal presenting part has crowned to a diameter of 3-4 cm.

vasa previa

fetal umbilical cord vessels branch over the amniotic sac rather than inserting into the placenta. fetal hemorrhage possible.

corticosteroids

for fetal lung maturity. for birth before 34 weeks. reduces the incidence and severity of RDS and intraventricular hemorrhage.

how often are perineal cold applications applied after birth.

for the first 12 hours

magnesium sulfate

given for neuroprotection of the fetus. can cause respiratory paralysis, hyporeflexia, smooth muscle relaxation.

risk of oxytocin's antidiuretic effects

maternal water intoxication if hypertonic solutions are used to dilute oxytocin.

maternal considerations for the administration of corticosteroids for a type 1 diabetic

may experience hyperglycemia.

dexamethasone

med for lung maturity in fetus over 34 weeks, but under 37 weeks.

mediolateral episiotomy

more postpartum pain. more blood loss. more enlargement.

fetal tachycardia

more than 160 beats/min

what does a score of 6 for bishop scoring mean?

need for cervical ripening before treatment.

what can cause hypertonic contractions

oxytocin

bethamethasone

(celestone)=surfactant. Med for lung expansion. 34 -37 weeks.

what to monitor for patients on magnesium sulfate

1. RR. 2. heart and lung sounds. 3. deep tendon reflexes. 4. oxygen saturation. 5. bowel sounds.

dinoprostone

1. cervical gel. prostaglandin. 2. vaginal insert in place for 12 hours. 3. 10mg. 4. patient must lay down for 2 hours. 5. patient to empty bladder before insertion.

causes of premature rupture of membranes.

1. chorioamnionitis. 2. incompetent cervix. 3. infection. 4. amniotic sac with weak structure. 5. fetal abnormalities or malpresentation. 6. over distention of the uterus. 7. maternal hormonal changes. 8. recent vaginal intercourse. 9. maternal stress. 10. maternal nutritional deficiencies.

interventions for PPROM (earlier than 37 weeks)

1. determine if membranes have ruptured. 2. test for infection and fetal lung maturity. 3. perform ultrasound for cervical length and cervical incompetence. 4. ultrasound for amount of amniotic fluid. 5. administer meds/antibiotics as prescribed.

interventions for PROM (37-42 weeks)

1. determine if membranes have ruptured. 2. test for infection. 3. check dilation and effacement. 4. administer cervical ripening agents if cervix is not favorable.

contraindications for oxytocin

1. fetal malpresentation. 2. fetal distress. 3. contraindication to vaginal birth.

when would a episiotomy be performed

1. fetal shoulder dystocia. 2. forceps or vacuum assisted. 3. occiput posterior (face-up) position

fetal conditions with high risk for preterm labor.

1. growth restriction. 2. inadequate amniotic fluid volume. 3. chromosome or other birth defects.

social and environmental factors with high risk for preterm labor.

1. inadequate or absent prenatal or dental care. 2. maternal domestic violence episodes. 3. maternal smoking. 4. homelessness. 5. age and ethnicity.

maternal medical conditions that can increase risk for preterm labor.

1. infection of the genitourinary tract, reproductive organs, or systemic organs. 2. preexisting or gestations diabetes. 3. connective tissue disorders. 4. chronic hypertension. 5. drug abuse.

medications for PTL and PROM

1. magnesium sulfate. 2. nifedipine. 3. indomethacin. 4. corticosteroids.

conditions associated with preterm labor

1. maternal medical conditions. 2. maternal obesity. 3. assisted reproductive technology. 4. obstetric conditions. 5. fetal conditions. 6. social and environmental factors.

types of episiotomies

1. median or midline. 2. mediolateral.

side effects of indomethacin

1. nausea. 2. heartburn. 3. heartburn. 4. vomiting. 5. rash. 6. prolonged bleeding time.

contradictions for misoprostol

1. previous uterine scarring. 2. maternal real impairment. 3. contradictions to vaginal birth.

misoprostol

1. prostaglandin. 2. vaginal tablet. 3. 25-50mcg q4hrs. 4. cervical ripening agent. 5. empty bladder before insertion.

interventions for nonreassuring FHR or hypertonic contractions for patient on oxytocin.

1. reduce/stop oxytocin and increase primary nonadditive infusion. 2. keep patient on her side to prevent aortocaval compression and increase placental blood flow. 3. 100% oxygen on 8-10mL to increase fetal oxygen. 4. patient take slow deep breaths to increase oxygen circulation.

oligohydraminos

< 500 mL of amniotic fluid associated with - utero-placental insufficiency - fetal renal abnorms

umbilical cord prolapse

Protrusion of the umbilical cord alongside or ahead of the presenting part of the fetus

which pregnant women are at risk for preterm premature rupture of membranes (PROM)? a. a woman who is bearing twins. b. a woman who sits eight hours a day at her job. c. a woman who eats spicy foods at each meal. d. a woman with gardnerella vaginalis infection

a. a woman who is bearing twins. d. a woman who is depressed over losing her job. e. a woman with a gardnerella vaginalis infection.

which intervention by the health care team will decrease the risk of infection for a patient with preterm premature rupture of membranes during labor, delivery, and the postpartum period? a. avoiding frequent vaginal examinations to check for cervical dilation. b. inserting an indwelling urinary catheter to measure urinary output. c. check maternal temperature every 12 hours. d. using clean technique when performing speculum examinations

a. avoiding frequently vaginal examinations to check for cervical dilation.

when caring for an infant after vacuum-assisted delivery, which would the nurse monitor for? a. chignon. b. ecchymosis. c. intracranial hemorrhage. d. cephalohematoma. e. exaggerated grasp and moro reflexes bilaterally. f. facial nerve damage.

a. chignon. b. ecchymosis. c. intracranial hemorrhage. d. cephalohematoma. f. facial nerve damage.

a G1/P0 patient arrives for elective induction of labor at 39 weeks and is 1 to 2 cm dilated and 50% effaced. the fetal station is -3 with a posterior and firm cervix. which order is most appropriate based on this patient's bishop score? a. discharge to home with follow-up in 1 week at the office. b. administer oxytocin and titrate per protocol. c. assist with amniotomy and initiate oxytocin as prescribed. d. initiate electronic fetal monitoring and insert peripheral intravenous device.

a. discharge to home with follow-up in 1 week at the office.

while monitoring a patient receiving oxytocin for augmentation of labor, the nurse notes tachysystole with recurrent late decelerations and minimal variability on the electronic fetal monitor. which actions are appropriate? a. discontinue the oxytocin infusion. b. reposition the patient on her side. c. administer an intravenous bolus of fluid per protocol. d. administer 100% oxygen via tight face mask. e. notify the health care provider. f. place the patient in semi-fowler position and continue to monitor.

a. discontinue the oxytocin infusion. b. reposition the patient on her side. c. administer an intravenous bolus of fluid per protocol. d. administer 100% oxygen via tight face mask. e. notify the health care provider.

which factors are included in patient evaluation when considering induction of labor using the bishop score? a. fetal station. b. cervical effacement. c. cervical dilation. d. cervical consistency. e. cervical position. f. fetal size.

a. fetal station. b. cervical effacement. c. cervical dilation. d. cervical consistency. e. cervical position.

a woman in labor has been having regular contractions but has remained 5 cm dilated for 5 hours, with a reassuring fetal heart rate. which intervention may be necessary for this patient? a. labor augmentation. b. cesarean delivery. c. vacuum-assisted delvier. d. intrauterine resuscitation.

a. labor augmentation.

when preterm premature rupture of membranes is confirmed, which actions would the nurse implement? a. educate the patient on the need for a cesarean section delivery. b. prepare the patient for admission to labor and delivery. c. collect a group B streptococcus swab, if not done previously. d. initiate continuous fetal monitoring. e. anticipate the administration of corticosteroids. f. alert the neonatal care provider of the patient status.

b. prepare the patient for admission to labor and delivery. c. collect a group B streptococcus swab, if not done previously. d. initiate continuous fetal monitoring. e. anticipate the administration of corticosteroids. f. alert the neonatal care provider of the patient status.

the nurse is caring for a patient who had a forceps delivery that caused a perineal hematoma. which nursing intervention is most appropriate? a. administer topical analgesic ointment prescribed. b. provide the patient with an ice pack and educate her about its use. c. encourage the patient to lie on her side as much as possible until the injury heals. d. educate the patient about the fact that the hematoma was caused by the introduction of forceps.

b. provide the patient with an ice pack and educate her about its use.

the nurse administered magnesium sulfate to a woman experiencing preterm labor, following a health care provider prescription. which assessment would concern the nurse? a. urine output of 50mL. b. oxygen saturation of 95%. c. 10 respirations per minute. d. bronchial sounds heard over the body of the sternum.

c. 10 respirations per minute.

the nurse is caring for a patient whose delivery was assisted by forceps. which assessment finding would the nurse report to the health care provider immediately? a. pain with defecation. b. fundus that is firm on palpation. c. a hard, turgid area on the labia minora. d. episiotomy incision flush with the surrounding skin.

c. a hard, turgid area on the labia minora.

the nurse is caring for a patient in the second stage of labor. which patient condition is most likely to result in the need for an episiotomy? a. a patient with a history of perineal laceration. b. a patient receiving oxytocin for induction of labor. c. a patient whose fetus is experiencing shoulder dystocia. d. a patient who had an episiotomy during a previous delivery.

c. a patient whose fetus is experiencing shoulder dystocia.

which order during labor augmentation would cause the nurse to question the health care provider? a. administer oxytocin in lactated ringer solution per protocol. b. administer oxytocin in normal saline per protocol. c. administer oxytocin in dextrose 10% per protocol. d. administer oxytocin in water per protocol

c. administer oxytocin in dextrose 10% per protocol.

when a preterm patient presents with a complaint of feeling wet, which intervention would the nurse anticipate the obstetric provider performing? a. intermittent fetal monitoring. b. a prescription to discharge to home with complete bedrest. c. fern and pH tests. d. vaginal exams every hour to check for advancing cervical dilation. e. an ultrasound. f. a sterile speculum examination.

c. fern and pH tests. e. an ultrasound. f. a sterile speculum examination.

nifedipine

calcium channel blocker. given in large frequent doses to stop uterine contractions.

antidote for magnesium sulfate

calcium gluconate

preterm labor (ptl)

cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy

what should be checked before administration of indomethacin?

check the fundal height and amniotic fluid index.

chignon

circular scalp edema and redness or bruising caused by a vacuum extractor.

which bishop score has a positive predictive value of a vaginal delivery? a. 3. b. 5. c. 7. d. 9.

d. 9.

which patient would the nurse anticipate needing an assisted deliver? a. a patient with a history of perineal laceration. b. a patient who rates her pain at 10 out of 10. c. a patient whose bladder is distended and who is unable to void. d. a patient who has been pushing for 3 hours with minimal fetal progress.

d. a patient who has been pushing for 3 hours with minimal fetal progress.

which patient cue would lead the nurse to suspect preterm labor in a patient rather than braxton hicks contractions? a. contractions that occur during the evening. b. contractions that go away with ambulation. c. contrations that are irregular and vary in intensity. d. contractions that are perceived in the back and are intermittent.

d. contractions that are perceived in the back and are intermittent.

which assessment can the nurse initiate to determine fetal well-being in utero? a. amniotic sac assessment. b. cervical length. c. fern test. d. electronic fetal monitoring.

d. electronic fetal monitoring.

placenta previa

implantation in lower uterus. can result in hemorrhage during labor.

chorioamnionitis

inflammation of the amniotic sac

chorioamnionitis

intraamniotic infection. cause and result of PPROM. CM: maternal fever and uterine tenderness.

what should be used to dilute oxytocin

lactic ringer or normal saline

median or midline episiotomy

less postpartum pain. less blood loss. limited elargement.

fetal bradycardia

less than 110 beats/min

short cervical length

less than 25mm

abruptio placentae

premature separation of the placenta from the uterine wall

indomethacin

prostaglandin synthesis inhibitor. stops uterine contractions. short term solution to allow for administration of corticosteroids.

how often is the FHR recorded during the first stage of labor for a patient on oxytocin?

q 15 min.

what does a score of 8 mean for bishop scoring mean?

ready for vaginal delivery

what are the effects of hypertonic contractions to the fetus

reduces placental blood flow and reduces exchange of fetal oxygen and waste products.

tocolysis

repression of uterine contractions

incompetent cervix

short cervical length under 25 mm.

late decelerations

slowing after the peak of the contraction.

what decreases the risk for oxytocin's antidiuretic effects?

solutions containing electrolytes (NS or LR).

episiotomy

surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth

what is the importance of administration of nifedipine?

the stopping of uterine contractions allows for for administration of corticosteroids for fetal lung maturity.

mechanical cervical ripening

use of a variety of cervical inserts to gradually stretch and soften the cervix before induction of labor with oxytocin

how would you determine if membranes have been ruptured?

use of fern test or pH screening

prostaglandin

used for cervical ripening. comes in form of gel, timed-release insert, or tablet. soften cervix and promote dilation.

bishop score

uses 5 factors to estimate cervical readiness for labor. 1. dilation. 2. effacement. 3. fetal station. 4. cervical consistency. 5. cervical position.

augmentation

uses artificial methods to stimulate the patient's existing uterine contractions. used for slow labor. use of oxytocin, cervical ripening methods, and amniotomy.

when should forceps or vacuum be used for delivery?

when delivery needs to be accomplished quickly. exhaustion, inability to push, cardiac or pulmonary disease, and intrapartum infection.

are forceps used during a c-section?

yes. can help pull the fetus through the incision.