SLP- Maternity- pregnancy, labor, and childbirth

A pregnant woman reports nausea and vomiting during the first trimester of pregnancy. The nurse explains that an increase in which hormone is the precipitating cause of the nausea and vomiting?

Chorionic gonadotropin Rationale Chorionic gonadotropin, secreted in large amounts by the placenta during gestation, and the metabolic changes associated with pregnancy can precipitate nausea and vomiting in early pregnancy; usually the manifestations of morning sickness disappear after the first trimester. Estrogen and progesterone are increased throughout pregnancy, but neither is the cause of the nausea and vomiting. Luteinizing hormone is present only during ovulation.

A 36-year-old primigravida is receiving treatment for preeclampsia at 29 weeks' gestation. In light of the latest information on the client's record, which nursing intervention is of the highest importance at this time?

Notifying the primary healthcare provider regarding the epigastric pain, headache, and blurred vision Epigastric pain, blurred vision, and headache are prodromal symptoms of eclampsia in a client with preeclampsia. Minimal urine output in 8 hours would be 240, or 30 mL/hr. The risk for a tonic-clonic seizure increases dramatically, and death is possible. Because the client is receiving a central nervous system depressant, it is more likely that the fetal heart rate will be decreased. The client is usually on nothing-by-mouth status during magnesium sulfate administration, particularly with unstable clinical findings, because of the possible need for an emergency cesarean birth. Although it is important to monitor the client's respirations and to ensure that calcium gluconate (magnesium sulfate antagonist) is available, neither is the priority in a life-threatening situation.

A primipara gives birth to an infant weighing 9 lb 15 oz (4508 g). During labor a midline episiotomy is performed and the client sustains a third-degree laceration. The client tells the nurse that her perineal area is very painful. What is the physiological finding that is the cause of this pain?

The anal sphincter muscle has been injured. A third-degree laceration extends through the perineal muscles and continues through the anal sphincter muscle. Cutting of the perineal muscles constitutes a second-degree laceration. Trauma to the rectum constitutes a fourth-degree laceration. Damage to superficial muscles is a first-degree laceration.

A 42-year-old client at 39 weeks' gestation has a reactive nonstress test (NST). What should the nurse explain to the client about the positive result?

This is the desired response at this stage of gestation. An NST indicates that the fetus is healthy because there is an active pattern of fetal heart rate acceleration with movement. The result is positive and desired; immediate birth is not required. Further testing is needed. If the pregnancy continues, another test of fetal well-being will probably be done. The results were positive, not inconclusive.

The nurse instructs a multipara who has just given birth to a large-for-gestational-age (LGA) infant how best to maintain a contracted uterus. Which statement indicates to the nurse that the teaching was effective?

"I'll massage my uterus regularly to keep it firm." The uterus responds rapidly to touch, and the mother may be involved in her own care. The uterus must be massaged before there are signs of bleeding. Although frequent urination may be beneficial, the client should be taught to massage the uterus to cause it to contract. Stating that she will call every 15 minutes to have her uterus massaged does not actively involve the mother in her own care and could be unsafe if the uterus becomes boggy during the 15-minute intervals.

A client at 40 weeks' gestation is admitted to the birthing unit, and an amniotomy is performed to facilitate labor. Once the nurse determines that the umbilical cord has not prolapsed, what is her next action?

Assessing the fetal heart rate Once cord prolapse and consequent cord compression have been ruled out, it is imperative to evaluate the effect of the amniotomy on the fetus. Obtaining the maternal vital signs is not the priority; it can be done later. Although turning the client on her left side is important, fetal well-being is the priority concern. There are no data to indicate that contractions have started.

The nurse is caring for a client in transitioning labor and notes an early deceleration on the fetal heart monitor. Which nursing intervention would be most appropriate at this time?

Continuing to monitor fetal heart rate (FHR) tracing Early FHR decelerations, with onset before the peak of the contraction and low point at the peak of the contraction, are due to fetal head compression. This is a normal finding during the transition stage of labor as the head descends.

The nurse explains the purpose of a nonstress test to a pregnant client who is at 39 weeks' gestation. This test is a way of evaluating the condition of the fetus by comparing the fetal heart rate with what?

Fetal movement In a healthy, well-oxygenated fetus the heart rate increases with fetal movement; there should be an acceleration of 15 beats with fetal movement. Fetal lie and maternal blood pressure are not a part of the evaluation of the fetus in the nonstress test. Maternal uterine contractions are used in the contraction stress test.

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease for what reason?

Morning sickness may result in decreased food intake. Morning sickness, a common occurrence during pregnancy, contributes to decreased food intake; the insulin dosage must be reduced to prevent hypoglycemia. The body's metabolism increases during pregnancy, because the needs of the fetus, as well as those of the mother, must be met. Rapid organogenesis requires large amounts of glucose. During the first trimester the blood glucose level is reduced and glycemic control is enhanced; glycemic control is more difficult to maintain later in the pregnancy.

Which client should the nurse identify as being at the greatest risk for a hypertensive disorder of pregnancy?

Obese primigravida A first pregnancy and obesity are both documented risk factors for hypertensive disorders of pregnancy. The risk for a hypertensive disorder of pregnancy increases when the client is younger than 20 years of age or older than 35 years of age. Grand multipara status and oral contraceptive use during the first 3 months of pregnancy are not known risk factors.

A client is admitted to the emergency department at 34 weeks' gestation with trauma and significant bleeding from the leg. What is the priority intervention after determining fetal well-being?

Placing the client in a left lateral position The left lateral position will increase placental perfusion, which may be compromised because of the significant bleeding. Obtaining the client's vital signs is not the priority. Although providing emotional support and drawing the client's blood for laboratory screening are both important, preventing fetal and maternal compromise is the priority.

The nurse is developing a care plan for a client with postpartum psychosis. Which priority intervention should the nurse implement?

Referring the client to a psychiatric healthcare provider as prescribed Assessment and management of postpartum psychosis are beyond the scope of a maternity nurse. A mother who experiences this condition must be referred to a specialist for comprehensive therapy. Women with signs of postpartum psychosis need immediate medical attention to prevent suicide or infanticide. In light of this psychiatric emergency condition it would not be appropriate to plan bonding time for the client and infant, teach her about normal newborn care, or allow expression of her feelings.