Mom Baby Prep U #2
A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? Assess fetal heart sounds. Place the woman in Trendelenburg position. Administer oxygen at 10 L/min by face mask. Administer amnioinfusion.
Assess fetal heart sounds. To rule out cord prolapse, always assess fetal heart sounds immediately after rupture of the membranes whether this occurs spontaneously or by amniotomy, as the fetal heart rate will be unusually slow or a variable deceleration pattern will become apparent when cord prolapse has occurred. The other answers refer to therapeutic interventions to implement once cord prolapse has been confirmed.
Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. Which maneuver is first attempted to deliver an infant with shoulder dystocia? McDonald maneuver McGeorge maneuver McRoberts maneuver McRonald maneuver
McRoberts maneuver
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
A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer? sedatives tocolytics uterine stimulants corticosteroids
uterine stimulants
A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn? asphyxia clavicular fracture cephalohematoma central nervous system injury
cephalohematoma Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as ecchymoses, facial and scalp lacerations, facial nerve injury, cephalohematoma, and caput succedaneum. Asphyxia may be related to numerous causes, but it is not associated with use of a vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous system injury is not associated with the use of a vacuum extractor.
A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? corticosteroids magnesium sulfate nifedipine indomethacin
corticosteroids Corticosteroids are given to help reduce or prevent the frequency and severity of respiratory distress syndrome in preterm infants delivered between 24 and 34 weeks' gestation. Medications most commonly used for tocolysis include magnesium sulfate, indomethacin, and nifedipine.
A nurse is conducting a program for pregnant women with gestational diabetes about reducing complications. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes? reduction in retinopathy risk by frequent ophthalmologic evaluations degree of blood glucose control achieved during the pregnancy stability of the woman's emotional and psychological status control of blood urea nitrogen (BUN) levels for optimal kidney function
degree of blood glucose control achieved during the pregnancy
The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? 11 7 5 3
11 The Bishop score helps identify women who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score: a score over 8 indicates a successful vaginal birth. Therefore the woman with a Bishop score of 11 would have the greatest chance for success. Bishop scores of less than 6 usually indicate that a cervical ripening method should be used prior to induction.
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: 5. 6. 7. 9.
5. A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.
A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 8% 14% 6% 12%
6% The upper normal level of HbA1C is 6% of total hemoglobin.
Which assessment would lead the nurse to believe a postpartum woman is developing a urinary complication? At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. She says she is extremely thirsty. Her perineum is obviously edematous on inspection.
At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. Postpartum women who void in small amounts may be experiencing bladder overflow from retention.
A pregnant client in her 20th week of gestation, having systemic lupus erythematosus (SLE), is admitted to the healthcare unit for management of the exacerbation of SLE. Which of the following would be most appropriate to treat the client's condition? Prostaglandin E Beta2 agonists Corticosteroids Hydroxyurea
Corticosteroids Corticosteroid therapy is the treatment of choice for pregnant clients with SLE. SLE is an autoimmune disorder where there is deposition of immune complexes in the capillaries and in visceral structure. Corticosteroid therapy in pregnant clients with SLE has a favorable outcome. Hydroxyurea, beta2 agonists and prostaglandin E are not used in the treatment of pregnant clients with SLE. Hydroxyurea is a drug used in the treatment of sickle cell anemia. Beta2 agonists are drugs given to asthmatic clients. Prostaglandin E is a drug used for the induction of labor.
A woman with cardiac disease at 32 weeks' gestation reports she has been having spells of light-headedness and dizziness every few days. Which instruction should the nurse prioritize? Discuss induction of labor with the health care provider. Bed rest and bathroom privileges only until birth. Increase fluids and take more vitamins. Decrease activity and rest more often.
Decrease activity and rest more often. Explanation:If the patient is developing symptoms associated with her heart condition, the first intervention is to monitor activity levels, decrease activity and treat the symptoms. At 32 weeks gestation, the suggestion to induce labor is not appropriate and without knowledge of the type of heart condition one would not recommend increase of fluids or vitamins. Total bed rest may be required if the symptoms do not resolve with decreased activity.
A 40-year-old female client with a chronic pelvic infection expresses her desire to conceive post-treatment. When discussing this with the client the nurse keeps in mind that the client is at increased risk for which of the following? Ectopic pregnancy Symptoms of menopause Decreased menses Gestational diabetes
Ectopic pregnancy Chronic pelvic infection increases the risk for narrowed or blocked fallopian tubes. It decreases the possibility of fertility or increases the risk of ectopic pregnancy. Only in case of a premature ovarian failure will the client experience symptoms of menopause earlier than expected. A client with hyperthyroidism will experience decreased or absent menses. The client with chronic pelvic infection is not susceptible to gestational diabetes. Clients with multiple gestations are more susceptible to gestational diabetes.
TORCH is an acronym for maternal infections associated with congenital malformations and disorders. Which of the following disorders does the H represent? Hemophilia Hepatitis B virus Herpes simplex virus Human immunodeficiency virus
Herpes simplex virus TORCH represents the following maternal infections: toxoplasmosis; others, such as gonorrhea, syphilis, varicella, hepatitis, and human immunodeficiency virus; rubella; cytomegalovirus; and herpes simplex virus. Hemophilia is a clotting disorder in which factors VII and X are deficient.
A nurse is teaching a 42-week nulliparous pregnant woman about labor induction which is being recommended by her health care provider. The nurse determines that the woman needs additional teaching when she identifies which assessment as being done before induction? Maneuvers for fetal positioning fetal dating Bishop scoring amniotic fluid studies
Maneuvers for fetal positioning Before labor induction is started, fetal maturity (dating, ultrasound, amniotic fluid studies) and cervical readiness (vaginal examination, Bishop scoring) must be assessed. Both need to be favorable for a successful induction. Maneuver's to determine fetal position (Leopold's maneuver) is a technique done as the fetus moves through the labor process.
Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? oxytocin promethazine ondansetron methotrexate
Methotrexate a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.
A nurse is assessing a client in her seventh month of pregnancy who has an artificial valve prosthesis. The client is taking an oral anticoagulant to prevent the formation of clots at the valve site. Which of the following nursing interventions is most appropriate in this situation? Urge the client to discontinue the anticoagulant to prevent pregnancy complications Put the client on bed rest Observe the client for signs of petechiae and premature separation of the placenta Instruct the client to avoid wearing constrictive knee-high stockings
Observe the client for signs of petechiae and premature separation of the placenta Rationale: Subclinical bleeding from continuous anticoagulant therapy in the woman has the potential to cause placental dislodgement. Observe a woman who is taking an anticoagulant for signs of petechiae and signs of premature separation of the placenta, therefore, during both pregnancy and labor. The nurse should not urge the client to discontinue the anticoagulant, as this is not within the nurse's scope of practice and, in any case, the client still needs the anticoagulant to prevent clots. Bed rest is prescribed for clients with a thrombus, to prevent it from moving and becoming a pulmonary embolus. Avoiding the use of constrictive knee-high stockings is to prevent thrombus formation.
A woman with an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which measure would the nurse stress with her during the remainder of the pregnancy? discontinuing her prepregnancy anticoagulant maintaining a high fluid intake obtaining enough rest beginning a low-impact aerobics program
Obtaining enough rest As the blood volume doubles during pregnancy, heart failure can occur. The pregnant woman needs to obtain adequate rest to prevent overworking the heart. Fluid may need to be restricted.
A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next? Check deep tendon reflexes. Measure fundal height. Palpate the fundus and check fetal heart rate. Obtain a voided urine specimen and determine blood type.
Palpate the fundus and check fetal heart rate. The classic signs of placental abruption (abruptio placentae) are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.
Which medication would you expect to see prescribed for a pregnant woman with an artificial heart valve shortly before or during labor? Digoxin Coumadin Penicillin A hypotensive
Penicillin Explanation: Women with artificial heart valves have an increased risk of subacute bacterial endocarditis following delivery because some bacteria enter the bloodstream from the denuded placental surface. Such bacteria settle in the eddying blood surrounding cardiac shunts or valves.
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.
The nurse is assisting with a vaginal birth. The patient is fully dilated, 100% effaced and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus? Shoulder dystocia Umbilical cord prolapse Nuchal cord Breech position
Shoulder dystocia The "turtle sign" is the classic sign that alerts the practitioner to the probability of shoulder dystocia. The fetal head delivers, but then retracts similar to a turtle. The fetal head may wiggle from side to side and fail to rotate.
A pregnant patient with a history of premature cervical dilatation undergoes cervical cerclage. Which outcome indicates that this procedure has been successful? The client delivers a full-term fetus at 39 weeks' gestation. The client's membranes spontaneously rupture at week 30 of gestation. The client experiences minimal vaginal bleeding throughout the pregnancy. The client has reduced shortness of breath and abdominal pain during the pregnancy.
The client delivers a full-term fetus at 39 weeks' gestation. Premature cervical dilatation is when the cervix dilates prematurely and cannot retain a fetus until term. After the loss of one child because of premature cervical dilatation, a surgical operation termed cervical cerclage can be performed to prevent this from happening in a second pregnancy. This procedure is the use of purse-string sutures placed in the cervix to strengthen the cervix and prevent it from dilating until the end of pregnancy. Evidence that this procedure is effective would be the client delivering a full-term fetus at 39 weeks' gestation. Spontaneous rupture of the membranes could indicate that the procedure was not successful. Vaginal bleeding could indicate another health problem or that the procedure was not successful. This procedure does not impact the patient's respirations or amount of abdominal pain while pregnant. These manifestations could indicate another health problem with the pregnancy.
A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. For what should the nurse immediately check the patient? Amniotic fluid infection Amniotic fluid embolus Umbilical cord prolapse Placental abruption
Umbilical cord prolapse Because the patient is not in labor, this development is considered premature rupture of membranes. The sudden onset of deep variable decelerations may indicate umbilical cord prolapse, which is an obstetric emergency that requires immediate intervention.
A client is in active labor. The nurse does a Leopold maneuver and notifies the RN that there is a fetal malpresentation. The infant is in a breech position. The physician is notified and it is ascertained that the infant is in a frank breech presentation. What type of delivery does this presentation call for? Vaginal delivery Piper forceps Vacuum delivery Standard forceps
Vaginal delivery There are three types of breech presentation: (1) frank (hips flexed, knees extended; also known as pike position), (2) complete (hips and knees flexed, a.k.a. tailor position), and (3) footling or incomplete (one or both hips extended with the foot or feet presenting). Frank breech is the preferred breech position for vaginal delivery.
A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? limiting sodium intake assessing for cardiac decompensation inspecting the extremities for edema ensuring that the client consumes a high fiber diet
assessing for cardiac decompensation
A nurse is teaching a 30-year-old gravida 1 who has sickle cell anemia. Providing education on which topic is the highest nursing priority? avoidance of infection constipation prevention administration of immunoglobulins consumption of a low-fat diet
avoidance of infection Prevention of crises, if possible, is the focus of treatment for the pregnant woman with sickle cell anemia. Maintaining adequate hydration, avoiding infection, getting adequate rest, and eating a balanced diet are all common-sense strategies that decrease the risk of a crisis. Fat intake does not need to be decreased and immunoglobulins are not normally administered. Constipation is not usually a result of sickle cell anemia.
A young patient with heart disease asks the physician if it would be safe for her to have a baby. The physician responds that it is possible but she would have to maintain almost complete bed rest. Which classification of heart disease is this woman? class I class II class III class IV
class III To predict pregnancy outcome, heart disease is divided into four categories. A woman with class I or II heart disease can expect to experience a normal pregnancy and birth. A woman with class III can complete a pregnancy by maintaining almost complete bedrest. Women with class IV heart disease are poor candidates for pregnancy, because they are in cardiac failure even at rest and when not pregnant. They are usually advised to avoid pregnancy.
A client at 32 weeks' gestation receives an ultrasound that identifies intrauterine growth restriction. Which findings from the client's nutritional assessment would indicate to the nurse that additional teaching is needed? Select all that apply. eating large quantities of empty-calorie foods difficulty eating because of continuing nausea history of gestational diabetes in previous pregnancy maternal age less than 18 years consuming 5 to 6 small meals each day
eating large quantities of empty-calorie foods difficulty eating because of continuing nausea maternal age less than 18 years Low caloric intake because of continued nausea as well as eating large quantities of empty calories can impact fetal growth. Pregnant adolescents also are more likely to have poor fetal growth because the adolescent's growth needs are competing with the fetus for nutrients. Consuming small, frequent meals is a strategy for increasing caloric and nutrient intake during pregnancy. A history of gestational diabetes makes it more likely the client will experience elevated blood glucose levels and fetal macrosomia.
A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding? hyperglycemia elevated platelet count disseminated intravascular coagulation (DIC) elevated liver enzymes
elevated liver enzymes HELLP is an acronym for hemolysis, elevated liver enzymes, and low platelets. Hyperglycemia is not a part of this syndrome. HELLP may increase the woman's risk for DIC but it is not an assessment finding.
A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? cord compression fetal distress related to hypoxia infection central nervous system (CNS) involvement
fetal distress related to hypoxia When meconium is present in the amniotic fluid, it typically indicates fetal distress related to hypoxia. Meconium stains the fluid yellow to greenish brown, depending on the amount present. A decreased amount of amniotic fluid reduces the cushioning effect, thereby making cord compression a possibility. A foul odor of amniotic fluid indicates infection. Meconium in the amniotic fluid does not indicate CNS involvement.
Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor? macrosomia gestational hypertension gestational diabetes low parity
gestational hypertension Risk factors for placental abruption (abruptioo placentae) include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, intimate partner violence, and placental pathology. Macrosomia, gestational diabetes, and low parity are not considered risk factors.
A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? hemorrhage macrosomia infection dystocia
macrosomia Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection. Amniotic fluid volume begins to decline by 40 weeks of gestation, possibly leading to oligohydramnios. Hemorrhage, infection, and dystocia are risk to the mother not the fetus.
A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. nifedipine magnesium sulfate dinoprostone misoprostol indomethacin
nifedipine magnesium sulfate indomethacin Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), indomethacin (a prostaglandin synthetase inhibitor), and nifedipine (a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix.
A nurse is reviewing a postpartum woman's history and labor and birth record. The nurse determines the need to closely monitor this client for infection based on which factor? labor less than 3 hours hemoglobin of 11.5 mg/dl (115 g/L) placenta removed via manual extraction multiparity
placenta removed via manual extraction
A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? preterm labor normal labor dystocia precipitate labor
preterm labor Preterm labor is the occurrence of regular uterine contractions accompanied by cervical effacement and dilation before the end of the 37th week of gestation. If not halted, it leads to preterm birth. Normal labor can occur after the 37th week. Dystocia refers to a difficult labor. Precipitate labor is one that is completed in less than 3 hours from start of contraction to birth.
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.
A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests? semen analysis, urinalysis, and ovulation monitoring serologic test for syphilis, semen analysis, and tubal patency assessment semen analysis, ovulation monitoring, and tubal patency assessment pelvic sonogram, ovulation monitoring, and semen analysis
semen analysis, ovulation monitoring, and tubal patency assessment
A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time? premature birth hypertension spontaneous abortion (miscarriage) preterm labor
spontaneous abortion (miscarriage) The client's advanced maternal age (pregnancy in a woman 35 years or older) increases her risk for spontaneous abortion (miscarriage). Hypertension, preterm labor, and prematurity are risks as this pregnancy continues. Her greatest risk at 13 weeks' gestation is losing this pregnancy.
A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? fetal heart rate of 150 beats/minute contractions every 2 minutes, lasting 45 seconds uterine resting tone of 14 mm Hg urine output of 20 mL/hour
urine output of 20 mL/hour Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is within the accepted range of 120 to 160 beats/minute. Contractions should occur every 2 to 3 minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require intervention.
A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy? high number of pregnancies multiple gestation pregnancy use of oral contraceptives use of IUD for contraception
use of IUD for contraception Use of an IUD with progesterone has a known increased risk for development of ectopic pregnancies. The nurse needs to complete a full history of the client to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple elective abortions. Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. Hormonal factors may play a role because tubal pregnancy occurs more frequently in women who take fertility drugs or who use progesterone intrauterine contraceptive devices (IUDs). A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy.
A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect? amniotic fluid embolism shoulder dystocia uterine rupture umbilical cord prolapse
uterine rupture Uterine rupture is associated with crack cocaine use disorder. Generally, the first and most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part. Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress. Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered. Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of the presenting part of the fetus.
