hurst maternity questions
What is the priority nursing action for a pregnant client who has dilated to 6 centimeters while receiving an epidural? 1. Continuous monitoring of maternal blood pressure. 2. Frequent auscultation of the fetal heart rate. 3. Administer an IV fluid bolus of at least 500 mL. 4. Frequent monitoring of the maternal temperature.
1. Correct: Decreased blood pressure is dangerous to both the laboring mother and fetus because of the decrease in cardiac output and placental perfusion. The most common negative side effect of epidural anesthesia is a precipitous drop in blood pressure. 2. Incorrect: The fetal heart rate should be continuously monitored, but with an epidural, the first priority is maternal circulation. 3. Incorrect: Even though an IV fluid bolus may prevent hypotension, it should be administered before the epidural placement. 4. Incorrect: We are not worried about infection at this time.
The nurse is caring for a client that is undergoing an induction for fetal demise at 34 weeks. Immediately after delivery the mother asks to see the infant. What is the nurse's best response? 1. Bring the swaddled baby to the mother. 2. Explain that the cause of death must be determined before she can see the baby. 3. Ask her if she is sure she wants to see the baby. 4. Tell her it would be better to wait until she is in her room before she sees the baby.
1. Correct: Let the grieving mother see the infant to continue the grieving process. The mother has the right to make her own decision. 2. Incorrect: This is an untrue statement. In some cases, the cause may never be found. 3. Incorrect: This is non-therapeutic and implies that the nurse disagrees with the mother's decision to see the infant. 4. Incorrect: This is non-therapeutic and delays the mother's request. This response may also cause additional fear and anxiety.
All of the beds in a 10 bed Labor, Delivery, Recovery, Postpartum Unit (LDRP) are full when one of the nurses assigned that day calls in sick. A nurse from the Med surg unit is transferred to the LDRP unit. Which client should the charge nurse assign to this nurse? 1. Client at 32 weeks gestation on oral terbutaline with 4 contractions/hour. 2. One hour postpartum client with a continuous trickle of vaginal bleeding. 3. 2 hours postpartum client reporting intense perineal pain. 4. Client at 36 weeks gestation with a blood pressure of 148/92.
1. Correct: This client is at lowest risk for complications. She is having infrequent contractions and is not at high risk for preterm delivery. She is also receiving an oral tocolytic, terbutaline. Tocolytic agents are used to inhibit uterine contractions and suppress preterm labor. The medical surgical nurse should be able to safely provide care for this client. 2. Incorrect: Continuous vaginal bleeding (even a trickle) with a firm fundus indicates excessive bleeding and is suggestive of lacerations of the vagina, cervix or perineum. This client needs the assessment skills and nursing care of a trained LDRP nurse. The medical surgical nurse may not have the specialized assessment skills and knowledge needed to appropriately care for this client. 3. Incorrect: Intense perineal pain is a symptom of a genital tract hematoma. A client can lose 500 mL of blood into the perineal tissues in a very short period of time. Immediate intervention is also needed for this client. Small hematomas may be managed with ice packs and close observation. However, clients with enlarging hematomas may have to return to surgery for incision and removal of the clot. This client would need a trained LDRP nurse for close monitoring and care. This would not be a client to assign to the medical surgical nurse. 4. Incorrect: This client's blood pressure indicates the presence of a complication known as pregnancy induced hypertension (PIH). This condition is characterized by high blood pressure during pregnancy which can lead to a serious condition known as preeclampsia. Protein will be found in the urine. If not treated, serious complications for the mother and fetus can develop. This client would need the specialized care of the LDRP nurse.
Which client should the nurse assign to a room closest to the nurse's station? 1. A multigravida admitted with a new diagnosis of gestational diabetes 2. A primigravida admitted with a diagnosis of placenta previa 3. A primigravida admitted with a diagnosis of complete abortion 4. A pregestational diabetic admitted for glycemic control
2. Correct: A client with a diagnosis of placenta previa is at high risk for bleeding and must be monitored closely. Placenta previa is a complication of pregnancy in which the placenta is either partially or wholly inserted in the lower uterine wall and blocks the cervix. It is the leading cause of antepartum hemorrhage. Clients with this complication will have to have a C-section to prevent harm to the mother and fetus from bleeding. 1. Incorrect: This client's primary needs are monitoring and education. While important to educate this client to ensure the health of the mother and fetus, this does not take priority over monitoring a client that is at risk for hemorrhage. 3. Incorrect: All the products of conception are expelled with a complete abortion, and she is at low risk for hemorrhage. 4. Incorrect: This client's primary needs are monitoring and education and are not priority over a client that is at risk for hemorrhage.
The nurse is working in the term nursery. Which task should be performed first on a newborn? 1. Prepare the circumcision equipment for a two day old newborn. 2. Assess the five minute APGAR of a newborn. 3. Perform the gestational age assessment on a 30 minute old newborn. 4. Obtain a blood sample for metabolic testing on a 24 hour old newborn.
2. Correct: The APGAR is done to determine whether a newborn needs help breathing or is having heart trouble. It looks at the newborn's breathing effort, HR, muscle tone, reflexes, and skin color and is the most important initial assessment for a newborn. 1. Incorrect: This task is not emergent and can be performed later at an appropriate time. 3. Incorrect: This task is not emergent and can be performed later at anytime during the transition stage of the newborn's nursery care. 4. Incorrect: This task is not emergent and can be performed at anytime between 24 hours and 7 days old. Typically it is done before the newborn is discharged home.
Which lab value on a client who is one day postpartum should the nurse report to the primary healthcare provider immediately? 1. Hemoglobin of 11 g/dL (110 g/L) (6.8266 mmol/L) 2. White Blood Cell count of 22,000 mm3 3. Hematocrit of 18% 4. Serum glucose of 80 mg/dL (4.44 mmol/L)
3. Correct: A hematocrit in postpartum women can drop as low as 20% (0.2) and not require transfusion in the absence of symptoms of hypovolemia. A hematocrit of 18% and lower should be reported even in the absence of dizziness, lightheadedness, shortness of breath with exertion, and syncope. 1. Incorrect: A hemoglobin of 11 g/dl (110 g/L) (6.8266 mmol/L) is considered to be normal for pregnancy and postpartum. 2. Incorrect: It is not unusual for a postpartum woman to have a WBC up to 25,000 mm3 without infection because of the healing process of the reproductive system. 4. Incorrect: Serum glucose of 80 m/dL (4.44 mmol/L) is within the normal range of glycemic control.
The labor nurse is assessing a client admitted in preterm labor. Which client finding would require a social service consult? 1. Very quiet and avoids eye contact. 2. Reports that she is not married. 3. Has injuries in various stages of healing. 4. Reports frequent arguments with her partner.
3. Correct: Injuries in various stages of healing indicate a pattern of abuse. Abuse not only harms the mother, but also increases the risk of fetal harm or death and preterm delivery. 1. Incorrect: While these signs may indicate abuse, cultural differences may explain her demeanor. 2. Incorrect: Single parenthood is not an indicator for referral to social services. 4. Incorrect: Frequent arguments with her partner are not an indicator for referral to social services. This could also be from other stressors in the client's life, emotional mood swings from hormone changes, or other factors unrelated to the pregnancy.
A primigravida client at 35 weeks gestation has been diagnosed with human papillomavirus (HPV). The nurse knows that the most important information to discuss with this client is what? 1. The infant will not be able to breast feed. 2. The mother will need frequent follow up Pap smears. 3. The fetus will need to be delivered by C-section. 4. The mother must start metronidazole immediately.
2. Correct: HPV is a sexually transmitted viral infection that can cause genital warts or even precancerous lesions. This virus is spread by direct contact with infected mucous membranes and is transmitted through sexual contact. Although HPV generally clears itself through the human immune system, clients diagnosed with this infection are recommended to have a follow-up Pap smear every six months for the first year, particularly if infected with HPV 16 or HPV 18. 1. Incorrect: The risk of transmitting HPV in breast milk is extremely minimal. Research has shown that the miniscule amounts of HPV which could be transmitted do not outweigh the benefits of allowing the infant to breastfeed. 3. Incorrect: The chance of transmitting HPV during vaginal birth is small. Even in the presence of non-cancerous genital warts, the greatest concern is whether the birth canal is blocked by these growths. The existence of warts does not mean the client will automatically need a cesarean section. 4. Incorrect: The primary healthcare provider will treat the mother and all sexual partners for the HPV, usually with a medication such as metronidazole. However, this information is not the most important topic for the nurse to discuss with the client at this time.
A primagravida asks the nurse about the purpose of the RhoGam injection. What would be the best explanation by the nurse? 1. RhoGam changes the RH positive fetus to Rh negative. 2. RhoGam prevents the mother from forming Rh antibodies. 3. RhoGam inhibits Rh antibodies in the newborn infant. 4. RhoGam destroys antibodies in the RH positive mother.
2. Correct: RhoGam is an immunoglobulin given via injection to an Rh negative mother following the birth of an Rh positive infant. The mixing of mother and fetal blood during birth causes the mother to develop antibodies which can be fatal to the next fetus. RhoGam prevents the formation of these antibodies in the mother. 1. Incorrect: RhoGam has no effect on the Rh factor in the fetus. RhoGam is administered to the mother and does not alter the Rh factor at all. RhoGam works to prevent antibody formation in the mother. 3. Incorrect: RhoGam is never given to an infant because the fetus does not form RH antibodies. Only the mother will form antibodies. 4. Incorrect: RhoGam does not "destroy" antibodies; rather, it prevents the actual formation of antibodies in the mother. Also, RhoGam is only given to Rh negative mothers.
A female client considers using spermicidal agents because she wants both birth control and protection from sexually transmitted infections (STIs). What information should the nurse provide the client about spermicidal agents? 1. Effectively reduces vaginal fungal infections such as Candida albicans. 2. Eliminates bacterial and viral sexually transmitted infections. 3. Most effective when used in conjunction with barrier methods, such as a diaphragm. 4. Causes few side effects.
3. Correct: Spermicidal agents have an approximately 25% failure rate in preventing pregnancy. These agents kill sperm by destroying the protective surface of sperm and preventing metabolic activities necessary for survival. 1. Incorrect: They do not kill fungi such as Candida albicans, even in high concentrations. 4. Incorrect: Spermicidal agents are used only when sexual intercourse is expected, but side effects include vaginal and penile irritation, lesions, and ulcerations due to the detergent effect. Disruption of normal protective vaginal flora results in an increased risk of opportunistic vaginal infections and urinary tract infections. 2. Incorrect: Spermicidal agents do not eliminate bacterial and viral STIs.
After artificial rupture of membranes (AROM), the baseline fetal heart rate tracking begins to show sharp decreases with a rapid recovery with and between contractions. Which of the following actions by the RN has priority? 1. Position the client on her left side 2. Increase the IV fluid rate 3. Place the client in the knee-chest position 4. Administer oxygen per tight face mask
3. Correct: The fetal heart pattern is that of repetitive deep variable decelerations. This pattern is likely due to a prolapsed umbilical cord after AROM. The priority intervention is to relieve the pressure on the cord from being trapped between the presenting part and the pelvis. This can be accomplished by manual pressure on the presenting part, placing the client in Trendelenburg position, or placing her in the knee-chest position. 1. Incorrect: This intervention will improve placental perfusion, but will not relieve compression of a prolapsed cord. If the cord is compressed, it doesn't matter how well perfused the placenta is because the oxygen cannot reach the baby. Late decels and low BP would be an indicator that we need to increase uterine perfusion by positioning on left side. 2. Incorrect: This intervention will not improve placental perfusion. IV fluids will not relieve compression of a prolapsed cord. 4. Incorrect: This intervention will improve placental perfusion, but will not relieve compression of a prolapsed cord. If the cord is compressed, it doesn't matter how well perfused the placenta is because the oxygen cannot reach the baby.
The lactation consultant is preparing to make rounds on the breastfeeding clients on the Labor, Delivery, Recovery, Postpartum (LDRP). Which client should the consultant see first? 1. The mother who is nursing her newborn every 2-3 hours for 15-20 minutes at a time. 2. The mother who stated that her newborn sucks in short bursts and has audible swallowing. 3. The mother who reported blisters on her nipples and pain whenever the newborn latches on. 4. The mother who stated that her baby was so good that she has to wake him for each feeding.
4. Correct: A baby who is so sleepy that he doesn't wake on his own for feeding is at high risk for dehydration and malnourishment. This newborn needs further evaluation and close monitoring to prevent serious complications. 1. Incorrect: This is a normal finding for a breastfeeding mother and is not the priority concern for the consultant. 2. Incorrect: This is a normal finding for a breastfeeding mother and is not the priority concern for the consultant. 3. Incorrect: Blisters and pain are concerns that need to be assessed, but the sleepy baby situation has first priority. This would be the next client for the consultant to see, but not the first.
The nurse is caring for a client with hyperemesis gravidarum. What electrolyte imbalance is most likely? 1. Hypocalcemia 2. Hypomagnesemia 3. Hyponatremia 4. Hypokalemia
4. Correct: Hyperemesis gravidarum is characterized by persistent severe pregnancy related nausea and vomiting. There is a large amount of potassium in the upper GI tract. A client with prolonged vomiting will lose potassium in the emesis. Additionally, the client is unable to replace the lost potassium due to the persistent nausea and vomiting. 1. Incorrect: Hypocalcemia results from any condition that causes a decrease in the production of parathyroid hormone (PTH). Hyperemesis gravidarum does not affect PTH. 2. Incorrect: The lower GI tract has a lot of magnesium; this client is at risk for hypomagnesemia, but not more than hypokalemia. The client with hyperemesis gravidarum is losing upper GI contents. 3. Incorrect: The client with hyperemesis gravidarum is at high risk for being dehydrated. The electrolyte imbalance associated with dehydration is hypernatremia, not hyponatremia. Remember, this client's blood will be concentrated, and concentrated makes numbers go up i.e. sodium, hematocrit and specific gravity.
A postpartum client who is 2 hours post vaginal delivery remains on a oxytocin infusion for bleeding. Upon examination, the nurse determines that the client's fundus is boggy and soft. What is the priority nursing intervention? 1. Ambulate in the room 2. Perform crede' exercises 3. Reassess the fundus in 30 minutes. 4. Massage the fundus.
4. Correct: If the fundus is boggy and soft, massaging the fundus until firm will increase uterine tone and decrease bleeding. This is the only option that will fix the problem. 1. Incorrect: Ambulation will not fix a boggy fundus and would not be safe. 2. Incorrect: Crede' exercises are for bladder tone. Although urinary retention will prevent uterine contraction, the appropriate nursing intervention in the case of a full bladder is to have the client empty her bladder or to catheterize her if she is unable to void. 3. Incorrect: Postponing care could make the bleeding worse. This is delaying care.
A term primipara is admitted in active labor and with rupture of membranes. Her last vaginal exam one hour ago revealed that she was dilated to 6 centimeters, 100% effaced, and at -1 station. The client calls out "My belly really hurts. I feel like I have to have a bowel movement!" Which action should the nurse perform first? 1. Offer her a bedpan. 2. Call the primary healthcare provider. 3. Prepare for epidural administration. 4. Perform a sterile vaginal exam.
4. Correct: Labor can progress rapidly even in a primipara. As the fetal presenting part descends, pressure is placed on the rectum and many women report that it feels as though they need to have a bowel movement. The symptoms described indicate that the client has fully dilated and is at +1 or better station, and delivery may be imminent. 1. Incorrect: The nurse should first determine labor progress with a vaginal exam since this complaint is a common symptom of labor progressing and the fetus descending through the birth canal. Often, the client has had an enema to cleanse the colon prior to delivery so there usually is no fecal material present. 2. Incorrect: First determine labor progress with a vaginal exam. This might be necessary later, but is not the first action to perform. 3. Incorrect: First determine labor progress with a vaginal exam prior to preparing the client for anesthesia.
What room assignment would be best for the nurse to make for a primigravida with gestational diabetes who was admitted for glycemic control? 1. A private room near the nurses' station. 2. A room with a client admitted with a placenta previa. 3. A room with a client in preterm labor. 4. A room with a client admitted with pregestational diabetes.
4. Correct: Placing clients with similar diagnoses together can result in information sharing and emotional support. It is ok to put these two clients together. 1. Incorrect: A private room is not required since the client has no emotional or infection control issues. Also, it is not necessary to place them near the nursing station because they do not need monitoring on that close of a level. 2. Incorrect: A client with placenta previa is in an unstable state and can have emotional issues concerning this diagnosis. The client would be best in a private room. 3. Incorrect: The client in preterm labor needs a private room that is quiet with limited visitors, she is having issues herself and concerned about her unborn child.
The nurse is caring for a client in the 8th week of pregnancy. The client is spotting, has a rigid abdomen and is on bedrest. What is the most important assessment at this time? 1. Protein in the urine 2. Fetal heart tones 3. Cervical dilation 4. Hemoglobin and hematocrit levels
4. Correct: The client may be bleeding, and that is an emergency! Common causes of hemorrhage during the first half of pregnancy include abortion and ectopic pregnancy. Ectopic pregnancy is a significant cause of maternal death from hemorrhage and the classic signs of ectopic pregnancy include positive pregnancy test, abdominal pain and vaginal "spotting". Remember that in the ruptured ectopic pregnancy, bleeding may be concealed and severe pain could be the only symptom. 1. Incorrect: Protein in the urine indicates preeclampsia, which is a condition in which hypertension develops during the last half of pregnancy. 2. Incorrect: We can't hear them yet because the client is just 8 weeks pregnant. It may be possible to detect heart beat with a Doppler transducer at 10 weeks, but this client is only in the eighth week of pregnancy. 3. Incorrect: A vaginal exam may stimulate heavier bleeding and will not provide information about concealed bleeding. A transvaginal ultrasound will be performed to determine whether a fetus is present and if so, whether it is alive.
The nurse is having an education class for pregnant women. A question is raised about exercise. What is the nurse's best response? 1. Discuss with healthcare provider your current exercise regimen and history. 2. You can continue any exercise that you have been doing before pregnancy. 3. If you haven't already started an exercise program, you should wait until after delivery. 4. Exercise is required during pregnancy for a minimum of 15 minutes each day.
1. Correct: Best advice for pregnant women. The healthcare provider can individualize according to the physical condition of the woman and the stage of pregnancy. 2. Incorrect: As pregnancy progresses, the exercise program may need modification because the change in the woman's center of gravity makes her more prone to falls. Therefore, an activity that is safe in the first trimester may not be safe in the third trimester. Those women who have been exercising strenuously before pregnancy should consult the healthcare provider but may be able to continue much of their usual routine. Recreational sports generally can be continued if no risk of falling or abdominal trauma exists. 3. Incorrect: Exercise during pregnancy is generally beneficial and can strengthen muscles, reduce backache, reduce stress and provide a feeling of well-being. The amount and type of exercise recommended depend on the physical condition of the woman and the stage of pregnancy. 4. Incorrect: Women who have no medical or obstetric complications should exercise in moderation each day for 30 minutes or more during pregnancy.
A client comes into the emergency department (ED) with intense abdominal pain. The nurse completes a physical assessment and evaluates the vital signs and lab work. Based on the information gathered, the nurse expects which diagnostic test will be priority? 1. Transvaginal ultrasound 2. Esophagogastroduodenoscopy (EGD) 3. CAT Scan of the abdomen 4. KUB (Kidney, Ureter, and Bladder) ** 16 year old female admitted to treatment room 3, reporting "intense abdominal pain" at 10/10. States, "pain started 3 days ago, but got worse this morning". Confirms no injury to abdominal area. Rigid, board-like abdomen noted. Last menstrual cycle "6 weeks ago." Temperature - 100 degrees F (37.77 degrees C) Heart rate - 110/min Respirations - 28/min Blood Pressure - 90/62 Hemoglobin - 10 grams/dL (100 grams/L) Hematocrit - 32% (0.32) serum hcg - 27 mIU/mL
1. Correct: The serum hCG indicates that the client is pregnant. The Hgb and Hct along with a BP of 90/62, and a rigid board like abdomen indicates bleeding in the peritoneum. Intense pain at 10/10 without injury can lead the nurse to thinking tubal pregnancy. How do determine if the client has a tubal pregnancy? With an ultrasound. A transvaginal ultrasound is a type of pelvic ultrasound used to examine the uterus, fallopian tubes, ovaries, cervix, and vagina. 2. Incorrect: No, an EGD looks into the stomach and small intestine. All clues lead to tubal pregnancy. 3. Incorrect: No, tubal pregnancy can be seen quickly by ultrasound. 4. Incorrect: Kidney, Ureter, and Bladder-general picture of the abdomen-less specific than the Ultrasound. The focus is not on the fallopian tubes.
