Saunders maternal nursing flashcard app (amniotic fluid & placenta)
a (Rationale: Abruptio placentae is thepremature separation of the placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered. The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the client or the fetus is in jeopardy. ***Note the words: term gestation and moderate vaginal bleeding)
An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate abruptio placentae is present. On the basis of these findings, the nurse should prepare the client for which anticipated prescription? a) delivery of the fetus b) strict monitoring of intake and output c) complete bed rest for the remainder of the pregnancy d) the need for weekly monitoring of coagulation studies until the time of delivery
b (Rationale: In placenta previa, the placenta is implanted in the lower uterine segment. The lower uterine segment does not contain the same intertwining musculature as the fundus of the uterus, and this site is more prone to bleeding)
The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa? a) infection b) hemorrhage c) chronic hypertension d) Disseminated intravascular coagulation
a, b, c, d (Rationale: The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the mother and the fetus)
The nursing instructor asks a nursing student to explain the characteristics of the amniotic fluid. The student responds correctly by explaining which as characteristics of amniotic fluid? Select all that apply a) Allows for fetal movement b) Surrounds, cushions, and protects the fetus c) Maintains the body temperature of the fetus d) Can be used to measure fetal kidney function e) Prevents large particles such as bacteria from passing to the fetus d) Provides an exchange of nutrients and waste products between the mother and the fetus
c, e Rationale: (The placenta provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. Nutrients. medications, antibodies, and viruses can pass through the placenta)
Which purpose of placental functioning should the nurse include in a prenatal class? Select all that apply a) It cushions and protects the baby b) It maintains the temperature of the baby c) It is the way the baby gets food and oxygen d) It prevents all antibodies and viruses from passing to the baby e) It provides an exchange of nutrients and waste products between the mother and the developing fetus
b (Rationale: Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent until a diagnosis is made and placenta previa is ruled out. Digital examination of the cervix can lead to hemorrhage. A diagnosis of placenta previa is made by ultrasound. The hemoglobin and hematocrit levels are monitored, and external electronic fetal heart rate monitoring is initiated. Electronic fetal monitoring (external is crucial in evaluating status of the fetus, who is at risk for severe hypoxia)
The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the health care provider's prescriptions and should question which prescription? a) prepare the client for an ultrasound b) obtain equipment for a manual pelvic examination c) prepare to draw a hemoglobin and hematocrit blood sample d) obtain equipment for external electronic fetal heart rate monitoring
a (Rationale: Signs of umbilical cord infection are moistness, oozing, discharge, and a reddened base around the cord. If signs of infection occurs, the client should be instructed to notify a health care provider. ***Noting the word discharge in the question will assist in directing you to the option that indicates the newborn need to be seen by the HCP)
The mother of a newborn calls the clinic and reports that when cleaning the umbilical cord, she noticed that the cord was moist and that discharge was present. What is the most appropriate nursing instruction for this mother? a) bring the infant into the clinic b) this is a normal occurrence and no further action is needed c) increase the number of rimes that the cord is cleaned per day d) monitor he cord for another 24 to 48 hours and call the clinic if the discharge continues.
b (rationale: When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The client should be positioned with the hips higher than the head to shift the fetal presenting part towards the diaphragm. The nurse should push the call light to summon help, and the other staff members should call the HCP and notify the delivery room. If the cord is protruding from the vagina, no attempt should be made to replace it because to do so could traumatize it and reduce blood flow further. Also as a first action, the examiner should place a gloved hand into the vagina and hold the presenting part off the umbilical cord. Oxygen, 8-10 L/minute, by face mask is administered to the client to increase fetal oxygenation)
The nurse in a labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. What is the first nursing action with this finding? a) gently push the cord into the vagina b) place the client in Trendelenburg position c) Find the closest telephone and page the health care provider stat d) call the delivery room to notify the staff that the client will be transported immediately
b (Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered. In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen feels hard and board like on palpation as the blood penetrates the myometrium and causes uterine irritability. A soft abdomen and painless, bright red vaginal bleeding in the second or third trimester of pregnancy are signs of placenta previa. ***Remember that the difference between placenta previa and abruptio placentae involves the presence of uterine pain and tenderness with abruptio placentae, as opposed to painless bleeding with placenta previa)
The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present? a) soft abdomen b) uterine tenderness c) absence of abdominal pain d) painless, bright red vaginal bleeding
d, e, f (Rationale: Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa. The client has a soft, relaxed, nontender uterus, and fundal height may be more than expected for gestational age. In abruptio placenta, severe abdominal pain is present. Uterine tenderness accompanies placental abruption. In addition, in abruptio placentae, the abdomen feels hard and board like on palpation as the blood penetrates the myometrium and causes uterine irritability)
The nurse is performing an assessment on a client diagnosed with placenta previa. Which assessment findings should the nurse expect to note? Select all that apply a) uterine rigidity b) uterine tenderness c) severe abdominal pain d) bright red vaginal bleeding e) soft, relaxed, nontender uterus f) fundal height maybe greater than expected for gestational age
c (Rationale: Vaginal examinations should not be done routinely on a client with premature rupture of the membranes because of the risk of infection. The nurse would expect to monitor fetal heart rate, monitor maternal vital signs. and administer an antibiotic)
The nurse is reviewing the health care provider's prescriptions for a client admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which prescription should the nurse question? a) Monitor the fetal heart rate continuously b) Monitor maternal vital signs frequently c) Perform a vaginal examination every shift d) Administer an antibiotic per HCP prescription and per agency protocol
