OB My Nursing Lab ?s 80Qw/exp (for the most part) good for complications
The nurse is caring for a client who had a classical uterine incision for her cesarean birth. The nurse knows that the client understands implications for future pregnancies that are secondary to her classical uterine incision when the client makes which of the following statements? "Every time I have a baby, I will have to have a cesarean delivery." "I can only have one more baby." "The risk of rupturing my uterus is too high for me to have any more babies." "The next time I have a baby, I can try to deliver vaginally.
"Every time I have a baby, I will have to have a cesarean delivery." A classical uterine incision is made in the upper uterine segment and holds an increased risk of rupture in subsequent pregnancy, labor, and birth. Future births will be planned cesareans.
A client who has undergone a vacuum-assisted birth asks the nurse how long the swelling on the infant's head will remain. Which would be the best response by the nurse? 8-12 hours 12-24 hours 48-72 hours 5-7 days
48-72 hours The suction can create swelling of the newborn's scalp known as a "chignon." This will resolve in about 48-72 hours.
What is the success rate of an ECV? 75% 90% 50% 60%
60%
A client is going to have a cephalic version at 38 weeks gestation for a breech presentation. The nurse determines that the client has understanding of the procedure when the client makes which of the following statements? "The procedure cannot be stopped even if my baby shows signs of distress." "After the baby is turned, I must remain in bed." "My baby's head will be turned slightly to make the delivery easier." "My baby will be turned to a head-down position.
"My baby will be turned to a head-down position Cephalic version is a procedure used to change the position of the fetus in utero. It is used to manipulate the fetus from an oblique, shoulder, or breech presentation to a cephalic presentation.
What percentage of pregnancies is affected by cardiac disease? 10% 5% 15% 1%
1%
What is the maximum length of time a vacuum extractor can be used without increasing the risk of injury to the fetal scalp? 45 minutes 10 minutes 15 minutes 1 hour
10 minutes The use of a vacuum extractor for longer than 10 minutes increases the risk of fetal scalp injury.
During which period of gestation is gestational diabetes usually diagnosed? 36-38 weeks 28-32 weeks 15-18 weeks 24-28 weeks
24-28 weeks Successful management of diabetes during pregnancy begins with diagnosis. Gestational diabetes is usually diagnosed between 24 and 28 weeks gestation using a 1-hour glucose challenge test and/or a 3-hour oral glucose tolerance test.
Which test result indicates a higher risk for preeclampsia and eclampsia? An increase in calcium A decrease in folic acid An increase in protein A decrease in potassium
A decrease in folic acid Folic acid appears to decrease the risk of preeclampsia, so a decrease in the level of folic acid may indicate a higher risk for the occurrence of preeclampsia. Calcium, protein, and potassium are all nutrients that are necessary for bone and tissue growth but are not associated with decreasing the risk of preeclampsia.
An external cephalic version (ECV) to change the position of the fetus is generally performed when? After the 20-week anatomy scan Immediately preceding labor As soon as malpresentation is detected After 36---37 weeks gestation
After 36---37 weeks gestation An ECV is generally performed as late in the pregnancy as possible, preferably after 36-37 weeks, because it is less likely that the fetus will return to a malpresentation.
Why would you add a urinary catheter to the delivery room table before a vaginal birth? As a comfort to the laboring woman An empty bladder provides more room on the pelvic floor. To increase the safety of the fetus If the operative vaginal birth fails, you should be prepared for a cesarean birth
An empty bladder provides more room on the pelvic floor.
A nurse performs a cervical exam on a client with ruptured membranes and palpates a loop of umbilical cord. What is the initial nursing action? Giving the mother oxygen via face mask at 15 L/min Applying firm pressure on the presenting part to relieve cord compression Stopping oxytocin administration immediately Preparing an amnioinfusion to try and float the cord up into the uterus
Applying firm pressure on the presenting part to relieve cord compression Applying firm pressure on the presenting part is the standard treatment and should be the initial nursing action. The hand is not removed until orders are received from the health care provider to do so.
The midwife asks the nurse to assist the laboring client with McRoberts maneuver to help with shoulder dystocia. What is the appropriate nursing action? Ask the client to flex her knees to her chest. Rotate the fetal shoulder 180 degrees. Apply firm pressure to the fundus until the shoulder releases. Apply suprapubic pressure for 5 minutes.
Ask the client to flex her knees to her chest. McRoberts maneuver involves having the woman flex her knees to her chest. This provides room in the pelvic floor and decreases the force necessary to extract the shoulders. The nurse may assist the client into this position. A health care provider or midwife may perform the Woods maneuver, which involves rotation of the fetal shoulder by 180 degrees. This is not a responsibility of the registered nurse.
A nurse is writing a plan of care for a client at 34 weeks gestation with a placenta partially covering the cervical os. The plan of care includes which of the following? Select all that apply. Assess uterine tone Vaginal checks every shift Bed rest with bathroom privileges No vaginal exams Up ad lib
Assess uterine tone, Bed rest with bathroom privileges, No vaginal exams Putting the client on bed rest will give the fetus more time to mature and decrease the pressure of the fetus on the cervical os to decrease any bleeding the client may be having. Doing a vaginal exam would increase bleeding and possibly put the client into preterm labor. If the uterus becomes hard, it is a good indication that the placenta is separating away from the wall of the uterus. Being up ad lib and vaginal checks could increase bleeding and possibly put the client into labor.
Nursing care of the woman experiencing preterm labor includes which of the following? Select all that apply. Assessing fetal well-being Monitoring response to oxytocic therapy Assessing maternal vital signs Providing patient education about preterm labor Monitoring uterine activity
Assessing fetal well-being Assessing maternal vital signs Providing patient education about preterm labor Monitoring uterine activity
In the recovery room following a cesarean birth, your responsibilities include which of the following? Select all that apply. Inserting a Foley catheter Assessing fundal height and firmness Monitoring the woman's response to anesthesia Removal of the incisional dressing Monitoring maternal vital signs
Assessing fundal height and firmness Monitoring the woman's response to anesthesia Monitoring maternal vital signs
The health care provider has performed an amniotomy on a client in labor. Which interventions by the nurse are indicated when caring for this client during and immediately following the procedure? Select all that apply. Assessment of fetal heart rate Assessment for prolapse of umbilical cord Assessment for cervical dilation Assessment of the amniotic fluid color Assessment of the amount of amniotic fluid
Assessment of fetal heart rate Assessment for prolapse of umbilical cord Assessment of the amniotic fluid color Assessment of the amount of amniotic fluid Monitor the fetal heart rate immediately after rupture of membranes, observing for any fetal heart decelerations. Decelerations of the fetal heart rate could indicate a prolapse of the umbilical cord. The amniotic fluid color and amount should be assessed after rupture of membranes. Assessment for cervical dilation should be done prior to the amniotomy. The cervix should be dilated at least 2 cm.
Which factor may increase the risks of having preterm labor? Bacterial vaginosis infection Working while pregnant Hispanic race Primagravida
Bacterial vaginosis infection Prevention of preterm labor requires patient education regarding risk factors. This includes screening for certain infections that may increase the risk of preterm labor. These include bacterial vaginosis, Trichomonas vaginalis, group B hemolytic streptococcus, and urinary tract infections
A pregnant client's preterm labor will be managed at home. The nurse anticipates which of the following in the plan of care? Select all that apply. Administration of IV tocolytics Bed rest and pelvic rest Regular prenatal visits to assess cervical dilation Home uterine monitoring Biophysical profiles and fetal kick counts
Bed rest and pelvic rest Regular prenatal visits to assess cervical dilation Home uterine monitoring Biophysical profiles and fetal kick counts
Which of the following pieces of information would you use to determine how favorable the cervix is for induction? Apgar score Bishop Score Premature rupture of the membranes (PROM) Fetal heart rate
Bishop Score The Bishop Score assesses cervical dilation, effacement, fetal station, cervical consistency, and position, which are all indicators as to how favorable the cervix is for induction.
Which of the following is commonly seen in newborns that experience shoulder dystocia during delivery? Ankle fracture Delayed growth Hydrocephalus Brachial plexus injury
Brachial plexus injury Shoulder dystocia occurs when the fetal shoulder becomes impacted above the symphysis pubic bone. The newborn should be monitored for signs of brachial plexus injury, clavicle crepitus, and the ability to adapt to newborn life.
A physician orders magnesium sulfate IV for a primigravida client at 37 weeks gestation diagnosed with severe preeclampsia. Which medication would the nurse have readily available at the client's bedside? Diazepam (Valium) Hydralazine (Apresoline) Phenytoin (Dilantin) Calcium gluconate
Calcium gluconate Receiving magnesium sulfate IV, the client is at risk for magnesium toxicity. Calcium gluconate is the antidote for magnesium toxicity. Diazepam (Valium) and Phenytoin (Dilantin) are used to treat the patient having seizures; Hydralazine (Apresoline) is used to treat hypertension.
A laboring client suddenly sits up in bed, is dyspneic, becomes cyanotic, and has frothy sputum from her mouth. The nurse is unable to palpate a pulse. What is the initial action by the nurse? Call for assistance and start CPR. Assess the fetal heart rate. Position the client on her side with her feet elevated. Obtain the client's blood pressure.
Call for assistance and start CPR. The client's manifestations suggest amniotic fluid embolism and cardiac arrest. This is a medical emergency; the nurse must begin CPR immediately. The fetal heart rate will be assessed; however, the priority action of the nurse is to revive the mother through CPR.
Which of the following must be ruled out before labor may be augmented with an amniotomy or oxytocin? Twin gestation Cephalopelvic disproportion Vertex positioning of the fetus Full-term pregnancy status
Cephalopelvic disproportion Hypotonic labor is often the cause of labor augmentation. Prior to beginning labor augmentation the nurse understands that the health care provider will rule out cephalopelvic disproportion.
A pregnant client is admitted to the hospital in premature labor. The nurse anticipates which of the following assessment findings? Decreased fetal movement Headache Elevated blood pressure Cervical dilation
Cervical dilation Signs of preterm labor include cervical dilation, abdominal pain, diarrhea, lower back pain, pelvic pressure, and increased vaginal discharge.
The health care provider of a client at 40 weeks gestation has ordered Cytotec for labor induction. The nurse should be aware that Cytotec will produce what change for this client? Cervical ripening Decrease anxiety Rupture membranes Decrease pain
Cervical ripening
Which of the following are risk factors for gestational diabetes? Select all that apply. Chronic hypertension Family history of diabetes Underweight for height Previous gestational diabetes Maternal age younger than 25
Chronic hypertension Family history of diabetes Previous gestational diabetes
A nurse is caring for a pregnant client who is being monitored for gestational hypertension. Which assessment finding indicates a worsening of gestational hypertension and the need to notify the health care provider? Complaints of blurred vision and a headache Edema 2+ Urine output has increased. Blood pressure is 140/90.
Complaints of blurred vision and a headache Complaints of blurred vision, headache, and/or epigastric pain are indications that the condition is worsening. Baseline BP for preeclampsia is 140/90. Any increase of 30 systolic and 15 diastolic can indicate possible gestational hypertension. Gestational hypertension will cause a decrease in urine output, not an increase. Edema of 2+ is a normal finding.
When caring for a pregnant client who has a history of rheumatic heart disease, the nurse would be alert for the increased risk of which of the following? Congestive heart failure Mitral valve prolapse Peripartum cardiomyopathy Cardiac arrhythmias
Congestive heart failure Rheumatic heart disease results when recurrent inflammation causes scar tissue to form on the valves. The scarring results in stenosis of the valves. The increased blood volume of pregnancy, coupled with the pregnant woman's need for increased cardiac output, stresses the heart, and increases her risk of congestive heart failure.
What is an appropriate nursing diagnosis for a client with Class III cardiac disease? Decreased cardiac output related to effects of disease process Altered thought processes related to chronic disease impairment Risk for infection related to elevated levels of blood glucose Knowledge deficit related to newborn care
Decreased cardiac output related to effects of disease process The nurse formulates diagnoses as a component of the nursing process. Appropriate nursing diagnostic labels for the pregnant client with cardiac disease may include decreased cardiac output, impaired gas exchange, and anxiety. The client is not at an increased risk for infection due to blood glucose elevations, unless she is also a gestational diabetic. There may be a knowledge deficit for any new parent of a newborn; however, this is not related to having cardiac disease. The client with maternal heart disease does not generally demonstrate altered thought processes.
The nurse has taught a diabetic primigravida client about the symptoms of hyperglycemia and hypoglycemia. The client understands the instruction when she states that hyperglycemia may be manifested by which of the following? Pallor Blurred vision Sweating Dehydration
Dehydration Instruct the client on signs and symptoms of hyperglycemia: polyphagia, nausea, hot flushes, polydipsia, polyuria, fruity breath, abdominal cramps, rapid breathing, headache, weakness, drowsiness, and general malaise. Instruct the client on signs of hypoglycemia: hunger, clammy skin, irritability, slurred speech, seizures, tachycardia, headache, pallor, sweating, disorientation, shakiness, blurred vision, and, if untreated, coma or convulsions.
Mrs. McIntyre has been stabilized and discharged. She now has been resting at home for the past 24 hours. She continues to have swelling in her ankles. Her BP is 158/88 mmHg on anti-hypertensive medications. She was given anti-seizure medication but doesn't remember if she took it. Her friend comes to visit, and discovers Mrs. McIntyre having seizure-type movements and calls 911. Mrs. McIntyre continues to have seizure-like activity en route to the emergency department. In addition to monitoring fetal heart tones, what would you anticipate would be the next intervention for Mrs. McIntyre? Administration of hypertensive medications Bed rest Delivery of the infant Administration of seizure medications
Delivery of the infant Delivery of the infant is the only cure for preeclampsia. Hypertensive medications, seizure medications, and bed rest are treatment options for the symptoms, but do not "fix" or cure the condition. You would anticipate the health care provider would want to deliver this infant.
The nurse is caring for a client who is scheduled for induction of labor. Which of the following conditions are indications for induction? Select all that apply. Diabetes mellitus Preeclampsia Multiple gestation Post term gestation Fetal demise
Diabetes mellitus, Post term gestation Fetal demise, Preeclampsia Indications for labor induction or augmentation include maternal preexisting or concurrent medical conditions (preeclampsia, diabetes), infections, post term pregnancy, premature rupture of membranes (PROM), fetal demise, and fetal compromise (Category III fetal heart tracing, IUGR).
The nurse in a prenatal clinic would expect a client with heart disease to be prescribed iron supplements and prenatal vitamins during her pregnancy. What other medications may be indicated for clients with various types of cardiac disease? Select all that apply. Prednisone Digitalis Penicillin Furosemide Warfarin (Coumadin)
Digitalis Penicillin Furosemide
A woman is being discharged after being treated for a hydatidiform mole (gestational trophoblastic disease). In doing her discharge teaching, what should the nurse include? Do not become pregnant for at least 1 year. RhoGam should be given with the next pregnancy and delivery. Have hemoglobin and hematocrit checked weekly for 3 months. Have blood pressure checked weekly for 3 months.
Do not become pregnant for at least 1 year. The nurse needs to encourage the client not to become pregnant for 1 full year after a hydatidiform mole diagnosis since the increase in human chorionic gonadotrophin (hCG) can also increase the presence of choriocarcinoma. Blood pressure does not need to be checked weekly with gestational trophoblastic disease. The hCG levels need to be checked every 1dash2 weeks until normal pre-pregnancy levels return, and then every 1dash2 months for a year. RhoGam is only given to Rh-negative women. The question does not give this information. Also, the RhoGam would be given with this pregnancy, not the next pregnancy. Hydatidiform mole does not affect the hemoglobin and hematocrit.
A laboring client experiences an amniotic fluid embolism and cardiac arrest. The nurse should prepare for which type of delivery? Normal spontaneous vaginal Vacuum extracted vaginal Forceps-assisted vaginal Emergency cesarean section
Emergency cesarean section A woman who experiences cardiac arrest as a result of an amniotic fluid embolism will require an emergency cesarean section. The cesarean section is the best approach to ensuring viability of the fetus. Vaginal delivery is contraindicated in this case.
A client is admitted to the obstetrical unit with preterm labor. The nurse anticipates that the client will have which of the following needs? Financial difficulties Emotional support Work release note Anxiety medication order
Emotional support
A client with grade II abruptio placentae is admitted to the emergency room. The client is at 35 weeks gestation and complaining of severe abdominal pain and uterine tenderness. In managing the care of a client with abruptio placentae, the nurse would expect to do which of the following? Select all that apply. Evaluate uterine hyperactivity. Prepare the mother for a cesarean delivery. Monitor the mother for signs of hypovolemic shock. Evaluate fetal status. Evaluate the mother for painless uterine bleeding.
Evaluate uterine hyperactivity. Prepare the mother for a cesarean delivery. Monitor the mother for signs of hypovolemic shock. Evaluate fetal status. In grade II abruptio placentae there is a 20dash50% separation. The fetus will show signs of distress by decelerations in fetal heart rate. With large amount of blood loss, the mother is at risk for hypovolemic shock. Uterine hyperactivity also occurs, presenting with a board-like abdomen. Bleeding is painful with abruptio placentae. Immediate cesarean delivery is indicated with fetal compromise or excessive bleeding.
A client is experiencing a hypertonic pattern of uterine contractions. How often are her contractions occurring? Every 3-5 minutes Less than 5 minutes apart Every 2 minutes or less Less than 6-8 minutes between contractions
Every 2 minutes or less Tachysystole, also known as hypertonic contractions, is defined as spontaneous or stimulated uterine activity that is excessive in nature. It is characterized by contractions occurring every 2 minutes or less.
A laboring client at term is experiencing a prolonged second stage of labor. She has made no progress for more than 2 hours. The fetal scalp is visible between contractions. The client says, "I just can't push any longer, please help me!" The nurse notifies the health care provider and anticipates the need to do which of the following? Provide emotional support. Expect an instrument-assisted delivery. Provide perineal hygiene. Encourage the client to empty her bladder.
Expect an instrument-assisted delivery.
A client in labor is having hypertonic contractions. Which assessment findings would the nurse observe with this contraction pattern? Select all that apply. Decreased maternal oxygenation Fatigue Painful contractions Rapid dilation Frequent contractions
Fatigue Painful contractions Frequent contractions Tachysystole, also known as hypertonic contractions, is defined as excessive spontaneous or stimulated uterine activity. It is characterized by uterine contractions occurring every 2 minutes or less. Women experiencing hypertonic contractions have increased pain and discomfort as a result of the constant uterine activity. The maternal oxygenation level is generally not affected by hypertonic contractions.
Which of the following conditions would indicate that induction of labor is needed? Select all that apply. Fetal compromise Unfavorable cervix Preeclampsia Transverse fetal lie Infection
Fetal compromise, Preeclampsia, Infection Fetal compromise, preeclampsia, and infection are all conditions that pose a danger to the fetus, the mother, or both and may require intervention to speed labor. If the fetus is presenting in a transverse lie, it cannot be delivered vaginally; therefore, labor should not be induced.
Mrs. McIntyre is sent home with the diagnosis of mild preeclampsia. She is placed on bed rest and instructed to return in one week for a follow-up visit. Mrs. McIntyre misses her appointment in one week, but then returns to the clinic in three weeks with worsening symptoms. Which symptoms displayed by Mrs. McIntyre would indicate worsening preeclampsia? Select all that apply. Headache, visual disturbances, and epigastric pain experienced during the third trimester Sudden, rapid weight gain by the client Blood pressure of 130/88 mmHg, minimal swelling, but a weight gain of 35 pounds Blood pressure over 140/90 mmHg especially after 20 weeks of pregnancy Abnormal edema or swelling outside of slight puffiness in the feet
Headache, visual disturbances, and epigastric pain experienced during the third trimester Sudden, rapid weight gain by the client Blood pressure over 140/90 mmHg especially after 20 weeks of pregnancy Abnormal edema or swelling outside of slight puffiness in the feet
The nurse is reviewing the medications for a 14-week gestation primigravida who has mitral valve stenosis. What medications would the nurse expect to be ordered for this client? Heparin Enoxaparin (Lovenox) Ardeparin (Normiflo) Warfarin (Coumadin)
Heparin Heparin is typically the drug of choice for anticoagulation therapy since it does not cross the placenta membrane. Warfarin is not used since it crosses the placental membrane. Enoxaparin can result in thrombocytopenia. Ardeparin can cause fetal malformations.
A 20-year-old client at 34 weeks gestation is admitted to the hospital with vaginal bleeding. After reviewing the client's history, which of the following factors might lead the nurse to suspect abruptio placentae? Several hypotensive episodes Previous low transverse cesarean delivery One induced abortion History of cocaine use
History of cocaine use The exact cause is unknown, but abruptio placentae is associated most with maternal hypertension, smoking, cocaine use, short umbilical cord, abdominal trauma, and a previous history of abruption.
Which condition occurs in the initial newborn period due to maternal diabetes? Hypobilirubinemia Spontaneous abortion Hypertension Hypoglycemia
Hypoglycemia Hypoglycemia can occur in the newborn once the umbilical cord is cut. This leaves the newborn with a diminishing supply of glucose but an excessive supply of circulating insulin. Hyperbilirubinemia may occur as the result of the neonate's immature liver being unable to metabolize bilirubin. Since it occurs after 20 weeks gestation, gestational diabetes is not associated with spontaneous abortion. Hypertension is not an effect seen in the newborn whose mother had gestational diabetes.
While caring for a primigravid client with Class II heart disease at 28 weeks gestation, the nurse would teach the client to contact her health care provider immediately if she experiences which of the following? Mild ankle edema Emotional stress on the job Increased dyspnea at rest Weight gain of 1 pound in a week
Increased dyspnea at rest Class II cardiac heart disease is characterized by slight limitation of physical activity. It is asymptomatic at rest; symptoms occur with ordinary physical activity. Increased dyspnea at rest must be reported immediately because it may be indicative of increasing congestive heart failure. Mild ankle edema and weight gain of 1 pound a week are common findings during the third trimester. Emotional stress on the job can increase cardiac demand. It needs to be reported only if the client experiences symptoms, such as palpations or irregular heart rate, indicating heart failure.
The nurse is caring for a woman following a cesarean delivery with a low transverse incision. What are the advantages of a low transverse uterine incision versus a classical incision for a cesarean birth? Select all that apply. Less likely to cause bowel adhesions Less likely to rupture with subsequent pregnancies Involves less blood loss More appropriate for preterm births or multiple gestations Easier to repair surgically
Less likely to cause bowel adhesions Less likely to rupture with subsequent pregnancies Involves less blood loss Easier to repair surgically The low transverse incision is preferred because it involves the thinnest portion of uterus, results in less blood loss, is easier to repair, is less likely to cause adhesions to the bowel, and is less likely to rupture during later pregnancies. The low vertical incision is preferred for multiple births, and the classic incision is preferred for very small fetuses.
The nurse is making a plan of care for a client with severe preeclampsia. One of the complications is HELLP syndrome. Which of the following laboratory values would indicate the patient has gone into HELLP syndrome? Select all that apply. Low platelets Low hematocrit Elevated liver enzymes Low hemoglobin Low liver enzymes
Low platelets, Low hematocrit, Elevated liver enzymes A client with HELLP syndrome will have a low hematocrit due to hemolysis, elevated liver enzymes, and low platelets. The nurse would not anticipate a low hemoglobin or low liver enzymes for this client.
Which of the following is the most common cesarean incision? Classic High transverse Low vertical Low transverse
Low transverse The low transverse is the most commonly used incision because it results in less blood loss and is less likely to cause adhesions to the bowel or rupture during later pregnancies. Both the low vertical and classical incisions are more likely to rupture during an ensuing labor,
Which of the following are clinical manifestations of preterm labor? Select all that apply. Lower back pain Abdominal pain Cervical dilation Diarrhea Decreased vaginal discharge
Lower back pain Abdominal pain Cervical dilation Diarrhea Preterm labor refers to onset of labor prior to the 37th week of gestation. The manifestations of preterm labor include abdominal pain, diarrhea, lower back pain, pelvic pressure, increased vaginal discharge, and cervical dilation and effacement.
A nurse is caring for a pregnant client with preeclampsia. She is at the bedside and notes that the client has now progressed to eclampsia. What would be the nurse's first priority? Maintain an open airway. Administer oxygen by mask. Assess BP and fetal heart rate. Administer magnesium sulfate IV.
Maintain an open airway. A patent airway is the immediate action when someone is having a seizure. When the client progresses from preeclampsia to eclampsia a seizure is involved. The other options are all actions that would be done, but maintaining a patent airway is the priority concern.
The nurse is assessing clients in the prenatal clinic. Which are maternal risk factors for preterm labor? Select all that apply. Maternal genital tract infection Preterm premature rupture of membranes African American race Maternal obesity Intrauterine bleeding
Maternal genital tract infection Preterm premature rupture of membranes African American race Intrauterine bleeding There are various causes of preterm labor. One of the most common is early rupture of membranes. Intrauterine bleeding may lead to preterm labor if not controlled quickly. This is one of the most common causes of preterm labor and delivery. African American women are twice as likely as Caucasian women to experience preterm labor, and their infants are less likely to survive.
The nurse is teaching a primigravid client with diabetes about common causes of hyperglycemia during pregnancy. Which of the following would the nurse include? Pregnancy-induced hypertension Obesity before conception Fetal macrosomia Maternal infection
Maternal infection Maternal infection is the most common cause of maternal hyperglycemia and can lead to ketoacidosis, coma, and death. The client should notify her health care provider immediately if she experiences symptoms of an infection. Fetal macrosomia, obesity before conception, and pregnancy-induced hypertension are not associated with maternal hyperglycemia during pregnancy.
Match the proper type of forceps to be used with each location of the fetal head. Outlet Forceps Mid-forceps Low Forceps Fetal Head: Between 0 and +2 station At +2 station or lower At or on the perineum and visible at the vaginal opening
Mid-forceps for Between 0 & +2 station Low forceps for At +2 or lower Outlet forceps for At or on the perineum & visible at the vaginal opening
A client at 37 weeks gestation is discharged after a successful external cephalic version. What aftercare instructions would be important to discuss with the client? Select all that apply. Recognizing signs of infection Monitoring for uterine contractions Maintaining clear liquids for 12 hours Observing for excessive fetal movement Performing fundal massage
Monitoring for uterine contractions Observing for excessive fetal movement The client should be aware of signs that the fetus has reverted to the previous position such as excessive movement or the feeling that the fetus "has turned around." The client may go into labor after discharge so she should be instructed to monitor for uterine contractions. An external cephalic version does not increase the risk of infection.
Once the external cephalic version is completed, what is your responsibility? Removing the Foley catheter Ensuring the woman doesn't have questions regarding the procedure Monitoring maternal uterine activity and fetus status Providing emotional support
Monitoring maternal uterine activity and fetus status Your primary responsibility after an ECV, successful or not, is to monitor the status of the fetus and maternal uterine activity for any adverse reactions. The procedure does not require catheterization
The health care provider sent Mrs. McIntyre to the hospital to be admitted for 24-hour antepartal observation. At the beginning of your shift, you perform a full assessment on Mrs. McIntyre. There is currently no seizure activity; however, it was noted in report that she had a mild seizure during the night. Her vital signs are now T 99.1degreesF, P 90 bpm, R 22/min, and BP 168/88 mmHg. Which symptom would indicate that Mrs. McIntyre has progressed from preeclampsia to eclampsia over the course of the last 24 hours? Proteinuria is evident in a urine sample Her blood pressure remains unstable New onset of seizures This is the correct answer. Normal blood sugar levels but fluctuating blood pressure readings
New onset of seizures Eclampsia includes the occurrence of seizures. The other symptoms occur during the preeclampsia phase of pregnancy.
Which of the following describes Class I cardiac disease in pregnancy? Comfortable at rest, marked intolerance of activity Slight limitations in activity, comfortable at rest No activity limitations, no signs of cardiac insufficiency Cardiac insufficiency at rest, no activity tolerated
No activity limitations, no signs of cardiac insufficiency Cardiac disease in pregnancy is diagnosed through history and physical along with diagnostic testing. The severity of the mother's disease is determined by her tolerance for physical activity and is classified accordingly. Class I involves no activity restrictions and no signs of cardiac insufficiency. Class II clients have slight limitations in activity with fatigue. They are comfortable at rest. Class III disease includes being comfortable at rest, but having marked intolerance of activity. Class IV disease involves intolerance of any activity and signs of cardiac insufficiency at rest.
If you administered the ripening agents Cervidil and Prepidil, which of the following could you expect to be associated with the drug? Select all that apply. Difficulty in administration The need for more oxytocin during labor Nonreassuring fetal status Uterine hyperstimulation Postpartum hemorrhage
Nonreassuring fetal status Uterine hyperstimulation Postpartum hemorrhage Possible side effects associated with the use of Cervidil and Prepidil are uterine hyperstimulation, nonreassuring fetal status, and postpartum hemorrhage. Cervidil and Prepidil often lead to the use of less oxytocin during labor, not more. And because they are prostaglandin inserts or gels, they are easy to administer.
What is the most common fetal malposition? Vertex Breech Occiput anterior Occiput posterior
Occiput posterior The most common fetal malposition is occiput posterior. This is seen most often in women with an anthropoid-shaped pelvis. During labor women may experience low back pain.
The nurse discusses the importance of prenatal care with Mrs. McIntyre and would like to establish a schedule of office visits for her to follow once she is stabilized. Which change in the schedule of office visits would be made to assess for symptoms of preeclampsia? Select all that apply. Office visit every week from 28-36 weeks gestation. Office visits are every 4 weeks until delivery. After 36 weeks, office visits are scheduled twice a week until delivery. Office visits every 2 weeks until 28 weeks gestation. Office visits should be increased with signs of preeclampsia as needed.
Office visit every week from 28-36 weeks gestation. After 36 weeks, office visits are scheduled twice a week until delivery. Office visits every 2 weeks until 28 weeks gestation. Office visits should be increased with signs of preeclampsia as needed.
A woman at 28 weeks gestation is admitted to the hospital with possible placenta previa. What would the nurse expect to find on the admission assessment? Painless vaginal bleeding Braxton-Hicks contractions Severe lower abdominal pain A board-like abdomen
Painless vaginal bleeding Placenta previa is a low implantation of the placenta where some or all of it overlays the cervical os. It is characterized by the sudden onset of bright red bleeding in the third trimester. This bleeding is usually painless. Depending on how much of the cervical os is covered, a cesarean delivery may be required. Severe lower abdominal pain and a board-like abdomen are signs of abruptio placentae. Braxton-Hicks contractions are painless irregular contractions of the uterus that occur throughout the pregnancy.
The client about to have a forceps-assisted delivery asks what complications can occur. The nurse understands that which of the following is a potential maternal complication of a forceps delivery? Erb's palsy Postpartum infection Uterine rupture Maternal hypertension
Postpartum infection Potential maternal complications from a forceps-assisted vaginal birth include trauma to the birth canal, periurethral, and perineal areas; hematomas; cervical lacerations; and an increased incidence of postpartum infection. Erb palsy is a potential fetal complication from a forceps-assisted delivery.
You are reviewing the provider's orders for Maria Gonzalez, a pregnant client admitted with placenta previa at 30 weeks. Which of the following orders would be concerning to you? Vaginal examinations every 4 hours Regular diet as tolerated Normal saline IV at 125mL/hr Bed rest with bathroom privileges
Vaginal examinations every 4 hours if the mother is preterm, expectant management of placenta previa may include bed rest with bathroom privileges, no vaginal examinations, IV hydration, and perhaps corticosteroids to produce lung maturity. The nurse would question an order to perform vaginal exams every 4 hours on a client diagnosed with placenta previa due to the increased risk of bleeding.
it was also reported that Mrs. McIntyre had experienced some vaginal bleeding before she had the seizure last night. The occurrence of vaginal bleeding, hypertension, and seizures all affect the fetus in a variety of ways during a pregnancy and delivery. Which complication for the fetus can be directly related to preeclampsia and eclampsia? Select all that apply. Prematurity Renal failure Intrauterine growth retardation Abruptio placenta Large for gestational age (LGA)
Prematurity, Intrauterine growth retardation, Abruptio placenta Infants from maternal preeclampsia may suffer from prematurity because of being delivered before term. Because of a decrease in placental circulation the infant may be small for gestational age and not large for gestational age. The infant may be in shock from an abruption placenta and need fluids at delivery. The infant most likely will not suffer from renal failure although maternal kidney problems are possible.
A woman admitted to the hospital with a diagnosis of possible ectopic pregnancy is presenting with abdominal pain and vaginal spotting for the past 24 hours. In reviewing her medical history the nurse knows that which of the following factors may be associated with ectopic pregnancy? Multiparity Age younger than 20 years Recurrent spontaneous abortions Previously diagnosed with pelvic inflammatory disease (PID)
Previously diagnosed with pelvic inflammatory disease (PID) Risk factors for an ectopic pregnancy include a history of previous ectopic pregnancy, history of STIs or pelvic inflammatory disease (PID), failed tubal ligation, previous tubal surgery, advanced maternal age, smoking, and ovulation-inducing medications. Multiparity, females younger than age 20, and recurrent spontaneous abortions are not risk factors for ectopic pregnancy.
A client is going to have an external version for a transverse fetus and is concerned about the terbutaline she is about to receive. The nurse explains that terbutaline (a tocolytic) is used to do which of the following? Prevent abruptio placentae Lower the maternal blood pressure Prevent preterm labor Relax the uterus
Relax the uterus
The nurse in a prenatal care setting is caring for a woman at 39 weeks gestation. The health care provider is going to strip the client's amniotic membrane. The client asks the nurse what this will do. What would be the best response by the nurse? Stripping the membranes will cause the fetus to drop lower in the pelvis. Stripping the membranes releases prostaglandins that may help labor begin. Stripping the membranes will help stimulate the fetus. Stripping the membranes releases progesterone that will prevent preterm labor.
Stripping the membranes releases prostaglandins that may help labor begin. Stripping of the amniotic membranes is a nonpharmacological method of labor induction or augmentation. It involves the health care provider or CNM inserting a gloved finger into the internal os of the cervix and rotating it to separate the membranes from the lower uterine segment
Before a woman undergoes a cesarean birth, you are responsible for which of the following? Explaining the details of the procedure Explaining the risks involved Supporting the woman and her partner Obtaining informed consent
Supporting the woman and her partner The doctor, however, is the person who obtains informed consent and explains the risks involved and the details of the procedure if necessary.
Which of the following may be assessed in the fetus with a prolapsed umbilical cord? Select all that apply. Sustained fetal bradycardia Late decelerations Variable decelerations Fetal heart rate accelerations Increased uterine contractions
Sustained fetal bradycardia Variable decelerations Changes that may be observed in the fetus with a prolapsed umbilical cord include variable decelerations and sustained fetal bradycardia.
Which of the following is a common side effect associated with the use of vacuum extraction? Memory loss Fetal distress Swelling of the scalp Fetal hair loss
Swelling of the scalp The suction from the vacuum can lead to swelling of the scalp, known as a "chignon," which resolves in about 48 to 72 hours
A laboring client at 39 weeks gestation has been pushing for 2 hours. The nurse anticipates that the health care provider may choose to use forceps to assist in the delivery. What criteria must be met to consider forceps? Select all that apply. The cervix must be fully dilated. Membranes must be ruptured. Adequate maternal anesthesia should be provided. The maternal bladder should be full. Cephalopelvic disproportion should be present
The cervix must be fully dilated. Membranes must be ruptured. Adequate maternal anesthesia should be provided. Health care providers must follow certain prerequisites prior to the application of forceps during an operative birth. They are as follows: appropriate health care provider knowledge regarding the use, advantages, and disadvantages of the different types of forceps, completely dilated cervix and ruptured amniotic membranes, an empty maternal bladder, nothing below the fetal head to obstruct birth, and adequate anesthesia to the mother (epidural or pudendal block). Contraindications to the use of forceps include severe fetal compromise, high fetal station, and cephalopelvic disproportion (CPD).
The nurse formulates a diagnosis of fear related to fetal outcomes for a laboring client with fetal malpresentation. What is an appropriate client outcome to include in the care plan? The mother is able to verbalize understanding of the labor process. The mother reports a decrease in fear and anxiety related to the birth. The mother safely delivers a viable newborn. The mother identifies two support people for the birth.
The mother reports a decrease in fear and anxiety related to the birth.
A primigravid with insulin-dependent diabetes is at 32 weeks gestation and undergoes a nonstress test; the results of the test are documented as reactive. The nurse tells the client that the results indicate which of the following? A contraction stress test is necessary. Fetal biophysical profile. The nonstress test should be repeated. There is evidence of fetal well-being.
There is evidence of fetal well-being. A nonstress test is considered reactive when two or more fetal heart rate accelerations of at least 15 beats/min occur (from a baseline fetal heart rate of 120 to 160 beats/min), along with fetal movement, during a 20-40 minute period. A reactive nonstress test indicates fetal heart rate accelerations and well-being. There is no indication for further evaluation (such as contraction stress test). However, if the nonstress test is nonreactive, a fetal biophysical profile or contraction stress test is preformed.
A client is in the recovery room following a cesarean birth. She is stable and alert. Which of the following should be the nurse's focus for teaching during this time? How to bathe the newborn What to expect during the postpartum period Future birth control options When to follow up with her health care provide
What to expect during the postpartum period
The nurse is assessing a client's understanding of her preterm labor. Which of the following questions are appropriate to include? Select all that apply. "Can you share with me what you know about the risks of preterm delivery?" "Tell me what you understand about causes of preterm labor." "We will be doing fetal monitoring. Have you learned about this already?" "How is this affecting your pregnancy? What concerns do you have?". "Do you have any questions about your pediatrician?"
"Can you share with me what you know about the risks of preterm delivery?" "Tell me what you understand about causes of preterm labor." "We will be doing fetal monitoring. Have you learned about this already?" "How is this affecting your pregnancy? What concerns do you have?".
A G3P2 client presents at 38 weeks gestation with a transverse lie. The nurse is preparing the client for an external version. Which client statement indicates that the client understands the procedure? Select all that apply. "I will have an ultrasound done after the procedure." "I will need a nonstress test before the procedure." "The procedure is uncomfortable." "I will need to get an IV started for the procedure." "I will be starting labor after the procedure."
"I will have an ultrasound done after the procedure." "I will need a nonstress test before the procedure." "The procedure is uncomfortable." "I will need to get an IV started for the procedure."
The nurse is caring for a client who will be having a cesarean delivery. Which of the following statements by the client would cause the nurse to determine that the client does not understand what to expect during a cesarean delivery? "My husband can be present during birth." "I will receive a blood transfusion during surgery." "An indwelling (Foley) catheter will be inserted before surgery." "I may be given an antacid before surgery."
"I will receive a blood transfusion during surgery."
A client with type 1 diabetes has just learned she's pregnant. The nurse is teaching her about insulin requirements during pregnancy. Which guideline should the nurse provide? "Insulin requirements don't change during pregnancy. Continue your current regimen." "Insulin requirements increase greatly during labor." "Insulin requirements usually decrease during the last two trimesters." "Insulin requirements usually decrease during the first trimester."
"Insulin requirements usually decrease during the first trimester." Maternal insulin requirements usually decrease during the first trimester from rapid fetal growth and maternal metabolic changes, requiring adjustment of insulin dosage. Maternal insulin requirements fluctuate throughout pregnancy; after decreasing during the first trimester, they rise during the second and third trimester when fetal growth slows. During labor, insulin requirements diminish from increased maternal energy expenditure.
A client is told that her pelvic diameters are slightly contracted. The client asks the nurse what this means for her vaginal birth plan. What is the correct response by the nurse? "Yes, you can deliver vaginally." "You will have to have a cesarean delivery." "It might be possible, but I would count on a cesarean delivery." "You will have a trial of labor first; a cesarean section will occur if the trial is not successful."
"You will have a trial of labor first; a cesarean section will occur if the trial is not successful." With only a minimal contracture of the pelvis, a trial of labor is indicated. A cesarean is not the only option in this case. The nurse cannot assume that the client will not be successful with a trial of labor.