maternity test 2
A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client? 750 mL 1000 mL 250 mL 500 mL
1000 mL
progesterone
CI med -IM or vaginally from 16-20 weeks GA -36 weeks
implantation bleeding
usually around 6-11 days after fertilization, bright red or dark brown, lasting ~1 day
Fetal surveillance
-non-stress test -contraction stress test -FHR monitoring -ultrasound -biophysical profile
McRoberts Maneuver and Suprapubic Pressure
-legs flexed onto abdomen and causes rotation of the pelvis, alignment of sacrum, and opening of birth canal -pressure on suprabpubic bone, NOT fondus
herpes simplex virus - HSV
can be transmitted to the fetus, can cause severe infection and death -vaginal birth contraindicated IF active lesions present -women with herpes are typically prescribed an antiviral medication (acyclovir/Valtrex) the month before pregnancy due date and are delivered by C-section if lesions are present
hypovolemic shock
caused by uncontrolled hemorrhage -volume of circulating blood decreases to degree that cells and organs don't have enough oxygen to function properly
deep vein thrombosis
clot in a deep vein -symptoms - unilateral swelling, redness, edema, pain/hardened mass -diagnosed: ultrasound image -treatment: anticoagulation therapy or surgery
intrapartum procedures
episiotomy, operative vaginal delivery, cesarean birth
misoprostol
-route & dose - 800-1000 ug RECTALLY -side effects - N&V, diarrhea, headache, fever, chills
hepatitis B
-90% of newborns who contract from mothers will develop chronic liver disease -if mother is Hep B+, newborn should be given Hep B vaccine and Hep B immune globulin within 12 hours of birth
cardiovascular disease
A general term for all diseases of the heart and blood vessels -only complicates a small number of pregnancies -significant cause of maternal morbidity and mortality in pregnancy -cardiac output increases 50% during pregnancy and may exacerbate any underlying cardiac conditions -fetal well-being around 32-34 weeks, monitor mothers more frequent -management depends on disease type, severity, complications and involves collaboration between obstetrics, cardiology, and neonatology
postpartum mood disorders
PP blues, PP depression, PP psychosis - PPB, PPD, PPP
Chapter 20
Conditions Occurring During Pregnancy
A pregnant client in her 35th week of gestation arrives at the clinic with bright red vaginal spotting. An ultrasound indicates that the placenta is partially covering the cervical os. The nurse interprets this as which? Grade I- Low lying placenta Grade II- Marginal previa Grade III- Partial previa Grade IV- Complete previa
Grade III- Partial previa
intrahepatic cholestasis
-caused by impaired bile flow from liver -symptoms - pruritus, clay-colored stools, dark urine, fatigue -treatment goals - minimizing itching (topical meds), reducing concentration of bile acid (PO ursodeoxycholic acid and induced delivery at 36-37 weeks -resolves with the end of pregnancy
infections in pregnancy
-chlamydia, gonorrhea, herpes simplex virus, HIV, hepatitis B, TORCH infections - toxoplasmosis, other (syphilis, varicella, mumps), rubella, cytomegalovirus, herpes (genital), UTIs (cystitis, asymptomatic bacteriuria, pyelonephritis
A patient with asthma who is 32 weeks' pregnant is concerned that the health care provider has reduced the doses of asthma maintenance medications. How should the nurse respond to this patient's concern? Asthma medication may reduce labor contractions and should be reduced. Asthma improves during pregnancy so higher doses are not needed. Asthma medication is ineffective during pregnancy and should be stopped. Asthma medication is teratogenic and should not be taken.
Asthma medication may reduce labor contractions and should be reduced.
The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? firm closed posterior position shortened
shortened
urinary tract infection
-postpartum women are prone to because of frequency of bladder catheterization and multiple cervical exams during labor -treatment - antibiotics
cesarean birth
-32% -complications: bowel and bladder injury, hemorrhage, amniotic fluid embolism, infection, neonatal respiratory distress -indications: failure to progress, non-reassuring FHR, fetal malpresentation, umbilical cord prolapse, fetal macrosomia -if unplanned, cause sense of frustration, disappointment, failure
5 P's of Labor
-Power - refers to uterine contractions and pushing efforts -Passageway - refers to the maternal bony pelvis and soft tissues -Passenger - refers to fetal factors -Psyche - refers to maternal state of mind -Position - refers to maternal position
psyche: anxiety
-can have a negative impact on normal labor progress and fetal outcomes -nurse play a role in labor support
The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? Reduce risk of complications The fetus is descending too slowly Abnormal position of the fetal head To lessen the mother's pain
Abnormal position of the fetal head
A laboring woman is receiving oxytocin IV to augment her labor and 2 hours later begins having contractions every 2 minutes lasting 60 to 90 seconds each with little, if any, rest time in between the contractions. At this time, which interventions would be the priority for the nurse caring for this client? Select all that apply. Administer an IV bolus of fluids. Discontinue the oxytocin infusion. Apply oxygen to the woman via mask at 8 to 10 L/min. Administer betamethasone to mature the fetal lungs. Ask the woman to drink 32 ounces (1 L) of water.
Administer an IV bolus of fluids. Discontinue the oxytocin infusion. Apply oxygen to the woman via mask at 8 to 10 L/min.
Which of the following statements regarding weight and pregnancy is correct? An underweight woman should increase her caloric intake by 500 to 1000 calories a day. Women who are underweight coming into pregnancy should gain the same amount of weight as women with a normal BMI. Dieting during pregnancy to reduce weight is recommended only for morbidly obese women. Obesity usually occurs from hypothyroidism.
An underweight woman should increase her caloric intake by 500 to 1000 calories a day.
Preterm premature rupture of membranes (PROM) can be a serious complication of labor. What is the most common cause of preterm PROM? Cephalopelvic disproportion Infection Incompetent cervix Macrosomia
Infection
A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? Preterm labor that was undiagnosed Premature separation of the placenta Possible fetal death or injury Placenta previa obstructing the cervix
Premature separation of the placenta
A client is admitted to the health care facility. The fetus has a gestational age of 42 weeks and is suspected to have cephalopelvic disproportion. Which should the nurse do next? Administer oxytocin intravenously at 4 mU/minute. Prepare the client for a cesarean birth. Place the client in lithotomy position for birth. Perform artificial rupture of membranes.
Prepare the client for a cesarean birth.
The nurse is assisting with a vaginal birth. The patient is fully dilated, 100% effaced and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus? Nuchal cord Shoulder dystocia Umbilical cord prolapse Breech position
Shoulder dystocia
Over the past 20 weeks, the following blood pressure readings are documented for a pregnant client with chronic hypertension: week 16 - 130/86 mm Hg; week 20 - 138/88 mm Hg; week 24 - 136/82 mm Hg; and week 28 - 138/88 mm Hg. The nurse interprets these findings as indicating which classification of her blood pressure? Stage 2 Elevated Stage 1 Hypertensive crisis
Stage 1
pyelonephritis
UTI of upper urinary tract and kidneys symptoms - flank (area of kidney) pain, N&V, fever, possibly cystitis symptoms as well
vacuum-assisted
a device that applies suction to the fetal head to aid in extraction -after 3 sets of "pulls" (traction) or a total application time of 15-30 mins, go to c-section
Chapter 19
conditions existing before conception
severe preeclampsia features
blood pressure, thrombocytopenia, impaired liver function, progressive renal insufficiency, pulmonary edema, now-onset cerebral or visual changes
A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which measure would the nurse include as the most cost-effective method for prevention? prophylactic heparin administration warm compresses early ambulation compression stockings
early ambulation
A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which condition in the mother and the newborn? hemorrhage infection hypovolemia trauma
infection
dystocia
labor with abnormally fast/slow progression
A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth? shoulder dystocia macrosomia fetal hydrocephalus cord compression
cord compression
A nurse is interviewing a pregnant woman who has come to the clinic for her first prenatal visit. During the interview, the client tells the nurse that she works in a day care center with 2- and 3-year olds. Based on the client's history, the nurse would be alert for the development of which condition? gonorrhea cytomegalovirus chlamydia toxoplasmosis
cytomegalovirus
superimposed preeclampsia
development of preeclampsia in women with chronic hypertension
obesity
-35% of women between 20-39 -fat has endocrine function and can have detrimental effect on inflammatory pathways, vasculature, and metabolism -complications: higher risk of gestational diabetes, preeclampsia, labor induction and induction failure, slower first stage of labor, macrosomic infants, postpartum thromboembolism -pre-pregnancy weight loss can improve outcomes -encourage healthy behaviors -challenges - difficult to monitor/find FHR - can result in inability to monitor FHR during medication administration (oxytocin) and a greater chance of surgical deliveries
postpartum infections
-common cause - perineal wounds (lacerations), cesarean wounds, endometritis, mastitis, urinary tract infections (prolonged second stage of labor - cervical exams) -all of these increase the risk for bacteria to be brought into the uterus, cervix -general symptoms - nonspecific, BUT if fever persists beyond initial 24 hours; fever begins 2-10 days after birth or WBC continues to rise rather than fall **low grade fever and high WBC count in first 24 hours is normal**
mild to moderate chronic hypertension
-140-159 / 90-109 (either one or both) -no clear benefit to treating during pregnancy; no meds
power: hypotonic uterine dysfunction
-contractions are either too uncoordinated (in duration and frequency) or too weak to effectively dilate the cervix -occurs in the active phase of labor -related to polyhydramnios, macrosomia, or multiple pregnancy -contractions palpate soft (mild, moderate) and occur at rate of less than 3 or 4 every 10 minutes lasting less than 30 seconds -internal contraction monitoring may be indicated (IUPC - measures intensity) -treatment: rest, amniotomy, oxytocin (Pitocin)
GDM medications
-diet and exercise oral: -Glyburide -Metformin -Insulin - more challenging to maintain for patient and provider; patient teaching is key
biophysical profile
-each element gets up to 2 points -NST, fetal breathing, fetal activity, fetal muscle tone, amniotic fluid (AFI) -score can indicate whether further testing is needed or not
pruritic urticarial papules and plaques of pregnancy
-highly pruritic papules that may be associated with an inflammatory process cause by stretching of the skin -treatments include oral/topical corticosteroids and an antihistamine -resolves within a few weeks of delivery
preeclampsia fetal assessment****
-Non-stress test -BPP -Ultrasound to monitor placental degradation -Doppler flow studies - to measure umbilical blood flow -Determination of fetal lung maturity for delivery (decide whether need to administer corticosteroids to enhance lung maturity)
The nurse is comforting and listening to a young couple who just suffered a spontaneous abortion (miscarriage). When asked why this happened, which reason should the nurse share as a common cause? Maternal smoking Chromosomal abnormality Lack of prenatal care The age of the mother
Chromosomal abnormality
A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position? Brachial plexus injury Uterine atony Cord prolapse Placental abruption
Cord prolapse
A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? Bed rest and bathroom privileges only until birth. Increase fluids and take more vitamins. Discuss induction of labor with the health care provider. Decrease activity and rest more often.
Decrease activity and rest more often.
The nurse is assessing a new client who is being admitted with gestational hypertension. Which nursing diagnosis should the nurse prioritize for this client? Imbalanced nutrition related to decreased sodium levels Deficient fluid volume related to vasospasm of arteries Risk for injury related to fetal distress Decreased reflexes due to medication administration
Deficient fluid volume related to vasospasm of arteries
Which response is most appropriate for a client with diabetes who wants to breast-feed but is concerned about the effects of breastfeeding on her health? Diabetic clients who breast-feed have a hard time controlling their insulin needs Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding Diabetic clients shouldn't breast-feed because of potential complications Diabetic clients shouldn't breast-feed; insulin requirements are doubled
Diabetic clients may breast-feed; insulin requirements may decrease from breast-feeding
A pregnant patient receiving intravenous oxytocin for 1 hour has contractions lasting 80 seconds. What should the nurse do first for this patient? Increase the flow rate of the main line infusion. Slow the infusion to below 10 gtt/minute. Continue to monitor contraction duration every 2 hours. Discontinue the oxytocin infusion.
Discontinue the oxytocin infusion.
A pregnant patient asks why an α-fetoprotein serum level has been ordered. What should the nurse explain to the patient about this test? It screens for placenta function. It may reveal chromosomal abnormalities. It tests the ability of the patient's heart to accommodate the pregnancy. It measures the fetal liver function.
It may reveal chromosomal abnormalities.
A pregnant client is admitted to a health care facility with a diagnosis of premature rupture of membranes (PROM). Which of the following tests would the nurse expect to be used to predict fetal lung maturity when the client goes into labor? Lecithin/sphingomyelin ratio Reticulocyte count Nitrazine test Test for antiphospholipids
Lecithin/sphingomyelin ratio
The nurse is assessing vital signs on the client and notes a normal blood pressure along with an elevated pulse when the patient moves from a lying to a standing or sitting position. What would this indicate? Delayed labor Overhydration Low fluid volume Arrested labor
Low fluid volume
warning signs of eating disorder
-low BMI -history -lack of weight gain over 2 prenatal visits -electrolyte abnormalities -tooth enamel problems (from vomiting) -hyperemesis gravidarum -anxiety/mood disorder
treatment of eclampsia
-magnesium sulfate slow IV push in 4-6 g bolus + maintenance dose -Oxygen therapy -safe environment -Hypertensive medications
preeclampsia etiology/risks
etiology - not well understood; may be associated with abnormal attachment of placenta or abnormal pre-gestational maternal inflammation or epithelial cell functioning risks - poor circulation: oligohydramnios - low volume of amniotic fluids, placental abruption - premature detachment of placenta from uterine wall, intrauterine growth restriction
Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor? gestational diabetes gestational hypertension macrosomia low parity
gestational hypertension
conditions during the 2nd trimester
gestational hypertension, preeclampsia, eclampsia
chronic hypertension
high blood pressure -diagnosis prior to pregnancy or prior to 20 weeks -associated with higher rate of poor pregnancy outcomes: intrauterine growth restriction, stillbirth, preeclampsia, and stroke -BP > 140/90
preeclampsia treatment
high risk - aspirin and calcium supplementation mild & gestational HTN - monitor severe - hospitalization, control, then induced magnesium sulfate - given by IV to prevent seizures (reduces CNS irritability, can lower seizure threshold by 50%) AND given for neuroprotection for the fetal brain
pyelonephritis
kidney infection and inflammation -same symptoms as cystitis plus fever, chills, N&V, lower back pain -associated with preterm birth can also progress to sepsis, kidney failure, respiratory failure
A client at 36 weeks' gestation who is 2 years post bariatric surgery would be expected to have a weight gain that is: the same as other pregnant clients at that gestational age determined by the client's BMI and gestational age. less than other pregnant clients at the same gestational age. more than other pregnant clients at the same gestational age.
less than other pregnant clients at the same gestational age
A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. manifestations of mania loss of confidence bizarre behavior decreased interest in life inability to concentrate
loss of confidence decreased interest in life inability to concentrate
A pregnant woman at the emergency department informs staff that she is at least 2 weeks past her due date. The physician begins to perform several tests to determine fetal age. The nurse anticipates that the woman's amniotic fluid volume will be decreased. How would the nurse measure the amniotic fluid in this situation? aspiration x-ray palpation ultrasound
ultrasound
Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? moderate amount of lochia rubra uterine atony hemoglobin level of 12 g/dl (120 g/L) thrombophlebitis
uterine atony
Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? flushing seizures headache uterine hyperstimulation
seizures
A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests? pelvic sonogram, ovulation monitoring, and semen analysis serologic test for syphilis, semen analysis, and tubal patency assessment semen analysis, ovulation monitoring, and tubal patency assessment semen analysis, urinalysis, and ovulation monitoring
semen analysis, ovulation monitoring, and tubal patency assessment
thioamides
treatment for hyperthyroidism (class of medications) -cross the placenta, suppress fetal thyroid hormone synthesis -associated with fetal anomalies, *take anyway
A pregnant woman with a history of mitral valve stenosis is to be prescribed medication as treatment. Which medication class would the nurse expect the client to be prescribed? inotropic angiotensin receptor blockers vasodilator anticoagulant
anticoagulant
A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: birth is likely within the next 2 weeks. birth is unlikely within the 2 next weeks. infection is present. no infection is present.
birth is unlikely within the 2 next weeks.
It is necessary for the mother to have a forceps delivery. To reduce complications from this procedure, the nurse should: empty the mother's bladder. have anesthesia provider present. call the neonatologist. provide pain medication.
empty the mother's bladder.
hyperthyroidism
excessive activity of the thyroid gland -0.1-0.4% of pregnancies; can cause pregnancy loss, low birth weight baby, maternal heart failure -goal is to control, and avoid the opposite disorder
Metformin
for GDM -increases sensitivity of cells to insulin and decreases release of glucose from the liver; often requires supplemental insulin, associated with lower birth weight
Glyburide
for GDM stimulates pancreas to release more insulin; -contra: patients with sulfa allergy or kidney failure -can cause hypoglycemia; teach about signs n symptoms, encourage to carry a source of sugar
A client has been admitted with placental abruption. She has lost 1,200 mL of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? grade 2 grade 3 grade 1 grade 4
grade 2
A client appears to be resting comfortably 12 hours after giving birth to her first child. In contrast, she labored for more than 24 hours, the primary care provider had to use forceps to deliver the baby, and she had multiple vaginal examinations during labor. Based on this information what postpartum complication is the client at risk for developing? hemorrhage infection pulmonary emboli depression
infection
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? nifedipine betamethasone magnesium sulfate indomethacin
magnesium sulfate
contraction stress test - CST
monitor FHR reaction to contractions (at least 3 contractions in 30 mins) interpreted by presence/absence of late decelerations -positive (ABNORMAL) - FHR shows late decelerations w/ 50% or more of contractions -negative - no late or significant variable decelerations -equivocal-suspicious - intermittent late decelerations or significant variable decelerations
A woman is experiencing a postpartum hemorrhage due to uterine atony. Which risk factor would the nurse recognize as contributory to this specific problem? fetal demise placenta accreta multiparity preeclampsia
multiparity
conditions in the 3rd trimester
polyhydramnios, oligohydramnios, IUGR, dermatoses
postpartum hemorrhage
postpartum bleeding is greater than normal values despite uterine message and first-line uterotonics (oxytocin) >1000 mL is major >2000 mL is severe, OR >1000mL in a 24 hour period that persists despite interventions -early: within 24 hours of birth -delayed/secondary: occurs >24 hours up to 12 weeks (usually 1-2 weeks post-delivery)
A woman having contractions comes to the emergency department. She tells the nurse that she is at 34 weeks' gestation. The nurse examines her and finds that she is already effaced and dilated 2 cm. What is this woman demonstrating? preterm labor macrosomia normal labor dystocia
preterm labor
supplemental iron
treatment for iron deficiency anemia -can cause pruritus, rash, GI symptoms -take on empty stomach (an hour before eating) ***but may cause GI distress. if you can not handle the distress, take 2 hours after eating with citrus
position
upright positions - sitting, kneeling, squatting, standing - can shorten the first stage of labor by 90 mins -DON'T stand w an epidural
A woman is in the hospital only 15 minutes when she begins to give birth precipitously. The fetal head begins to emerge as the nurse walks into the labor room. The nurse's best action would be to: attach a fetal monitor to determine fetal status. ask her to push with the next contraction so birth is rapid. place a hand gently on the fetal head to guide birth. assess blood pressure and pulse to detect placental bleeding.
place a hand gently on the fetal head to guide birth.
A patient who experiences premature rupture of membranes can expect to be put on pelvic rest. The nurse should explain to the patient that pelvic rest involves which of the following? staying off of the feet the majority of the day staying in bed at all times staying in bed with bathroom privileges placing nothing in the vagina
placing nothing in the vagina
forceps-assisted
-applied to either side of the fetal head to allow the provider to pull with contractions -if difficult to apply forceps safely of delivery does not occur within 15-20 mins, go to c-section
questions to ask about eating disorder
-are you trying to restrict what you eat? -feel out of control of your eating? -eat secretly? -concerned about gaining weight in pregnancy? -how do you feel about your weight? -guilt about how you eat? -do you vomit after you eat or take medications such as laxatives or water pills? -do you exercise? how often, how long, what intensity?
asthma interventions
-auscultate lungs -document cough (productive vs. nonproductive) -pulse ox -supplemental Oxygen -review exacerbation history -avoid all triggers
hemabate (15-methylprostaglandin F2-alpha)
-route & dose - 0.25 mg IM every 15-90 min up to 8 doses; OR 500 ug IM up to 3 mg; OR 0.5 mg IM - injected into the myometrium (uterine muscle) -side effects - N&V, diarrhea, headache, fever, chills, tachycardia, HTN -contraindications - asthma, hypertension
signs and symptoms of hypothryroidism
-tiredness -dry skin -weight gain -cold sensitivity
The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? 2 cm/hour for cervical dilation 1/2 cm/hour for cervical dilation 1 cm/hour for cervical dilation 1/4 cm/hour for cervical dilation
1 cm/hour for cervical dilation
When evaluating fetal well-being, what is the maximum score on a biophysical profile?
10
chronic hypertension
HTN before pregnancy or before 20 weeks gestation
if mom is having a seizure,
fetus becomes hypoxic; evidenced by late decelerations on FHR
A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? precipitate labor preterm labor normal labor dystocia
preterm labor
Chapter 22
Complications Occurring During Labor and Delivery
A patient having an examination to check the placement of an intrauterine device (IUD) is diagnosed as being pregnant. For which action should the nurse prepare the patient at this time? Potential for a spontaneous abortion Surgery to abort the fetus Removal of the IUD Nothing since the IUD can remain in place
Removal of the IUD
A postpartum client calls the nurse to her room and states that she knows something awful is going to happen to her. What should the nurse do? Call a code. Ask if she would like to see the social worker. Tell her she is being silly; nothing is going to happen to her. Report this immediately to the health care provider.
Report this immediately to the health care provider.
The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain? On her left side Trendelenburg Flat in bed Semi-Fowler
Semi-Fowler
The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? "Pregnancy affects insulin production, so I'll need to make adjustments in my diet." "I'll basically follow the same diet that I was following before I became pregnant." "I'll adjust my diet and insulin based on the results of my urine tests for glucose." "Because I need extra protein, I'll have to increase my intake of milk and meat."
"Pregnancy affects insulin production, so I'll need to make adjustments in my diet."
rubella
-vaccination contraindicated in pregnancy - give PP if needed -maternal symptoms - rash, fever, flu-like symptoms, fetal anomalies: CNS, cardiac, ocular, endocrine..
pre-gestational diabetes - 2nd&3rd trimester assessments
-vasculopathy may be evidenced by fetal growth restriction -antepartum testing for fetal well-being begins between 32-34 weeks and may include Non-stress Test, Biophysical Profiles, Contraction Stress Test (least likely)
Which situation should concern the nurse treating a postpartum client within a few days of birth? The client would like to watch the nurse give the baby her first bath. The client is nervous about taking the baby home. The client feels empty since she gave birth to the neonate. The client would like the nurse to take her baby to the nursery so she can sleep.
The client feels empty since she gave birth to the neonate.
A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client? diminished reflexes elevated liver enzymes serum magnesium level of 6.5 mEq/L seizures
diminished reflexes
A patient is confirmed to be in labor. Upon examination she is 3 cm dilated and the fetus has started to descend. Three hours after admission, however, she appears not to be progressing. She remains only 3 cm dilated, and the fetus is in the same position. The physician correctly terms this as which of the following? disorder of protraction precipitous delivery disorder of arrest precipitous labor
disorder of arrest
Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also reports significant pelvic pain and is experiencing problems with voiding. The nurse suspects which condition? hematoma uterine atony laceration bladder distention
hematoma
perineal wounds
infection that occurs at the perineal laceration or episiotomy (space between the anus and the vulva) -risk factors - operative vaginal delivery, prolonged 2nd stage of labor, 3&4 degree lacerations, mediolateral episiotomy, maternal smoking, meconium-stained fluid -assessment findings: tenderness, redness, swelling of the area, purulent discharge -treatment: removal of sutures and opening of the wound; antibiotics not necessary unless evidence of cellulitis
gonorrhea
may also cause IUGR, postpartum sepsis, and chorioamnionitis (influx of membranes surrounding fetus); infants may be born with conjunctivitis, arthritis, pharyngitis
Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? oxytocin methotrexate promethazine ondansetron
methotrexate
*non-stress test - NST
monitor FHR for 20 mins results: -reactive - normal FHR, 2 accelerations in 20 mins -non-reactive - absence of 2 accelerations in 20 mins
signs and symptoms of cardiac decompensation
objective -generalized progressive edema -frequent moist cough -cyanosis of nail beds and lips -tachypnea (25 or more respirations per minute) -crackles in lungs that do not clear with coughing -rapid, weak, irregular pulse subjective -feeling of being smothered -palpitations -generalized edema -difficulty catching breath -cough
The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client? Monitor the fetal heart rate (FHR). Monitor the client's vital signs and bleeding. Monitor the client's beta-hCG level. Monitor the mass with transvaginal ultrasound.
Monitor the client's vital signs and bleeding.
A nursing instructor is teaching students about caring for a pregnant patient with a pre-existing disease. Which of the following does the instructor suggest has added to an increased incidence of pregnant women with a pre-existing disease? More women waiting until after age 30 years to get pregnant Women seeking out earlier prenatal care Better tests to diagnose diseases Better assessment skills by physicians
More women waiting until after age 30 years to get pregnant
A postpartum woman is prescribed oxytocin to stimulate the uterus to contract. Which action would be most important for the nurse to do? Administer the drug as an IV bolus injection. Withhold the drug if the woman is hypertensive. Piggyback the IV infusion into a primary line. Give as a vaginal or rectal suppository.
Piggyback the IV infusion into a primary line.
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placental abruption requires "watchful waiting" during labor and birth. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placental abruption results in painless, bright red vaginal bleeding during labor.
Placenta previa is an abnormally implanted placenta that is too close to the cervix.
The nurse is admitting a client in labor. The nurse determines that the fetus is in a transverse lie by performing Leopold maneuvers. What intervention should the nurse provide for the client? Administer an analgesic to the client. Prepare for a precipitous vaginal birth. Prepare to assist the care provider with an amniotomy. Prepare the client for a cesarean birth.
Prepare the client for a cesarean birth.
A pregnant client arrives at the clinic for a regular antenatal check-up. Examinations and weight recording reveal a slow fetal weight gain. About which of the following pregnancy-related risks should the nurse alert the client? Preterm labor Uterine infections Prolonged labor Pre-eclampsia
Preterm labor
A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal? Decrease blood pressure Reverse edema Prevent maternal seizures Decrease protein in urine
Prevent maternal seizures
A pregnant client with diabetes in the hospital reports waking up with shakiness and diaphoresis. Which action should the nurse prioritize after discovering the client's fasting blood sugar is 60 mg/dl (3.33 mmol/L)? Withhold her insulin, and notify the health care provider. Stay with her, and ask another nurse to bring her insulin. Provide the client some milk to drink. Recheck her blood sugar for accuracy.
Provide the client some milk to drink.
The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? Magnesium sulfate level Reflexes Lung sounds Oxygen saturation
Reflexes
GDM care considerations and patient teaching
care considerations: -no set guidelines for fetal monitoring w well-controlled GDM -woman who require meds are. monitored more closely -outcomes are optimized when. blood sugars are controlled: -fasting <95 -1 hr postprandial <140 -2 hr postprandial <120 -vaginal birth is preferred if no contraindicated; (too large), may require c-section -typically resolves after delivery of placenta; greater risk for developing again or type 2 later in life patient teaching: -follow weight gain recommendations, monitor carb intake (30-40% of diet), eliminate simple sugars, avoid spikes and dips in blood glucose (3 meals a day w 2-3 snacks; and eat a snack w carbs before bedtime), don't go more than 10 hours without eating, keep a food log that includes finger stick glucose test results; ADA website w lots of resources; exercise regularly (3x/wk)
A pregnant client with type I diabetes asks the nurse about how to best control her blood sugar while she is pregnant. The best reply would be for the woman to: exercise for 1 to 2 hours each day to keep the blood glucose down. limit weight gain to 15 pounds during the pregnancy. begin oral hyperglycemic medications along with the insulin she is currently taking. check her blood sugars frequently and adjust insulin accordingly.
check her blood sugars frequently and adjust insulin accordingly.
epilepsy
chronic brain disorder characterized by recurrent seizure activity -1-2% of people have this -increased risk of passing disorder onto fetus -mostly uneventful, complications can include: preeclampsia, preterm labor, fetal death -anti-seizure medications* -monitor CBC (hemoglobin, hematocrit, platelets); and for bruising or Petechiae (to look for bleeding/hemorrhaging)
multiple sclerosis
chronic immune-modulated demyelinating disease of the CNS that includes relapses and remissions -pregnancy is often remission, while postpartum is relapse -may increase need for Cesarean birth, and decreased neonatal birth weight -medications are often teratogenic and contraindicated, may have to go off meds and hope for no relapse -breastfeeding is not contraindicated but the medications may not be safe for the infant (don't take meds or don't breastfeed)
pulmonary embolism
clot breaks off and travels to lungs (pulm); potentially blocking a vessel in lungs -medical emergency -upon suspicion, prompt anticoagulant treatment, prior to confirmation -continue anticoagulant therapy for 6 months -diagnosis: CT scan; ventilation/perfusion (V/Q) scan and computer tomographic pulmonary angiography -symptoms: nonspecific; dyspnea, cough, sweating, sharp/stabbing pain
A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which findings would lead the nurse to suspect that the woman is developing an infection? Select all that apply. cloudy malodorous fluid fetal bradycardia decreased C-reactive protein levels abdominal tenderness elevated maternal pulse rate
cloudy malodorous fluid abdominal tenderness elevated maternal pulse rate
intrauterine growth restriction
condition that indicates there has been a complication of pregnancy -20% of stillbirths -root may be maternal, placental, or fetal and should be evaluated -short term risks for infants: respiratory depression after birth, hypoglycemia, problems with thermoregulation, necrotizing enterocolitis (NEC), retinopathy of prematurity, polycythemia (increase for elevated bilirubin > jaundice) -long term risks for infants (chronic conditions later in life) - HTN, type 2 DM, high cholesterol, CVD, PCOS, motor/cognitive delays
A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? congenital anomalies incompetent cervix placental abruption (abruptio placentae) placenta previa
congenital anomalies
Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? noting the space at the maternal umbilicus auscultating the fetal heart rate at the level of the umbilicus applying suprapubic pressure against the fetal back continuing to monitor maternal and fetal status
continuing to monitor maternal and fetal status
A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? nifedipine magnesium sulfate corticosteroids indomethacin
corticosteroids
pre-gestational diabetes
diabetes identified before conception -receive preconception care; achieve excellent glycemic control prior to attempting pregnancy -at risk for: preeclampsia, perinatal death, macrocosmic fetus (more than 4000 g), congenital anomalies, polyhydramnios, fetal loss, and preterm birth -vaginal deliveries are not contraindicated, but some providers suggest cesarean section due to macrosomia diagnosed by ultrasound -labor induced often around 39-40 weeks -diet, exercise, and medications closely monitored
The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders? medications used during labor and birth preexisting conditions in the client drop in estrogen and progesterone levels after birth lack of social support from family or friends
drop in estrogen and progesterone levels after birth
The nurse is assessing a pregnant client with a known history of congestive heart failure who is in her third trimester. Which assessment findings should the nurse prioritize? dyspnea, crackles, and irregular weak pulse increased urinary output, tachycardia, and dry cough shortness of breath, bradycardia, and hypertension regular heart rate and hypertension
dyspnea, crackles, and irregular weak pulse
A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? halts the progression of the abortion alleviates strong uterine cramping ensures passage of all the products of conception suppresses the immune response to prevent isoimmunization
ensures passage of all the products of conception
The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding? brief. well coordinated. poor in quality. erratic.
erratic
A client at 38 weeks' gestation has an ultrasound performed at a routine office visit and learns that her fetus has not moved out of a breech position. Which intervention does the nurse anticipate for this client? trial labor external cephalic version vacuum extraction forceps birth
external cephalic version
A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion. The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first trimester abortions? uterine fibroids cervical insufficiency fetal genetic abnormalities maternal disease
fetal genetic abnormalities
A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM? blue color on nitrazine paper foul odor ferning yellow-green fluid
foul odor
A woman with type 2 diabetes is considering becoming pregnant and asks the nurse whether she will be able to continue taking her current oral hypoglycemics. The nurse's response will point out which factor? are usually suggested primarily for women who develop gestational diabetes. have been shown to be effective and safe in recent short term studies. can be used as long as they control serum glucose levels. can be taken until the degeneration of the placenta occurs.
have been shown to be effective and safe in recent short term studies.
A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? hypotonic contractions uncoordinated contractions hypertonic contractions Braxton Hicks contractions
hypotonic contractions
A client in her sixth week postpartum reports general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which condition? hyperglycemia hypovolemia hypertension hypothyroidism
hypovolemia
A nurse is describing the risks associated with post-term pregnancies as part of an inservice presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems in the fetus? meconium aspiration increased amniotic fluid volume aging of the placenta cord compression
increased amniotic fluid volume
A nursing instructor is teaching students about fetal presentations during birth. The mostcommon cause for increased incidence of shoulder dystocia is: increased number of overall pregnancies. poor quality of prenatal care. longer length of labor. increasing birth weight.
increasing birth weight.
endometritis
infection of the uterine lining -27% of cesarean births, 1-3% of vaginal births -risk factors: chorioamnionitis, prolonged labor, prolonged rupture of membranes, multiple cervical examinations, internal monitoring -infection may cause uterus to become soft and involuted, predisposing a woman to hemorrhage -signs and symptoms: fever, uterine tenderness, flu-like symptoms, tachycardia -can get in the way of the uterus involuting and cause a PP hemorrhage indirectly -treatment: broad spectrum antibiotics through IV
A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. magnesium sulfate misoprostol indomethacin dinoprostone nifedipine
magnesium sulfate indomethacin nifedipine
conditions during 1st trimester
multiple pregnancies, bleeding, hyperemesis gravidarum, miscarriage, ectopic pregnancy, gestational trophoblastic disease
multiple pregnancies
multizygotic or monozygotic -3% of births are twins symptoms: same but amplified risk for: gestational diabetes, hypertensive disorders (preeclampsia), pulmonary embolism, preterm birth (50%), perinatal mortality (2x more for twins, 3x more for triplets), placenta previa, fetal anomalies, cord entanglement, twin-to-twin transfusion syndrome assessments - more monitoring for risks and potential issues interventions - more calories, vitamins, minerals, folic acid, protein, weight gain, stress
While providing care to a pregnant woman at the clinic, the nurse suspects that the client may be a victim of intimate partner violence. Which findings would lead the nurse to suspect this? Select all that apply. relaxed appearance during pelvic examinations not keeping up with scheduled treatments up and down weight gain frequent questions about how she and the baby are doing irregular adherence to scheduled prenatal visits
not keeping up with scheduled treatments up and down weight gain irregular adherence to scheduled prenatal visits
passenger: shoulder dystocia
obstruction by the shoulders after the birth of the head -many cases, no risk, some: macrosomia and maternal diabetes -5% experience complications temporary/permanent -turtle sign: first sign, head comes out then goes back in -interventions: make sure you have all equipment (warmer, resuscitation, bed) steps: call for help, lower the HOB, McRobert's maneuver, Suprapubic pressure, Documentation -other maneuvers (Gaskins, Zaveneli's)
chorion
outer membrane that surrounds the amnion -support platform for fetus and amnion -provides nutrient exchange from mother to fetus and foundation for embryonic development -chorionic villi - barrier between maternal and fetal blood
A client with full-term pregnancy who is not in active labor has been prescribed oxytocin intravenously. The nurse would notify the health care provider if which finding is noted? postterm status dysfunctional labor pattern overdistended uterus prolonged ruptured membranes
overdistended uterus
A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority? fluid replacement birth of the fetus oxygenation control of hypertension
oxygenation
eclampsia
preeclampsia with tonic-clonic seizure activity or coma -most likely in antepartum phase
antihypertensives - labetalol, methyldopa, and nifedipine
preferred medications to treat severe hypertension in pregnancy
ectopic pregnancy
pregnancy that occurs outside of the uterus (fallopian tube, ovaries, intestines, cervix) but mostly fallopian tube -life-threatening and must be ended urgently -signs: severe pelvic pain (unilateral, may refer to shoulder), bleeding, beta hCG levels slow rise, OR asymptomatic -risk factors: history of ectopic pregnancy, pelvic infection, pelvic surgery, advanced maternal age, cigarette smoking, IDU, STI - gonorrhea/chlamydia
A nursing instructor identifies which factor as increasing the chances of infection when coupled with prolonged labor? maternal age premature rupture of membranes multiple births number of previous pregnancies
premature rupture of membranes
A patient who is at 7 months' gestation presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This patient is showing clinical signs of which of the following? precipitous labor premature rupture of membranes dystocia all of the above
premature rupture of membranes
The nursing student doing a rotation in obstetrics is talking to her preceptor about dystocia. She asks what is meant by the term "expulsive forces," better known as the "powers." The preceptor correctly tells her that the "powers" include which factors? Select all that apply. analgesia mother's age presentation fetal development position
presentation fetal development position
A nursing student correctly identifies the causes of labor dysfunction to include which factors? Select all that apply. problems with the mother's diet problems with the uterus problems with access to health care problems with finances problems with the fetus
problems with the uterus problems with the fetus
A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? premature birth spontaneous abortion (miscarriage) preterm labor hypertension
spontaneous abortion (miscarriage)
A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion? strong abdominal cramping no passage of fetal tissue slight vaginal bleeding closed cervical os
strong abdominal cramping
gestational hypertension
systolic BP >140 and/or diastolic BP >90 WITHOUT presence of protein in the urine or end-organ dysfunction after 20 weeks -up to half of these develop preeclampsia -complications: preterm birth, small for gestational age, placental abruption
uterine rupture
tear in the uterine lining secondary to increased pressure -may occur in women attempting TOLAC -symptoms: sudden development of category II & III FHR pattern, weakening contractions, abdominal pain -treatment: c-section, possible hysterectomy -avoid at ALL costs -contra: avoid VBACS -nursing considerations: increased awareness of risk factors, monitor signs and symptoms, use caution with tachysystole tracing, stabilize and prepare for c-section
cord prolapse
the cord slips down and proceeds the presenting part; condition in which the umbilical cord precedes fetal head in the birth canal -obstetric emergency that requires immediate c-section -causes: high station, small or preterm fetus, malposition of the fetus, polyhydramnios -first sign: change in FHR tracing, VARIABLE (cord compression) decelerations and bradycardia -management: relieve pressure of the cord to improve blood flow to the fetus and therefore increase oxygenation -presenting part should be held off of the cord, and cord should be handled as little as possible to prevent spasm of the umbilical artery
Group Beta Streptococcus - GBS
type of bacterium commonly found in the vagina and intestinal tract -asymptomatic for women, but devastating for infant -symptoms of the neonate: sepsis, pneumonia, meningitis -screened at 35-37 weeks - swab (yourself, or by professional) -treated: if positive, treated during labor with antibiotics (penicillin, vancomycin - every 12 hours) -pre-term labor are treated without screening
hyperemesis gravidarum - HG
unusually acute N&V -0.5-2%, weeks 11-20 -risk for: weight loss, malnutrition, dehydration, ketonuria, electrolyte imbalance -treatment: rest, possible anti-emetics, IV fluids, parenteral nutrition risk factors: history of it, gestational trophoblastic disease, multiple pregnancy, hyperthyroidism, GI disease, depression, anxiety, female fetus
A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? urine output of 20 mL/hour uterine resting tone of 14 mm Hg contractions every 2 minutes, lasting 45 seconds fetal heart rate of 150 beats/minute
urine output of 20 mL/hour
postpartum risk factors
uterine atony: -retained placenta/membranes -failure to progress to 2nd stage of labor -adherent placenta -LGA infant (>4000 g) -prolonged 1st stage of labor -high parity (>5 pregnancies, >20 weeks) (parity=# of pregnancy that have lasted 20 weeks) -uterine over-distension (big baby, multiple pregnancy, bleeding, polyhydramnios) -uterine infection trauma: -lacerations -instrumental delivery (vacuum/forceps) (hematoma , swelling) -LGA coagulopathy: -hypertensive disorder (preeclampsia, eclampsia, HEELP syndrome) -intrauterine fetal demise (DIC) -sepsis -congenital clotting deficiency
A nurse is interviewing a couple at a preconception counseling session. The couple is of Greek heritage and are concerned about the possibility of their children being born with a genetic disorder. Based on the nurse's understanding of genetic disorders, the nurse would identify this couple as being at risk for which condition? Tay-Sachs disease sickle cell anemia α-thalassemia β-thalassemia
β-thalassemia
After teaching a class of pregnant women on ways to decrease the postpartum complication of thrombotic conditions, the nurse recognizes more teaching is needed when one of the participants states: "He has to do the deep breathing exercises with me." "Using passive range-of-motion exercises in bed sounds easy enough." "At least I don't have to give up smoking for this one." "I should drink more so I don't get dehydrated."
"At least I don't have to give up smoking for this one."
The nurse provides education to a postterm pregnant client. information will the nurse include to assist in early identification of potential problems? "Increase your fluid intake to prevent dehydration." "Continue to monitor fetal movements daily." "Monitor your bowel movements for constipation." "Be sure to measure 24-hour urine output daily."
"Continue to monitor fetal movements daily."
A nursing instructor is teaching about causes of infertility and identifies a need for further instruction when a student states which of the following? "Diet does not play a role in infertility." "Exercise can influence infertility." "A genetic abnormality may cause infertility." "An absence of ovulation may cause infertility."
"Diet does not play a role in infertility."
A woman with hyperemesis gravidarum asks the nurse about suggestions to minimize nausea and vomiting. Which suggestion would be most appropriate for the nurse to make? "Make sure that anything around your waist is quite snug." "Drink fluids in between meals rather than with meals." "Lie down for about an hour after you eat." "Try to eat three large meals a day with less snacking."
"Drink fluids in between meals rather than with meals."
A patient with diabetes is in the first trimester of pregnancy and is currently having difficulty keeping blood glucose levels within normal limits. The patient explains that she has been "eating for two" so the baby is healthy. How should the nurse respond to the patient? "Elevated blood glucose levels in the first trimester have been linked to congenital anomalies." "Elevated blood glucose levels hasten the development of the fetus in utero." "Elevated blood glucose levels ensure the baby has mature lungs at birth." "Elevated blood glucose levels cause low birth weights in infants."
"Elevated blood glucose levels in the first trimester have been linked to congenital anomalies."
A nurse is conducting a class for pregnant women who are in their third trimester. The nurse is reviewing information about the emotional changes that occur in the postpartum period, including postpartum blues and postpartum depression. After reviewing information about postpartum blues, the group demonstrates understanding when they make which statement about this condition? "Postpartum blues is a long-term emotional disturbance." "Extended psychotherapy is needed for treatment." "Getting some outside help for housework can lessen feelings of being overwhelmed." "The mother loses contact with reality."
"Getting some outside help for housework can lessen feelings of being overwhelmed."
A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction? "I will monitor my peak expiratory flow rate regularly to help me predict when an asthma attack is coming on." "I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring." "I need to be aware of my triggers and avoid them as much as possible." "It is fine for me to use my albuterol inhaler if I begin to feel tight."
"I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring."
A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about the prescribed iron supplement, which statement indicates successful teaching? "I need to drink plenty of fluids to prevent constipation." "I will call the health care provider if my stool is black and tarry." "I should take my iron with milk." "I should avoid drinking orange juice."
"I need to drink plenty of fluids to prevent constipation."
A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman makes which statement? "I will call my health care provider if my stools are black and tarry." "I will use a soft toothbrush to brush my teeth." "I can take ibuprofen if I have any pain." "I need to avoid drinking any alcohol."
"I will use a soft toothbrush to brush my teeth."
A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse? "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?" "You should talk to the doctor about that; the medications you're on can damage the fetus." "I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." "That's great. I've got a 4-year-old and a 2-year-old myself."
"I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet."
The nurse is teaching a client with gestational diabetes about complications that can occur either following birth or at delivery for her baby. Which statement by the mother indicates that further teaching is needed by the nurse? "I may need an amniocentesis during the third trimester to see if my baby's lungs are ready to be born." "If my blood sugars are elevated, my baby's lungs will mature faster, which is good." "My baby may be very large and I may need a cesarean section to have him." "Beginning at 28 weeks' gestation, I will start counting with my baby's movements every day."
"If my blood sugars are elevated, my baby's lungs will mature faster, which is good."
A nurse is teaching a pregnant woman with preterm prelabor rupture of membranes about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching? "It's okay for my husband and me to have sexual intercourse." "I can shower, but I shouldn't take a tub bath." "I need to keep a close eye on how active my baby is each day." "I need to call my doctor if my temperature increases."
"It's okay for my husband and me to have sexual intercourse."
A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question? "Maybe your baby has developed hydrocephaly and the head is too swollen." "Maybe your uterus is just tired and needs a rest." "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." "It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby."
"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."
The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? "If I develop this complication, I will have bright red vaginal bleeding," "Since I am over 30, I run a much higher risk of developing this problem." "I need a cesarean section if I develop this problem." "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best? "Please come in now for an evaluation by your health care provider." "Bleeding during pregnancy happens for many reasons, some serious and some harmless." "Lie on your left side and drink lots of water and monitor the bleeding." "If the bleeding lasts more than 24 hours, call us for an appointment."
"Please come in now for an evaluation by your health care provider."
The nurse is preparing discharge instructions for a client at 32 weeks' gestation who was admitted for PROM. What is the best response from the nurse when the client asks when she can have intercourse with her husband again? "Intercourse has nothing to do with preterm labor; you can have sex with your husband." "That is a question to ask your health care provider; at this point you are on pelvic rest to try and stop any further labor." "You will not be able to have intercourse again until 6 weeks after you give birth." "The need to keep the infant safe should be of more concern than when to have sex."
"That is a question to ask your health care provider; at this point you are on pelvic rest to try and stop any further labor."
A multipara woman is fully dilated and effaced and has been pushing for over 2 hours. The student nurse observing asks the nurse, "What is causing this to last so long?" Which response by the nurse would be the most accurate? "The fetal head and shoulders are too large to get through the canal." "The woman's bladder is too full, so the fetus cannot descend." "The fetus probably turned to a breech position at the last minute." "The fetal head is in an abnormal position."
"The fetal head is in an abnormal position."
The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. "The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I am sad because I am not spending as much time with my toddler now that my newborn is here." "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."
"The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."
A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best? "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." "You have experienced an incomplete miscarriage and must have the placenta and any other tissues cleaned out." "The choice is up to you but the health care provider is recommending an abortion." "I know that it is sad but the pregnancy must be terminated to save your life."
"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."
smoking
-15.4% of pregnant women smoke -can cause preterm birth, intrauterine growth restriction, and stillbirth
preeclampsia*
-3-5% of pregnancies -diagnosis: patient with HTN (>140/90) on 2 occasions at least 4 hours apart and proteinuria OR patient has HTN w/ or w/ out proteinuria w/ a platelet count <100000, serum creatinine liver >1.1 mg/dL, elevated liver enzymes, pulmonary edema, new-onset visual or cerebral systems* (headaches, blurred vision, spots - not responding to medications)* -developed after 20 weeks of gestation in a previously normotensive pregnant woman; proteinuria of at least +1
opioids and opioid replacements
-5.4% pregnant women use illegal drugs high risk for neonatal abstinence syndrome (NAS) - withdrawal syndrome signs and symptoms -Body shakes (tremors) -seizures (convulsions) -overactive reflexes (twitching), tight muscle tone -Fussiness, excessive crying/high-pitched cry -Poor feeding/sucking or slow weight gain -Breathing problems, breathing really fast -Fever, sweating or blotchy skin
intimate partner violence - IPV
-7-20% of pregnancies are complicated by physical abuse -psychologic and sexual abuse, goes underreported -5% women report partners tried to get them pregnant and they did not want to be -screen for this during prenatal visits, hospitalization, and postpartum appointments -use standardized screening tool bc can be intimidating -screen when alone -make appropriate referrals
alcohol
-9.4% of pregnant women drink alcohol -teratogen that can cause fetal alcohol syndrome; no known safe amount of alcohol during pregnancy -FAS signs and symptoms -Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip -Deformities of joints, limbs and fingers -Slow physical growth before and after birth -Vision difficulties or hearing problems
severe chronic hypertension
->160 / >110 (either one or both) -goal is to maintain 140-150 / 90-100, unless there is evidence of organ damage, goal may be even lower -treated with meds -carefully monitored for preeclampsia and HELLP syndrome
home management of preeclampsia
-Bedrest lying on side (best to promote profusion) -Monitor BP & symptoms -Monitor weight gain: edema from plasma leakage into maternal tissues (especially in face) -Monitor fetal activity: late decelerations may indicate a deterioration of fetal reserve -Normal diet - no restrictions, increase protein
magnesium sulfate administration***
-administered IV as secondary infusion (loading dose of 4-6g over 15-30 mins; then a maintenance dose of 1-3 g/hr to maintain a serum Mg level of 4-7 mEq/L - Therapeutic level)****** -Mg toxicity signs*** - respiratory depression, maternal bradycardia, oliguria, absent deep tendon reflexes, lethargy, slurred speech, loss of consciousness, muscle weakness -Interventions to address toxicity - STOP the infusion immediately, Administer Calcium Gluconate (antidote) as ordered (typically 1 g by slow IV push over 3 mins)
monozygotic
-all fetuses came from the same ovum - identical twins/triplets/etc. -time of ovum split determines the number of amnion, chorions, placenta -random/spontaneous event -not associated with a genetically inherited trait or ethnic group -3/1000 twin pregnancies
amniotic fluid embolism
-anaphylactoid syndrome of pregnancy; can occur in pregnancy, labor, delivery, and immediate postpartum (up to 48 hours) -caused when amniotic fluid enters maternal circulation and is associated with maternal mortality rate of 32% -symptoms: respiratory failure and cardiac arrest -if patient survives, at risk for hemorrhagic shock with disseminated intravascular coagulation
symmetric IUGR
-both head and body grow at slower rate -AKA global growth restriction -associated with significant neurological problems in neonate -often seen in second trimester -causes: TORCH infections, maternal substance abuse, maternal anemia, chromosomal abnormality of the fetus, smoking, teratogenic medications
postpartum hemorrhage treatment
-call for help -assess uterus: -if boggy, massage fundus firmly -if firm, assess for lacerations or hematoma -if, bladder distension, have void on own, or empty with a catheter (straight/foley) -ensure/establish IV access (worried about hypovolemic shock) -administer oxytocin IV or IM, or other uterine uterotonics (hemabate, misoprostol (rectally), methylergonovine) -if unsuccessful, uterine tamponade (put a balloon in the uterus and blow it up with fluid so it is doing the compression that the uterus is suppose to do on its own) or surgical intervention (ligation, embolization of blood vessels, hysterectomy)
amniotic fluid embolism interventions
-call for help, open airway, initiate CPR -prior to birth, place in side-lying position to displace the uterus -continuously monitor pulse ox, HR and rhythm, RR, BP -prior to birth, continuous fetal monitoring -anticipate central venous and arterial catheters bc: CVC - infusion of fluids, medicine, blood; blood draws, monitors central venous pressure and central venous oxyhemoglobin saturation; AC - continuous monitor of BP and arterial blood gasses -supplemental oxygen w goal of keeping PaO2 >65 mmHg w/ nonrebreather at rate of 8-10mL, resuscitation bag w 100% oxygen, intubation and mechanical ventilation -provide hemodynamic support by administering as ordered: vasopressor (norepinephrine), IV fluids, blood products -prior to birth, prepare for emergent delivery
power: ineffective pushing
-can also lead to dystocia -laboring down allows the primary powers to facilitate fetal descent in the second state; pushing resumes when the woman feels the urge to bear down -used w epidurals -evidence: completely dilated, but station -2; fetal not descended -therapeutic: open legs (gravity)
trauma
-can be related to motor vehicle accidents, falls, gun/stab wounds, intimate partner violence -place wedge under hip to minimize supine hypotension -chest compressions may be more challenging/ineffective in pregnant women -oxygen consumption is increased; monitor for hypoxia -abdominal trauma may result in placental abruption -may indicate administration of Rh immune globulin to Rh negative women -carefully assess woman (ABCs, VB, contractions, abdominal pain) and fetus (FHR) -in the event of unsuccessful maternal CPR, goal is to have c-section within 5 mins
types of uterine incisions for cesarean birth
-classical (vertical) or transverse -safest to attempt vaginal delivery after cesarean if low transverse incision was used (TOLAC - trial of labor after cesarean) -if vertical, cannot attempt vaginal delivery after c-section (VBAC - vaginal birth after c-section)
asthma
-complicates 3-5% of pregnancies -some experience worsening or symptoms and some experience improvement -complications: antepartum & postpartum hemorrhage, pulmonary embolism (life threatening - high mortality), miscarriage, increased bleeding risk -treatment - control and limit exacerbations -nurses encourage to TAKE asthma medications and avoid smoking/2nd hand smoke -asthma exacerbation can be recognized by dyspnea with wheezing or cough
gestational diabetes. mellitus - GDM
-complicates 6-7% of pregnancies -associated with insulin resistance and results in high blood glucose levels - similar to type 2 DM -risks - preeclampsia, infection, ketoacidosis, spontaneous abortion, fetal macrosomia, polyhydramnios, fetal organomegaly, operative delivery, birth trauma to mother/fetus, neonatal respiratory problems or metabolic problems (hypoglycemia/hypocalcemia, jaundice), perinatal mortality, stillbirth, congenital anomalies, intrauterine growth restriction, respiratory depression syndrome, fetal hyperinsulinism
oxytocin
-first line* -route & dose - 10-40 Units IV in 500 mL; -1 L normal saline at a rate sufficient to control atony; OR 10 Units IM -side effects - occasional nausea, AND rarely: water intoxication -contraindications - none when using for PPH
pre-gestational diabetes - 1st trimester assessments
-hemoglobin A-1C (average blood glucose) -evaluation of baseline kidney function with a 24-hour urine collection -screening or thyroid, heart, and eyes
passenger: breech position
-in 1/33 births (frank, footling, complete) ends up in c-section*; risk for asphyxia/birth trauma; diagnosed by leopold's maneuvers and confirmed by ultrasound; ECV - external cephalic version may be attempted after 36 weeks to turn fetus to a head down position: if this causes non-reassuring FHR, deliver by c-section immediately!
thromboembolic disease
-include: venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), superficial vein thrombosis -risk factors in pregnant woman: dilated vessels lead to slower blood flow; endothelial injury bc surgical intervention or placental detachment; increase of coagulation factors; risk is 2-5x higher in postpartum than during pregnancy
anti-seizure medications
-increased risk for congenital anomalies, ****but continue to take meds and avoid seizure triggers -if on ________________, should take 4mg of folic acid daily beginning 3 months before conception -can cause increased risk for bleeding
cesarean birth pre-op nursing considerations
-labs - hemoglobin w/ in the past month, blood type and antibody screen -antibiotics - single dose given 60 mins before incision -thromboembolism prophylaxis -pneumatic compression devices for women at low risk, pneumatic compression devices and pharmacologic prophylaxis (heparin) for high risk -FHR - recording on admission, continuous monitoring throughout labor: discontinue external monitoring when prep for incision begins, discontinue internal monitoring prior to incision -placental location and fetal position assessment - ultrasound, leopolds -bladder catheterization -skin prep - scrub with chlorhexidine or iodine; if hair removal is indicated, clip (don't shave) before procedure -vaginal prep - scrub with chlorhexidine or iodine for patients with ROM -draping around surgical site -displacement of uterus to avoid supine hypotension - wedge, rolled blanket, pillow, tilt table
postpartum depression
-major depression with an onset during pregnancy or in the first 4 weeks after birth OR up to a year after birth -risk factors: history of depression or history of PPD, postpartum blues, stress, low socioeconomic status, poor social support, <25 unplanned pregnancy, anxiety, lack of partner, complicated pregnancy, misbehaved infant~~~~~~~just understand these -must meet 5/9 of the criteria within a 2 week period -at least 1 symptom must be a depressed mood or diminished pleasure in all/most activities -warning signs: low mood for 2 weeks; negative attitude towards infant/little interest; excessive anxiety about health of infant; concern about ability to care for infant; use of alcohol, street drugs, tobacco; noncompliance with care; frequent off-schedule calls to HCP; unsuccessful/no breastfeeding; -treatment: medication and therapy
depression
-majorly not treated in pregnancy in up to half of woman because of: not diagnosed, cost, stigma, fear of harming the fetus -untreated can lead to: substance abuse, poor adherence to care, less prenatal care, suicide risk -treated with SSRIs, which do not have any teratogenic effects but may have low Apgar scores -SSRIs not contraindicated in breastfeeding -stigma is common and women may feel shame and unwillingness to discuss the problem
ectopic pregnancy treatment
-methotrexate - inhibits cell reproduction and DNA synthesis -surgical - removal of ovum only if possible OR more structures depending on pregnancy progression -salpingectomy - removal or one or both fallopian tubes -administration of blood products -Rhogam administration if woman is Rh negative -support client education: report signs of heavy bleeding, dizziness, tachycardia; return for BhCG testing, refer for counseling and support
passenger: cephalopelvic disproportion - CPD
-mismatch between the size of the fetal head and the size of the maternal pelvis -fetal position in relation to maternal pelvis (ideal - flexed) -most common malpresentation: OP - occiput posterior position - can cause low back pain -asynclitic - fetal head tilted -face presentation - c-section
after an unsuccessful forceps-assisted delivery, the provider will.....
-perform a c-section NOT a vacuum-assisted (increases risks without improving outcomes)
eating disorders
-poor health and psychologic outcomes -pregnancy may be challenging due to normal body changes because of body image -women may not menstruate, but they may ovulate -pregnancy should be planned for a time of remission, need to get nutrients to fetus -anorexia nervosa, bulimia nervosa, binge eating disorder
cesarean birth post-op nursing considerations
-routine monitoring: systolic BP >90, HR <120, RR <30, Temp (fever), pulse ox >95%, urine output >30 ml/h, uterine tone and bleeding from the vagina and incision -breastfeeding to be started in delivery room -remove catheter ASAP (when safe ambulation is established) -ambulation within 6 hours after anesthetic effects are resolved -regular diet -would dressing removal in 24-48 hours: most are closed with sutures, if closed w staples anticipate removal in 4-10 days -increase activity as tolerated -avoid heavy lifting or lifting from a squat position up to 1-2 weeks after delivery
toxoplasmosis
-transmitted through exposure to litter of infected cat, gardening without gloves, eating raw/rare meat -greatest risk to fetus in 1st trimester - damage to CNS, skin, ears; hydrocephalus, IUGR
postpartum hemorrhage problems/causes
-uterine atony: failure of the uterus to accurately contract (boggy) > sub-involution -blood coagulation: failure of blood to clot OR -trauma: lacerations or uterine inversion (cervical, vaginal, perineal) -retained placenta -disseminated intravascular coagulation defects: causes clotting factors to occur abnormally
When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action? Removing the infant quickly. Keeping the communication lines open. Leaving the parents alone. Contacting a grief counselor.
Keeping the communication lines open.
The nurse is caring for a diabetic, postpartum client who has developed an infection.The nurse is aware that infections in diabetic clients tend to be more severe and can quickly lead to complications. Which complication should the nurse assess this client for? Respiratory acidosis Anemia Respiratory alkalosis Ketoacidosis
Ketoacidosis
iron deficiency anemia
-16-29% will become during pregnancy -severe, is associated with non-reassuring FHR, prematurity, fetal loss, maternal death (rare in developed countries) -physiologic - expected finding with normal hemoglobin level 11-14 g/dL -below 10.5 g/dL for diagnosis
A client who is HIV-positive is in her second trimester and remains asymptomatic. She voices concern about her newborn's risk for the infection. Which statement by the nurse would be most appropriate? "Wait until after the infant is born, and then something can be done." "Antibodies cross the placenta and provide immunity to the newborn." "Antiretroviral medications are available to help reduce the risk of transmission." "You'll probably have a cesarean birth to prevent exposing your newborn."
"Antiretroviral medications are available to help reduce the risk of transmission."
The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? "The hormones of pregnancy may cause anxiety or depression postpartum." "Expect your other children to react positively to their new brother/sister." "Caring for your new infant is instinctual and will come naturally to you." "Your old coping methods will adequately get you through this period of adjustment."
"The hormones of pregnancy may cause anxiety or depression postpartum."
After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching? "I need to call my doctor if my temperature goes above 100.4° F (38° C)." "When I put on a new pad, I'll start at the back and go forward." "I'll point the spray of the peri-bottle so the water flows front to back." "If I have chills or my discharge has a strange odor, I'll call my doctor."
"When I put on a new pad, I'll start at the back and go forward."
A patient in her late twenties visits the clinic to begin the process of in vitro fertilization (IVF). Her husband in his late fifties asks if there are any tests to check for any irregularities. What tests should the nurse discuss with this couple? CVS PPD Examination of egg and sperm amniocentesis
Examination of egg and sperm
oligohydramnios
amniotic fluid disorder -decreased amniotic fluid -causes: 2nd trimester - fetal anomalies, premature rupture of membranes; 3rd trimester - fetal anomalies, PROM, uteroplacental insufficiency -associated with poor prognosis - usually preterm birth, early induction, or c-section related to concerns about fetal well-being -diagnosed with ultrasound findings of decrease AFI <5 cm -treatment may include amnioinfusion of Ringer's lactate into the amniotic sac
A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? infection central nervous system (CNS) involvement cord compression fetal distress related to hypoxia
fetal distress related to hypoxia
A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? firm, rigid uterus on palpation fetal heart rate within normal range bright red vaginal bleeding absence of pain
firm, rigid uterus on palpation
A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as: ectopic pregnancy. hydatidiform mole. hydramnios. placenta accrete.
hydatidiform mole.
TORCH infections
a group of infections commonly implicated in congenital anomalies: Toxoplasmosis Other (hepatitis or varicella) Rubella Cytomegalovirus (CMV) Herpes simplex
A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? 3 7 5 9
9
superficial vein thrombosis
-more common than DVT -symptoms - pain, tenderness, & redness along the length of the vein; may feel cord-like or self-limiting (resolve on own)
A nursing instructor is teaching students about preexisting illnesses and how they can complicate a pregnancy. The instructor recognizes a need for further education when one of the students makes which statement? "A pregnant woman needs to be careful of and cautious about accidents and illnesses during her pregnancy." "A pregnant woman with a chronic condition can put herself at risk." "A pregnant woman with a chronic illness can put the fetus at risk." "A pregnant woman does not have to worry about contracting new illnesses during pregnancy."
A pregnant woman does not have to worry about contracting new illnesses during pregnancy."
A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? 2 to 7 days 4 to 8 days 6 to 10 days 1 to 5 days
2 to 7 days
A client is 33 weeks pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled? 120 mg/dL 85 mg/dL 136 mg/dL 45 mg/dL
85 mg/dL
precipitous labor
3 hours or less
Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? "I know you are hurting, but you can have another baby in the future." "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" "I will make handprints and footprints of the baby for you to keep." "Have you named your baby yet? I would like to know your baby's name."
"I know you are hurting, but you can have another baby in the future."
A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? "Your primary care provider will order safe doses of your medication." "They won't cause any major defects." "It's OK to not use them if you would feel more comfortable." "I'll let your primary care provider know how you feel about it."
"Your primary care provider will order safe doses of your medication."
bleeding during pregnancy
-20% of women report bleeding during pregnancy -implantation bleeding, spotting, miscarriage, ectopic pregnancy, gestational trophoblastic disease -any time bleeding is reported, evaluate
asymmetric IUGR
-70% of cases -growth restriction happens mostly or entirely in 3rd trimester -normal growth of fetal head, slower growth of body -causes: uteroplacental insufficiency, maternal HTN disorders, severe maternal malnutrition, select maternal acquired disease, abnormal placentation, multiple gestation
hypovolemic shock nursing interventions
-FIRST: establish/access 2 large bore IV lines** -administer blood, blood products -monitor for fluid overload - crackles, short of breath, edema -monitor urine output -vitals -labs
support for perinatal loss
-communicate warmly -avoid medical terms -use words death/dying -validate emotions -treat infant with respect -memory box -give them as much time as possible -leaf on door signals loss -refer to support organizations -support for funeral arrangements and lactation
signs of hyperthyroidism
-decreased weight -decreased appetite
dermatoses of late pregnancy
-intrahepatic cholestasis -pruritic urticarial papules and plaques of pregnancy
in-hospital management of preeclampsia
-magnesium sulfate -antihypertensive meds in severe cases (labetalol, hydralazine, methyldopa, nifedipine) -monitor BP -minimize stimulation - low lights, noise, activity to decrease probability of seizures -NST and BPP -lab monitoring -preventing injury from seizures -corticosteroids IM for fetal lung maturity ** - betamethazone (2 doses), dexamethasone -delivery
control of BP
-meds not given to mild preeclampsia or mild gestational HTN -meds given to severe gestational HTN (BP - 160/110) & eclampsia - IV hydralazine or labetalol; only correct BP to 140/90 -given to women w chronic HTN throughout pregnancy
passageway: maternal pelvis smaller than normal; android/platipoid pelvis
-occur in conjunction with passenger issues -can lead to dystocia -pelvimetry: associated with higher cesarean risks (if not ideal pelvic shape) but not overall improved outcomes -soft tissue dystocia - can be caused by full bladder/bowel, scar tissue on the cervix (abortion) OR, pushing before cervix is fully dilated (can also lead to swelling) -issues can occur w out awareness
urinary tract infections
-often asymptomatic and should be treated with antibiotics during pregnancy -cystitis, asymptomatic bacteriuria, pyelonephritis -treatment - antibiotics oral or IV depending on infection and severity
cervical insufficiency
-painless, premature dilation of the cervix in the second trimester of pregnancy -caused by congenital or acquired cervical/uterine defects -high risk for miscarriage of premature birth -diagnosed with history of second-trimester pregnancy losses and/or measurement of cervical length by ultrasound treatment - progesterone, cerclage
HIV
-pregnancy not contraindicated for + women -chance of transmission to fetus <2% -often c-section to reduce transmission risk -newborn treated with antiretroviral medications for 4-6 weeks -breastfeeding in contraindicated in US because causes increased risk of transmission
hypovolemic shock treatment
-restore circulating blood volume (fluids, blood, blood products) -address the source of bleeding -O2 supplement as needed
methylergonovine (methergine)
-route & dose - 0.2 mg IM every 2-4 hours -side effects - N&V, headache, hypotension, hypertension -contraindications - CAUTION - ergots should not be given to patients with CVD or HTN
gestational diabetes screening/diagnosis
-screening for all patient between 24-28 weeks: non-fasting 50 g oral glucose tolerance test (OGTT); if blood glucose is >130, diagnostic test required -high risk may be screened at first prenatal visit for preexisting diabetes -diagnostic testing: fasting 100 g GTT; blood sugar evaluated fasting 1,2&3 hours after ingesting good; if two or more values are elevated, patient has it -fasting >95 -1 hr >180 -2 hr >155 -3 hr >140
perinatal loss
-still birth occurs in approximately of 6/1000 pregnancies that reach 20 weeks gestation -risk is higher for african americans, adolescents, women over 35, multifetal gestations, congenital anomalies, maternal disease -prevention: folic acid before and during pregnancy, routine syphilis screening and treatment, screening for and treating hypertensive disorders and maternal diabetes, access to emergency obstetric care -families who experience may experience anxiety, depression, PTSD
episiotomy
-surgical incision of the posterior aspect of the vulva made during the second stage of labor -used if patient is at high risk for a third or fourth degree perineal tear or if expedited delivery is needed because of fetal compromise -risks: infection, bleeding, pain
signs of hypovolemic shock
-tachycardia (early) -hypotension (later) -tachypnea (sign of metabolic acidosis) -oliguria (blood shunted away from kidneys, lowers blood volume) -mental status changes (poor perfusion) -cool, pale, clammy skin (peripheral vasoconstriction to redirect blood to vital organs) -slowed capillary refill (peripheral vasoconstriction)
postpartum blues
-transient, self-limiting mood disorder that starts 2-3 days after delivery and resolves within 2 weeks -symptoms - insomnia, fatigue, dysphoria (unease/dissatisfaction) and impaired concentration
Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth? Delay breastfeeding the newborn for a day. Ensure that the client does not cough or breathe deeply. Assess uterine tone to determine fundal firmness. Avoid early ambulation to prevent respiratory problems.
Assess uterine tone to determine fundal firmness.
A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? Assess the temperature. Assess the fundal height. Monitor the pain level. Check the lochia.
Check the lochia.
A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? Depressed deep tendon reflexes Elevated blood glucose Bradycardia Tachypnea
Depressed deep tendon reflexes
A client with a high-risk pregnancy has been prescribed inpatient bed rest. When assessing the client each morning, which risk factor of is common with this treatment plan? Diarrhea Muscle rigidity Depression Weight loss
Depression
A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? Fetal heart tones Signs of shock Infection Uterine stabilization
Fetal heart tones
The nurse is caring for a client with a high-risk pregnancy. Which circumstance(s) may have caused the pregnancy to be labeled as high-risk? Select all that apply. multiple gestation pregnancy three-vessel umbilical cord daily exercises by mother maternal high blood pressure genetic defect of fetus HIV-positive mother
HIV-positive mother multiple gestation pregnancy genetic defect of fetus maternal high blood pressure
A pregnant patient reports feeling pain similar to menstrual cramps. What should the nurse explain about this patient's symptoms? Exercise helps reduce the frequency of them. Lying down for a few hours will help them stop. They are false labor and do not need to be reported. If rhythmical, they could indicate preterm labor.
If rhythmical, they could indicate preterm labor.
The nurse is caring for a woman at 32 weeks' gestation who expresses deep concern because her previous pregnancy ended in a stillbirth. The nurse would encourage the mother to have what screening test? Nonstress test (NST) Contraction stress test Doppler ultrasound Vaginal ultrasound
Nonstress test (NST)
A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth? The mother's age Prophylactic ART to infant at birth Amniocentesis results at 34 weeks The viral load
The viral load
When preparing a mother for a trial of labor after cesarean (TOLAC), what information should the nurse include in the teaching plan? There may be a shorter active phase of first stage of labor. There may be a shorter latent phase of labor. There may be a longer active phase of first stage of labor. There may be a longer latent phase of labor.
There may be a longer active phase of first stage of labor.
The nurse is caring for a multigravid who experienced a placental abruption 4 hours ago. For which potential situation will the nurse prioritize assessment? Blood incompatibilities Maternal blood loss Uterine atony Hypertensive crisis
Uterine atony
A nurse is assigned to care for a client with a uterine prolapse. Which of the following would be most important for the nurse to assess when determining the severity of the prolapse? Pain in the lower abdomen Uterine protrusion into the vagina Foul smelling lochia Uterine bleeding present
Uterine protrusion into the vagina
postpartum period
after birth, the uterus prevents PPH by clotting and contraction of the uterus which compresses open blood vessels from placental site to prevent hemorrhage -commonly thought that risk is low, but severe complications can still occur during this: -hemorrhage, sepsis, hypertensive crisis (preeclampsia, eclampsia, HELLP syndrome, venous thromboembolism, heart failure) -nurses should be - vigilant and attentive during this time -typical blood loss: vaginal birth - 500 mL; c-section - 1000 mL
After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? laminaria breast stimulation amniotomy prostaglandin
amniotomy
When preparing a schedule of follow-up visits for a pregnant woman with chronic hypertension, which schedule would be most appropriate? bi-monthly visits until 28 weeks, then weekly visits bi-monthly visits until 36 weeks, then weekly visits monthly visits until 32 weeks, then bi-monthly visits monthly visits until 20 weeks, then bi-monthly visits
bi-monthly visits until 28 weeks, then weekly visits
cystitis
bladder UTI; bladder infection symptoms - urinary urgency, pain/burning with urination, may have blood in urine, lower abdominal discomfort
cystitis
bladder infection -symptoms - frequent urination, sensation of incomplete emptying, pain w urination, lower abdominal or pelvic pain
venous thromboembolism - VTE
blood clot or multiple blood clots that form inside a vein -can either be DVT or superficial vein thrombosis; can then progress to PE -risk is higher in postpartum (2-5x higher than in pregnancy) -supportive measures - elevate effected leg (NOT on strict bed rest), warm or cold compresses for comfort, NSAIDs, compression stockings/devices, maintain ambulation
Which measurement best describes delayed postpartum hemorrhage? blood loss in excess of 1,000 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 300 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 800 ml, occurring at least 24 hours and up to 12 weeks after birth
blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth
A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth? monitor for a cardiac anomaly extensive lacerations brachial plexus assessment assess for cleft palate
brachial plexus assessment
spotting
due to infection, sex, increased blood flow to cervix; usually brief and painless
A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? disseminated intravascular coagulation (DIC) elevated platelet count hyperglycemia elevated liver enzymes
elevated liver enzymes
HELLP Syndrome
hemolysis elevated, liver enzymes low, platelets
lactational mastitis
inflammation of the breast tissue, associated with infection -provoked by poor/blocked milk drainage, causing overgrowth of bacteria in area of stagnated milk -risk factors: delayed breast emptying/infrequent feeding, poor drainage of one or more ducts, inconsistent pressure on breasts (poorly fitting bra), oversupply of milk, nipple trauma, rapid weaning; NOT caused by breastfeeding -most common in first 3 months of breastfeeding -symptoms: red, swollen, painful area of breast; flu-like malaise; high fever (symptoms that persist 24 hours suggest bacterial infection) -treatment: cold compresses as tolerated for first 24 hrs; NSAIDs (ibuprofen for discomfort); regular and complete emptying of the breast* (do NOT tell them to stop breastfeeding - have to unclog the duct before an infection occurs or clear out infection); antibiotics if >24 hours
After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? knee-chest sitting side-lying supine
knee-chest
A nurse is explaining to a group of nurses new to the labor and birth unit about methods used for cervical ripening. The group demonstrates understanding of the information when they identify which method as a mechanical one? membrane stripping laminaria amniotomy herbal agents
laminaria
A nurse informs a pregnant woman with cardiac disease that she will need two rest periods each day and a full night's sleep. The nurse further instructs the client that which position for this rest is best? left lateral recumbent right lateral recumbent on her back prone
left lateral recumbent
In women with cardiac failure, the maternal blood pressure becomes insufficient to provide an adequate supply of blood to the placenta. The infant will likely experience some undesired effects, including which of the following? high birth weight hypoglycemia low birth weight hyperglycemia
low birth weight
The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition? postpartum psychosis anxiety disorders postpartum depression postpartum blues
postpartum depression
postpartum psychosis
rare disorder that affects a woman's sense of reality; severe (drowning child, throwing out the window) -evidenced by hallucinations, thought disorganization, disorganized behavior, and delusions - medical emergency -common - in bipolar depression, schizophrenia, schizoaffective disorder, psychosis -may occur within 48 hours of birth, almost always within the few weeks of delivery -4.5% of infants have been killed by their mother with PPP; 30% repeats in future pregnancies -priority of care - safety of mother and infant -treatment - inpatient psychiatric care, antipsychotic medications, treatment for underlying psychiatric disorders, psychotherapy
A nurse is reviewing a client's history and physical examination findings. Which information would the nurse identify as contributing to the client's risk for an ectopic pregnancy? heavy, irregular menses ovarian cyst 2 years ago use of oral contraceptives for 5 years recurrent pelvic infections
recurrent pelvic infections
The nurse is appraising the medical record of a pregnant client who is resting in a darkened room and receiving betamethasone and magnesium sulfate. The nurse recognizes the client is being treated for which condition? postterm pregnancy gestational diabetes severe preeclampsia gestational hypertension
severe preeclampsia
levothyroxine (T4 replacement)
treatment for hypothyroidism -adjusted based on TSH levels every 4 weeks to 3 months -required more frequently in early pregnancy -take first thing in the morning on an empty stomach with no further oral intake for 1 hour
Which factor would contribute to a high-risk pregnancy? type 1 diabetes history of allergy to honey bee pollen first pregnancy at age 33 blood type O positive
type 1 diabetes
labor and delivery: complications
uterine rupture, cord prolapse, amniotic fluid embolism, perinatal loss
A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. The nurse knows to prepare the client for which test first? transthoracic echocardiogram venous duplex ultrasound of the right leg noninvasive arterial studies of the right leg venogram of the right leg
venous duplex ultrasound of the right leg
A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression? "I keep hearing voices telling me to take my baby to the river." "I just feel so overwhelmed and tired." "It's strange, one minute I'm happy, the next I'm sad." "I'm feeling so guilty and worthless lately."
"I'm feeling so guilty and worthless lately."
anxiety: Generalized anxiety disorder (GAD)
-12% of people in the US -report fatigue, tension, irritability, pervasive sense of apprehension -assessed with seven-item scale (GAD-7) -main treatment with SSRIs because then are safe, and counseling -some treatment with benzodiazepines but they may cause withdrawal in neonate and a higher risk of fetal loss and preterm birth -nurses can empower patients with realistic education about therapies and self-care measures; mindfulness, exercise, good nutrition
multizygotic
-2 or more eggs are released and fertilized at the same time -2 eggs fertilized = dizygotic or fraternal twins -70% of multiple pregnancies -risk factors: artificial reproductive technology (ART), ethnicity (African descent), family history, advanced maternal age (bc increased FSH can cause release of >1 egg as menopause approaches -each fetus has a separate amnion and chorion (placentas may grow together)
postpartum complication, early warning signs
-maternal agitation, confusion, unresponsiveness -headache or SOB w preeclampsia -systolic BP <90 or >160 (low BP - hypovolemia, hemorrhage; high BP - hypertensive disorder) -diastolic BP >100 -HR <50, >120 -RR <10, >30 (note type of anesthesia) -Oxygen saturation <95% -Oliguria for 2 or more hours (<35 mL/h) - can indicate hypovolemic shock
operative vaginal delivery
-may be attempted for a prolonged second stage of labor, fetal compromise, or a disorder that limits the mother's ability to push risks: shoulder dystocia, tissue damage to mother and fetus -forceps-assisted, vacuum-assisted, cesarean section
chlamydia and gonorrhea
-may cause preterm labor, preterm rupture of membranes, postpartum endometritis -treated with antibiotics followed by retesting 3. months later - treat partners as well
substance abuse
-may not seek prenatal care bc they feel ashamed or are worried about the involvement of social services -ALL women should be screened -stopping consumption at any point can improve outcomes -some have comorbid conditions and psychosocial challenges ex. homelessness; treat underlying cause to reduce use -don't threaten that baby will be taken -focus on positives (smoking 1 less cigarette per day)
cytomegalovirus - CMV
-most common cause of congenital, nonhereditary hearing loss -can cause vision impairment and cerebral palsy -60% of women infected w/ CMV by age 44; transmitted through blood, saliva, urine, semen, breastmilk
hypothyroidism
A disorder caused by a thyroid gland that is slower and less productive than normal -sometimes diagnosed in pregnancy (lack of doctor visits) -0.3-0.5% pregnancies; can cause preeclampsia, postpartum hemorrhage, and early pregnancy loss
What would the nurse use to monitor the effectiveness of intravenous anticoagulant therapy for a postpartum woman with deep vein thrombosis? Platelet level Fibrinogen level Prothrombin time Activated partial thromboplastin time
Activated partial thromboplastin time
While the placenta is being delivered after labor, a patient experiences an amniotic fluid embolism. What should the nurse do first to help this patient? Administer oxygen by mask. Increase intravenous fluid infusion rate. Put firm pressure on the fundus of the uterus. Tell the patient to take short, shallow breaths.
Administer oxygen by mask.
The nurse is reviewing orders written for a postpartum patient with a fourth-degree perineal laceration. Which order should the nurse question before implementing? Administering an enema Providing a sitz bath Urging to drink all the milk provided during meals Administering acetaminophen and codeine for pain
Administering an enema
During a prenatal ultrasound, the client is discovered to have a placenta succenturiata. Following delivery of the fetus and placenta, which nursing assessment is most important? Assessment for hemorrhage Assessment for pain Assessment for shortness of breath Assessment for a thrombus
Assessment for hemorrhage
The nurse notes uterine atony in the postpartum client. Which assessment is completed next? Assessment of bowel function Assessment of the lung fields Assessment of laboratory data Assessment of the perineal pad
Assessment of the perineal pad
Which assessment would lead the nurse to believe a postpartum woman is developing a urinary complication? She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. Her perineum is obviously edematous on inspection. At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. She says she is extremely thirsty.
At 8 hours postdelivery she has voided a total of 100 mL in four small voidings.
A pregnant client mentions to the nurse that a friend has given her a variety of herbs to use during her upcoming labor to help manage pain. Specifically, she gave her chamomile tea, raspberry leaf tea, skullcap, catnip, jasmine, lavender, and black cohosh. Which of these should the nurse encourage the client not to take because of the risk of acute toxic effects such as cerebrovascular accident? Skullcap Catnip Black cohosh Jasmine
Black cohosh
A client develops mastitis 3 weeks after giving birth. What part of client self-care is emphasized as most important? Administer antibiotic medication for the full 10 days even if she begins to feel better Increase her fluid intake to ensure that she will continue to produce adequate milk Breastfeed or otherwise empty her breasts every 1 to 2 hours Use NSAIDs, warm showers, and warm compresses to relieve her discomfort
Breastfeed or otherwise empty her breasts every 1 to 2 hours
cerclage
CI treatment -cervix stitched close; reinforces cervix, helps prevent premature dilation, help protect fetal membranes; transvaginal cerclage is removed at 36 weeks & transabdominal placement is an indication for c-section
The nurse is caring for a mother laboring with her second baby. Her last vaginal exam revealed 5 cm dilated at a -2 station. The nurse notes on the monitor that the fetus is now experiencing severe bradycardia and variable decelerations. What should the nurse do first? Call for help Apply oxygen to the mother Lift the head off the cord Notify the obstetric provider
Call for help
Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? Make sure the client is lying on her left side. Assess vital signs every 30 minutes. Check for a full bladder. Make sure the epidural medication is turned down.
Check for a full bladder.
Chapter 23
Conditions Occurring After Delivery
The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? Need to have the baby manually rotated Shorter dilation (dilatation) stage of labor Experience of additional back pain Necessity for vacuum extraction for birth
Experience of additional back pain
The nurse is identifying nursing diagnoses for a client with gestational hypertension. Which diagnosis would be the most appropriate for this client? Risk for injury related to fetal distress Ineffective tissue perfusion related to vasoconstriction of blood vessels Ineffective tissue perfusion related to poor heart contraction Imbalanced nutrition related to decreased sodium levels
Ineffective tissue perfusion related to vasoconstriction of blood vessels
A pregnant woman has been admitted to the hospital due to preeclampsia with severe features. Which measure will be important for the nurse to include in the care plan? Plan for immediate induction of labor. Institute and maintain seizure precautions. Admit the client to the middle of ICU where she can be constantly monitored. Institute NPO status.
Institute and maintain seizure precautions.
The nurse is performing a postpartum check on a 40-year-old client. Which nursing measure is appropriate? Wear sterile gloves when assessing the pad and perineum. Perform the examination as quickly as possible. Instruct the client to empty her bladder before the examination. Place the client in a supine position with her arms overhead for the examination of her breasts and fundus.
Instruct the client to empty her bladder before the examination
The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation? Urinary retention Jugular distention Abdominal cramps Nausea and vomiting
Jugular distention
A woman in labor is having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. What is the highest priorityfetal assessment the health care provider should focus on at this time? Monitor heart rate for tachycardia. Monitor fetal movements to ensure they are neurologically intact. Look for late decelerations on monitor, which is associated with fetal anoxia. Monitor fetal blood pressure for signs of shock (low BP, high FHR).
Look for late decelerations on monitor, which is associated with fetal anoxia.
A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth? Lamaze position McRoberts maneuver fundal pressure positioning the woman prone
McRoberts maneuver
A postpartum patient is prescribed methylergonovine 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the patient? Measure urine output. Measure blood pressure. Assess ambulation. Evaluate current hematocrit level.
Measure blood pressure.
A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation? Urge the client to discontinue the anticoagulant to prevent pregnancy complications Put the client on bed rest Observe the client for signs of petechiae and premature separation of the placenta Instruct the client to avoid wearing constrictive knee-high stockings
Observe the client for signs of petechiae and premature separation of the placenta
The nurse is preparing to teach a pregnant client with iron deficiency anemia about the various iron-rich foods to include in her diet. Which food should the nurse point out will help increase the absorption of her iron supplement? Dried apples Orange juice Fortified grains Dried beans
Orange juice
What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage? Calcium gluconate Magnesium sulfate Oxytocin Domperidone
Oxytocin
When assessing a pregnant client for possible gestational hypertension, which factors would lead the nurse to suspect that the client is at increased risk? Select all that apply. High socioeconomic status Preexisting hypertension History of antiphospholipid syndrome Primiparas, particularly obese clients Age group within 18-35 years
Preexisting hypertension History of antiphospholipid syndrome Primiparas, particularly obese clients
The nurse is assessing a postpartum client at a 6-week well-care check and notes questionable behavior on assessment. Which behaviors should the nurse prioritize and report to the RN or health care provider? Restless and agitated, concerned with self and not the infant States being tired and happy at same time Tearful during appointment Talkative and asking questions
Restless and agitated, concerned with self and not the infant
A woman who had preterm labor and preterm PROM successfully halted has reached week 36 of pregnancy and is doing well on home care. Which of the following nursing diagnoses should the nurse prioritize for this client? Hopelessness related to potential loss of pregnancy Risk for fetal infection related to early rupture of membranes Powerlessness related to inability to sustain pregnancy Anticipatory grieving related to high probability for fetal death from placental dysfunction
Risk for fetal infection related to early rupture of membranes
The nurse is caring for a pregnant client admitted for abdominal trauma following an assault. The nurse will monitor the client for which potential complications? Select all that apply. Spontaneous abortion (miscarriage) Placental abruption (abruptio placentae) Preterm labor Uterine rupture Gestational hypertension
Spontaneous abortion (miscarriage) Placental abruption (abruptio placentae) Preterm labor Uterine rupture
The client is 32 weeks pregnant and has been referred for biophysical profile (BPP) after a nonreassuring nonstress test (NST). Which statement made by the client indicates that the nurse's explanation of the procedure was effective? The BPP is a blood test to detect placental problems. The BPP is a screening for neural tube defects. The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume. The BPP is a diagnostic procedure whereby a needle is inserted into the amniotic sac to obtain fluid.
The BPP is an ultrasound that measures breathing, body movement, tone, and amniotic fluid volume.
The obstetric nurse is caring for a pregnant client who has been diagnosed with hydatidiform mole. What assessment should the nurse prioritize? Blood pressure Pain Vaginal bleeding Severe nausea and vomiting
Vaginal bleeding
The nurse is evaluating the fetal heart rate rhythm strip and determines that the amplitude varies with a rate 15 to 20 beats/min. What does this assessment finding indicate to the nurse about variability? Variability is normal. Variability is absent. Variability is minimal. Variability is marked.
Variability is normal.
polyhydramnios
amniotic fluid disorder -excessive amniotic fluid -NORMALLY - amniotic fluid starts to form at 12 days post-conception; serves as a protective buffer for fetus and allows movement -THIS is a mismatch between production and absorption of amniotic fluid, between fetal swallowing and elimination -40% cases are idiopathic -causes: congenital anomalies of fetal gut, heart, neural tube (most common), diabetes, twin pregnancy (suspected twin-to-twin transfusion) -associated with poor maternal and fetal outcomes: maternal - preterm birth, cord prolapse, pp hemorrhage. placental abruption, perinatal death; fetal - birth defects, meconium-stained fluid, poor labor tolerance, low Apgar score, increase NICU admissions -diagnosed by ultrasound assessment of 4 largest pockets of amniotic fluid to obtain AFI - amniotic fluid index: AFI 20-25 cm is abnormal -monitor serial BPPs and NSTs weekly -treatment - amnioreduction, administration of indomethacin (prior to 34 weeks) to stabilize amniotic fluid, corticosteroids and fetal lung maturity assessment, induction of labor, ideally after 34 weeks
A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? dyspnea, diaphoresis, hypotension, and chest pain dyspnea, bradycardia, hypertension, and confusion weakness, anorexia, change in level of consciousness, and coma pallor, tachycardia, seizures, and jaundice
dyspnea, diaphoresis, hypotension, and chest pain
A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP? elevated lipoproteins liver enzyme elevation low platelet count hemolysis
elevated lipoproteins
preeclampsia maternal assessment**
maternal -BP >140/90 -Deep tendon reflex (high = hyper: CNS excitability getting higher is a sign of preeclampsia/seizure) (low = Mg to decrease seizure is causing overload and hyporeflexia) -Epigastric pain (liver problems) -Headache - CNS -Oliguria - <30 mL; sign of things going wrong with kidneys -Peripheral edema, Pulmonary Edema -24-hour urine test -Lab test (CBC w platelets, liver enzymes, serum creatinine)
amnion
thin, tough sac of membrane that covers the embryo -protective, filled with amniotic fluid - inner membrane
The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? 750 mL 500 mL 300 mL 1000 mL
500 mL
A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? ensuring that the client consumes a high fiber diet inspecting the extremities for edema limiting sodium intake assessing for cardiac decompensation
assessing for cardiac decompensation
GTP assessment
assessment - abnormally rapid growth, abnormally high beta hCG, ultrasound - snowstorm - no expected fetal structures, vaginal bleeding treatment - dilation and curettage (D&C); remove products of conception if not passed spontaneously; Rhogam is Rh negative, support symptoms - brownish vaginal bleeding, uterine size large for dates, nausea education - report signs of heavy bleeding, foul-smelling vaginal discharge, abdominal pain and tenderness, fever; refer to counseling and support
The nurse is caring for a client after experiencing a placental abruption. Which finding is the priority to report to the health care provider? hematocrit of 36% 45 ml urine output in 2 hours platelet count of 150,000 mm3 hemoglobin of 13 g/dl
45 ml urine output in 2 hours
miscarriage
APA spontaneous abortion -occurs before 20 weeks gestation -usually occurs early 5-8 weeks -likely due to chromosomal abnormalities -risk factors: advanced parental age, drug/alcohol use, poor maternal nutrition, teratogenic meds, certain maternal health conditions (diabetes, lupus, uterine abnormalities) assessments - clots/tissues? cramping? how long? color? cervix? weeks gestation? FHR, hCG levels, CBC - hematocrit, hemoglobin interventions - bed rest, don't have sex; if bleeding persists - DNC, DNE -any time potential for maternal and fetal blood to mix, think about Rhogam especially if mother is Rh neg; comfort client education: report all episodes of heavy bleeding, fever, foul-smelling discharge, abdominal tenderness; refer to counseling
A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe? Administer oxytocin diluted in the main intravenous fluid. Administer oxytocin in two divided intramuscular sites. Administer oxytocin in a 20 cc bolus of saline. Administer oxytocin diluted as a "piggyback" infusion.
Administer oxytocin diluted as a "piggyback" infusion.
A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? administration of immunoglobulins consumption of a low-fat diet avoidance of infection constipation prevention
avoidance of infection
A pregnant patient with intermittent preterm contractions at 30 weeks has been on weekly home care assessments for 1 month without health care visits to the doctor or any activities outside the home. The nurse has established adequate fetal growth and is aware that contractions have been occurring roughly two times a day. The patient makes little effort to look at the nurse or discuss her plans for the upcoming delivery. The nurse makes which diagnosis of the current needs of this patient? Inadequate dietary intake related to activity restriction At risk for venous thromboembolism because of restricted activity At risk for depression because of extended activity restriction, as evidenced by affect Threatened preterm delivery related to contractions, as evidenced by reports by the patient of contractions before 38 weeks' gestation
At risk for depression because of extended activity restriction, as evidenced by affect
A patient with type 2 diabetes mellitus is planning to become pregnant within the next several months. What should the nurse instruct the patient to support the 2020 National Health Goals of reducing the complications of pregnancy from diabetes? Reduce the use of insulin for blood glucose coverage. Avoid episodes of hyperglycemia. Limit the intake of carbohydrates and fats in the diet. Reduce the current exercise regimen by half.
Avoid episodes of hyperglycemia.
TORCH is an acronym for maternal infections associated with congenital malformations and disorders. Which of the following disorders does the H represent? Herpes simplex virus Hepatitis B virus Human immunodeficiency virus Hemophilia
Herpes simplex virus
A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV? Ability to sleep Urine protein Respiratory rate Hemoglobin
Respiratory rate
The nurse is explaining the discharge instructions to a client who has developed postpartum cystitis. The client indicates she is not drinking a glass of fluid every hour because it hurts too much when she urinates. What is the best response from the nurse? Instruct to use a sitz bath while voiding. Advise her to take acetaminophen to ease symptoms. Teach that adequate hydration helps clear the infection quicker. Ask primary care provider to prescribe an analgesic.
Teach that adequate hydration helps clear the infection quicker.
A pregnant patient with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful? The client has reduced shortness of breath and abdominal pain during the pregnancy. The client's membranes spontaneously rupture at week 30 of gestation. The client delivers a full-term fetus at 39 weeks' gestation. The client experiences minimal vaginal bleeding throughout the pregnancy.
The client delivers a full-term fetus at 39 weeks' gestation.
The nurse is caring for a client who underwent a cesarean birth 24 hours ago. Which assessment finding indicates the need for further action? The client is having a moderate amount of rubra lochia. The client is afebrile. Bowel sounds are active. The client requires assistance to ambulate in the hallway. The fundus is located 2 fingerbreadths above the umbilicus.
The fundus is located 2 fingerbreadths above the umbilicus.
The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging? Use McRoberts maneuver. Use Zavanelli maneuver. Apply pressure to the fundus. Attempt to push in one of the fetus's shoulders.
Use McRoberts maneuver.
gestational trophoblastic disease - GDP - molar
a nonviable mass of trophoblastic tissue - never will be a baby -failure of a fertilized egg to develop properly due to: fertilization of egg with no material, or 2 sperm simultaneously fertilize 1 egg w/ normal genetic material -can grow beyond uterus and become carcinogenic: gestational trophoblastic neoplasia, gestational choriocarcinoma (malignancy to lungs, vagina, CNS), ongoing monitoring for 6-12 months; avoid pregnancy
A woman who is 8 months' pregnant comes to the clinic with urinary frequency and pain on urination. The client is diagnosed with a urinary tract infection (UTI). Which medication would the nurse anticipate the physician will prescribe? tetracycline bactrim amoxicillin septra
amoxicillin
A nurse is caring for a pregnant client. The initial interview reveals that the client is accustomed to drinking coffee at regular intervals. For which increased risk should the nurse make the client aware? anemia scurvy heart disease rickets
anemia
A woman who is Rh negative asks the nurse how many children she will be able to have before Rh incompatibility causes them to die in utero. The nurse's best response would be that: no more than three children is recommended. she will have to ask her primary care provider. as long as she receives Rho(D) immune globulin, there is no limit. only her next child will be affected.
as long as she receives Rho(D) immune globulin, there is no limit.
