NURS215 Exam 1 PrepU wrong

Preterm prelabor rupture of membranes (PPROM) can be a serious complication of labor. What is the most common cause of preterm PROM?

Infection Infection is the most common cause of preterm PROM.

The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true? Variable decelerations Late decelerations

Late Deceleration When the fetus is being deprived of oxygen the fetus will demonstrate late decelerations on the fetal monitoring strip. This is an indication the mother is in need of further assessment. Early decelerations are a normal finding. Variable decelerations usually coincide with cord compression.

Which changes in the female body occur to allow the passage of the fetus down the birth canal? Select all that apply.

The cervix dilates to 10 cm. Vaginal rugae stretch and smooth out. The cervix softens. Changes in the female body occur to allow the passage of the fetus down the birth canal. Vaginal rugae stretch and smooth out allowing for the ability of the fetus to descend. The cervix thins to a maximum of 10 cm and the cervix softens, becoming more accepting of the transition through by the fetus. Full effacement is noted as 100%. Round ligaments stretch to accommodate the expanding uterus and frequently result in discomfort in the antepartum period.

A pregnant client receiving intravenous oxytocin for 1 hour has contractions lasting 85 seconds. What should the nurse do first for this client? Slow the infusion to below 10 gtt/minute. Discontinue the oxytocin infusion.

discontinue the oxytocin infusion!! Contractions should last no longer than 70 seconds. If contractions become longer in duration, stop the IV infusion and seek help immediately. The infusion needs to be discontinued and not slowed. Increasing the flow rate could cause fetal distress. The client needs to be assessed more frequently than every 2 hours.

When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching?

"You have no trouble walking around and using the bathroom after you receive the epidural." Explanation: Epidural anesthesia impairs mobility; most clients are placed on bed rest after epidural anesthesia is given. Urinary catheterization is frequently required.

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?

ultrasound When a client presents with an intrauterine pregnancy at or past 42 weeks, the team will attempt to determine fetal age using different methods. Decreased amniotic fluid may be present and can be measured by ultrasound. The other methods cannot determine volume of amniotic fluid.

14. A nurse is providing care to several pregnant women at the clinic. The nurse would screen for group B streptococcus infection in a client at: A) 16 weeks' gestation B) 28 week' gestation C) 32 weeks' gestation D) 36 weeks' gestation

D) 36 weeks' gestation

23. A group of nursing students are reviewing information about methods used for cervical ripening. The students demonstrate understanding of the information when they identify which of the following as a mechanical method? A) Herbal agents B) Laminaria C) Membrane stripping D) Amniotomy

B) Laminaria Laminaria is a hygroscopic dilator that is used as a mechanical method for cervical ripening. Herbal agents are a nonpharmacologic method. Membrane stripping and amniotomy are considered surgical methods.

A pregnant client in labor has to undergo a sonogram to confirm the fetal position of a shoulder presentation. For which condition associated with shoulder presentation during a vaginal birth should the nurse assess?

fetal anomalies Explanation: The nurse, along with the primary care provider, has to assess for fetal anomalies, which are usually associated with a shoulder presentation during a vaginal birth. The other conditions include placenta previa and multiple gestations. Uterine abnormalities, congenital anomalies, and prematurity are conditions associated with a breech presentation of the fetus during a vaginal birth.

A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. The nurse should immediately check the client for:

umbilical cord prolapse. Because the client is not in labor, this development is considered premature rupture of membranes. The sudden onset of deep variable decelerations may indicate umbilical cord prolapse, which is an obstetric emergency that requires immediate intervention.

21. A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms.The nurse determines that the teaching was successful when the woman states that if she experiences any symptoms, she will do which of the following? A) "I'll sit down to rest for 30 minutes." B) "I'll try to move my bowels." C) "I'll lie down with my legs raised." D) "I'll drink several glasses of water."

"I'll drink several glasses of water." If the woman experiences any signs and symptoms of preterm labor, she should stop what she is doing and rest for 1 hour, empty her bladder, lie down on her side, drink two to three glasses of water, feel her abdomen and note the hardness of the contraction, and call her health care provider and describe the contraction.

A mother has delivered her baby vaginally in the occiput posterior position. When the mother holds her new baby she cries because she fears there is something seriously wrong. What reassurance can the nurse give the mother about her baby? "His head shape is from the birth canal and it will resolve in about 2 weeks." "The bruising and swelling will resolve in about 48 hours."

"The bruising and swelling will resolve in about 48 hours." Neonates born face first generally have significant bruising and edema and skull molding. These generally resolve in 48 hours.

A client in labor who is dilated 8 cm tells the nurse, "My opioid pain medication given 3 hours ago has worn off. I would like another dose." Which response by the nurse is appropriate?

"Where you are in your labor progress would make it unsafe to give you another dose." Explanation: The timing of the administration of an opioid in labor is especially important. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after administration to the pregnant client. For this reason, opioids are preferably given when the pregnant client is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth. The nurse does not need to get permission from the health care provider. Pain medication can be provided when needed and not on a set schedule of every 4 hours. The client is nearing birth, so 3 hours from the last dose will not influence the decision to provide more medication.

20. A nurse is assessing a pregnant woman who has come to the clinic. The woman reports that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman may be experiencing preterm labor based on which additional assessment findings? A) Dull low backache B) Malodorous vaginal discharge C) Dysuria D) Constipation

Dysuria Symptoms of preterm labor are often subtle and may include change or increase in vaginal discharge with mucus, water, or blood in it; pelvic pressure; low, dull backache; nausea, vomiting or diarrhea, and intestinal cramping with or without diarrhea.

19. After teaching a group of nursing students about tocolytic therapy, the instructor determines that the teaching was successful when they identify which drug as being used for tocolysis? (Select all that apply.) A) Nifedipine B) Terbutaline C) Dinoprostone D) Misoprostol E) Indomethacin

A) Nifedipine B) Terbutaline E) Indomethacin Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), terbutaline (Brethine, a beta-adrenergic), indomethacin (Indocin, a prostaglandin synthetase inhibitor), and nifedipine (Procardia, a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix.

A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.) A) Dark red vaginal bleeding B) Insidious onset C) Absence of pain D) Rigid uterus E) Absent fetal heart tones

A, D, E Feedback:Assessment findings associated with abruption placenta include a sudden onset, with concealed or visible bleeding, dark red bleeding, constant pain or uterine tenderness on palpation, firm to rigid uterine tone, and fetal distress or absent fetal heart tones.

After teaching a group of students about fetal heart rate patterns, the instructor determines the need for additional teaching when the students identify which of the following as indicating normal fetal acid-base status? (Select all that apply.)A) Sinusoidal patternB) Recurrent variable decelerationsC) Fetal bradycardiaD) Absence of late decelerationsE) Moderate baseline variability

Ans. A,B,C Sinusoidal patternRecurrent variable decelerationsFetal bradycardiaPredictors of normal fetal acid-base status include a baseline rate between 110 and 160 bpm, moderate baseline variability, and absences of later or variable decelerations. Sinusoidal pattern, recurrent variable decelerations, and fetal bradycardia are predictive of abnormal fetal acid-base status.(pg. 453)

When assessing fetal heart rate, the nurse finds a heart rate of 175 bpm, accompanied by a decrease in variability and late decelerations. Which of the following would the nurse do next?A) Have the woman change her position.B) Administer oxygen.C) Notify the health care provider.D) Continue to monitor the pattern every 15 minutes.

Ans. C Notify the health care provider.Fetal tachycardia as evidenced by a fetal heart rate greater than 160 bpm accompanied by a decrease in variability and late decelerations is an ominous sign indicating the need for prompt intervention. The health care provider should be notified immediately and then measures should be instituted such as having the woman lie on her side and administering oxygen. In this instance, monitoring should be continuous to detect any further changes and evaluate the effectiveness of interventions.(pg. 453)

The licensed practical nurse is evaluating the tracings on the fetal heart monitor. The nurse is concerned that there is a change in the tracings. What should the LPN do first?

Assess and reposition the woman. Due to maternal movement, the fetal heart monitor may become dislodged and not provide accurate tracings. Reposition and assess the woman to note any change with the next contraction. If concern remains, notify the registered nurse. The registered nurse will interpret the tracing and notify the health care provider.

A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first?

Assess for labor progression. Performing breathing exercises, ambulating, changing position, and emptying the bladder all can help the client experience a reduction in pain. However, the best first step is to assess the client for labor progress before assisting her otherwise. Bearing down can be a sign that the client is 10 cm dilated.

A nurse is assessing a woman after birth and notes a second-degree laceration. The nurse interprets this as indicating that the tear extends through which of the following? A) Skin B) Muscles of perineal body C) Anal sphincter D) Anterior rectal wall

B) Muscles of perineal body The extent of the laceration is defined by depth: a first-degree laceration extends through the skin; a second-degree laceration extends through the muscles of the perineal body; a third-degree laceration continues through the anal sphincter muscle; and a fourth-degreelaceration also involves the anterior rectal wall

23. A nursing student is reviewing an article about preterm premature rupture of membranes. Which of the following would the student expect to find as factor placing a woman at high risk for this condition? (Select all that apply.) A) High body mass index B) Urinary tract infection C) Low socioeconomic status D) Single gestations E) Smoking

B, C, E Feedback:High-risk factors associated with preterm PROM include low socioeconomic status, multiple gestation, low body mass index, tobacco use, preterm labor history, placenta previa, abruptio placenta, urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis.

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which of the following would lead the nurse to suspect that the woman is developing an infection? (Select all that apply.) A) Fetal bradycardia B) Abdominal tenderness C) Elevated maternal pulse rate D) Decreased C-reactive protein levels E) Cloudy malodorous fluid

B, C, E Feedback:Possible signs of infection associated with premature rupture of membranes includeelevation of maternal temperature and pulse rate, abdominal/uterine tenderness, fetaltachycardia over 160 bpm, elevated white blood cell count and C-reactive protein levels,and cloudy, foul-smelling amniotic fluid.

The client presents in the early stage of labor with mild contractions 7 to 9 minutes apart and blood pressure 130/80 mm Hg. The client changes from happy, excited, and confident to introverted and restless. Assessment reveals heart rate 100, blood pressure 137/85 mm Hg, and hyperventilation. EFM reveals no variability for almost 20 minutes, then evident variability with no late decelerations. Which action should the nurse prioritize? A. Notify the RN about the lack of FHR variability. B. Notify the RN that client's blood pressure has increased. C. Help the client regain control of her breathing technique. D. Assist the client into a hands-and-knees position.

C. Help the client regain control of her breathing technique The primary focus is to regain her breathing to a normal rhythm; focus her on breathing and relaxation and relief from the hyperventilation. If there is no improvement, notify the RN. Putting the client in the hands-and-knees position should be avoided until later in labor.

14. A woman who is 42 weeks pregnant comes to the clinic. Which of the following would be most important? A) Determining an accurate gestational age B) Asking her about the occurrence of contractions C) Checking for spontaneous rupture of membranes D) Measuring the height of the fundus

Determining an accurate gestational age Incorrect dates account for the majority of prolonged or postterm pregnancies; many women have irregular menses and thus cannot identify the date of their last menstrual period accurately. Therefore, accurate gestational dating via ultrasound is essential. Asking about contractions and checking for ruptured membranes, although important assessments, would be done once the gestational age is confirmed. Measuring the height of the fundus would be unreliable because after 36 weeks, the fundal height drops due to lightening and may no longer correlate with gestational week

4. Assessment of a woman in labor who is experiencing hypertonic uterine dysfunction would reveal contractions that are:A) Well coordinatedB) Poor in quality C) Rapidly occurring D) Erratic

Erratic Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction. Hypotonic uterine contractions are poor in quality and lack sufficient intensity to dilate and efface the cervix. Contractions of precipitous labor occur rapidly such that labor is completed in less than 3 hours.

2. A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? A) A low-lying placenta B) Fetopelvic disproportion C) Contraction ring D) Uterine bleeding

Fetopelvic disproportionThe woman is experiencing dystocia most likely due to hypotonic uterine dysfunction and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring, or uterine bleeding would not be associated with a change in labor pattern.

The nurse in a busy L & D unit is caring for a woman beginning induction via oxytocin drip. Which prescription should the nurse question with regard to titrating the infusion upward for adequate contractions? Start oxytocin drip, piggyback to main IV line to port closest to client. Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min.

Hyperstimulation is usually defined as five or more contractions in a 10-minute period or contractions lasting more than 2 minutes in duration or occurring within 60 seconds of each other. The surest method to relieve hyperstimulation is to immediately discontinue the oxytocin infusion. The rate should not be increased by more than 2 milliunits at a time. When the infusion is administered, the oxytocin solution should be "piggybacked" to a maintenance IV solution such as Ringer's lactate and the piggyback added to the main infusion at the port closest to the woman. Infusions are usually begun at a rate of 1 to 2 milliunits/min. If there is no response, the infusion is gradually increased every 30 to 60 minutes by small increments of 1 to 2 milliunits/min until contractions begin.

A woman in labor who is receiving an opioid for pain relief is to receive promethazine. The nurse determines that this drug is effective when the woman demonstrates which finding?

Less anxiety Promethazine is used in combination with an opioid to decrease nausea and vomiting and lessen anxiety. It may also be used to increase sedation. It does not affect the progress of labor. Benzodiazepines are used to calm a woman who is out of control, allowing her to relax enough to participate effectively during labor.

A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position? Use pillows and wedges to stay in a fully recumbent position. Lie in a semi-recumbent position.

Lie in Semi-recumbent position Semi-recumbent position is the best position for circulation of the mother and fetus. Lying flat on the back can induce supine hypotensive syndrome and fully recumbent impedes other circulation. The high Fowler position would not be comfortable for sleeping, as well as possibly impede the blood flow through the hips and lower abdomen.

The nurse understands the need to be aware of the potential of bleeding disorders in pregnant clients. Which disorder should she be aware of that occurs in the second trimester? cervical insufficiency Spontaneous abortion (miscarriage) ectopic preganacy Hydatidiform mole (mole preganacy) Placenta Previa

Placenta previa Second trimester bleeding usually results from placenta previa, where the placenta lies either partially or completely over the cervical os. The pregnant client begins to experience vaginal bleeding of bright, red blood. Spontaneous abortion (miscarriage), hydatidiform mole, and ectopic pregnancy occur in the first trimester and cervical insufficiency is not a bleeding disorder.

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? Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placenta previa is an abnormally implanted placenta that is too close to the cervix.

Placenta previa is an abnormally implanted placenta that is too close to the cervix Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless, bright red bleeding in the third trimester. Placental abruption is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor. Placental abruption can result in concealed or apparent dark red bleeding and is painful. Immediate intervention is required for placental abruption.

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?

Prepare the client for a cesarean birth. If a transverse lie persists, the fetus cannot be born vaginally. Thus, the nurse will prepare the client for a caesarean birth. There is no indication the client will have precipitous labor. Amniotomy, artificial rupture of the membranes, is not indicated when preparing from a caesarean birth. The nurse would not administer analgesic before surgery unless prescribed by the health care provider.

24. The nurse notifies the obstetrical team immediately because the nurse suspects that the pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. Which findings would the nurse most likely assess? (Select all that apply.) A) Significant difficulty breathing B) Hypertension C) Tachycardia D) Pulmonary edema E) Bleeding with bruising

Significant difficulty breathing Tachycardia Pulmonary edema Bleeding with bruising The clinical appearance is varied, but most women report difficulty breathing. Other symptoms include hypotension, cyanosis, seizures, tachycardia, coagulation failure, disseminated intravascular coagulation, pulmonary edema, uterine atony with subsequent hemorrhage, adult respiratory distress syndrome, and cardiac arrest.

A nurse is caring for a client in labor who has been diagnosed with placental problems. Which of the following is indicative of placenta succenturiata?

Small accessory lobes develop in the membranes at a distance from the main placenta. With placenta succenturiata, one or more small accessory lobes develop in the membranes at a distance from the main placenta, which may result in connecting vessels tearing during birth or when the membranes rupture. In placenta circumvallata, the membranes are folded back on the fetal surface of the placenta, exposing part of the umbilical cord. With a velamentous placenta, umbilical blood vessels course unprotected for long distances through the membranes to insert into the margin of the placenta. In a battledore placenta, the umbilical cord inserts at the placental margin rather than in the center.

A nurse is presenting an in-service program about complications that can arise during labor. The nurse determines that the teaching was successful when the group correctly chooses which findings as suggesting an amniotic fluid embolism? Select all that apply. Sudden onset of respiratory distress Maternal hypotension Maternal tachycardia Acute, continuous abdominal pain

Sudden onset of respiratory distress Maternal hypotension Maternal tachycardia Explanation: The client with an amniotic fluid embolism commonly reports difficulty breathing. Other signs include hypotension, tachycardia, cyanosis, seizures, coagulation difficulties, and uterine atony with subsequent hemorrhage. If the mother is still in labor, the fetus may demonstrate distress with bradycardia occurring in most cases. A sudden onset of fetal distress and acute continuous abdominal pain is more often associated with uterine rupture.

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? Bradypnea Bradycardia Sudden shortness of breath

Sudden shortness of breath Sudden shortness of breath can be a sign of amniotic fluid embolism and requires emergent intervention. This can occur suddenly during labor or immediately after. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension. It must be reported to the care team so proper interventions may be taken. Other symptoms can include hypotension, cyanosis, hypoxemia, uterine atony, seizures, tachycardia, coagulation failure, DIC, and pulmonary edema.

26. A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse assesses the woman closely for which of the following? A) Uterine hyperstimulation B) Headache C) Blurred vision D) Hypotension

Uterine hyperstimulation A major adverse effect of the obstetric use of Cytotec is hyperstimulation of the uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Headache, blurred vision, and hypotension are associated with magnesium sulfate.

The nurse is caring for a client who has remained in stable condition at 37 weeks' gestation. The client's condition suddenly changes. Which assessment change should the nurse prioritize? Uterine contractions with vaginal mucus Vaginal bleeding and no pain

Vaginal Bleeding and no pain Placenta previa includes bright red and painless vaginal bleeding, which is different from the dark red bleeding of placental abruption (abruptio placenta) accompanied by severe pain. This differentiates the two conditions. Uterine contractions with vaginal mucus may be indications of the start of labor with the mucus plug being discharged. The fetal heart rate, fundal height, and contour of the abdomen are normal components that are assessed during the labor process.

A nurse is preparing an in-service program about labor and the hormones involved with the initiation of labor. Which information would the nurse include as believing to play a role in the onset of labor? decrease in fetal cortisol levels withdrawal of progesterone

Withdrawal of progesterone The onset of labor is believed to be due to a number of factors involving hormones. The uterine muscle stretches from the increasing size of the fetus, which results in release of prostaglandins. The fetus presses on the cervix, which stimulates the release of oxytocin from the posterior pituitary. Oxytocin stimulation works together with prostaglandins to initiate contractions. Changes in the ratio of estrogen to progesterone occurs, increasing estrogen in relation to progesterone, which is interpreted as progesterone withdrawal.

During a prenatal ultrasound, the client is discovered to have a succenturiate placenta. Following delivery of the fetus and placenta, which nursing assessment is most important?

assessment for hemorrhage A succenturiate placenta can be first identified with a sonogram as the placenta is composed of several lobes instead of being one structure. A danger of this type of placental formation is that a lobe may tear and remain in the uterus after delivery. Assessment for hemorrhage is most important following delivery and in the postpartum period. While the other nursing assessments are important, due to the specific situation, the most important assessment relates to hemorrhage.

As part of a review class for perinatal nurses, the nurse is explaining the laboratory and diagnostic tests that can be conducted to evaluate a woman's risk for preterm labor. The nurse determines that additional teaching is needed when the group identifies which test as being used?

blood chemistry levels Commonly used diagnostic testing for preterm labor risk assessment includes a complete blood count, urinalysis, amniotic fluid analysis, fetal fibronectin testing, cervical length evaluation by transvaginal ultrasound, salivary estriol, and home monitoring of uterine activity to recognize preterm contractions. Blood chemistry levels will inform the primary care provider as to the condition of the mother but would not be definitive in determining preterm labor risks.

When planning the care of a client scheduled for induction of labor with exogenous oxytocin, the nurse should make which assessment?

cervical ripening Explanation: The nurse should assess for cervical ripening before inducing labor with exogenous oxytocin. Oxytocin administration produces uterine contractions when the cervix is ripe. Cervical ripening indicates the presence of many oxytocin receptors. Exogenous oxytocin administration is ineffective when the cervix is unripe. Assessment of fetal heart rate is always important, but it is not a criteria for induction. Additionally, assessments of vaginal discharge and fundal height are not necessary prior to induction of labor with oxytocin.

The nurse is aware that the newborn's circulatory dynamics during transition can be positively affected by which action?

delayed umbilical cord clamping Explanation: Early (before 30 to 40 seconds) or late (after 3 minutes) clamping of the umbilical cord changes circulatory dynamics during transition. Recent studies indicate that the benefits of delayed cord clamping include improving the newborn's cardiopulmonary adaptation; preventing iron deficiency anemia in full-term newborns without increasing hypervolemia-related risks and increased iron stores; increasing blood pressure; improving oxygen transport; and increasing red blood cell flow. Although a tailored approach is required in the case of cord clamping, current available data suggest that delayed cord clamping offers the newborn many physiological benefits, which include at least a 30 percent increase in blood volume for term infants and a 50 percent increase in preterm infants; improvement of systemic blood pressure; increase in the cerebral oxygen index; higher hemoglobin levels at 24 to 48 hours of age; and increased serum iron levels at 4 to 6 months.

A pregnant client with a history of spinal injury is being prepared for a cesarean birth. Which method of anesthesia is to be administered to the client?

general anesthesia Explanation: General anesthesia is administered in emergency cesarean births. Local anesthetic is injected into the superficial perineal nerves to numb the perineal area generally before an episiotomy. Although an epidural block is used in cesarean births, it is contraindicated in clients with spinal injury. Regional anesthesia is contraindicated in cesarean births.

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 With hypotonic uterine contractions, the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg. Hypertonic uterine contractions are marked by an increase in resting tone to more than 15 mm Hg. However, the intensity of the contraction may be no stronger than that associated with hypotonic contractions. In contrast to hypotonic contractions, these occur frequently and are most commonly seen in the latent phase of labor. Uncoordinated contractions can occur so closely together they can interfere with the blood supply to the placenta. Because they occur so erratically, such as one on top of another and then a long period without any, it may be difficult for a woman to rest between contractions or to breath effectively with contractions. Braxton Hicks contractions are sporadic contractions that occur in pregnancy before the onset of true labor.

A mother having her third baby is to deliver via a repeat cesarean birth. There are factors in the mother's health history that place her at a higher risk for hemorrhage and the need for blood transfusions. Identify these factors. Select all that apply. multiple cesarean sections placenta accreta with first delivery gestational diabetes mild preeclampsia

multiple cesarean sections placenta accreta with first delivery Explanation: A woman is considered at higher risk for transfusion during delivery under these conditions: use of general anesthesia; history of multiple cesarean births; anemic prior to the birth; severe preeclampsia, eclampsia, or HELLP syndrome; and placental complications such as placenta previa, placental abruption (abruptio placentae), or placenta accreta.

The nurse is caring for a laboring mother experiencing a precipitous delivery. The nurse would assess the mother for symptoms of which complication?

placental abruption (abruptio placentae) Explanation: The primary complication associated with precipitous delivery is placental abruption. It is attributed to uterine tachysystole. Due to the intensity of the contractions and briefer intervals between contractions, there is a high risk for fetal hypoxia and intracranial trauma.

Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions? Select all that apply.

placental abruption (abruptio placentae) severe preeclampsia septicemia DIC is not itself a specific illness; rather it is always a secondary diagnosis that occurs as a complication of placental abruption, anaphylactoid syndrome of pregnancy, intrauterine fetal death with prolonged retention of the fetus, acute fatty liver of pregnancy, severe preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), septicemia, and postpartum hemorrhage.

A nurse is explaining to a pregnant client about the changes occurring in the body in preparation for labor. Which hormone would the nurse include in the explanation as being responsible for causing the pelvic connective tissue to become more relaxed and elastic? progesterone relaxin prolactin oxytocin

relaxin As the pregnancy progresses, the hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to become more flexible to prepare the mother's pelvis for birth. Progesterone, oxytocin, and prolactin are not involved.

Immediately following an epidural block, a woman's blood pressure suddenly falls to 90/50. The nurse's first action would be to:

turn her on her left side or raise her legs. Turning her to her side or elevating her legs increases blood volume in her central body, thereby increasing blood pressure.