Susan Wilson (2): A 26-year-old primigravida during labor and delivery

You go on to assess the condition of Susan's uterus. The term that describes the expected gradual reduction in size of the uterus after delivery as it contracts to return to normal size is [blank]

Involution

The correct term for the cone shape of a vaginally-delivered infant's head is

Molding or Molded

Susan expresses concern about engorged breasts. Some of her friends have told her that it's painful. You discuss engorgement with Susan and suggest:

A. to help avoid engorgement, feed Jason at least every 2-3 hours around the clock B. to help avoid engorgement, make sure Jason is positioned for good milk transfer during feedings D. if engorgement occurs, express some milk prior to feedings to facilitate latching-on

Susan's Pitocin (oxytocin) drip is infusing with an infusion pump at a rate of 60 mL per hour. [blank] milliunits of drug is infusing per minute.

10 (10U/1000mL=xU/60mL x=0.6 0.6 U/60mL Convert 0.6 U to mU 1 u=1000 mU So, 0.6 U= 600 mU Therefore, there are 600 mU in that 60 mL that are given in an hr, but we have to know how many mU in a minute, so divide 600 by 60 (because there are 60 minutes in an hr) and you are left with 10 mU/min.)

Based on your assessment of this male neonate, you determine that his 1-minute Apgar score is:

9

You examine a recent strip from the fetal monitor. The abnormal fetal heart rate pattern you observe is interpreted as a [blank] deceleration

Late

As you perform the assessment, you teach Susan that the vaginal discharge that occurs during the postpartum period (puerperium), which and consists of blood, tissue, and mucous, is called

Lochia or Lochial discharge

You also know that when an infant suckles at the breast, the milk ejection or let-down reflex is stimulated to allow milk to fill the lactiferous sinuses just behind the nipple. The hormone responsible for milk ejection is [blank]

Oxytocin

When John describes to you the advantages he sees in breastfeeding, you agree when he says:

B. breastfed babies are not likely to have allergies to their mother's breast milk C. breastfeeding is more economical D. breastfed babies experience fewer respiratory illnesses than formula-fed babies

The anesthesiologist performs the epidural procedure and Susan begins to feel almost immediate relief from painful contractions. You know that a priority nursing intervention is to:

B. frequently monitor Susan's blood pressure for hypotension (Sympathetic vasoconstrictor impulses can be blocked, leading to arteriole dilation, venous pooling, and decreased blood return to the heart. These can subsequently result in hypotension.)

You then apply erythromycin ophthalmic ointment to the newborn's eyes to:

B. protect the infant from gonorrheal or chlamydial infection

Based on your assessment, you position the ultrasound transducer on Susan's abdomen at the:

B. right lower quadrant (The heart rate would be heard best through the fetal back at this location.)

As Susan and John admire their new son, you notice a sudden gush of blood from Susan's perineum and an apparent lengthening of the umbilical cord. You recognize that these signs indicate:

B. separation of the placenta

A number of factors may affect the length of time a woman's labor will last. These include:

B. the parity of the mother C. maternal activity and position D. fetal position and size

You perform a vaginal exam to check for shortening and thinning of Susan's cervix. This is called

Effacement or Effacing

You identify this as a/an [blank] deceleration

Early

You know, that early deceleration is caused by:

A. compression of the fetal head

Fetal heart rate increases can be associated with a variety of factors. These include:

A. maternal fever or infection C. fetal anemia D. the mother receiving the drug Brethine (terbutaline) E. the mother receiving the drug Yutopar (ritodrine)

Based on your assessment, you determine that the fetus is in a/an [blank] presentation

Vertex or Cephalic or Occiput

John asks, "Why does he need to have a shot already?" Your explanation to John is based on the knowledge that:

A. newborns are unable to synthesize vitamin K due to absence of intestinal flora at birth D. vitamin K is needed to prevent bleeding problems in the early neonatal period

Because Susan had an epidural she has not exhibited some of the signs/behaviors that otherwise characterize the transition phase. These include:

A. physical shaking B. reluctance to be touched C. amnesia between contractions D. diaphoresis

After the placenta has been expelled, Dr. Cooper asks you to start a Pitocin (oxytocin) drip, at a concentration of 10 units in 1000 mL Lactated Ringer's. You know that Pitocin (oxytocin) is administered at this time to:

A. stimulate uterine contractions

You also determine that the fetus is at zero station. John is curious about what you mean by "the fetus is at zero station." Your response is based on the knowledge that zero station means that:

A. the baby's presenting part is at the level of the mother's ischial spines (The presenting part is now "engaged.")

Susan has been monitored for 15 minutes. Which of the following actions on your part is indicated?

A. Continue to monitor the fetal heart rate (Transitory accelerations up to 15 bpm with contractions are reassuring. A maintained increase in baseline fetal heart rate beyond 160 bpm would suggest fetal hypoxia and require immediate attention.)

Susan has decided to rest in bed for a while. Which of the following positions are acceptable?

A. Left lateral D. Right lateral

Which of the following is the expected progression of lochial changes during the puerperium?

A. Rubra, serosa, alba

Based on your assessment of Susan (3 cm dilated, 80% effaced, fetus at zero station) and your interpretation of her data, you determine that she is now in which stage of labor?

A. Stage one (Stage one - ends at complete cervical dilation Stage two - ends at delivery of neonate Stage three - ends with expulsion of placenta Stage four - ends 1-2 hours after delivery)

The warmer will maintain the infant's temperature within normal limits (36.5-37 degrees C / 97.7-98.6 degrees F, axillary). The newborn is prone to hypothermia because:

A. blood vessels are close to the skin surface B. there is minimal subcutaneous fat D. newborns have a large body surface to body weight ratio

You remind Susan that it is important for her to try to urinate every two hours. The rationale for this is that a distended bladder can:

A. cause difficulty in voiding after delivery B. interfere with fetal descent D. increase the pain associated with uterine contractions

Which of the following statements would indicate that Susan understands correct information on breastfeeding?

B. "To break suction, I will insert my finger into the corner of Jason's mouth before removing him from the breast." D. "When Jason has a growth spurt, he will want to nurse more often, which will increase my milk supply."

You determine that Susan is now in which phase of stage one labor?

B. Active phase (During the active phase of stage one labor, the cervix is dilated 4-7 cm, and the woman becomes more focused as contractions become more painful. )

At this point, which of the following would be appropriate advice for Susan?

C. "Don't push yet. Pant through contractions if you need to." D. "Let me help you assume the knee-chest position if the urge to push is uncontrollable."

With regard to Susan's rupture of membranes, which questions are important?

C. "What was the color of the fluid?" D. "What time did your 'water break'?" (Amniotic fluid is normally pale and straw-colored with whitish flecks. Greenish-brown (meconium-stained) fluid can indicate fetal distress, or may suggest a breech presentation. Yellow-stained amniotic fluid might be indicative of fetal infection or fetal hemolytic disease. Port-wine colored fluid may be associated with abruptio placentae. Thick, foul-smelling amniotic fluid indicates the presence of infection.) (The risk of perinatal infection is increased if delivery does not occur within 24 hours of membrane rupture. Susan says her membranes ruptured about 2 AM.)

In response to the order for Stadol (butorphanol tartrate), which of the following is indicated?

C. Administer the Stadol (butorphanol tartrate) as ordered (If she were expected to deliver within an hour, Stadol (butorphanol tartrate) would not be advisable in that it could cause respiratory depression in the neonate at birth. The dosage of 1 mg is appropriate.)

The position and firmness of Susan's uterus is important to determine. Which of the following assessments would be considered normal at this time? Hint

C. Fundus is firm, at the midline, and two fingerbreadths below the umbilicus

To measure the frequency of Susan's contractions you examine a 10-minute strip and:

C. determine the time from the beginning of one contraction to the beginning of the next (You may also count from the peak of one contraction to the peak of the next to determine frequency.)

Based on Susan's assessment data and history, you identify which of the following as a priority nursing diagnosis for Susan at this time?

D. Deficient Fluid Volume related to inadequate intake of liquids (Susan has had little intake and has voided only once in the past 12 hours. These suggest that she is fluid deprived.)

At the next assessment, Susan's uterus is midline. The fundus feels boggy at one fingerbreadth below the umbilicus. What should you do first?

D. Massage Susan's uterus

What is the best nursing action to take at this time?

D. Suggest that John take a short break and have another family member coach Susan temporarily

In response to the occurrence of a late deceleration, which of the following actions should be carried out FIRST?

D. Turn Susan on her left side

After delivery, a declining level of estrogen allows for rising levels of the hormone responsible for milk production. You know that the hormone that stimulates milk production is [blank]

Prolactin