Pregnancy, Labor, Childbirth, Postpartum - Uncomplicated (Level 1)
What should a nurse include in nutritional planning for a newly pregnant woman of average height who weighs145 lb?
An increase of 300 calories per day An increase of 500 calories per day is the recommended caloric increase for breastfeeding mothers.
An Rh-negative mother who gave birth at 10:30 am on January 7 should receive her Rh immune globulin (RhoGAM) injection no later than: (how many hours?)
10:30 am on January 10 RhoGAM needs to be administered within 72 hours of delivery. Administration at 10:30 pm on January 10 or at any time on January 11 is too late.
What is Amniotomy?
Artificial rupture of membranes (AROM), also known as an amniotomy, may be performed by a midwife or obstetrician to induce or accelerate labor. The membranes may be ruptured using a specialized tool, such as an amnihook or amnicot, or they may be ruptured by the proceduralist's finger.
A nurse is obtaining the health history of a woman who is visiting the prenatal clinic for the first time. She states that she is 5 months pregnant. For what positive sign of pregnancy should the nurse look in this patient? Quickening Enlarged abdomen Cervical color change Audible fetal heartbeat
Audible fetal heartbeat The presence of the fetal heartbeat is a positive sign of pregnancy. The feeling of movement is a presumptive sign of pregnancy. An enlarged abdomen is a probable sign of pregnancy. The bluish color of the cervix (Chadwick's sign) is caused by pelvic congestion and edema; it is a probable sign of pregnancy.
A 36-year-old multigravida who is at 14 weeks' gestation is scheduled for an α-fetoprotein test. She asks the nurse, "What does this test do?" The nurse bases the response on the knowledge that this test can reveal: Kidney defects Cardiac anomalies Neural tube defects Urinary tract anomalies
Neural tube defects The α-fetoprotein test can detect not only neural tube defects but also Down syndrome and other congenital anomalies. It is a screening test that affords a tentative diagnosis; confirmation requires more definitive testing. Anomalies of the kidneys, heart, and urinary tract are not revealed by the α-fetoprotein test.
A client is admitted to the birthing unit in active labor. Amniotomy is performed by the health care provider. What physiologic change does the nurse expect to occur after the procedure? Diminished vaginal bleeding Less discomfort with contractions Progressive dilation and effacement Increased maternal and fetal heart rates
Progressive dilation and effacement Amniotomy permits more effective pressure of the fetal head on the cervix, enhancing dilation and effacement. Vaginal bleeding may increase because of the progression of labor. Discomfort may increase because contractions usually become more intense after amniotomy. Amniotomy should not affect maternal or fetal heart rates.
Examination of a client in active labor reveals fetal heart sounds in the right lower quadrant. The head is in the anterior position, is well flexed, and is at the level of the ischial spines. What fetal position should the nurse document? ROA, 0 station LOP, −2 station ROP, −3 station LOA, +1 station
ROA, 0 station The fetal heart is in the right quadrant; therefore the fetus's head and back are on the right side. The head is engaged and is at 0 station. In left occiput posterior (LOP) position, −2 station, the fetal heart should be heard on the left side; at station −2 the head is mobile. The information states that the head is anterior and flexed; at −3 station the head is mobile. In left occiput anterior (LOA) position, +1 station the fetal heart should be heard on the left side; at +1 station the head is engaged below the ischial spines.
A nurse is teaching participants in a prenatal class about breastfeeding versus formula feeding. A client asks, "What is the primary advantage of breastfeeding?" What is best reply by the nurse? "Breastfed infants have fewer infections." "Breastfeeding inhibits ovulation in the mother." "Breastfed infants adhere more easily to a feeding schedule." "Breastfeeding provides more protein than cow's milk formula does."
"Breastfed infants have fewer infections." Maternal antibodies are transferred from the mother in breast milk, providing protection for a longer time than do antibodies transferred to the fetus by way of the placenta. The neonate is protected by these antibodies; the fetus's own antibody system is immature at birth. Lactating mothers rarely ovulate for the first 9 postpartum weeks; however, they may ovulate at any time after that period; although this may be considered an advantage, it is not a primary advantage. Because of the higher carbohydrate content of breast milk, which is digested rapidly, breastfed infants wake more frequently than formula-fed infants. Their feeding demands take more time to regulate than the formula-fed infant's. Breast milk has 1.1 g protein/100 mL; cow's milk has 3.5 g/100 mL. Whole cow's milk is unsuitable for infants.
What is a contraction stress test (CST) and what should a mother do before it?
Empty the bladder before the test. A contraction stress test checks to see if your baby will stay healthy during contractions when you are in labor. This test includes external fetal heart monitoring . The test is done when you are 34 or more weeks pregnant. During a contraction, the blood and oxygen supply to your baby drops for a short time. This is not a problem for most babies. But the heart rate of some babies gets slower. This change in heart rate can be seen on the external fetal monitor.
A 14-year-old emancipated minor at 22 weeks' gestation comes in for her second prenatal examination. As she enters the examination room with her mother, she tells the nurse that she does not want her mother present for the examination. What should the nurse say? "Your mother needs to be present for the examination." "What's the problem with your mother being present?" "I'm sure that your mother wants to be with you for support." Tell the mother, "I'm sorry, but I need to ask you to stay in the waiting area."
Tell the mother, "I'm sorry, but I need to ask you to stay in the waiting area." In many states a minor who is self supporting and living away from home, providing military service, married, pregnant, or a parent is considered a emancipated minor. The emancipated minor assumes most responsibilities before the age of 18 years. An emancipated minor is entitled to confidentiality in dealings with health care providers.
When a client at 39 weeks' gestation arrives at the birthing suite she says, "I've been having contractions for 3 hours, and I think my water broke." What will the nurse do to confirm that the membranes have ruptured? Take the client's oral temperature. Test the leaking fluid with Nitrazine paper. Obtain a clean-catch urine specimen. Inspect the perineum for leaking fluid.
Test the leaking fluid with Nitrazine paper. Nitrazine paper will turn dark blue if amniotic fluid is present; it remains the same color in the presence of urine. Temperature assessment is not specific to ruptured membranes at this time; vital signs are part of the initial assessment. Although this may be done as part of the initial assessment, a urine test is unrelated to leakage of amniotic fluid. Inspecting the vagina for leaking fluid will not confirm rupture of the membranes.
A client has a first-trimester aspiration abortion. Which statement indicates to the nurse that the client understands the discharge instructions? "We can start having sex again in 4 or 5 days." "My period should start again in 2 or 3 weeks." "I can use tampons instead of pads after 24 hours." "I'll call you if I have to change my pad more than once in 4 hours."
"I'll call you if I have to change my pad more than once in 4 hours." Needing to change a sanitary pad more than once in 4 hours indicates that the bleeding is excessive and that the health care provider should be notified. Although instructions vary among providers, sexual intercourse may usually be resumed in 1 to 3 weeks. The menstrual period usually resumes in 4 to 6 weeks. Although instructions vary among health care providers, tampons should be avoided for 3 days to 3 weeks.
A 29-year-old gravida 3 para 3, was admitted to the recovery unit 2 hours after the birth of a 9-lb baby girl. The nurse assesses the client an hour later and finds her fundus, which is slightly boggy, three fingerbreadths above the umbilicus and displaced to the right. The peripad, which was changed before the client's transfer, is now saturated. The nurse recognizes: A distended bladder A probable perineal infection Uncontrolled postpartum pain A typical finding in the immediate postpartum period
A distended bladder Urine retention resulting in a distended bladder will lift and displace the uterus, making it difficult to remain contracted. These findings would not be caused by uncontrolled postpartum pain. It is too early after the delivery for signs of a perineal infection to be noted. The loss of uterine tone (atony) leads to an increase in bleeding.
A client at 16 weeks' gestation is scheduled for an ultrasonography. What instruction should the nurse give the client about preparing for the procedure? Fast for 12 hours before the test. Take an enema the morning of the test. Drink a quart of water about 1 hour before the test. Arrange to have a companion drive you home after the test.
Drink a quart of water about 1 hour before the test. A full bladder improves resolution of the sonogram images in women at less than 20 weeks' gestation; a full bladder serves as an anatomic landmark and elevates the uterus out of the pelvis for better visualization. A sonogram does not affect the alimentary tract; fasting is contraindicated during pregnancy. A sonogram does not involve the colon. Arranging for a companion to drive the client home is not necessary; anesthesia is not administered during a sonogram.
A nurse is caring for an obese client in early labor. The anesthesiologist discusses several types of analgesia/anesthesia with the client and recommends one. The client requests clarification before signing the consent form. Which type has the anesthesiologist recommended? Epidural anesthesia Oral opioid analgesia Pudendal nerve anesthesia Intravenous opioid analgesi
Epidural anesthesia Epidural anesthesia during the first stage of labor decreases metabolic and respiratory demands and is preferred for obese clients. Obese women are sensitive to systemic opioids, which predispose them to respiratory depression; oral medications do not have a uniform rate of absorption and are not recommended during labor. A pudendal block does not reach the uterus, so contractions are felt; it is used during the second stage of labor.
A client is scheduled for amniocentesis. What should the nurse do before the procedure? Give the client the prescribed sedative. Remind the client to empty her bladder. Prepare the client for an intravenous infusion. Encourage the client to drink three glasses of water.
Remind the client to empty her bladder. An empty bladder reduces the risk of bladder puncture during the procedure. Sedation is not necessary. An intravenous line is not necessary. The client is encouraged to drink three glasses of water before a sonogram, not an amniocentesis. Amniocentesis is a prenatal test in which a small amount of amniotic fluid is removed from the sac surrounding the fetus for testing.
A nurse is admitting a client in active labor. When the fetal monitor is applied to the client's abdomen, it records late decelerations. What should the nurse do first? Notify the practitioner. Elevate the head of the bed. Reposition her on her left side. Administer oxygen by way of facemask.
Reposition her on her left side. Late decelerations may indicate impaired placental profusion. Turning the client on her left side relieves pressure on the vena cava and aorta, improving circulation to the placenta. Calling the practitioner is premature. The nurse should notify the practitioner if late decelerations continue after nursing interventions are implemented. Elevating the head of the bed will increase pressure on the vena cava and aorta, further reducing placental perfusion. Oxygen may be administered if placing the client on her left side does not resolve the late decelerations.
