OB test TWO part 2

A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment? -uterine hypertonicity -active genital herpes infection -blood pressure of 130/88 mm Hg -decreased urine output

uterine hypertonicity The nurse should ensure that the client does not have uterine hypertonicity to confirm that amnioinfusion is not contraindicated. Other factors that enforce contraindication of amnioinfusion include vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, and severe fetal distress. Active genital herpes infection is a condition that enforces contraindication of labor induction rather than amnioinfusion. Urine output and blood pressure do not determine a client's ability to receive an amnioinfusion.

The nursing student demonstrates an understanding of dystocia with which statement? -"Dystocia is diagnosed at the start of labor." -"Dystocia is not diagnosed until after the birth." -"Dystocia is diagnosed after labor has progressed for a time." -"Dystocia cannot be diagnosed until just before birth."

"Dystocia is diagnosed after labor has progressed for a time." Nursing management of the woman with dystocia, regardless of etiology, requires patience. The nurse needs to provide physical and emotional support to the client and family. Dystocia is diagnosed not at the start of labor, but rather after it has progressed for a time.

A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant? -6 months -3 months -9 months -12 months

6 months If the woman is considering pregnancy, it is recommended that she postpone conception until the disease has been stable or in remission for six months. Active disease at the time of conception and history of renal disease increase the likelihood of a poor pregnancy outcome.

Effects of Select Drugs on Pregnancy Marijuana

Anemia, inadequate weight gain, "amotivational syndrome," hyperactive startle reflex, newborn tremors, prematurity, IUGR

TAKE NOTE!

Avoid doing vaginal examinations in the woman with placenta previa because they may disrupt the placenta and cause hemorrhage.

CVD is now a leading cause of maternal death

CVD is the leading cause of death for women in the United States. It kills nearly 400,000 women each year. Despite the prominent reduction in cardiovascular mortality among men, the rate has not declined for women.

TAKE NOTE!

Classic manifestations of placental abruption include painful, dark red vaginal bleeding (port-wine color) because the bleeding comes from the clot that was formed behind the placenta; "knife-like" abdominal pain; uterine tenderness; contractions; and decreased fetal movement. Rapid assessment is essential to ensuring prompt, effective interventions to prevent maternal and fetal morbidity and mortality.

Placental abruption is classified according to the extent of separation and the amount of blood loss from the maternal circulation.

Classification of 0 or 1 is typically associated with a partial or marginal separation, whereas classification of 2 or 3 is associated with a complete or central separation.

TAKE NOTE!

Nutrient requirements and recommendations for weight gain for the pregnant woman with diabetes are the same as those for the pregnant nondiabetic woman.

KEY CONCEPTS

Gestational hypertension is the leading cause of maternal death in the United States and the most common complication reported during pregnancy.

Human papillomavirus (HPV)

Infection causes warts in the anogenital area, known as condylomata acuminata. These warts may grow large enough to block a vaginal birth. Fetal exposure to HPV during birth is associated with laryngeal papillomas. Two HPV vaccines have been FDA-approved (9-valent Gardasil and Cervarix) against the viral types most likely to cause cervical cancer (types 16 and 18) and genital warts (types 6 and 11) and have been licensed in the United States for girls and women 9-26 years old. The vaccines are 95-100% effective. The vaccines are now recommended for young girls and boys.

Chlamydia (Chlamydia trachomatis)

Majority of women are asymptomatic. Infection is associated with infertility and ectopic pregnancy, spontaneous abortions, preterm labor, premature rupture of membranes, low birth weight, stillbirth, and neonatal mortality. Infection is transmitted to the newborn through vaginal birth. Neonate may develop conjunctivitis or pneumonia. All pregnant women should be screened at the first prenatal visit and treated with erythromycin.

Syphilis (Treponema pallidum)

Maternal infection increases risk of premature labor and birth. Newborn may be born with congenital syphilis, causing jaundice, rhinitis, anemia, IUGR, and central nervous system involvement. All pregnant women should be screened for this STI and treated with benzathine penicillin G 2.4 million units IM to prevent placental transmission.

Grading Deep Tendon Reflexes Grade 0

Reflex absent, none elicited

KEY CONCEPTS

Rh incompatibility is a condition that develops when a woman with Rh-negative blood is exposed to Rh-positive fetal blood cells and subsequently develops circulating titers of Rh antibodies.

A nurse is conducting a presentation for a group of pregnant women about conditions that can occur during pregnancy and that place the woman at high-risk. When discussing blood incompatibilities, which measure would the nurse explain as most effective in preventing isoimmunization during pregnancy? -blood typing of mothers with type A or B blood -Rho(D) immune globulin administration to Rh-negative women -amniocentesis -cerclage

Rho(D) immune globulin administration to Rh-negative women Rh incompatibility can be prevented with the use of Rho(D) immune globulin. Hemolysis associated with ABO incompatibility is limited to mothers with type O blood and their fetuses with type A or B blood. Amniocentesis would be appropriate for treatment of polyhydramnios, not isoimmunization. Cerclage is a treatment for cervical insufficiency.

If signs and symptoms of magnesium toxicity develop

expect to administer calcium gluconate as the antidote.

A pregnant client has tested positive for cytomegalovirus. What can this cause in the newborn? -microcephaly -bicuspid valve stenosis -hypertension -clubbed fingers and toes

microcephaly Signs that are likely to be present in the 10% of newborns who are symptomatic at birth include microcephaly, seizures, IUGR, hepatosplenomegaly, jaundice, and rash.

Hypotonic uterine dysfunction

occurs during active labor (dilation more than 5 to 6 cm) when contractions become poor in quality and lack sufficient intensity to dilate and efface the cervix. Factors associated with this abnormal labor pattern include overstretching of the uterus, a large fetus, multiple fetuses, hydramnios, multiple parity, bowel or bladder distention preventing descent, and excessive use of analgesia. Clinical manifestations of hypotonic uterine dysfunction include weak contractions that become milder, a uterine fundus that can be easily indented with fingertip pressure at the peak of each contraction, and contractions that become more infrequent and briefer

Which should the nurse identify as a risk associated with anemia during pregnancy? -newborn with heart problems -fetal asphyxia -preterm birth -newborn with an enlarged liver

preterm birth The nurse should identify preterm birth as a risk associated with anemia during pregnancy. Anemia during pregnancy does not increase the risk of a newborn with heart problems, an enlarged liver, or fetal asphyxia.

A woman at 35 weeks' gestation with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client? -preterm rupture of membranes followed by preterm birth -development of eclampsia -hemorrhaging -development of gestational trophoblastic disease

preterm rupture of membranes followed by preterm birth Even with precautions, in most instances of hydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are less concerning than preterm birth in this pregnancy.

With an ectopic pregnancy, the ovum implants outside the uterus. The most common site for implantation is?

the fallopian tubes (96%) but some ova may implant in the ovary, the intestine, the cervix, or the abdominal cavity. None of these anatomic sites can accommodate placental attachment or a growing embryo.

A client experiencing a threatened abortion is concerned about losing the pregnancy and asks what she can do to help save her baby. What is the most appropriate response from the nurse? -"Carry on with the activity you engaged in before this happened." -"Restrict your physical activity to moderate bed rest." -"Strict bed rest is necessary so as not to jeopardize this pregnancy." -"There is no research evidence that I can recommend to you."

"Restrict your physical activity to moderate bed rest." With a threatened abortion, moderate bedrest, light activities, and supportive care are recommended. Regular physical activity may increase the chances of miscarriage. Strict bedrest is not necessary and may hide additional bleeding as it pools in the vagina, only to begin again as the woman ambulates. Activity restrictions are part of standard medical management.

A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? -2 to 7 days -1 to 5 days -6 to 10 days -4 to 8 days

2 to 7 days Tocolytic drugs may prolong the pregnancy for 2 to 7 days. During this time, steroids can be given to improve fetal lung maturity, and the woman can be transported to a tertiary care center.

The nurse is caring for a client after experiencing a placental abruption (abruptio placentae). Which finding is the priority to report to the health care provider? -hematocrit of 36% (0.36) -45 ml urine output in 2 hours -hemoglobin of 13 g/dl (130 g/L) -platelet count of 150,000 mm3

45 ml urine output in 2 hours The nurse knows a placental abruption places the client at high risk of hemorrhage. A decreased urine output indicates decreased perfusion from blood loss. The hematocrit, hemoglobin, and platelet counts are all within expected levels.

Medications Related to Abortions Mifepristone (RU-486)

Acts as progesterone antagonist, allowing prostaglandins to stimulate uterine contractions; causes the endometrium to slough; may be followed by administration of misoprostol within 48 hours • Monitor for headache, vomiting, diarrhea, and heavy bleeding. • Anticipate administration of antiemetic prior to use to reduce nausea and vomiting. • Encourage client to use acetaminophen to reduce discomfort from cramping.

Effects of Select Drugs on Pregnancy Caffeine

Vasoconstriction and mild diuresis in mother; fetal stimulation, but teratogenic effects not documented via research

Anemia

a reduction in red blood cell volume, is measured by hematocrit (Hct) or a decrease in the concentration of hemoglobin (Hgb) in the peripheral blood. This results in reduced capacity of the blood to carry oxygen to the vital organs of the mother and fetus. Anemia is a sign of an underlying problem but does not indicate its origin. Anemia during pregnancy is generally defined as an Hgb below 11 g/dL in the first and third trimesters, and below 10.5 g/dL in the second trimester

Cervical insufficiency

also called premature dilation of the cervix describes a weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions in the second trimester or early third trimester, resulting in the loss of the pregnancy. Since this typically occurs in the fourth or fifth month of gestation before the point of fetal viability, the fetus dies unless the dilation can be arrested. The incidence of cervical insufficiency is less than 1% in the obstetric population

Human papillomavirus (HPV) can cause condylomata acuminata that can develop in clusters on the vulva, within the vagina, on the cervix, or around the anus. What is their risk? -neonatal auricular papillomas -block a vaginal birth -heavy bleeding during vaginal birth -neonatal hemorrhage

block a vaginal birth Genital warts have a tendency to increase in size during pregnancy. These warts may grow large enough to block a vaginal birth. The pregnant woman can pass HPV to her fetus during the birth process. In rare instances, neonatal HPV infection can result in life-threatening laryngeal papillomas. HPV infection transmitted to the infant may not appear for as long as 10 years after birth.

Perinatal drug abuse

includes the use of alcohol and other drugs by pregnant women. The incidence of substance abuse during pregnancy is highly variable because most pregnant women are reluctant to reveal the extent of their use

Multiple sclerosis (MS)

is a chronic inflammatory, demyelinating autoimmune disorder of the central nervous system.

Oligohydramnios

is a decreased amount of amniotic fluid (less than 500 mL) between 32 and 36 weeks' gestation that is associated with poor pregnancy outcomes.

The nurse is caring for a pregnant client who is in her 30th week of gestation and has congenital heart disease. Which finding should the nurse recognize as a symptom of cardiac decompensation with this client? -swelling of the face -dry, rasping cough -slow, labored respiration -elevated temperature

swelling of the face Swelling of the face is a symptom of cardiac decompensation, along with moist, frequent cough and rapid respirations. Dry, rasping cough; slow, labored respiration; and an elevated temperature are not symptoms of cardiac decompensation.

teratogen

a substance known to be toxic to human development

Hyperemesis gravidarum

is a severe form of nausea and vomiting of pregnancy associated with significant costs and psychosocial impacts. At least 70% of women experience nausea and vomiting during their pregnancies

Umbilical cord prolapse

is a rare obstetric emergency that occurs when the cord precedes the fetus out

HELLP syndrome

is an acronym for hemolysis, elevated liver enzymes, and low platelet count. It is a variant of the preeclampsia/eclampsia syndrome that occurs in up to 20% of clients whose conditions are labeled as preeclampsia with severe features.

Severe (grade 3) Placental abruption

Absent to moderate bleeding (more than 1,500 mL), severe separation (more than 50%), profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased maternal blood pressure, significant maternal tachycardia and the development of DIC

After conducting a refresher class on possible congenital infections with a group of perinatal nurses, the nurse recognizes the class was successful when the group identifies which congenital viral infection as the most common? -CMV -HIV -HPV -RSV

CMV Cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. Human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) are other potential viruses.

Effects of Select Drugs on Pregnancy Sedatives

Central nervous system depression, newborn withdrawal, maternal seizures in labor, neonatal abstinence syndrome, delayed lung maturity

Gonorrhea (Neisseria gonorrhea)

Majority of women are asymptomatic. It causes ophthalmia neonatorum in the newborn from birth through infected birth canal. All newborns receive mandatory eye prophylaxis with tetracycline or erythromycin within the first hour of life. Mother is treated with ceftriaxone (Rocephin) 125 mg IM in a single dose before going home.

TAKE NOTE!

The absolute blood pressure (value that validates elevation) of 140/90 mm Hg should be obtained on two occasions 4 to 6 hours apart to be diagnostic of preeclampsia. Proteinuria is defined as 300 mg or more of urinary protein per 24 hours or more than 1+ protein by chemical reagent strip or dipstick of at least two random urine samples collected at least 4 to 6 hours apart with no evidence of urinary tract infection (UTI)

The WHO recommends that the treatment of TB in pregnant women should be the same as that in nonpregnant women and the rest of the general population.

The only exception is that streptomycin should be avoided in pregnancy because it is ototoxic to the fetus.

Effects of Select Drugs on Pregnancy Cocaine

Vasoconstriction, gestational hypertension, placental abruption, abortion, central nervous system defects, IUGR

Placenta previa

is the complete or partial covering of the uterine internal os of the cervix with the placenta, typically identified during the second or third trimester of pregnancy.

When caring for a client requiring a forceps-assisted birth, the nurse would be alert for: -increased risk for uterine rupture. -potential lacerations and bleeding. -increased risk for cord entanglement. -damage to the maternal tissues.

potential lacerations and bleeding. Forcible rotation of the forceps can cause potential lacerations and bleeding. Cervical ripening increases the risk for uterine rupture in a client attempting vaginal birth after undergoing at least one previous cesarean birth. There is an increased risk for cord entanglement in multiple pregnancies. Damage to the maternal tissues happens if the cup slips off the fetal head and the suction is not released.

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor? -If the woman has a full bladder, labor may be uncomfortable for her. -If the woman's bladder is distended, it may rupture. -A full bladder or rectum can impede fetal descent. -A full rectum can cause diarrhea.

A full bladder or rectum can impede fetal descent. Throughout labor the nurse needs to assess the woman's fluid balance status as well as check skin turgor and mucous membranes. In addition she needs to monitor the bladder and bowel status. A full bladder or rectum can impede fetal descent.

Gestational hypertension

A new-onset blood pressure elevation (140/90 mm Hg) identified after 20 weeks' gestation without proteinuria; blood pressure returns to normal by 12 weeks' postpartum

KEY CONCEPTS

DIC can be described in simplest terms as a loss of balance between the clot-forming activity of thrombin and the clot-lysing activity of plasmin.

Gestational diabetes mellitus

Glucose intolerance with its onset during pregnancy usually diagnosed in the second or third trimester of pregnancy that was not clearly overt prior to gestation. The prevalence of gestational diabetes has been increasing in the United States and is as high as 10%.

Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? -Hemoglobin of 13 g/dl (130 g/L) or lower -Hematocrit of 32% or less -Blood pressure of 100/68 mm Hg -Heart rate of 84 beats/min

Hematocrit of 32% or less Iron-deficiency anemia is diagnosed in a pregnant woman if the hematocrit is less that 33% or the hemoglobin is less than 11 g/dl (110 g/L). Tachycardia, hypotension, and tachypnea are all symptoms of iron-deficiency anemia but are not diagnostic criteria.

Type 2 diabetes

Insulin resistance or deficiency due to a progressive loss of beta cell insulin secretion frequently on the background of insulin resistance. This type is related to obesity and sedentary lifestyle. It is diagnosed primarily in adults older than 30 but is now being seen in children. It is the most common type of diabetes and is diagnosed more frequently in African Americans, Latino Americans, Native Americans, Asian Americans, and Pacific Islanders, as well as older adults.

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? -Lie flat on her back. -Stay in high Fowler position. -Lie in a semi-recumbent position. -Use pillows and wedges to stay in a fully recumbent position.

Lie in a 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.

Effects of Select Drugs on Pregnancy Opiates and Narcotics

Maternal and fetal withdrawal, placental abruption, preterm labor, premature rupture of membranes, perinatal asphyxia, newborn sepsis and death, intellectual impairment, malnutrition

Preeclampsia/eclampsia and HELLP

Most common hypertensive disorder of pregnancy, which develops with proteinuria after 20 weeks' gestation; a multisystem disease process, which is accompanied by at least one of the following: proteinuria, elevated creatinine, liver involvement, epigastric or abdominal pain, neurologic complications, hematologic complications, and uteroplacental dysfunction; eclampsia occurs when seizure activity develops

KEY CONCEPTS

Nursing care related to PROM centers on infection prevention and identification of preterm labor contractions.

The nurse is caring for a 2-day-old newborn whose mother was diagnosed with cytomegalovirus during the first trimester. On which health care provider prescription should the nurse place the priority? -Perform a hearing screen test. -Obtain a urine specimen. -Monitor growth and development. -Assess pulse rate.

Perform a hearing screen test. Symptoms of CMV in the fetus and newborn, known as CMV inclusion disease, include hepatomegaly, thrombocytopenia, IUGR, jaundice, microcephaly, hearing loss, chorioretinitis, and intellectual disability. A hearing screen would be priority over monitoring growth and development because that will have to be done over an extended period of time. Urine and pulse are not important with this diagnosis.

The maternal health nurse is caring for a group of high-risk pregnant clients. Which client condition will the nurse identify as being the highest risk for pregnancy? -Secondary hypertension -Repaired atrial septal defect -Pulmonary hypertension -Loud systolic murmur

Pulmonary hypertension Pulmonary hypertension is considered the greatest risk to a pregnancy because of the hypoxia that is associated with the condition. The remaining conditions represent potential cardiac complications that may increase the client's risk in pregnancy; however, these do not present the greatest risk in pregnancy.

The nurse would prepare a client for amnioinfusion when which action occurs? -Severe variable decelerations occur and are due to cord compression. -Fetal presenting part fails to rotate fully and descend in the pelvis. -The fetus shows abnormal fetal heart rate patterns. -Maternal pushing is compromised due to anesthesia.

Severe variable decelerations occur and are due to cord compression. Indications for amnioinfusion include severe variable decelerations resulting from cord compression, oligohydramnios (decreased amniotic fluid), postmaturity, preterm labor with rupture of the membranes, and thick meconium fluid. Failure of the fetal presenting part to rotate fully; descent in the pelvis; abnormal fetal heart rate patterns or acute pulmonary edema; and compromised maternal pushing sensations from anesthesia are indications for forceps-assisted birth, and not for amniofusion.

neonatal abstinence syndrome (NAS)

This collection of symptoms may include irritability, hypertonicity, jitteriness, fever, excessive and often high-pitched cry, vomiting, diarrhea, feeding disturbances, respiratory distress, disturbed sleeping, excessive sneezing and yawning, nasal stuffiness, diaphoresis, fever, poor sucking, tremors, and seizures

The nurse is caring for a multigravid who experienced a placental abruption 4 hours ago. For which potential situation will the nurse prioritize assessment? -Maternal blood loss -Uterine atony -Blood incompatibilities -Hypertensive crisis

Uterine atony A placental abruption (abruptio placentae) may occur any time before and during the labor process. After delivery, the woman who has had an abruption requires close monitoring for postpartum hemorrhage because of the risk for uterine atony. This does not cause increased blood pressure or blood incompatibilities.

Effects of Select Drugs on Pregnancy Nicotine

Vasoconstriction, reduced uteroplacental blood flow, decreased birth weight, abortion, prematurity, placental abruption, fetal demise

The medical approach today for an unruptured tubal pregnancy most often consists of?

a single-dose IM injection of methotrexate (Rheumatrex, Trexall) with outpatient follow-up. Medical management with methotrexate, though not approved by the Food and Drug Administration (FDA) for this purpose, has been endorsed by the American College of Obstetricians and Gynecologists (ACOG). Prostaglandins, misoprostol, and actinomycin have also been used in the medical nonsurgical management of ectopic pregnancy with a reported success rate of approximately 90%. Methotrexate is a folic acid antagonist that inhibits cell division in the developing embryo.

A nurse is caring for a client who just experienced a spontaneous abortion (miscarriage) in her first trimester. When asked by the client why this happened, which is the best response from the nurse? -abnormal fetal development -rejection of the embryo through an immune response -implantation abnormality -lack of sufficient progesterone produced by the corpus luteum

abnormal fetal development The most frequent cause of spontaneous abortion (miscarriage) in the first trimester of pregnancy is abnormal fetal development, due either to a teratogenic factor or to a chromosomal aberration. In other miscarriages, immunologic factors may be present or rejection of the embryo through an immune response may occur. Another common cause of early miscarriage involves implantation abnormalities. Miscarriage may also occur if the corpus luteum on the ovary fails to produce enough progesterone to maintain the decidua basalis.

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 -fetal fibronectin testing -salivary estriol levels -transvaginal ultrasound

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.

A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth? -extensive lacerations -monitor for a cardiac anomaly -assess for cleft palate -brachial plexus assessment

brachial plexus assessment The nurse should identify nerve damage as a risk to the fetus in cases of shoulder dystocia. Other fetal risks include asphyxia, clavicle fracture, central nervous system injury or dysfunction, and death. Extensive lacerations is a poor maternal outcome due to the occurrence of shoulder dystocia, which should be assessed and treated. Cleft palate and cardiac anomalies are not related to shoulder dystocia.

Preeclampsia

can be described as new-onset hypertension accompanied by proteinuria and/or maternal organ dysfunction that targets the cardiovascular, hepatic, renal, and central nervous systems (CNS). Preeclampsia can present with severe features, or it may not.

The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus? -cervical lacerations -perineal hematoma -infection of episiotomy -caput succedaneum

caput succedaneum Caput succedaneum is a complication that may occur in the newborn of a woman who had a forceps-assisted birth. Maternal complications include tissue trauma such as lacerations of the cervix, vagina, and perineum; hematoma; extension of episiotomy into the anus; hemorrhage; and infection.

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? -lack of cervical dilation past 2 cm -fetal buttocks as the presenting part -reports of severe back pain -contractions most forceful in the middle of uterus rather than the fundus

contractions most forceful in the middle of uterus rather than the fundus Contractions that are more forceful in the midsection of the uterus rather than in the fundus suggest hypertonic uterine dysfunction. Reports of severe back pain are associated with a persistent occiput posterior position due to the pressure of the fetal head on the woman's sacrum and coccyx. Cervical dilation (dilatation) that has not progressed past 2 cm is associated with dysfunctional labor. A breech position is one in which the fetal presenting part is the buttocks or feet.

A woman who immigrated here from a third world country presents to the clinic to find out if she is pregnant. Which signs and/or symptoms would the nurse assess as possible indicators that she might have an active case of tuberculosis as well? Select all that apply. -fatigue -night sweats -hemoptysis -anorexia -weight gain

fatigue night sweats hemoptysis anorexia Women emigrating from developing countries are at high risk for tuberculosis. Clinical manifestations include fatigue, fever or night sweats, nonproductive cough, weakness, slow weight loss, anemia, hemoptysis, and anorexia.

A nurse is admitting a pregnant woman with sickle cell anemia to the emergency department. Which findings would lead the nurse to suspect the client is in crisis? Select all that apply. -fever -joint pain -increased skin turgor -pallor -fatigue

fever joint pain fatigue Signs and symptoms of a sickle cell crisis commonly include severe abdominal pain, muscle spasm, leg pains, joint pain, fever, stiff neck, nausea and vomiting, and seizures. Skin turgor would most likely be poor because the client would probably be dehydrated. The client may also be fatigued during the crisis. Pallor would be the result of the anemia but not necessarily indicative of a crisis.

A nurse is conducting a class on gestational diabetes for a group of pregnant women who are at risk for the condition. The nurse determines that additional teaching is needed when the class identifies which complication as affecting the neonate? -hyperglycemia -macrosomia -hypoglycemia -birth trauma

hyperglycemia Gestational diabetes is associated with either neonatal complications such as macrosomia, hypoglycemia, and birth trauma or maternal complications such as preeclampsia and cesarean birth.

Uterine rupture

in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. Uterine rupture is a catastrophic tearing of the uterus at the site of a previous scar into the abdominal cavity. Its onset is often marked only by sudden fetal bradycardia, and treatment requires rapid surgery for good outcomes. From the time of diagnosis to delivery, only a short amount of time is available before clinically significant fetal morbidity occurs. Fetal morbidity occurs secondary to catastrophic hemorrhage, fetal anoxia, or both.

A pregnant woman diagnosed with cardiac disease 4 years ago is told that her pregnancy is a high-risk pregnancy. The nurse then explains that the danger occurs primarily because of the increase in circulatory volume. The nurse informs the client that the most dangerous time for her is when? -in weeks 8 to 12 -in weeks 28 to 32 -in weeks 12 to 20 -in weeks 20 to 28

in weeks 28 to 32 The danger of pregnancy in a woman with cardiac disease occurs primarily because of the increase in circulatory volume. The most dangerous time for a woman is in weeks 28 to 32, just after the blood volume peaks.

Toxoplasmosis

is a relatively widespread parasitic infection caused by a one-celled organism, Toxoplasma gondii It is transferred by hand to mouth after touching cat feces while changing the cat litter box or through gardening in contaminated soil. Consuming undercooked infected meat, such as pork, lamb, or venison drinking contaminated water, and eating unwashed fruits and vegetables can also transmit this organism. A fetus who contracts congenital toxoplasmosis typically has a low birth weight, enlarged liver and spleen, visual problems, cerebral palsy, hearing loss, seizures, chorioretinitis, jaundice, IUGR, hydrocephalus, microcephaly, neurologic damage, and anemia. Severity varies with gestational age; usually, the earlier the infection, the more severe the effects

A pregnant client has a history of asthma. After reviewing the possible medications that may be prescribed during her pregnancy to control her asthma, the nurse determines additional teaching is needed when the client identifies which drug as being used? -misoprostol -ipratropium -albuterol -salmeterol

misoprostol Pharmacologic agents used to treat asthma in pregnancy fall into two categories: rescue agents and maintenance agents. Rescue agents provide immediate symptomatic relief by reducing acute bronchospasm. Agents used in this category include albuterol and ipratropium. Maintenance agents, by contrast, reduce the inflammation that leads to bronchospasm. Agents used in this category are inhaled steroids. Common ones prescribed include beclomethasone and salmeterol. Misoprostol is a prostaglandin that is used for treating postpartum hemorrhage but is contraindicated with asthma clients due to the risk of bronchial spasm and bronchoconstriction.

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client? -monoamine oxidase inhibitors (MAOIs) -methadone therapy -restricted sodium intake -ginger therapy

restricted sodium intake The client with peripartum cardiomyopathy should be prescribed a restricted sodium intake to control the blood pressure. Monoamine oxidase inhibitors are given to treat depression in pregnancy, not peripartum cardiomyopathy. Methadone is a drug given for the treatment of a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.

The nurse is assessing a primigravida woman who reports vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. The nurse suspects the woman has contracted which disorder? -chlamydia -simple yeast infection -trichomoniasis -gonorrhea

trichomoniasis Trichomoniasis is caused by a one-celled protozoa. The symptoms include large amounts of foamy, yellow-green vaginal discharge. Treatment is with metronidazole, and her partner needs to be treated as well. A yeast infection presents with a cottage cheese-like discharge. Chlamydia often has no symptoms. If the woman does experience symptoms, these may include vaginal discharge, abnormal vaginal bleeding, and abdominal or pelvic pain. Gonorrhea may have symptoms so mild that they go unnoticed in the woman. The woman who contracts gonorrhea may have vaginal bleeding during sexual intercourse, pain and burning while urinating, and a yellow or bloody vaginal discharge.

A pregnant woman at 36 weeks' gestation comes to the care center for a follow-up visit. The woman is to be screened for group B streptococcus (GBS) infection. When describing this screening to the woman, the nurse would explain that a specimen will be taken from which area(s)? Select all that apply. -throat -nasal cavity -vagina -rectum -conjunctiva

vagina rectum According to Centers for Disease Control and Prevention guidelines, all pregnant women should be screened for GBS at 35 to 37 weeks' gestation and treated. Vaginal and rectal specimens are cultured for the presence of the bacterium. Specimens from the throat, nasal cavity, or conjunctiva are not used.

Placental abruption

is the early separation of a normally implanted placenta after the 20th week of gestation prior to birth, which leads to hemorrhage. Abruption results from bleeding between the decidua and placenta. It is a significant cause of second- or third-trimester bleeding with a high mortality rate. It occurs in about 1% of all pregnancies throughout the world, or approximately one in 100 pregnancies. There is about a 20-fold increase in risk of reoccurrence in a subsequent pregnancy

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination, there is an elevated human chorionic gonadotropin (hCG) level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition? -ectopic pregnancy -placenta previa -gestational trophoblastic disease -placental abruption (abruption placentae)

gestational trophoblastic disease The client is most likely experiencing gestational trophoblastic disease, or a molar pregnancy. In gestational trophoblastic disease, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi. The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds. Placental abruption is characterized by premature separation of the placenta. Ectopic pregnancy is a condition where there is implantation of the blastocyst outside the uterus. In placenta previa, the placental attachment is at the lower uterine segment.

The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? -To lessen the mother's pain -The fetus is descending too slowly -Abnormal position of the fetal head -Reduce risk of complications

Abnormal position of the fetal head Forceps are mechanical devices which can be used to help deliver the fetus. Although no longer used routinely they are still used in certain situations to assist with the birth. One of those situations is when the fetus is in an abnormal position and the health care provider attempts to reposition the fetus to facilitate birth. The use of forceps is not to lessen the mother's pain or to speed up the process. The use of forceps is not without risk of complications, include perineal lacerations and injury to the fetus if the forceps are not used correctly.

A pregnant client has tested positive for HIV using an enzyme-linked immunoassay (ELISA) test. When talking with the client about the results, she asks, "So what happens next?" Which response by the nurse would be appropriate as the next step? -"You will need to have another test to confirm the diagnosis." -"First you will get treated with antibiotics and then antiviral medicines." -"You will need testing for other infections like gonorrhea or syphilis." -"You will need to have an amniocentesis to check on the baby."

"You will need to have another test to confirm the diagnosis." The client with a reactive screening test, such as the ELISA test, needs to be prepared for an additional test, such as the Western blot or an immunofluorescence assay. The Western blot is the confirmatory diagnostic test. A positive antibody test confirmed by a supplemental test indicates that the client has been infected with HIV and can pass it on to others. Antiviral therapy and testing for other sexually transmitted infections will be done, but the diagnosis must be confirmed first. Antibiotics are not used for HIV. Also, amniocentesis is to be avoided to prevent contamination of the amniotic fluid with maternal blood.

Placenta previa

(meaning "afterbirth first") exists when the placenta is inserted wholly or partly into the lower uterine segment of the uterus, partially or completely covering the internal cervical opening. It is a bleeding condition that occurs during the last two trimesters of pregnancy. It poses a high risk of prenatal and postpartum hemorrhage as well as perinatal mortality. Placenta previa affects about one out of every 200 pregnancies

A woman with diabetes is in labor. To promote optimal outcomes for the mother and neonate, the nurse monitors the client's blood glucose level closely ensuring that it is maintained below which level? -110 mg/dl -150 mg/dl -130 mg/dl -120 mg/dl

110 mg/dl For the laboring woman with diabetes, the blood glucose levels are monitored every 1 to 2 hours with the goal to maintain the levels below 110 mg/dl throughout the labor to reduce the likelihood of neonatal hypoglycemia. If necessary, an infusion of regular insulin may be given to maintain this level.

A student nurse asks the instructor what percentage of clinically recognized pregnancies end in miscarriages during the first trimester. Which response from the nurse is the most accurate? -5% to 10% -15% to 20% -21% to 30% -31% to 40%

15% to 20% During the first trimester, 15% to 20% of all clinically recognized pregnancies end in miscarriage.

Type 1 diabetes

Absolute insulin deficiency due to autoimmune beta cell destruction.

Grade 0 Placental abruption:

Clinically unrecognized before birth, diagnosis is made retrospectively after birth

A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole? -Bright red, painless vaginal bleeding -Brisk deep tendon reflexes and shoulder pain -Dark red, "clumpy" vaginal discharge -Painful uterine contractions and nausea

Dark red, "clumpy" vaginal discharge Women with hydatidiform mole ("molar pregnancy") often pass blood clots or watery brown/dark red discharge from the vagina in the first trimester. If a complete molar pregnancy continues into the second trimester undetected, other signs and symptoms appear. The woman often presents with complaints of dark to bright red vaginal bleeding and pelvic pain. Infrequently, she will report passage of grapelike vesicles.

Grading Deep Tendon Reflexes Grade 4

Hyperactive, brisk, clonus present

Grading Deep Tendon Reflexes Grade 1

Hypoactive response, sluggish

Trichomonas (Trichomonas vaginalis)

Infection produces itching and burning, dysuria, strawberry patches on cervix, and vaginal discharge. Infection is associated with premature rupture of membranes and preterm birth. Treatment is with a single 2-g dose of metronidazole (Flagyl).

Moderate (grade 2) Placental abruption

No sign of bleeding or moderate bleeding (1,000 to 1,500 mL), moderate separation (20% to 50%), continuous abdominal pain, mild shock, normal maternal blood pressure, maternal tachycardia, evidence of fetal distress

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? -Hydatidiform mole (molar pregnancy) -Spontaneous abortion (miscarriage) -Ectopic pregnancy -Placenta previa -Cervical insufficiency

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.

A G3P2 woman at 39 weeks' gestation presents highly agitated, reporting something "came out" when her membranes just ruptured. Which action should the nurse prioritize after noting the umbilical cord is hanging out of the vagina? -Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord. -With the client in lithotomy position, hold her legs and sharply flex them toward her shoulders. -Place the client in Trendelenburg position and gently attempt to reinsert the cord. -Contact the health care provider and prepare the client for an emergent vaginal birth.

Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord. The nurse must put the woman in a bed immediately, while calling for help, and holding the presenting part of the fetus off the cord to ensure its safety. Umbilical cord prolapse occurs when the umbilical cord slips down in front of the presenting part, which can result in the presenting part compressing the cord, cutting off oxygen and nutrients to the baby, and the baby is at risk of death. This is an emergency. When a prolapsed cord is evident the nurse does not put the woman in lithotomy position, and cannot attempt to reinsert the cord. A vaginal birth is contraindicated in this situation.

protracted disorders

Refers to a series of events including protracted active phase dilation (slower-than-normal rate of cervical dilation) and protracted descent (delayed descent of the fetal head in the active phase). A laboring woman with a slower-than-normal rate of cervical dilation is said to have a protracted labor pattern disorder. Slow progress may be the result of cephalopelvic disproportion. Most women, however, benefit greatly from adequate hydration and some nutrition, emotional reassurance, and position changes; these women may go on and give birth vaginally.

Grading Deep Tendon Reflexes Grade 2

Reflex in lower half of normal range

Grading Deep Tendon Reflexes Grade 3

Reflex in upper half of normal range

A client has been admitted to the birthing suite in labor. She has been in labor for 12 hours and is dilated to 4 cm. The primary care provider notes that the client is in hypotonic labor. What does this mean? -The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix. -The uterine contractions are irregular, but the quantity or quality or strength is insufficient to dilate the cervix. -The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix. -The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix.

The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix. There are two types of uterine dysfunction: hypotonic and hypertonic. The most common is hypotonic dysfunction. This labor pattern manifests by uterine contractions that may or may not be regular, but the quantity or strength is insufficient to dilate the cervix.

TAKE NOTE!

Uterine blood flow increases by at least 1 L per minute, requiring the body to produce more blood during pregnancy. This results in a 25% increase in red blood cells, a 50% expansion of plasma volume during pregnancy, and an overall hemodilution. In addition, the increase in total red blood cellular volume includes an increase in clotting factors and platelets, defining the hypercoagulable state of pregnancy

Arrest disorders

include secondary arrest of dilation (no progress in cervical dilation in over 2 hours), arrest of descent (fetal head does not descend for more than 1 hour in primiparas and more than 30 minutes in multiparas), and failure of descent (no descent). About 20% of labors involve either protracted or arrest disorders

A woman at 10 weeks' gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize? -report of frequent mild nausea -blood pressure of 120/84 mm Hg -history of bright red spotting 6 weeks ago -fundal height measurement of 18 cm

fundal height measurement of 18 cm A fundal height of 18 cm is larger than expected and should be further investigated for gestational trophoblastic disease (hydatidiform mole). One of the presenting signs is the uterus being larger than expected for date. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 mm Hg would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion (miscarriage).

ectopic pregnancy

is any pregnancy in which the fertilized ovum implants outside the uterine cavity. refers to the implantation of a fertilized egg in a location outside of the uterine cavity, including the fallopian tubes, cervix, ovary, and the abdominal cavity.

Multiple gestation

is defined as a pregnancy with two or more fetuses. This includes twins, triplets, and higher-order multiples such as quadruplets.

Women with PROM present with

leakage of fluid, vaginal discharge, vaginal bleeding, and pelvic pressure, but they are not having contractions.

Hypertonic uterine dysfunction

occurs when the uterus never fully relaxes between contractions. Subsequently, contractions are ineffectual, erratic, and poorly coordinated because they involve only a portion of the uterus and because more than one uterine pacemaker is sending signals for contraction.

Placental abruption

refers to premature separation of a normally implanted placenta from the maternal myometrium. Placental abruption occurs in about 1% of all pregnancies throughout the world and is associated with significant perinatal mortality and morbidity

A client with a pendulous abdomen and uterine fibroid tumors has just begun labor and arrived at the hospital. After examining the client, the primary care provider informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman? -transverse lie -anterior fetal position -cephalic presentation -occipitoposterior position

transverse lie A transverse lie, in which the fetus is more horizontal than vertical, occurs in the following instances: women with pendulous abdomens; uterine fibroid tumors that obstruct the lower uterine segment; contraction of the pelvic brim; congenital abnormalities of the uterus; or hydramnios. Anterior fetal position and cephalic presentation are normal conditions. Occipitoposterior position tends to occur in women with android, anthropoid, or contracted pelvis.

PROM is diagnosed by

speculum vaginal examination of the cervix and vaginal cavity. Pooling of fluid in the vagina or leakage of fluid from the cervix, ferning of the dried fluid under microscopic examination, and alkalinity of the fluid as determined by nitrazine paper (pH indicator) confirm the diagnosis.

The nurse provides education to a postterm pregnant client. information will the nurse include to assist in early identification of potential problems? -"Increase your fluid intake to prevent dehydration." -"Be sure to measure 24-hour urine output daily." -"Continue to monitor fetal movements daily." -"Monitor your bowel movements for constipation."

"Continue to monitor fetal movements daily." The nurse will teach the postterm client to monitor fetal movements daily to help determine if the fetus is experiencing distress. A 24-hour urine is needed for postterm clients; however, this is not collected daily. Although all pregnant clients should avoid dehydration, there is no indication this client needs to increase her fluid intake and this will not help identify potential problems. Monitoring bowel movements for constipation is not needed.

A woman at 26 weeks' gestation is undergoing screening for diabetes with a 1-hour oral glucose challenge test. On the client's return visit, the nurse anticipates the need to schedule a 3-hour glucose challenge test based on which result of the previous test? -100 mg/dl (5.55 mmol/L) -114 mg/dL (6.33 mmol/L) -130 mg/dL (7.21 mmol/L) -146 mg/dL (8.10 mmol/L)

146 mg/dL (8.10 mmol/L) For a 1-hour glucose challenge test, a 75-g oral glucose load is given, without regard to the timing or content of the last meal. Blood glucose is measured 1 hour later; a level above 140 mg/dl (7.77 mmol/L)is abnormal. If the result is abnormal, a 3-hour glucose tolerance test is done. At 1 hour: Less than 140 mg/dL At 2 hours: Less than 120 mg/dL At 3 hours: Less than 95 mg/dL

A woman comes to the clinic for her first prenatal visit. As part of the assessment, the woman is screened for rubella antibodies. The nurse determines that a client has immunity against rubella based on which rubella titer? -1:8 -1:6 -1:0 -1:4

1:8 A rubella antibody titer of 1:8 or greater proves evidence of immunity. Women with titers of less than 1:8 should be immunized.

In a normal intrauterine pregnancy, beta-hCG levels typically double every?

2 to 4 days until peak values are reached 60 to 90 days after conception. Concentrations of hCG decrease after 10 to 11 weeks and reach a plateau at low levels by 100 to 130 days. Therefore, low beta-hCG levels are suggestive of an ectopic pregnancy or impending abortion. Additional tests may be done to rule out other conditions such as spontaneous abortion, ruptured ovarian cyst, appendicitis, and salpingitis.

A nurse is providing care to a couple who have experienced intrauterine fetal demise. Which action would be least effective in assisting a couple at this time? -Avoid any discussion of the situation with the couple. -Allow the couple to spend as much time as they want with their stillborn infant. -Give the parents a lock of the infant's hair. -Assist the family in making arrangements for their stillborn infant.

Avoid any discussion of the situation with the couple. The nurse should encourage discussion of the loss and allow the couple to vent their feelings of grief and guilt. The nurse should allow the parents to spend unlimited time with their stillborn infant so that they can validate the death. Providing the parents and family with mementos of the infant helps validate the reality of the death. Assisting the family with arrangements is helpful to reduce the stress of coping with the situation and making decisions at this difficult time.

A shoulder dystocia situation is called in room 4. The nurse enters the room to help and the health care provider says to the nurse, "McRoberts maneuver." What does the nurse do next? -Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis -Move the client into a hands-and-knees position, to straighten the sacral curve and release the posterior shoulder -Apply downward pressure above the pubic bone of the client, in an attempt to rotate the anterior shoulder -Push the fetal head back into the uterus and prepare the client for cesarean birth

Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis To implement McRoberts maneuver, the nurse brings the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis. This maneuver enlarges the space for delivery of the fetal shoulders. Applying pressure above the pubic bone is suprapubic pressure. Pushing the fetal head back into the vagina is a Zavanelli maneuver. Since the fetal head has been delivered, it is not safe to move the client to a hands-and-knees position.

KEY CONCEPTS

The three most common causes of hemorrhage early in pregnancy (first half of pregnancy) are spontaneous abortion, ectopic pregnancy, and GTD.

Mild (grade 1) Placental abruption

No sign of vaginal bleeding or minimal bleeding (less than 500 mL), marginal separation (10% to 20%), tender uterus, no coagulopathy, no signs of shock, no fetal distress

Effects of Select Drugs on Pregnancy Alcohol

Spontaneous abortion, inadequate weight gain, IUGR, FASD (the leading cause of intellectual disability)

Medications Related to Abortions Misoprostol (Cytotec)

Stimulates uterine contractions to terminate a pregnancy and to evacuate the uterus after abortion to ensure passage of all the products of conception • Monitor for side effects such as diarrhea, abdominal pain, nausea, vomiting, and dyspepsia. • Assess vaginal bleeding, and report any increased bleeding, pain, or fever. • Monitor for signs and symptoms of shock, such as tachycardia, hypotension, and anxiety.

TAKE NOTE!

The diagnosis of cervical insufficiency remains difficult in many circumstances. The cornerstone of diagnosis is a history of a pregnancy loss during the second or early third trimester associated with painless cervical dilation without evidence of uterine activity.

Polyhydramnios

also called hydramnios, is a condition in which there is too much amniotic fluid (more than 2,000 mL) surrounding the fetus between 32 and 36 weeks.

A pregnant client with multiple gestation arrives at the maternity clinic for a regular antenatal check up. The nurse would be aware that client is at risk for which perinatal complication? -postterm birth -maternal hypotension -congenital anomalies -fetal nonimmune hydrops

congenital anomalies Multiple gestation involves two or more fetuses. The perinatal complications associated with multiple pregnancy include preterm birth, maternal hypertension and congenital anomalies. Fetal nonimmune hydrops occurs in the infection of pregnant clients with parvovirus. Postterm birth, maternal hypotension, and fetal nonimmune hydrops are not seen as complications of multiple pregnancy.

Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? -applying suprapubic pressure against the fetal back -continuing to monitor maternal and fetal status -noting the space at the maternal umbilicus -auscultating the fetal heart rate at the level of the umbilicus

continuing to monitor maternal and fetal status Once a breech presentation is confirmed by ultrasound, the nurse should continue to monitor the maternal and fetal status when the team makes decisions about the method of birth. The nurse usually plays an important role in communicating information during this time. Applying suprapubic pressure against the fetal back is the nursing intervention for shoulder dystocia and may not be required for breech presentation. Noting the space or dip at the maternal umbilicus and auscultating the fetal heart rate at the umbilicus level are assessments related to occipitoposterior positioning of the fetus.

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply. -hyperthermia -hemolysis -elevated liver enzymes -leukocytosis -low platelet count

hemolysis elevated liver enzymes low platelet count The HELLP syndrome is a syndrome involving hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, and a low platelet count. Hyperthermia and leukocytosis are not features of HELLP syndrome.

gestational trophoblastic disease (GTD)

includes disorders of placental development (hydatidiform mole) and neoplasms of the trophoblast (choriocarcinoma). A common feature of all trophoblastic lesions is that they produce hCG, which serves as a clinical marker for the presence of persistent or progressive trophoblastic disease

Shoulder dystocia

is defined as the obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has been delivered. Shoulder dystocia is a fundamentally mechanical problem. The incidence of shoulder dystocia is increasing due to increasing birth weight, with reports of it occurring in about one in every 200 (3%) vaginal births. It can result in approximately 5,000 new permanent brachial plexus palsy cases annually in the United States

Eclampsia

is the hallmark neurologic complication of preeclampsia, the onset of seizure activity. Eclamptic seizures are a medical emergency and require immediate treatment to prevent mortality in both the mother and fetus.

A 28-year-old primigravida client with type 2 diabetes comes to the health care clinic for a routine first trimester visit reporting frequent episodes of fasting blood glucose levels being lower than normal, but glucose levels after meals being higher than normal. What should the nurse point out that these episodes are most likely related to? -tissue sensitivity to insulin increases -using too much insulin at this stage of the pregnancy -normal response to the pregnancy -insulin resistance is starting to decrease

normal response to the pregnancy This is a normal response to the pregnancy. During pregnancy, tissues become resistant to insulin to provide sufficient levels of glucose for the growing fetus. This can result in three normally occurring responses: blood glucose levels are lower than normal when fasting; blood glucose levels are higher than normal after meals; and insulin levels are increased after meals. The various hormones will prevent the mother from using most of the insulin produced to allow the extra glucose to get to the growing fetus.

fetal alcohol spectrum disorder (FASD)

this disorder includes the full range of birth defects, such as structural anomalies and behavioral and neurocognitive disabilities caused by prenatal exposure to alcohol . FASD affects one in 100 infants each year, more than autism, Down syndrome, cerebral palsy, cystic fibrosis, spina bifida, and sudden infant death syndrome (SIDS) combined. Each year in the United States, up to 40,000 infants are born with FASD. It is the leading cause of nongenetic intellectual disability in the United States, possibly exceeding even Down syndrome, which is currently approaching one in 500 live births. Alcohol consumption during pregnancy results in brain, craniofacial, and heart defects, neurotoxicity, and immune systems dysfunction.

The nurse is assessing a pregnant client who has a long history of asthma. She states, "I'm trying not to use my asthma medications because I certainly don't want my baby exposed to them." What is the nurse's best response? -"Actually, having uncontrolled asthma is much riskier for your baby than the medication." -"In fact, most modern asthma medications are categorized as safe for use in pregnancy." -"I'm glad to hear that you're focused on ensuring your baby's health." -"Your health care provider will likely agree with your decision."

"Actually, having uncontrolled asthma is much riskier for your baby than the medication." It is important for pregnant clients with asthma to keep taking their medications because the risks of exacerbations exceed the risks of the medications.

A pregnant client has been diagnosed with gestational diabetes. Which are risk factors for developing gestational diabetes? Select all that apply. -maternal age less than 18 years -genitourinary tract abnormalities -obesity -hypertension -previous large-for-gestational-age (LGA) infant

obesity hypertension previous large-for-gestational-age (LGA) infant Obesity, hypertension, and a previous infant weighing more than 9 lb (4 kg) are risk factors for developing gestational diabetes. Maternal age less than 18 years and genitourinary tract abnormalities do not increase the risk of developing gestational diabetes.

Dystocia

is the abnormal progression of labor. It can be influenced by a number of maternal and fetal factors. Dystocia is characterized by a slow and abnormal progression of labor. It occurs in approximately 10% of all labors and is the leading indicator for primary cesarean birth in the United States

Prelabor rupture of membranes (PROM)

is the spontaneous rupture of the amniotic sac, sometimes called the bag of waters, before the onset of true labor. There are a number of associated conditions and complications, such as infection, prolapsed cord, placental abruption, and preterm labor.

The nurse is admitting a G3 P2 client at 38 weeks' gestation who arrived reporting painless bleeding from the vagina leading to the diagnosis of placenta previa. When questioned by the client as to what caused this, which most likely factor should the nurse point out in her answer? -morbidly obese -maternal age more than 30 years -living in coastal areas -previous cesarean birth

previous cesarean birth The risk of placenta previa is greatly increased when a woman has had a previous cesarean delivery due to the scarring of the endometrial lining. Maternal age over 35 years, and not just more than 30 years, is considered another risk factor. Placenta previa is more common among those living in high altitudes not among those living in coastal areas. Obesity is not recognized as a potential risk for this condition. Other risk factors can include uterine insult or injury, cocaine use, prior placenta previa, infertility treatment, multiple gestations, previous induced surgical abortion, smoking, previous myomectomy to remove fibroids, short interval between pregnancies, hypertension, or diabetes.

A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation? -the 41-year-old client who conceived by in vitro fertilization -the 38-year-old client whose spouse is a triplet -the 19-year-old client diagnosed with polycystic ovary syndrome -the 27-year-old client who gave birth to twins 2 years ago

the 41-year-old client who conceived by in vitro fertilization The nurse should assess infertility treatment as a contributor to the increased probability of multiple gestations. Multiple gestations do not occur with an adolescent birth; instead, chances of multiple gestations are known to increase due to the increasing number of women giving birth at older ages.

The nurse is doing meal planning with a pregnant woman with iron-deficiency anemia. What dietary recommendations would the nurse make to enhance the woman's intake of iron? Select all that apply. -Drink orange juice with the iron supplement. -Increase intake of dried beans and green leafy vegetables. -Cook food in an iron skillet, if possible. -Limit intake of dried fruits, eating only fresh fruit. -Since fortified cereals are a poor source of iron, eat eggs or pancakes for breakfast.

Drink orange juice with the iron supplement. Increase intake of dried beans and green leafy vegetables. Cook food in an iron skillet, if possible. Dried fruits, fortified grains and cereals, and animal protein are all good sources of iron for a pregnant woman. Cooking in an iron skillet also will increase the amount of iron ingested. Vitamin C, like what is found in orange juice, enhances absorption of iron and is recommended to drink when taking iron supplements. Folate also increases the effectiveness of iron supplements; foods high in folate include green leafy vegetables, fortified grains and dried beans.

Medications Related to Abortions PGE2, dinoprostone (Cervidil, Prepidil Gel, Prostin E2)

Stimulates uterine contractions, causing expulsion of uterine contents; expels uterine contents in fetal death or missed abortion during second trimester; effaces and dilates the cervix in pregnancy at term • Bring gel to room temperature before administering. • Avoid contact with skin. • Use sterile technique to administer. • Keep client supine for 30 minutes after administering. • Document time of insertion and dosing intervals. • Remove insert with retrieval system after 12 hours or at the onset of labor. • Explain purpose and expected response to client.

cesarean birth

is the surgical birth of the fetus through an incision in the abdomen and uterine wall

Medications Related to Abortions Rh(D) immunoglobulin (Gamulin, HydroRho-D, RhoGAM, MICRhoGAM)

Suppresses immune response of nonsensitized Rh-negative clients who are exposed to Rh-positive blood to prevent isoimmunization in Rh-negative women exposed to Rh-positive blood after abortions, miscarriages, and pregnancies. • Administer intramuscularly in deltoid area. • Give only MICRhoGAM for abortions and miscarriages <12 weeks unless fetus or father is Rh-negative (unless client is Rh-positive, Rh antibodies are present). • Educate woman that she will need this after subsequent deliveries if fetuses are Rh-positive; also check lab study results prior to administering the drug

TAKE NOTE!

The hallmark of ectopic pregnancy is abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period. Although this is the classic triad, all three of these signs and symptoms occur in only about 50% of cases. Many women have symptoms typical of early pregnancy, such as breast tenderness, nausea, fatigue, shoulder pain, and low back pain.

abortion

is the loss of an early pregnancy, usually before week 20 of gestation. Abortion can be spontaneous or induced. A spontaneous abortion refers to the loss of a fetus resulting from natural causes, that is, not elective or therapeutically induced by a procedure. A stillbirth is the loss of a fetus after the 20th week of development, while a miscarriage is a loss before the 20th week.

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question? -"Maybe your uterus is just tired and needs a rest." -"It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby." -"Maybe your baby has developed hydrocephaly and the head is too swollen." -"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." Arrest of descent results when no descent has occurred for 2 hours in a nullipara or 1 hour in a multipara. The most likely cause for arrest of descent during the second stage is CPD. Rest should allow the uterine contractions to be more efficient. The hormones secreted during pregnancy allow ligaments to soften so bones can shift to allow birth. Ultrasound would have previously been diagnosed prior to the onset of labor.

A 16-year-old client has been in the active phase of labor for 14 hours. An ultrasound reveals that the likely cause of delay in dilation (dilatation) is cephalopelvic disproportion. Which intervention should the nurse most expect in this case? -cesarean birth -administration of oxytocin -administration of morphine sulfate -darkening room lights and decreasing noise and stimulation

cesarean birth If the cause of the delay in dilation (dilatation) is fetal malposition or cephalopelvic disproportion (CPD), cesarean birth may be necessary. Oxytocin would be administered to augment labor only if CPD were ruled out. Administration of morphine sulfate (an analgesic) and darkening room lights and decreasing noise and stimulation are used in the management of a prolonged latent phase caused by hypertonic contractions. These measures would not help in the case of CPD.

A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize? -A systolic blood pressure increase of 10 mm Hg -Weight gain of 1.2 lb (0.54 kg) during the past 1 week -A dipstick value of 2+ for protein -Pedal edema

A dipstick value of 2+ for protein The increasing amount of protein in the urine is a concern the preeclampsia may be progressing to severe preeclampsia. The woman needs further assessment by the health care provider. Dependent edema may be seen in a majority of pregnant women and is not an indicator of progression from preeclampsia to eclampsia. Weight gain is no longer considered an indicator for the progression of preeclampsia. A systolic blood pressure increase is not the highest priority concern for the nurse, since there is no indication what the baseline blood pressure was.

A woman presents at Labor and Delivery very upset. She reports that she has not felt her baby moving for the last 6 hours. The nurse listens for a fetal heart rate and cannot find a heartbeat. An ultrasound confirms fetal death and labor induction is started. What intervention by the nurse would be appropriate for this mother at this time? -Explain to her that there was probably something wrong with the infant and that is why it died. -Offer to take pictures and footprints of the infant once it is delivered. -Call the hospital chaplain to talk to the parents. -Recommend that she not hold the infant after it is delivered so as to not upset her more.

Offer to take pictures and footprints of the infant once it is delivered. When parents are faced with a fetal death, they need comfort and support without being intrusive. Taking pictures, footprints and gathering other mementos are very important in helping the family deal with the death. The mother is encouraged to hold the infant after delivery and name it. Telling the parents that the infant was probably defective is hurtful and not supportive to them. Calling the hospital chaplain is something that can be offered but should not be done without the parent's approval.

The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging? -Use McRoberts maneuver. -Use Zavanelli maneuver. -Apply pressure to the fundus. -Attempt to push in one of the fetus's shoulders.

Use McRoberts maneuver. McRoberts maneuver intervention is used with a large baby who may have shoulder dystocia and requires assistance. The legs are sharply flexed by a support person or nurse, and the movement will help to open the pelvis to the widest diameter possible. Zavanelli maneuver is performed when the practitioner pushes the fetal head back in the birth canal and performs an emergency cesarean birth. Fundal pressure is contraindicated with shoulder dystocia. It is outside the scope of practice for the LPN to attempt birth of the fetus by pushing one of the fetus' shoulders in a clockwise or counterclockwise motion.

The nurse is teaching a pregnant woman about how to prevent contracting cytomegalovirus (CMV) during pregnancy. What tips would the nurse share with this client? Select all that apply. -Wash your hands thoroughly with soap and water after touching saliva or urine. -Do not share food or drinks with young children, especially if they are in day care. -If you contract CMV, your doctor will give you some oral medicine to treat it. -If you have CMV, it is suggested that you not breastfeed your infant. -If you develop any flu-like symptoms, notify your physician immediately to be evaluated for CMV.

Wash your hands thoroughly with soap and water after touching saliva or urine. Do not share food or drinks with young children, especially if they are in day care. If you develop any flu-like symptoms, notify your physician immediately to be evaluated for CMV. Cytomegalovirus (CMV) is a mild infection and women may not know they have contracted it. The problem arises when a pregnant woman contracts it during the first 20 weeks of gestation. Prevention is the key, so the nurse would reinforce handwashing, not eating or drinking from a container after a small child has done so, and notifying the physician if the client develops mild flu-like symptoms so she can be tested to rule out CMV.

A woman with known cardiac disease from childhood presents at the obstetrician's office 6 weeks' pregnant. What recommendations would the nurse make to the client to address the known cardiac problems for this pregnancy? Select all that apply. -Plan periods of rest into the workday. -Continue taking the scheduled warfarin. -Receive pneumococcal and influenza vaccines. -Let the physician know if you become short of breath or have a nighttime cough. -Increase the amount of sodium in your diet to compensate for the expanding fluid needs of the fetus.

Plan periods of rest into the workday. Receive pneumococcal and influenza vaccines. Let the physician know if you become short of breath or have a nighttime cough. Women with known heart conditions need to be closely followed by both the obstetrician and a cardiologist. Recommendations would include rest periods, reduction of stress, getting immunizations, and monitoring for heart failure as demonstrated by a nighttime cough and shortness of breath. Consuming more sodium in the diet is not recommended due of the potential of developing hypertension. Warfarin is contraindicated during pregnancy since it crosses the placental barrier and can cause spontaneous abortion, stillbirth or preterm birth.

A woman in active labor suddenly experiences a sharp, excruciating low abdominal pain, which the nurse suspects may be a uterine rupture since the shape of the abdomen has changed. The nurse calls a code, and a cesarean birth is performed stat, but the infant does not survive the trauma. A few hours later, after the woman has stabilized, she asks to hold and touch her infant, and the nurse arranges this. Later, the nurse's documentation should include which outcome statement? -The parents continue to mourn the loss of their infant. -The parents just cannot believe their perfect infant died. -The parents are beginning to demonstrate positive grieving behaviors. -The parents are exhibiting dysfunctional coping mechanisms related to the death of their newborn.

The parents are beginning to demonstrate positive grieving behaviors. An evaluation of proposed outcomes may reveal unhappiness because not every woman who experiences a deviation from the normal in labor and birth will be able to give birth to a healthy child. Some infants will die. Outcome achievement might include the client begins positive grieving behaviors (touching, counting toes/fingers, etc.) in response to the loss of the newborn. The other statements are probably accurate but are not written as outcome statements.

A pregnant woman who is HIV-positive comes to the labor and birth unit in labor. When developing the plan of care for this client, which intervention would be most important for the nurse to include? -adhering to standard precautions -educating her about family planning -preparing the woman for cesarean birth -helping her choose a newborn feeding method

adhering to standard precautions For the pregnant woman who is HIV-positive, standard precautions must be used to reduce the risk of HIV transmission. Educating the woman about family planning methods is not as important as adhering to standard precautions. The decision about the mode of delivery is based on the woman's viral load, duration of ruptured membranes, progress of labor, and other clinical factors. Breastfeeding is contraindicated, so helping her choose a feeding method would be inappropriate.

A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out. Which intervention would the nurse expect to include in the plan of care for this client? -administering oxytocin -preparing the woman for an amniotomy -encouraging the woman to assume a hands-and-knees position -providing a comfortable environment with dim lighting

administering oxytocin Oxytocin would be appropriate for the woman experiencing dysfunctional labor (hypotonic uterine dysfunction). Comfort measures minimize the woman's stress and promote relaxation so that she can work more effectively with the forces of labor. An amniotomy may be used if the membranes were intact. It may also be used with hypotonic uterine dysfunction to augment labor. A hands-and-knees position helps to promote fetal head rotation with a persistent occiput posterior position.

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? -breast stimulation -amniotomy -laminaria -prostaglandin

amniotomy Amniotomy is considered a surgical method of cervical ripening. Breast stimulation is considered a nonpharmacologic method for ripening the cervix. Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. Prostaglandins are pharmacologic methods for cervical ripening.

A pregnant client with a history of heart disease has been admitted to a health care center reporting breathlessness. The client also reports shortness of breath and easy fatigue when doing ordinary activity. The client's condition is markedly compromised. The nurse would document the client's condition using the New York Heart Association (NYHA) classification system as which class? -class I -class II -class III -class IV

class III The nurse should classify the client's condition as belonging to class III of NYHA. In class III of NYHA classification, the client will be symptomatic with ordinary activity, and her condition is markedly compromised. The client is asymptomatic with all kinds of activity and is in uncompromised state in class I. The client is symptomatic with increased activity and is in slight compromised state in class II. The client is symptomatic when resting and is incapacitated in class IV.

At 31 weeks' gestation, a 37-year-old woman with a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Assessment reveals cervix 2.1 cm long; fetal fibronectin in cervical secretions, and cervix dilated 3 to 4 cm. Which interactions should the nurse prepare to assist with? -bed rest and hydration at home -hospitalization, tocolytic, and corticosteroids -an emergency cesarean birth -careful monitoring of fetal kick counts

hospitalization, tocolytic, and corticosteroids At 31 weeks' gestation, the goal would be to maintain the pregnancy as long as possible if the mother and fetus are tolerating the continuation of the pregnancy. Stopping the contractions and placing the client in the hospital allows for monitoring in a safe place if the woman continues and gives birth. Administration of corticosteroids may help to develop the lungs and prepare for early preterm birth. Sending the woman home is contraindicated in the scenario described. An emergency cesarean birth is not indicated at this time. Monitoring fetal kick counts is typically done with a postterm pregnancy.

The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of having a heroin use disorder. The nurse would be alert for which finding when assessing the neonate? -low, feeble cry -hypertonicity -easy consolability -vigorous sucking

hypertonicity Newborns of mothers with heroin or other opioid use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

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 -hypertonic contractions -uncoordinated contractions -Braxton Hicks contractions

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.

Cytomegalovirus

is a member of the herpesvirus family, which includes herpes simplex virus (HSV) types 1 and 2, varicella zoster virus, and Epstein-Barr virus. Cytomegalovirus (CMV) infects more than 60% of the human population. Humans are the only known hosts of CMV, which is transmitted via body fluids. It is typically asymptomatic in most individuals. CMV is the most common congenital and perinatal viral infection in the world The risk of serious fetal injury is greatest when maternal infection develops in the first trimester or early in the second trimester.

Group B streptococcus (GBS)

is a naturally occurring bacterium found in approximately 50% of healthy adults. It is a Gram-positive bacteria which colonizes in the gastrointestinal and genitourinary tracts. Women who test positive for GBS bacteria are considered carriers. Carrier status is transient and does not indicate illness. Although GBS is rarely serious in adults, it can be life threatening to newborns. GBS is the most common cause of sepsis and meningitis in newborns and is a frequent cause of newborn pneumonia The principal defense against early-onset GBS infection is administration of antibiotic prophylaxis to mothers during childbirth. Penicillin G is the treatment of choice for GBS infection because of its narrow spectrum. Alternative antibiotics can be prescribed for clients with a penicillin allergy. The drug is usually administered IV at least 4 hours before birth so that it can reach adequate levels in the serum and amniotic fluid to reduce the risk of newborn colonization. Close monitoring is required during the administration of IV antibiotics because severe allergic reactions can occur rapidly.

Anaphylactoid syndrome of pregnancy (ASP)

is an unforeseeable, life-threatening complication of childbirth. The etiology of ASP remains an enigmatic, devastating obstetric condition associated with significant maternal and newborn morbidity and mortality. It is a rare and often fatal event characterized by the sudden onset of hypotension, cardiopulmonary collapse, hypoxia, and coagulopathy. Amniotic fluid containing particles of debris (e.g., hair, skin, vernix, or meconium) enters maternal circulation and obstructs the pulmonary vessels, causing respiratory distress and circulatory collapse Prediction and diagnosis of the event are nearly impossible. However, timely recognition and response is critical in saving a woman's life. Although estimates vary, ASP, also called amniotic fluid embolism, occurs in one in 40,000 births with a reported mortality rate reaching 20% despite technologic advances in critical care life support

A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client? -sexual development of the client -whether sex was consensual -options for birth control in the future -knowledge of child development

knowledge of child development The nurse should address the client's knowledge of child development during assessment of the pregnant adolescent client. The nurse need not address the sexual development of the client or whether sex was consensual. This would not be an opportune time to discuss birth control methods to be used after the pregnancy.

A pregnant woman with chronic hypertension comes to the clinic for evaluation. The last several blood pressure readings have been gradually increasing. On today's visit her blood pressure is 166/100 mm Hg. The health care provider prescribes an antihypertensive agent. The nurse anticipates which agent as likely to be prescribed? -hydroxychloroquine -labetalol -albuterol -ipratropium

labetalol Medications used to treat chronic hypertension with pregnancy include labetalol hydrochloride, hydralazine hydrochloride, and nifedipine. Hydroxychloroquine would be used to treat rheumatoid arthritis. Albuterol and ipratropium would be used to treat asthma.

Which measure would the nurse include in the plan of care for a woman with prelabor rupture of membranes if her fetus's lungs are mature? -reduction in physical activity level -observation for signs of infection -administration of corticosteroids -labor induction

labor induction With prelabor rupture of membranes (PROM) in a woman whose fetus has mature lungs, induction of labor is initiated. Reducing physical activity, observing for signs of infection, and giving corticosteroids may be used for the woman with PROM when the fetal lungs are immature.

serum magnesium levels

levels ranging from 4 to 7 mEq/L are considered therapeutic, while levels more than 8 mEq/dL are generally considered toxic. As levels increase, the woman is at risk for severe problems: 10 mEq/L: Possible loss of DTRs 15 mEq/L: Possible respiratory depression 25 mEq/L: Possible cardiac arrest