Chapter 16 - The Prenatal Period
The nurse assesses the newborn 1 minute after delivery and documents the following data:• Body pink, extremities blue• Heart rate is 120 beats/min• Weak cry, hypoventilation• Some flexion of extremities• GrimaceThe nurse documents the 1 minute Apgar score as: 6. 8. 9. 10.
6. The nurse determines the Apgar score at 1 and 5 minutes after birth. It is based on five signs noted in the newborn. The nurse evaluates the newborn for these five signs and then totals the numbers for the total score. The score is from 0 to 10. The higher the score, the better; the newborn is adapting to the extrauterine environment.
Which mother is a candidate for the administration of Rho(D) immune globulin (RhoGAM)? An Rh-negative mother with an Rh-negative newborn An Rh-positive mother with an Rh-negative newborn A mother demonstrating the presence of Rh+ antibodies A pregnant Rh-negative mother who experiences a spontaneous abortion
A pregnant Rh-negative mother who experiences a spontaneous abortion All women should be assessed for blood type, Rh factor, and antibody development to Rh-positive cells at their first prenatal care visit and again at 24 to 28 weeks of pregnancy unless the father of the baby is Rh negative (USPSTF, 2011e). Rh incompatibility between a mother and future fetus may be prevented by administering Rho (D) immune globulin (RhoGAM) to an Rh-negative mother at 28 weeks of gestation and within 72 hours after birth. The immunization prevents the mother's sensitization to fetal Rh-negative cells by inactivating fetal red blood cells in the mother before she can develop an antibody response. The ideal injection time is after the mother's first delivery of an Rh-positive infant, miscarriage, or therapeutic abortion. The incompatibility generally does not occur during the first pregnancy, and the immunization prevents problems with later pregnancies.
Which of the following elements of nutrition education are included when teaching the lactating mother about her nutritional needs? (select all that apply) Select all that apply. - Lactating women should consume the same amount of calories as those consumed with pregnancy. - Lactating women need 7 to 11 servings of carbohydrates per day. - Calcium requirements can be met using supplements. - Seventy grams of protein per day should come from eating lean meat, fish, eggs, poultry, milk, and dairy products. - Lactating women should consume 500 micrograms of folic acid.
Lactating women need 7 to 11 servings of carbohydrates per day. Seventy grams of protein per day should come from eating lean meat, fish, eggs, poultry, milk, and dairy products. Lactating women should consume 500 micrograms of folic acid. Nutritional needs for the lactating woman include:• The consumption of 500 additional calories from a variety of sources• 70 grams of protein per day from lean meat, fish, eggs, poultry, milk and dairy products • 1000 mg per day of calcium from milk, cheese, dark green leafy vegetables, nuts, and dried fruit. Women with low calcium intake may use calcium supplements with vitamin D.• 9 mg of iron per day and 500 micrograms of folic acid• 7 to 11 servings of carbohydrates and 30% of calories from fat
Which maternal action demonstrates a mother's ability to ensure safe passage for her fetus? Fantasizes about the gender of her baby Seeks prenatal care from a health care provider Integrates the fetus as an integral part of her Examines what she will gain and lose by becoming a mother
Seeks prenatal care from a health care provider The woman attempts to ensure safe passage for herself and her infant by seeking health care from a doctor, midwife, or cultural health practitioner; by gaining support and information from family and friends; and by reading and watching videos. Fantasizing about the gender of her baby is a behavior seen in the mother as she attempts to ensure acceptance of her child. Integrating the fetus as an integral part of her is seen in the pregnant woman as she binds into her unknown child. The woman is learning to give of herself by examining what she will gain and lose by becoming a mother.
Question 2 of 10 What are the roles of the nurse in caring for the patient in the laboring process? (select all that apply) Select all that apply. Assess labor discomfort every 20 to 30 minutes. Implement nursing interventions to deal with labor discomfort as needed. Prepare the client for epidural anesthesia. Assess cultural beliefs during labor and delivery management. Provide teaching about the labor and delivery process. Monitor the fetal response to administration of systemic analgesia.
Assess labor discomfort every 20 to 30 minutes. Implement nursing interventions to deal with labor discomfort as needed. Assess cultural beliefs during labor and delivery management. Provide teaching about the labor and delivery process. Options 1, 2, 4, and 5 are all interventions that will assist the labor client to cope with her contractions during labor. Preparing the client for an epidural will eliminate the pain of contractions but is not the priority nursing intervention for ineffective coping during active labor. Administration of systemic analgesia and monitoring is an important assessment to be performed during labor but does not directly address the client's needs or ineffective coping.
The nurse performs assessments of the mother and her fetus throughout the labor process. Which finding indicates a complication? Clear amniotic fluid Active fetal movement Fetal heart rate below 100 beats/min Contractions every 3 minutes, lasting 60 seconds
Fetal heart rate below 100 beats/min Events that may signal difficulties with the progression of labor or development of a complication include unusual fetal or uterine activity, presence of fetal meconium in the amniotic fluid, fetal tachycardia (heart rate above 160 beats/min), or fetal bradycardia (heart rate below 120 beats/min) in a full-term infant, and the fetal heart rate decreases with uterine activity (late deceleration) during labor. Clear amniotic fluid is a normal finding during labor. The presence of fetal activity during labor is considered a good finding. Contraction with a frequency of 3 minutes and duration of 60 seconds indicates an acceptable contraction pattern.
The nurse assesses the woman for positive signs of pregnancy, which include: enlargement of the uterus. bluish color of the cervix and upper vagina. detection of fetal heart tones by Doppler auscultation. positive test results for human chorionic gonadotropin (hCG).
detection of fetal heart tones by Doppler auscultation. Positive signs of pregnancy are those that document the existence of the fetus. The presence of fetal heart tones is a positive sign of pregnancy. Other positive signs of pregnancy include the palpation of fetal parts through Leopold's maneuvers, the objective detection of fetal movements, and radiological or ultrasonic demonstration of fetal parts. Enlargement of the uterus, bluish color of cervix, and positive test results for hCG are all probable signs of pregnancy. They indicate that a pregnancy is likely but do not confirm the pregnancy.
The nurse prevents cold stress in the newborn in the delivery room by: maintaining the delivery at 73° F. drying the baby with warm blankets. bathing the baby immediately after delivery. placing the baby in an open warmer with manual control.
drying the baby with warm blankets. Cold stress should be avoided by keeping the newborn dry, warmly wrapped, and avoiding environments causing heat loss in the newborn. The labor and delivery room should have the temperature increased to at least 78° F at the time of delivery. The infant should not be bathed immediately after birth, because evaporative heat loss will occur as the water evaporates from the skin. The newborn should be placed into an open warmer with servo control, so the heat output is regulated to deliver heat according to the newborn's skin temperature.
The nurse teaches the expectant client about interventions that decrease sibling rivalry after birth. These instructions would include: encouraging the sibling to participate in decisions such as selecting toys for the newborn. disciplining the sibling when negative comments are made about the baby. instructing the sibling to "be careful" and "be quiet" around the newborn. requesting the grandparents care for the sibling during prenatal visits.
encouraging the sibling to participate in decisions such as selecting toys for the newborn. The older sibling must be involved in the pregnancy and birth experience according to his or her growth and development. After delivery, involving the sibling in choosing toys and clothes for the new baby will decrease sibling rivalry. The sibling may make negative comments, as he or she now must share time with the parents and the baby. Explanations and planning separate time for the sibling should be the intervention and not discipline. The sibling may also be admonished to "be careful" and "be quiet," and the child may not accept the baby with open arms. Involving the sibling during prenatal visits helps set the stage for the arrival of the new baby. It provides an extended time for the sibling to begin to understand the additional of a new baby to his or her family.
The goal for the couple who attends childbirth education classes is to: promote a medication-free birth. prepare for an early discharge. increase knowledge of labor and delivery. provide information about hospital policies.
increase knowledge of labor and delivery. The nurse refers couples to early pregnancy and Lamaze childbirth preparation classes to increase their social support and help couples increase their knowledge about labor and delivery. Couples make decisions regarding pain relief during labor and birth based on information provided in the childbirth classes. Information provided during childbirth classes does facilitate a smooth transition to an early discharge, but that is not the goal of the education. Childbirth education may be provided to couples who are planning to deliver at different health care settings. The focus is not on sharing the policies of each of these facilities.
