Family Focused Exam 2

marijuana is safe to use in pregnancy if used in states that have legalized it and you have a prescription for it - true - false

-false • rationale: marijuana can cause IUGR. some studies suggest that it can cause ADD in the child's life. just like with many other drugs, just because you have a prescription for it does. not make it safe for pregnancy (pg 273)

insulin needs dramatically decrease postpartum - true - false

-true • rationale: insulin needs decrease substantially because the major source of insulin resistance, the placenta, has been removed (pg 252)

arrange the steps in the order in which diabetic ketoacidosis (DKA) develops in a pregnant patient. 4. the hepatic glucose production increases because of some infection 1. the stress hormones that cause impaired insulin action are secreted 6. the fatty acids are mobilized from fat stores & enter the circulation 2. the extra glucose & ketone bodies are released into the circulation 5. the buffering system is unable to compensate, & acidosis develops 3. osmotic diuresis results with volume depletion & cellular dehydration

4, 1, 6, 2, 5, 3 • a stress factor, such as an infection, increases the hepatic glucose production & decreases peripheral glucose use. therefore the stress hormones are released, which act to impair insulin action. fatty acids are mobilized from fat stores to enter the circulation. as they are oxidized, ketone bodies are released into the peripheral circulation. the patient's buffering system is unable to compensate, which causes DKA to develop. the excessive blood glucose & ketone bodies result in osmotic diuresis, which then cause loss of fluid & electrolytes, volume depletion, & cellular dehydration. because the body's buffering system cannot compensate, this results in a diagnosis of diabetes ketoacidosis

which viral infection can result in neonatal brain complications? A) herpes infection B) rubella infection C) varicella-zoster infection D) cytomegalovirus infection

A) • rationale: herpes infection can cause neonatal encephalitis a rubella infection, varicella zoster infection, and cytomegalovirus infection do not cause neonatal encephalitis

which major concern regarding epilepsy in pregnancy would the nurse recognize? A) many antiseizure medications are known teratogens B) there is an increased risk for miscarriage and preeclampsia C) a woman who has been seizure free for many years may have a severe exacerbation in pregnancy D) epilepsy in pregnancy may lead to Graves disease

A) • rationale: many women who are pregnant and have epilepsy may require specialized medication management to prevent adverse fetal effects while managing their condition there is an increased risk for miscarriage and preeclampsia with SLE, not epilepsy the longer a woman has been seizure free, the less likely she is to have seizures in pregnancy graves disease is a hyperthyroid disorder and is not related to epilepsy

Which type of anemia is an inherited anemia? A) sickle cell anemia B) aplastic anemia C) iron deficiency anemia D) pernicious anemia

A) • rationale: sickle cell anemia is an autosomal recessive disorder aplastic anemia is acquired iron deficiency anemia is acquired and can be corrected by increasing intake of food high in iron pernicious anemia is acquired and may be corrected with diet and supplementation

which nursing intervention would be included in the care of a woman with lupus during her 1st trimester? A) monitor for liver function B) monitor for increased joint pain and fatigue C) provide patient education on remission of lupus D) administer subcutaneous heparin for thrombosis prevention

A) • rationale: renal function, not liver function often worsens with lupus pregnancy can worsen progression of disease, and the disease should be carefully monitored during pregnancy remission of lupus does not usually occur with pregnancy lupus does not increase the risk for thrombosis and heparin is not indicated

which antihypertensive classifications are contraindicated in pregnancy? - beta blockers - ACE inhibitors - calcium channel blockers - vasodilators - ARBs

ACE, ARBs • rationale: ACE inhibitors have been linked to adverse fetal effects and are contraindicated in pregnancy ARBs have been linked to fetal morbidity and are not approved for use in pregnancy beta blockers are considered relatively safe for blood pressure management in pregnancy calcium channel blockers are used for a variety of reasons in pregnancy vasodilators are frequently used with hypertensive crisis in pregnancy

which is the ideal treatment for severe unmanageable hyperthyroidism in a patient who is pregnant? A) radioactive iodine B) subtotal thyroidectomy C) methimazole D) propylthiouracil

B) • a subtotal thyroidectomy is prescribed for a pregnant patient with severe hyperthyroidism if the drug therapy proves toxic. oral methimazole & propylthiouracils are prescribed for hyperthyroidism but may be ineffective in severe cases. radioactive idodine is not used to treat hyperthyroidism in pregnant patients, because it may destroy the fetus's thyroid gland

which description is true of congenital cytomegalovirus (CMV)? A) can lead to severe maternal anemia B) can lead to neonatal hearing loss C) often causes severe flulike symptoms in the mother D) causes weeping skin lesions on the neonate

B) • rationale: CMV is a leading cause of neonatal hearing loss CMV is not known to cause maternal anemia cytomegalovirus is most often asymptomatic herpes simplex virus, not CMV, lead to skin lesions

which condition in a pregnant patient includes signs of fatigue, lethargy, glossitis, & rough skin? A) thalassemia B) megaloblastic anemia C) iron-deficiency anemia D) sickle cell hemoglobinopathy

B) • signs of fatigue, lethargy, glossitis, & skin roughness indicate megaloblastic anemia. this is caused by a folic acid deficiency. thalassemia is indicated by severe anemia & congestive heart failure in a pregnant patient. fatigue indicates iron-deficiency anemia, but glossitis & skin roughness are not present. anemia, repeated infections, SOB, fatigue, & jaundice are seen in a patient with sickle cell hemoglobinopathy

Which method would the nurse recognize as a low-tech assessment of fetal well-being? A) fetal aneuploidy screening B) fetal kick counts C) ultrasonography D) biophysical profile assessment

B) • rationale: fetal kick counts are an inexpensive, noninvasive method of fetal assessment Fetal aneuploidy screening requires complex maternal serum analysis sometimes combined with ultrasound of amniocentesis. this is a high-tech assessment of the fetus Ultrasonography involves expensive machinery and provides detailed information regarding fetal well-being The biophysical profile includes ultrasound and a nonstress test and is not considered low tech

how many ounces of alcohol are considered safe in the first trimester of pregnancy? A) 18-22 B) 12-16 C) 0 D) 4-8

C) • rationale: no amount of alcohol is considered safe at any point in pregnancy

During pregnancy, alcohol withdrawal may be treated using which medication? A) aminophylline B) corticosteroids C) benzodiazepines D) disulfiram

C) • symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. disulfiram is contraindicated in pregnancy because it is teratogenic. corticosteroids are not used to treat alcohol withdrawal. aminophylline is not used to treat alcohol withdrawal

which factor during a nonstress test of a pregnant patient indicates it is nonreactive? A) no qualifying accelerations in a 20 min period B) 2 qualifying accelerations in a 20 minute period C) less than 2 qualifying accelerations in a 20 minute period D) more than 2 qualifying accelerations in a 20 minute period

C) • the nonstress test is the most widely used technique for prenatal evaluation of the fetus. the results are either nonreactive or reactive. in a nonreactive test, there are less than 2 qualifying accelerations of the fetal HR in a 20 minute period. absence of fetal HR accelerations during the nonstress test indicates that the fetus is sleeping. in a reactive test, there are at least 2 qualifying accelerations in a 20 minute time period. more than 2 fetal HR accelerations within a 20 minute time period also would be considered a reactive test

which medication is preferred in the treatment of SLE in a pregnant patient? A) aspirin B) corticosteroids C) prednisone D) hydroxychloroquine

D) • Plaquenil reduces SLE disease activity in a pregnant patient without any adverse effects of the fetus. aspirin is not recommended during pregnancy, because it has an increased risk for premature closure of the fetal ductus arterioles. corticosteroids are used to treat multiple sclerosis. prednisone is prescribed to treat SLE during pregnancy, but it increases the risk for bone demineralization, gestational diabetes, preeclampsia, premature rupture of membranes (PROM), & IUGR

which parameter would the nurse check in the amniocentesis report of a pregnant patient to assess fetal lung growth? A) antibody titer in the blood B) alfa-fetoprotein (AFP) levels C) creatinine levels in the blood D) lecithin-to-sphingomyelin (L/S) ratio

D) • the L/S ratio indicates fetal lung maturity. AFP is assessed to check for the presence of neural defects. presence of creatinine in the amniotic fluid indicates that the patient's gestational age is more than 36 weeks. the antibody titer is used to determine Rh incompatibility in the fetus

Insulin needs through a pregnancy overall: A) stay the same B) level off after 20 weeks gestation C) decrease D) increase

D) • rationale: after 20 weeks is when they really start to increase considerably

thalassemia is a relatively common anemia in which what occurs? A) folate deficiency occurs B) there are inadequate levels of vitamin B12 C) RBCs have a normal life span but are sickled in shape D) an insufficient amount of hemoglobin is produced to fill the RBCs

D) • thalassemia is a hereditary disorder that involves the abnormal synthesis of the alpha or beta chains of hemoglobin. an insufficient amount of hemoglobin is produced to fill the RBCs. this is the underlying description for sickle cell anemia. folate deficiency is the most common cause of megaloblastic anemias during pregnancy. B12 deficiency must also be considered if the pregnant woman presents with anemia

Match the type of diabetes with its characterization - lack of insulin secretion: - insulin resistance: - gestational diabetes mellitus: • type 2 DM, type 1 DM, gestational diabetes mellitus

lack of insulin secretion: type 1 diabetes mellitus insulin resistance: type 2 diabetes mellitus early gluconeogenesis: gestational diabetes mellitus

Which pregnancy related condition is realted to both maternal and fetal influences? A) amniotic banding B) polyhydramnios C) nuchal cord D) preeclampsia

polyhydramnios • rationale: polyhydramnios can happen without a known cause. however, maternal diabetes can also lead to polyhydramnios. because the fetus creates amniotic fluid, the condition is considered both maternal and fetal amniotic banding is a fetal condition that happens within the amniotic sac nuchal cord is a fetal condition preeclampsia is a maternal condition

the nurse is developing the plan of care for a pregnant patient with an underlying history of cardiovascular disease. this patient would be at risk for which condition? SATA - stillbirth - miscarriage - hypoglycemia - atrial septal defect - intrauterine growth restriction

stillbirth, miscarriage, IUGR • stillbirth & miscarriage may occur because of CV disease in pregnancy. IUGR results in a pregnant patient with CV disease because of low oxygen pressure. hypoglycemia is seen in a pregnant patient with diabetes because of a decrease in glucose levels. an atrial septal defect is a congenital birth defect that is not related to underlying maternal cardiac disease

Which signs & symptoms would a patient with pica demonstrate? - uncontrollable urge to eat toothpaste - increased levels of blood toxins - intestinal parasites - epistaxis - diplopia - large-for-gestational age babies

uncontrollable urge to eat toothpaste, increased levels of blood toxins, intestinal parasites • rationale: pica is defined as a strong urge to eat a nonnutritive or harmful substance. women may crave potting soil, lip balm, coffee grounds, charcoal, toothpaste, baking soda, or any substance that is not considered culturally or developmentally appropriate for the individual pica can cause ingestion of substances that can contain substances that are harmful to the mother and baby such as toxins or parasites epistaxis are not associated with pica directly double vision is not directly related to pica women with eating disorders have babies that are small for gestational age or growth restricted

The nurse is assisting a pregnant patient in labor. Which instructions will the nurse give to the patient to promote comfort? Select all that apply. One, some, or all responses may be correct.

"Breathe with your mouth open." "Lie down in the lateral position." "Lie in the semi-Fowler position."

The charge nurse instructed a group of student nurses about the monitoring of uterine activity (UA) during labor. Which statement by the student nurse is accurate regarding the calculation of Montevideo units?

"They can be calculated with an intrauterine pressure catheter (IUPC)." Montevideo units can only be calculated using the internal monitoring of UA. An intrauterine pressure catheter (IUPC) monitors UA internally. Therefore, Montevideo units can only be calculated using the IUPC. Spiral electrode monitoring is used for assessing the fetal heart rate (FHR), not UA internally. The tocotransducer monitoring system is used to monitor the UA externally. An ultrasound transducer is also used to monitor the FHR externally.

The nurse is assessing the fetal heart rate (FHR) by using an ultrasound transducer. The patient asks the nurse, "Why are my baby's heart readings not continuous?" Which is the nurse's best response?

"This is a result of fetal movement." The FHR is documented on a sheet of paper by an electronic method; continuous reporting sometimes may be hindered because of maternal or fetal movements. Anxiety levels of the patient would increase the patient's heart rate. It would not affect the FHR. The position of the patient would not affect the recording of the FHR. Fullness of the bladder would not affect the ultrasonic transmission and thus would not give an irregular heart rate pattern.

Which instructions does the nurse give to a patient when preparing to assess the uterine activity using a tocotransducer?

"You will sit up at about a 30-degree angle." The use of a tocotransducer requires the patient to be sitting in a chair or lying in a bed du ring the test. The nurse asks the patient to lie in semi-Fowler position, which is sitting up at a 30-degree angle. This helps hold the device to the fundus firmly throughout the test. The patient can drink water before or after the test. Performing exercises before the test will not affect uterine activity and thus should not be instructed to the patient. Because this is not a requirement for the test, the nurse should not ask the patient to stay in a still position.

1 Hour Glucose Tolerance Test Guidelines

- Administer between 24-28 weeks - Not required to follow any pretest dietary instructions - Ingests 50 g of oral glucose solution - Blood sample taken one hour later - If glucose is 140+, then 3 hour OGTT is recommended

Thyroid Disorders during pregnancy

- Early pregnancy causes HCG to bind to TSH receptors --> activates the production of thyroid hormones (makes it difficult to detect hypothyroidism. - Untreated - risk for infertility, miscarriage, premature birth, stillbirth - S/S: Weight gain, lethargy, decrease in exercise capacity, cold intolerance - Tx: levothyroxine supplements, monitor thyroid studies

Interventions for substance use during pregnancy

- Education and lifestyle changes - Tx: pharmacotherapy, detox (in or outpatient), Nicotine replacement, 12-step meetings - opioid agonist therapy is standard care for pregnant women with SUB (methadone o& buprenorphine) - follow up care: home assessments for safety, social services, home visits

Seven cardinal movements of mechanisms of labor (vertex presentation)

- Engagement - when biparietal diameter of fetal head passes the pelvic inlet - DESCENT & FLEXION - Internal rotation - Extension - Restitution and External rotation - Expulsion (birth)

preeclampsia

- HTN and proteinuria after 20 wks - Vasospastic systemic disorder categorized as mild or severe based on S/S and labs - caused by disruptions in placental perfusion and hypoxia - placental ischemia results in generalized vasospasm - normally resolves after placenta is delivered

S/S of onset of second stage of labor

- Increase in frequency and intensity of uterine contractions - urge to push or feeling the need to have a bowel movement - episode of vomiting - increased bloody show - uncontrolled shivering - verbalizations of feeling out of control or unable to cope - involuntary bearing down efforts

CV changes during pregnancy

- Increased intravascular volume (almost doubles) - decreased SVR - CO changes during labor and birth - Intravascular volume changes that occur just after childbirth

CV Interventions - Postpartum

- Monitor for cardiac decompensation - ABG monitoring - monitor for chest pain - activity as tolerated - stool softeners - assess for additional care assistance with infant - contraceptive counseling - watch bleeding closely

Immediate care for eclampsia

- NEVER leave room during seizure - maintain patent airway and safety during seizure - stabilize mother after seizure - magnesium sulfate - assess fetal status

CV interventions - Intrapartum

- Routine assessments - assess for cardiac decompensation - ABGs, ECG monitoring - Promote cardiac function (side-lying labor position, or c-sec) - minimize anxiety - minimize pain (increases BP)

Chronic HTN with superimposed preeclampsia

- SUDDEN increase of BP that was previously controlled - NEW onset or increase of *proteinuria* after 20 wks - BP 160/110+ - severe preeclampsia symptoms - increases morbidity of mother and fetus

Match the fetal surveillance method to its corresponding advantage. - accurate measurement of fetal heart rate - accurate measurement of uterine contractions, including intensity - noninvasive and suitable for most patients in labor A) intrauterine pressure catheter B) fetal scalp electrode C) external electronic fetal monitoring

- accurate measurement of fetal heart rate = B - accurate measurement of uterine contractions, including intensity = A - noninvasive and suitable for most patients in labor = C

Second stage of labor

- begins with full dilation (10 cm) and complete effacement (100%), ends with birth - Two phases: Latent phase (passive fetal descent), acting pushing phase (strong urges to bear down)

match the expected event with the stage of labor - birth of the baby to expulsion of the placenta - complete cervical dilation and effacement to birth of the baby - cervical effacement and dilation from onset of true labor to complete dilation - expulsion of the placenta to physical recover of mother and infant A) first stage B) second stage C) third stage D) fourth stage

- birth of the baby to expulsion of the placenta = C) - complete cervical dilation and effacement to birth of the baby = B) - cervical effacement and dilation from onset of true labor to complete dilation = A) - expulsion of the placenta to physical recover of mother and infant = D)

A complete molar pregnancy, if treated properly, leads to a high-risk pregnancy, but can produce a healthy neonate. (T/F)

- false • there is no fetus in a molar pregnancy

3 hour Oral Glucose Tolerance Test Guidelines

- fasting glucose level taken - 100 g ingested of glucose solution - Plasma levels determined at 1, 2, and 3 hours post-ingestion -Diagnosed with GDM if fasting is abnormal or if 2+ values occur: fasting > 95, 1 hr > 180, 2 hr > 155, 3 hr > 140

First stage of labor

- initial stage of childbirth in which regular contractions begin and the cervix dilates - Two stages: Latent (effacement to 6cm dilation), Active (more rapid dilation and descent of fetus)

Preeclampsia incidence and severity is associated with:

- multifetal pregnancy - chronic HTN - Hx of preeclampsia previously - Pregestational DM - preexisting thrombophilias

Match the appropriate type of anesthesia to the patient description. - patient requires a vaginal laceration repair after delivery - patient in labor wants pain relief while being awake for the birth - patient with active skin infection requires an emergency cesarean delivery - patient wants pain relief while being able to move and feel contractions A) epidural block B) combined spinal-epidural anesthesia C) pudendal block D) general anesthesia

- patient requires a vaginal laceration repair after delivery = C - patient in labor wants pain relief while being awake for the birth = A - patient with active skin infection requires an emergency cesarean delivery = D - patient wants pain relief while being able to move and feel contractions = B

Which patient data would the nurse validate as part of routine preparation for cesarean delivery to determine adequate fetal maturity? - Rh-positive antibody test performed 4 weeks before surgery - negative rubella titer performed 6 weeks before surgery - positive serum pregnancy test performed at least 36 weeks before surgery - high serum alpha-fetoprotein (AFP) level performed 26 weeks before surgery - ultrasound examination between 6 & 11 weeks of pregnancy

- positive serum pregnancy test performed at least 36 weeks before surgery, ultrasound examination between 6 & 11 weeks of pregnancy • Positive serum pregnancy test, performed at least 36 weeks before the date of cesarean delivery, can be used to verify gestational age. An early ultrasound is one of the most reliable and accurate ways to date a pregnancy. Although Rh antibody screening is routinely performed early in the pregnancy, these findings do not indicate gestational age. Although a rubella vaccine administration is recommended early in the pregnancy, these findings do not indicate gestational age. Although high serum AFP may indicate fetal abnormalities, such as neural tube defects, these findings do not indicate gestational age.

Chronic HTN in pregnancy

- present before pregnancy or Dx BEFORE 20 wks gestation - persists after pregnancy/birth - no proteinuria

Which are the advantages of external electronic fetal monitoring (EFM)? - suitable for most patients in labor - visualization of heart rate pattern - allows measurement of contraction intensity - uninterrupted by fetal or patient movement - allows mobility if connected to mobile unit

- suitable for most patients in labor, visualization of the heart rate pattern, allows mobility if connected to mobile unit • External EFM is a noninvasive method for continuously monitoring fetal heart rate and uterine contractions. It is safe to use in high-risk pregnancies. External EFM provides visualization of the fetal heart rate pattern in response to uterine contractions. Mobile external EFM units allow patients to remain mobile, as the unit may be wheeled during ambulation. Internal EFM uses intrauterine pressure catheters to measure contraction intensity. Internal EFM is uninterrupted by fetal or patient movement. Disruption of electronic fetal monitoring by fetal or patient movement is a known disadvantage of external EFM.

CV interventions - Antepartum

- therapy focused on minimizing stress on heart - S/S of cardiac decompensation - bed rest - nutrition counseling - cardiac meds as needed - heart surgery

Purpose for Leopold maneuvers

- which fetal part is in fundus? - where is fetal back located? - what is presenting part of fetus?

Gestational HTN

-Systolic >140 -Diastolic >90 -Develops after 20th wk -No proteinuria or signs of end-organ dysfunction -Resolves by 12 wk postpartum

Reading FHR monitors

1. find baseline 2. determine accelerations or decelerations 3. Make call to doctor if late, variable, or prolonged decelerations that are not relieved by side-lying

Two goals of antepartal assessment

1. identify fetuses at risk for injury due to interrupted acute or chronic oxygenation so that permanent injury or death might be prevented 2. identify appropriately oxygenated fetuses so that unnecessary intervention can be avoided

Care management for Pregestational DM (generally, first visit for pregnancy)

1. interview and assess patient - 24 hr urine collection for total protein excretion and creatinine (assesses baseline renal function), UA and culture (UTI common in DM pregnancies), Thyroid function test (TFT), Glycosylated Hemoglobin A1C (assesses glycemic control and est. baseline) 2. review self-monitoring blood glucose level 3. assess for falsification of results 4. apply nursing diagnoses (need for health teaching, anxiety, grieving, decreased ability to cope, decreased adherence, decreased self-esteem, risk of injury to fetus, risk of injury to mother

Levels of ultrasonography

1. standard (basic) - most frequent for fetal presentation, AFV, cardiac activity, placental position, fetal growth parameters, number of fetuses, used for anatomic survey (can be done by nurse with special training) 2. limited - determines specific info about pregnancy like fetal presentation during labor or AFV (done by OB or in L&D unit) 3. Specialized (detailed or targeted) - done when anatomic or physiological abnormality is suspected (done by highly trained and experienced personnel)

The nurse is instruction a childbirth class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths/min. Which should the patient's rate be while performing slow-placed breathing techniques?

11 breaths/min The ideal rate for slow-paced breathing is half the normal breathing rate. Because her baseline respiratory rate is 22 breaths/min, the ideal breathign rate for slow paced breathing is 11 breaths/min

Normal fetal heart rate

110-160 bpm

The nurse is assessing the fetal heart rate (FHR) in a pregnant patient with diabetes during the first stage of labor. At which time intervals should the nurse perform FHR tracing?

15 minutes Diabetes is a risk factor in pregnancy. If any risk factors are present, the FHR tracing should be evaluated more frequently (every 15 minutes) in the first stage of labor and every 5 minutes in the second stage of labor. FHR should not be evaluated every hour in either low-risk or high-risk patients. In low-risk patients the FHR tracing should be evaluated for every 30 minutes during the first stage of labor.

fourth stage of labor

2 hours post delivery of the placenta until woman's condition is stable

Place the steps in the order in which they would be applied to perform Leopold maneuvers. 1) palpate suprapubic area to confirm presentation 2) palapte uterine fundus 3) palpate for fetal back 4) determine if head is flexed (vertex) or extended (face)

2, 3, 1, 4 • Leopold maneuvers are performed to identify fetal presentation and position and to help the nurse locate the fetal back, which is the area of maximal intensity for the fetal heart rate. The nurse first palpates the uterine fundus, then palpates for the fetal back. Then the nurse palpates the suprapubic area to confirm presentation. The nurse would finally determine if the head is flexed or extended.

Preterm baby is considered born between ________.

20 0/7 to 36 6/7 weeks Very preterm <32 Moderate 32-34 Late preterm 34-36 6/7

The nurse is assessing a pregnant patient during labor and reports the normal duration of the contraction period as 2 minutes, 15 seconds in a span of 10 minutes. Which is the number of contractions observed in this span of 10 minutes? Record your answer using a whole number.

3 In a pregnant patient the normal range of uterine contractions (UCs) during labor are noted to be 2 to 5 in every 10 minutes. Each one contraction lasts from 45 to 80 seconds. Therefore, when the nurse reports the contraction period as 2 minutes, 15 seconds (135 seconds) in 10 minutes of time, the nurse should have observed 135/45 = 3 contractions.

List relevant patient cues in the order the nurse recognizes them in a primipara during labor as the patient progresses from the first stage of labor to the second stage of labor. 1. cervix is 6 cm dilated 2. contractions become closer and coordinated 3. patient wakes up and feels mild contractions at home 4. patient has bloody show and reports rectal pressure 5. cervix is thick and 50% effaced on assessment at the hospital

3, 5, 2, 1, 4 • The relevant patient cues the nurse recognizes as the patient progresses from the first stage of labor to the second stage of labor in order would be feeling mild contractions at home, then the cervix is thick and 50% effaced on assessment at the hospital. Next the contractions become closer and coordinated and then the cervix is 6 cm dilated. And the then the patient has bloody show and reports rectal pressure.

The nurse is caring for a pregnant patient during labor and documents the strength of uterine contractions (UCs) as "mild" after palpating the patient's abdomen. Which reading by the intrauterine pressure catheter (IUPC) is consistent with the strength of the UCs as assessed by the nurse?

40 mm Hg The UCs a reassessed by palpating the patient's abdomen and reported as mild, moderate, or strong. The IUPC is an internal mode used to assess uterine activity, (UA). The IUPC reading of less than 50 mm Hg is indicative of mild UCs. IUPC readings greater than 50 mm Hg are reported as moderate or strong after palpation .

Arrange the cardinal movements in order of their occurrence 1. internal rotation 2. extension 3. descent 4. flexion 5. restitution 6. engagement

6, 3, 4, 1, 2, 5 • the cardinal movements that occur in a vertex presentation are engagement, descent, flexion, internal rotation, extension, restitution (external rotation), and finally birth by expulsion. The fetal head is said to be engaged in the pelvic inlet when the biparietal diameter of the head passes through the pelvic inlet. During descent, the presenting part progresses through the pelvis. As soon as the descending head meets resistance from the cervix or pelvic wall or pelvic flood, it undergoes flexion. The fetus flexes such that the chin is brought into closer contact with the fetal chest. Internal rotation begins at the level of the ischial spines but is not completed until the presenting part reaches the lower pelvis. When the fetal head reaches the perineum for birth, it undergoes extension. It is deflected anteriorly by the perineum. Restitution occurs after the head is born. It rotates briefly to the position it occupied when it was engaged in the inlet

The nurse has performed vibroacoustic stimulation and determines that the fetal heart rate (FHR) has increased by 1 5 beats/min from the baseline for 15 seconds. Which condition does this acceleration indicate?

A normal pH level in the fetus FHR acceleration by about 15 beats/min in 15 seconds on vibroacoustic stimulation indicates a normal blood pH of the fetus. A decreased pH and elevated carbon dioxide pressure indicate respiratory acidemia. Therefore, FHR acceleration is not indicative of either respiratory acidemia or mixed acidemia in the fetus. The umbilical cord acid-base method involves the determination of both the carbon dioxide pressure and the oxygen pressure of the fetus.

A G5/P4 is experiencing painful contractions that start in her back every 10 minutes for the last hour. How would the telephone triage nurse advise this woman? A) advise the patient to report to the hospital for labor and delivery B) tell the patient to call an ambulance C) instruct the woman to come to the hospital when the contractions are every 5 minutes D) inform the patient that she is experiencing Braxton Hicks contractions

A)

The nurse admitting a patient for preeclampsia notes that the patient's platelet count is 95,000. Which additional laboratory result would support the diagnosis of HELLP syndrome? A) elevated AST/ALT B) low hemoglobin C) increased GFR D) decreased serum lactate (LD)

A)

The nurse is completing a medication reconciliation for a pregnant patient with chronic hypertension. Which medication would cause the nurse to alert the HCP? A) captopril (ACE inhibitor) 25 mg bid B) labetalol (BB) 200 mg tid C) nifedipine (CCB) 30 mg qd D) oral (PO) hydralazine (vasodilator) 25 mg tid

A)

Which of the following is appropriate nursing care for a client in the second stage of labor? A) Perform frequent maternal vital signs, frequent fetal heart rate assessments, and assess for signs of fetal descent. B) Assist the client with ambulation when they feel the need to have a bowel movement C) Report any shivering to the CNM or physician immediately as this is a sign of a major complication in the second stage. D) Continue to perform cervical exams to assess for progressive dilation

A)

Which passenger position would interfere with a safe vaginal birth? A) transverse fetal lie B) flexed fetal head C) cephalic presentation D) longitudinal fetal lie

A)

Which sign would lead the nurse to suspect ectopic pregnancy in a patient with a missed period? A) severe, localized abdominal pain in the left lower abdominal quadrant B) vaginal bleeding after intercourse C) nausea and vomiting D) painless, bright-red vaginal bleeding

A)

which investigation would the nurse suggest for a patient in the 6th month of pregnancy who expresses her wish to see the fetus? A) ultrasonography B) nuchal translucency (NT) C) computed tomography (CT) D) magnetic resonance imaging (MRI)

A) • 3-dimenstional (3D) or 4-dimensional (4D) US is adviseable for women who want to see the fetus. MRI cannot be used in this case because it requires the fetus to be still for a long period of time for a clear image. CT uses ionizing radiation for imaging, which can be harmful to the fetus. therefore CT is contraindicated for fetal imaging. NT is a specific ultrasonography screening procedure used to test for genetic abnormalities in the fetus

While awaiting the delivery of the placenta in the third stage of labor, the nurse observes a large gush of blood and an increase in the length of the umbilical cord. Which event would the nurse recognize has probably occurred? A) placental separation from the uterine wall B) placental abruption C) umbilical cord detachment from the placenta D) postpartum hemorrhage as a result of retained placenta

A) • A large gush of blood and an increase in the length of the umbilical cord are signs of placental separation from the uterine wall. Placental abruption happens during labor or pregnancy and is when the placenta prematurely separates from the uterine wall. Umbilical cord detachment is a medical emergency and usually results when too much tension is placed on the umbilical cord. When the placenta is retained, these signs are not observed. These are signs of normal placental separation.

On assessment, the nurse notices that the fetal heart rate (FHR) is 100 beats/min. Which is a possible cause for this condition? A) maternal hypoglycemia B) chorioamnionitis C) low fetal oxygen supply D) decreased fetal hemoglobin levels

A) • An FHR of less than 110 beats/min is referred to as bradycardia. Maternal hypoglycemia is a common cause of bradycardia in the fetus. Chorioamnionitis is an infection that also causes tachycardia in the fetus. Hypoxemia and anemia (decreased hemoglobin) of the fetus cause tachycardia in which the heart rate is more than 160 beats/min

Which maternal physiologic change may occur for a patient in the first stage of labor? A) decrease in absorption of solid food B) increase in systolic and diastolic pressures C) increase in nausea and vomiting sensation D) increase in cardiac output by 30-50%

A) • During the first stage of labor, gastrointestinal motility and absorption of solid foods are decreased, and stomach-emptying time is slowed down. Only systolic BP increases during uterine contractions in the 1st stage of labor. Systolic and diastolic pressures increase during contractions in the 2nd stage of labor and return to baseline levels between contractions. Nausea and vomiting sensations may occur during the transition from the 1st stage to 2nd stage of labor. In the 1st stage of labor, the cardiac output increases by 10% to 15%. Cardiac output increases by 30-50% only at the end of the first stage of labor and not in the first stage

A patient in latent labor who is positive for opiates on a urine drug screen is complaining of severe pain. Maternal VS are stable, and the fetal heart monitor displays a reassuring pattern. Which is the nurse's most appropriate analgesic for pain control? A) fentanyl B) promethazine C) butorphanol tartrate D) nalbuphine

A) • Fentanyl is a commonly used opioid agonist analgesic for patients in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Promethazine is not an analgesic, it is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drug's undesirable effects. Butorphanol tartrate is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nalbuphine is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use.

Which method of anesthesia in labor is considered safest for the fetus? A) local infiltration B) epidural block C) spinal block D) combined spinal-epidural (CSE) block

A) • Local anesthesia rarely has any adverse effects on either the laboring woman or fetus.Maternal hypotension associated with epidural administration can affect the fetus and cause bradycardia.

The nurse would be aware of which strength and limitation of various biochemical assessments during pregnancy? A) maternal serum alpha-fetoprotein (AFP) is a screening tool only; it identifies candidates for more definitive procedures B) chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis C) percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for down syndrome D) screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects

A) • MSAFP is a screening tool, not a diagnostic tool. further diagnostic testing is indicated after an abnormal MSAFP. CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for down syndrome

which information would the nurse give when preparing a patient for a transvaginal ultrasonography? A) there is no pain felt during TVUS B) there is no pressure felt during TVUS C) the patient needs to be in semi-fowler position for the test D) the patient needs to drink lots of fluids to keep the bladder full before the test

A) • TVUS is a painless procedure in which a transducer probe is inserted into the vagina & the pelvic anatomic features are evaluated. the patient is positioned in lithotomy position, not semi-fowler position. this helps in proper insertion of the probe. intake of large amounts of fluids is generally recommended for transabdominal US but not for TVUS. some pressure is felt on the vaginal walls as the transducer probe is moved to get a complete view of the pelvis

The nurse finds that the resting tone of the uterus of a pregnant patient is 30 mm Hg. Under which circumstance is this finding normal? A) when an amnioinfusion is administered to the patient B) when oxytocin (Pitocin) has been given to the patient C) when a blood sample is obtained from the fetal scalp D) when the blood sample is testing for umbilical acid-base

A) • The average resting tone of the uterus is 10 mmHg. When an amnioinfusion is done, the patient's uterine resting tone increases up to 40 mmHg because of resistance to outflow of the fluid or turbulence of the catheter. Oxytocin (Pitocin) increases uterine activity (UA) but does not increase the resting tone of the uterus. Neither fetal scalp blood sampling nor umbilical cord sampling will have any effect on the resting tone of the uterus.

After assessment of an actively laboring woman, the nurse finds a fetal heart rate (FHR) of 180 beats/min with contractions occurring less than 2 minutes apart and lasting more than 90 seconds. Which action would the nurse take next? A) reposition the patient to her side and alert the HCP B) nothing, these are normal findings C) prepare for emergency cesarean delivery D) reposition the patient only

A) • These findings are indicative of tachysystole and incomplete uterine relaxation, which can lead to fetal compromise. Lateral positioning allows for optimal placental perfusion. The health care provider will need to evaluate this patient at the bedside. Although these findings are not normal, there are things that can be done to correct them before emergent cesarean delivery.

The nurse is helping a pregnant patient during labor by applying fundal pressure. Which alteration in the FHR pattern may result from this intervention? A) early decelerations B) late decelerations C) variable decelerations D) prolonged decelerations

A) • applying fundal pressure can cause fetal head compression and may cause early decelerations in FHR. Disruption of oxygen transfer from the maternal environment to the fetus may result in late decelerations. Variable decelerations may be observed as a result of umbilical cord compression. If the mechanisms responsible for late or variable decelerations last for an extended period, then they cause prolonged decelerations.

The nurse is teaching about the use of primrose oil to a pregnant patient. Which statement would the nurse include in the teaching? A) primrose oil helps ripen the cervix B) primrose oil helps prevent vaginal infections C) primrose oil helps reduce the risk of preterm labor D) primrose oil helps improve uterine contractions (UCs)

A) • evening primrose oil is an alternative method used to ripen the cervix of a pregnant patient before labor. Maintaining good hygiene conditions and cleaning the vaginal region regularly prevent vaginal infections. Premature labor risk is not reduced by primrose oil, because it usually occurs because of the rupturing of membranes prematurely. UCs or labor stimulations are improved by using castor oil

Fetal well-being during labor is assessed by which factor? A) the response of the FHR to uterine contractions (UCs) B) maternal pain control C) accelerations in the FHR D) a FHR greater than 110 beats/min

A) • fetal well-being during labor is measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline int he range of 110-160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being.

Which action will the nurse take to determine whether the carbohydrate intake is inadequate in a pregnant patient with diabetes? A) monitor for urine ketones B) evaluate the nonstress test results C) determine the degree of glycosuria D) schedule a baseline fetal sonogram

A) • if a patient with diabetes does not take in enough carbohydrates, the body resorts to breaking down fats for energy. the by-product of fat metabolism is ketones. therefore the nurse monitors the urine for ketones. the amount of ketones in the urine helps detect inadequate carbohydrate intake. nonstress tests will help assess the well-being of the fetus. glycosuria does not accurately reflect the blood glucose levels because of a lowered renal threshold for glucose during pregnancy. the nurse obtains a baseline sonogram to assess gestational age in the 1st trimester

which are indicators for performing a contraction stress test? A) maternal DM & postmaturity B) adolescent pregnancy & poor prenatal care C) increased fetal movement & small for gestational age D) history of preterm labor & intrauterine growth restriction

A) • maternal DM & post maturity are 2 indications for performing a contraction stress test. decreased fetal movement is an indictor for performing a contraction stress test; the size (small for gestational age) is not an indicator. although adolescent pregnancy & poor prenatal care are risk factors for poor fetal outcomes, they are not indicators for performing a contraction stress test. intrauterine growth restriction is an indicator, but history of a previous stillbirth (not preterm labor) is the other indicator

In caring for the patient with disseminated intravascular coagulation (DIC), which order should the nurse anticipate? A) administration of blood B) preparation of the patient for invasive hemodynamic monitoring C) restriction of IV fluids D) administration of steroids

A) • primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because this can contribute to more areas of bleeding. Management of DIC includes volume replacement, not volume restriction. Steroids are not indicated for the management of DIC

A patient is prescribed lamotrigine for bipolar depression. Which patient teaching statement made by the nurse is accurate regarding lamotrigine and preganncy A) serum levels should be monitored in the second & third trimesters B) this medication is a high alert & not recommended for use in pregnancy C) the dose should be decreased between 24-48 hours prior to delivery D) lamotrigine causes known effects in newborns, including floppy baby syndrome, hypothyroid, poor feeding, & developmental delays

A) • rationale: serum levels monitored in the 2nd & 3rd trimesters due to increased renal clearance lamotrigine is preferred to other medications in pregnancy for the treatment of bipolar depression lithium, not lamotrigine, should be decreased between 24-48 hours prior to delivery lithium, not lamotrigine, causes known effects in newborns, including floppy baby syndrome, hypothyroid, poor feeding, & developmental delays

a pregnant woman is yawning excessively, is diaphoretic, and is experiencing nausea, vomiting, diaphoreses, and diarrhea. the nurse suspects that the woman may be withdrawing from which substance? A) opioids B) alcohol C) cocaine D) marijuana

A) • rationale: symptoms of opioid withdrawal include yawning, diaphoresis, rhinorrhea, restlessness, tearing of the eyes, nausea, vomiting, and abdominal cramps symptoms of alcohol withdrawal may include irritability, tachycardia, seizures, delirium, and altered LOC symptoms of cocaine withdrawal can include agitation, irritability, cravings, and rarely, paranoia marijuana does not have characteristic symptoms of withdrawal in most patients

which action should the nurse take when a pregnant patient with bulimia nervosa presents to the office with tachycardia & orthostatic hypotension? A) alert the HCP & consider hospitalization B) nothing; these are expected abnormal findings C) advise the patient to rest & retake the VS in 10 minutes D) encourage vitamin B12 & calcium supplementation

A) • rationale: tachycardia & orthostatic hypotension are indicative of severe malnutrition & dehydration requiring hospitalization monitoring the patient is necessary, but immediate action is required supplementation will not treat these symptoms

The nurse palpates the fontanels and sutures to determine the fetal presentation. Which is the prominent feature of the anterior fontanel? A) it is diamond shaped in appearance B) it measures about 1 cm by 2 cm C) it closes after 6-8 weeks of birth D) it lies near the occipital bone

A) • the anterior fontanel is diamond shaped and measures about 3 cm by 2 cm. It closes by 18 months after birth. It lies at the junction of the sagittal, coronal, and frontal sutures. The posterior fontanel is triangular in shape and measures about 1 cm by 2 cm. It closes 6-8 weeks after birth. It lies at the junction of the sutures of the 2 parietal bones and the occipital bone

While caring for a patient who is treated with terbutaline, the nurse tries to reduce the pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant? A) suggesting that the patient lie on her side B) infusing Ringer's lactate solution IV C) increasing the terbutaline concentration D) encouraging drinking a full glass of water periodically

A) • the nurse should suggest that the patient lie on her side because this enhances placental perfusion and reduces pressure on the cervix. LR solution is infused when amniotic fluid levels are lowered in a pregnant patient. Nurses should not increase the terbutaline concentration. This may cause adverse effects and can be fatal to the mother and the fetus. Water intake prevents dehydration during labor, but it does not reduce pressure on the cervix

The nurse is caring for a pregnant patient. Which intervention does the nurse follow to ensure proper hygiene in the patient? A) clean the perineum of the patient frequently B) clean the patient's teeth with a warm wet cloth C) offer a warm washcloth to the patient for a face wash D) allow cool water to flow on the patient's back for 5 minutes

A) • the patient's perineum should be cleaned frequently to prevent the risk for infection. this helps maintain proper hygiene and provides comfort to the patient. the nurse can clean the patient's teeth with an ice-cold wet washcloth, which helps prevent a feeling of thirst and dryness of the mouth. using a warm cloth may not be helpful. the patient is offered a cool cloth for wiping her face, which helps prevent diaphoresis. warm water should be poured on the patient's back to provide relaxation and accelerate labor. using a warm washcloth for a face wash and placing cool water on the patient's back will not help in providing comfort

On interacting with the partner of a pregnant patient, the nurse suggests that the partner soothe the patient's forehead, palms of her hands, and soles of her feet. Which patient observation could be the possible reason for such advice to the partner? A) hyperesthesia B) flushing of cheeks C) bladder distention D) postural hypotension

A) • the pregnant patient becomes more sensitive to touch as the labor progresses. This condition is called hyperesthesia. Soothing the surfaces of the body where hair does not grow can reduce this sensitivity. these areas include the patient's forehead, palms, soles of the feet. Flushed cheeks appear to be normal in the later phase. Soothing the patient's forehead does not reduce flushing of the patient's cheeks. the advice of soothing the patient's forehead, palms, and soles is not a suitable intervention to reduce bladder distention. additionally, postural hypotension is not resolved by soothing the patient; it is reduced by placing a pillow under the patient's hips

In an umbilical cord acid-base report, which value determines placental function? A) umbilical vein report B) umbilical artery report C) amniotic fluid concentration D) blood glucose concentration

A) • the umbilical acid-base report helps determine the immediate condition of the newborn after birth. The nurse should check the umbilical vein report to determine the placental functioning of the patient. The placental function would help to assess the nutritional status of the newborn baby. The umbilical artery report is used to determine the physiologic functioning of the newborn. Amniotic fluid concentrations are monitored during labor, but not after birth. Blood glucose levels in the fetus are not assessed with the umbilical cord test.

When managing the care of a patient in the 2nd stage of labor, the nurse uses various measures to enhance the progress of fetal descent. Which measure does the nurse include? A) encouraging the woman to try various upright positions, including squatting and standing B) telling the woman to start pushing as soon as her cervix is fully dilated C) continuing an epidural anesthetic so that pain is reduced, and the woman can relax D) coaching the woman to use sustained, 10-15 second, closed-glottis bearing-down efforts with each contraction

A) • upright positions and squatting may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only 1 factor. If the fetal head is still in a higher pelvic station the HCP may allow the woman to "labor down" (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if she is able. The epidural may mask the sensations and muscle control needed for the woman to push effectively. Close-glottic breathing may trigger Valsalva maneuver, which increases intrathoracic and CV pressure, reducing CO and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5-7 seconds diminishes the perfusion of oxygen across the placenta, resulting in fetal hypoxia

A nurse caring for a patient immediately postpartum after a precipitate labor would monitor the patient for which possible postpartum complication related to her precipitate labor? A) retained placenta B) infection C) low Apgar scores D) postpartum depression

A) • A patient who experiences precipitate labor is at increased risk for retained placenta secondary to a rapid delivery. A patient who experiences prolonged labor is at increased risk for infection. A baby who experiences prolonged labor is at increased risk for low Apgar scores. Precipitate labor does not increase a woman's risk for postpartum depression.

A G1/P0 gestational diabetic mother is undergoing induction of labor. She is in her 39th week of gestation, and she has been diagnosed with polyhydramnios. The nurse recognizes which patient cue as a risk factor for umbilical cord prolapse? A) polyhydramnios B) being a primigravida C) gestational diabetes D) term gestation

A) • An excessive amount of amniotic fluid, as with polyhydramnios, increases the risk for umbilical cord prolapse in labor. Primigravidas do not have an increased risk for umbilical cord prolapse. Gestational diabetes increases a patient's risk for a large infant, among other things, but does not increase the risk for umbilical cord prolapse. Term gestation is not a risk for umbilical cord prolapse.

Which intervention by the health care team will decrease the risk of infection for a patient with preterm premature rupture of membranes during labor, delivery, and the postpartum period? A) avoiding frequent vaginal examinations to check for cervical dilation B) inserting an indwelling urinary catheter to measure UO C) checking maternal temperature every 12 hours D) using clean technique when performing speculum examinations

A) • Avoiding frequent vaginal examinations, once the membranes are ruptured, helps prevent the introduction of pathogenic bacteria to the vagina and uterus, which may infect the mother or fetus. In most patients, urinary output can be measured without a urinary catheter. Maternal temperature should be checked at least every 2 hours to help detect any infection. Sterile technique should be utilized for any internal examinations for a patient with preterm premature rupture of membranes to help prevent infection.

A G4/P3 patient experiencing precipitate labor presents to the labor wing fully dilated and at +1 station stating that she feels a strong, involuntary urge to push. Which immediate intervention would the nurse take? A) encourage the patient to push in a side-lying position B) initiate an oxytocin infusion to prevent postpartum hemorrhage C) assess for umbilical cord prolapse D) allow the fetus to rest and descend until birth is imminent

A) • Birth is imminent, and the nurse is responsible for assisting with a safe delivery. A side-lying position enhances placental blood flow and reduces the effects of aortocaval compression associated with a supine position. Side lying slows the rapid fetal descent and minimizes perineal tears. Oxytocin is not indicated before the birth of this infant, and initiating the infusion may even cause harm. Umbilical cord prolapse, although very serious, is also rare. The priority at this time is to assist with a safe delivery in a safe position for the mother and baby. The patient is experiencing an involuntary urge to push, which suggests birth is already imminent.

Which education would the nurse provide a patient who is worried that the intrauterine catheter will hurt the baby? A) the catheter is placed in the uterus next to the baby B) don't be nervous; everything will be fine! C) the catheter attaches only to the outer layer of skin on the baby's head D) this is the equipment needed for high-risk pregnancies

A) • By providing information about the safety and location of the catheter, the nurse can decrease the patient's anxiety and provide reassurance. When explaining equipment use, the nurse would not try to pacify the patient but rather would use a response that validates or reassures the patient. The intrauterine catheter does not attach to the fetal scalp. The fetal scalp electrode attaches to the fetal scalp. In explaining the equipment use to a patient, the nurse would avoid calling a pregnancy high-risk, even if it truly is high-risk, to avoid causing further anxiety.

Which kind of anesthesia may be necessary for a patient who is to have an emergency cesarean birth due to fetal distress? A) general anesthesia B) pudendal nerve block C) nitrous oxide with oxygen D) local infiltration anesthesia

A) • General anesthesia may be necessary if indications necessitate rapid birth (vaginal or emergent cesarean) when there is a pressing need for time and/or primary health care providers to perform a block. Pudendal nerve block is administered late in the 2nd stage of labor. It may be required if an episiotomy is to be performed or if forceps or a vacuum extractor is to be used to facilitate birth. Nitrous oxide mixed with oxygen can be inhaled in 50% or less concentration to provide analgesia during the 1st and 2nd stages of labor. Local infiltration anesthesia may be used when an episiotomy is to be performed or when lacerations must be sutured after birth in a woman who does not have regional anesthesia.

Which of the following is the purpose for giving antenatal glucocorticoid IM injections to a pregnant client? A) to accelerate fetal lung maturity by stimulating fetal surfactant production B) To decrease the sensitivity of the central nervous system and prevent seizure C) To decrease the amniotic fluid volume before labor begins D) To stop uterine contractions

A) • Glucocorticoids are given to the client to accelerate fetal lung maturity by stimulating fetal surfactant production

After reviewing the laboratory reports of a pregnant patient at term, the primary health care provider (PHP) advises the nurse to administer IV fluids to the patient. Which is the reason for this? A) dehydration B) hypertension C) maternal hyperglycemic D) preterm labor

A) • IV fluids are administered to increase the amount of fluids and restore the electrolyte balance. As the patient is dehydrated, the PHP advises the nurse to administer IV fluids. Administration of IV fluids as a medical treatment for the prevention of preterm labor is not indicated unless medical management involves the use of therapeutic protocols such as magnesium sulfate. As the patient is at term, preterm labor would not be a factor. Adminsitering fluids may increase the venous pressure thereby enhancing BP. Other prospective medical management should be initiated if maternal hypertension is noted. IV fluids should not be administered to hyperglycemic patients, but rather other prospective medical management should be initiated.

When the nurse notes a prolapsed umbilical cord, after calling for assistance to notify the team, the nurse should next A) don a glove and insert two fingers vaginally to elevate the presenting part B) Encourage the woman to push to see if contractions with pushing efforts will result in delivery and relief on the cord. C) Move the client immediately to the operating room D) Insert an IV and begin oxygen administration

A) • It is not in the scope of practice of the RN to decide when pushing efforts should begin. If the RN did this in this situation, there would be more pressure on the cord and further decreased blood flow.

A woman in labor has been having regular contractions but has remained 5 cm dilated for 5 hours, with a reassuring fetal heart rate. Which intervention may be necessary for this patient? A) labor augmentation B) cesarean delivery C) vacuum-assisted delivery D) intrauterine resuscitation

A) • Labor augmentation may be necessary when labor progress has stopped or slowed. If there is no fetal or maternal indication, cesarean delivery is not yet indicated. The need for vacuum-assisted delivery cannot be determined at this point in this patient's labor. Intrauterine resuscitation is only indicated with a nonreassuring fetal heart rate.

While evaluating an external monitor tracing of a woman who just received regional analgesia for pain management, the nurse notes recurrent late decelerations. Which action should the nurse take next? A) change the woman's position B) notify the obstetric provider C) assist with amnioinfusion D) rupture the membranes and insert a scalp electrode

A) • Late decelerations may be caused by maternal supine hypotension syndrome. They may be corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava.If the fetus does not respond to primary nursing interventions for late decelerations (changing the woman's position), the nurse should continue with subsequent intrauterine resuscitation measures, including notifying the obstetric provider.An amnioinfusion may be used to relieve pressure on an umbilical cord that has not prolapsed. The fetal heart rate (FHR) pattern associated with this situation most likely reveals variable decelerations.A fetal scalp electrode would provide accurate data for evaluating the well-being of the fetus; however, this is not a nursing intervention that would alleviate late decelerations, nor is it the nurse's first priority.

Which assessment is most important to monitor after the administration of epidural anesthesia? A) maternal BP B) fetal BP C) platelet count D) respiratory rate

A) • Maternal hypotension may occur after administration of epidural anesthesia; therefore, the nurse must have an accurate maternal BP reading for several minutes after the epidural is placed.Fetal BP is not monitored; fetal heart rate would be monitored after the administration of epidural anesthesia.The platelet count should be collected before administration of epidural anesthesia, not after administration.The respiratory rate is important to monitor after administration of a combined spinal epidural (CSE), in which an opioid is used as a component of the pain relief.

What is the purpose of the McRoberts maneuver? A) Facilitating the delivery of the fetal shoulder by changing the relationship of the maternal pelvis to the lumbar spine. B) The process of placing the client in the Trendelenburg position to facilitate delivery C) Neonatal resuscitation efforts designed to increase fetal surfactant production D) Deep suction techniques that are required in the presence of meconium stained amniotic fluid at birth

A) • McRoberts maneuver is used with nursing assistance to facilitate the delivery of the fetus during a shoulder dystocia. The nurse hyperflexes the maternal legs onto the abdomen. This opens the pelvis and changes the relationship of the pelvis to the maternal lumbar spine, facilitating delivery.

A 36-week gestation patient presents with membranes grossly ruptured and is not contracting. Which diagnosis does the nurse anticipate? A) preterm premature rupture of membranes (PPROM) B) preterm labor (PTL) C) premature rupture of membranes (PROM) D) AROM

A) • PPROM is PROM that occurs before 36 weeks of gestation. Contractions may or may not be present. PPROM is often associated with PTL, with the greatest risks from preterm birth occurring before completing 34 weeks of gestation (ACOG, 2016). Preterm labor is labor that begins after the 20th week but before the end of the 37th week of pregnancy. To be considered labor, a patient should be making progressive, cervical change. PROM is rupture of the amniotic sac before the onset of true labor. This can occur at any week of gestation. PPROM, however, refers to rupture before the onset of labor at 37 weeks or greater (term). This is preterm, so an additional "P" is required. This is artificial rupture of the membranes, also known as amniotomy.

When administering nifedipine for tocolysis, it is important for the nurse to monitor for which serious side effect? A) reflex tachycardia B) hyperglycemia C) change in fundal height D) bradypnea

A) • Reflex tachycardia (maternal pulse greater than 120) can occur with large doses of nifedipine. Hyperglycemia can occur with corticosteroids and should be administered with caution in diabetics and individuals with renal failure. Indomethacin can cause a decrease in amniotic fluid and therefore fundal height may be monitored. Magnesium sulfate, a central nervous system depressant can cause bradypnea.

Which of the following is an important nursing consideration after a client undergoes an amniotomy procedure? A) Monitor fetal heart rate and take the maternal temperature at least every 2 hours after the procedure B) Monitor for maternal heart rate and respirations at least every 30 minutes after the procedure C) Monitor for fetal increase in movement and assess the maternal blood pressure at least every hour after the procedure D) Monitor for maternal bradycardia and orthostatic hypotension at least every hour after the procedure

A) • The FHR must be monitored closely after the procedure due to the increased risk for cord prolapse after amniotomy. Amniotomy also breaks the barrier for infection, so monitoring for maternal fever as a sign of infection is indicated at least every 2 hours once the membranes rupture

The nurse is caring for a pregnant patient during labor and documents the strength of uterine contractions (UCs) as "mild" after palpating the patient's abdomen. Which reading by the IUPC is consistent with the strength of the UCs as assessed by the nurse? A) 40 mmHg B) 60 mmHg C) 80 mmHg D) 100 mmHg

A) • The UCs are assessed by palpating the patient's abdomen and reported as mild, moderate, or strong. The IUPC is an internal mode used to assess uterine activity (UA). The IUPC reading of less than 50 mmHg is indicative of mild UCs. IUPC readings greater than 50 mmHg are reported as moderate or strong after palpation.

Which of the following complications has the lowest rate of maternal survival? A) amniotic fluid embolus B) shoulder dystocia C) vaginal birth after cesarean (VBAC) D) meconium-stained amniotic fluid

A) • The combination of sudden respiratory and cardiovascular collapse along with coagulopathy make the symptoms of AFE seem similar to anaphylaxis. If clients survive the event, they are likely placed on ventilator support in the ICU.

In the fourth stage of labor, the nurse monitors the hemodynamic stability of the postpartum patient through which assessment? A) obtaining maternal VS every 15 minutes in the first postpartum hour B) assessing the couplet for bonding C) obtaining maternal VS every 30 minutes in the first postpartum hour D) assessing the color, amount and odor of urine after the first void

A) • The maternal pulse, blood pressure, and respiratory rate should be assessed and documented every 15 minutes in the fourth stage of labor. Bonding does not provide an indication of maternal hemodynamic stability. The character and quality of the urine are not necessarily indicative of hemodynamic stability in the fourth stage of labor.

Which intervention will the nurse perform while caring for a patient is set to receive spinal anesthesia? A) assess maternal VS B) monitor for signs of toxicity C) keep side rails up on the bed D) have oxygen readily available

A) • The nurse must assess maternal VS, level of hydration, labor progress, and fetal heart rate and pattern before the procedure is initiated. This helps to prepare for a possible emergency. When the procedure is initiated, the nurse ensures that oxygen and suction are readily available to ensure airway at all times. While the anesthesia is in effect, the nurse must monitor the patient for signs of toxicity and keep the side rails up on the bed to ensure patient safety

The nurse caring for a patient with a history of a previous cesarean delivery notes a small incision scar on the patient's bikini line (transverse). The patient asks the nurse if a trial of labor will be possible. Which response would the nurse provide? A) "Transverse uterine incisions allow for vaginal births, but the skin and uterine incisions do not always match, so we will have to verify." B) "You have a transverse skin incision, so that means you also have a transverse uterine incision and a trial of labor is possible." C) "Because you have a transverse skin incision, there is a greater chance of having a uterine incision rupture with labor." D) "It is never safe to have a vaginal birth after a cesarean delivery."

A) • The nurse needs to verify the type of incision on the uterus because it may not match the skin incision. Skin incisions and uterine incisions may be different. It is important to verify before labor onset. Vertical skin and uterine incisions have a greater risk for uterine incision rupture. If the conditions are favorable, it is possible to have a safe vaginal birth after cesarean delivery.

Which statement regarding pain experienced during labor is accurate? A) the predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen B) referred pain is the extreme discomfort between contractions C) the somatic pain of the second stage of labor is more generalized and related to fatigue D) pain during the third stage is a somewhat milder version of the second stage

A) • This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia. Referred pain occurs when the pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, and gluteal area. Second-stage labor pain is intense, sharp, burning, and localized. Third-stage labor pain is similar to that of the first stage

A G1/P0 patient arrives for elective induction of labor at 39 weeks and is 1 to 2 cm dilated and 50% effaced. The fetal station is −3 with a posterior and firm cervix. Which order is mostappropriate based on this patient's Bishop score? A) discharge home with follow up in 1 week at the office B) administer oxytocin and titrate per protocol C) assist with amniotomy and initiate oxytocin as prescribed D) initiate electronic fetal monitoring and insert peripheral IV device

A) • This patient has a very low Bishop score, is a primigravida, and is only at 39 weeks gestation. The most appropriate action would be to reevaluate in 1 week because her risk for cesarean delivery is increased based on her Bishop score. This patient would need cervical ripening before oxytocin administration if the health care provider determined the benefits of induction outweighed the risks. Amniotomy is not indicated, and cervical ripening should be initiated before oxytocin administration. The most appropriate action would not be to continue to monitor the patient, because it is not medically indicated. The patient has a higher risk for cesarean delivery if induction of labor is initiated during this encounter.

when would the nurse refer the patient for US to detect maternal abnormalities that could affect the fetus? A) 1st trimester B) 3rd trimester C) 2nd trimester D) 2nd & 3rd trimesters

A) • US is performed in the 1st trimester to detect maternal abnormalities such as bicornuate uterus, ovarian cysts, & fibroids. in the 2nd trimester, US is usually performed to detect congenital abnormalities & conditions such as polyhydramnios & oligohydramnios. in the 3rd trimester, US is used for visualization during amniocentesis & to measure gestational age. in the 2nd & 3rd trimesters, US is used mostly to observe the fetal growth pattern

Which fetal condition can cause a fetal heart rate (FHR) of <60 beats/min for more than 60 seconds that does not quickly return to baseline? A) cord compression B) fetal head compression C) uteroplacental insufficiency D) no compromise; variable decelerations are normal

A) • Variable decelerations that last a long time and do not quickly return to baseline can occur with cord compression, which could compromise the fetus. Early, not variable, decelerations can indicate fetal head compression. Late, not variable, decelerations can indicate uteroplacental insufficiency. Variable decelerations are nonreassuring and not normal.

Which pelvic type is most common for vaginal birth? A) gynecoid B) platypelloid C) anthropoid D) android

A) • gynecoid is the classic female pelvis and is most common for vaginal birth. Platypelloid is the least common pelvic shape. Anthropoid is an oval-shaped pelvis that favors occiput posterior position. This is the classic male pelvis. Vaginal birth is more difficult with the android pelvic type

Which instruction will the nurse give to the patient who has a high beta hCG level and is on methotrexate therapy for dissolving an abdominal pregnancy? A) avoid sexual activity B) avoid next pregnancy C) avoid feeling sad and low D) take folic acid without fail

A) • high beta hCG levels indicate that the abdominal pregnancy is not yet dissolved. Therefore the nurse advises the patient to avoid sexual activity until the beta hCG levels drop and the pregnancy is dissolved completely. If the patient engages in vaginal intercourse, the pelvic pressure may rupture the mass and cause pain. Abdominal pregnancy increases the chances of infertility or recurrent ectopic pregnancy in patients. However, the nurse need not instruct the patient to avoid further pregnancy, because it may increase the feelings of sadness and guilt in the patient. The nurse encourages the patient to share feelings of guilt or sadness related to pregnancy loss. Folic acid is contraindicated with methotrexate therapy because it may exacerbate ectopic rupture

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temp 37.1C, HR 96, RR 24, BP 155/112, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the HCP, anticipating an order for which medication? A) hydralazine B) magnesium sulfate bolus C) diazepam D) calcium gluconate

A) • hydralazine is an antihypertensive commonly used to treat HTN in severe preeclampsia. An additional bolus of Mg sulfate may be ordered for increasing signs of CNS irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops.

Which finding is considered a component of a category II fetal heart rate (FHR) tracing? A) minimal variability B) moderate variability C) less than 110 beats/min D) presence of accelerations

A) • minimum variability in the FHR indicates that there is insufficient oxygen supply to the fetus. This is categorized as a category II in a three-tier FHR classification system. Moderate variability in FHR indicates the normal cardiac activity of the fetus, which is categorized under category I. Bradycardia (FHR less than 110 beats/min) is categorized under category III. The FHR acceleration is completely absent according to category II and is present in category I.

a primigravida Hispanic patient asks why she needs to be screened for gestational diabetes when she is not a diabetic. which response by the nurse is appropriate? A) many patients with gestational diabetes show no symptoms. it is an important way to help you have a healthy pregnancy B) we test all patients for diabetes because today's diet makes you more likely to get diabetes C) your race makes you more likely to develop gestational diabetes, so we are screening you just in case D) because this is your first pregnancy, we don't know what to expect, so we are going to test you just in case

A) • most patients with gestational diabetes are asymptomatic. for this reason, universal screening is best practice to promote the best pregnancy outcomes although diets are changing in the US, this is not the best reason to test for gestational diabetes. some women with balanced diets go on to develop gestational diabetes some races and ethnicities are at increased risk for developing gestational diabetes. however, everyone is screened for gestational diabetes, so this is not the best response all patients should be screened for gestational diabetes regardless of the number of times that they have been pregnant

which condition would the nurse suspect in a fetus with oligohydramnios? A) potter syndrome B) down syndrome C) twin-twin syndrome D) fetal alcohol syndrome

A) • oligohydramnios means that there is a low amniotic fluid volume (AFV). oligohydramnios is known to cause Potter syndrome. Potter syndrome is the atypical physical appearance of a fetus or a neonate. excessive alcohol intake during pregnancy may cause fetal alcohol syndrome & is not associated with oligohydramnios. down syndrome is a genetic abnormality of the fetus & can be identified using prenatal screening tests such as triple marker screen & quad screen. down syndrome is not associated with oligohydramnios. twin-twin syndrome is associated mainly with polyhydramnios

After being rehydrated in the emergency department for hyperemesis gravidarum, a 24-year-old primipara in her 18th week of pregnancy is discharged home. Discharge teaching at the hospital by the nurse has been effective if the patient makes which statement? A) i am going to eat 5-6 small servings per day, which contain such foods and fluids as tea, crackers, or a few bites of baked potato B) i'm going to stay only on clear fluids for the next 24 hours and then add dairy products like eggs and milk C) as long as i eat small amounts and allow enough time for digestion, i can eat almost anything, like barbequed chicken or spaghetti D) a strip of bacon and a fried egg will really taste good as long as i eat them slowly

A) • once the vomiting has stopped, feedings are started in small amounts at frequent intervals. in the beginning, limited amounts of oral fluids and bland foods such as crackers, toast, or baked chicken are offered. clear fluids alone do not contain enough calories and contain no protein. most women can take nourishment by mouth after several days of treatment. they should be encouraged to eat small, frequent meals and foods that sound appealing (e.g., nongreasy, dry, sweet, and salty foods)

During which phase of labor does passive fetal descent and rotation to an anterior position primarily occur? A) latent B) active C) transition D) second stage

A) • passive fetal descent and rotation to an anterior position primarily occur in the latent phase (early phase) of labor. The 2nd stage of labor lasts from the time the cervix is fully dilated to the birth of the fetus. During the transition and active phases of labor, there is a more rapid dilation of the cervix and increased rate of descent of the presenting fetal part

Which condition is seen in a pregnant patient if uterine artery Doppler measurements in the 2nd trimester of pregnancy are abnormal? A) preeclampsia B) HELLP syndrome C) molar pregnancy D) gestational hypertension

A) • preeclampsia is a condition in which patients develop HTN & proteinuria after 20 weeks of gestation. it can be diagnosed if uterine artery Doppler measurements in the 2nd trimester of pregnancy are abnormal. HELLP syndrome is characterized by hemolysis, elevated liver enzymes, low platelet count in a patient with preeclampsia. Molar pregnancy refers to the growth of the placental trophoblast due to abnormal fertilization. Gestational HTN is a condition in which HTN develops in a patient after 20 weeks of gestation

which factor is known to increase the risk of gestational diabetes mellitus? A) previous birth of large infant B) maternal age younger than 25 C) underweight before pregnancy D) previous diagnosis for type 2 DM

A) • previous birth of a large infant suggests gestational diabetes mellitus. a woman younger than 25 is not at risk for gestational diabetes mellitus. obesity (greater than 90 kg or 198 lb) creates a higher risk for gestational diabetes. the person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy

Which is the MOST significant finding in a urinalysis for a patient with preeclampsia? A) protein B) ketones C) glucose D) leukocytes

A) • protein is a significant finding in a urinalysis for a patient diagnosed with preeclampsia. Normally protein should not be present in the urine. It is reflective of glomerular damage caused by HTN in preeclampsia. Ketones are reflective of nutritional status. Glucose in the urine primarily occurs in the presence of elevated blood glucose. Leukocytes are present when there is inflammation or infection of the urinary tract system

Which of the following is true about fetal movements? A) a pregnant client usually perceives about 80-90% of fetal movements B) a client should continue to feel fetal movements during a fetal sleep cycle C) the client should expect the absence of fetal movement around 39 weeks gestation D) a client should start fetal kick count monitoring at 20 weeks gestation

A) • rationale: fetal movements should not slow down

Which supplement would the nurse recommend to prevent fetal neural tube defects as a result of pernicious anemia? A) folic acid B) calcium carbonate C) magnesium hydroxide D) red raspberry leaf tea

A) • rationale: folic acid supplementation has been shown to decrease the incidence of neural tube defects when initiated at least 1 month before conception and continued throughout the pregnancy calcium carbonate may be recommended for dyspepsia by some HCP but does not prevent neural tube defects magnesium hydroxide has not been shown to decrease the incidence of neural tube defects in the fetus red raspberry leaf tea in used in the third trimester by some HCPs because of the belief that it promotes good uterine tone. however, it does not prevent neural tube defects

which statement by the HCP is an example of coercive behavior? A) your child will be taken away if you continue to use marijuana in your pregnancy B) your child may be born with multiple birth defects and learning disorders if you continue to use alcohol while pregnant C) the staff at the hospital will discuss all possible options for pain management in labor if you have too much pain D) using alcohol and cocaine while pregnant is not a healthy behavior for you or your baby

A) • rationale: stating that the patient's child will be taken away is a threatening statement that suggests legal retaliation for maternal behaviors stating that the child may be born with multiple birth defects and learning disorders if the patient continues to use alcohol while pregnant is an appropriate statement. it is important for the parent to understand how alcohol can affect a growing fetus stating that the hospital staff will discuss all possible options for pain management is an appropriate statement. it is important to provide reassurance to the patient that she will receive the same care as patients who do not suffer from substance misuse disorders stating that using alcohol and cocaine while pregnant is not a healthy behavior for the patient and their baby is an appropriate statement. it is important for the parent to understand how alcohol and cocaine can affect a growing fetus

The laboring patient becomes verbally abusive when denied a cigarette to relax. which response by the nurse is most appropriate? A) I know this is scary and may be causing some anxiety, but I'll help you the best way that I can B) I'm sorry but smoking isn't allowed inside the hospital C) I'm sorry, but smoking is bad for you and the baby D) Please don't talk to me like that--I'm here to help you

A) • rationale: the nurse is providing nonjudgmental therapeutic communication with the patient although it is hospital policy, it may encourage the patient to leave the hospital during labor and is nontherapeutic the nurse needs to provide nonjudgmental therapeutic communication this will only anger the patient and will not help deescalate the situation

A patient who is positive for HIV is about to be discharged from the hospital with her new infant. which patient statement indicates that further patient teaching is required? A) I'm glad I'll still be able to breastfeed my baby B) "It's still possible that I gave my baby HIV, even though I took all my medication C) "I will go to the pharmacy right now to fill my antiretroviral drug D) "Even though I don't feel sick, I should plan on bottle-feeding my baby

A) • rationale: the patient's statement that she will be able to breastfeed her baby is incorrect, so further teaching is required. breast milk is a route of HIV virus transmission and should be avoided the patient's statement that it is possible she gave her baby HIV is correct. even with medication compliance, vertical transmission is a concern, especially for women who deliver vaginally the patient's statement that she should take antiretroviral drugs is correct. antiretroviral drugs can prolong the mother's life and prevent transmission to the infant. the mother should understand the importance of taking the appropriate medication the patient's statement that she should bottle-feed her baby is correct. regardless of how the patient feels, HIV can be passed to the infant through the mother's breast milk, so an alternate feeding method must be chosen

The nurse observes that a pregnant patient who is taking terbutaline for preterm labor has a heart rate of 135 beats/min. Which medication does the nurse expect the primary health care provider (PHP) to order? A) IV propranolol B) 1 g IV calcium gluconate C) oral dose of 20 mg of nifedipine D) 500 mg of IV calcium chloride for 30 minutes

A) • terbutaline is a beta-adrenergic agonist that is used as a tocolytic to reduce uterine contractions in preterm labor. the patient has a HR of 135, which implies that the patient has intolerance to the drug and has tachycardia. therefore the patient should be administered a beta-adrenergic blocker, such as propranolol, to reverse the adverse effects of terbutaline. administering calcium gluconate, nifedipine, and calcium chloride does not help to reduce the adverse effects of terbutaline in the patient. rather, 1 g of calcium gluconate and 500 mg of calcium chloride are administered in case of magnesium sulfate toxicity. nifedipine is a calcium channel blocker, which should not be given after terbutaline because it affects the patient's HR and BP

The nurse is studying the chart of a patient in labor. If the patient's chart indicates "RMA", which is the presenting part? A) chin B) sacrum C) scapula D) occiput

A) • the chin or mentum is the presenting part of the fetus if the chart indicates RMA. If the sacrum is presenting part, the middle letter is S. If the scapula is the presenting part, the middle letter is Sc. If the occiput is the presenting part, the middle letter is O

When the nurse observes this fetal heart pattern, which nursing action would be most important (early decelerations)? A) document the finding B) to position mother on left side C) to apply 10L of oxygen via face mask D) to notify the HCP

A) • the fetal heart strip shows an early deceleration indicating expected head compression during contractions. Documenting this finding is appropriate. Positioning the woman on the left side, applying oxygen via a face mask, and notifying the HCP are correct actions for a late deceleration.

The nurse is teaching pain relief techniques to a group of expectant patients. Which will the nurse teach the patients about the gate-control theory of pain? A) distractions block the nerve pathways B) neuromuscular activity can increase pain C) all sensations travel together to the brain D) motor activity during labor intensifies pain

A) • the gate-control theory of pain explains the way pain relief techniques work to relieve the pain of labor. distractions close a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. According to this theory only a limited number of sensations can travel through the sensory nerve pathways to the brain at one time. When the laboring patient engages in motor activity and neuromuscular activity, activity within the spinal cord itself further modifies the transmission of pain

Which instructions will the nurse give to a patient who is prescribed methotrexate therapy for dissolving a tubal pregnancy? A) discontinue folic acid supplements B) get adequate exposure to sunlight C) take stronger analgesics for severe pain D) vaginal intercourse is safe during the therapy

A) • the nurse advises the patient to discontinue folic acid supplements as they interact with methotrexate and may exacerbate ectopic rupture in the patient. Exposure to sunlight is avoided as the therapy makes the patient photosensitive. Analgesics stronger than acetaminophen are avoided because they may mask symptoms of tubal rupture. Vaginal intercourse is avoided until the pregnancy is dissolved completely

Which medication is the antidote for magnesium toxicity in a pregnant patient with preeclampsia? A) calcium gluconate B) nifedipine C) hydralazine D) labetalol hydrochloride

A) • the nurse needs to obtain a prescription for calcium gluconate because it acts as an antidote to magnesium toxicity. nifedipine and labetalol hydrochloride are antihypertensive medications, which are prescribed for gestational hypertension or severe preeclampsia. hydralazine is also an antihypertensive medication used for treating hypertension intrapartum

when teaching a patient with a body mass index (BMI) of 20 about recently prescribed subcutaneous insulin, which statement is correct? A) you will need to insert the needle at a 45 degree angle to ensure it is delivered to the subcutaneous tisse B) if you need to deliver more than 0.5mL of insulin, you will need to use 2 injection sites C) if you use the no-pinch method, you should use an 8 mm needle D) gently massage the injection site with sterile gauze after administration to ensure the medication is absorbed

A) • this patient has a very low BMI & likely minimal subcutaneous tissue. entering at a 45 degree angle will ensure the medication is delivered into subcutaneous tissue and not muscle up to 2 mL of insulin can be delivered using a subcutaneous injection because of this patient's BMI, a 5-mm needle is more appropriate than an 8-mm needle the site should not be massaged after administration, but a band aid may be applied

The nurse is assessing a pregnant patient with multifetal gestation. Upon reviewing her medical history, the nurse finds that the patient had a previous preterm delivery. Which intervention will the nurse do to prevent preterm delivery in the patient during the 2nd pregnancy? A) suggest that the patient avoids smoking and consuming alcohol B) suggest that the patient increases physical activity to prevent risk C) administer progesterone suppositories to the patient D) administer a 17-alpha hydroxyprogesterone injection to the patient

A) • to prevent preterm labor, the nurse can suggest health promotion activities to the patient, such as avoiding smoking and alcohol consumption. this helps to promote intrauterine growth and fetal development. the nurse should suggest that the patient get proper rest and care at home. the nurse should not suggest that the patient increase physical activity, which could worsen the condition. progesterone supplements, such as progesterone suppositories and 17-alpha hydroxyprogesterone injections, are ineffective in preventing preterm birth in patients with multifetal gestation

Which of the following statements is true regarding opioid administration in labor & delivery? A) Opioids dec maternal HR &RR as well as BP & fetal oxygenation. Therefore maternal VS as well as the FHR & pattern must be assessed & documented before & after administration of opioids for pain relief B) Opioids dec maternal HR &RR as well as increase BP & fetal oxygenation. Therefore maternal VS as well as the FHR & pattern must be assessed & documented before and after administration of opioids for pain relief C) Opioids inc maternal HR&RR as well as BP & fetal oxygenation. Therefore maternal VS as well as the FHR & pattern must be assessed & documented before & after administration of opioids for pain relief. D) Opioids dec maternal HR&RR as well as BP & fetal oxygenation. Therefore maternal VS as well as the FHR & pattern must be assessed & documented before and after administration of opioids for pain relief

A) Opioids decrease maternal heart and respiratory rates as well as blood pressure and fetal oxygenation. Therefore maternal vital signs as well as the FHR and pattern must be assessed and documented before and after administration of opioids for pain relief • page 341

Which of the following abolishes pain perception by interrupting the nerve impulses to the brain? A) anesthesia B) analgesia C) antispasmotic D) anxiolytic

A) anesthesia

which of the following is the antidote to magnesium sulfate in the case of magnesium sulfate toxicity? A) calcium gluconate B) ethinyl estradiol C) sodium phosphate D) sodium chloride

A) calcium gluconate

Where should the fetal heart monitoring device be placed to obtain the clearest sounds? A) over the fetal back B) over the maternal pubic bone C) over the fetal head D) over the maternal umbilicus

A) over the fetal back • perform Leopold's maneuvers to identify fetal position. Usually fetal back is the best location to hear heart sounds (pg 357)

which organ is at the root cause of preeclampsia? A) the placenta B) the maternal heart C) the hypothalamus D) the cervix

A) the placenta

The most narrow dimension of the bony pelvis is formed by which 3 structures? A) tip of the coccyx, ischial spines, pubic symphysis B) ischial tuberosity, sacrum, and brim of the pelvis C) iliac crest, ischial tuberosity, and coccyx D) sacrum, axis, and sacral promontory

A) tip of the coccyx, ischial spines, and pubic symphysis

Which of the following is true teaching point about epidural anesthesia? A) you may still feel pressure as the fetus descends B) an epidural will wear off 1-2 hours after it is administered C) an epidural will take away all sensation and motor function D) we will need to monitor you for hypertension as this is more common with clients with epidurals

A) you may still feel pressure as the fetus descends • hypotension is more common, not hypertension

How is effacement measured? A) through digital palpation by a trained professional B) using transvaginal ultrasound C) by estimating the stage of labor D) through palpation of cervical dilation E) through Leopold maneuvers

A), B)

A patient presents with bleeding caused by placenta previa in late pregnancy. Which physical assessments are the most important for the nurse to perform? A) monitor urinary output B) monitor vaginal bleeding C) assess vital signs for the patient D) monitor fetal HR and contraction patterns E) perform digital vaginal examination for dilation F) measure fundal height

A), B), C), D)

A patient asks the nurse to describe which factors are included in HELLP syndrome. Which factors would the nurse include in response? A) low platelets B) hemolysis C) low leukocytes D) elevated erythrocytes E) elevated liver enzymes

A), B), D)

Which instructions would the nurse include when educating the family of a patient admitted for preeclampsia? A) dim the lights B) limit activity C) increase fluid intake D) turn off the television E) limit the number of visitors F) decrease protein intake

A), B), D), E)

A patient with preeclampsia has an emergency delivery at 32 weeks gestation. Which findings would the nurse anticipate in this premature neonate? A) yellow skin B) weight of 2000 g C) axillary temperature of 97.7F D) heart rate of 120 beats per min E) poor respiratory effort

A), B), E)

A woman is visibly anxious, refuses position changes in labor, and verbalizes "I'm afraid I'm going to die". The nurse knows it is important to help the woman relax through effective coaching because of which responses to stress experienced in labor? A) fetal intolerance to labor B) bradycardia related to vagal response C) release of catecholamines in the mother's body D) inhibited uterine contractions because of decreased blood flow to the placenta E) umbilical cord prolapse

A), C), D)

The nurse understands that which hormonal changes are thought to encourage the onset of labor? A) rising estrogen counteracts the relaxing effect of progesterone on the uterus B) follicle-stimulating hormone is secreted in large quantities by the anterior pituitary C) prostaglandins are secreted by the fetal membranes preparing the uterus D) the fetus secretes cortisol, which may act as an additional uterine stimulant E) thyroid-stimulating hormone is enhanced and helps make the uterus contractile F) oxytocin is secreted by the mother, which causes uterine contractions

A), C), D), F)

A woman with an epidural is 10 cm dilated and the baby is at 0 station. There is a reassuring fetal heart pattern, although the woman does not feel the urge to push. Which are appropriate actions by the nurse? A) encourage the patient to wait to push until she feels the urge B) perform another vaginal examination to check for dilation C) encourage the patient to push so that the baby can be born D) encourage frequent position changes while remaining in the bed E) turn off the epidural so the patient can feel the urge to push

A), D)

Type 1 and Type 2 Diabetes in Pregnancy

AKA Pregestational diabetes mellitus - occurs in women who already have DM before pregnancy - complicated by vascular disease, retinopathy, or nephropathy - these patients are normally insulin dependent

Which information would the nurse consider when educating patient and support people about nonpharmacologic pain management techniques?

Acupressure to either side of the spine can facilitate the release of endorphins and decrease some back pain.

After delivering a healthy baby with epidural anesthesia, a woman on the postpartum unit reports having a severe headache. Which action does the nurse anticipate in the woman's plan of care?

Administering oral analgesics Assisting with a blood patch procedure Frequently monitoring vital signs Conservative management for a postdural puncture headache (PDPH) includes administration of oral analgesics and methylxanthines. They cause constriciton of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. Close monitoring of vital signs is essential.

Which education would the nurse provide a low-risk patient regarding the advantages of intermittent auscultation? Select all that apply. One, some, or all responses may be correct.

Allows patient movement Allows for a less medical atmosphere Appropriate for low-risk patients in labor Offers patient more freedom in choosing pain management Intermittent auscultation of the fetal heart rate (FHR) allows more patient mobility than high-tech methods. Intermittent auscultation is intermittent, so the patient is not focused on watching the monitor and listening to beeping noises. Intermittent auscultation is appropriate for low-risk pregnancies. However, it is not the preferred method if the pregnancy is complicated or high-risk. Continuous external or internal electronic fetal monitoring is preferred with high-risk pregnancies. Intermittent auscultation allows the patient to use waterbased methods of pain management (for example, a whirlpool) because no equipment is attached continuously. Intermittent auscultation does not allow the nurse to listen to the FHR during every contraction, because it is intermittent. A contraction may not occur while the nurse is listening to the FHR with the Doppler ultrasound or fetoscope, or one may occur when the nurse is not present.

spontaneous preterm birth

An early initiation of the labor process Comprises 75% of preterm births Causes are multifactorial

The nurse is caring for a patient in the last trimester of pregnancy. Which will the patient display related to the effects of fear and anxiety during labor?

An increase in muscle tension

Fetal monitoring of a pregnant patient reveals a regular smooth, undulating wavelike pattern of the fetal heart rate (FH R). Which will the nurse infer about the fetus from this tracing?

Anemia A regular smooth, undulating wavelike pattern in the FHR is referred to as a sinusoidal pattern. This uncommon pattern mostly occurs with severe fetal anemia. lschemia refers to impaired circulation. FHR patterns cannot indicate this condition. Blood pressure levels below 120/80 mm Hg indicate hypotension. Blood pressure levels above 120/80 mm Hg indicate hypertension. The FHR pattern cannot indicate conditions such as hypotension or hypertension.

Interventions needed for DM in pregnancy

Antepartum: diet, exercise, self-monitoring glucose, pharmacologic therapy, fetal surveillance Intrapartum: glucose monitor hourly, insulin infusion possible (1:1 monitoring like ICU pts), AVOID dextrose soln Postpartum: most return to normal, high risk for GDM in future pregnancies, increased risk for T2DM, reassess at 6-12 weeks

What action must the nurse take when implementing aromatherapy for a patient in labor?

Ask the patient to choose the scents

Which intervention will the nurse perform while caring for a patient who is set to receive spinal anesthesia?

Assess maternal vital signs

While assessing a pregnant patient using a fetoscope, the nurse also palpates the abdomen of the patient. Which is the purpose of palpating the abdomen of the patient?

Assessment of changes in FHR during and after contraction While assessing the FHR with a fetoscope, the nurse palpates the abdomen of the fetus to evaluate uterine contractions (UCs). This is done to detect any changes in the FHR during and after UCs. FHR decelerations are not identified by palpating the abdomen. It is assessed using the electronic fetal monitoring system. Pain perception is a subjective assessment. Moreover, the pressure from the fetoscope is very minimal and does not cause pain.

which statement by the nurse is an appropriate response when the pregnant patient asks about the safety of psychiatric medication during pregnancy? A) "The medications used to treat mental illness will cause birth defects, so you should discontinue your antidepressants" B) "your mental wellness is an important part of pregnancy wellness, & continuing your medication is sometimes necessary" C) "all psychiatric medications have been proven to cross the placenta & cause birth defects in babies" D) "your obstetrician should have enough information to prescribe your antipsychotics without consulting with your psychiatrist"

B • rationale: many patients are encouraged to continue their medications throughout pregnancy under the guidance of a HCP many antidepressants are considered relatively safe to use in pregnancy, & some patients are encouraged to continue them throughout pregnancy it is known that all medications used to treat mental illness can cross the placenta, can be detected in amniotic fluid, & are present in breast milk a standardized, interdisciplinary approach is the optimal way to ensure safe & effective treatment of mental illness in pregnancy

A woman at 37 weeks gestation calls and reports, "My water broke, and I have a bloody show. I am changing my pad every 10 minutes." Which advice would the nurse provide in response? A) engage in activity such as walking B) call her HCP and go to the hospital or birthing center C) advise the woman that overreacting is not good for her or the baby and to call back when she is in "true labor" D) remain home, and only come in the hospital or birthing center if contractions are regular, frequent, and intense

B)

Occiput posterior refers to which component of the birth process? A) powers B) passenger C) passagae D) psyche

B)

The nurse assesses the BP of a pregnant patient with preeclampsia and notes that is elevated. Which antihypertensive classification would be avoided for this patient? A) calcium channel blockers B) ACE inhibitors C) vasodilators D) beta blockers

B)

The nurse notes recurrent late decelerations that do not respond to intrauterine resuscitation on the fetal monitor attached to a patient with a concealed placental abruption. Which order would the nurse anticipate? A) administer pain meds as prescribed B) prepare for emergency cesarean birth C) turn the patient to the left lateral position D) palpate the fundal tone

B)

What would the nurse expect when caring for a full-term primigravida who presents for a routine office visit and is not in labor? A) a fundal height that measures 30 cm B) a fetus that is engaged in the maternal pelvis C) a cervix that is already 3 cm dilated D) fetal station of -3

B)

Which cause of spontaneous abortion is the most common? A) infection B) congenital anomalies C) vaginal bleeding D) anomalies of the maternal reproductive tract

B)

Which woman has an increased risk for developing preeclampsia? A) a 25 year old woman with liver disease B) a 26 year old woman with a BMI of 32 C) a 34 year old woman who has breast cancer D) a 30 year old woman with a family history of diabetes

B)

The primary HCP has asked the nurse to draw blood for an umbilical cord acid-base determination test. Which will the nurse do in this situation? A) administer terbutaline (Brethine) before the test B) collect blood from the umbilical artery and vein C) first perform the fetal scalp stimulating technique D) collect blood only from the baby's umbilical artery

B) • An umbilical cord acid-base determination test is performed to assess the immediate condition of the neonate postpartum if there is an abnormal or confusing FHR tracing found during labor. The nurse should collect blood from both umbilical artery and umbilical vein to perform the test. The fetal scalp stimulating technique is an indirect method to assess fetal blood pH. This test need not be performed before the acid-base determination test. It is not necessary to administer terbutaline (Brethine), a uterine relaxant, before performing a test; it is administered during the time of labor if uterine contractions are too frequent.

The nurse is assisting a patient in labor. Which breathing pattern must the nurse remind the patient to use when the contractions increase in frequency and intensity in the first phase of labor? A) slow-paced breathing B) modified-paced breathing C) 3:1 pattern-paced breathing D) 4:1 pattern-paced breathing

B) • During the 1st phase of labor, as contractions increase in frequency and intensity, the patient must change breathing patterns to a modified-paced breathing technique. This breathing pattern is shallower and faster than the patient's normal rate of breathing, but it should not exceed twice the resting RR. Slow-paced breathing is performed at approximately half the normal breathing rate and is initiated when the patient can no longer walk or talk through contractions. Patterned-paced breathing is suggested in the 2nd phase of labor. It consists of panting breaths combined with soft-blowing breaths at regular intervals. The patterns may vary, the 3:1 pattern is pant, pant, pant, blow and the 4:1 pattern is pant, pant, pant, pant, blow.

Which solution can the nurse consider to encourage a positive birth experience for the patient and her support person following delivery? A) offer to take the baby to the nursery to promote rest for the patient and the support person B) encourage the family to talk about the labor and delivery experience C) immediately after birth, remove amniotic fluid and vernix from the baby before placing it skin to skin with the mother D) provide all infants with pacifiers to promote infant and family rest

B) • Encouraging the patient and the support person to talk freely about the birth experience is a very important way to help them make sense of the experience and to reflect on the positive and negative aspects of the labor and delivery. Rooming in should be encouraged as it helps the parents to learn how to recognize neonatal feeding cues and allows them to feel empowered to care for the infant. The baby should be dried and stimulated on the mother's chest. The baby should be immediately placed on the mother's abdomen and moved to the chest after the cutting of the umbilical cord. Vernix should not be removed because it is healthy for the baby's skin. Breastfed babies should not receive pacifiers until breastfeeding is well established.

The nurse midwife writes in the progress note that the baby is in the occiput posterior presentation. The nurse knows that which maternal position will help facilitate rotation of the fetal head? A) side lying B) hands and knees C) semi-recumbant D) lithotomy

B) • Hands-and-knees positions are thought to be especially useful when a baby presents in the occiput posterior position. This is thought to pull the fetal back forward, allowing for better rotation of the fetal head. Other benefits of this position are similar to those of the upright position. Side-lying positions may be especially favorable for a woman who is too exhausted to be in an upright position. Benefits of this position include optimal and complete body rest in between contractions, optimal placental perfusion resulting from decreased pressure on the vena cava, and increased maternal satisfaction. The semi-recumbent or lithotomy position is favored by some health care providers. This position allows for easy access to the baby and perineum in emergencies and makes for easier suturing with vaginal repair. This position does not help enhance the fetal head rotation from occiput posterior to occiput anterior. The semi-recumbent or lithotomy position is favored by some health care providers. This position allows for easy access to the baby and perineum in emergencies and makes for easier suturing with vaginal repair. This position does not help enhance the fetal head rotation from occiput posterior to occiput anterior.

A G2/P1 woman presents for evaluation. She is excited, can talk through regular contractions every 7 to 10 minutes, and states that her pain is "manageable." She does not desire epidural anesthesia in labor. The nurse suspects this patient is in which phase of labor? A) transitional labor B) early labor C) the 2nd stage of labor D) active labor

B) • In early labor a woman may present for evaluation as excited and able to talk and walk through most contractions, though they are still uncomfortable. She may be focused on herself and her baby. She may follow directions well and pain may be easily managed. Transitional labor was traditionally defined as 6 to 10 cm dilation and is a term that is no longer considered evidence-based. The second stage of labor starts at 10 cm and involves maternal pushing efforts until delivery of the baby. A woman who presents in this phase may complain of pain that is not well controlled or manageable, may be noticeably irritable, and may require more attention and support. She may exhibit physical symptoms such as sweating, nausea, and vomiting. A woman in active labor may experience intense pain, may have difficulty moving through contractions, and may complain of rectal pressure.

A woman received 25 mg of meperidine intravenously 1 hour before delivery. Which drug would the nurse have readily available? A) ibuprofen B) naloxone C) nalbuphine D) pitocin

B) • Naloxone is the antagonist for opioid medications and should be available for administration to the neonate who exhibits signs of respiratory depression after birth.Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) given for muscular pain and is not appropriate for this situation.Nalbuphine is a systemic analgesic given for pain and is not appropriate for this situation.Pitocin is used to promote contractions and is not appropriate for this situation.

which can the nurse interpret about the development in the fetus after reviewing the amniocentesis reports of a pregnant patient indicating the phosphatidylglycerol (PG) is absent in the amniotic fluid? A) impaired brain development B) impaired lung development C) impaired limb development D) impaired cardiac development

B) • PG is a glycerophospholipid found in the lungs as a pulmonary surfactant. the presence of PG in amniotic fluid is an early indicator of fetal lung maturity. the PG test is used mostly to assess fetal lung maturity in late pregnancy; therefore absence of PG indicates impaired lung development. the PG test is not used to assess the heart, brain, or limb growth of the fetus. fetal heart activity can be assessed by using transvaginal ultrasound. MRI is used to observe the growth & development of the fetal brain. limb development of the fetus can be observed on ultrasound

Which risk factor identified by the nurse places the patient at risk for preterm labor (PTL)? A) family history of cervical cancer B) homelessness C) hypertension D) history of birth of a child at 37 weeks

B) • Social and environmental factors, such as inadequate or absent prenatal or dental care, maternal domestic violence episodes, maternal smoking, homelessness, and age and ethnicity are all associated with increasing a woman's risk for PTL. Family history of cancer does not increase a woman's risk for PTL. Hypertension places the patient at risk for induced/cesarean birth, but not PTL. This is a previous term delivery. History of preterm birth is a risk factor for PTL. However, a birth at 37 weeks is considered a term delivery, so this is not a risk factor.

The nurse is assessing the FHR by using an ultrasound transducer. The patient asks the nurse, "Why are my baby's heart readings not continuous?" Which is the nurse's best response? A) this is because you may have anxiety B) this is a result of fetal movement C) perhaps you have a full bladder D) it is because you are lying down now

B) • The FHR is documented on a sheet of paper by an electronic method; continuous reporting sometimes may be hindered because of maternal or fetal movements. Anxiety levels of the patient would increase the patient's heart rate. It would not affect the FHR. The position of the patient would not affect the recording of the FHR. Fullness of the bladder would not affect the ultrasonic transmission and thus would not give an irregular heart rate pattern.

The nurse is instructing a childbirth class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths/min. What should the patient's rate be while performing slow-paced breathing techniques? A) 9 breaths/min B) 11 breaths/min C) 15 breaths/min D) 20 breaths/min

B) • The ideal rate for slow-paced breathing is half the normal breathing rate. Because her baseline respiratory rate is 22 breaths/min, the ideal breathing rate for slow-paced breathing is 11 breaths/min. The range of respirations should be no lower than half of the base rate and no more rapid than double the base rate. Nine breaths per minute is too low for a baseline rate of 22. 15 breaths/min would still be too fast and may not be effective. 20 breaths/min would still be too fast and may not be effective.

During the fourth stage of labor, the nurse notes an increased amount of bleeding. The uterine fundus consistency is boggy. Which is the most appropriate initial nursing action? A) alert the HCP that the patient is experiencing postpartum hemorrhage B) massage the uterine fundus and observe for change in consistency C) administer uterotonic medications to increase uterine tone D) do nothing, this is a normal finding in the 4th stage of labor and the tone is transient

B) • This is the most appropriate initial nursing action. Often uterine massage will cause a change in uterine tone from boggy to firm and will decrease vaginal lochia flow. Increased bleeding can lead to postpartum hemorrhage. The nurse would perform initial interventions such as uterine massage and assess for response before alerting the health care provider. The nurse would perform initial interventions such as uterine massage and assess for response before administering medications. Increased bleeding and a boggy uterine fundus consistency are not normal. Uterine massage is necessary.

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of which finding? A) uterine contractions occurring every 8-10 minutes B) a FHR of 180 bpm with absence of variability C) the woman needing to void D) rupture of the woman's amniotic membranes

B) • a FHR of 180 bpm with absence of variability is nonreassuring. the oxytocin should be disocntinued immediately and the HCP should be notified. the oxytocin should be discontinued if uterine hyperstimulation occurs. uterine contractions that occur every 8-10 minutes do not qualify as hyperstimulation. the woman needing to void is not an indication to discontinue the oxytocin induction immediately or to call the HCP. unless a change occurs in the FHR pattern that is nonreassuring or the woman is experiencing uterine hyperstimulation, the oxytocin does not need to be discontinued. the HCP should be notified that the woman's membranes have ruptured

Which instruction would the nurse include when teaching a pregnant woman with class II heart disease? A) advise her to gain at least 30 lbs B) instruct her to avoid strenuous activity C) inform her of the need to limit fluid intake D) explain the importance of a diet high in calcium

B) • activity may need to be limited so that cardiac demand does not exceed cardiac capacity. weight gain should be kept to a minimum with heart disease. fluid intake is necessary to prevent fluid deficits. fluid intake should not be limited during pregnancy. she may also be put on a diuretic. iron and folic acid intake is important to prevent anemia

when a pregnant woman with diabetes experiences hypoglycemia while hospitalized, which would the nurse have the woman do? A) eat a candy bar B) eat 6 saltine crackers or drink 8 oz of milk C) drink 4 oz of orange juice followed by 8 oz of milk D) drink 8 oz of orange juice with 2 teaspoons of sugar added

B) • crackers provide carbohydrates in the form of polysaccharides. a candy bar provides only monosaccharides. milk is a disaccharide, & orange juice is a monosaccharide. this will provide an increase in blood sugar but will not sustain it to normal levels. orange juice & sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar

Which is important for nurses to understand about the use of systemic analgesics during labor? A) systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier B) effects on the newborn can include significant neonatal respiratory depression C) IM administration is preferred over IV administration D) IV patient-controlled analgesia (PCA) results in increased use of an analgesic

B) • effects depend on the specific drug given, the dosage, and the timing. Effects on the newborn can include significant respiratory depression. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic

which test would the nurse evaluate to understand the cause of fatigue, SOB, and dyspnea in the pregnant patient? A) nonstress test B) electrocardiography C) 24-hour urine collection D) glycosylated hemoglobin

B) • fatigue, SOB, & dyspnea in a pregnant patient indicate primary hypertension (PPH). therefore the nurse needs to evaluate electrocardiography results, which diagnose the condition. the 24-hour urine collection is used to evaluate total protein excretion & creatinine clearance in a pregnant patient with diabetes. the nonstress test is used to assess fetal well-being in a pregnant patient with diabetes. the glycosylated hemoglobin test is used to assess glycemic control in a pregnant patient with diabetes

A pregnant patient visits the clinic for a prenatal check up during early pregnancy. The patient tells the nurse, "one of my friends told me that the chances of preterm labor can be detected by a fetal fibronectin test. how can i get this done?" Which is the nurse's best response? A) you can take the test only after 35 weeks of gestation B) i have to collect a sample of vaginal fluids for the test C) this test is recommended only if you were born preterm D) i have to collect your blood sample now and send it for analysis

B) • fibronectin is a glycoprotein used as a biomarker to test the chances of preterm labor in pregnant patients. it is found in the cervical and vaginal secretion during early and late pregnancy stages. the nurse can inform the patient that vaginal fluids would be collected for the test. this test can be done during early and late labor before 35 weeks gestation. this can be recommended for any pregnant patient regardless of whether they were born preterm or not. Blood samples are not collected for the test, because they would not contain fibronectin

when reviewing the amniocentesis reports of a patient who has completed 20 weeks of pregnancy, the nurse finds the presence of high alpha-fetoprotein (AFP) levels. which can the nurse infer from this information related to the clinical condition of the fetus? A) cardiac disorder B) neurologic disorder C) circulatory disorder D) pulmonary disorder

B) • high AFP levels after 15 weeks of gestation indicate an open neural tube or other disorder relating to the CNS. AFP levels in amniotic fluid cannot test cardiac disorders. doppler blood flow analysis can be used to assess circulatory disorders in the fetus. the lecithin-to-sphingomyelin (L/S) ratio of the amniotic fluid is a useful predictor of pulmonary disorders in the fetus

how will the nurse advise the patient who has given birth to an infant with microcephaly in the past and is now planning for the next child? A) there is a higher chance of having a preterm birth B) you should be screened for phenylketonuria (PKU) C) you must go for genetic counseling before conception D) there may be a miscarriage in your 2nd pregnancy

B) • if a patient has given birth to an infant with microcephaly in the past, there is a possibility that the patient has PKU. PKU results from a deficiency in the enzyme phenylalanine hydrolase. preterm birth is a possibility in pregnant women with untreated hypothyroidism. PKU affects brain development & function in the child; it does not cause miscarriage. genetic counseling is more important for patients who have hereditary disorders, which can be passed on to the child

Which medication can be administered to a pregnant patient to prevent cerebral palsy in a preterm newborn? A) calcium gluconate to the pregnant patient B) magnesium sulfate to the pregnant patient C) glucocorticoid drugs to the pregnant patient D) antibiotic medications to the pregnant patient

B) • newborns who are born before 32 weeks of gestation may be at risk for cerebral palsy. administering magnesium sulfate to the patient can prevent this risk as it would delay delivery. calcium gluconate is administered when the preterm child has magnesium toxicity. this intervention would not help to prevent cerebral palsy. also, the newborn would not have a fully developed respiratory system. therefore administering glucocorticoids to the pregnant patient would help to prevent the risk for respiratory depression in the baby. however, it does not help in preventing cerebral palsy. administering antibiotics during labor would help prevent neonatal group B streptococci infection

The nurse is caring for a pregnant patient who is receiving terbutaline for preterm labor. The primary health care provider (PHP) adds nifedipine to the patient's prescription. How does the nurse administer nifedipine to the patient? A) infuse nifedipine along with terbutaline B) infuse nifedipine only after terbutaline is stopped C) provide a glass full of orange juice before administering nifedipine D) provide the patient with calcium supplements before administering nifedipine

B) • nifedipine is a caclium channel blocker that is used to relax the uterine muscles during pregnancy. therefore the nurse should avoid administering nifedipine along with terbutaline, because it causes adverse effects and may alter the HR & BP of the patient. infusing nifedipine along with terbutaline may impair CV functioning in the patient. therefore the nurse should avoid infusing the drugs simultaneously. orange juice is administered to relax the patient during labor. however, it is not necessary to administer it with nifedipine. nifedipine is administered to reduce the calcium activity; no additional calcium supplementation is required

which is the most likely reason for referring a pregnant patient in the third trimester for transvaginal and transabdominal ultrasound scanning? A) to determine genetic abnormalities B) to determine the risk of preterm labor C) to assess development of the embryo D) to determine the risk of ectopic pregnancy

B) • premature labor occurs when the mother's body starts preparing for childbirth too early in her pregnancy. in some instances, during the 2nd & 3rd trimesters, transvaginal US scan may be used along with transabdominal scanning to evaluate the preterm labor. to detect genetic abnormalities in the fetus, chorionic villus sampling (CVS) is used in the 1st trimester and amniocentesis is used in the 2nd & 3rd trimesters. US scan is usually not used to detect genetic abnormalities in the fetus. transvaginal US scan is used in the 1st trimester of pregnancy to detect ectopic pregnancies & monitor development of the embryo

which clinical finding in a pregnant patient will indicate proper fetal brain development? A) hemoglobin A1c levels greater than 6 B) normal maternal thyroxine (T4) levels C) 3% amniotic fluid phosphatidylglycerol D) fasting glucose levels less than 95 mg/dL

B) • proper fetal brain development depends on normal maternal T4 levels early in pregnancy. mild maternal hypothyroidism during the 1st trimester can cause neuropsychological damage in the infant. hemoglobin A1c levels greater than 6 indicate long-term elevated glucose levels in the patient. A 3% amniotic fluid phosphatidylglycerol indicates proper lung maturation in the fetus. fasting glucose levels less than 95 mg/dL indicate proper glycemic control in the pregnant patient

a pregnant woman presents with clumpy, white vaginal discharge, vulvar pruritus, and burning. which treatment would the nurse expect for this patient? A) clindamycin B) miconazole C) metronidazole D) imiquimod

B) • rationale: clumpy, white vaginal discharge with vulvar pruritus and burning is associated with candidiasis and should be treated with the appropriate anti fungal, such as miconazole clindamycin and metronidazole are antibacterials imiquimod is an antiparasitic drug. an antiparasitic would be prescribed to a patient with a parasitic infection, not to a patient presenting with signs of candidiasis

which action would the nurse take if a pregnant patient opts out of prenatal human immunodeficiency virus (HIV) testing? A) report the mother to child protective services B) inform the mother that the baby will likely be screened for HIV after birth C) collect the sample anyway D) requesting the patient's sexual partners come in for screening

B) • rationale: it is recommended that the neonate be screened after birth even if the mother has opted out of prenatal testing opting out of prenatal testing is not a reportable occurrence. however, it is essential that the nurse document her decision performing testing without patient consent is illegal and could result in legal action against the nurse requesting that the patient's sexual partners come in for screening is not a part of most office routines and may violate patient privacy laws

which of the following is the most widely applied technique for antepartum evaluation of the fetus? A) the contraction stress test B) the nonstress test C) vibroacoustic stimulation (VAS) D) amniocentesis

B) • rationale: this is done during an NST to stimulate the fetus

The primary health care provider (PHP) reports that the baby of a patient may have an injury resulting from a shoulder dystocia during birth. Which patient clinical condition would the nurse infer from the report? A) preterm labor B) post-term pregnancy C) secondary uterine inertia D) hypertonic uterine dysfunction

B) • shoulder dystocia is the fetal risk in pregnant women that is associated with an increase in birth weight (macrosomia) resulting from a post-term pregnancy. in preterm labor the fetus may reduced birth weight, which does not increase the risk of shoulder dystocia. secondary uterine inertia is also called hypotonic uterine dysfunction. hypotonic and hypertonic uterine dysfunction have no relation with delay in pregnancy and do not cause shoulder dystocia

the nurse reviews the US reports of a pregnant patient & finds that the images of fetal anatomic details are not clear. which would the nurse administer to the patient before performing the MRI? A) a diuretic B) a sedative C) an analgesic D) an antipyretic

B) • the MRI scan may take 20-60 minutes. during the scan, the patient must be perfectly still. moreover, fetal movement during the scan will obscure the anatomic details. to avoid this problem, the patient would be administered to increase the rate of urine formation. if a diuretic is given before the MRI, frequent urination may occur. because the patient does not complain of pain, analgesics need not be administered. antipyretics would not helpful in decreasing the patient's activity level. they would be administered only if the patient has a fever

Which pelvic shape is most conducive to vaginal labor and birth? A) android B) gynecoid C) platypelloid D) anthropoid

B) • the gynecoid pelvis is round and cylinder shaped, with a wide pubic arch. Prognosis for vaginal birth is good. Only 23% of women have an android-shaped pelvis, which has a poor prognosis for vaginal birth. The platypelloid pelvis is flat, wide, short, and oval. The anthropoid pelvis is a long, narrow oval with a narrow pubic arch. It is more favorable than the android or platypelloid pelvic shape

the amniotic fluid index (AFI) of a pregnant patient is 3 cm. which clinical information related to the fetus does the nurse infer from this? A) fetal hydrops B) renal defects C) low activity level D) neural tube defect

B) • the normal value of AFI is 10 cm or greater, with the upper limit of normal around 25 cm. an AFI less than 5 cm indicates oligohydramnios. this condition is associated with renal genesis in the fetus. a high AFI indicates neural tube defects & fetal hydrops. the AFI is not directly related to fetal movement. fetal activity can be assessed using ultrasonography

which instruction would the nurse give to a pregnant patient who takes iron supplements and is also prescribed levothyroxine (T4)? A) perform your aerobic exercises after taking T4 B) take iron supplements and T4 at different times C) discontinue the iron supplements in case of nausea or vomiting D) lower the T4 dosage as the pregnancy progresses

B) • the nurse advises the patient to take the iron supplements and T4 at different times, because the supplements decrease the absorption of T4. the T4 dosage is increased as the pregnancy progresses because of increased estrogen levels. iron supplements are not discontinued, because discontinuing the supplements may increase chances of anemia. instead, iron is administered parenterally if the patient is unable to take iron supplements orally. aerobic exercises do not affect the drug action of T4. aerobic exercises are prescribed for patients with diabetes

After performing the nitrazine test for pH in a pregnant patient, the nurse finds that the amniotic membranes are ruptured. Which finding led the nurse to confirm the result of the test? A) pH of 5 and yellow in color B) pH of 6.5 and blue-green in color C) pH of 6.0 and olive-green in color D) pH of 5.5 and olive-yellow in color

B) • the nurse finds that the amniotic membranes are ruptured because the pH of the vaginal fluid is 6.5 (alkaline) and the color is blue-green. This is because of the presence of amniotic fluid, which is alkaline. Vaginal pH values of 5.0, 5.5, and 6.0 indicate that the fluid is still acidic due to the absence of amniotic fluid. This indicates that the amniotic membranes are probably intact. Therefore these findings do not show that the amniotic membranes are ruptured

The nurse administers the prescribed nifedipine to a pregnant patient during labor to reduce uterine contractions (UCs). Which nursing action is the most appropriate after the drug administration? A) monitoring the HR of the fetus B) monitoring the BP of the patient C) monitoring the RR of the patient D) monitoring the BG levels in the patient

B) • the nurse should monitor the BP of the patient after administering nifedipine. it is a calcium channel blocker that compresses the smooth muscle contractions, resulting in hypotension. nifedipine does not alter fetal HR or RR and blood sugar levels of the patient. HR of the fetus is monitored when other classes of tocolytics are administered. RR is monitored when oxytocin is administered to the patient. blood glucose levels are monitored in patients with DM who are receiving glucocorticoid therapy

which would the nurse advise for a patient diagnosed as having a fetus with hemolytic anemia? A) begin an iron-rich diet B) count fetal movements C) undergo US D) undergo blood transfusion

B) • the patient would be instructed to count the fetal movements, because fetal hypoxia may decrease fetal activity. fetal hemolytic anemia is a disorder in which the fetal blood cells act as antigens & the maternal immune system develops antibodies. this results in hemolysis in the fetus, which may lead to low oxygen levels & low activity in the fetus. in hemolytic anemia, maternal antibodies are constantly killing the fetal cells, so an iron-rich diet may not be helpful. blood transfusion may not be helpful in treating fetal hemolytic anemia. plasma exchange may be useful. US is not used to detect hemolytic anemia in the fetus

A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to order? A) propranolol B) clindamycin C) morphine D) terbutaline

B) • the pregnant patient had chorioamnionitis before childbirth, which implies that bacteremia may develop in the patient. because of bacteremia, there may be wound infection or pelvic abscess after cesarean section. therefore after cesarean birth, the patient should be given an antibiotic, such as clindamycin, which acts against anaerobic organisms. propranolol, morphine, and terbutaline are not antibiotics and are not administered after childbirth. they are drugs used to treat complications of labor

Which instructions does the nurse give to a patient when preparing to assess the uterine activity using a tocotransducer? A) no water can be taken until after the test B) you will sit up at about a 30 degree angle C) Kegel exercises must be done before the test D) remain still while the test is being performed

B) • the use of a tocotransducer requires the patient to be sitting in a chair or lying in a bed during the test. The nurse asks the patient to lie in semi-Fowler position, which is sitting up at a 30 degree angle. This helps hold the device to the fundus firmly throughout the test. The patient can drink water before or after the test. Performing exercises before the test will not affect uterine activity and thus should not be instructed to the patient. Because this is not a requirement for the test, the nurse should not ask the patient to stay in a still position.

The nurse is caring for a patient in labor who is having an indwelling catheter threaded into the epidural space for the administration of pain medication. Which does the nurse tell the patient? A) your body will go numb after 15 seconds B) you may experience a momentary twinge down your hip or back C) notify someone immediately if you experience any tingling sensations D) there are no medication side effects associated with this route of drug administration

B) • when a laboring woman receives an indwelling catheter threaded into the epidural space, the nurse should tell the patient she may have a momentary twinge down her leg, hip, or back. This feeling is normal and is not a sign of injury. The patient's body will not go numb after 15 seconds. The patient does not have to notify anyone immediately if there is a tingling sensation. All drugs used for pain management have some kind of side effect, regardless of the route of administration.

A nurse is caring for a patient in labor who is receiving oxytocin via intravenous infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? A) three contractions occurring within a 10 minute period B) a fetal HR of 90 bpm C) a resting uterine tone of 15 mmHg via the intrauterine pressure catheter D) early decelerations

B) • A normal fetal heart rate is 110 to 160 beats/min. Bradycardia and/or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin infusion. The goal of labor augmentation is to achieve three good-quality contractions in a 10-minute period. A normal resting uterine tone during labor is less than 25 mm Hg via an intrauterine pressure catheter. Any resting tone greater than 25 mm Hg is considered abnormal, and the oxytocin may need to be discontinued. An early deceleration mirrors the uterine contraction, and the nadir of the early deceleration occurs with the peak of a contraction. Early decelerations are the result of head compression, which is considered a positive sign of labor progression and not an assessment finding that would require the discontinuation of oxytocin.

Which explanation of cesarean delivery incisions would a nurse provide to a patient? A) "There are a total of three incisions that will be made in your body by the surgeon." B) "The surgeon may make a vertical incision or a transverse incision on your skin." C) "You will not be able to the see the incision once it is fully healed if the surgeon makes a Pfannenstiel incision on your skin." D) "If you have a transverse incision on your uterus, you can never have a vaginal birth."

B) • A transverse (Pfannenstiel) incision or vertical incision may be made on the skin at the discretion of the surgeon based on various considerations. There are two incisions made during cesarean delivery: the skin incision and the uterine incision. Regardless of the incision type, the incision site will still be visible. The site will be less visible, however, with a Pfannenstiel incision. Women cannot have a vaginal birth after a vertical uterine incision, but it is still possible after a transverse incision.

In which situation is there an increased likelihood for prolonged labor? A) the woman is a teen mother B) the woman is nulliparous C) the woman has been diagnosed with an incompetent cervix D) the woman has a history of postpartum hemorrhage

B) • A woman who has never before given birth vaginally is at increased risk for prolonged labor. Advanced maternal age, not teen pregnancy, increases the likelihood of prolonged labor. An incompetent cervix increases a woman's risk for precipitous labor and delivery, not prolonged labor. A history of postpartum hemorrhage does not increase a woman's risk for prolonged labor.

A postpartum patient who had a spinal block for a scheduled cesarean delivery complains of a headache. Which intervention would the nurse anticipate? A) oral (PO) administration of promethazine B) administration of blood patch by the anesthesia provider C) having a patient sit up in chair to help relieve headache D) allowing the spinal headache to run its course

B) • Administration of a blood patch by an anesthesia professional is a procedure in which the patient's blood is injected into the spinal space, creating a seal over the site where the dural puncture occurred. Promethazine is a medication given for nausea or vomiting. It is not a treatment option for a spinal headache.A spinal headache is postural; it is worse when a woman is upright and may disappear when she is lying flat.Treatment for a spinal headache may include fluids, narcotics, or a blood patch.

A patient in labor experiences minimal relief after nonpharmacologic interventions, and she is not coping well in labor. Which action would the nurse take next? A) suggest an epidural B) educate on the risks and benefits of pharmacologic interventions C) encourage the patient to ambulate in the room D) administer the prescribed dose of IV pain medication

B) • By providing the patient with education and options, the nurse empowers her to make decisions about her body and labor and delivery experience. This patient may choose to have an epidural, but a discussion of pain management options and the risks and benefits of pharmacologic interventions should occur first. This patient has been trying nonpharmacologic interventions, and she is not experiencing relief. The nurse should discuss other options and allow the patient to choose. The nurse should not administer medication without first discussing the risks and benefits of the medication with the patient.

A nurse caring for a patient experiencing maternal exhaustion who desires a natural labor would implement which intervention to promote normal labor progress and decrease fatigue? A) limit IV fluids to prevent overhydration B) encourage the patient to take a warm shower or bath C) insert an indwelling catheter so the patient does not have to ambulate as frequently D) restrict visitation to given time intervals to allow for sleep

B) • Hydrotherapy is an effective way to promote rest and relaxation in the laboring patient. Administering IV fluids as prescribed can help decrease maternal exhaustion by ensuring proper hydration and fluid and electrolyte balance. An indwelling urinary catheter is not indicated in this situation and may even cause harm. Restricting visitors, especially support persons, may cause added stress to the patient.

The nurse is caring for a patient who had a forceps delivery that caused a perineal hematoma. Which nursing intervention is most appropriate? A) administer topical analgesic ointment as prescribed B) provide the patient with an ice pack and educate her about its use C) encourage the patient to lie on her side as much as possible until the injury heals D) educate the patient about the fact that the hematoma was caused by the introduction of forceps

B) • Ice packs can help relieve the pain of hematomas or lacerations after operative delivery by causing vasoconstriction and decreasing blood flow to the area, as well as decreasing edema. Patients should be guided toward use for the first 12 hours, followed by intermittent use. Topical analgesics would have little therapeutic effect on the hematoma and any pain associated with it. The nurse would encourage the patient to adopt a position that relieves pressure and pain. However, there is no reason to believe that side lying is more likely than other positions to relieve the patient's pain. A hematoma is generally painful, and addressing this physiologic need is a priority over education about the cause.

A G5/P4 laboring patient with suspected fetal intrauterine growth restriction has just experienced spontaneous rupture of membranes. On examination, the nurse notes that the cervix is dilated 3 cm and is 70% effaced and that the fetal station is 0. Fetal heart tracing shows recurrent and severe variable decelerations. Which explanation is the most likely cause for this change in fetal heart rate? A) high fetal station B) umbilical cord prolapse C) fetal intrauterine growth restriction D) grand multiparity

B) • Recall that umbilical cord prolapse may be "hidden" or otherwise not palpable during a cervical or vaginal examination. This patient has a very small fetus, and she just experienced rupture of membranes, both of which are cues indicating an increase in the risk for umbilical cord prolapse. Variable decelerations and bradycardia also accompany umbilical cord prolapse. This fetal station is 0, which means that the fetus is engaged in the maternal pelvis and is not high. Fetuses with growth restrictions may be more vulnerable to decelerations, but the most likely cause for the sudden change in fetal heart rate at this time is umbilical cord prolapse. Grand multiparity is not a known cause of sudden-onset, severe, recurrent variable decelerations.

A woman is 10 cm dilated and feels occasional rectal pressure at the peak of a contraction, and the fetal station is 0. There is a reassuring fetal heart tracing. Which nursing action is appropriate at this time? A) recheck the cervical dilation to ensure she is 10 cm B) allow the woman to labor down for passive descent C) encourage the woman to push with every contraction D) prepare for cesarean delivery for cephalopelvic disproportion

B) • The latent phase may also be referred to as laboring down, delayed pushing, or passive descent. The woman should be encouraged to rest until she feels the strong urge to push with each contraction. The woman is most likely in the latent phase of the second stage of labor. Rechecking the cervical dilation is not necessary. Pushing without a strong urge can lead to maternal exhaustion and fetal distress. The assessment of the mother and fetus is normal. There is no indication of cephalopelvic disproportion

which action would the nurse take after calculating a score of 5 on the Edinburgh Postpartum Depression scale for a pregnant patient with a history of depression? A) initiate a referral to psychiatry B) nothing; this is a normal score C) advice the patient to discontinue her selective serotonin reuptake inhibitor D) rescore the patient before she leaves the office

B) • a score of less than 8 is not suggestive of current depressive symptoms or exacerbation a psychiatric referral is not indicated at this time the nurse does not discontinue medications without a HCP's prescription. this discussion should occur between the HCP and the patient obtaining a normal score on the Edinburgh Postpartum Depression scale does not indicate rescoring during the same visit

Which test is performed to determine if membranes are ruptured? A) urine analysis B) fern test C) Leopold maneuvers D) artificial rupture of membranes (AROM)

B) • a sterile speculum exam and a nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid. A urine analysis should be performed on admission to labor and delivery. This test is used to identify the presence of glucose and protein. The nurse performs Leopold maneuvers to identify fetal lie, presenting part, and attitude. AROM is the procedure of artificially rupturing membranes, usually with a device known as an amnihook.

Which characteristic is associated with false labor contractions? A) painful B) decrease in intensity with ambulation C) regular pattern of frequency established D) progressive in terms of intensity and duration

B) • although false labor contractions decrease with activity, true labor contractions are enhanced or stimulated with activity such as ambulation. True labor contractions are painful. A regular pattern of frequency is a sign of true labor. A progression of intensity and duration indicates true labor

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. Which is the nurse's best response? A) don't worry about it. You'll do fine B) it is normal to be anxious about labor. Let's discuss what makes you afraid C) labor is scary to think about, but the actual experience isn't D) you may have an epidural. You won't feel anything

B) • discussing the woman's fears allows her to share her concerns with the nurse and is a therapeutic communication tool. Telling the woman not to worry negates her fears and is not therapeutic. Telling the woman that labor is not scary negates her fears and offers a false sense of security. A number of criteria must be met for use of an epidural. Furthermore, many women will experience the feeling of pressure with an epidural

When assessing a FHR tracing, the nurse notes a decrease in the baseline rate from 155 to 110 beats/min. The rate of 110 beats/min persists for more than 10 minutes. The nurse can attribute this decrease in baseline to which factor? A) maternal hyperthyroidism B) initiation of epidural anesthesia that resulted in maternal hypotension C) maternal infection accompanied by fever D) alteration in maternal position from semi-recumbent to lateral

B) • fetal bradycardia is the pattern described and results from the hypoxia that occurs when uteroplacental perfusion is reduced by maternal hypotension. The woman receiving epidural anesthesia needs to be well hydrated before and during induction of the anesthesia to maintain an adequate CO and BP. Hyperthyroidism would result in baseline tachycardia. A maternal fever could cause fetal tachycardia. The assumption of a lateral position enhances placental perfusion and should result in a reassuring FHR pattern.

Which is the factor that enables the baby to initiate respiration immediately postpartum? A) fetal respiratory movements increase during labor B) fetal lung fluid is cleared from the air passage C) arterial carbon dioxide pressure is decreased D) arterial pH and bicarbonate levels are increased

B) • fetal lung fluid is cleared from the air passage as the infant passes through the birth canal during labor and vaginal birth. There is a decrease in fetal respiratory movements during labor. Arterial carbon dioxide pressure (Pco2) increases. There is a decrease in arterial pH and bicarbonate levels

Where does an anesthesia provider inject an epidural anesthesia (block)? A) L1 to L3 B) T8 to S1 C) L3 to L5 D) T10 to S5

B) • if a cesarean birth is to be conducted an epidural anesthesia (block) is administered from at least T8 to S1. A block from T10 to S5 is required for relieving the discomfort of labor and vaginal birth. In spinal anesthesia (block), an anesthetic solution containing a local anesthetic alone or in combination with an opioid agonist analgesic is injected between L3 to L5. L1 to L3 is not blocked for anesthesia.

A pregnant patient does not allow her partner to touch her and wants to be left alone. Which can the nurse suggest to the patient's partner in this situation? A) it is due to depression and loneliness B) it is a common behavior during pregnancy C) massage would help to make your partner relax D) you should leave your partner alone for a few days

B) • many patients experience hyperesthesia or sensitivity to touch during the transition phase of labor and do not allow their partners to touch them. To prevent anxiety of the partner and to provide effective care, the nurse should inform the partner that this behavior is common during pregnancy. The active support of the partner is still required by the patient, so the patient's partner should not leave the patient alone. These are normal emotions during pregnancy, so the nurse should not tell the partner that the patient is depressed or feeling lonely. As the patient has become sensitive to touch, massaging the patient's back may irritate the patient

Which intervention will the nurse implement for a patient immediately after a severe abdominal trauma? A) prepare the patient for cesarean birth B) send the patient for pelvic computed tomography (CT) scanning C) provide fluids to the patient as part of the protocol for US examination D) prepare to administer Rho(D) immunoglobulin

B) • pelvic CT scanning helps visualize extraperitoneal and retroperitoneal structures and the genitourinary tract. The nurse needs to prepare the patient for cesarean birth if there is no evidence of a maternal pulse. US exam is not as effective as electronic fetal monitoring for determining placental abruption in the patient after the trauma. therefore the nurse prepares the patient for a CT scan after a severe abdominal trauma. the nurse needs to administer Rho(D) immunoglobulin in an Rh-negative pregnant trauma patient. This helps protect the patient from isoimmunization

An Rh-negative woman needs an amniocentesis. The nurse understands which statement to be true based upon the information provided? A) the amniocentesis will determine if the mother needs a blood transfusion B) a shot of Rho(D) immune globulin will be required for this procedure C) a Coombs test should be performed immediately after the procedure D) the fetus is likely Rh-positive, so delivery should be expedited

B) • rationale: as a result of the potential for maternal fetal hemorrhage, Rho(D) immune globulin should be given after an amniocentesis when a woman is Rh-negative The amniocentesis can detect fetal hemorrhage and isoimmunization, but the need for a maternal blood transfusion would be determined by using maternal serum A Coombs test is only performed when fetal hemolytic anemia caused by isoimmunization is suspected. amniocentesis generally follows a positive Coombs test in pregnancy There is no information provided that allows the nurse to determine fetal Rh or whether delivery should be expedited

The client with gestational diabetes has risks for which of the following A) liver failure, cesarean delivery, the development of type 2 DM during the current pregnancy B) preeclampsia, cesarean birth, the development of type 2 DM later in life C) thyroid disorder, forceps-assisted vaginal birth, the development of type 1 DM later D) cholestasis, vacuum-assisted vaginal birth, the development of type 2 DM later in life

B) • rationale: in those with gestational diabetes, preeclampsia risk increases by 9.8% if well controlled & 18% if not well controlled, cesarean section delivery by 17-23%, and the development of type 2 DM later in life by up to 70% (pg253-54)

which of the below is the most common type of anemia during pregnancy? A) sickle cell anemia B) iron deficiency anemia C) thalasemia D) folic acid deficiency anemia

B) • rationale: iron deficiency anemia is by far the most common anemia of pregnancy, accounting for approximately 75% of cases (pg 266)

Which pelvic type is least favorable for a vaginal birth? A) gynecoid B) android C) anthropoid D) platypelloid

B) • the android pelvis is heart shaped & angulated. the sidewalls are convergent, the sacrum is slightly curved, and the terminal portion is often beaked. The subpubic arch is narrow, often resulting in cesarean births or difficult vaginal forceps births. It is least favorable for vaginal birth. The gynecoid pelvis is slightly ovoid or transversely rounded. The sidewalls are straight and the sacrum is deep and curved. The subpubic arch is wide, thus enabling spontaneous vaginal births. The anthropoid pelvis is oval and wider anteroposteriorly. The sidewalls are straight, sacrum slightly curved. The subpubic arch is narrow and may result in forceps vaginal birth. The platypelloid pelvis is flattened anteroposteriorly and wide transversely. The sidewalls are straight, the sacrum is slightly curved, and the subpubic arch is wide, resulting in spontaneous vaginal birth.

When assessing a patient for the possibility of a vaginal birth, which must the nurse keep in mind about the coccyx of the bony pelvis? A) it is the part above the brim of the bony pelvis B) it is moveable in the latter part of the pregnancy C) it has three planes: the inlet, midpelvis, and outlet D) it is ovoid and bound by the pubic arch anteriorly

B) • the coccyx is moveable in the latter part of the pregnancy unless it has been broken and fused to the sacrum during healing. The bony pelvis is separated by the brim into the false and true pelvis. The false pelvis is the part above the brim and plays no part in childbearing. The true pelvis is involved in birth and is divided into 3 planes: inlet, midpelvis, and outlet. The pelvic outlet is the lower border of the true pelvis. Viewed from below is the ovoid. It is shaped somewhat like a diamond and bound by the pubic arch anteriorly, the ischial tuberosities laterally, and the tip of the coccyx posteriorly

Concerning the 3rd stage of labor, of which statement should the nurses be aware? A) the placenta eventually detaches itself from a flaccid uterus B) the duration of the 3rd stage may be as short as 3-5 minutes C) it is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface D) the major risk for women during the 3rd stage is a rapid heart rate

B) • the duration may be as short as 3-5 minutes, although up to 1 hour is considered WNL. The 3rd stage of labor lasts from birth of the fetus until the placenta is delivered. The placenta cannot detach itself from a flaccid relaxed uterus. Which surface of the placenta comes out first is not clinically important. The major risk for women during the 3rd stage of labor is after birth hemorrhage. The risk of hemorrhage increases as the length of the 3rd stage increases

A pregnant patient is at risk for cardiac arrest because of profound hypovolemia after a trauma. Which action does the nurse take? A) the nurse assesses airway, breathing, and pulse rate B) the nurse administers warmed crystalloid solutions C) the nurse administers calcium gluconate intravenously D) the nurse obtains a prescription for magnesium sulfate

B) • the nurse administers warmed crystalloid solutions for massive fluid resuscitation in the patient who has profound hypovolemia after a trauma. The nurse needs to assess the airway, breathing, and pulse in a patient after a convulsion so that prompt actions can be taken to stabilize the patient. The nurse administers calcium gluconate as an antidote to a patient who has magnesium toxicity. The nurse may administer magnesium sulfate for the treatment of eclamptic seizures in a patient with preeclampsia

The nurse records uterine contractions in a patient who is in active labor as being 3-5 minutes apart and lasting for about 1 minute. Which nursing intervention is most effective to assess the patient's status during this phase of labor? A) check BP every 2 hours B) note patient's appearance and mood every 15 minutes C) assess the patient's temp every 2 hours until membranes rupture D) monitor temp every 4 hours after membranes rupture

B) • the patient is experiencing uterine contractions that are 3-5 min apart and last for about 60 seconds. the patient also exhibits flushed cheeks. these indicate that the patient is in the active phase of the 1st stage of labor. the nursing assessment in the active stage of labor is to check the patient's appearance and mood every 15 minutes. the patient's mood and energy levels fluctuate, and therefore the nurse should constantly assess them to ensure effective patient care. the patient's blood pressure should be assessed every 30 min. the nurse should assess the patient's body temp every 4 hours until membrane rupture and thereafter every 2 hours

The nurse restricts the visitors of a pregnant patient and gives a specific time for the patient to rest and sleep after the labor. Which maternal experience might be the probable reason for this nursing action? A) severe pain during labor B) severe fatigue during labor C) ineffective birth process D) problem of irregular urination

B) • the patient may have severe fatigue after labor due to depletion of energy. to restore the energy levels, the nurse gives a specific time for the patient to rest and sleep by restricting the visitors. severe pain, ineffectiveness in the birth process, and a problem of irregular urination are not reasons for the nurse to limit visitors. The nurse would administer analgesics or anesthesia on a prescription if the patient experienced acute pain. the nurse would provide comfort measures if the patient was ineffective in the birth process. the nurse would palpate the patient's bladder if irregular urination were a concern

Which is the primary cause of maternal weight loss preceding labor? A) diarrhea B) water loss C) loss of appetite D) nausea and vomiting

B) • the primary cause of maternal weight loss is water loss, which is responsible for a 0.5-1.5 kg of maternal weight loss preceding labor. Diarrhea, loss of appetite, and nausea and vomiting may precede labor but are less responsible for maternal weight loss prior to labor

Which postpartum nursing intervention should be taught to an obese patient who gave birth through cesarean delivery? A) cleaning the stitches once a day with soapy water B) drying the wound by using a hair dryer at low setting C) removing the sutures as soon as the wound starts healing D) keeping the wound covered at all times for better healing

B) • the surgical wound should be kept dry at all times to prevent infections. this can be achieved by drying the wound with the help of a hair dryer at a low setting, the would should be washed several times a day with soapy water to prevent infection and promote healing. the sutures should not be removed for some time to prevent wound disruption, which is a common problem in an obese patient. the wound should be left open for some time to prevent the formation of moisture and promote better healing

Which category of fetal heart rate (FHR) tracing includes tachycardia with minimal variability and periodic variable decelerations? A) category I B) category II C) category III D) category IV

B) • the tracing that contains tachycardia with minimal variability and periodic variable decelerations is a category II FHR tracing. A category II tracing is neither normal nor abnormal; it is indeterminate. A category I FHR tracing is normal (reassuring). A category FHR III is abnormal. Category IV does not exist.

A patient in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18-20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect? A) buccal oxytocin B) terbutaline sulfate C) calcium gluconate D) magnesium sulfate

B) • the woman receiving decreasing doses of magensium sulfate often is switched to oral terbutaline to maintain tocolysis. buccal oxytocin increases the strength of contractions and is used to augment or stimulate labor. buccal oxytocin dosing is uncontrollable. calcium gluconate reverses magnesium sulfate toxicity. the drug should be available for complications of magnesium sulfate therapy. magnesium sulfate usually is given IV or IM. the patient must be hospitalized for magnesium therapy because of the serious side effects of this drug

During a vaginal examination of a laboring patient, the nurse notes that the fetus is in the right occiput anterior (ROA) position at -1 station. Which is the position of the lowermost portion of the fetal presenting part? A) 2 cm above the ischial spine B) 1 cm above the ischial spine C) at the level of the ischial spine D) 1 cm below the ischial spine

B) • when the lowermost portion of the presenting part is 1 cm above the ischial spine, it is noted as being -1. When positioned 2 cm above the ischial spine, it is -2 station. At the level of the spines the station is referred to as 0 (zero). When the presenting part is 1 cm below the ischial spine, the station is said to be +1

Which of the following represents a normal FHR baseline? A) 80-105 B) 110-160 C) 145-190 D) 60-90

B) 110-160 • normal baseline fetal heart rate is 110-160 (pg 362)

Which is the term that describes measuring a contraction from the beginning of one contraction to the beginning of the next contraction? A) duration B) frequency C) speed D) intensity

B) frequency

clients at risk for preeclampsia may be advised to take which of the following drugs for prevention? A) diphenhydramine (25 mg) B) low dose aspirin (81 mg) C) ferrous sulfate (325 mg) D) folic acid (4 mg)

B) low dose aspirin

Which of the following is an emergency concern with labor anesthesia? A) fetal tachycardia on EFM B) maternal hypotension C) maternal hypertension D) moderate variability on EFM

B) maternal hypotension • Maternal hypotension with accompanying placenta insufficiencies is common for regional anesthesia administration. Fetal bradycardia and minimal/absent variability is also a concern. Pg 346

You witness your client admitted with preeclampsia become eclamptic. Which of the following is the best nursing action to take? A) place a bite guard in the mouth, turn the patient to the side, run to the hallway for help B) place one pillow under the shoulder if possible, raise and pad bedrails, observe and record the convulsion activity, and press the emergency button in the room for help C) immediately run to the nurse's station for assistance to help reposition the patient to the prone position D) immediately run to the hallway and call for help, once you return to the room administer calcium gluconate per the protocol

B) place one pillow under the shoulder if possible, raise and pad bedrails, observe and record the convulsion activity, and press the emergency button in the room for help

Which classic findings would the nurse identify in a patient with placental abruption (abruptio placentae)? A) absent vaginal bleeding B) uterine irritability with low-intensity contractions C) severe abdominal cramping D) painless vaginal bleeding E) boardlike abdomen

B), C), E)

Which interventions are most appropriate when caring for a patient admitted for preeclampsia on magnesium sulfate therapy? A) encourage increased PO fluid intake B) monitor strict intake and output C) place protective padding on the bed's side rails D) assist patient with ambulating to the bathroom instead of using a bedpan E) ensure that calcium gluconate is immediately available

B), C), E)

The nurse assesses the fetal heart rate (FH R) of a pregnant patient and finds minimal FHR variability. The nurse reassesses the patient 30 minutes later and finds moderate variability. Which will the nurse infer?

Baseline fetal heart rate is 150 beats/min If the nurse notes minimal FHR variability, the nurse should reassess the heart rate to determine a pattern. If in 30 minutes the nurse notices moderate variability, the fetus may be in a sleep state. The nurse would further confirm after half an hour and report it as moderate variability, where the heart rate baseline is confirmed as normal (110-160 beats/min). Heart rate variability is a characteristic of the baseline FHR and does not include accelerations or decelerations of the FH R. A fetal baseline heart rate of 180 beats/min is considered severe variability.

The nurse is instructed to count the fetal heart rate (FH R) for 30 to 60 seconds after each uterine contraction in a pregnant patient via intermittent auscultation. Th is assessment helps to identify a change in what?

Baseline heart rate Counting the FH R for 30 to 60 seconds after a uterine contraction (UC) helps to identify the basel i n e heart rate of the fetus and determine any changes in the pattern of the FHR. Palpating the abdomen will help identify the fetal position. Neither uterine activity (UA) nor placental flow can be identified by assessing the FHR after each UC. UA can be assessed by various methods, such as electronic fetal monitoring and external monitoring. A Doppler flow study under ultrasound visualization is mostly used to assess the placental flow from mother to fetus.

Biochemical assessment

Biologic exam and chemical determinations or lamellar body count (LBC) Procedures used to obtain the needed specimens: amniocentesis, PUBS, CVS, and maternal blood sampling Implications: based on test result, woman could choose to have an induced abortion

Third stage of labor

Birth of fetus until delivery of placenta - usually within 30 mins after birth (no longer than an hour)

The nurse teaches acupressure methods for pain relief during labor to a couple in the prenatal clinic. Which will the nurse teach about acupressure?

Blood circulation is enhanced Flow of qi (energy) is restored Pressure is applied with the fingers Pressure is applied with contractions

A patient in early pregnancy presents with heavy bleeding and clots. Her hemoglobin and hematocrit are low. Based upon the information given, which order would the nurse anticipate? A) prepare for emergency cesarean birth B) administer 650 mg acetaminophen for pain stat C) transfuse 1 unit packed RBCs stat D) massage the fundus

C)

The nurse recognizes that the patient understands the teaching when she makes which statement? A) premonitory labor signs include rupture of membranes B) i will know I'm in labor when i lose my mucus plug C) increasing clear vaginal secretions could mean labor will begin soon D) bright red bleeding is considered bloody show and means labor will begin soon

C)

Tocolytics are medications that A) are given to speed up labor B) are given to augment labor contractions C) are given to stop labor D) are given to encourage rupture of membranes

C)

Which action taken by the patient will reduce discomfort during Leopold maneuvers and make fetal presenting parts easier to feel? A) standing B) lying prone C) emptying the bladder D) pushing or bearing down with contractions

C)

Which type of placenta previa would the nurse recognize as being most dangerous? A) concealed previa B) marginal previa C) complete previa D) partial previa

C)

which technique is used to assess genetic abnormalities in a 12-week old fetus? A) amniocentesis B) standard ultrasonography C) chorionic villus sampling (CVS) D) magnetic resonance imaging (MRI)

C) • CVS is a popular technique used for genetically studying the fetus in the 1st trimester (11-14 weeks) of pregnancy. the advantage of CVS over other techniques is that it reveals the presence of genetic abnormalities at an early stage of pregnancy very accurately. amniocentesis can be used for diagnostic genetic abnormalities only after 14 weeks of pregnancy; before 14 weeks, the amount of amniotic fluid available is insufficient for testing. standard US is not used to detect genetic abnormalities in the fetus. this diagnostic technique is used only for visualizing the fetus. MRI is used mostly to evaluate the fetal structure & overall growth, the placenta, & the quantity of amniotic fluid. this technique is not useful for genetic studies

The nurse instructs a pregnant patient to breathe through the mouth and keep it open while pushing during labor. Which is the rationale for this nursing intervention? A) to avoid nasal congestion in the patient B) to decrease the efforts required for pushing C) to facilitate increased oxygen to the fetus D) to avoid deceleration in the fetal heart rate

C) • During labor, the nurse asks the patient to breathe through the mouth to keep the mouth open to increase both maternal and fetal oxygenation. Nasal congestion is not a complication associated with labor. Opening of the mouth does not increase the pushing capability. Early decelerations are observed by pushing, which does not require any intervention.

The second stage of labor, the descent phase, has begun when which happens? A) the amniotic membranes rupture B) the cervix cannot be felt during a vaginal examination C) the woman experiences a strong urge to bear down D) the presenting part is below the ischial spines

C) • During the descent phase of the 2nd stage of labor, the woman may experience an increase in the urge to bear down. Rupture of membranes has no significance in determining the stage of labor. The 2nd stage of labor begins with full cervical dilation. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the 1st stage of labor, as early as 5 cm of dilation

The nurse administered magnesium sulfate to a woman experiencing preterm labor, following a health care provider prescription. Which assessment would concern the nurse? A) urine output of 50 mL B) oxygen saturation of 95% C) 10 respirations per minute D) bronchial sounds heard over the body of the sternum

C) • The nurse assesses the woman who has been administered magnesium sulfate for respirations. Ten respirations per minute is a common hospital criterion to discontinue magnesium sulfate therapy. A urinary output of 50 mL/hour is considered normal and would not concern the nurse. On the other hand, a urine output of less than 30 mL/hour is a common hospital criterion to discontinue magnesium sulfate therapy. The nurse assesses the woman who has been administered magnesium sulfate for oxygen saturation. Oxygen saturation of 95% is considered normal and would not concern the nurse. The nurse assesses the woman who has been administered magnesium sulfate for lung sounds. The nurse expects to hear bronchial sounds over the body of the sternum.

Which intervention does the nurse perform to provide a relaxed environment for labor? A) stand at the bedside B) encourage rapid birth C) control sensory stimuli D) demonstrate excitement

C) • The nurse must assist the patient by providing a quiet and relaxed environment. A relaxed environment for labor is created by controlling sensory stimuli, such as light, noise, and temperature, as per the patient's preferences. The nurse must provide reassurance and comfort by sitting rather than standing at the bedside whenever possible. The nurse must not encourage or hurry the patient for rapid birth. The nurse must maintain a calm and unhurried attitude when caring for the patient.

A patient arrives at a birthing center in active labor. Her membranes are still intact, and the health care provider prepares to perform an artificial rupture of membranes (AROM). What will the nurse relay to the patient as the most likely outcome of the procedure? A) less pressure on the cervix B) decreased number of contractions C) increased pressure on the cervix D) the need for more cervical exams

C) • The rupture of the amniotic membranes releases the cushion provided by the amniotic sac and causes an increase in the pressure of the fetal head on the cervix. This increased pressure will often result in an increase in contractions and a decrease in the time for dilation and effacement of the cervix. Rupturing amniotic membranes releases the cushion provided by the amniotic sac and causes an increase in the pressure of the fetal head on the cervix. The rupture of the amniotic membranes typically causes an increase in pressure on the cervix and an increase in uterine contractions. Once the amniotic membranes have been ruptured (either spontaneously or artificially), the health care provider should prepare to check the cervix less frequently to decrease the risk for infection.

For which reason would a nurse administer a narcotic to a woman at the beginning of a contraction? A) to allow the medication to be transferred to both the laboring woman and the fetus B) the allow for no medication to be transferred to the fetus C) to allow for less medication to be transferred to the fetus D) to decrease the likelihood of maternal hypotension

C) • To obtain the most beneficial effects of the opioid analgesia during labor and limit transfer to the fetus, the nurse would start the injection of the medication at the beginning of the contraction, when the blood flow to the placenta is normally reduced. When placental blood flow resumes, much of the drug is in maternal tissues (El-Wahab & Fernando, 2014).Systemic analgesia passes through the placenta, and therefore the fetus is at risk for transfer of the medication; however, blood flow to the placenta is lowest during a contraction, which is the best time for administration of an opioid.Systemic analgesia passes through the placenta, and therefore the fetus is at risk for transfer of the medication.Maternal hypotension is not related to narcotic administration.

While caring for a multiparous patient in the 2nd stage of labor, the patient reports the urge to defecate. Which is the best nursing intervention? A) provide a bedpan to the patient to defecate B) place an enema in the rectum of the patient C) assess cervical dilation and station of the patient D) use running water to stimulate defecation for the patient

C) • a multiparous patient feels an urge to defecate in the 2nd stage of labor due to rectal pressure by the deeply descending presenting part in the pelvis. rectal pressure may occur even in the absence of stool in the anorectal area. this often means that the patient is about to give birth to the child. therefore the nurse must perform vaginal examination of the patient to assess cervical dilation and station. the patient does not really defecate, so providing a bedpan is not necessary. placing an enema in the rectum of the patient is not a suitable intervention, as it is done to increase peristalsis. Running water is used to stimulate voiding for the patient if there is a risk of urinary elimination. however, it is unrelated to the patient's urge of defecation

Which is the rationale for the nurse asking a pregnant patient with heart disease to document her daily weight? A) to monitor for heart failure B) to monitor for nutritional intake C) to assess for fluid retention D) to assess for any weight loss

C) • a sudden weight gain in a patient with heart disease indicates water retention. hence the nurse advises the patient to check her weight daily. nutritional intake is monitored by consuming the prescribed foods & supplements. heart failure is indicated by dyspnea, frequent, moist cough, or palpitations. weight loss is a concern for a patient who has elevated free thyroxine (T4) because of hyperthyroidism

which is a risk factor for a prolapsed umbilical cord? A) oligohydramnios B) pregnancy at 38 weeks of gestation C) presenting part at a station of -3 D) meconium-stained amniotic fluid

C) • because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed cord could occur if the membranes rupture. hydramnios puts the woman at risk for a prolapsed umbilical cord. a very small fetus, normally preterm, puts the woman at risk for a prolapsed umbilical cord. meconium-stained amniotic fluid shows that the fetus already has been compromised, but it does not increase the chance of a prolapsed cord

Which tocolytic drug should be avoided in a pregnant patient with a history of migraine headaches? A) nitrous oxide B) magnesium sulfate C) terbutaline D) prednisolone

C) • beta-2 adrenergic agonists are contraindicated in patients with migraine headaches. terbutaline is a tocolytic agent and a beta-2 adrenergic agonist. therefore the patient was prescribed terbutaline. nitrous oxide is an anesthetic that is contraindicated in patients with asthma but not migraine headaches. magnesium sulfate is also used as a tocolytic and is contraindicated in patients with cardiac disorders but not migraines. prednisolone is a corticosteroid, which is not contraindicated in the patients with migraine headaches

The nurse is teaching a group of pregnant patients about preterm labor. Which patient statement indicates the need for further teaching? A) i will empty my bladder immediately B) i will drink 3-4 glasses of water or juice C) i will lie in the supine position for 1 hour D) i will go to the hospital if symptoms continue

C) • if there are signs and symptoms of preterm labor, the patient should lie down on her side for 1 hour, because it helps improve placental and fetal circulation. the patient should empty her bladder immediately because a full bladder may sometimes irritate the uterus. dehydration may also irritate the uterus. therefore the patient should drink 3-4 glasses of water or juices. the patient should go to the hospital if the symptoms of preterm labor do not subside

the nurse understands that which concurrent condition during pregnancy is the leading cause of maternal mortality in the united states today? A) cytomegalovirus (CMV) B) human immunodeficiency virus (HIV) C) cardiovascular disease D) anemia secondary to blood loss

C) • rationale: CVD is now the leading cause of maternal mortality in the US today CMV is not a known cause of maternal mortality. most infected adults have mild to no symptoms HIV is not a significant cause of maternal mortality in the US acute blood loss is a significant cause of maternal mortality, but it is not the leading cause

which condition is related to the increased risk for respiratory distress in neonates born to mothers with gestational diabetes? A) hyperinsulinemia after birth B) recurrent fetal hypoxia and subsequent increased production of erythrocytes C) decreased fetal cortisol levels and therefore insufficient surfactant D) decreased maternal magnesium levels

C) • rationale: surfactant helps the alveoli function properly after birth and promote adequate ventilation in the newborn. when surfactant is insufficient, ventilation may be impaired hyperinsulinemia in utero is responsible for decreased cortisol, which leads to an increased risk for respiratory distress as a result of decreased surfactant. hyperinsulinemia after birth leads to hypoglycemia recurrent fetal hypoxia leads to hyperbilirubinemia after birth, not respiratory distress syndrome decreased maternal magnesium may lead to hypocalcemia in the neonate, not respiratory distress

A patient reports a fishy, greenish, malodorous vaginal discharge after intercourse. the nurse understands these findings to be classic symptoms of which condition? A) genital warts (condyloma) B) chlamydia C) bacterial vaginosis (Gardnerella) D) vaginal yeast infections (Candidiasis)

C) • rationale: the number one complaint for women with bacterial vaginosis is a fishy, greenish, thin discharge that is worse after intercourse genital warts appear as bumps on the skin although chlamydia may have discharge, the majority of patients are asymptomatic yeast infections present as copious, thick, white discharge that may accompany dysuria

which test would the nurse recommend for the patient to help assess fetal genetic abnormalities? A) fetal heart activity B) fetal body movements C) nuchal translucency (NT) D) amniotic fluid volume (AFV)

C) • the NT ultrasound screening technique is used to measure fluid in the nape of the fetal neck between 10 & 14 weeks of gestation. fluid volume greater than 3 mm is considered abnormal. NT is used mostly to identify possible fetal genetic abnormalities. AFV, fetal body movements, & fetal heart activity are measured to assess fetal well-being

The nurse caring for a patient in labor asks the support person to use heat application for pain relief. Why is heat applied to the body? A) to relieve muscle spasms B) to relax anesthetized areas C) the relieve general backache D) to provide comfort in the chest

C) • the application of heat enhances relaxation and reduces pain during labor. Heat application is effective for general backache from fatigue or back pain caused by posterior presentation. Cold applications, such as cold cloths, frozen gel packs, or ice packs, may be applied to relieve muscle spasms. Cold, not heat, is applied to the chest to increase comfort when the patient feels warm. Neither heat nor cold should be applied over ischemic or anesthetized areas because tissues can be damaged.

A blunt abdominal trauma causes fetal hemorrhage in a pregnant patient. The nurse finds that the patient is Rh negative. Which action will the nurse take? A) initiate magnesium sulfate per protocol B) administer oxytocin C) administer prescribed Rho(D) immunoglobulin D) prepare the patient for magnetic resonance imaging (MRI)

C) • the nurse administers the prescribed Rho(D) immunoglobulin to the patient to protect the patient from isoimmunization. the nurse needs to obtain a prescription for magnesium sulfate if there are eclamptic seizures in a patient with preeclampsia. Oxytocin is administered to prevent bleeding after birth or the evacuation of the uterus. MRI is used to assess injuries in a patient after trauma

During the 2nd phase of labor, the patient initiates pattern-paced breathing. Which adverse symptom must the nurse watch for when the patient initiates this method? A) pallor B) nausea C) dizziness D) diaphoresis

C) • the nurse must watch for symptoms of hyperventilation and resulting respiratory alkalosis. Symptoms of respiratory alkalosis during pattern-paced breathing include dizziness, light-headedness, tingling of fingers, or circumoral numbness. Pallor, nausea, and diaphoresis are generally observed in the active and transition phases of the 1st stage of labor. They are physiologic effects of pain.

when do the severity of symptoms in a pregnant asthmatic patient usually peak? A) in the first trimester B) immediately postpartum C) between 17-24 weeks gestation D) during the last 4 weeks of pregnancy

C) • the period between 17 & 24 weeks of pregnancy is associated with the greatest severity of symptoms. women often have few symptoms of asthma during the 1st trimester. during the last 4 weeks of pregnancy symptoms often subside. often issues have resolved by the time the woman gives birth

Which is accurate about tactile approaches to comfort management? A) either hot or cold applications may provide relief, but they should never be used together in the same treatment B) acupuncture can be performed by a skilled nurse with just a little training C) hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited D) therapeutic touch (TT) uses handheld stimulators that produce sympathetic vibrations

C) • the woman and her partner should experiment with massage before labor to see what might work best. Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. Therapeutic touch is a laying-on-of-hands technique that claims to redirect energy fields in the body.

The nurse observes that a pregnant patient at 31 weeks of gestation who is in labor has a cervical dilation of 5 cm with intact membranes. Which nursing intervention is the most appropriate in this situation? A) monitor blood glucose in the patient on a regular basis B) ensure that the propranolol is available for administration C) prepare to administer IV magnesium sulfate D) assess fetal ductus arteriosus and neonatal pulmonary hypertension

C) • this patient is at 31 weeks of gestation is considered preterm. with membranes intact, the therapeutic plan of care would include stopping the labor process. magnesium sulfate may be administered to the patient to prevent cerebral palsy of the fetus that may occur due to preterm birth. therefore the nurse has to prepare for the administration of magnesium sulfate IV to the patient. assessment of BG levels is not useful to prevent preterm birth. propranolol is used to reverse the adverse effects of terbutaline, and is not useful to prevent preterm birth. assessment of fetal ductus arteriosus and neonatal pulmonary HTN is useful when indomethacin is administered to the patient but not before administering magnesium sulfate to the patient

During a prenatal assessment, a patient asks the nurse about the disadvantages of spinal anesthesia. Which will the nurse teach the patient about the potential effect of spinal anesthesia? A) it reduces maternal consciousness B) it increases maternal muscular tension C) it increases probability of operative birth D) it increases the possibility of fetal hypoxia

C) • when a spinal anesthetic is given, the need for episiotomy, forceps-assisted birth, or vacuum-assisted birth tends to increase because voluntary expulsive efforts are reduced or eliminated. Maternal consciousness is maintained. Fetal hypoxia is absent as maternal blood pressure is maintained within a normal range. There is no muscular tension; excellent muscular relaxation is achieved.

A woman is experiencing strong contractions every 1.5 to 2 minutes, feels rectal pressure, and has a large amount of bloody show. At which frequency would the nurse anticipate assessing the fetal heart rate and pattern? A) every 30-45 minutes B) every 5-10 minutes C) every 15-30 minutes D) every 45-60 minutes

C) • Based on the patient's signs and symptoms, she is in active labor, so it is recommended that the nurse assess the fetal heart rate and pattern every 15 to 30 minutes. Every 30-45 & every 45-60 minutes would be appropriate in early labor. Every 5-10 minutes is recommended during the 2nd stage of labor

Which statement indicates a need for further teaching cesarean delivery? A) i might need a blood transfusion after the surgery B) having a c-section might make my hospital stay longer C) because I am not having a vaginal birth, my babies can't be harmed during delivery D) depending on how they do the incision, I may be able to have a vaginal delivery if i become pregnancy again

C) • Cesarean delivery carries risk for injury to the newborn, such as bruising, fractures, or other trauma. Maternal risks of cesarean delivery include hemorrhage and possible transfusion. Patients who have a cesarean delivery may require longer hospital stays. Classical uterine incisions eliminate the likelihood of vaginal delivery after a cesarean delivery, but a low transverse uterine incision makes vaginal delivery after a cesarean delivery possible.

Which deceleration is considered a normal finding? A) variable B) prolonged C) early D) late

C) • Early decelerations are a result of fetal head compression and are considered a normal finding that is not associated with poor fetal status or outcomes. Variable decelerations may result from reduced blood flow through the umbilical cord; recurrent variable decelerations may indicate hypoxemia and are nonreassuring. Prolonged decelerations indicate a prolonged interruption in fetal oxygen supply and are an ominous finding; immediate intervention is needed. Late decelerations may result if there is impaired oxygen exchange and waste products in the placenta. Late decelerations are nonreassuring.

The nurse caring for the woman in labor recognizes that maternal hypotension puts the laboring woman at risk for which result? A) early decelerations B) fetal dysrhythmias C) uteroplacental insufficiency D) spontaneous rupture of membranes

C) • Low maternal blood pressure reduces placental blood flow during uterine contractions and results in fetal hypoxemia. This hypoxemia can lead to late decelerations in the fetal heart rate.Maternal hypotension is not associated with early decelerations. Early decelerations are caused by fetal head compression.Maternal hypotension is not associated with fetal dysrhythmias. The cause of fetal dysrhythmias may be unknown, but some cases are caused by electrolyte imbalances, genetic mutations, heart defects, or a heart block.Maternal hypotension is not associated with rupture of membranes. The rupture of membranes may be caused by the weakening of the membranes or the force of contractions.

The nurse receives reports on two women in early labor, a nulliparous woman and a multiparous woman. Both are 3 cm dilated. Which statement is true regarding who will enter active labor first? A) the multiparous woman will enter active labor first B) the nulliparous woman will enter active labor first C) they will both progress at similar rates D) the patient whose contractions palpate stronger will enter active labor first

C) • Nulliparous and multiparous women have been found to progress at similar rates in this phase. Palpation is a subjective assessment and can vary based upon patient size. Nulliparous and multiparous women have been found to progress at similar rates in this phase.

The nurse is caring for a nulliparous patient in labor. Which is the reason why the experiences for a nulliparous patient may be different from that of a multiparous patient? A) less sensory pain during early labor B) greater sensory pain in the 2nd stage of labor C) greater fatigue due to longer duration of labor D) greater effective pain in the 2nd stage of labor

C) • Parity influences the perception of labor pain. The nulliparous patient often has longer labor and therefore greater fatigue. Sensory pain for nulliparous women is often greater than that for multiparous women during early labor, because their reproductive tract structures are less supple. Affective pain in the nulliparous patient is greater in the 1st stage as compared to a multiparous patient. It decreases for both patients during the 2nd stage of labor. During the 2nd stage of labor, the multiparous patient may experience greater sensory pain than the nulliparous patient. This is because tissues of the multiparous patient are more supple and increase the speed of fetal descent, thereby intensifying the pain.

Which statement is true regarding the care of a laboring client? A) any laboring client should be placed on NPO status as soon as active labor is diagnosed. B) The nurse should take every baby to the warmer for assessment immediately after birth for a full assessment C) Frequent position changes should be encouraged, even if the patient has an epidural for anesthesia D) The nurse should be an advocate for labor induction or augmentation from the CNM or physician

C) • Position changes are encouraged through the labor process. Peanut balls and other tools can be used to facilitate position changes for clients with labor epidurals.

The nurse is caring for a patient in the second stage of labor. Which patient condition is mostlikely to result in the need for an episiotomy? A) a patient with a h/o perineal laceration B) a patient receiving oxytocin for induction of labor C) a patient whose fetus is experiencing should dystocia D) a patient who had an episiotomy during a previous delivery

C) • Shoulder dystocia is an indication for episiotomy because it is necessary to allow as much room as possible for the delivery of the shoulder. History of perineal laceration is not an indication for episiotomy because an earlier laceration does not mean that perineal tissues will be weakened in subsequent pregnancies.An episiotomy would be indicated if the risk for perineal tear were present, but the administration of oxytocin does not necessarily increase this risk. Each pregnancy is different, and conditions that might necessitate an episiotomy are not predictable on the basis of a previous history of episiotomy. An episiotomy would be indicated if the risk for a perineal tear were present, but this cannot be determined solely on the basis of a previous episiotomy.

The nurse is checking the pad of a patient recovering from a cesarean delivery who has called out, "I just had a large gush of blood!" The nurse does not note an abnormal amount of blood under the patient's legs. Which action would the nurse take next? A) request that the HCP evaluate the patient for possible postpartum hemorrhage B) administer the as-needed (PRN) dose of methylgonovine C) check for pooling of blood under the patient's buttocks and back D) explain that this can be normal and evaluate with the next scheduled fundal check

C) • Significant amounts of blood can pool under a patient's buttocks or even up the back when the patient is bedbound. It is important to immediately evaluate this patient's concern. The nurse would evaluate the patient before calling the health care provider to the bedside. Methylergonovine may be indicated, but it is important that the nurse complete an assessment before administering a PRN medication. Blood can pool under and behind a patient. The nurse would roll the patient to check for pooling and should not wait for the next fundal check to evaluate the patient's concern.

The nurse notes fetal tachycardia and suspects that the patient may be dehydrated. Which nursing action is appropriate to address this nonreassuring finding? A) consult with dietician B) administer parenteral feeding C) increase rate of IV saline administration D) provide the patient an oral (PO) electrolyte replacement

C) • Tachycardia can be the result of maternal hypovolemia caused by dehydration. Increasing the rate of nonadditive intravenous fluids can improve placental perfusion by increasing maternal blood volume. The nurse does not have to consult with the dietician to provide an appropriate intervention for fetal tachycardia. Parenteral feeding is necessary for a woman whose digestive tract cannot absorb nutrients, not to address fetal tachycardia for a woman who is dehydrated. PO electrolyte replacement may be appropriate to address dehydration but would not result in immediate management of fetal tachycardia.

A laboring woman wishes to labor in the shower to alleviate pain. Which nonpharmacologic pain relief method is she applying? A) massage B) acupressure C) hydrotherapy D) relaxation

C) • Taking a shower is an example of hydrotherapy, a form of cutaneous stimulation, and it is a relaxation technique that can be very helpful for laboring women. Massage is a form of cutaneous stimulation that involves rubbing areas of pain to reduce discomfort. This relaxation technique can help with lower back pain during labor.Acupressure is a directed form of massage in which the support person applies pressure to specific pressure points using hands, rollers, balls, or other equipment. This is different from massage, but it is another type of cutaneous stimulation. Relaxation techniques include mental imagery, concentrating on a focal point, and music.

Which response would the nurse provide the patient who asks why oxygen is being given after the nurse identifies a nonreassuring fetal heart rate? A) I will call the HCP to discuss the new care plan B) we need to increase the perfusion of the baby's placenta C) we need to increase your oxygen, which will increase the baby's oxygen D) don't worry. This happens all of the time, and everything is fine

C) • The nurse provides a simple and direct explanation for the intervention being provided. The nurse is responsible for using simple, concise language to describe the problem and intended intervention. It is not appropriate to defer to the health care provider. Oxygen would not be given to increase the placental perfusion; the nurse would not provide this explanation. The nurse would not provide false reassurance. Instead, the nurse would explain what the concern is and why the intervention is being provided.

Of these options, which is the nurse's priority action when observing this fetal heart pattern? (late decelerations) A) notify the HCP B) assist with vaginal examination to assess for cord prolapse C) change maternal position D) assist with amnioinfusion

C) • The usual priority is as follows: (1) discontinue oxytocin if infusing; (2) change maternal position (side to side, knee chest); (3) administer oxygen at 8-10 L/min by nonrebreather face mask; (4) notify physician or nurse-midwife; (5) assist with vaginal or speculum examination to assess for cord prolapse; (6) assist with amnioinfusion if ordered; (7) assist with birth (vaginal-assisted or cesarean) if pattern cannot be corrected

Which order during labor augmentation would cause the nurse to question the health care provider? A) administer oxytocin in LR solution per protocol B) administer oxytocin in NS per protocol C) administer oxytocin in dextrose 10% per protocol D) administer oxytocin IM per protocol

C) • Using hypertonic solutions such as dextrose 10% increases the risk for water intoxication because it increases the antidiuretic effects of oxytocin. Solutions that contain electrolytes have been shown to decrease the risk for water intoxication when using oxytocin. Lactated Ringer and NS contain electrolytes. When administered in labor, oxytocin must be carefully titrated to ensure adequate fetal oxygenation. Administering a dose intramuscularly does not allow for titration or for discontinuation. It is inappropriate to give IM oxytocin during labor.

Which of the following is the most concerning complication risk for clients who desire vaginal birth after cesarean (VBAC) A) chorioamnionitis B) amniotic fluid embolus C) uterine rupture D) sepsis

C) • VBAC is contraindicated for clients with a high risk for uterine rupture. It should not be attempted by clients with a previous classical or T-shaped uterine incision, previous uterine rupture, or medical or obstetric complication for which vaginal birth is contraindicated.

A patient asks the nurse about the use of transcutaneous electrical nerve stimulation (TENS). Which will the nurse teach about TENS? A) it involves the use of one pair of electrodes B) it is kept at low intensity during contractions C) it releases continuous low-intensity impulses D) it is useful for pain in the 2nd stage of labor

C) • When TENS is applied for pain relief, the electrodes provide continuous low-intensity electrical impulses or stimuli from a battery-operated device. TENS is most useful for lower back pain during the early first stage of labor. TENS involves the placing of 2 pairs of flat electrodes on either side of the woman's thoracic and sacral spine. During a contraction, the patient increases the stimulation from low to high intensity by turning the control knobs on the device.

The nurse knows that patient education has been effective when the patient makes which statement about the difference between a tocodynamometer and an intrauterine pressure catheter (IUPC)? A) only the tocodynamometer shows my uterine activity B) the tocodynamometer is much more accurate than the IUPC C) the tocodynamometer is positioned outside my body, while the IUPC is positioned inside my body D) the tocodynamometer will be connected to my bedside monitor, but the IUPC will not

C) • Whereas the tocodynamometer is an external monitoring device, the IUPC is an internal monitoring device. Both the tocodynamometer and the IUPC can provide information on uterine activity, such as contraction strength. Because it is placed internally versus outside of the abdomen, the IUPC would give a more accurate reading. Both a tocodynamometer and an IUPC can output information via a bedside monitor.

Which maternal risk is associated with placenta previa? A) preeclampsia B) placental abruption C) surgery-related trauma D) gestational hypertension

C) • a patient with placental previa has a cesarean birth and is at risk for surgery-related trauma to the sutures adjacent to the uterus. the patient is at risk for placental abruption if the patient experiences trauma

The nurse observes that maternal hypotension has decreased uterine and fetal perfusion in a pregnant patient. Which will the nurse need to assess further to understand the maternal status? A) D-dimer blood test B) Kleihauer-Betke (KB) test C) electronic fetal monitoring D) electrocardiogram reading

C) • electronic fetal monitoring reflects fetal cardiac responses to hypoxia & hypo perfusion & helps to assess maternal status after a trauma. The D-dimer blood test is used to rule out thrombus. The KB test is used to evaluate transplacental hemorrhage. Electrocardiogram reading is more useful to assess the cardiac functions in non pregnant cardiac patients

The nurse is caring for a patient who is using fentanyl citrate through patient-controlled analgesia (PCA) while in labor. Which effect of fentanyl citrate does the nurse expect? A) provides long duration of action B) requires only a single dose C) provides quick relief to pain D) causes sedation and nausea

C) • fentanyl citrate is a potent short-acting opioid agonist analgesic. Therefore it provides quick pain relief. It rapidly crosses the placenta, so it is present in the fetal blood within 1 minute after IV maternal administration. It is a short-acting drug, so the patient will require more frequent dosing. It is often administered as a patient-controlled analgesic. It has fewer neonatal effects as compared to meperidine and causes less maternal sedation and nausea

After a vaginal examination, the nurse documents "RSA" on the patient's chart. This indicates which presenting part? A) the sacrum in the left anterior quadrant of the maternal pelvis B) the scapula in the right anterior quadrant of the maternal pelvis C) the sacrum in the right anterior quadrant of the maternal pelvis D) the scapula in the left transverse quadrant of the maternal pelvis

C) • fetal position is denoted by a 3 letter abbreviation. The first letter denotes the location of the presenting part in the R or L side of the mother's pelvis. The middle letter stands for the specific presenting part of the fetus: O for occiput, S for sacrum, M for mentum, and Sc for scapula. The 3rd letter stands for the location of the presenting part in relation to the anterior (A), posterior (P), or transverse (T) portion of the maternal pelvis. RSA indicates that the presenting part is the sacrum in the right anterior quadrant of the maternal pelvis. LSA indicates that the presenting part is the sacrum in the left anterior quadrant of the maternal pelvis. RScA shows that the presenting part is the scapula in the right anterior quadrant of the maternal pelvis. LScT indicates that the presenting part is the scapula in the left transverse quadrant of the maternal pelvis

Which explains the term fetal presentation? A) the relation of the presenting part to the mother's pelvis B) the relation of the fetus's and mother's spine C) the part of the fetus that enters the pelvic inlet first D) the relation of the fetal body parts to one another

C) • fetal presentation refers to the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor at term. In a cephalic presentation, the fetal head enters the pelvic inlet first. Fetal position is the relationship of the reference point on the presenting part of the fetus to the 4 quadrants of the mother's pelvis. The fetal lie is the relation of the long axis or spine of the fetus to the long axis or spine of the mother. The fetal attitude is the relation of the fetal body parts to one another in utero

Which statement does the nurse use to describe to the patient's partner why opioid analgesics are being administered? A) opioid analgesics prevent nausea B) opioid analgesics remove the pain of labor C) opioid analgesics helps the laboring woman relax between contractions D) opioid analgesics reduce respiratory depression for the laboring woman

C) • he nurse explains that opioid analgesics affect the perception of pain, allowing the laboring woman to relax during contractions.The nurse would not make the statement that opioids prevent nausea; in fact, it is a common side effect of use.The nurse would not make the statement that opioids remove the pain of labor, because they suppress the perception of pain but do not take pain away completely.The nurse would not make the statement that opioids reduce respiratory depression for the laboring woman, because opioids given at the beginning of a contraction do not reduce respiratory depression for the laboring woman. In fact, they can cause respiratory depression in the newborn.

Which condition is a contraindication to subarachnoid and epidural blocks? A) maternal hypertension B) maternal hypervolemia C) infection at injection site D) reduced intracranial pressure

C) • if the patient has an infection at the needle insertion site, subarachnoid or epidural blocks are contraindicated. Infection can spread through the peridural or subarachnoid spaces if the needle transverses an infected area. Maternal hypovolemia, not hypervolemia, leads to increased sympathetic tone to maintain the BP. An anesthetic technique that blocks the sympathetic fibers can produce significant hypotension that can endanger the mother and fetus. Maternal hypotension, not hypertension, is contraindicated for anesthetic blocks. Increased intracranial pressure caused by a mass lesion is a contraindication for anesthetic blocks.

Which instruction will the nurse provide to a pregnant patient with mild preeclampsia? A) you need to be hospitalized for fetal evaluation B) nonstress testing can be done once every month C) fetal movement counts need to be evaluated daily D) take complete bed rest during the entire pregnancy

C) • preeclampsia can affect the fetus & may cause fetal growth restrictions, decreased amniotic fluid volume, abnormal fetal oxygenation, low birth weight, and preterm birth

Which intervention will help prevent the risk of pulmonary edema in a pregnant patient with severe preeclampsia? A) assess fetal HR abnormalities regularly B) place the patient on bed rest in a darkened environment C) restrict total IV & oral fluids to 125 mL/hr D) ensure that magnesium sulfate is administered as prescribed

C) • pulmonary edema may be seen in patients with severe preeclampsia. Therefore the nurse needs to restrict total IV and oral fluids to 125 mL/hr. FHR monitoring helps assess any fetal complications. the patient is placed on bed rest in a darkened environment to prevent stress. Magnesium sulfate is administred to prevent eclamptic seizures

The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. The nurse understands that the baby is at high risk for which condition? A) shoulder dystocia B) umbilical cord prolapse C) aspiration pneumonia D) brachial plexus injury

C) • some babies may pass meconium even before birth, thus staining the amniotic fluid green. this meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk for meconium aspiration syndrome, which may cause respiratory depression and aspiration pneumonia. meconium-stained amniotic fluid does not increase the risk for should dystocia. shoulder dystocia is common when there is fetopelvic disproportion because of excessive fetal size or maternal pelvic abnormalities. umbilical cord prolapse is an obstetric emergency where the umbilical cord lies before the presenting part of the fetus. brachial plexus injury is common in babies when the vaginal delivery takes place despite shoulder dystocia

The nurse is examining a newly admitted patient who is 39 weeks pregnant and notes that the patient is in the active phase of labor. Which symptom does the nurse note to reach this conclusion? A) no evidence of UCs B) mild UCs C) strong UCs D) moderate UCs

C) • strong UCs may occur in the active phase of labor. Absence of uterine contractions means that the labor has not started. Mild UCs can be observed during early labor. Mild to moderate UCs can be observed during the latent active phases of labor

Which describes the Ferguson reflex? A) release of endogenous oxytocin B) involuntary uterine contractions C) maternal urge to bear down D) mechanical stretching of the cervix

C) • the ferguson reflex occurs when stretch receptors in the posterior vagina cause the release of endogenous oxytocin. The involuntary uterine contractions or primary powers originate at certain pacemaker points in the thickened muscle layers of the upper uterine segment. Intrauterine pressure caused by contractions exerts pressure on the descending fetus and the cervix. When the presenting part of the fetus reaches the perineal floor, mechanical stretching of the cervix occurs

A patient has given birth to a baby 1 hour ago. Which intervention should the nurse perform while caring for the patient? A) massage the fundus if it is firm to expel any clots B) measure BP every 30 minutes for 2 hours C) check the perineal pads and linen under the patient's buttocks D) access pulse rate and regularity every 30 minutes for 2 hours

C) • the nurse should check the perineal pads and linen under the patient's buttocks for lochia and note the color, odor, and size of the clots. This helps to detect the presence of intrauterine complication after birth. BP should be monitored every 15 min for 1 hour. this enables the nurse to assess the state of the patient and prevent any complications. the fundus of the uterus should be massaged until it is firm, and the clots are expelled. the pulse rate and regularity should be measured every 15 minutes for 1 hour

In which stage of labor is the placenta expelled? A) first B) second C) third D) fourth

C) • the placenta normally separates with the 3rd or 4th strong uterine contraction after the infant has been born. The 1st stage of labor lasts from the time dilation begins to the time when the cervix is fully dilated. The 2nd stage of labor lasts from the time of full cervical dilation to the birth of the infant. The 4th stage of labor lasts for the first 2 hours after birth

Which fetal heart rate (FHR) change might warrant an amnioinfusion? A) late deceleration B) early deceleration C) variable decelerations D) prolonged decelerations

C) • variable decelerations in the FHR are observed when the umbilical cord is compressed. An amnioinfusion refers to the infusion of isotonic fluid into the uterine cavity when the amniotic fluid levels are decreased. This intervention is usually done for the prevention of umbilical cord compression. Late decelerations are observed when infections or elevated UCs are seen in a patient. This condition will be reversed by maintaining an IV solution, but amnioinfusion is not administered. Early deceleration in the FHR is a normal sign that does not require any intervention. Prolonged deceleration of the FHR occurs when there is a marked reduction of the fetal oxygen supply

The primary health care provider (PHP) advises the nurse to assess the maternal temperature and vaginal discharge of a pregnant patient every 2 hours. Which reason is behind this advice? A) to evaluate fetal status B) to know the onset of labor C) the assess for potential risk for infection D) to prevent fetal hypertension

C) • when the membranes rupture, there is a possible risk of infection, as the microorganisms can ascend from the vagina to the uterus. ruptured membranes can be assessed by monitoring the body temp and vaginal discharge every 2 hours. the assessment is not used for knowing the onset of labor because it does not indicate the progress of labor. the fetal status is not known by the assessment of the temperature and vaginal show; it may be known by another procedure called Leopold maneuvers. this measure is not done to prevent fetal hypertension, because the maternal body temp and vaginal discharge do not indicate fetal BP

The term used to describe the part of the fetus that first enters the pelvic inlet during labor is referred to as: A) power B) parietal bone C) presentation D) passageway

C) presentation

Which signs would the nurse recognize as indicative of missed abortion? A) vaginal bleeding B) products of conception partially expelled C) decrease in uterine size D) absent fetal heart rate E) subsiding nausea F) absence of breast tenderness

C), D), E), F)

Which category of fetal heart rate (FHR) tracing includes tachycardia with minimal variability and periodic variable decelerations?

Category II The tracing that contains tachycardia with minimal variability and periodic variable decelerations is a category II FHR tracing. A category II tracing is neither normal nor abnormal; it is indeterminate. A category I FHR tracing is normal (reassuring). A category FHR III is abnormal. Category IV does not exist.

Which fetal heart rate classification is considered non reassuring?

Category III Category III classification refers to abnormal findings that are nonreassuring. Category I is considered normal and reassuring. Category II classification is indeterminate, meaning equivocal or ambiguous. When category II is present, additional clinical assessments are necessary to determine whether the fetal heart rate (FHR) is nonreassuring. Category IV is not a fetal heart rate classification.

Which will the nurse teach the patient about the benefits of breathing techniques in the second stage of labor?

Causes increase in abdominal pressure In the second stage of labor, breathing techniques are used to increase abdominal pressure and expel the fetus.

Of these options, which is the nurse's priority action when observing this fetal heart pattern?

Change maternal position. The usual priority is as follows: (1) discontinue oxytocin if infusing; (2) change maternal position (side to side, knee chest); (3) administer oxygen at 8 to 10 L/min by nonrebreather face mask; (4) notify physician or nurse midwife; (5) assist with vaginal or speculum examination to assess for cord prolapse; (6) assist with amnioinfusion if ordered; (7) assist with birth (vaginal-assisted or cesarean) if pattern cannot be corrected.

The nurse acts as an advocate for the patient during an informed consent for anesthesia. Which care must the nurse take while obtaining an informed consent?

Check for the patient's signature Check for the date on the consent form Check the anesthetic care provider's signature

The primary health care provider has asked the nurse to draw blood for an umbilical cord acid-base determination test. Which will the nurse do in this situation?

Collect blood from both the umbilical artery and vein. An umbilical cord acid-base determination test is performed to assess the immediate condition of the neonate postpartum if there is an abnormal or confusing fetal heart rate (FH R) tracing found during labor. The nurse should collect blood from both umbilical artery and umbilical vein to perform the test. The fetal scalp stimulating technique is an indirect method to assess the fetal blood pH. This test need not be performed before the acid-base determination test. It is not necessary to administer terbutaline (Brethine), a uterine relaxant, before performing the test; it is administered during the time of labor if uterine contractions are too frequent.

What are high-risk medical and obstetric disorders within pregnancy?

Complications of current and past pregnancies, obstetric-related illness, and pregnancy losses put woman at risk

Which intervention will the nurse perform to provide emotional support to the patient in labor?

Compliment patient efforts during labor Use a calm, confident approach Involve the patient in care decisions

Which clinical measure is transmitted by a tocodynamometer?

Contraction frequency Contraction frequency and duration are transmitted by the tocodynamometer (or toco). The toco detects pressure changes of the abdomen to detect contractions. Fetal heart rate is transmitted by the ultrasound transducer, not the tocodynamometer. Contraction intensity is not a clinical measure that is available by external electronic fetal monitoring. Fetal decelerations in heart rate are transmitted by the ultrasound transducer, not the tocodynamometer.

What two things must be present for patient to be in labor?

Contractions and dilation

The primary health care provider prescribes terbutaline (Brethine) for a pregnant patient. As the nurse reviews the patient's medical record, which is the rationale for this prescription?

Contractions are increased. Terbutaline (Brethine) is administered to the patient who has premature labor. It slows down the contractions. Terbutaline (Brethine) has no effect on blood volume, blood pressure, or hemoglobin. Blood volume is elevated by infusing aggressive intravenous infusion or from sodium and water retention. Maternal hypotension, as evidenced by reduced blood pressure, is relieved by elevating the legs during labor. Patients with decreased hemoglobin are treated with iron supplements, not terbutaline (Brethine).

Which intervention does the nurse perform to provide a relaxed environment for labor?

Control sensory stimuli

Nursing role with ultrasound

Counsel and educate about procedure nonmusical ultrasounds (3D, 4D imaging which AIUM and ACOG strongly discourage)

A woman is experiencing back labor and reports having intense pain in her lower back. The nurse instructs the support person to use which nonpharmacologic technique?

Counterpressure against the sacrum

Nonpharmacologic Pain Management during labor

Cutaneous stimulation strategies (counter pressure, massage, position change, TENS, acupressure, water therapy) Sensory stimulation strategies (aromatherapy, breathing, music, imagery) Cognitive strategies (education, hypnosis)

A patient reports a feeling of lightness in her abdomen, increasing whitish, thin, and odorless vaginal discharge, and occasional contractions that go away after an hour or so. Which action would the nurse take next? A) advise the patient to report to the birthing center B) suggest routine sexual transmitted infection counseling C) call the ambulance because she is experiencing an emergency D) educate the patient on the premonitory signs of labor

D)

A woman who is at 38 weeks gestation reports suspected signs of labor to the triage nurse. Which statement by the nurse supports the beginning of true labor? A) your contractions will decrease with activity B) the contractions will be mild and more annoying than painful C) you will feel the contractions in your front pelvic area and not in your back D) labor contractions will occur in a consistent pattern that increases in frequency, duration, and intensity

D)

After administration of oral (PO) labetalol for a patient with gestational hypertension, the nurse notes a BP of 178/96 mm Hg. The patient also reports headache and blurry vision. Which order from the patient's health care provider would the nurse anticipate? A) up ad lib B) lisinopril C) salt-free diet D) magnesium sulfate

D)

The second stage of labor involves A) a time of recovery, monitoring, and bonding with the baby B) delivery of the placenta C) progressive cervical dilation D) delivery of the baby

D)

When assessing a patient with preeclampsia on magnesium sulfate for seizure prophylaxis, the nurse notes the patient demonstrates hyperreflexia (+4). How does the nurse interpret this patient cue? A) the nurse should administer a 500-mL bolus of lactated Ringer's solution B) the nurse should interpret this as normal and continue the therapy as prescribed C) the nurse should request a prescription for calcium gluconate immediately D) the nurse should question the HCP regarding the current dose of magnesium sulfate

D)

When assessing the neonate born to a mother with preeclampsia, the nurse knows that low birth weight may be attributed to which factor? A) maternal diabetes B) limited maternal diet C) maternal hypotension D) poor placental perfusion

D)

which finding would the nurse recognize as indicating progression of preeclampsia to eclampsia? A) proteinuria B) weight gain in the absence of edema C) pitting edema in the absence of weight gain D) a generalized seizure not attributed to other causes

D)

which information is important to obtain when assessing a patient admitted with ruptured membranes?Leopold's maneuvers are an assessment of: A) the neck to assess of any JVD in labor B) the chest to assess lactation capabilities C) the pelvis to assess for pelvic adequacy to accomodate the fetus D) the abdomen to identify fetal positioning and size

D)

A patient is experiencing intense back pain and discomfort during active labor. Which position would the nurse encourage the patient to assume? A) standing straight B) side-lying C) semi-sitting D) hands and knees

D) • A hands-and-knees position reduces back pain because the fetus falls forward, away from the sacral promontory. It promotes normal mechanisms of birth. The woman can use pelvic rocking to decrease back pain. Caregivers can rub the woman's back or apply sacral pressure easily. Contractions are less uncomfortable and more efficient when upright. Back pain is relieved by bending forward, not standing straight. de-lying does not efficiently reduce back pain, because the fetus still puts pressure on the sacral promontory. Unless leaning forward, the pressure is not relieved from the sacral promontory in a semi-sitting position. This position may cause more pain as the fetal head rests on the sacral promontory.

Which information would the nurse consider when educating patients and support people about nonpharmacologic pain management techniques? A) music applied by the support person has to be discouraged because it could disturb others or upset the hospital routine B) women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time C) effleurage is permissible, but counterpressure is almost always counterproductive D) acupressure to either side of the spine can facilitate the release of endorphins and decrease some back pain

D) • Acupressure is an effective nonpharmacologic technique that can be used to relieve a variety of pain during labor. Music is a relaxation technique that is encouraged for women to use during labor. Hydrotherapy is not offered in all facilities; however, if available, the nurse would refer to the policy of the facility. A 15-minute time line is not a standard policy for hydrotherapy during labor. Effleurage and counterpressure are 2 different massage techniques that are used for an unmedicated birth. Counterpressure is effective for lower back pain and hip pain during labor.

Maternity nurses often have to answer questions about the many, sometimes unusual, ways people have tried to make the birthing experience more comfortable. Which information would the nurse consider when educating patients and support people about nonpharmacologic pain management techniques? A) Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine. B) Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time. C) Effleurage is permissible, but counterpressure is almost always counterproductive. D) Acupressure to either side of the spine can facilitate the release of endorphins and decrease some back pain.

D) • Acupressure is an effective nonpharmacologic technique that can be used to relieve a variety of pain during labor. Music is a relaxation technique that is encouraged for women to use during labor. Hydrotherapy is not offered in all facilities; however, if available, the nurse would refer to the policy of the facility. A 15-minute timeline is not a standard policy for hydrotherapy during labor. Effleurage and counterpressure are two different massage techniques that are used for an unmedicated birth. Counterpressure is effective for lower back pain and hip pain during labor.

During fundal assessment 30 minutes after a cesarean delivery, the patient reports discomfort and exhaustion and asks the nurse, "Why do you keep poking at me?" Which response from the nurse is appropriate? A) "I'll wait until you're on the postpartum floor to assess you again." B) "I need to do this assessment to make sure your incision is healing correctly." C) "This assessment must be done every 30 minutes until you transfer out of the recovery room." D) "A cesarean delivery puts you at risk for excessive bleeding, so it's important to assess you frequently."

D) • Fundal assessment must be performed frequently after cesarean delivery to assess for uterine atony, which can lead to hemorrhage. Postpartum hemorrhage and uterine atony are risks of cesarean delivery. Fundal assessment after cesarean delivery should not be delayed until the patient is transferred to the postpartum unit. Fundal assessment after cesarean delivery is performed to assess for uterine atony, not to ensure healing of the incision. Fundal assessment should be performed every 15 minutes for the first hour after delivery, every 30 minutes for the second hour, and then hourly until the patient transfers to the postpartum unit.

which test would the nurse recommend for an obese pregnant patient to assess the risk for intrauterine growth restriction? A) daily fetal movement count B) abdominal US C) computed tomography (CT) D) transvaginal ultrasonography

D) • IUGR is poor growth of the fetus during pregnancy. transvaginal US allows early diagnosis of IUGR & detailed examination of the pelvic anatomic features. thick abdominal layers in obese women may not allow adequate penetration during abdominal US; therefore TVUS is preferred in obese women. daily fetal movement count is used to monitor the complications related to poor fetal oxygenation. CT is contraindicated in pregnant women because the ionizing radiation may cause adverse effects in the fetus

The charge nurse instructed a group of student nurses about the monitoring of uterine activity (UA) during labor. Which statement by the student nurse is accurate regarding the calculation of Montevideo units? A) they can be calculated using an ultrasound transducer machine B) they can be calculated using a spiral electrode monitoring device C) they can be calculated using a tocotransducer monitoring system D) they can be calculated with an intrauterine pressure catheter (IUPC)

D) • Montevideo units can only be calculated using the internal monitoring of UA. An intrauterine pressure catheter (IUPC) monitors UA internally. Therefore, Montevideo units can only be calculated using the IUPC. Spiral electrode monitoring is used for assessing the fetal heart rate, not UA internally. The toco monitoring system is used to monitor the UA externally. An ultrasound transducer is also used to monitor the FHR externally.

The nurse observes variable decelerations in the fetal heart rate (FHR) while assessing a pregnant patient with oligohydramnios. Which medication should be immediately given to the patient? A) oxytocin (Pitocin) B) terbutaline (Brethine) C) phenylephrine (Endal) D) Lactated Ringer's solution

D) • Oligohydramnios is a condition that may cause umbilical cord compression and results in variable decelerations in the FHR. Usually, lactated ringers or normal saline solution can be administered into the umbilical cord to increase the amniotic fluid volume and normalize fetal heart activity. Terbutaline (Brethine) is a uterine relaxant. It is mostly used to reduce uterine tachysystole. The nurse can administer phenylephrine (Endal) if other measures are unsuccessful in improving maternal hypotension. Oxytocin (Pitocin) is a uterine stimulant to induce labor. It is not used to reduce the umbilical cord compression.

A woman in labor is given an opioid analgesic for pain. Which vital sign is a priority for the nurse to monitor in the newborn infant? A) pulse B) temperature C) blood pressure D) respiratory rate

D) • Opioid analgesics can cause respiratory depression, which is more likely to occur in the newborn than in the mother; therefore respiratory rate should be monitored.Although pulse should be checked in a newborn, it is not the priority vital sign to monitor in a newborn whose mother was given an opioid analgesic. Although temperature should be checked in a newborn, it is not the priority vital sign to monitor in a newborn whose mother was given an opioid analgesic.Although blood pressure should be checked in a newborn, it is not the priority vital sign to monitor in a newborn whose mother was given an opioid analgesic.

A patient sustained a first-degree laceration during childbirth. Which physical finding should the nurse infer from this? A) the laceration also involves the anterior rectal wall B) the laceration continues through the anal sphincter muscle C) the laceration extends through muscles of the perineal body D) the laceration extends through the skin and structures superficial to muscles

D) • a 1st degree laceration extends through the skin and structures superficial to muslces. A 2nd degree laceration extends through muscles of the perineal body. A 3rd degree laceration continues through the anal sphincter muscle. A 4th degree laceration involves the anterior rectal wall

Which device is used for monitoring the intensity of uterine contractions (UCs) in a pregnant patient? A) tocotransducer B) spiral electrode C) ultrasound transducer D) intrauterine pressure catheter (IUPC)

D) • an IUPC measures the frequency, duration, and intensity of contractions during the intrapartum period. The device records the pressure at the catheter tip, and the values are expressed in terms of mmHg. However, for accurate readings, the membranes should be ruptured, and the cervix should be dilated. A tocotransducer monitors the frequency and duration of contractions for both antepartum and intrapartum care. This device is placed on the abdomen of the patient. The spiral electrode and ultrasound transducer are used for assessing the FHR and not the intensity of contractions. The spiral electrode is an invasive mode, whereas an ultrasound transducer is a noninvasive mode.

The nurse is instructed to administer 12 mg of betamethasone to a pregnant patient at 30 weeks of gestation. Which nursing intervention should be performed for the safe administration of the drug? A) give the medication by oral route B) assess platelet levels after drug administration C) administer increased doses of insulin with the drug D) follow a strict time interval of 24 hours between 2 doses

D) • betamethasone is an antenatal glucocorticoid that is given IM to pregnant women between 24 & 34 weeks of gestation. it is administred to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome. therefore the nurse should administer the drug in 2 doses with a time interval of 24 hours because optimal fetal benefits start 24 hours after the first injection. the drug cannot be administered orally because it may impair the absorption of the drug; therefore the drug must be given only through the IM injection route. The drug causes increased blood glucose levels and increases WBCs but not blood platelet levels. therefore it is not useful to assess the blood platelet levels in the patient after the drug is administered. increased doses of insulin are administered only if the patient has a history of well-controlled blood sugar levels

which medication will the primary HCP ask the nurse to administer in a vaginal delivery to a patient who has a history of MI? A) oxytocin B) diuretics C) anticoagulant D) epidural analgesia

D) • epidural analgesia is administered during labor to a patient with MI to prevent pain, which can result in tachycardia & increased cardiac demands. oxytocin is administered to a patient after birth to prevent hemorrhage. diuretics are administered to prevent fluid retention in a pregnant patient with a heart disease. anticoagulant therapy is administered for recurrent venous thrombosis in pregnancy

which finding in the Doppler umbilical flow reports of a pregnant patient would cause the nurse to advise the patient to quit smoking immediately? A) high amniotic fluid volume (AFV) B) low amniotic fluid volume (AFV) C) low systolic-to-diastolic (S/D) ratio D) high systolic-to-diastolic (S/D) ratio

D) • exposure to nicotine from maternal smoking has been reported to increase the fetal S/D ratio. an elevated S/D ratio indicates a poorly perfused placenta. to improve the blood supply to the placenta, the patient would quit smoking as soon as possible. the AFV cannot be assessed through Doppler umbilical blood flow study. moreover, smoking does not affect amniotic fluid volume. smoking increases the S/D ratio; it does not decrease it

which test would the nurse recommend to a pregnant patient who has undergone a cesarean section in her previous pregnancy and needs to be checked for the fetal heart rate pattern? A)biophysical profile B) nipple-stimulated test C) oxytocin-stimulated test D) fetal acoustic stimulation

D) • fetal acoustic stimulation is a nonstress test for monitoring the fetal HR pattern. it can be used in cases of previous cesarean birth becasue there is no stress to the fetus. a BPP is done to determine the physical profile of the fetus; it cannot be used to monitor the HR of the fetus. an oxytocin-stimulated test is a type of stress testing that is contraindicated in cases of previous cesarean birth because of the stress caused by the injected oxytocin. a nipple-stimulated test is a contraction stress test that is contraindicated in patients with previous cesarean birth. in this test, the released oxytocin may cause distress to the fetus

A pregnant woman arrives at the emergency department, and after completing a vaginal examination the nurse midwife states that the patient is 5 cm dilated and 75% effaced and the fetus is at -3 station. Which statement is accurate regarding this statement? A) the patient may initiate pushing efforts B) the cervix is fully dilated C) the cervix is fully effaced D) the fetus is not engaged within the maternal pelvis

D) • fetal engagement begins at 0 station

When does the nurse use the fetal scalp stimulation technique to assess the fetal scalp pH? A) if the patient's contractions have increased B) if there is maternal weight loss in the last trimester C) if fetal bradycardia is present D) when the fetal heart rate (FHR) is within the baseline

D) • fetal scalp and vibroacoustic stimulation are 2 stimulating methods that are used to determine the fetal scalp blood pH. They are performed only when the fetal baseline HR is WNL. These techniques are not suggested if there is fetal bradycardia. These stimulation methods are related to neither the patient's weight nor uterine contractions

Which umbilical blood gas reading is consistent with respiratory acidosis? A) a base deficit value greater than or equal to 12 mmol/L B) blood glucose levels = 120 mg/dL C) arterial pH >7.20 D) partial pressure carbon dioxide >55 mmHg

D) • if Pco2 >55 mmHg (elevated) and base deficit value < 12 mmol/L and pH is <7.20, it indicates respiratory acidosis. In this case, the partial pressure carbon dioxide >55mmHg is indicative of respiratory acidosis. A pH >7.20 and base deficit value greater than or equal to 12 mmol/L are all considered normal. Blood glucose level is not a part of this acid-base report

which advice would the nurse provide to a pregnant patient with late decelerations in fetal heart rate occurring with 60% of contractions during a contraction stress test? A) continue with the weekly testing schedule B) take the test again tomorrow at the same time C) you should take the test again today after resting D) you should be hospitalized and monitored continuously

D) • if late decelerations occur with more than 50% of the contractions in the contraction stress testing, this is a positive test result. in this situation, the patient must be hospitalized & evaluated further. if the fetus has no significant variable HR decelerations with at least 3 uterine contractions for a period of 10 minutes, the patient can continue with the weekly testing schedule. if late deceleration in the HR occurs with less than 50% of the contractions, the patient would be advised to repeat the test the next day. repeating the test on the same day can cause fetal distress and would be avoided

Which information would the nurse teach a patient with phenylketonuria (PKU) about breastfeeding? A) you should breastfeed your child every 3-4 hours B) eat a phenylalanine-restricted diet for breastfeeding C) eat wheat products immediately after breastfeeding D) you should bottle-feed, because it is not safe to breastfeed

D) • it is not advisable to breastfeed if the patient has PKU, because the milk will contain a high concentration of phenylalanine. the nurse instructs the patient to breastfeed every 3-4 hours for patients without PKU. wheat products contain phenylalanine and are not recommended for patients with PKU. eating a phenylalanine-restricted diet is effective before conception to lower the phenylalanine levels in the patient

A patient with gestational diabetes experiences rupture of membranes at 36 weeks gestation. which patient teaching statement regarding this condition is accurate? A) rupture of membranes is more common in women with gestational diabetes because of the excess amounts of glucose in your urine B) rupture of membranes at this time in your pregnancy is normal and sometimes happens before labor begins C) your membranes likely ruptured because of excess ketones in your blood D) preterm rupture of membranes is more common in women with gestational diabetes, and it might be related to overdistention of your uterus

D) • it is thought that the cause of increased incidence of preterm rupture of membranes in gestational diabetics is overdistention of the uterus UTI, not rupture of membranes, is a common result of excess amounts of glucose in the urine 36 weeks is considered preterm, and therefore rupture of membranes is not normal ketones in the blood have not been directly linked to preterm rupture of membranes

After administering phenylephrine (Neo-Synephrine) as prescribed to a pregnant patient, the nurse places the patient in the Trendelenburg position. Which is the rationale for this intervention? A) to reduce the FHR B) to reduce effects of tachysystole C) to prevent adverse effects of the drug D) to increase the patient's BP

D) • phenylephrine (Neo-Synephrine) is used to treat maternal hypotension. Placing the patient in the Trendelenburg position would supplement the action of the drug and prevent the maternal hypotension from affecting the fetus. Tachysystole is reduced by administering terbutaline (Brethine), not by changing the position of the patient. The prescribed dose of phenylephrine (Neo-Synephrine) is unlikely to cause any adverse effects in the patient. Phenylephrine (Neo-Synephrine) has no effect on the FHR.

Which of the following is an assessment finding that should alert the nurse to the possibility of cardiac decompensation? A) a decrease in perceived edema B) brisk capillary refill C) a slow, deep respiratory rate D) moist, frequent cough

D) • rationale: a nurse might see an irregular weak pulse, generalized edema, crackles at the lung bases, orthopnea, rapid respirations, moist frequent cough, and cyanosis of the lips and nail beds (pg 263)

During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. these are most likely signs of which condition? A) euglycemia B) pneumonia C) rheumatic fever D) cardiac decompensation

D) • symptoms of cardiac decompensation may appear abruptly or gradually. euglycemia is a condition of normal glucose levels. these symptoms indicate cardiac decompensation. rheumatic fever can cause heart problems, but it does not present with these symptoms, which indicate cardiac decompensation. pneumonia is an inflammation of the lungs and would not likely generate these symptoms, which indicate cardiac decompensation

which will the nurse inform a breastfeeding patient who is taking propylthiouracil for hyperthyroidism? A) the medication is likely to decrease milk production B) stop breastfeeding the child & start infant formula C) it can adversely affect the neonate's thyroid function D) take the medication immediately after breastfeeding

D) • the nurse advises the patient to take the medication immediately after breastfeeding to allow a 3-4 hour period for the medication to absorb before nursing again. milk production decreases if there is poor metabolic control, not because of antithyroid medications. it is not necessary to stop breastfeeding or provide infant formula, because there are no side effects of the medication in the infant. the medication also does not adversely affect the neonate's thyroid function

for which clinical condition in the fetus would the primary HCP advise a pregnant woman to undergo a Doppler blood flow analysis after reviewing the amniocentesis reports that indicate the presence of bilirubin? A) fetal hydrops B) down syndrome C) potter syndrome D) hemolytic anemia

D) • the presence of bilirubin in the amniotic fluid indicates the possibility of hemolytic anemia in the fetus. the degree of hemolytic anemia can be determined by using Doppler blood flow analysis. the presence of the placental hormone inhibit-A in the quad screen indicates down syndrome. the AFI values are used to detect Potter syndrome. fetal hydrops is caused by polyhydramnios, which can be assessed by US scanning

After a pelvic examination of a pregnant woman, the nurse concludes that the patient may require a forceps-assisted delivery. What pelvic finding would support this conclusion? A) slightly ovoid-shaped B) moderate depth C) blunt ischial spines D) subpubic arch is narrow

D) • this indicates that the patient has either an android pelvis or an anthropoid pelvis. In such situations, the fetus may not easily pass through the birth canal & the patient may require forceps-assisted delivery. The prescence of a slightly ovoid pelvis with moderate depth and blunt ischial spines indicates a gynecoid pelvis. these pelvis's have a wider subpubic arch which allow the fetus to more easily pass through the birth canal.

when caring for a patient in the first phase of labor, the nurse observes that the patient is experiencing visceral pain. In which area does visceral pain occur? A) abdominal wall and thighs B) gluteal area and iliac crests C) lumbosacral area of the back D) lower portion of the abdomen

D) • visceral pain in the 1st stage of labor occurs in the lower portion of the abdomen. Visceral pain is a result of distention of the lower uterine segment and stretching of cervical tissue as it effaces and dilates. Pressure and contraction on uterine tubes, ovaries, ligaments, nerves, and uterine ischemia also cause visceral pain. Pain that originates in the uterus radiates to the gluteal area, iliac crests, abdominal wall, thighs, lumbosacral area of the back, and lower back. This pain is called referred pain.

Which fetal heart rate finding may result from maternal fever? A) no expected changes B) prolonged decelerations C) fetal HR of 90 bpm for 15 min D) fetal HR of 180 bpm for 12 min

D) • A maternal fever can directly increase the fetal temperature or infect the fetus in cases of infection. The fetus responds with an increased heart rate, which can lead to fetal tachycardia. Maternal fever does affect the fetal heart rate. Prolonged decelerations reflect a disturbance in the oxygen transfer from the environment to the fetus but do not typically result from maternal fever. Bradycardia is not caused by maternal fever. Causes of fetal bradycardia include head compression, hypoxia, and acidosis.

Which patient would most likely require general anesthesia during labor and delivery? A) a patient with a vaginal infection B) a patient with severe pain from uterine contractions C) a patient requiring a vaginal episiotomy D) a patient refusing regional and local anesthetic methods who needs a cesarean delivery

D) • A patient who refuses regional and local anesthetic methods and needs a cesarean delivery does require general anesthesia.A patient with a vaginal infection would not require general anesthesia during labor but would need an antibiotic to combat the infection.A patient who has severe pain from uterine contractions does not require general anesthesia during labor but would benefit from an epidural or a combined spinal-epidural (CSE).A patient who needs anesthesia for a vaginal episiotomy does not require general anesthesia during labor but would benefit from a local anesthetic.

Which uterine contraction strength classification is used when labor is measured at >500 Montevideo units (MVUs)? A) normal B) moderate C) hypotonic D) hypertonic

D) • Above 400 MVUs, the uterine contraction strength is considered hypertonic, which is abnormal. Normal uterine contraction strength would be less than 400 MVUs.Moderate uterine activity would be a description of the frequency of the contractions. The nurse is measuring the uterine pressure. Hypotonic describes uterine activity that is decreased, not increased above the expected 400 MVUs.

Which of the following is the most common complication of preterm prelabor rupture of membranes (PPROM) A) placental abruption B) retained placenta C) polyhydramnios D) chorioamnionitis

D) • Chorioamnionitis is the most common maternal complication of preterm PROM, making it a potentially serious complication of pregnancy.

When administering corticosteroids to a patient in preterm labor, which information is relevant to the nurse regarding the patient's history? A) the patient is 33 weeks gestation B) the patient suffers from chronic hypertension C) the patient's membranes are ruptured D) the patient has type 1 DM

D) • Corticosteroids can increase blood glucose levels and increase insulin resistance; therefore they should be administered cautiously or avoided altogether in patients with type 1 diabetes to avoid complications. Corticosteroids may be indicated in any viable preterm patient if delivery is imminent and they are not contraindicated. Chronic hypertension is not relevant to the administration of corticosteroids. Corticosteroids should be administered to a patient with preterm premature rupture of membranes.

Which situation demonstrates how an environmental factor could negatively affect a woman's experience of pain during labor? A) the woman experienced tearing of the perineum during delivery B) the woman had a complicated delivery with her previous child C) the woman's family views vocalizing about pain as "complaining" D) the woman has no support at her bedside

D) • Environmental factors that affect a woman's perception of pain include a support person or people present, a supportive physical environment, and comfort with her health care providers. Physiologic factors that affect a woman's perception of pain can be visceral or somatic. Psychological factors that affect a woman's perception of pain include preparation, coping skills, and prior experience. Cultural factors that affect a woman's perception of pain include religion and cultural influence.

Which indicates normal umbilical cord blood values? A) umbilical artery: pH, 7.1; Pco2, 50 mmHg; Po2, 20 mmHg B) umbilical artery: pH, 7.3; Pco2, 40 mmHg; Po2, 10 mmHg C) umbilical artery: pH, 7.4; Pco2, 52 mmHg; Po2, 27 mmHg D) umbilical artery: pH, 7.3; Pco2, 45 mmHg; Po2, 25 mmHg

D) • In the umbilical cord acid-base stimulation method, arterial values indicate the condition of the newborn. Arterial blood pH of 7.2-7.3, carbon dioxide pressure (Pco2) value of 45-55 mmHg, and oxygen pressure (Po2) value of 15-25 mmHg approximately indicate the normal fetal condition. Therefore, pH of 7.3, Pco2 of 45 mmHg, and Po2 of 25 mmHg represent the normal fetal condition. Arterial blood pH of 7.1, Pco2 of 50 and Po2 of 20 indicate that the fetus may have respiratory acidosis. Arterial blood pH of 7.4 is indicative of fetal alkalosis.

Which maternal or fetal condition might require an amnioinfusion? A) the mother has polyhydramnios (excess amniotic fluid) B) the fetal HR is 140 bpm C) the patient's BP has dropped D) the fetus has experienced umbilical cord compression

D) • One common indication for amnioinfusion is umbilical cord compression. Instillation of sterile fluid often relieves the compression. Polyhydramnios is a condition in which there is excess amniotic fluid. Amnioinfusion would increase the volume of amniotic fluid; therefore amnioinfusion in a patient with polyhydramnios is contraindicated. An FHR of 140 beats/min is normal and would not require an amnioinfusion. Amnioinfusion is performed in response to fetal changes, not maternal blood pressure changes.

Which action would the nurse take to improve placental blood flow immediately after administration of an epidural? A) place the woman flat on her back B) place the woman prone C) place the woman in the high-Fowler position D) place a wedge under the woman's right hip

D) • Placing a wedge under the right hip improves placental blood flow after a procedure that causes vasodilation.Placing a pregnant woman flat on her back may cause supine hypotension.Placing a pregnant woman prone would not be beneficial.Placing a pregnant woman in the high-Fowler position after an epidural is discouraged because epidural blocks work via gravity, and the patient will experience numbness in her legs and not her abdomen, where uterine contractions are experienced.

Which nonreassuring fetal heart rate (FHR) pattern includes a reduction in FHR of ≥15 beats/min for more than 2 minutes? A) accelerations B) tachycardia C) early decelerations D) prolonged decelerations

D) • Prolonged decelerations cause a decrease in FHR of ≥15 beats/min below baseline and last longer than 2 minutes but less than 10 minutes. The return to baseline FHR usually occurs after the contraction is over. Accelerations refers to an increase in fetal heart peaking at least 15 beats/min above the baseline (typically 110 to 160 beats/min), not a decrease in heart rate in relation to a contraction. Tachycardia describes an FHR greater than 160 beats/min as a baseline for at least 10 minutes, not a decrease in heart rate in relation to a contraction. Early decelerations mirror the contraction and return to baseline once the contraction is over. FHR nadir is usually no lower than 30 to 40 beats/min from baseline.

A patient experiences nausea and vomiting during labor. Which medication might the nurse anticipate administering? A) fentanyl B) naloxone C) nalbuphine D) promethazine

D) • The nurse would anticipate promethazine because it relieves the nausea and vomiting that may occur when opioid drugs are given. Fentanyl helps reduce the perception of pain and does not reduce N/V. Naloxone reverses opioid-induced respiratory depression and does not reduce N/V. Nalbuphine helps reduce the perception of pain and does not reduce N/V.

Which of the following is a sign that the third stage is getting close to complete? A) there is a shortening of the umbilical cord B) no signs of fetal membranes at the vaginal introitus C) a lax uterus with rare contractions D) a gush of dark blood vaginally

D) • This indicates placental separation and that the placenta is ready to deliver. Fetal membranes at the introitus indicate impending delivery of the placenta.

Which will the nurse teach the patient about the benefits of combining relaxation with walking, slow dancing, or rocking? A) this method may help distract and divert from pain B) this method may help increase abdominal pressure C) this method may help manage stress throughout life D) this method may help the baby rotate through the pelvis

D) • When relaxation is combined with an activity such as walking, slow dancing, rocking, and position changes, it helps the baby to rotate through the pelvis. Simple relaxation exercises can help couples with the stresses of pregnancy, childbirth, and adjustment of parenting and can be a form of stress management throughout life. Breathing techniques provide distraction and diversion from pain. It helps to increase abdominal pressure in the 2nd stage of labor and assists in expelling the fetus.

Which term describes a flat pelvis? A) gynecoid B) android C) anthropoid D) platypelloid

D) • about 3% of women may have a flat pelvis, which is referred to as platypelloid pelvis. It is flattened anteroposteriorly and wide transversely. About 50% of women have gynecoid pelvis or the classic female type of pelvis. It is slightly ovoid or transversely rounded. An android pelvis resembles the male pelvis and may be found in 23% of women. It is heart shaped or angulated. The anthropoid pelvis resembles the pelvis of anthropoid apes and may be found in 24% of women. It is oval and wider anteroposteriorly

Which statement made by the nursing student about the management of cervical insufficiency (premature dilation of the cervix) in a pregnant patient indicates effective learning? A) progesterone supplementation is the only effective treatment B) an abdominal cerclage is performed at the 1st week of gestation C) surgical treatment is ineffective in patients with an extremely short cervix D) a prophylactic cerclage is used to constrict the internal os of the cervix

D) • best treatment option for premature dilation of the cervix is to surgically place a prophylactic cerclage to constrict the internal os of the cervix. it is usually placed at 11-15 weeks of gestation. progesterone supplementation may not be effective in constricting the cervix and surgical intervention may be necessary. an abdominal cerclage is necessary in case of a failed vaginal cerclage & is usually placed a 11-13 weeks in patients by means of a laparotomy. in patients with an extremely short cervix, an abdominal cerclage is used, which is followed by a cesarean birth

A patient reports excessive vomiting in the 1st trimester of the pregnancy, which has resulted in nutritional deficiency, weight loss, and ketonuria. Which disorder of pregnancy does the patient have? A) preeclampsia B) hyperthyroid disorder C) gestational hypertension D) hyperemesis gravidarum

D) • characterized by excessive vomiting during pregnancy which causes nutritional deficiency & weight loss. presence of ketonuria is another indication of this disorder

Which is a priority nursing intervention while caring for a pregnant patient with hyperemesis gravidarum? A) initiate parenteral nutrition B) observe the patient for seizures C) administer magnesium sulfate D) initiate IV fluid therapy

D) • hyperemesis gravidarum results in weight loss & electrolyte imbalance in a patient, therefore the nurse needs to initiate & monitor IV fluid therapy to prevent further deterioration of the patients health. Parenteral nutrition has potential risks & is initiated only if multiple medical management and enteral tube feeding attempts have not been successful

the nurse advise would the pregnant patient to repeat the test on a weekly basis for which biophysical profile (BPP) score? A) 1 B) 4 C) 6 D) 9

D) • if the BPP score is 8-10, then the test would be repeated weekly or twice weekly. if the BPP score is 0-2, then chronic asphyxia may be suspected. in this case the testing time would be extended to 120 minutes. if the BPP score is 4 after 36 week's gestation, then clinical conditions exist that may lead to an imminent delivery. if the BPP score is 4 before 32 weeks, the test would be repeated. if the BPP score is 6 at 36-37 weeks with positive fetal pulmonary testing, then delivery can be performed. if the BPP score is 6 before 36 weeks of gestation with negative pulmonary testing, then BPP can be repeated in 4-6 hours; if oligohydramnios is present, then delivery can be done. the BPP provides an insight into fetal maturity & well-being & as such would be used as a diagnostic tool to plan & evaluate management of care. findings are related to several factors involving both maternal & fetal characteristics

Which fetal risk is associated with an ectopic pregnancy? A) miscarriage B) fetal anemia C) preterm birth D) fetal deformity

D) • in an ectopic pregnancy, the risk for fetal deformity is high because of the pressure deformities caused by oligohydramnios. there may be facial or cranial asymmetry, various joint deformities, limb deficiency, and CNS anomalies. miscarriage is not likely to happen in an ectopic pregnancy. instead, the patient is at risk for pregnancy-related death resulting from ectopic rupture. fetal anemia is a risk associated with placenta previa. preterm birth is not possible because the pregnancy is dissolved when it is diagnosed, or a surgery is performed to remove the fetus

Which condition of pregnancy is typically characterized by painless, bright red vaginal bleeding in the 2nd or 3rd trimester? A) eclampsia B) preeclampsia C) pyelonephritis D) placenta previa

D) • placenta previa is indicated by painless, bright red vaginal bleeding during the 2nd or 3rd trimester of pregnancy. the patients VS may be normal even after blood loss, because a pregnant patient can lose up to 40% of the blood volume without signs of shock.

Preceding labor, a pregnant patient reports a backache and increased vaginal discharge. She is also worried because she has blood-tinged cervical mucus secretions. Which will the nurse do in this situation? A) send cervical mucus for a culture and sensitivity test B) prepare the patient for induction of labor immediately C) give antibiotics and other medicines to stop hemorrhage D) reassure the patient by informing her that these are normal signs

D) • preceding labor, normal signs include backache, copious brownish or blood-tinged cervical mucus secretions, and congestion of the vagina. Therefore, in this scenario, the pregnant patient needs reassurance and careful observation. Culture and sensitivity tests are not required because the patient does not show any signs of infection. The patient does not have any need for immediate induction of labor. The signs presented by the patient are not indicative of hemorrhage; therefore no medications needs to be administered

Which is a priority nursing action when a pregnant patient with severe HTN is admitted to the health care facility? A) administer IV & oral fluids B) provide diversionary activities during bed rest C) prepare the patient for cesarean delivery D) administer the prescribed magnesium sulfate

D) • prevent eclamptic seizures

which finding in the US reports of a pregnant woman would indicate a normal fetus? A) amniotic fluid index of 6 cm B) amniotic fluid index of 2 cm C) amniotic fluid index of 30 cm D) amniotic fluid index of 13 cm

D) • rationale: an AFI of 10 cm or more is considered normal. an amniotic fluid index of 25 cm is considered above the normal range & indicates polyhydramnios. an AFI less than 10 cm is considered below the normal range. an AFI before 5 cm is considered oligohydramnios

why is it so important that diabetic clients seek early preconception care? A) because uncontrolled diabetes can lead to several major birth defects of the musculoskeletal system and reproductive system B) because uncontrolled diabetes can lead to several major birth defects of the integumentary system and gastrointestinal system C) because uncontrolled diabetes can lead to several major birth defects of the genitourinary system and biliary system D) because uncontrolled diabetes can lead to several major birth defects of the cardiovascular system and central nervous system

D) • rationale: hyperglycemia during the first trimester of pregnancy, when organs and organ systems are forming, is the main cause of diabetes-associated birth defects (pg 245)

Which adverse maternal effect can be caused when a patient experiences anxiety disorders in pregnancy? A) increased incidence of 1st trimester bleeding B) increased risk for cord prolapse in labor C) increased risk for maternal mortality D) increased risk for forceps delivery

D) • rationale: women with anxiety disorders have an increased risk for operative delivery (forceps/vacuum/episiotomy) 1st trimester bleeding, cord prolapse, and maternal mortality have not been statistically proven in pregnant women with anxiety disorders

Which is the definitive sign indicating that labor has begun? A) lightening B) rupture of membranes C) passage of the mucus plug (operculum) D) progressive uterine contractions with cervical damage

D) • regular, progressive uterine contractions that increase in intensity and frequency are a definitive sign of true labor along with cervical change. Lightening is a premonitory sign indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself. Passage of the mucus plug is premonitory sign indicating that the onset of labor is getting closer

The nurse is assisting a laboring patient is aware that the birth of the fetus is imminent. Which is the station of the presenting part? A) -1 B) +1 C) +3 D) +5

D) • station is the relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines. The placement of the presenting part is measured in centimeters above or below the ischial spines. Birth is imminent when the presenting part is at +4 to +5 cm. When the lowermost portion of the presenting part is 1 cm above the spine, it is noted as -1. When the presenting part is 1 cm below the spine, the station is said to be +1. At +3, the presenting part is still descending the birth canal. Birth is imminent when the presenting part is at +4 to +5

Which fetal heart rate (FHR) can the nurse expect at 20 weeks of gestation? A) 100 beats/min B) 120 beats/min C) 140 beats/min D) 160 beats/min

D) • the FHR is higher earlier in the gestation. At 20 weeks of gestation, the FHR on an average is 160 bpm approximately. The rate decreases progressively as the maturing fetus reaches term. An FHR of 100 bpm is below normal. The normal range of FHR is 110-160 bpm. An FHR of 120 bpm at 20 weeks gestation is not normal. The average FHR at term is 140 bpm

which condition causes low birth weight (LBW) despite full-term gestation? A) preterm labor B) maternal age C) diabetic condition of the patient D) intrauterine growth restriction (IUGR)

D) • the LBW of the newborn is result of IUGR, a condition of inadequate fetal growth. It may be caused by various conditions, such as gestational HTN that interferes with uteroplacental perfusion. Interference with uteroplacental perfusion limits the flow of nutrients into the fetus and causes LBW. the onset of labor is at 40 weeks gestation, so it is not a preterm labor. The patient's age is normal for pregnancy and therefore is not a reason for LBW. infants born to patients with diabetes would have a higher birth weight

The nurse is preparing to perform a fetal fibronectin test for a pregnant patient. Which intervention should the nurse perform to collect the sample for the test? A) take a blood sample from the forearm B) take a sample of the patient's amniotic fluid C) ask the patient to provide a urine sample D) collect the vaginal secretions using a swab

D) • the fetal fibronectin test is conducted to assess whether a patient is at risk for preterm labor. fetal fibronectin is a glycoprotein found in the vaginal secretions during early and late pregnancy. to conduct the test, the nurse should collect the vaginal secretions using a swab and send it for analysis. urine, blood, and amniotic fluid are not collected for fetal fibronectin test, as they may not contain adequate glycoprotein levels

which statement by the woman at 36 weeks of gestation indicates a correct understanding of a nonstress test? A) i will need to have a full bladder for the test to be done accurately B) i should have my spouse drive me home after the test because i may be nauseous C) this test will help determine if the baby has Down syndrome or a neural tube defect D) this test will observe for fetal activity & an acceleration of the fetal HR to determine the well-being of the baby

D) • the nonstress test is one of the most widely used techniques to determine fetal well-being & is accomplished by monitoring fetal HR in conjunction with fetal activity & movements. an US is the test that requires a full bladder. an amniocentesis is the test that a pregnant woman should be driven home afterward. a maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, & human chorionic gonadotropin (hCG) helps to determine down syndrome

Which action will the nurse take before performing cardiopulmonary resuscitation (CPR) to revive a pregnant patient undergoing a cardiac arrest? A) administer normal saline solution B) assess for fetal-maternal hemorrhage C) call 2 staff nurses to hold the patient D) place a rolled blanket under the patient's hips

D) • the nurse needs to displace the uterus to enhance cardiac output in the patient during CPR. therefore the nurse places a rolled blanket under the patient's hips, which helps displace the uterus manually.

The nurse notes that the fetus in a laboring patient is in brow presentation. Which is the expected occipitomental diameter? A) 9.25 cm B) 9.5 cm C) 12.00 cm D) 13.5 Cm

D) 13.5 cm • in a brow presentation, the presenting part is the mentum or chin. The occipitomental diameter is 13.5 cm at term, which is too large to permit the infant's head to enter the pelvis region of the mother. The biparietal diameter, which is about 9.25 cm at term, is the largest transverse diameter. The smallest anteroposterior diameter is the suboccipitobregmatic diameter, which is about 9.5 cm at term, in a vertex presentation. In a sinciput presentation, the occipitofrontal diameter is about 12.00 cm at term, with moderate extension of the head

Which mode of birth is most appropriate for a client in labor at 36 weeks with placenta previa? A) forceps-assisted vaginal B) vacuum-assisted vaginal C) spontaneous vaginal D) cesarean section delivery

D) cesarean section delivery

Which statements by the nurse are the most appropriate to make to a patient who has recently had a miscarriage? A) when it is meant to happen, it will happen B) the fetus likely had a congenital anomaly that was incompatible with life C) don't worry; nature has a way of taking care of mistakes. It is for the best D) this is often a consequence of unavoidable factors, and it is important to realize this is not your fault E) I am very sorry for your loss. Having a miscarriage must be so emotionally painful. How are you feeling?

D), E)

Which effect does a pudendal nerve block have on a laboring patient?

Decrease in pain in the vagina and perineum

On review of a fetal monitor tracing, the nurse notes that for several contractions the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. Which will the nurse do?

Describe the finding in the nurse's notes. An early deceleration pattern from head compression is described. No action other than documentation of the finding is required because this is an expected reaction to compression of the fetal head as it passes through the cervix. Repositioning the woman onto her side would be implemented when non reassuring or ominous changes are noted. Calling the physician would be implemented when non reassuring or ominous changes are noted. Administering oxygen would be implemented when non reassuring or ominous changes are noted.

What is the most common endocrine disorder in pregnancy?

Diabetes Pregnancy will be considered high-risk, but can be successfully managed with multidisciplinary approach.

Amniocentesis testing

Diagnostic, usually done at or after 15 weeks to obtain amniotic fluid (to get fetal cells) Should be avoided before 13-14 wks b/c higher risk of pregnancy loss, amniotic fluid leakage, and club foot Indications: prenatal dx for genetic disorders or congenital anomalies (NTDs), assessment of pulmonary maturity, and RARELY fetal hemolytic disease

Care management for Pregestational DM - antepartum

Diet and exercise insulin therapy self-monitoring blood glucose levels urine testing complications requiring hospitalization fetal surveillance

Which major side effect will the nurse expect if a patient in labor is administered diazepam?

Disrupted temperature control in the newborn Diazepam dirupts the thermoregulation in the newborn. Thus the newborn is less able to maintain body temperature. Benzodiazepines, when given with an opioid analgesic, seem to enhance pain relief and reduce nausea and vomiting.

The nurse is teaching pain relief techniques to a group of expectant patients. Which will the nurse teach the patients about the gate-control theory of pain?

Distractions block the nerve pathways

During the second phase of labor, the patient initiates pattern-paced breathing. Which adverse symptom must the nurse watch for when the patient initiates this method?

Dizziness

While performing a vaginal examination of a patient in active labor, the nurse notes decelerations in the fetal heart during uterine contractions (UCs). Which will the nurse do in this situation?

Document it as a normal finding. Early decelerations in the FHR are common during. UCs. These decelerations may also happen because of increased fundal pressure and during the placement of the internal mode of fetal monitoring. Applying fundal pressure during vaginal examination helps in accurate assessment; therefore, fundal pressure needs to be applied. Oxytocin (Pitocin) administration induces UCs and indirectly causes the FHR to decelerate, but the medication should not be discontinued. The nurse would have the patient change positions if the umbilical cord was compressed.

The nurse is assessing a pregnant patient through a tocotransducer placed externally and a spiral electrode placed internally. Which information will the nurse obtain by this arrangement? Select a l l that apply. One, some, or all responses may be correct.

Duration of uterine contractions Frequency of uterine contractions Accelerations of fetal heart rate A tocotransducer is an external device that is used for assessment of uterine activity (UA). This instrument would report duration and frequency of the uterine contractions (UCs). The spiral electrode can monitor accelerations of the fetal heart rate. These systems do not report the intensity of UCs. Strength of UCs can be assessed using an intrauterine pressure catheter (IUPC). Neither a tocotransducer nor a spiral electrode is used to determine the lactate level; it is obtained by the fetal scalp sampling method.

The nurse is helping a pregnant patient during labor by applying fundal pressure. Which alteration in the fetal heart rate (FHR) pattern may resuIt from this intervention?

Early decelerations Applying fundal P-ressure can cause fetal head compression and may cause early decelerations in FHR. Disruption of oxygen transfer from the maternal environment to the fetus may result in late decelerations. Variable decelerations may be observed as a result of umbilical cord compression. If the mechanisms responsible for late or variable decelerations last for an extended period, then they cause prolonged decelerations.

Which is important for nurses to understand about the use of systemic analgesics during labor?

Effects on the newborn can include significant neonatal respiratory depression.

Which intervention will the nurse perform for the patient demonstrating increased anxiety at the onset of labor?

Encourage a support person to stay with the patient.

Use of ultrasound

FHR activity, gestational age, fetal growth, fetal anatomy, fetal genetic disorder/physical anomalies, placental position and function, adjunct to other invasive tests, fetal wellbeing, doppler blood flow analysis, amniotic fluid volume (AFV), biophysical profile, modified biophysical profile

A patient in latent labor who is positive for opiates on a urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. Which is the nurse's most appropriate analgesic for pain control?

Fentanyl

After observing the fetal heart activity on the electronic fetal monitor, the nurse suspects that the patient's umbilical cord is compressed. Which observation did the nurse make on the fetal monitor?

Fetal heart rate (FH R) variable decelerations A compressed umbilical cord, which can be determined by variable decelerations in the FHR, is commonly observed at the time of labor. Variable decelerations are seen as W- or U-shaped waves on the monitor. Umbilical cord compression does not affect the heart rate. Early decelerations in the FHR are observed when the head of the fetus is compressed.

When monitoring a woman in labor who has just received spinal analgesia, which assessment finding should the nurse report to the health care provider?

Fetal heart rate of 100 beats/min Minimal variability on a fetal heart monitor

Passenger - main points

Fetal lie - ideal longitudinal size of head presentation - vertex of head fetal attitude- chin to chest (flexion) fetal position- OA (occiput anterior) is best

The electronic fetal monitor reveals a base Ii ne fetal heart rate (FH R) of 17 5 beats/min. Which does this finding indicate to the nurse?

Fetal tachycardia The normal baseline fetal heart rate ranges from 110 to 160 beats/min. If the fetal heart rate is more than 160 beats/min, then tachycardia in the fetus is indicated. lschemia is a condition in which there is a reduced blood supply to the fetal tissues. Baseline heart rate below 110 beats/min indicates bradycardia in fetus. Hypotension indicates a blood pressure level below 120/80 mm Hg, which is a life-threatening condition for the fetus.

Which will the nurse teach the patient about the reason for effectiveness of the intradermal water block?

Gate control mechanisms Counterirritation mechanism Increase in endogenous opioids

Which kind of anesthesia may be necessary for a patient who is to have an emergency cesarean birth due to fetal distress?

General anesthesia

What are high-risk biophysical factors for a pregnant woman?

Genetic considerations that may interfere with normal fetal or neonatal development (result in congenital anomalies or create difficulty for mother) examples: defective genes, transmissible inherited disorders/ chromosomal anomalies, multiple gestation, large fetal size, and ABO incompatibility

The nurse is caring for a nulliparous patient in labor. Which is the reason why the experiences for a nulliparious patient may be different from that of a multiparous patient?

Greater fatigue due to longer duration of labor

Which is accurate about tactile approaches to comfort management?

Hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited.

Which intervention will the nurse provide to prevent respiratory alkalosis in the patient with hyperventilation?

Have the patient breathe into a paper bag

Maternal complications of Amniocentesis

Hemorrhage, fetomaternal hemorrhage, infection, labor, abruptio placentae, damage to intestines or bladder, amniotic fluid embolism

What does a high alpha fetoprotein level suggest?

High levels after 15 wks gestation suggest neural tube defect (NTD) or other defects. 80-85% of NTDs and abdominal wall defects can be detected early.

Most common medical complication in pregnancy

Hypertensive disorder

Fetal monitoring of a pregnant patient reveals the fetal baseline heart rate is at 170 beats/min. Which maternal condition might the nurse suspect as the cause for this increased fetal heart rate?

Hyperthermia If the feta l heart rate goes above 160 beats/min, this indicates that the fetus has tachycardia. Maternal hyperthermia or fever may cause tachycardia. Maternal hypoglycemia and hypothermia can cause bradycardia in the fetus. Maternal hyperthyroidism can cause tachycardia i n the fetus. Hypothyroidism of the mother may not have any effect on the fetal heart rate.

Several hours into an unmedicated labor, a woman reports lightheadedness and anxiety. The nurse assists the woman with patterned breathing techniques to address which condition>

Hyperventilation

While auscultating for fetal heart tones in a pregnant patient, the nurse observes that there is persistent fetal tachycardia. In which situation would this finding be considered as normal?

If the patient's body temperature has increased. Accelerations in the fetal heart rate (FHR) are usually episodic, and sometimes they may be persistent. When the patient is febrile, fetal tachycardia is not considered a serious event. The tachycardia would resolve once the patient is afebrile. Elevation in uterine contractions may cause episodic tachycardia, but it would not cause persistent tachycardia. Persistent tachycardia when associated with late deceleration or minimal variability is considered a risk to the fetus.

The nurse is teaching a couple about the use of imagery and visualization in managing pain during labor. Which is the patient expected to do during this technique?

Imagine breathing in light and energy Imagine walking through a restful garden Envisage breathing out worries and tension

The primary health care provider has administered terbutaline (Brethine) to a pregnant patient to postpone preterm labor. Which changes will the nurse observe for in the fetal heart monitor after this drug is administered?

Increase in fetal heart rate Terbutaline (Brethine) is usually prescribed to postpone labor, because the drug reduces the frequency of uterine contractions. Terbutaline (Brethine) can also increase the fetal heart rate (FHR). Terbutaline (Brethine) does not decrease the heart rate, nor does it cause any accelerations or decelerations in the FHR. Heart block or viral infections can decrease the FHR and may result in bradycardia. There may be accelerations in the FHR during a vaginal examination. A parasympathetic response may cause decelerations in heart rate. Terbutaline is a sympathomimetic drug and thus does not cause decelerations in FHR.

After monitoring the fetal heart activity, the nurse concludes that there is impaired fetal oxygenation. Which did the nurse observe in the fetal monitor to come to this conclusion? Select all that apply. One, some, or all responses may be correct.

Increase in the fetal heart rate (FHR) to over 160 beats/min Late decelerations Tachycardia (an increase in the FHR) is the early sign of fetal hypoxemia. Late decelerations are caused by a reflex fetal response to transient hypoxemia during a uterine contraction that reduces the delivery of oxygenated blood to the intervillous space of the placenta. Early decelerations, moderate variability, and occasional variable decelerations in the FHR are common observations during labor. These are normal findings and require no intervention.

S/S of preeclampsia

Increased BP, dyspnea Reduced kidney perfusion w/ oliguria and proteinuria tissue edema impaired liver function- elevated liver enzymes, N/V, Epigastric pain, RUQ pain neurologic complications - HA, hyperreflexia HELLP syndrome Blurred vision, scotoma DIC, low platelet count, increased hematocrit

Which physiologic effect results from labor pain?

Increased production of catecholamines

Which is a condtraindication to subarachnoid and epidural blocks?

Infection at injection site

When assessing a fetal heart rate (FH R) tracing, the nurse notes a dec rease in the baseline rate from 155 to 110 beats/min. The rate of 110 beats/min persists for more than 10 minutes. The nurse can attribute this decrease in baseline to which factor?

Initiation of epidural anesthesia that resulted in maternal hypotension. Fetal bradycardia is the pattern described and results from the hypoxia that occurs when uteroplacental perfusion is reduced by maternal hypotension. The woman receiving epidural anesthesia needs to be well hydrated before and during induction of the anesthesia to maintain an adequate cardiac output and blood pressure. Hyperthyroidism would result in baseline tachycardia. A maternal fever could cause fetal tachycardia. Assumption of a lateral position enhances placental perfusion and should result in a reassuring FHR pattern.

Which intervention must the nurse perform when assisting a patient in labor who has been administered nitrous oxide for analgesia?

Instruct the patient to breathe normally during contractions

Care Management for Pregestational DM - Postpartum

Insulin requirements decrease SUBSTANTIALLY after birth - with all types of DM Encourage breastfeeding Contraception access and teaching

The nurse is caring for a low-risk obstetrical patient in the latent phase of labor. The patient states, "I want to walk around without the fetal monitor on me." How will the labor nurse safely monitor the fetus?

Intermittently auscultate before, during, and for at least 30 seconds after the contraction. The nurse will intermittently auscultate before, during, and for at least 30 seconds after the contraction to assess for nonreassuring FHR findings such as an abnormal rate or baseline changes. The nurse is unable to assess variability with a Doppler, and in a laboring woman, fetal wellbeing is partly evaluated by assessing the fetal heart rate in response to uterine contractions. It is not necessary to place the external fetal monitor back on the patient to evaluate the FHR. The patient may be monitored by intermittent auscultation as long as no risk factors are present. The nurse must also auscultate the FHR before, during, and after, not between, the contractions to ensure there are no abnormal rate or baseline changes.

Which device is used for monitoring the intensity of uterine contractions (UCs) in a pregnant patient?

Intrauterine pressure catheter (IUPC) An IUPC measures the frequency, duration, and intensity of contractions during the intrapartum period. The device records the pressure at the catheter tip, and the values are expressed in terms of mm Hg. However, for accurate readings, the membranes should be ruptured, and the cervix should be dilated. A tocotransducer monitors the frequency and duration of contractions for both antepartum and intrapartum care. This device is placed on the abdomen of the patient. The spiral electrode and ultrasound transducer are used for assessing the fetal heart rate and not the intensity of contractions. The spiral electrode is an invasive mode, whereas an ultrasound transducer is a noninvasive mode.

During a prenatal assessment, a patient asks about the use of hypnosis for pain management. Which will the nurse teach the patient about this modality?

It gives a better sense of control It is form of deep relaxation or meditation It can cause dizziness, nausea, and headache Hypnosis is a form of deep relaxation, like daydreaming of meditation. It enhances relaxation and diminishes fear, anxiety, and perception of pain. It allows the patient to have a greater sense of control over painful contractions.

During a prenatal assessment a patient asks the nurse about the disadvantages of spinal anesthesia. Which will the nurse teach the patient about the potential effect of spinal anesthesia?

It increases probability of operative birth

The health care provider recommends the patient use nitrous oxide during labor to help with analgesia. The patient asks the nurse about the drug. Which does the nurse explain to the patient about nitrous oxide?

It is given as a gas that you can self-administer.

During a prenatal assessment, the nurse teaches the patient about nonpharmacologic pain management. Which will the nurse tell the patient about this method?

It provides the patient with a sense of control

A patient asks the nurse about the use of transcutaneous electrical nerve stimulation (TENS). Which will the nurse teach about TENS?

It releases continuous low-intensity impulses

The nurse observes variable decelerations in the fetal heart rate (FHR) while assessing a pregnant patient with oligohydramnios. Which medication should be immediately given to the patient?

Lactated Ringer's solution Oligohydramnios is a condition that may cause umbilical cord compression and results in variable decelerations in the FHR. Usually, lactated Ringer's or normal saline solution can be administered into the umbilical cord to increase the amniotic fluid volume and normalize fetal heart activity. Terbutaline (Brethine) is a uterine relaxant. It is mostly used to reduce uterine tachysystole. The nurse can administer phenylephrine (Endal) if other measures are unsuccessful in improving maternal hypotension. Oxytocin (Pitocin) is a uterine stimulant to induce labor. It is not used to reduce the umbilical cord compression.

Sociodemographic risk factors of pregnancy

Low income/SES Lack of prenatal care age - young (adolescent) or older (>35yo) Parity - number of pregnancies along with age Marital status Social determinants of health Ethnicity - African Americans have a higher rate of preterm birth

When caring for a patient in the first phase of labor, the nurse observes that the patient is experiencing visceral pain. In which area does visceral pain occur?

Lower portion of the abdomen Visceral pain is a result of distention of the lower uterine segment and stretching of cervical tissue as it effaces and dilates.

The nurse is caring for a patient in the first stage of labor. Which nerve segment transmits pain impulses during this stage?

Lumbar spinal nerve segment L1 T10 to T12 spinal nerve segments Upper lumbar sympathetic nerves T10 to T12 and L1 spinal nerve segments and upper lumbar sympathetic nerves originate in the uterine body and cervix.

What is administered for seizure prevention?

Magnesium sulfate - if they go on during intrapartum, then they will be on for 12-24 hrs postpartum Also, control BP with meds

On assessment, the nurse notices that the fetal heart rate (FHR) is 100 beats/min. Which is a possible cause for this condition?

Maternal hypoglycemia An FHR of less than 110 beats/min is referred to as bradycardia. Maternal hypoglycemia is a common cause of bradycardia in the fetus. Chorioamnionitis is an infection that also causes tachycardia in the fetus. Hypoxemia and anemia (decreased hemoglobin) of the fetus cause tachycardia in which the heart rate is more than 160 beats/min.

CV disorder risks during pregnancy

Maternal risk: increased incidence of miscarriage, PTL and birth, IUGR Fetal risk: congenital heart lesions

Effects of weed use during pregnancy

Maternal: IUGR Fetal: attention deficits, impulsivity, depression, future substance use

Effects of caffeine use during pregnancy

Maternal: IUGR Fetal: decreased executive function as school age

Effects of psychostimulant use during pregnancy

Maternal: PTL Fetal: short and long term growth deficits, cardiac anomalies, behavioral problems, social effects, attention deficits, aggression

Effects of Tobacco use during pregnancy

Maternal: decreased thyroid function, ectopic pregnancy, placenta prevue, placental abruption, PPROM, IUGR Fetal: orofacial clefts, LBW, PTL/birth

Pregestational DM Risks and Complications

Maternal: macrosomia, hydramnios, ketoacidosis, hyperglycemia, hypoglycemia Fetal/Neonatal: perinatal mortality risk increased, congenital malformations, respiratory distress syndrome (RDS), prematurity, IUFD (intrauterine fetal demise)

Effects of Alcohol use during pregnancy

Maternal: no specific effects Fetal: fetal alcohol syndrome, LBW, PTL or birth

Effects of opioid use during pregnancy

Maternal: withdrawal, IUGR, placental abruption, intrauterine passage of meconium, PTL Fetal: fetal death, neonatal withdrawal

Hemorrhagic disorders are considered a _______________ ______________.

Medical emergency

Tocolytics

Medications given to arrest labor in order to give steroids (glucocorticoids as IM injection) for lung development in fetus Magnesium sulfate is most common tocolytic - off label use.

Which finding is considered a component of a category II fetal heart rate (FHR) tracing?

Minimal variability Minimum variability, in the FHR indicates that there is insufficient oxygen supply to the fetus. This is categorized as a category II in a three-tier FHR classification system. Moderate variability in FHR indicates the normal cardiac activity of the fetus, which is categorized under category I. Bradycardia (FHR less than 110 beats/min) is categorized under category Ill. The FHR acceleration is completely absent according to category II and is present in category I.

The nurse is assisting a patient in labor. Which breathing pattern must the nurse remind the patient to use when the contractions increase in frequency and intensity in the first phase of labor?

Modified-paced breathing

Care Management for Pregestational DM - Intrapartum

Monitor pt closely (NST, growth ultrasounds) Complications May require C-section d/t macrosomia

What is Cell free (DNA) screening?

Newest screening test for noninvasive prenatal genetic dx. Includes: Fetal RH status, fetal gender, paternally transmitted single gene disorder Works by amplifying cell free DNA

When is Gestational DM (GDM) diagnosed?

Normally at or after 24 weeks Screening includes: 1 hour oral glucose tolerance test (OGTT) screening, 3 hour OGTT **3 Hr OGTT is given if the 1 hour test is 140 mg/dL or higher

The nurse is evaluating the fetal monitor tracing of a patient who is in active labor. Suddenly, the fetal heart rate (FHR) drops from its baseline of 125 beats/min down to 80 beats/min. The nurse repositions the mother, provides oxygen, increases intravenous (IV) fluid, and performs a vaginal examination. The cervix has not changed. A few minutes have passed, and the FHR remains 80 beats/min. Which additional nursing measures will the nurse take?

Notify the primary health care provider (HCP) immediately. If the FHR does not resolve, the primary HCP should be notified immediately. Notifying the nursery nurse that birth is imminent is not the most important nursing measures at this time. The patient needs to be evaluated by the HCP immediately to determine whether delivery is warranted at this time. If the FHR were to continue in abnormal or non reassuring pattern , a cesarean birth may be warranted. This requires the insertion of a Foley catheter; however, the HCP must make that determination. Oxytocin may put additional stress on the fetus. To relieve an FHR deceleration , the nurse can reposition the mother, increase IV fluid , and provide oxygen. Also, if oxytocin is infusing, it should be discontinued.

Which intervention will the nurse perform for a laboring patient with hypotension and fetal bradycardia?

Notify the primary health care provider or anesthesiologist Monitor the fetal heart rate (FHR) every 5 minutes Administer oxygen using a nonrebreather face mask

The nurse is administering an amnioinfusion to a patient with oligohydramnios. Which risk will the nurse monitor for during administration?

Overdistention of the uterus Oligohydramnios is the condition where the patient has low levels of amniotic fluid. In this condition the nurse should administer an amnioinfusion. During this process the nurse should assess the abdominal size to make sure the patient is not receiving too much fluid. This may cause overdistention of the uterus. This procedure does not affect the uterine activity (UA), placental hemorrhage, or the FHR. Placental abruption would cause conditions such as oligohydramnios. Decelerations in the FHR are observed in oligohydramnios, but accelerations are not.

The nurse caring for an active laboring patient reports to the health care provider that the fetal heart rate (FHR) tracing is reassuring, and the Montevideo units are 60. Which changes in the plan of care will the nurse anticipate from the health care provider?

Oxytocin augmentation The nurse can anticipate an order for oxytocin augmentation to increase the strength of the uterine contractions, which will be reflected in the increase of Montevideo units. Montevideo units of 60 are not reflective of an adequate labor pattern so the plan of care will be changed. Montevideo units can only be calculated with an internal monitor, which means the patient's membranes are already ruptured. The internal monitor that calculates Montevideo units is an intrauterine pressure catheter (IUPC); an internal fetal monitor is not necessary in this situation.

4 Ps to screen and assess for substance abuse

Parents, Partner, Past, Pregnancy

Which umbilical blood gas reading is consistent with respiratory acidosis?

Partial pressure carbon dioxide >55 mm Hg If Pco 2 >55 mm Hg (elevated) and base deficit value <12 mmol/L and pH is <7.20, it indicates respiratory acidosis. In this case, the partial pressure carbon dioxide >55 mm Hg is indicative of respiratory acidosis. A pH >7.20 and base deficit value >12 mmol/L are all considered normal. Blood glucose level is not a part of this acid-base report.

P's in labor and birth

Passenger Passageway Powers (contractions) Position of mother Psychological response

The nurse is assisting a patient who has just received spinal anesthesia (block). Which intervention does the nurse perform to prevent supine hypotension?

Place a wedge under one of the hips. The nurse placed a wedge under one of the hips of the patient or tilts the operating table to displace the uterus laterally to prevent supine hypotensive syndrome.

After observing the electronic fetal monitor, a primary health care provider asks the nurse to conduct an electrocardiogram (ECG) of the fetus. Which will the nurse assess before obtaining an ECG of the fetus? Select all that apply. One, some, or all responses may be correct.

Placental membranes Cervical dilation When performing the ECG of the fetus, the nurse should insert the electrode into the cervix to reach the fetus. Therefore, the nurse should check if the cervix is dilated up to 3 cm and if the membranes are ruptured. This allows the nurse to reach the fetus's position. Lactate levels do not affect the ECG testing and thus need not be checked before the test. Umbilical cord compression and decreased frequency of UCs are not required conditions for performing an ECG on the fetus.

While assessing a pregnant patient, the nurse observes a sinusoidal heartbeat pattern on the electronic heart monitor. Which will the nurse interpret about the fetus from this report?

Presence of fetal anemia A sinusoidal pattern of the fetal heart rate (FHR) is observed as a smooth wave-like pattern on the monitor. This indicates that the fetus has severe anemia. Minimal variability in the FHR indicates that the fetus may have mild hypoxemia and metabolic acidemia. Moderate variability in the FHR indicates that the fetus is at a risk of congenital anomalies.

Which is a cause of somatic pain in a patient who is in the second phase of labor?

Pressure against the bladder Distention of the peritoneum Stretching of the perineal tissue Somatic pain is a result of distention and traction of the peritoneum, stretching of the perineal tissue, and pressure against the bladder and rectum.

Which intervention will the nurse perform while caring for a laboring patient who has been administered regional anesthesia?

Provide an indwelling urinary catheter A distended bladder can inhibit uterine contraction and fetal descent. This slows down the progress of labor. Spinal nerve blocks can reduce bladder sensation.

The nurse is caring for a patient who is using fentanyl citrate through patient-controlled analgesia (PCA) while in labor. Which effect of fentanyl citrate does the nurse expect?

Provides quick relief to pain

After change of shift report, tehenurse assumes care of a multiparous patient in labor. The woman reports pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this is which type of pain?

Referred Pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs

Which characteristics describe early decelerations? Select a l l that apply. One, some, or all responses may be correct.

Referred to as mirror images of contraction Primarily periodic and often benign Onset, nadir, and recovery correspond with beginning, peak, and end of contraction Early decelerations are sometimes called a mirror image of a contraction because they correspond to the beginning, peak, and end of a contraction. Early decelerations are usually periodic and are considered a benign finding, as they are not associated with fetal hypoxia, academia, or low Apgar scores. The onset, nadir, and recovery of an early deceleration correspond with the beginning, peak, and end of a contraction. Early decelerations are most common during the first stage of labor, though they may occur during second-stage pushing. The nadir (lowest) fetal heart rate is usually no lower than 30 to 40 beats/min from baseline during an early deceleration .

The nurse is caring for a patient who has been administered nalbuphine while in labor. The nurse will watch for which sign of opioid withdrawal?

Rhinorrhea Piloerection Muscle spasms

What's the best way to manage diabetes during pregnancy?

STRICTLY control glucose levels

Differentiate between screening and diagnostic techniques in pregnancy including when they are used and for what purpose.

Screening: maternal assays (alpha fetoprotein, cell free screening), antepartum assessment (EFM, NST, vibroacoustic stimulation, CST) Diagnostic: ultrasonography, amniocentesis, biochemical assessment

Pharmacologic pain relief during labor

Sedatives (barbiturates, phenothiazines, benzodiazepines) Analgesic/ anesthesia Nerve block analgesia and anesthesia (epidural)

Which is accurate about how differing experiences affect labor pain?

Sensory pain for nulliparous women often is greater than for multiparous women during early labor

Psychosocial risk factors of a pregnancy

Smoking - LBW, higher neonatal mortality, increased rate of miscarriage, increase in PPROM Caffeine - more than 200mg of caffeine/ day may increase risk of IUGR alcohol - adverse effects on the fetus, fetal alcohol syndrome/effects, learning disabilities, and hyperactivity drugs - teratogenic, cause metabolic disturbances, chemical effects, depression of alternation of CNS function (included OTC and Rx meds) psychological status - specific intrapsychic disturbances and addictive lifestyles, Hx of child abuse or intimate partner violence, inadequate support systems, family disruption/dissolution, maternal role changes/conflicts, noncompliance with cultural norms, unsafe culture/ethnic/ religious practice, and/ or situational crises

Where does an anesthesia provider inject an epidural anesthesia (block)?

T8 to S1 A block from T10 to S5 is required for relieving the discomfort of labor and vaginal birth.

Which will the nurse teach a couple expecting their first child about the use of therapeutic touch (TT) to relieve pain during labor?

TT uses the concept of energy fields within the body Therapeutic touch (TT) uses the concept of energy fields within the body, called prana. Specially trained persons lay hands on the patient to redirect energy fields associated with pain. According to this concept, prana is thought to be deficient in some people who are in pain.

The nurse is assisting a patient who is prepared to use the paced breathing method. Which will the nurse remind the patient to do at the beginning of the breathing pattern?

Take a deep relaxing breath

The nurse is assessing a pregnant patient and uses spiral electrode monitoring to record the fetal heart rate. Under which circumstances can the nurse consider implementing this method ?

The cervix has partially dilated. Spiral electrode monitoring is used to determine the fetal heart rate during the intrapartum period. Because the spiral electrode is introduced into the cervix, the nurse needs to make sure that the patient's cervix is partially dilated. This allows the nurse to properly place the equipment to hear the heart sounds of the fetus. Ruptured placental membranes are also one of the considerations for using spiral electrode monitoring. A compressed umbilical cord and increased uterine contractions (UCs) are not factors that are considered for using a spiral electrode.

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware of which factor?

The examiner's hand should be placed over the fund us before, during, and after contractions. The assessment includes palpation: duration, frequency, intensity, and resting tone. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.

Which maternal or fetal condition might require an amnioinfusion?

The fetus has experienced umbilical cord compression. One common indication for amnioinfusion is umbilical cord compression. Instillation of sterile fluid often relieves the compression. Polyhydramnios is a condition in which there is excess amniotic fluid. Amnioinfusion would increase the volume of amniotic fluid; therefore amnioinfusion in a patient with polyhydramnios is contraindicated. An FHR of 140 beats/min is normal and would not require an amnioinfusion. Amnioinfusion is performed in response to fetal changes, not maternal blood pressure changes.

Profuse bleeding is when:

The patient is soaking a medium-sized pad in 1-2 hours.

Which statement regarding pain experienced during labor is accurate?

The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.

Fetal well-being during labor is assessed by which factor?

The response of the fetal heart rate (FHR) to uterine contractions (UCs). Fetal well-being during labor is measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being.

The nurse is teaching a couple about nonpharmacologic pain relief measure during labor. Which will the nurse tell the couple about the use of counterpressure?

The support person applies pressure to the sacral area

Which will the nurse teach the patient about the benefits of combining relaxation with walking, slow dancing, or rocking?

This method may help the baby rotate through the pelvis

When the nurse observes this fetal heart pattern, which nursing action would be the most important?

To document the finding. The fetal heart strip shows an early deceleration indicating expected head comP-ression during contractions. Documenting this finding is appropriate. Positioning the woman on the left side, applying oxygen via a face mask, and notifying the health care provider are correct actions for a late deceleration.

The nurse instructs a pregnant patient to breathe through the mouth and keep it open while pushing during labor. Which is the rationale for this nursing intervention?

To facilitate increased oxygen to the fetus. During labor, the nurse asks the patient to breathe through the mouth to keep the mouth open to increase both maternal and fetal oxygenation. Nasal congestion is not a complication associated with labor. Opening of the mouth does not increase the pushing capability. Early decelerations are observed by pushing, which does not require any intervention.

A laboring woman becomes anxious during the transition phase of the first stage of labor and deep respiratory pattern and complains of feeling dizzy and light-headed. Which should be the nurse's immediate response?

To help the woman breathe into a paper bag

After administereing phenylephrine (Neo-Synephrine) as prescribed to a pregnant patient, the nurse places the patient in the Trendelenburg position. Which is the rationale for this intervention?

To increase the patient's blood pressure. Phenylephrine (Neo-Synephrine) is used to treat maternal hyP-otension. Placing the patient in the Trendelenburg position would supplement the action of the drug and prevent the maternal hypotension from affecting the fetus. Tachysystole is reduced by administering terbutaline (Brethine), not by changing the position of the patient. The prescribed dose of phenylephrine (Neo-Synephrine) is unlikely to cause any adverse effects in the patient. Phenylephrine (Neo-Synephrine) has no effect on the fetal heart rate (FHR).

The nurse caring for a patient in labor asks the support person to use heat application for pain relief. Why is heat applied to the body?

To relieve general backache

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of oxytocin (Pitocin). The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1 ½ to 2 minutes. Which is the nurse's immediate action?

To stop the Pitocin The immediate action is to stoP- the Pitoci n infusion because Pitocin is an oxytocic that stimulates the uterus to contract. The woman is already in an appropriate position for uteroplacental perfusion. Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. Elevation of her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.

A woman is experiencing back labor and reports a constant, intense pain in her lower back. Which is an effective relief measure?

To use counterpressure against the sacrum

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?

Turn the woman to the left lateral position or place a pillow under her hip This will increase placental perfusion to the infant while waiting for the health care provider's instruction.

Which device can be used as a noninvasive way to assess the fetal heart rate (FHR) in a patient whose membranes are not ruptured?

Ultrasound transducer An ultrasound transducer is used to assess the FH R by an external mode of electronic fetal monitoring. It does not require membrane rupture and cervical dilation. A tocotransducer can be used to assess the uterine activity (UA) in a pregnant patient whose cervix is not sufficiently dilated, but it does not assess the FH R. Spiral electrode is used as an internal mode of electronic fetal monitoring to assess the FHR. It can be used only when the membranes are ruptured, and the cervix is dilated during the intrapartum period. IUPC is used to assess uterine activity in internal mode. It can be used only when the membranes are ruptured, and the cervix is dilated during the intrapartum period.

Which methods are used to assess uterine activity externally?

Ultrasound transducer Palpation Tocodynamometer The ultrasound transducer is an external method to monitor fetal heart rate. The tocodynamometer (toco) is an external method to monitor uterine activity. The toco measures uterine contraction frequency and duration; palpation is needed to assess intensity and uterine resting tone. Palpation is an external method of assessing uterine activity. If using external electronic fetal monitoring, palpation is needed to assess contraction intensity and uterine resting tone. The fetal scalp electrode is an internal method to monitor fetal heart rate. The intrauterine pressure catheter is an internal method to monitor uterine activity.

Which indicates normal umbilical cord blood values?

Umbilical artery: pH, 7.3; Pco2, 45 mm Hg; Po2, 25 mm Hg In the umbilical cord acid-base stimulation method, arterial values indicate the condition of the newborn. Arterial blood pH of 7.2 to 7.3, carbon dioxide pressure (Pco2) value of 45 to 55 mm Hg, and oxygen pressure (Po2) value of 15 to 25 mm Hg approximately indicate the normal fetal condition. Therefore, pH of 7.3, Pco2 of 45 mm Hg, and Po2 of 25 mm Hg represent the normal fetal condition. Arterial blood pH of 7.1, Pco2 of 50 mm Hg, and Po2 of 20 mm Hg indicate that the fetus may have respiratory acidosis. Arterial blood pH of 7.4 is indicative of fetal alkalosis.

Which condition may cause W-shaped waves on the fetal heart rate (FHR) monitor?

Umbilical cord compression W-shaped waves in the FHR monitor are indicative of variable decelerations in the FHR. Variable decelerations are seen when the umbilical cord is compressed at the time of labor. Placental abruption and dilated cervical layers do not cause variable decelerations but may cause late decelerations. Similarly, increased rate of uterine contractions may also cause late decelerations in FHR.

In an umbilical cord acid-base report, which value determines placental function?

Umbilical vein report The umbilical acid-base report helps determine the immediate condition of the newborn after birth. The nurse should check the umbilical vein report to determine the placental functioning of the patient. The placental function would help to assess the nutritional status of the newborn baby. The umbilical artery report is used to determine the physiologic functioning of the newborn. Amniotic fluid concentrations are monitored during labor, but not after birth. Blood glucose levels in the fetus are not assessed with the umbilical cord test.

Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern?

Variability averages between 6 to 10 beats/min. Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system. FHR should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats/min. Late deceleration patterns are never reassuring, although early and mild variable decelerations are expected, reassuring findings.

Which fetal heart rate (FHR) change might warrant an amnioinfusion?

Variable decelerations Variable decelerations in the fetal heart rate (FHR) are observed when the umbilical cord is compressed. An amnioinfusion refers to the infusion of isotonic fluid into the uterine cavity when the amniotic fluid levels are decreased. This intervention is usually done for the prevention of umbilical cord compression. Late decelerations are observed when infections or elevated uterine contractions (UCs) are seen in a patient. This condition will be reversed by maintaining an IV solution, but amnioinfusion is not administered. Early deceleration in the FH R is a normal sign that does not require any intervention. Prolonged deceleration of the FHR occurs when there is a marked reduction of the fetal oxygen supply.

While monitoring the fetal heart rate (FH R), the nurse instructs the patient to change positions and lie in the knee-to-chest position. Which is the reason for the nurse to give this instruction to the patient?

Variable decelerations in the FHR Variable decelerations in the FHR are usually caused by umbilical cord compression . The knee-to-chest position is useful for relieving cord compression, and thus the nurse should ask the patient to move into this position. Prolonged decelerations in the FH R are not affected by the mother's position. If the nurse finds late decelerations in the FHR, the nurse should ask the mother to lie in the lateral position. Early decelerations in the FHR are a normal finding, and no nursing intervention is required.

Which condition contraindicates hydrotherapy?

Viral infection Preterm labor Excessive vaginal bleeding

The nurse finds that the resting tone of the uterus of a pregnant patient is 30 mm Hg. Under which circumstance is this finding normal?

When an amnioinfusion is administered to the patient The average resting tone of the uterus is 10 mm Hg. When an amnioinfusion is done, the patient's uterine resting tone increases up to 40 mm Hg because of resistance to outflow of the fluid or turbulence of the catheter. Oxytocin (Pitocin) increases uterine activity (UA) but does not increase the resting tone of the uterus. Neither fetal scalp blood sampling nor umbilical cord blood sampling will have any effect on the resting tone of the uterus.

In which situation is local perineal infiltration anesthesia used?

When an episiotomy is required

When does the nurse use the fetal scalp stimulation technique to assess the fetal scalp pH?

When the fetal heart rate (FHR) is within the baseline Fetal scalp and vibroacoustic stimulation are two stimulating methods that are used to determine the fetal scalp blood pH. They are performed only when the fetal baseline heart rate is within the normal range. These techniques are not suggested if there is fetal bradycardia. These stimulation methods are related to neither the patient's weight nor uterine contractions.

The nurse is caring for a patient in labor who is having an indwelling catheter threaded into the epidural space for the administration of pain medication. Which does the nurse tell the patient?

You may experience a momentary twinge down your hip or back

preeclampsia

a pregnancy-specific condition in which hypertension and proteinuria develop after 20 weeks gestation or in the postpartum period in a client who previously had neither condition

Which methods can all women use to reduce risk in the preconception period? - increasing saturated fats in their diet - abstaining from alcohol - taking a folic acid supplement - learning about inherited conditions that can affect pregnancy - achieving a healthy weight - waiting to update vaccines until after pregnancy to prevent exposure to teratogens

abstaining from alcohol, taking a folic acid supplement, learning about inherited conditions that can affect pregnancy, achieving a healthy weight • rationale: abstaining from alcohol for at least 1 month before conceiving and throughout pregnancy can prevent complications from fetal alcohol exposure folic acid deficiencies are linked to open neural tube defects. all women of childbearing age who may become pregnant should take a supplement certain conditions can be passed on to offspring or can adversely affect a pregnancy being severely overweight or underweight has serious health consequences for the mother and fetus eating a healthy, balanced diet is important for overall pregnancy health. saturated fats should be limited, not increased although certain vaccines should not be administered to a pregnant individual, obtaining recommended vaccines before pregnancy (the preconception period) is a good way to promote health and well-being

a woman tests positive for group B streptococcus (GBS) at 36 weeks gestation before a vaginal birth. which interventions would the nurse include in the plan of care? - retest for GBS upon admission to labor and delivery - instruct the patient to use condoms until the infection clears - administer antibiotics during labor until delivery as prescribed - monitor the neonate for signs and symptoms of respiratory illness - inspect the perineum carefully for lesions upon admission for labor and delivery

administer antibiotics during labor until delivery as prescribed, monitor the neonate for signs and symptoms of respiratory distress • rationale: antibiotics are administered in labor to help prevent transmission to the neonate during delivery monitor the neonate for signs and symptoms of respiratory distress retesting is not recommended. treatment is based upon initial testing results between 35 and 37 weeks gestation GBS is a bacterium that is present on the skin. it is not a STI, so condoms are not necessary inspecting the perineum for lesions is necessary for genital herpes. GBS bacteria, however, do not cause lesions

During an emergency cesarean section, which interventions can help minimize maternal risk? - eliminating surgical instrument counts to expedite the procedure - administering antibiotics before skin inscision - performing the Foley catheter insertion using clean technique to expedite the procedure - performing an interdisciplinary time-out before skin incision - having a prewarmed isolette available for the birth

administering antibiotics before skin incision, performing an interdisciplinary time-out before skin incision • Administering antibiotics prior to skin incision is a standard of care, and it helps to prevent postoperative infection. An interdisciplinary time-out allows for proper patient identification, interdisciplinary collaboration, and identification of patient-specific surgical risks and allergies, and it helps minimize maternal risk. If time and personnel allow, surgical counts should not be eliminated, even in an emergent procedure. Eliminating counts would increase maternal risk. Emergency or routine, a Foley catheter should always be inserted using sterile technique, not clean technique. Using clean technique increases maternal risk. Having a prewarmed isolette ready for the birth will help minimize the risk for neonatal hypothermia after an emergency cesarean section, but it does not decrease maternal risk.

What are high-risk nutritional status factors in a pregnancy?

adolescent pregnancy 3 pregnancies in the previous 2 years tobacco, alcohol, or drug use inadequate dietary intake (chronic illness or food fads) Hx of bariatric surgery Inadequate or excessive weight gain hematocrit values less than 33%

A patient with bipolar depression & bulimia nervosa who is homeless enters care at 30 weeks' gestation. Which HCPs should be a part of the interdisciplinary team when developing a plan of care for this patient? - dentist - obstetrician - nurse - psychiatrist - social worker - legal aid

all of the above • all pregnant patients are at risk for adverse pregnancy outcomes related to tooth decay. patients with bulimia are at increased risk due to frequent vomiting the obstetrician will coordinate care for a safe passage & delivery of the baby the nurse will conduct targeted assessments, administer necessary treatments, conduct home health visits, & act as an advocate for the patient the psychiatrist, together with the obstetrician, will choose medications that are safer for the mother & fetus the social worker can help connect the patient with services such as counseling, nutrition, obtaining health insurance, & other community resources most HCPs in most states are mandated reporters when child abuse or neglect is suspected. this patient is homeless & will not be able to take her baby from the hospital without securing a safe place to live. a legal case worker can help her navigate the legal process & act as an advocate for the mother who loses custody of her child

Which measures should the nurse ensure are available and ready before a multiple gestation twin delivery? - an operating room set up for vaginal and cesarean delivery - neonatal HCPs capable of advanced resuscitation for each baby - a single warmer with supplies for each infant - two separate infant warmers with separate supplies for each baby - a fetal monitor with the capacity to monitor 2 babies at the same time

an operating room set up for vaginal and cesarean delivery, neonatal HCPs capable of advanced resuscitation for each baby, two separate infant warmers with separate supplies for each baby, a fetal monitor with the capacity to monitor 2 babies at the same time • In the event of an emergency or the need for an urgent cesarean delivery, multiple gestation deliveries are often done in the operating room, even when the planned delivery route is vaginal. Whether delivery is vaginal or cesarean, the neonatal care staff must be prepared for the care and possible resuscitation of multiple infants. Cord clamps, bulb syringes, radiant warmers, and resuscitation equipment must be prepared for each infant. A neonatal care team of nurses, a neonatal nurse practitioner, and a pediatrician or a neonatologist should be available for each infant, with another nurse caring for the mother. Two infant warmers should be available in the event that resuscitation is necessary of one or both babies. During labor, each fetus's FHR is monitored separately. While resting in bed, the patient should be in a lateral position to promote placental blood flow. Assessment of each FHR continues until delivery. Two infant warmers should be available in the event that resuscitation is necessary of one or both babies.

when cardiovascular disease is severe during pregnancy, which health care providers may be a part of the interdisciplinary care team? -anesthesiologists - nurses - dermatologists - neonatologists - obstetricians - maternal fetal medicine specialists

anesthesiologists, nurses, neonatologists, obstetricians, maternal-fetal medicine specialists • rationale: Anesthesiologists are important team members who help manage patient conditions, administer analgesia in labor, and manage the airway and hemodynamic stability in the operating room. they should be involved in care long before delivery nurses help monitor, care for, and implement interventions dermatologists are not typically involved in the care of a pregnant patient with CVD neonatologists must be involved in the care of the pregnant patient, as the neonate may have been exposed to dangerous medications, may have growth restrictions, and may have many other complications obstetricians lead the team in the care for the pregnant patient and work closely with specialists to develop a plan of care maternal-fetal medicine specialists focus on high-risk pregnancy and implement advanced monitoring and interventions specific to the high-risk pregnancy

which considerations would the nurse recognize for a pregnant patient with HIV? - a 2nd test toward the end of the 3rd trimester is not recommended - vaginal delivery is always contraindicated - antiretroviral therapy for the mother and neonate helps reduce transmission at birth - testing all pregnant women for HIV at the beginning of pregnancy is a best practice - breastfeeding should be avoided - an elective cesarean birth at 38 weeks helps prevent transmission to the neonate

antiretroviral therapy for the mother and neonate helps reduce transmission at birth, testing all pregnant women for HIV at the beginning of pregnancy is a best practice, breastfeeding should be avoided, an elective cesarean birth at 38 weeks helps prevent transmission to the neonate • rationale: the risk of transmission decreases from 30% to less than 2% with antiretroviral therapy all women, regardless of history, should be tested for HIV in the beginning of pregnancy breastfeeding is contraindicated with maternal HIV infection elective cesarean birth has been shown to reduce the rate of neonatal HIV transmission as a result of the risk of infection in pregnancy, a second test is recommended after a discussion of risks and benefits, a health care provider may decide to continue with vaginal delivery if the mother's viral count is low

During the assessment, the nurse palpates the abdomen of a pregnant patient to identify the number of fetuses. Which action should the nurse perform before conducting the assessment? SATA - help the patient change positions often - ask the patient to empty the bladder completely - place a small, rolled towel under the patient's hip - use running water to stimulate voiding of the patient - suggest that the patient lie in the supine position with a pillow under her head

ask the patient to empty the bladder completely, place a small, rolled towel under the patient's hip, suggest that the patient lie in the supine position with a pillow under her head • Leopold maneuvers involve abdominal palpitation to identify the number of fetuses and expected location of the point of maximal impulse (PMI) of the FHR on the patient's abdomen. Therefore the nurse should ask the patient to empty the bladder, as the maneuver can be painful if the bladder is full. The nurse can suggest that the patient lie in the supine position with 1 pillow under her head to make her feel comfortable. The nurse should place a small, rolled towel under the right or left hip to prevent supine hypotensive syndrome. The nurse should not ask the patient to change her positions frequently, as it may cause discomfort to the patient. Running water is used to stimulate voiding of the patient only when the patient has a problem of urinary elimination.

The nurse caring for a patient in the postanesthesia care unit (PACU) notes that a patient is having bradypnea after general anesthesia. Which immediate interventions are indicated to determine the next actions by the nurse? - assess the patient's LOC - ensure the pulse oximeter is on and WNL - call the anesthesiologist for possible intubation - administer the prescribed dose of naloxone - continue to monitor the patient, as bradypnea is a normal response to general anesthesia

assess the patient's LOC, ensure the pulse oximeter is on and WNL • Assessing the patient's level of consciousness is correct. Sometimes general anesthesia can make a patient sleepy, but by gently waking the patient, the respiratory rate may return to normal. Whenever the patient's respiratory status is compromised, a pulse oximeter is indicated. Intubation may not be indicated. The nurse would assess level of consciousness first and see if the patient awakens with stimulation. General anesthesia is not reversed with naloxone. Bradypnea is not an expected finding in a patient. If the patient does not respond to gentle stimulation, the anesthesia health care provider should be called immediately.

Which qualities are considered normal when assessing fetal heart rate (FHR)? - FHR variability of < 5 bpm - baseline FRH of 140 bpm - FHR variability of 20 bpm - baseline FHR of 100 bpm - baseline FHR of 170 bpm

baseline FHR of 140 bpm, FHR variability of 20 bpm • A baseline FHR of 110 to 160 beats/min is considered normal. FHR variability of 6 to 25 beats/min is classified as moderate variability and is considered normal (reassuring). FHR variability of ≤5 beats/min is classified as minimal variability and is considered abnormal or indeterminate and may be a sign of fetal compromise. A baseline FHR below 110 beats/min is classified as bradycardia and is considered abnormal (nonreassuring). A baseline FHR above 160 beats/min is classified as tachycardia and is considered abnormal (nonreassuring).

Passageway

birth canal Measured -5 (proximal pelvis edge) to +5 (perineum), where 0 is at the ischial spines

which characteristics are associated with sickle cell anemia? - causes frequent hospitalization throughout the life span - characterized by distorted and decreased erythrocytes - can lead to preterm birth - causes severe pain - commonly leads to fetal neural tube defects - may be cured with diet and supplementation

causes frequent hospitalization throughout the life span, characterized by distorted and decreased erythrocytes, can lead to preterm birth, causes severe pain • rationale: crises may cause frequent hospitalizations from childhood and beyond erythrocytes appear sickled under microscopy pregnant women with sickle cell anemia are at increased risk for preterm birth sickle-cell patients have extreme pain when experiencing a flare-up fetal neural tube defects are common in pernicious anemia, not sickle cell anemia sickle cell anemia is an inherited disorder and cannot be cured

Which clinical conditions must be met before placing a fetal scalp monitor? - patient should not be in labor - absence of fetal scalp hair - cervix should be at least 2 cm dilated - the patient's membranes must be ruptured - high fetal position

cervix should be at least 2 cm dilated, the patient's membranes must be ruptured • The fetal scalp monitor may be placed once the patient's cervix has dilated to at least 2 cm. The cervix must be dilated enough to allow contact with the fetal scalp. The fetal scalp monitor can be used once the patient's membranes have ruptured to allow contact with the fetal scalp. The fetal scalp monitor may be placed once the patient's membranes have ruptured and the patient is experiencing cervical dilation. Fetal scalp hair is not a contraindication to fetal scalp monitoring. However, the fetal scalp monitor may become tangled in the fetal hair. The fetal presentation must be low enough to allow placement of the fetal scalp monitor.

Which is a possible cause of miscarriage during early pregnancy? SATA - premature dilation of cervix - chromosomal abnormalities - endocrine imbalance - hypothyroidism - antiphospholipid antibodies

chromosomal abnormalities, endocrine imbalance, hypothyroidism, antiphospholipid antibodies • chromosomal abnormalities account for 50% of all early pregnancy losses. endocrine imbalance is caused by luteal phase defects, hypothyroidism, and DM in pregnant patients & results in miscarriage. antiphospholipid antibodies also increase the chances of miscarriage in pregnant patients. premature dilation of the cervix may cause a second trimester loss and is usually seen in patients between 12 & 20 weeks of gestation

Which hypertensive disorder can occur during pregnancy? SATA - chronic hypertension - preeclampsia-eclampsia - gestational trophoblastic disease - gestational hypertension - hyperemesis gravidarum

chronic hypertension, preeclampsia-eclampsia, gestational hypertension • chronic HTN refers to HTN that developed in pregnant patient before 20 weeks of gestation. preeclampsia refers to HTN & proteinuria that develop after 20 weeks. eclampsia is the onset of seizure activity in a pregnant patient with preeclampsia. gestational HTN is the onset of HTN after 20 weeks. gestational trophoblastic disease and hyperemesis gravidarum are not HTN disorders. gestational trophoblastic disease refers to a disorder without a viable fetus that is caused by abnormal fertilization. hyperemesis gravidarum is excessive vomiting during pregnancy that may result in weight loss and electrolyte imbalance

A nurse is beginning to care for a patient in labor. The health care provider has prescribed an intravenous (IV) infusion of oxytocin. The nurse makes sure that which implementations occur before initiation of the infusion? - placing the patient on complete bed rest - continuous electronic fetal monitoring - an IV infusion of antibiotics - making sure that the vial of terbutaline is immediately available - preparing an IV infusion pump - placing a code cart at the patient's bedside

continuous electronic fetal monitoring, making sure that the vial of terbutaline is immediately available, preparing and IV infusion pump • Continuous electronic fetal monitoring, either external or internal, is a standard of practice with the administration of IV oxytocin. Terbutaline, administered either intravenously or subcutaneously, is a tocolytic that can be used to decrease or stop uterine contractions when uterine tachysystole occurs. IV oxytocin should only be administered via an IV pump. IV oxytocin during labor should never be administered without the use of a pump for titration. The administration of antibiotics during labor is only necessary if the patient is positive for group beta strep (GBS), is diagnosed with chorioamnionitis, or has a preexisting condition that requires antibiotics with medical procedures. Antibiotics are not necessary with the administration of IV oxytocin. The maternity unit should have a code cart available on the unit; however, it is not necessary to have a code cart at the bedside of a patient receiving IV oxytocin for labor induction or augmentation.

Powers

contractions - primary- effacement and dilation of cervix and descent of fetus - secondary - bearing down and pushing

Which assessment findings in the laboring patient would suggest to the nurse that delivery is imminent? - woman can talk through contractions - contractions are 1.5-2 minutes apart - regular contractions are mild and 7 minutes apart - mucous vaginal discharge is bloody - the woman is experiencing vomiting, nausea, and sweating - the patient complains of rectal presure

contractions are 1.5-2 minutes apart, mucous vaginal discharge is bloody, the woman is experiencing N/V and sweating, the patient complains of rectal pain • contractions that are mild and 7 minutes apart are suggestive of early labor as well as talking through contractions

Which factors could improve a woman's experience with pain during labor? - cultural factors - financial factors - environmental factors - psychological factors - physiologic factors

cultural, environmental, psychological, physiologic • Physiologic factors, such as understanding the different types of pain, can improve a woman's experience in labor. Psychological factors including the laboring woman's partner or support person play a key role in maintaining a calm and supportive environment. Previous experience with childbirth, whether her own or experiencing someone else's birth, can affect the psyche of the laboring woman.The quality of a laboring woman's environment can play an integral part in how she experiences pain in labor. Environmental factors in labor may include a support person or people present, a supportive physical environment (availability of birthing ball, comfortable chairs, etc.), place of birth (home, birth center, hospital, etc.), and the laboring woman's comfort with her health care providers. Cultural influences may impose certain behavioral expectations regarding acceptable and unacceptable behavior when experiencing pain. Women with strong religious beliefs, for example, often accept pain as a necessary and inevitable part of bringing a new life into the world, whereas others tend to vocalize their pain by moaning, breathing rhythmically, or shouting. Financial factors do not improve a woman's experience with pain during labor. Financial factors might play a role in the experience of labor, but not the experience of pain.

fetal complications of amniocentesis

death, hemorrhage, infection, injury from a needle (Risks can be minimized by ultrasound to direct the procedure)

When teaching a childbirth class for first-time parents, the nurse includes which benefits of breathing techniques used during labor? - decreases sensation of pain - requires increased energy with continued use - provides a different focus during contractions - can also substitute for pharmacologic therapies - can be used with other nonpharmacologic techniques

decreases sensation of pain, provides a different focus during contractions, can also substitute for pharmacologic therapies, can be used with other nonpharmacologic techniques • The sensation of pain is decreased with breathing techniques. Breathing techniques provide laboring women with a different focus during contractions, reducing the perception of pain. This is a benefit of using breathing techniques in labor. Breathing techniques often decrease the need for pharmacologic therapies during labor, as they can work to decrease the sensation of pain. Breathing techniques can be used to supplement other relaxation techniques during labor, such as mental stimulation and cutaneous stimulation. Increased energy is not expected with continued use of breathing techniques during labor. Breathing techniques can cause fatigue the longer they are used.

While monitoring a patient receiving oxytocin for augmentation of labor, the nurse notes tachysystole with recurrent late decelerations and minimal variability on the electronic fetal monitor. Which actions are appropriate? - discontinue oxytocin infusion - reposition the patient on her side - administer an IV bolus of fluid per protocol - administer 100% O2 via tight face mask - notify HCP - place the patient in semi-Fowler position and continue to monitor

discontinue oxytocin infusion, reposition patient on her side, administer IV bolus of fluid, administer 100% O2 via tight face mask, notify HCP • Oxytocin infusion can cause tachysystole and decreased uteroplacental perfusion. It should be discontinued when fetal compromise is noted with tachysystole. Repositioning the patient on her side increases uteroplacental perfusion. Administering a fluid bolus is part of the intrauterine resuscitation protocol and is an appropriate action. Administering oxygen is part of the intrauterine resuscitation protocol and is an appropriate action. The patient is experiencing a medical emergency, and the health care provider should be notified. Semi-Fowler position can increase pressure on the vena cava, causing further uteroplacental/fetal compromise. Also, although continued monitoring is important, immediate interventions are required.

Which nursing actions are appropriate when the fetal monitor shows a pattern of late decelerations? - discontinue oxytocin - provide water to patient - administer oxygen by face mask - reposition patient onto her side - continue monitoring and document findings

discontinue oxytocin, administer oxygen by face mask, reposition the patient onto her side • Discontinuing oxytocin will decrease the effect of uterine stimulants on the contractions. Oxygen increases the oxygenation to the patient, which increases perfusion of oxygen to the placenta. Repositioning the patient on her side, rather than allowing a supine position, is preferred. A supine position increases pressure on the vena cava, which reduces the blood supply, causing decreased perfusion of the placenta. Although dehydration may be a cause of nonreassuring fetal heart rate patterns, more immediate action is necessary for a pattern of late decelerations. The administration of water is not preferred while the patient is in labor. Late decelerations are nonreassuring; therefore nursing actions are necessary.

The nurse is assessing a pregnant patient through a tocotransducer placed externally and a spiral electrode placed internally. Which information will the nurse obtain by this arrangement? SATA - lactate levels in the fetal blood - strength of uterine contractions - duration of uterine contractions - frequency of uterine contractions - accelerations of fetal heart rate

duration of uterine contractions, frequency of uterine contractions, accelerations of fetal heart rate • a toco is an external device that is used for assessment of uterine activity (UA). This instrument would report duration and frequency of the uterine contractions (UCs). The spiral electrode can monitor accelerations of the fetal heart rate. These symptoms do not report the intensity of UCs. The strength of UCs can be assessed using an intrauterine pressure catheter. Neither a toco nor a spiral electrode is used to determine the lactate level; it is obtained by the fetal scalp sampling method.

Environmental risk factors of pregnancy

environmental substances (lead, mercury) Infections radiation therapeutic drugs illicit drugs industrial pollutants cigarette smoke (even secondhand) stress diet

polymorphic eruption of pregnancy (PEP) also known as pruritic urticarial papules and plaques of pregnancy (PUPPs) usually occurs in the 3rd trimester and rarely resolves after delivery - true - false

false • rationale: PEP or PUPPs usually resolves before birth or within several weeks after birth (pg 269)

Doulas are only used in the home or birth center setting, not in the hospital where registered nurses are available. true or false

false • Certified doulas are a wonderful support resource in any birth setting and complement the role of the registered nurse

The dorsal lithotomy position is the evidence-based best position to allow for the use of gravity to help facilitate birth true or false

false • Dorsal lithotomy is on the back with knees flexed. Gravity does not help in this position.

According to the Emergency Medical Treatment and Active Labor Act (EMTALA), it is best practice to ensure that before treatment occurs the insurance plan of the patient matches the insurance plans used by the hospital so that the patient is not charged unnecessary fees for service. true or false

false • EMTALA mandates that pregnant women be evaluated and treated during an emergency (including r/o labor) regardless of insurance status or ability to pay.

Hands-and-knees position should never be used in a laboring woman in active labor true or false

false • Hands and knees position helps relieve backache and facilitations internal rotation of the fetus.

It is within the scope of practice for a registered nurse to perform an amniotomy true or false

false • Performing amniotomy is outside the scope of practice of nurses. Certified nurse midwives as advanced practice nurses or physicians are the only providers that may perform this procedure. However, some providers will ask an RN to do this. Be careful in upcoming practices and politely decline by referencing your facility's policy if you are asked to do this procedure as an RN.

Best practice for triage in labor in delivery is on a first-come first-serve basis true or false

false • Use the maternal-fetal triage index to prioritize triage and prioritize based on acuity.

the main purpose of administering magnesium sulfate to a client with preeclampsia is to lower blood pressure (T/F)

false • magnesium sulfate decreases the likelihood of eclamptic seizures; antihypertensives are used to lower BP

Intrapartum FHR monitoring leads to a significant decrease in neonatal neurologic morbidity - true - false

false • though fetal monitoring was originally intended to do this, there is no research evidence to suggest that it actually does (pg 356)

the nurse understands that which physiologic changes in the thyroid are considered abnormal in pregnancy? - fatigue, edema, and muscle aches may be the result of thyroid activity in pregnancy - the thyroid gland enlarges and becomes palpable - thyroid-stimulating hormone (TSH) decreases in the 1st trimester - free thyroxine (T4) levels increase - increased free thyroxine (T4) levels lead to weight loss and goiter

fatigue, edema, and muscle aches may be the result of thyroid activity in pregnancy, the thyroid gland enlarge and becomes palpable, increased free thyroxine (T4) levels lead to weight loss and goiter • rationale: fatigue, edema, and muscle aches may be the result of thyroid activity in pregnancy the thyroid gland enlarging and becoming palpable is not an expected finding in pregnancy weight loss and goiter would be abnormal and indicative of hyperthyroidism TSH decreasing in the first trimester is an expected change during pregnancy. TSH decreases as a result of the influence of human chorionic gonadotropin in early pregnancy T4 levels increasing is an expected change during pregnancy. the TSH decrease causes an increase in T4

Which assessments may be performed using ultrasonography? - fetal anatomy - fetal Rh status - gestational age - chromosomal disorders - fetal heart activity - amniotic fluid index

fetal anatomy, gestational age, chromosomal disorders, fetal heart activity, amniotic fluid index • rationale: ultrasounds are frequently used to assess fetal amniotic structures for abnormality gestational age can be estimated with ultrasound by collecting specific measurements in different trimesters certain chromosomal abnormalities may be initially detected using ultrasound soft markers. these findings are not diagnostic, however, and require further workup fetal heart activity is easily detected using ultrasonography amniotic fluid amount may be measured using ultrasound fetal Rh status cannot be determined with an ultrasound. this requires biochemical assessment and analysis

which symptom is associated with systemic lupus erythematosus (SLE)? SATA - fever - hyperactivity - hypotension - muscle aches - weight changes

fever, muscle aches, weight changes • common symptoms, including myalgias, fatigue, weight change, & fevers, occur in nearly all women with SLE at some time during the disease. fatigue, rather than hyperactivity, is a common sign of SLE. hypotension is not a characteristic sign of SLE. although a diagnosis of SLE is suspected based on clinical signs & symptoms, it is confirmed by laboratory testing that demonstrates the presence of circulating autoantibodies. as with other autoimmune diseases, SLE is characterized by a series of exacerbations (flares) and remissions

If a pregnant patient suspects signs and symptoms of preterm labor which condition would lead the patient to go to the hospital immediately? SATA - nausea and vomiting - upper abdominal pain - fluid leakage from vagina - presence of vaginal bleeding - contractions every 10 minutes

fluid leakage from vagina, presence of vaginal bleeding, contractions every 10 minutes • fluid leakage from the vagina indicates rupture of the amniotic membranes. the patient should seek immediate medical attention because ruptured amniotic membranes can compromise fetal health. presence of vaginal bleeding may indicate onset of labor or placental hemorrhage, which may compromise the fetal perfusion. therefore, the patient should go to hospital immediately. uterine contractions every 10 minutes indicate active labor, the patient should go to the hospital immediately. nausea and vomiting and upper abdominal pain do not indicate labor. the patient need not seek immediate medical attention for these conditions

Which condition during pregnancy can result in preeclampsia in the patient? SATA - genetic abnormalities - dietary deficiencies - abnormal trophoblast invasion - cardiovascular changes - maternal hypotension

genetic abnormalities, dietary insufficiencies, abnormal trophoblast invasion, cardiovascular changes • current theories consider that genetic abnormalities and dietary deficiencies can result in preeclampsia. abnormal trophoblast invasion causes fetal hypoxia and results in maternal hypertension. CV changes stimulate the inflammatory system and result in preeclampsia in the pregnant patient. maternal hypertension, and not hypotension, after 20 weeks of gestation is known as preeclampsia

which statements are true regarding hyperglycemia? - glucose levels in the blood may be elevated, but at the cellular level glucose may be low with some forms of diabetes - in gestational diabetes, hyperglycemia always leads to polydipsia - the body attempts to dilute the glucose load, resulting in polyuria - glycosuria can occur - glucose is stored in the pancreas when hyperglycemia occurs

glucose levels in the blood may be elevated, but at the cellular level glucose may be low with some forms of diabetes; the body attempts to dilute the glucose load, resulting in polyuria; glycosuria can occur • rationale: glucose may be low at the cellular level with hyperglycemia when there is insulin resistance or decreased insulin production with hyperglycemia, the body will try to compensate for the high glucose level using the renal system as the body compensates for hyperglycemia, more glucose may be spilled into the urine for excretion the classic signs of polydipsia, polyphagia, and polyuria may not occur with gestational diabetes the pancreas excretes insulin so that glucose can be absorbed by the body

What is aneuploidy?

having one or more extra or missing chromosomes in the 23 pairs normally present in each individual

HELLP syndrome

hemolysis, elevated liver enzymes, low platelets - more common in white women - increased risk for maternal death and adverse perinatal outcomes - increased risk: pulmonary edema, acute renal failure, DIC, placental abruption, liver hemorrhage or failure, ARDS, sepsis, stroke

The nurse is responsible for intake history at an obstetrics and gynecology (OB/GYN) office. Which medical conditions would the nurse recognize as high-risk conditions that could have adverse outcomes on a pregnancy? - hemophilia - type 1 DM - HIV - chronic hypertension - xeroderma

hemophilia, type 1 DM, HIV, chronic hypertension • rationale: hemophilia is a coagulopathy that increases a woman's risk in pregnancy type 1 DM is a medical condition that exists before pregnancy and can have serious adverse health outcomes for the pregnant mother and fetus HIV is a medical diagnosis that can have adverse outcomes on a pregnancy chronic HTN can cause adverse outcomes for a mother and fetus during pregnancy having dry skin alone does not increase a woman's pregnancy risk

A woman at 34 weeks gestation presents with preeclampsia. Which clinical finding in the patient indicates that the disease has progressed to HELLP syndrome? SATA - hepatic dysfunction - elevated liver enzymes - vaginal bleeding - low platelet count - chronic hypertension

hepatic dysfunction, elevated liver enzymes, low platelet count • hepatic dysfunction in a patient with preeclampsia indicates that the disease has progressed to HELLP syndrome. It can result in both endothelial damage and fibrin deposits in the liver. Hepatic tissue damage results in elevated liver enzymes. Narrowed blood vessels damage the RBCs, and they become hemolyses, resulting in a decreased RBC and platelet count. vaginal bleeding is sometimes seen in patients with severe gestational HTN or those who are at risk for miscarriage. Chronic HTN is a condition in which patients develop HTN before the pregnancy. it is not related to HELLP syndrome

Which is a cause of indicated preterm labor? SATA - herpes infection - multifetal gestation - gestational diabetes - chronic hypertension - second trimester bleeding

herpes infection, gestational diabetes, chronic hypertension • preterm labor may be spontaneous or indicated. indicated preterm labor is a means to resolve the maternal and fetal risk. the factors that can cause indicated preterm labor include gestational diabetes, chronic HTN, and herpes infection. spontaneous preterm labor is caused due to early initiation of the labor process. the factors responsible for spontaneous labor are multifetal gestation and bleeding during the 2nd trimester

which obstetric or medical complication is the pregnant patient with diabetes mellitus at risk? SATA - hydramnios - preeclampsia - hypoglycemia - monilial vaginitis - brachial plexus palsy

hydramnios, preeclampsia, hypoglycemia, monilial vaginitis • a pregnant patient with diabetes mellitus is at risk for hypertension, which may result in preeclampsia. hypoglycemia may occur because of an increase in insulin levels in the 1st trimester of pregnancy. hydramnios may occur in the 3rd trimester of pregnancy because of hyperglycemia. monilial vaginitis is a vaginal infection that is seen in women with diabetes during pregnancy. this results from an alteration in the normal resistance of the body to infection. brachial plexus palsy may be seen in the child born to a woman with diabetes because of a difficult vaginal birth

chronic hypertension

hypertension that develops before 20 weeks gestation

which condition is common in infants born to mothers with diabetes mellitus? - hypoglycemia - marfan syndrome - cephalhematoma - shoulder dystocia - brachial plexus palsy

hypoglycemia, cephalhematoma, shoulder dystocia, brachial plexus palsy • brachial plexus palsy & cephalhematoma may occur in the child because of a difficult vaginal birth. the brachial plexus is a group of nerves that originate from the spinal cord. they can be damaged because of a difficult birth. a cephalhematoma is a hemorrhage of blood between the skull & the periosteum. shoulder dystocia is a risk associated with diabetic pregnancy becasue the infants born to women with diabetes tend to have a disproportionate increase in the shoulder, trunk, & chest size. hypoglycemia is a risk if the patient does not control her blood glucose during the last half of pregnancy. marfan syndrome is a cardiac disease & is not seen in infants with diabetic mothers

Which is a factor that affects the onset of labor? SATA - increasing estrogen levels - decreasing oxytocin levels - increasing intrauterine pressure - decreasing progesterone levels - decreasing prostaglandin levels

increasing estrogen levels, increasing intrauterine pressure, decreasing progesterone levels • increasing intrauterine pressure is associated with increasing myometrial irritability. This is caused by increasing contractions of estrogen and decreasing progesterone levels. Oxytocin and prostaglandin levels are known to increase during the onset of labor

Which uterine activity indicators does the intrauterine pressure catheter (IUPC) measure in mm HG? - frequency - duration - intensity - resting tone - variability

intensity, resting tone • Contraction intensity is measured by the IUPC in mm Hg and is 50 to 75 mm Hg during labor and up to 110 mm Hg with pushing during the second stage. Resting tone is measured by the IUPC in mm Hg and is usually between 5 and 15 mm Hg. Frequency is not a pressure calculation. It is determined by the electronic fetal monitor. Duration is not a pressure calculation. It is determined by the electronic fetal monitor. Variability is an indicator of fetal heart rate, not uterine activity. It is not measured by an IUPC.

Which advantages of a low transverse skin incision would a nurse explain to a patient? - less visibility when healed - less chance of wound dehiscence - pubic hair will grow back - works well with obese patients - allows the surgeon to extend the incision upward - quicker to perform

less visibility when healed, less chance of wound dehiscence, pubic hair will grow back • The low transverse incision is less visible because it sits at or below the bikini line.There is less chance of wound dehiscence with low transverse skin incisions. Pubic hair will grow back with a low transverse incision. This helps hide the scar. Vertical skin incisions allow for better visualization of the uterus with obese patients. Vertical skin incisions, not transverse incisions, allow the surgeon to extend the incision upward. Vertical skin incisions are quicker to perform than transverse incisions.

The nurse is caring for a patient in the first stage of labor. Which nerve segment transmits pain impulses during this stage? SATA - lumbar spinal nerve segment L1 - pudendal nerve though S2 to S4 - T10 to T12 spinal nerve segments - parasympathetic nervous system - upper lumbar sympathetic nerves

lumbar spinal nerve segment L1, T10 to T12 spinal nerve segments, upper lumbar sympathetic nerves • pain impulses during the 1st stage of labor are transmitted via the T10 to T12 and L1 spinal nerve segments and upper lumbar sympathetic nerves. These nerves originate in the uterine body and cervix. Pain impulses during the 2nd stage of labor are transmitted through the pudendal nerve through S2 to S4 of spinal nerve segments and the parasympathetic system

A laboring patient reports moderate back pain. Her partner rubs her lower back and reminds her to look at the teddy bear they bought for the newborn. Which relaxation techniques are being used? - massage - focal point - hydrotherapy - acupressure - mental imagery

massage, focal point • Massage is a form of cutaneous stimulation that involves rubbing areas of pain to reduce discomfort. This relaxation technique can help with lower back pain during labor. The use of a teddy bear to look at during labor is an example of a focal point. By using a focal point, the woman focuses on an external focal point (usually an object with positive associations) as opposed to the internal sensation of pain. ydrotherapy (also known as water therapy) is an example of cutaneous stimulation. It is a relaxation technique that can be very helpful for laboring women but does not involve massage or focusing on an object. Acupressure is a directed form of massage in which the support person applies pressure to specific pressure points using hands, rollers, balls, or other equipment. This is different from massage, but it is another type of cutaneous stimulation. Mental imagery is a relaxation technique that requires the patient to focus on a detailed memory or an imaginary scene to dissociate herself from the physical experience of discomfort. This is not the same as a focal point, which is an actual physical object.

Which is a metabolic change associated with pregnancy? SATA - maternal insulin requirements increase during the 1st trimester - maternal production of insulin increases during the first trimester - there is enough glucose for the fetus during the 2nd trimester - fasting blood glucose levels will decrease during the 1st trimester - the patient's tolerance to glucose increases in the 2nd trimester

maternal production of insulin increases during the 1st trimester, there is enough glucose for the fetus in the 2nd trimester, fasting blood glucose levels will decrease in the 1st trimester • in the first trimester, an increase in estrogen & progesterone production stimulates the beta cells in the pancreas to increase insulin production. the beta cells also increase peripheral use of glucose & in turn, decrease the overall blood glucose levels. this reduces fasting glucose levels by approximately 10%. during the 2nd & 3rd trimesters, hormonal changes increase insulin resistance & ensure an abundant supply of glucose for the fetus. the body develops insulin resistance as a glucose-sparing mechanism. in the 2nd trimester, hormonal changes decrease tolerance to glucose. maternal insulin requirements increase from 18-24 weeks of gestation, not in the 1st trimester

Which clinical test evaluates the health status of a pregnant patient who abuses substances? - meconium testing - complete blood count - tuberculosis screening - urine toxicologic testing - glycosylated hemoglobin A1c

meconium testing, CBC, tuberculosis screening, urine toxicologic testing • urine toxicologic testing helps assess for illicit drug use in a pregnant patient. meconium from the neonate helps determine past drug use over a longer period. a CBC helps assess any deficiency in the patient. tuberculosis screening is important so that the infection, if present, can be prevented from progressing. glycosylated hemoglobin A1c levels are assessed in a patient with diabetes to assess recent glycemic control

Early pregnancy bleeding is caused by:

miscarriage (spontaneous abortion) cervical insufficiency ectopic pregnancy hydatidiform mole (molar preg)

The nurse is caring for a woman in the second stage of labor whose contractions have become more intense. What actions could the nurse take to assist this woman? - model modified-paced breathing - model slow-paced breathing - monitor for hyperventilation - conduct acupuncture - ask the patient if it is OK to hold her hand

model modified-paced breathing, monitor for hyperventilation, ask the patient if it is OK to hold her hand • Modified-paced breathing is most effective in the second stage of labor and involves the pant-blow method of breathing. Measures to combat hyperventilation include breathing into cupped hands or a paper bag or holding the breath for a couple of seconds. All of these techniques decrease partial pressure of carbon dioxide (PCO2). Holding a woman's hand is a nonpharmacologic method of pain relief and may help calm the woman during intense contractions. The nurse would always ask the woman's permission before grasping her hand. Slow-paced breathing is most effective in the first stage of labor. The ideal rate for slow-paced breathing is half the normal breathing rate. Acupuncture is a nonpharmacologic pain relief method that may be useful during labor; however, acupuncture is outside of the scope of nursing practice and therefore would not be performed by the nurse.

Gestational trophoblastic neoplasia (GTN)

molar pregnancy, cancer-related no viable fetus caused by abnormal fertilization

A patient is a G2/P0 at 32 weeks pregnant and experiencing regular contractions. She has a multifetal gestation pregnancy, a history of preterm birth, and has had recurrent bacterial vaginosis throughout the pregnancy. Her BMI is 22, she is 30 years' old, and she is a former smoker who quit two years ago. Of the data provided, which are risk factors for preterm labor? - age - multifetal gestation - recurrent bacterial vaginosis - former smoker status - BMI 22

multifetal gestation, recurrent bacterial vaginosis • The risk for preterm labor increases when a woman experiences a multifetal pregnancy because the uterus is overdistended. Recent studies have shown a link between vaginal infections in pregnancy and preterm labor. Very young and very old mothers are at risk for preterm labor. This mother is a normal age for childbirth. Woman who smoke while pregnant are at increased risk for preterm labor. Women who are obese have an increased risk of preterm birth. This patient's BMI is normal.

Which drugs would the nurse anticipate administering for tocolysis during preterm labor? - nifedipine - indomethacin - magnesium sulfate - labetalol - bethamethasone

nifedipine, inomethacin • Nifedipine is given in large, frequent doses to blunt or stop uterine contractions to allow for administration of corticosteroids for fetal lung maturity prior to delivery. Indomethacin is utilized to blunt or stop uterine contractions during preterm labor. It is a short-term solution to allow for the administration of corticosteroids. Magnesium sulfate, when utilized during early preterm labor, is given for neuroprotection of the fetus. When exposed to magnesium sulfate in utero, preterm babies have been shown to have less incidence and/or severity of cerebral palsy through multiple studies (ACOG, 2016). Generally speaking, magnesium sulfate is no longer utilized as a tocolytic agent. Labetalol is utilized to lower blood pressure.Corticosteroids to speed fetal lung maturation are often prescribed if birth before 34 weeks seems inevitable. Steroid therapy may reduce the incidence and severity of respiratory distress syndrome and intraventricular hemorrhage in the preterm infant. Receiving the steroid as late as 37 weeks may be necessary if fetal lung maturity studies demonstrate immature lungs later than 34 weeks. Betamethasone or dexamethasone may be used for this purpose.

Which patient is more susceptible to soft-tissue damage with vaginal deliveries? SATA - multiparous - nulliparous - patient needing forceps delivery - patient with fetal vertex presentation - patient with fetal breech presentation

nulliparous, patient needing forceps delivery, patient with fetal breech presentation • a nulliparous patient has rigid perineal tissue, making it susceptible to injury. fetal breech presentation exerts undue pressure on the tissues, increasing the risk of injuries. forceps delivery also increases the risk of injury due to undue stretch of the perineum. multiparous patients have stretchable perineal tissues, which are less likely to get injured during childbirth. fetal vertex presentation causes the least amount of tissue damage

The nurse is providing care for a patient in labor, and the health care provider has just stated the patient's need for a forceps-assisted delivery. Which actions would the nurse's preparation include? - obtaining a urinary catheter - establishing IV access - performing a head-to-toe assessment - educating the patient about the risk for lacerations - preparing the forceps using aseptic technique - monitoring the FHR for signs of distress

obtaining a urinary catheter, establishing IV access, preparing the forceps using aseptic technique, monitoring the FHR for signs of distress • The patient's bladder must be empty during an operative delivery. Use of an intermittent catheter is expected. If possible, IV access should be established for the patient who undergoes an operative vaginal delivery. This can provide a route for additional pain medication. It is also necessary if the forceps delivery fails and cesarean delivery is necessary. Delivery should not be delayed to obtain IV access. When an operative vaginal delivery is indicated, the nurse is often responsible for assisting the health care provider by preparing necessary supplies. The health care provider is occupied with the delivery, and the nurse is responsible for alerting the health care provider to signs of fetal distress during operative vaginal delivery. Assessments during labor are prioritized according to the patient's anticipated needs at that particular stage. Close monitoring is necessary before and during operative delivery, but a complete head-to-toe assessment is not necessary. It is not the nurse's responsibility to explain the risks of an operative delivery to the patient, although the nurse would address any of the patient's voiced concerns or questions. Explaining risks is the health care provider's responsibility.

which information is important to obtain when assessing a patient admitted with ruptured membranes? SATA - odor of fluid - amount of fluid - time of rupture - color of amniotic fluid - activity at time of rupture

odor of fluid, amount of fluid, time of rupture, color of fluid • this information is important in identifying potential maternal and fetal risk factors. activity at time of rupture is not necessary

Under which circumstance should a vaginal examination be performed by the nurse? SATA - on admission to the hospital at the start of labor - when accelerations of the FHR are noted - on maternal perception of perineal pressure or the urge to bear down - when membranes rupture - when bright, red bleeding is observed

on admission to the hospital at the start of labor, on maternal perception of perineal pressure or the urge to bear down, when membranes rupture • the nurse must be aware that there is an increased risk of prolapsed cord immediately after ROM. An accelerated FHR is a positive sign; variable decelerations, however, merit a vaginal examination. Examinations are never done by the nurse if vaginal bleeding is present because the bleeding could be a sign of placenta previa, and a vaginal exam could result in further separation of the low-lying placenta

When evaluating a patient with suspected preterm premature rupture of membranes and preterm labor, the nurse recognizes which cues as signs of preterm labor? - dysuria and urinary frequency - pain and discomfort in the upper inner thighs - intermittent or constant low back pain - a sensation that the fetus is frequently "balling up" - the perception of decreased fetal movements - diarrhea

pain & discomfort in the upper inner thighs, intermittent or constant low back pain, a sensation that the fetus is frequently "balling up", diarrhea • Pain in the upper inner thighs or vulva are often reported by women experiencing preterm labor. Preterm labor contractions are often perceived differently than term labor contractions. Women often complain of intermittent or constant lower back pain. The fetus balling up is actually how the mother is perceiving the uterine contraction and is likely a uterine contraction rather than fetal movement. Abdominal cramping with or without diarrhea is sometimes a cue experienced by women with preterm labor. These are cues of urinary tract infection, not preterm labor. This is a warning sign of fetal impairment and requires evaluation but is not associated with preterm labor.

Which is one of the 5 Ps of labor? SATA - passenger - placenta - passageway - psychological response - powers - position

passenger, passageway, psychological response, powers, position • at least 5 factors affect the process of labor and birth. These are easily remembered as the 5 Ps: passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother and psychological response

Late pregnancy bleeding is caused by:

placenta previa - bright red bleeding abruptio placentae - dark red painful bleeding cord insertion and placental variations

The labor nurse is evaluating the patient's mostrecent 10-minute segment on the monitor strip and notes a late deceleration. Which explanations most likely explains this occurrence? - spontaneous fetal movement - compression of the fetal head - placental abruption - nuchal cord around the baby's neck - vena cava syndrome

placental abruption, vena cava syndrome • Late decelerations are almost always caused by uteroplacental insufficiency, the result of uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, intrauterine growth restriction (IUGR), intraamniotic infection, or placental abruption. Late decelerations are almost always caused by uteroplacental insufficiency, the result of uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, intrauterine growth restriction (IUGR), intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure, and abdominal palpation are all likely to cause accelerations of the fetal heart rate (FHR). Early decelerations are most often the result of fetal head compression, which may be caused by uterine contractions, fundal pressure, vaginal examination, and placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression. This may happen when the umbilical cord is around the baby's neck, arm, leg, or other body part or when there is a short cord, a knot in the cord, or a prolapsed cord.

After observing the electronic fetal monitor, a primary health care provider asks the nurse to conduct an electrocardiogram (ECG) of the fetus. Which will the nurse assess before obtaining an ECG of the fetus? SATA - fetal lactate levels - placental membranes - cervical dilation - umbilical cord compression - frequency of uterine contractions

placental membranes, cervical dilation • when performing the ECG of the fetus, the nurse should insert the electrode into the cervix to reach the fetus. Therefore, the nurse should check if the cervix is dilated up to 3 cm and if the membranes are ruptured. This allows the nurse to reach the fetus's position. Lactate levels do not affect the ECG testing and thus need not be checked before the test. Umbilical cord compression and decreased frequency of UCs are not required conditions for performing an ECG on the fetus.

the nurse assessing for hypoglycemia in a neonate would monitor for which symptoms - poor feeding - flexion of the arms and legs - hypothermia - tremors - bluish hands and feet - rooting

poor feeding, hypothermia, tremors • rationale: poor feeding and lack of interest in feeding are signs of hypoglycemia in the neonate and are usually related to lethargy caused by lack of glucose hypothermia is a symptom of hypoglycemia tremors may be observed in a newborn that has low glucose level flexion of the arms and legs is a normal, healthy finding of a neonate; bluish hands and feet, known as acrocyanosis, are not related to hypoglycemia rooting is a normal infant feeding reflex and is indicative of a newborn interested in feeding

Which would the nurse assess at a routine prenatal visit for a patient that has gestational diabetes? - presence of bacteria, ketones, protein, and glucose in urine - fetal movement by palpation and patient report - serum calcium levels - blood pressure - fundal height

presence of bacteria, ketones, protein, & glucose in urine, fetal movement by palpation and patient report, blood pressure, fundal height • rationale: women with diabetes are at increased risk for UTI. additionally, the presence of ketones, glucose, and protein may indicate worsening diabetes or preeclampsia fetal movement is a reliable indicator of well-being. a patient that reports decreased fetal movement requires further evaluation a patient with diabetes is at increased risk for preeclampsia, so the blood pressure should be assessed at each visit an elevated fundal height may indicate macrosomia or hydramnios and requires further diagnostic evaluation low magnesium levels in the mother can cause low calcium levels in the neonate. serum calcium is not a routine assessment for this patient

Which is a cause for somatic pain in a patient who is in the second phase of labor? SATA - pressure against bladder wall - distention of the peritoneum - stretching of the perineal tissue - involuntary uterine contractions - decreased blood flow to uterus

pressure against the bladder, distention of the peritoneum, stretching of the perineal tissue • somatic pain is a result of distention and traction of the peritoneum, stretching of the perineal tissue, and pressure against the bladder and rectum. This pain is intense, sharp, burning, and well-localized in the second stage of labor. Uterine ischemia, or decreased blood flow to the uterus, causes pain in the first stage of labor. Involuntary uterine contractions leading to cervical dilation and effacement also lead to pain in the first stage of labor.

Which assessment finding might indicate the presence of a hypertensive disorder in a pregnant patient? SATA - proteinuria - epigastric pain - placenta previa - presence of edema - blood pressure of 160/100 mmHg

proteinuria, epigastric pain, presence of edema, BP of 160/100 mmHg • placenta previa is a condition wherein the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates

Which conditions are possible causes of dysfunctional labor? - psychological dysfunction and fear - absence of a void in 6 hours - rapid descent of the fetal head and small parts - an abnormally shaped maternal pelvis - meconium-stained amniotic fluid - use of oxytocin to augment labor

psychological dysfunction and fear, absence of a void in 6 hours, an abnormally shaped maternal pelvis • Maternal psychological problems can lead to a cascade of physiologic responses that can prolong labor. A full bladder is a possible cause because it causes maternal soft tissue obstruction. An abnormally shaped maternal pelvis can cause dysfunctional contractions and slow labor progress. Rapid descent leads to precipitate labor, not prolonged or dysfunctional labor. Dysfunctional labor can result in meconium-stained amniotic fluid. but the presence of meconium is not a cause of dysfunctional labor. Using oxytocin can help treat a dysfunctional labor but will not cause it.

the nurse caring for a pregnant patient with gestational diabetes at 33 weeks gestation assesses the fundal height at 36 cm. which actions by the nurse are correct regarding this finding? - assure the patient that the fetus is growing appropriately for its age - recommend that the HCP order an US - educate the patient on the importance of limiting weight gain for the remainder of the pregnancy - perform a fetal nonstress test and report the findings to the HCP - assist the patient with scheduling a cesarean delivery at 37 weeks

recommend that the HCP order an US, perform a fetal nonstress test and report the findings to the HCP, • rationale: recommending that the HCP order an US is an appropriate action. amniotic fluid volume & fetal size should be monitored for this patient gestational diabetics require additional fetal surveillance as a result of the high-risk nature of the pregnancy. when assessment findings are abnormal, fetal well-being should be assessed. a nonstress test is part of a biophysical profile and gives the HCP an insight into fetal well-being this fundal height is much higher than expected. gestational diabetics are at risk for polyhydramnios, which can cause higher-than-expected fundal heights. macrosomia is also an issue that can lead to higher-than-expected fundal heights excessive weight gain is likely not the cause of higher-than-expected fundal heights for this patient. hydramnios and macrosomia may be the causes and should be evaluated a cesarean delivery is not indicated based upon these findings alone

Eclampsia

seizure or coma onset in woman with preeclampsia - No HX or preexisting patio - can occur before, during, or after birth

Manifestations of hyperemesis gravidarum

significant weight loss, dehydration, dry mucous membranes, decreased BP, increased HR and poor skin turgor, cannot retain clear liquids

Hypothyroidism occurs in 2-3 pregnancies per 1000. pregnant women with untreated hypothyroidism are at risk for which condition? SATA - stillbirth - miscarriage - macrosomia - placental abruption - gestational hypertension

stillbirth, miscarriage, placental abruption, gestational hypertension • hypothyroidism is often associated with both infertility & an increased risk for miscarriage. these outcomes can be improved with early diagnosis & treatment. pregnant women with hypothyroidism are more likely to experience both preeclampsia & gestational hypertension. placental abruption & stillbirth are risks associated with hypothyroidism. infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm rather than have macrosomia

gestational hypertension

systolic BP of 140 mmHg or more or diastolic pressure 90 mmHg or more recorded on to separate occasions four hours apart without proteinuria after 20 weeks gestation

eclampsia

term for the onset of seizure activity or coma in a client with preeclampsia who has no history of preexisting pathology that can result in seizure activity

Which observations suggest that a woman is in the latent phase of the second stage of labor? - the fetus is at 0 station - there is an irregular and inconsistent urge to bear down with contractions - the woman exhibits loud, songlike vocalizations with every contraction - the fetus is at +3 station - the woman sleeps between contractions

the fetus is at 0 station, there is an irregular and inconsistent urge to bear down with contractions, the woman sleeps between contractions • The Ferguson reflex is not usually present until the fetus begins to descend deeper into the pelvis. Latent labor allows for passive descent with the primary force being contractions. In the latent phase of the second stage of labor, maternal behaviors may be relaxed. She may be very quiet as she rests in this phase. The woman may sleep or rest in between contractions. Maternal behaviors may demonstrate a sense of urgency. She may push voluntarily or involuntarily. Vocalizations may change from quiet to loud and rhythmic, coinciding with contractions and fetal descent, in the active phase of the second stage of labor. In the active phase of the second stage of labor the fetus descends from +2 to +4. The Ferguson reflex is activated when the fetus descends, causing the urge to push. When the fetus has descended into the pelvis, the woman in the active phase of the second stage of labor may push involuntarily.

which statements are true regarding rubella in pregnancy? - women develop a "slapped-cheek rash" - titers less than 1:8 demonstrate immunity - the virus can cross the placental barrier - most women of childbearing age in the US have received this vaccine already - if a woman is not immune, she can be offered the vaccine during pregnancy

the virus can cross the placental barrier, most women of childbearing age in the US have received this vaccine already • rationale: crossing of the placental barrier is a serious concern with rubella infection the measles-mumps-rubella (MMR) vaccine contains the rubella vaccine development of a "slapped-cheek rash" is characteristic of fifth disease, not rubella titers greater than 1:8 demonstrate immunity rubella is a live vaccine and is offered after pregnancy in the postpartum period

which signs would the nurse assess in a newborn exposed to tobacco while in utero? - flat nasal bridge - tremors - signs of prematurity - open spinal cord defect - colic/fussy behavior - a lower-than-expected weight

tremors, signs of prematurity, colic/fussy behavior, a lower-than-expected weight • rationale: neurodevelopmental delays are often seen in newborns exposed to tobacco in utero signs of prematurity are often seen in newborns exposed to tobacco in utero colic/fussy behavior is often seen in newborns exposed to tobacco in utero lower-than-expected weight is often seen in newborns exposed to tobacco in utero flat nasal bridge is associated with alcohol misuse, not tobacco use open spinal cord defect is associated with decreased folic acid intake, not tobacco use

Which position is suitable for the patient who has a prolapsed cord following the rupture of membranes to promote fetal perfusion? SATA - lithotomy - recumbent - trendelenburg - lateral recumbent position - knee-chest position

trendelenburg, lateral recumbent position, knee-chest position • if a prolapsed umbilical cord is not managed on time, it may result in fetal hypoxia and death. the prolapsed cord may get compressed by the presenting part of the fetus, blocking the blood supply to the fetus. the compression on the cord can be relieved by gravity facilitated by patient position. if the patient is placed in Trendelenburg, lateral recumbent, or knee-chest position, the presenting part shifts off the prolapsed cord. this helps to maintain the fetal perfusion. recumbent and lithotomy positions are preferred for vaginal delivery but may not be helpful if the cord has prolapsed

When documenting fetal monitoring findings from electronic fetal monitoring each of the following should be included in documentation: baseline rate, baseline variability, presence of accelerations, presence of periodic or episodic decelerations, contraction frequency, duration, intensity, and resting tone, and changes or trends over time. - true - false

true • all of these should be included in the documentation (pg 372)

Elective inductions of labor should not be initiated until 39 weeks of gestation. true or false

true • elective inductions before 39 weeks gestation increase the risks associated with early-term birth without a medical reason to do so.

To use internal fetal monitoring technology, the amniotic membranes must be ruptured. - true - false

true • the placement of the fetal scalp electrode and IUPC cannot be accomplished with membranes intact

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factor may prohibit the woman from having a vaginal birth? SATA - unstable CAD - previous cesarean birth - placenta previa - initial BP of 132/87 mmHg - history of 3 spontaneous abortions

unstable coronary artery disease (CAD), previous cesarean birth, placenta previa • indications for c section include maternal (1) specific cardiac disease (e.g., marfan, unstable CAD), (2) specific respiratory disease (e.g., Guillain-barre syndrome), (3) conditions associated with increased intracranial pressure, (4) mechanical obstruction of the lower uterine segment (tumors, fibroids), (5) mechanical vulvar obstruction, and (6) history of previous c section; fetal (1) abnormal FHR or pattern, (2) malpresentation (breech, transverse lie), (3) active maternal herpes lesions, (4) maternal HIV with a viral load of more than 1000, and (5) congenital anomalies; and maternal-fetal: (1) dysfunctional labor (cephalopelvic disproportion, failure to progress), (2) placental abruption, (3) placenta previa, and (4) elective cesarean birth. the BP can be elevated because of pain and is not necessarily a contraindication to vaginal birth until further assessment is completed. Having a history of 3 spontaneous abortions is not a contraindication to vaginal birth

When witnessing informed consent for cesarean delivery, which risks to the patient is the nurse acknowledging the patient understands? - urinary tract infection or trauma to the bladder - cervical laceration or trauma - increased risk for blood clots, which can be in the legs or can travel to the heart or lungs - injury to the newborn including lacerations, bruising, or fractures - the need for cesarean birth with every delivery after this procedure regardless of the incision type - the risk that the baby's lungs might be compromised or need extra support at birth

urinary tract infection or trauma to the bladder, increased risk for blood clots, which can be in the legs or can travel to the heart or lungs, injury to the newborn including lacerations, bruising or fractures, the risk that the baby's lungs might be compromised or need extra support at birth • An indwelling catheter increases the risk for urinary tract infection, and there is risk for trauma to the bladder during the procedure. Major surgery such as cesarean section increases a patient's risk for thrombophlebitis and thromboembolism. Cesarean delivery can be traumatic for the newborn, especially if the delivery is complicated by malpresentation, macrosomia, or other factors. There is risk for inadvertent fetal lung immaturity or transient tachypnea of the newborn with cesarean delivery. Trauma to the cervix is not a risk for cesarean delivery because the incision is performed on the uterus. It is possible for patients to have vaginal births after a cesarean birth with certain uterine incision types.

which complications of pregnancy are associated with substance misuse? - vaginal bleeding - gestational diabetes - preterm labor - intrauterine growth restriction (IUGR) - umbilical cord prolapse - congenital anomalies

vaginal bleeding, preterm labor, intrauterine growth restriction, congenital anomalies • rationale: vaginal bleeding, preterm labor, IUGR, and congenital abnormalities are associated with substance misuse gestational diabetes is not associated with substance misuse umbilical cord prolapse is not associated with substance misuse

A patient is concerned about the baseline variability in the heart rate of her fetus. Which responses by the nurse describe the significance of baseline variability to the patient? - variability is an artifact - variability is a periodic pattern - variability demonstrates that there is adequate oxygenation to the fetus - variability suggests that the fetus is able to adapt to the labor process - variability indicates that the fetus has no congenital abnormalities

variability demonstrates that there is adequate oxygenation to the fetus, variability suggests that the fetus is able to adapt to the labor process • Adequate oxygenation of the fetus, demonstrated by variability, is necessary, and therefore variability is significant. Variability is significant because its presence indicates that the autonomic nervous system is intact, allowing the fetus to adapt to the normal stress of labor. Variability is a characteristic of reassuring fetal heart rate patterns and is not an artifact. Variability is a baseline characteristic, not a periodic pattern. Although variability is a reassuring finding, it cannot predict the presence of congenital abnormalities.

Which methods of screening for substance abuse in a pregnant woman are considered acceptable? - verbally screening only at the first prenatal visit - collecting a urine sample and sending without consent - verbally using a validated screening tool - asking the pregnant woman's significant other - obtaining patient consent and collecting laboratory samples

verbally using a validated screening tool, obtaining patient consent and collecting laboratory samples • rationale: using a validated screening tool improves accuracy obtaining laboratory samples helps the nurse determine which substances a patient may have used recently and determine care for the neonate and mother. it is always important to obtain consent for toxicology by following hospital protocol screening for substance misuse is ongoing throughout pregnancy it is important to obtain consent verbally or in writing when collecting laboratory samples from the patient. this helps to build patient trust information obtained from significant others may be important. however, this is not an acceptable screen for substance misuse in pregnancy

Which condition contraindicates hydrotherapy? SATA - viral infection - preterm labor - vitamin deficiency - high blood pressure - excessive vaginal bleeding

viral infection, preterm labor, excessive vaginal bleeding • patients with infectious diseases, such as a viral infection, as well as fever, are contraindicated for hydrotherapy use. Tub hydrotherapy is also contraindicated for patients who are in preterm labor. Patients with vaginal bleeding greater than a normal blood show are contraindicated for hydrotherapy use. Vitamin deficiency and high BP are not contraindicating factors for hydrotherapy.