Maternity & Perinatal EAQ
Which intervention would the nurse initiate when a fetal heart pattern signifying uteroplacental insufficiency occurs? 1 Inserting a urinary catheter 2 Administering oxygen by means of nasal cannula 3 Helping the client turn to the side-lying position 4 Encouraging the client to pant with her next contraction
3 Helping the client turn to the side-lying position Assisting the client to turn to the side-lying position will improve uterine blood flow, and fetal oxygenation will increase. Inserting a urinary catheter is unnecessary; in addition, it requires a primary health care provider's prescription. Oxygen may be administered eventually if necessary, but this is not the first intervention. Encouraging the client to pant with her next contraction will not increase uterine blood flow or oxygen to the fetus.
The nurse would anticipate preparing to administer which prescribed medication to a client who is 30 weeks pregnant, reports low backache and abdominal cramps, and is suspected of having preterm labor? 1 Mifepristone 2 Methylergonovine 3 Calcium gluconate 4 Magnesium sulfate
4 Magnesium sulfate Low backache and abdominal cramps in a pregnant woman may indicate labor; however, labor pains may not be safe if the gestation is not at full term. Magnesium sulfate may be prescribed to prevent preterm labor. Mifepristone may cause an elective termination of pregnancy. Methylergonovine is prescribed to reduce postpartum uterine hemorrhage. Calcium gluconate may be prescribed to reverse magnesium toxicity.
The nurse reviews the laboratory data of four active labor clients. The nurse would anticipate administering Rho (D) immune globulin to the client with which laboratory values after delivery? 1 Rh positive and Coombs positive 2 Rh negative and Coombs positive 3 Rh positive and Coombs negative 4 Rh negative and Coombs negative
4 Rh negative and Coombs negative Rho(D) immune globulin is given to an Rh-negative mother after birth if the infant is Rh positive and the Coombs test reveals that the mother was not previously sensitized (negative). An Rh-positive mother will not develop antibodies to a fetus who is either Rh positive or Rh negative; therefore the Coombs test is not performed. A positive Coombs test result in an Rh-negative mother indicates that the mother has Rh-positive antibodies; Rho(D) immune globulin is not given because it will not be effective.
A laboring primigravida at 7 cm of dilation is administered a prescribed pain medication. Which medication administered requires monitoring of the newborn for respiratory depression? 1 Butorphanol 2 Hydroxyzine 3 Promethazine 4 Diphenhydramine
1 Butorphanol Respiratory depression may occur in the newborn because the duration of action of butorphanol is 3 to 4 hours and the circulating blood level will be high if birth occurs during that time. Hydroxyzine, promethazine, and diphenhydramine are all antihistamines that have a sedative effect and are administered early in labor to promote sleep and decrease anxiety.
Which physiological change in the medication metabolism would the nurse expect in a pregnant client receiving antiepileptic therapy? 1 The elimination of the medication will increase to 100%. 2 There will be a decreased clearance of the medication. 3 There will be an increased hepatic metabolism. 4 The medication's reabsorption will be decreased.
3 There will be an increased hepatic metabolism. The hepatic metabolism of antiepileptic medications may increase during pregnancy because of an increase in overall circulation volume. The elimination of lithium may be increased by 100%. Renal blood flow may be doubled and can cause an increased clearance of antiepileptic medications. The intestinal transit time may increase during pregnancy and can result in an increased time for reabsorption of the antiepileptic.
The nurse discusses the type of anesthesia that will be used for a vaginal birth with a client who has class I cardiac disease. Which type of block is most appropriate for this client? 1 Spinal 2 Epidural 3 Pudendal 4 Inhalation
2 Epidural Epidural analgesia is used for a client with class I cardiac disease because the client will be comfortable and have minimal stress when forceps or vacuum extraction is used to shorten the second stage of labor. Spinal anesthesia is rarely used for a birth. The anesthetic is injected into the subarachnoid space. Although a pudendal block is adequate, epidural analgesia is more effective because less energy is expended during labor, and it provides more effective pain relief. Inhalation anesthesia is not indicated for a vaginal birth for a client with class I cardiac disease; it may cause respiratory difficulty.
For which clinical situation would the nurse anticipate administering cervical-ripening medications to pregnant women? 1 There is a need for a termination of pregnancy. 2 The cervical status indicates a Bishop score of 6. 3 Uterine contractions occur after 25 weeks of gestation. 4 Uterine contractions occur after 18 weeks of gestation.
2 The cervical status indicates a Bishop score of 6. Cervical-ripening medications are used to soften the cervix and improve uterine muscle tone. The cervical status of a Bishop score of 6 indicates a need for cervical-ripening medications such as dinoprostone. Contractions that occur within 25 weeks of gestation are called preterm labor. Uterine contractions that occur within 18 weeks of pregnancy are due to the presence of a nonviable fetus. Cervical-ripening medications are not issued during the termination of a pregnancy.
Which occurs immediately after birth that increases the risk for cardiac decompensation in a client with a compromised cardiac system? 1 Increased pressure is placed on the veins. 2 Intra-abdominal pressure is significantly increased. 3 The blood flow to the heart is decreased considerably. 4 Extravascular fluid is remobilized into the vascular compartment.
4 Extravascular fluid is remobilized into the vascular compartment. During the immediate period after birth the extravascular fluid is remobilized into the vascular compartment, increasing the client's risk for cardiac decompensation. At the moment of birth, the pressure on the veins is removed, the intra-abdominal pressure decreases dramatically, and the blood flow to the heart is significantly increased.
The nurse will evaluate the client receiving oxytocin for which desired response? 1 Limitation of the discomfort of the episiotomy 2 Relaxation of the uterus so that it may be emptied 3 Stimulation of the client's breasts so that breast-feeding may be started 4 Prevention of the occurrence of profuse bleeding after placental separation
4 Prevention of the occurrence of profuse bleeding after placental separation Oxytocin will cause the uterus to contract after the placenta has been expelled, preventing hemorrhage. Oxytocin does not have an analgesic effect. Relaxation of the uterus is undesirable because it promotes bleeding. Prolactin, not oxytocin, stimulates milk production; oxytocin stimulates the let-down reflex.
A pregnant client with asthma is admitted for induction of labor. Which medication would the nurse question when performing a medication reconciliation during the admission process? 1 Albuterol inhaler 2 Epidural anesthesia 3 Intravenous D5W with piggyback oxytocin 4 Prostaglandin E2 vaginal suppository
4 Prostaglandin E2 vaginal suppository One side effect of prostaglandin E2 is bronchoconstriction, which may cause a bronchospasm in a client with asthma. An albuterol inhaler may be used as needed. Epidural anesthesia is not contraindicated for pregnant clients with asthma. Intravenous D5W with piggyback oxytocin is not contraindicated for a pregnant client with asthma.
Cramping and vaginal spotting occurring at 12 weeks' gestation in conjunction with a closed cervix is characteristic of which problem? 1 Missed abortion 2 Inevitable abortion 3 Incomplete abortion 4 Threatened abortion
4 Threatened abortion Because the cervix is closed, this is considered a threatened abortion. The lifeless products of conception are retained in a missed abortion. Once the cervix is dilated abortion is inevitable. Portions of the products of conception will have to be passed for a diagnosis of incomplete abortion.
Which postpartum client would the nurse assess first? 1 Client who vaginally delivered a 7-lb (3175 g) baby 1 hour ago 2 Client who vaginally delivered a 9-lb (4082 g) baby 1 hour ago 3 Client who vaginally delivered a preterm baby 4 hours ago 4 Client who had a planned cesarean delivery of an 8-lb (3629 g) baby 2 hours ago
2 Client who vaginally delivered a 9-lb (4082 g) baby 1 hour ago The nurse would assess the client at risk for postpartum hemorrhage first. Uterine atony after a vaginal delivery is the main cause of postpartum hemorrhage. An overdistended uterus caused by a large fetus (9 lb; 4082 g) can result in uterine atony. Delivering a 7-lb baby (3175 g) or a preterm baby is not a risk factor. Uterine atony is minimized in a planned cesarean delivery.
Which would be included in the plan of care for an obstetrical client who has been taking carbamazepine throughout the first trimester of pregnancy? 1 Evaluation for fetal hydramnios 2 Evaluation for a neural tube defect 3 Evaluation for cardiac malformation 4 Chromosomal assessment for Down syndrome
2 Evaluation for a neural tube defect Carbamazepine (an AED) is associated with neural tube defects. Fetal hydramnios, cardiac malformation, and Down syndrome are not related to the use of carbamazepine.
Assessment of a primigravida at 32 weeks' gestation shows a blood pressure of 170/110 mm Hg, 4+ proteinuria, and edema of the face and extremities. With which complication are these findings consistent? 1 Eclampsia 2 Severe preeclampsia 3 Chronic hypertension 4 Gestational hypertension
2 Severe preeclampsia With severe preeclampsia, arteriolar spasms result in hypertension and decreased arterial perfusion of the kidneys. This in turn causes an alteration in the glomeruli, resulting in oliguria and proteinuria, retention of sodium and water, and edema. Eclampsia is characterized by seizures; there are no data to indicate that the client is having or has had seizures. Chronic hypertension is hypertension diagnosed before pregnancy or before 20 weeks' gestation. Hypertension that is first diagnosed during pregnancy that persists beyond the postpartum period is also considered chronic hypertension. Gestational hypertension is hypertension that first occurs during midpregnancy without proteinuria; it is definitively diagnosed when the hypertension resolves 12 weeks after delivery.
