OB Chapter 17

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information should the nurse include?

"Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures."

The quantitative human chorionic gonadotropin (β-hCG) levels are high in a patient who is on methotrexate therapy for dissolving abdominal pregnancy. Which instruction does the nurse give to this patient?

"Avoid sexual activity."

A pregnant patient visits the clinic for a prenatal checkup during early pregnancy. The patient tells the nurse, "One of my friends told me that the chances of preterm labor can be detected by a fetal fibronectin test. How can I get this test done?" What would be the best response given by the nurse?

"I have to collect a sample of vaginal fluids for the test."

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman indicates a correct understanding of the discharge instructions?

"I should eat foods that are high in iron and protein to help my body heal."

The nurse is teaching a group of pregnant patients about preterm labor and the actions to take if the signs and symptoms of preterm labor develop. Which patient statement indicates the need for further teaching?

"I will lie in the supine position for 1 hour."

After being rehydrated in the emergency department, a 24 year-old primipara in her 18th week of pregnancy is at home and is to rest at home for the next two days and take in small but frequent fluids and food as possible. Discharge teaching at the hospital by the nurse has been effective if the patient makes which statement?

"I'm going to eat five to six small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato."

The nurse is assessing a pregnant patient and finds that the patient has inflammation around the teeth and bleeding of the gums. What should the nurse tell the patient after the assessment?

"You might be at risk for preterm labor."

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What findings indicate that preterm labor may be occurring?

A Uterine contractions more frequently than every 10 minutes for 1 hour or more. C The cervix is effacing and dilated to 2 cm.

Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?

A multiparous woman at 39 weeks of gestation who is expecting twins

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms should the nurse expect to observe?

Decreased urinary output and irritability Ankle clonus and epigastric pain Platelet count of less than 100,000/mm 3 and visual problems

The nurse is caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient?

Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped.

Which is a priority nursing intervention while caring for a pregnant patient with hyperemesis gravidarum?

Initiate intravenous (I.V.) fluid therapy.

The nurse observes that a pregnant patient who is taking terbutaline (Brethine) treatment has a heart rate of 135 beats/min. Which medication administration does the nurse expect the primary health care provider (PHP) to order?

Intravenous (I.V.) propranolol (Inderal)

A pregnant patient experienced preterm labor at 30 weeks' gestation. Upon assessing the patient, the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn?

Magnesium sulfate to the pregnant patient

A pregnant patient who is in preterm labor has been prescribed dexamethasone (Decadron). What benefit of the drug would the nurse identify in the patient?

Maturation of fetal lungs

The nurse is caring for a pregnant patient who has been recommended for an external cephalic version. What would the nurse do as part of the procedure?

Administer terbutaline (Brethine) intravenously.

The pregnant patient reports severe pain in the midsection of the uterus. Following the assessment, the nurse finds that the patient has frequent uterine contractions (UCs) with cervix dilation up to 2 cm. Which nursing interventions does the nurse perform?

Administers an analgesic to the patient Encourages the patient to take a warm shower Administers zolpidem (Ambien) to the patient

During the assessment of a pregnant patient, the nurse finds that the patient has a compressed umbilical cord. What instruction does the nurse expect to receive from the obstetrician?

Administer Ringer's lactate solution into the uterus.

A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to prescribe?

Clindamycin (Cleocin)

The nurse is caring for a pregnant patient who had an onset of labor during 34 weeks' gestation. What does the nurse expect the primary health care provider (PHP) to prescribe?

Antibiotics Glucocorticoids

At 37 weeks of gestation, the patient is in a severe automobile crash where her abdomen was hit by the steering wheel and her seat belt. What priority action would the emergency room nurse expect to perform upon the patient's arrival at the hospital?

Assess the patient's vital signs, determine location and severity of pain, and establish continual fetal heart rate monitoring.

The nurse is caring for a pregnant patient who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the patient. Which patient condition leads the nurse to such a conclusion?

Blood pressure of 80/60 mm Hg

The nurse administers the prescribed nifedipine (Adalat) to a pregnant patient during labor to reduce uterine contractions (UCs). Which nursing action is the most appropriate after the drug administration? Monitoring the:

Blood pressure of the patient

A labor and delivery nurse is in the process of admitting a patient who is 39 and at 5 weeks' gestation with a diagnosis of preeclampsia. The nurse has evaluated vital signs, weight, and deep tendon reflexes. Although the presence of edema is no longer included in the definition of preeclampsia, it is an important component of the nurse's evaluation. Edema is assessed for distribution, degree and pitting. Although the amount of edema is difficult to quantify, it is important to record the relative degrees of edema formation. From the graphic below, please select the illustration that best displays +3 edema.

C

The nurse observes that intravenous (I.V.) administration of magnesium sulfate has resulted in magnesium toxicity in a pregnant patient with preeclampsia. The nurse immediately discontinues the infusion and reports to the primary health care provider (PHP). For which drug does the nurse obtain a prescription from the PHP?

Calcium gluconate

A pregnant patient has been administered magnesium sulfate as prescribed. Following the assessment, the nurse reports to the primary health care provider (PHP) that the patient's respiratory rate is 11 breaths/min. Which medication administration can the nurse expect from the PHP?

Calcium gluconate intravenously to the patient

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant?

Cesarean section

The nurse is caring for an obese patient who gave birth to a child through a cesarean delivery. Which nursing intervention should be performed for providing effective postpartum care?

Drying the wound by using a hair dryer at low setting

Which statement is most likely to be associated with a breech presentation?

High rate of neuromuscular disorders

A patient reports excessive vomiting in the first trimester of the pregnancy, which has resulted in nutritional deficiency and weight loss. The urinalysis report of the patient indicates ketonuria. Which disorder does the patient have?

Hyperemesis gravidarum

A patient has been administered zolpidem (Ambien) as prescribed. What is the patient's clinical condition for prescribing this medication to the patient?

Hypertonic uterine contractions (UCs)

A pregnant patient has been administered terbutaline (Brethine) as prescribed. The nurse finds that the patient has a heart rate of 140 beats/min and complains of chest pain. What is the best nursing action in this situation?

Inform the primary health care provider (PHP).

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse?

One fetal movement noted in 1 hour of assessment by the mother

The primary health care provider (PHP) reports that the baby of a patient may have an injury resulting from shoulder dystocia during labor. What patient clinical condition should the nurse infer from the report?

Postterm pregnancy

Which is an important nursing intervention when a patient has an incomplete miscarriage with heavy bleeding?

Prepare the patient for dilation and curettage.

The nurse observes that a pregnant patient at 36 weeks' gestation who is in labor has a cervical dilation of 5 cm with membranes intact. Which nursing intervention is the most appropriate in this situation?

Prepare to administer intravenous magnesium sulfate (Epsom salt).

What does the nurse include in the plan of care of a pregnant patient with mild preeclampsia?

Provide diversionary activities. Encourage the intake of more fluids. Refer to Internet-based support group.

Which condition does the nurse monitor in a pregnant patient diagnosed with acute pyelonephritis?

Pulmonary injury

Which clinical reports does the nurse evaluate to identify ectopic pregnancy in a patient?

Quantitative human chorionic gonadotropin (β-hCG) levels Transvaginal ultrasound Progesterone level

During the active phase of labor, the nurse prepares for the insertion of an intrauterine pressure catheter (IUPC) to a pregnant patient. What patient clinical presentation would be the reason for this intervention?

Reduced uterine contractions (UCs)

A pregnant patient is receiving tocolytic therapy with magnesium sulfate. Under which patient circumstance would the nurse suggest to discontinue the therapy?

Respiratory rate is 10 breaths/min.

The nurse is teaching about the use of primrose oil to a pregnant patient. Which statement would the nurse include in the teaching? "Primrose oil helps:

Ripen the cervix."

A 24-year-old primipara, who is 18 weeks pregnant, has been having increasing vomiting since she was 8 weeks pregnant. Upon arrival at the emergency department, her skin turgor is diminished, temperature is 99.2F (o), pulse is 102, respiration is 18, blood pressure is 102/68, and she has deep furrows on her tongue. What would the nurse expect to do to care for her?

Start an intravenous infusion. Check her urine for ketones Obtain a complete history. Obtain blood for a complete blood count.

While caring for a patient who is treated with terbutaline (Brethine), the nurse tries to reduce pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant?

Suggesting that the patient lie on her side

During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis?

Teach gentle lower extremity exercises to the patient.

The nurse observes that a pregnant patient has a high temperature and a foul smell of amniotic fluid during labor. Which possible complications would the nurse find in the patient and in the neonate after the delivery?

The neonate may have pneumonia. The patient may have a pelvic abscess. The neonate may have bacteremia and sepsis.

The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug?

The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug?

The nurse finds that the umbilical cord in a pregnant patient who is in labor has prolapsed, following the rupture of membranes. Which positions are suitable for the patient to promote fetal perfusion?

Trendelenburg Modified Sims' Knee-chest position

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth?

Unstable coronary artery disease Previous cesarean birth Placenta previa

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of:

a fetal heart rate (FHR) of 180 with absence of variability.

A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse is to:

assess the fetal heart rate (FHR) pattern.

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

hydralazine.

A nurse providing care to a woman in labor should be aware that cesarean birth:

is performed primarily for the health of the mother and fetus.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:

its most important function is to afford the opportunity to administer antenatal glucocorticoids.