chapter 22 and 23 maternal newborn

Which woman is at highest risk for postpartum hemorrhage?

A 40-year-old primigravida at 37 weeks with twins when twin A has mild polyhydramnios

The mother asks the nurse when an episiotomy is performed. How should the nurse respond?

The episiotomy is done after the baby is crowning.

A nursing student is studying postpartal complications. Thromboembolic conditions have which risk factors? Select all that apply.

anemia diabetes cigarette smoking obesity multiparity

The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called?

external version

The nurse preceptor explains that several factors are involved with the "powers" that can cause dystocia. She focuses on the dysfunction that occurs when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This is known as which term?

precipitous labor

The nurse is developing a discharge teaching plan for a postpartum woman who has developed a postpartum infection. Which measures would the nurse most likely include in this teaching plan? Select all that apply.

taking the prescribed antibiotic until it is finished washing hands before and after perineal care handling perineal pads by the edges

A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the client is likely to increase the risk for shoulder dystocia?

diabetes

Effective nursing management involves many aspects and being aware of subtle changes in the client. Which finding should alert the nurse to a potential infection in the client?

temperature of 38° C or higher after the first 24 hours after birth

A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position?

Cord prolapse

The nurse is caring for a client who has been diagnosed with a deep vein thrombosis. Which assessment finding should the nurse prioritize and report immediately?

Dyspnea

The nurse is caring for a client within the first four hours after her cesarean birth. Which nursing intervention would be most appropriate to prevent thrombophlebitis?

Ambulate the client as soon as her vital signs are stable.

Which assessment would lead the nurse to believe a postpartal woman is developing a urinary complication?

At 8 hours postdelivery she has voided a total of 100 mL in four small voidings.

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question?

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

client presents to the clinic with her 3-week-old infant complaining of general flu-like symptoms and a painful right breast. Assessment reveals temperature 101o8F (38.8oC) and the right breast nipple with a hard area that is red and warm. Which instruction should the nurse prioritize for this client?

Complete the 10-day antibiotic prescription even if she begins to feel better.

A nurse is providing education to a woman who is experiencing postpartum hemorrhage and is to receive a uterotonic agent. The nurse determines that additional teaching is needed when the woman identifies which drug as treating postpartum hemorrhage?

terbutaline

In terms of planning care, why is the development of a pathologic retraction ring important?

It precedes uterine rupture.

The nurse instructs a patient on actions to prevent postpartum depression. During a home visit, which observation indicates that instruction has been effective?

Patient is chatting on the telephone with a friend.

A client is admitted to the health care facility. The fetus has a gestational age of 42 weeks and is suspected to have cephalopelvic disproportion. Which should the nurse do next?

Prepare the client for a cesarean birth.

Labor dystocia is an abnormal progression of labor. It is the most common cause of primary cesarean birth. When is it most common for labor dystocia to occur?

Second stage of labor

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team?

Sudden shortness of breath

The nurse is evaluating the fetal heart rate rhythm strip and determines that the amplitude varies with a rate 15 to 20 beats/min. What does this assessment finding indicate to the nurse about variability?

Variability is normal.

The nurse suspects that a mother who delivered her infant 2 weeks ago is experiencing postpartum depression. What is the first line of treatment for this client?

administrating a selective serotonin reuptake inhibitor

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfuction?

contractions most forceful in the middle of uterus rather than the fundus

While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect?

laceration

A 19-year-old nulliparous is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication?

reduced oxygen to the fetus

The nurse is to administer 3 million units penicillin G to a laboring mother as group B streptococcus (GBS) prophylaxis every 4 hours. The medication label states there are 3 million units of penicillin G in 50 mL D5W. The medication should infuse over 60 minutes. How many mL/hr should the nurse set the pump to deliver each dose of this medication?

50

The postpartum mother who was delivered via cesarean section is preparing for discharge from the hospital. As part of the discharge teaching the nurse instructs the mother to make an appointment with her physician to have the staples removed in:

6 days.

The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist in delivery?

Abnormal position of the fetal head

A mother has delivered her baby 20 minutes ago. Suddenly, the mother becomes very restless. Her previously normal vitals now change to: BP 90/60, HR 110, & RR 8. The mother becomes cyanotic and short of breath. The nurse acts quickly to intervene because she suspects an amniotic fluid embolus has occurred. Place in order the interventions the nurse should take.

Call a code Notify the obstetric provider Begin oxygen with a nonrebreather mask Prepare for intubation Increase the IV fluid rate

The nurse assesses the client who is 1 hour postpartum and discovers a heavy, steady gush of bright red blood from the vagina in the presence of a firm fundus. Which potential cause should the nurse question and report to the RN or primary care provider?

Laceration

The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true?

Late decelerations

A patient is experiencing dysfunctional labor that is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this patient?

Oxytocin therapy

The father of a 2-week-old infant presents to the clinic with his disheveled wife for a postpartum visit. He reports his wife is acting differently, is extremely talkative and energetic, sleeping only 1 or 2 hours at a time (if at all), not eating, and appears to be totally neglecting the infant. The nurse should suspect the client is exhibiting signs and symptoms of which disorder?

Postpartum psychosis

The nurse would be alert for which of the following complications when caring for a 38-year-old postpartal client with a history of obesity and diabetes?

Thromboembolic complications

A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds which can prolong labor. Which compounds is the nurse referring to in the explanation?

catecholamines