EAQ 2 Maternity & Women's Health Pregnancy, Labor, Children
A nurse performs Leopold's maneuvers on a newly admitted client in labor. Palpation reveals a soft, firm mass in the fundus; a firm, smooth mass on the mother's left side; several knobs and protrusions on the mother's right side; and a hard, round, movable mass in the pubic area with the brow on the right. On the basis of these findings, the nurse determines that the fetal position is: 1 LOA 2 ROA 3 LMP 4 RMP
1 LOA The fetus is in a left occiput anterior (LOA) position because the buttock (firm mass) is in the fundus, the back is on the left, the small parts are on the right, and the head is flexed, indicating an anterior occiput. The right occiput anterior (ROA) position is indicated by the presence of the back on the right side and the cephalic prominence on the left side; the occiput is anterior. The left mentum posterior (LMP) position is marked by cephalic prominence and the back on the same side, indicating an extended head and chin presentation. In the right mentum posterior (LMP) position, the back and cephalic prominence are on the same side (right), indicating an extended head and chin presentation.
A woman's pregnancy has been uneventful, and she has gained 25 lb. At term her hemoglobin level is 10.6 g/dL and her hematocrit is 31%. What does the nurse identify as the reason for these hemoglobin and hematocrit levels? 1 Infection 2 Hemodilution 3 Nutritional deficits 4 Concealed bleeding
2 Hemodilution Infection does not lead to a lower hematocrit. The increase in circulating blood volume during pregnancy is reflected in lower hemoglobin and hematocrit readings (physiological anemia of pregnancy). The history reveals no prenatal problems, and weight gain is adequate. In the absence of other significant signs and symptoms, concealed bleeding is unlikely.
A client arrives in the birthing room with the fetal caput emerging. What should the nurse say to the client during a contraction? 1 "Push hard." 2 "Hold your breath." 3 "Take slow, deep breaths." 4 "Use the panting-breathing pattern."
4 "Use the panting-breathing pattern." Panting will slow the birthing process, allowing the nurse to support the head as it emerges. Pushing will speed up the birth, which may injure the mother and fetus. Usually holding the breath causes involuntary pushing; it also depletes the mother and fetus of oxygen. This breathing technique is helpful when active labor begins; it is impossible to maintain during a second-stage labor contraction.
A client is receiving an epidural anesthetic during labor. For which side effect should the nurse monitor the client? 1 Hypertension 2 Urine retention 3 Subnormal temperature 4 Decreased level of consciousness
Correct2 Urine retention Anesthesia blocks the sensory pathways; therefore the mother does not sense bladder distention and may be unable to void. Hypotension, not hypertension, is a side effect of epidural anesthesia. An epidural anesthetic does not influence body temperature. A decreased level of consciousness occurs with general anesthesia, not epidural anesthesia; general anesthesia is used when there is an emergency.
During a prenatal visit a client who is at 36 weeks' gestation states that she is having uncomfortable irregular contractions. How should the nurse respond? 1 "Lie down until they stop." 2 "Walk around until they subside." 3 "Time the contractions for 30 minutes." 4 "Take 2 extra-strength aspirin if the discomfort persists."
walk around until they subside
During labor the nurse encourages the client to void periodically. The nurse knows that an over distended urinary bladder during labor can: 1 Predispose the client to uterine hemorrhage after birth 2 Interfere with the assessment of cervical dilation 3 Prevent the diagnosis of cephalopelvic disproportion 4 Delay expulsion of the placenta after the birth of the neonate
1 Predispose the client to uterine hemorrhage after birth An overdistended urinary bladder prevents the uterus from contracting after birth; contraction of the uterus constricts blood vessels, preventing hemorrhage. A digital examination to assess vaginal dilation does not require an empty urinary bladder to be accurate. An overdistended urinary bladder may impede descent but does not interfere with this diagnosis. Delaying expulsion of the placenta does not interfere with the third stage of labor.
What complication should a nurse be alert for in a client receiving an oxytocin (Pitocin) infusion to induce labor? 1 Intense pain 2 Uterine tetany 3 Hypoglycemia 4 Umbilical cord prolapse
2 Uterine tetany Because oxytocin (Pitocin) promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion must be stopped to prevent uterine rupture and fetal compromise. Intense pain can be associated with strong uterine contractions; this is not a complication. Hypoglycemia is unrelated to uterine contractions. Umbilical cord prolapse is not likely to occur when induction of labor is initiated.
What findings occur with supine hypotensive syndrome? (Select all that apply.) 1 Reflex tachycardia Correct2 Feeling of faintness 3 Increased cardiac output Correct4 Increased venous pressure 5 Increased diastolic pressure Correct6 Decreased systolic pressure
2 Feeling of faintness 4 Increased venous pressure 6 Decreased systolic pressure Compression of the vena cava hinders venous return, which in turn results in a decrease in the systolic pressure, an increase of venous pressure in the legs, and decreased blood flow to the brain, causing the woman to feel faint. Blood pressure decreases when venous return is compromised. Supine hypotensive syndrome results in a reflex bradycardia. Cardiac output is decreased by half.
While caring for a client in labor, a nurse notes that during a contraction there is a 15-beat/min acceleration of the fetal heart rate above the baseline. What is the nurse's next action? 1 Call the practitioner to prepare for an imminent birth 2 Turn the mother on her left side to increase venous return 3 Record the fetal response to contractions and continue to monitor the heart rate 4 Document the fetal heart rate abnormality and monitor the fetal heart rate continuously
3 Record the fetal response to contractions and continue to monitor the heart rate Periodic accelerations are the most reassuring of fetal heart rate indicators, regardless of the cause. This increase in the fetal heart rate does not require intervention at this time. Turning the mother on her left side to increase venous return is done when a fetal heart rate deceleration occurs. This is not a fetal heart rate abnormality and does not require a specific amount of time for observation; if the interventions are effective, monitoring should continue as before.
A client in labor is receiving an oxytocin (Pitocin) infusion. For which adverse reaction resulting from prolonged administration should the nurse monitor the client? 1 Change in affect 2 Hyperventilation 3 Water intoxication 4 Increased temperature
3 Water intoxication Oxytocin (Pitocin) has an antidiuretic effect, acting to reabsorb water from the glomerular filtrate. Oxytocin does not alter the client's affect. Hyperventilation is caused by an inappropriate breathing pattern, not prolonged use of oxytocin. Fever occurs with infection or dehydration, not prolonged administration of oxytocin.
A 24-year-old client who has been told that she is pregnant is at her first prenatal visit. She is 5 feet 6 inches tall and weighs 130 lb. What should the nutrition plan regarding her daily caloric intake include? 1 100 more calories during the first trimester 2 540 more calories during the third trimester 3 300 more calories during the three trimesters 4 340 more calories during the second trimester
4 340 more calories during the second trimester An extra 340 calories per day during the second trimester is the recommended caloric increase for adult women who are of average weight; this increase will meet the nutritional needs of both fetus and mother during the second trimester. The caloric intake during the first trimester should be about the same as in the nonpregnant state. The increase in caloric intake should be about 460 calories in the third trimester. Caloric needs, as well as caloric intake, vary from trimester to trimester, depending on fetal/maternal energy needs.
A postpartum client is being prepared for discharge. The laboratory report indicates that she has a white blood cell (WBC) count of 16,000/dL. What is the next nursing action? 1 Checking with the nurse manager to see whether the client may go home 2 Reassessing the client for signs of infection by taking her vital signs 3 Delaying the client's discharge until the practitioner has conducted a complete examination 4 Placing the report in the client's record because this is an expected postpartum finding
4 Placing the report in the client's record because this is an expected postpartum finding Leukocytosis (15,000-20,000 mm3 WBC) typically occurs during the postpartum period as a compensatory defense mechanism. There is no need for further intervention, because the client is exhibiting an expected postpartum leukocytosis.
