OB Exam #2

A client is receiving terbutaline (Brethine) for preterm labor. Which of the following findings would warrant stopping the infusion?

-Change in the amniotic sac from intact to ruptured -Change in fetal HR from 160bpm to 210bpm *rational: when Fetal HR is greater than 200 the med should be stopped// Terbutaline triggers fight or flight

Three 30 week gestation clients are on the L&D unit in preterm labor. For which of the clients should the nurses question a DR order for beta agonist tocolytics?

A client with cardiac disease *R:This would place client at risk for heart problems

A women is being induced with oxytocin and is contracting every 3 mins X 30 seconds. Suddenly the women becomes dyspneic and cyanotic and begins to cough up bloody sputum. Which of the following nursing interventions is of highest priority:

Administer oxygen *R:Airway

To reduce possible side effects from a cesarean section under general anesthesia, clients are routinely given which type of medication? 1. Antacids 2. Tranquilizers 3. Antihypertensives 4. Anticonvulsants

Antacids *Rational: Antacids are routinely administered pre surgically to csection clients.

A client with fetal demise is admitted to L&D unit in the latent phase of labor. Which of the following behaviors would the nurse expect client to exhibit?

Crying and sad

A gravid client, G3 P2 was examined 5 mins ago. Her cervix was 8 cm dilated and 90% effaced. She now states that she needs to have a bowel movement. Which action should nurse perform first?

Evaluate progress of labor

A woman, 39 wks gestation is admitted to the delivery unit w/vaginal warts from HPV. Which of the following actions by the nurse is appropriate?

Follow standard infectious disease precautions *Rational: Although HPV is a sexually transmitted infection and can be contracted by the neonate from the mother and they don't do c-sections because it can be transmitted through the air.

The nurse turns off the Oxy infusion after a period of tachysystole. Which of the following outcomes indicates that the nurses action was effective?

Frequency every 3 mins

The nurse is to intervene when caring for a laboring client whose baby is exhibiting signs of fetal distress. Which of the following actions should the nurse take?

Increase the IV infusion rate *R: Increasing the IV rate helps to improve perfusion to the placenta

Which of the following physical findings would lead the nurse to suspect that client with severe pre-eclampsia has developed HELLP sysndrome?

Jaundice, Petechiae

A 28 wk gestation client with intact membranes is admitted with the following findings: Contractions every 5 mins X 60 seconds, 3 cm dilated, 80% effaced. Which of the following meds will the obstetrician most likely order?

Mag Sulfate *Rational: Mag Sulfate is a tocolytic agent (prevents preterm labor and suppresses uterine contractions)

Which finding should nurse expect when assessing a client with placenta previa

Painless vaginal bleeding

There are four clients in the labor suite. Each client's labor is being augmented with oxytocin (Pitocin). Which of the women should the nurse monitor carefully for the potential of uterine rupture?

Patient age 25, G4, P3, last delivery was by C-section. * Rational is: A women no matter what her age, who has had a previous C-section and whose labor is being augmented with Oxytocin is at risk for uterine rupture.

A women is scheduled to have an external version for a breech presentation. The nurse carefully assesses the client's chart knowing that which of the following is a contraindication to this procedure?

Previous C-section *Rational: Presence of a C-section scar is a contraindication because significant stress is placed on the uterine body.

Which of the following situations should the nurse conclude is a vaginal delivery emergency?

Shoulder Dystocia (is when, after vaginal delivery of the head, the baby's anterior shoulder gets caught above the mother's pubic bone.) is an obstetric emergency. *R: It is an emergency because the head is out but the body is still stuck in mom.

The provider performed an amniotomy 5 mins ago on a client who is G3 P1, 40 weeks gestation, -4 station, and ROP position. The fetal HR is 140 with variable decels. The fluid is green tinged and smells musty. The nurse concludes that which of the following situations is present?

The cord is prolapsed. *R:

While evaluating the fetal heart monitor tracing on a client in labor, the nurse notes that there are fetal heart decelerations present. Which of the following assessments must the nurse make at this time?

The relationship between the decels and the labor contractions *Rational is: the relationship between the decel and the contractions will determine the type of decel pattern.

A client, 38 wks gestation is being induced with IV Oxytocin for HTN and oligohydramnios ( too little amniotic fluid). She is contracting every 3 mins X60-90 secs. She suddenly complains of abdominal pain accompanied by significant fetal heart bradycardia. Which of the following interventions should the nurse perform first?

Turn off the oxytocin infusion *R: Whenever there is marked fetal bradycardia and oxytocin is being administered the nurse should stop Oxy STAT

which of the following lab values should the nurse report to the physician as being consistent with the diagnosis of HELLP syndrome?

Platelets 75,000 *Rational: Low platelets are consistent with the diagnosis of hellp syndrome -HELLP syndrome is an acronym for a serious complication. H= Hemolysis , EL=elevated liver enzymes, LP= Low platelets

A nurse is monitoring a client who is receiving an amnioinfusion. Which of the following assessments is critical for the nurse tomake to prevent a serious complication related to the procedure?

Uterine Resting Tone *Rational: Uterine resting tone should be carefully monitored with an internal pressure electrode during amnioinfusion. Because there is fluid being instilled into uterine cavity there is potential for the fluid to overload the space causing a risk for rupture.