OB Exam 2

8 S/S of preterm labor

Contractions occurring q 10 minutes or less Dilated to 1 cm or more 80% or more effacement Low abdominal cramping with or without diarrhea Intermittent pelvic pressure, urinary frequency Low back ache (constant or intermittent) Increased vaginal discharge Leaking amniotic fluid

A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse takes. Stop of Pitocin infusion Perform a vaginal examination Reposition the client Check the client's blood pressure and heart rate Administer oxygen by face mask at 8 to 10 L/min A, D, B, E, C A, B, D, E, C A, D, B, C, E A, D, C, E, B

A, D, B, E, C If uterine hypertonicity occurs, the nurse immediately would intervene to reduce uterine activity and increase fetal oxygenation. The nurse would stop the Pitocin infusion and increase the rate of the nonadditive solution, check maternal BP for hyper or hypotension, position the woman in a side-lying position, and administer oxygen by snug face mask at 8-10 L/min. The nurse then would attempt to determine the cause of the uterine hypertonicity and perform a vaginal exam to check for prolapsed cord.

A nurse conducts a neurological assessment of the newborn. Which findings indicate the need for further evaluation? (select all that apply) A. Asymmetrical fine jumping movements of the legs and arm muscles B. Fanning and hyperextension of toes when the sole is stroked upward from the heel C. Grasping a finger placed in the neonate's palm D. Muscle flaccidity not relieved by holding the newborn E. Weak and ineffective suckling movements

A,D,E

A nurse's laboring patient has decided to try to get through labor without an epidural. The patient is requesting IV pain medication instead. The nurse determines that which factor would contraindicate the administration of stadol A. Transition stage of labor B. Fetal heart rate of 115 beats per minute C. Presence of variability D. presence of mild variable decelerations

A. Transition stage of labor

A nurse caring for multiple patients determines that which woman would be a candidate for intermittent monitoring during labor? A. A woman with a previous C-section B. A 41 week primigravida C. A woman with preeclampsia D. A women with gestational diabetes

B. A 41 week primigravida

Fourth-stage nursing care for a patient with an episiotomy includes which of the following? (select all that apply) A. Application of ice beginning four hours after delivery B. Ice pack to the perineum for up to 60 minutes per application C. Inspection every 15 minutes during the first hour after birth D. Instructions to avoid intercourse for at least 12 weeks E. Ice packs to be applied for 20-30 min and removed for at least 20 min.

C. Inspection every 15 minutes during the first hour after birth E. Ice packs to be applied for 20-30 min and removed for at least 20 min.

who is at risk for transient tachypnea of newborn

C/S preterm precipitous birth polyhydramnios r/t diabetes SGA male baby

8 S/S of preterm labor

Contractions occurring q 10 minutes or less (<6 per hour) Dilated to 1 cm or more 80% or more effacement Low abdominal cramping with or without diarrhea Intermittent pelvic pressure, urinary frequency Low back ache (constant or intermittent) Increased vaginal discharge (bloody show) Leaking amniotic fluid

A nurse is assessing a laboring patient who is morbidly obese. The nurse is unable to determine the fetal position. Which is the most accurate method of determining fetal position of this patient.? A. Inspection of the fetal abdomen B. palpation of the abdomen C. Vaginal examination D. Ultrasound

D. Ultrasound

Which of the following changes best described the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications? Increase Decrease Remain the same as before pregnancy Remain the same as during pregnancy

Decrease The placenta produces the hormone human placental lactogen, an insulin antagonist. After birth, the placenta, the major source of insulin resistance, is gone. Insulin needs decrease and women with type 1 diabetes may only need one-half to two-thirds of the prenatal insulin during the first few PP days.

A baby is born precipitously in the ER. The nurses initial action should be to: Ascertain the condition of the fundus Establish an airway for the baby Quickly tie and cut the umbilical cord Move mother and baby to the birthing unit

Establish an airway for the baby

A postpartum nurse is taking the vital signs of a woman who delivered a healthy newborn infant 4 hours ago. The nurse notes that the mother's temperature is 100.2ºF. Which of the following actions would be most appropriate? Retake the temperature in 15 minutes Notify the physician Document the findings Increase hydration by encouraging oral fluids

Increase hydration by encouraging oral fluids The mother's temperature may be taken every 4 hours while she is awake. Temperatures up to 100.4 (38 C) in the first 24 hours after birth are often related to the dehydrating effects of labor. The most appropriate action is to increase hydration by encouraging oral fluids, which should bring the temperature to a normal reading. Although the nurse would document the findings, the most appropriate action would be to increase the hydration.

A neonate has been diagnosed with caput succedaneum. Which statement is correct about this condition? It usually resolves in 3-6 weeks It involves swelling of tissue over the presenting part of the presenting head It doesn't cross the cranial suture line It's a collection of blood between the skull and the periosteum

It involves swelling of tissue over the presenting part of the presenting head

The nurse is about the give a Type 2 diabetic her insulin before breakfast on her first day postpartum. Which of the following answers best describes insulin requirements immediately postpartum? Lower than during her pregnancy Higher than during her pregnancy Lower than before she became pregnant Higher than before she became pregnant

Lower than before she became pregnant PP insulin requirements are usually significantly lower than pre pregnancy requirements. Occasionally, clients may require little to no insulin during the first 24 to 48 hours postpartum.

Four clients in labor are requesting pain relief. The nurse understands that which client can safely receive a dose of IV butorphanol tartrate, an opioid agonist-antagonist, at this time? Multipara, 6cm dilation, recent heroin use Multipara, 9cm, urge to push Nullipara, 3cm, desire to ambulate Nullipara, 7cm, moaning with contractions

Nullipara, 7cm, moaning with contractions Opioid agonist-antagonist medications used in labor include butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain). Maternal adverse effects include sedation, dizziness, and nausea. Butorphanol tartrate crosses the placental barrier, peaking in 30-60 minutes; its duration of action is approximately 2-4 hours. If given near the time of birth, there is a risk for newborn respiratory depression, which may require naloxone (Narcan) to reverse the effects. IV opioids are safest for clients who will give birth 2-4 hours after administration so that the opioid effect has time to wear off before the birth. IV opioids are also best for clients in active labor or those with a well-established contraction pattern because opioid administration may slow labor progression in the latent phase (Option 4). (Option 1) Although this client is in active labor, recent heroin use is a contraindication to opioid agonist-antagonists because of the risk for maternal and/or fetal withdrawal symptoms. (Option 2) An urge to push may indicate imminent birth, especially in a multiparous client. To ensure newborn safety, imminent birth is a relative contraindication for the administration of narcotics. (Option 3) Opioid administration in latent labor may slow labor progression. In addition, medication adverse effects (eg, sedation, dizziness) are a safety concern for a client desiring to ambulate.

7 Prevention/treatment of hyperbilirubinemia

Promote and support successful breastfeeding practices Teach mother to breastfeed 8-12 times day, first few days Advising breastfeeding moms not to supplement with water/dextrose Ensure all infants are monitored and assessed for jaundice Before discharge complete systematic assessment for jaundice Early follow up based on risk assessment Phototherapy when indicated to prevent encephalopathy

A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The priority nursing intervention would be to: Monitor the Pitocin infusion closely Provide pain relief measures Prepare the client for an amniotomy Promote ambulation every 30 minutes

Provide pain relief measures Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern.

S/S of sepsis

Respiratory distress: Tachypnea, retractions, grunting, nasal flaring and apnea. Oxygen required Abnormal skin perfusion: Mottling, pale color, gray color, delayed cap refill Temperature instability: Hypothermia and rarely hyperthermia Feeding intolerance: Vomiting, abdominal distention, poor feeding pattern Abnormal vital signs: Tachycardia, bradycardia, hypotension Abnormal neurological status Lethargy, hypotonia, seizures

8 characteristics of newborn heat loss

Thin skin, superficial vessels Lack of shivering ability Limited stores of metabolic substrates Limited use of muscle Large body surface Lack of subcutaneous fat Inability to conserve heat Inability to communicate

Mom comes in with hx of C/S and has chosen to attempt a vag delivery. You notice cessation of contractions and maternal tachycardia. WHAT DO YOU THINK THIS IS

UTERINE RUPTURE

Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage? Hypertension Cervical and vaginal tears Urine retention Endometritis

Urine retention Urine retention causes a distended bladder to displace the uterus above the umbilicus and to the side, which prevents the uterus from contracting. The uterus needs to remain contracted if bleeding is to stay within normal limits. Cervical and vaginal tears can cause PP hemorrhage but are less common occurrences in the PP period.

5 nursing interventions for shoulder dystocia +1 most important thing to know

Use McRoberts positioning Apply suprapubic pressure Notify NICU; infant may be pale or shocky Set timer on warmer; call for extra help Document thoroughly and carefully DO NOT USE FUNDAL PRESSURE!!!!!!!!!!!

A client is admitted to the L & D suite at 36 weeks' gestation. She has a history of C-section and complains of severe abdominal pain that started less than 1 hour earlier. When the nurse palpates tetanic contractions, the client again complains of severe pain. After the client vomits, she states that the pain is better and then passes out. Which is the probable cause of her signs and symptoms? Hysteria compounded by the flu Placental abruption Uterine rupture Dysfunctional labor

Uterine rupture

S/S of neonatal jaundice

yellow skin/eyes sleepiness poor feeding brown urine fever high pitch cry vomiting