FA Davis Questions chapter 7

A G2P1001 patient has been admitted with preeclampsia. Which signs or symptoms might indicate impending eclampsia? Select all that apply. SELECT 4

Severe headache, Clonus, Restlessness, Epigastric pain

Signs and symptoms of developing a DKA

Sore throat, sough, upper respiratory illness, eating ice cream, with honey, medications include cough drop, cough syrup, polyuria, blood glucose elevated

The nurse is caring for a primiparous client who is having an induction of labor for possible polyhydramnios with oxytocin. The nurse has been monitoring the client's EFM in the nurses' station and has now returned to the bedside to address a concern. Complete the bowtie by dragging and dropping the condition the client is most likely experiencing, two actions the nurse should take/anticipate related to the condition, and two parameters the nurse should monitor. G1P0 Hmong 32-y/o

Actions to take: Reposition the client onto her side Stop the oxytocin infusion Condition most likely experiencing: Tachysystole Parameters: EFM for fetal status and UC activity The need for terbutaline

While assessing a postoperative cesarean section (C-section) client, the nurse notes a temperature of 102.1°F (38.9°C). Before calling the provider, what other assessment should the nurse complete to include when reporting the concern? Identify the time of last pain medication Assess the C-Section incision Assess lung sounds and incentive spirometry Assess uterine fundus and Lochia

Assess the C-Section incision

The nurse is teaching a childbirth education class. Which statements regarding induction of labor would be included in the teaching? Select all that apply. Select 2 Labor induction is used only for medical reasons Before using oxytocin for labor induction, the cerix should be favorable As long as you are over 37 weeks gestation, your doctor may induce you for convenience The risks of labor induction are the same as the risk with spontaneous labor You should not have a labor induction if you have active herpes

Before using oxytocin for labor induction, the cervix should be favorable You should not have a labor induction if you have active herpes

A laboring client has just been recommended to have a c-section. Reviewing the client's data, the nurse knows the reason the provider recommended a c-section is which of the following? 39 week 3 day Category 1 strip Cephalopelvic Disproportion CPD Hypotonic uterine dysfunction

Cephalopelvic disproportion 24 hours of labor with infant not engaging in the pelvis has GDM

The nurse has been following a gravid patient since her first trimester. The patient has high blood pressure and later develops proteinuria in her third trimester. Which condition is the patient most likely experiencing?

Chronic hypertension with superimposed preeclampsia

The nurse is caring for a patient who is being induced with oxytocin. Upon assessment of the oxytocin infusion and patient status, the nurse would determine the effectiveness with which clinical finding? The patient reports a pain level of 4 on the numeric pain scale with bloody show noted on the peri-pad Contraction last 40-60 seconds every 2-3 minutes with cervical change Contractions are 4-5 minutes apart lasting about 30-40 seconds with no cervical change Intensity of contractions is at least 75-100 mm hg with intrauterine pressure catheter

Contractions last 40-60 second every 2-3 minutes with cervical change

The nurse is caring for a patient following a precipitous delivery. Which complication would the nurse watch for? Retained Placenta Postpartum Hemorrhage Hemorrhoids Uterine Rupture

Postpartum Hemorrhage Rationale: Uterine atony following precipitous labor and birth can occur and lead to postpartum hemorrhage

A nurse is preparing to assist a new mother with breastfeeding following a cesarean section (C-section) delivery. Which positions will the nurse recommend to maximize patient comfort while breastfeeding? Select all that apply. Side-lying position Cradle Hold C-Cup positioning Using a breast pump Football hold

Side-lying position Football hold

The nurse is circulating in a repeat cesarean section. After delivery of the infant, the provider begins having difficulty removing the placenta. Complete the bowtie by dragging and dropping the condition the client is most likely experiencing, two actions the nurse should take/anticipate related to the condition, and two parameters the nurse should monitor. White 32 y/o 39 weeks 3 day pre op scheduled C/S

Action to take: Alert blood bank, ensure infant is handed to father and assist with skin to skin Condition: Accreta Parameters to monitor: Monitor for sudden unexpected postnatal collapse, Monitor for signs and symptoms of DIC

The nurse is caring for a patient in OB triage complaining of bright red, vaginal bleeding and severe abdominal pain. Complete the bowtie by dragging and dropping the condition the client is most likely experiencing, two actions the nurse should take/anticipate related to the condition, and two parameters the nurse should monitor. 31 y/o with twins

Action to take: Notify OR of emergent Cesarean Section Anticipate orders for a blood type and cross and the blook bank making blood products available to the OR Condition most likely experiencing: Uterine Rupture Parameters to monitor: Vital signs and LOC, FHR of both twins

The obstetric nurse is preparing a client for an epidural. What is the priority nursing intervention before this procedure? Monitor Fetal Heart Tones Obtain maternal blood pressure Administer IV fluid Bolus Assess for prior epidural anesthesia

Administer IV fluid bolus

Alice, age 38, is a G6P3205 being induced at 39 weeks 5 days. Her induction so far has been uneventful, and her last sterile vaginal examination (SVE) showed that she was 8/90/+1. You remain at the bedside preparing Alice and her husband for delivery. Her strip is a Category II, and she's contracting every 2 to 3 minutes. Alice has been breathing well through her contractions until about 5 minutes ago, when you noticed she looked pale. Shortly thereafter, she started to have a seizure. Alice becomes cyanotic and the fetal heart rate (FHR) becomes bradycardic. As you push the emergency button, you note she's foaming at the mouth as her heart rate becomes irregular on the monitor. What intrapartal complication is Alice experiencing?

Amniotic Fluid Embolism

A mother-baby nurse just received report on three mother-baby couplets and is preparing to start the first assessments of the shift. All are recovering from cesarean section (C-section) deliveries. Which couplet will need to be seen first? Couplet #1: The infant and mother have been doing well since delivery 3 days ago and would like to be discharged in the next couple hours. Couplet #2: The infant has been breastfeeding successfully and the mother has required fundal massage for the fundus to become firm. Couplet #3: The mother has chosen to bottle feed the infant, and the infant has lost 89 grams of the 3,200-gram birth weight at 2 days of age. Couplet #4: The infant has been experiencing difficulties latching on to breastfeed and last nursed successfully an hour and a half ago.

Couplet #2: The infant has been breastfeeding successfully and the mother has required fundal massage for the fundus to become firm.

Following a cesarean section (C-section), the nurse caring for the client notes the following assessment data: temperature 99.1°F, heart rate 136, respirations 20, blood pressure 82/48 mm Hg. Her skin is pale and clammy to the touch. The nurse reports concern of what postpartum complication to the provider? Respiratory Depression Renal Failure Wound Infection Postpartum Hemorrhage

PostPartum Hemorrhage

The nurse is caring for a term gestation laboring patient who just had a sudden onset of hypoxia and hypotension shortly after spontaneous rupture of membranes. Which is the nurse's priority action? Assist the patient into high-fowler's position Call the provider and prepare for imminent delivery Draw a blood panel and prepare to administer blood products Provide supplemental oxygen and left uterine displacement

Provide supplemental oxygen and left uterine displace

Alex is a 34-year-old G3P2002 with a history of large-for-gestational-age infants in her prior deliveries and gestational diabetes. She's been pushing for approximately an hour and the head has just been delivered, but it is retracting back against the maternal perineum. What second stage complication would you suspect Alex is experiencing?

Shoulder Dystocia

A provider has determined a client needs a cesarean section (C-section) for cephalopelvic disproportion. The client asks the nurse to explain what cephalopelvic disproportion means. What is the best response by the nurse? "You are needing a C-section due to the baby experiencing stress from labor." "Let's focus on preparing for the surgery." "The baby is too large for your pelvis." "Have you had a recent ultrasound to estimate the baby's weight?"

The baby is too large for your pelvis

A woman in the second stage of labor has been pushing for 3 hours. The provider is preparing for a vacuum-assisted delivery. Which anticipatory guidance should the nurse give to the patient? "The blades of the forceps will be applied to the fetal head." "The baby may have some bruising and edema of the head." "You will need to push between contractions." "An episiotomy is required for a vacuum delivery."

The baby may have some bruising and edema of the head

The nurse is assessing a client 12 hours post-cesarean section (C-section) delivery of a healthy male infant weighing 9 pounds 3 ounces. The client's Foley catheter was removed 3 hours ago. Which subjective assessment data requires immediate intervention? The client reports pain at a level of four and can tolerate a five. The client reports the infant nursed for about 20 minutes one and a half hours ago. The client has a blood pressure of 92/48. The client reports no voiding since the catheter was removed.

The client reports no voiding since the catheter was removed.

Following cesarean delivery, a stable female infant weighing 3,126 grams is placed skin-to-skin with the mother. The client's partner asks why the infant is placed with the mother during the remainder of the surgery. What is the best response from the nurse? "Placing the infant with the mother reduces the need to have another nurse in the crowded operating room." "We can discuss this later, I need to help the surgeon right now." "Infants are less likely to need neonatal intensive care unit (NICU) care when placed skin-to-skin with the mother." "It is important to get a picture immediately after delivery of the infant."

"Infants are less likely to need neonatal intensive care unit (NICU) care when placed skin-to-skin with the mother."

Following a cesarean section (C-section) a few hours ago, the partner of a client comes out to the nurses' station to report the client is experiencing severe pruritus. The partner voices concern that the client is experiencing an allergic reaction to the morphine given during surgery. How does the nurse respond to the client when entering the room to assess the concern? "Itchiness, also known as pruritis, is a common reaction to morphine and is not considered an allergy." "Here is some medication to stop the itching." "I will note in your medical record that you have an allergy to morphine." "Let me call the provider and report the itching."

"Itchiness, also known as pruritis, is a common reaction to morphine and is not considered an allergy."

A woman who is 28 weeks' gestation is screened for gestational diabetes. Her 1-hour oral glucose tolerance test (GTT) is elevated at 145 mg/dL. What is the next step to determine if the patient has developed gestational diabetes?

3-hour glucose test Rationale: standard of care of diagnosing gestational diabetes is the 3-hr GTT

The labor and delivery unit has had four patients admitted for preterm labor. The nurse recognizes that which patient is not a candidate for tocolysis? 33 Weeks Gestation with a UTI 30 weeks gestation with placental abruption 34 weeks gestation with group B strep 35 weeks gestation with diabetes and amniocentesis confirming immaturity of the fetal lungs

A G1P0 at 35 weeks gestation with diabetes and amniocentesis confirming immaturity of the fetal lungs. Rationale: There is benefit in prolonging pregnancy when fetal lungs are not mature yet.

The nurse is caring for a client who was just admitted to the antepartum unit for observation. Complete the bowtie by dragging and dropping the condition the client is most likely experiencing, two actions the nurse should take/anticipate related to the condition, and two parameters the nurse should monitor Black 34-y/o G3P1102 Low CBC high BUN high creatinine high bilirubin

Action to Take: Administer platelets as ordered, Alert charge nurse and operating room staff of a possible repeat and emergenct c-section. COndition most likely experiencing, HELLP syndrome Paramaters to monitor: Monitor liver enzymes and CBC results, Assess for increased mucosal bleeding and bleeding at the IV site

While presenting an educational session on childbirth, the nurse was asked to discuss risk factors for a cesarean section (C-section). What should the nurse include in her response? Select all that apply. Advanced maternal age spontaneous labor onset breech position maternal request multiparity

Advanced maternal age Breech position

A gravid patient in labor suddenly has dyspnea, hypotension, frothy sputum, and loss of consciousness. The nurse knows these are signs and symptoms of which obstetrical emergency? Placental Abruption Uterine Rupture Uterine Inversion Amniotic Fluid Embolism

Amniotic Fluid Embolism Rationale: These are classic signs and symptoms of amniotic fluid embolism

A patient in labor is noted to have an occiput posterior presentation. Which complications would the nurse anticipate? Prolapsed cord Facial burising in neonate dystocia Shrtened second stage

Dystocia

Expected vs Unexpected Findings Of Post OP C/S

Expected: QBL 950, fundal height 2 cm umbilicus, pruritus, maternal disappointment, pain scale of 2 Unexpected: Hematuria, paralytic ileus, moderate to heavy lochia

The nurse is caring for a client during her first prenatal visit. After reviewing the client's history and assessment information, the nurse knows the client is at risk for developing a high-risk pregnancy because of which of the following factors? Select all that apply. SELECT 5 Black 41 y/o G4P1202

Her age, Her chronic Hypertension, This being an IVF pregnancy, her race, her history of pregnancy complications

The nurse is caring for a patient who is undergoing a term gestation pregnancy induction. Which is the nurse aware of regarding the induction of labor? It is achieved by external and internal version techniques. It is always done for medical indications.. It is rated for probability of success by a Bishop score. It is only achieved through oxytocin infusion.

It is rated for probability of success by a bishop score

The nurse is in the room with a laboring patient who was found to have a prolapsed umbilical cord. The nurse will place the patient in which positions to help relieve pressure on the cord? Select all that apply. SELECT 2 High-Fowler Left-Lateral Knee-Chest Squatting Trendelenburg

Knee-Chest Trendelenburg

A patient with preeclampsia has orders for magnesium sulfate administration. Which order would the nurse question?

Loading dose 1 gram 10% magnesium sulfate in 100 mL solution over 20 minutes Rational: Loading dose is 4-6 grams

If a patient presents as DKA, What is high priority and low priority actions

Low Priority: Assess weight gain, assess weekly blood glucose log, Obtain NST, Assess DTRs High Priority: Obtain vital signs, Test blood glucose, Place an IV

Suffering from severe preeclampsia, Shauna was admitted yesterday for an induction of labor. She is 23 years old and a G2P0010. The FHR tracing has been a Category II for a few hours and has not responded to intrauterine resuscitation measures. As you perform your hourly assessment at the bedside, you note the FHR tracing losing variability and late decelerations developing. Shauna tells you she's just felt a gush of fluid, and while performing perineal care you note that the fluid is not clear. What intrapartal complication did you find as you provided perineal care for Shauna?

Meconium-Stained Fluid Key Finding is with Hypoxia

The nurse is caring for a patient at risk for preterm labor. Which of the following are risk factors for preterm labor? Select all that apply. SELECT 3

Multiple Gestation, History of preterm Birth, Maternal Smoking

A term laboring patient is reporting severe lower back pain and has been pushing for 2 hours. The nurse would anticipate that the fetus is in which position? Frank Breech Occiput Posterior Occiput Anterior Shoulder Presentation

Occiput Posterior Rationale: severe back pain in second stage of labor

Magnesium Toxicity Side Effects

Oliguria, Altered DTRs, Respiratory Depression, Circulatory Collapse

A term, multiparous, laboring client has just had a SROM, and the nurse has performed an SVE. Based on the assessment findings, what does the nurse anticipate the provider's next course of action to be? G2P1001 40 weeks 2 days gestation Loop of pulsating cord in SVE

Perform an Emergent C-Section

A patient at 30 weeks' gestation presents to the labor and delivery unit reporting painless, bright red vaginal bleeding. Which condition would the nurse suspect?

Placenta previa

The nurse is assessing a patient who has been admitted for preeclampsia. Which findings would indicate severe features of preeclampsia? Select all that apply.

Platelet count of 90,000/mm3, severe headache, visual changes Only a blood pressure greater than 160/110 is a severe feature of preeclampsia

Maria is a 20-year-old G1P0 whose labor is being augmented with oxytocin. Her last SVE was 6/70/0 about 4 hours ago. Your orders for augmentation were also given at that time and were for oxytocin 2 mU/min, increased by 2 mU/min every 30 minutes. Maria's oxytocin is now at 16 mU/min. Taking Maria's vital signs, you notice she's having a hard time catching her breath between contractions. When you assess the last 30 minutes of her FHR monitoring strip, you note the FHR is a Category II and her contractions are every 30 seconds to 1 minute. What intrapartal complication is Maria experiencing?

Tachysystole

Regarding oxytocin for labor induction, what is the most concerning side effect of oxytocin? FHR baseline change from 140 to 130 Increased blood pressure Oliguria Tachysystole

Tachysystole Rationale: More than 5 UC in 10 minutes over 30 minute window is the definition, can cause adverse effects on fetal status

Oxytocin induction side effects

Tachysystole, Periodic FHR decelerations

While the nurse is preparing a client for an emergency cesarean section (C-section), the family voices concern that the client is extremely nervous about the procedure. How does the nurse respond to the client? Tell me about how you are feeling right now We do many C-section every day, you will be fine I am going to insert the Foley catheter now It is important that you try to calm down for the baby

Tell me about how you are feeling right now

A woman experiencing preterm labor has an order for betamethasone. Which statement is correct regarding antenatal corticosteroids? Select all that apply. SELECT 3

They are most beneficial from 24-34 weeks gestation. They Accelerate Fetal Lung Maturity, They reduce the risk of necrotizing enterocolitis in the neonate.

Preeclampsia Side Effects

Thrombocytopenia, Altered DTRs, Pulmonary Edema

Jenni is a 31-year-old G1P0 who arrived in spontaneous latent labor and spontaneous rupture of membranes (SROM) approximately 14 hours ago. Her original SVE was 3/70/-1, and she's been contracting regularly every 2 to 5 minutes since admit. She's been making steady progress as evidenced by her SVEs performed every 2 hours; her last one was 9/90/+1 that you just performed. Upon this last check you did note a foul odor to her vaginal discharge. FHR is 164, and Jenni's vital signs are blood pressure 128/75 mm Hg, heart rate 128, oxygen saturation 99%, respirations 24, and temperature 100.8°F. What intrapartal complication is Jenni showing signs of developing?

Triple I (Intraamniotic or Intrauterine infection)

A client is pregnant with her second child following a cesarean section (C-section) delivery with the first pregnancy for a breech fetal position. The couple plans to have three children total. What option does the nurse discuss as the best one for this couple? Vaginal Birth Repeat C-Section External Cephalic Version Only having two children

Vaginal Birth

The labor nurse is caring for a patient at risk for intraamniotic infection. Which assessment findings would alert the nurse of intraamniotic infection? Select all that apply. SELECT 3 Baseline fetal heart rate (FHR) of 170 Maternal fever Meconium-stained amniotic fluid Severe headache Foul-smelling vaginal discharge

Baseline FHR 170 Maternal Fever Foul-smelling vaginal discharge

A nurse is caring for a client following a cesarean section (C-section) 4 hours ago that occurred due to arrest of labor. Initially, the client was admitted to the hospital 2 days ago after experiencing spontaneous rupture of membranes. Which medication order does the nurse anticipate for this client? Bisacodyl Ampicillin Methergine Dexamthesone

Ampicillin

The nurse is discharging a woman after hospitalization for preterm labor. The nurse instructs the patient to call the provider for which signs or symptoms? Select all that apply.

Broken bag of water, Low back ache with menstrual cramps, regular contraction that do not go away with rest

Mia, 25 years old, was admitted last night for an induction with a Foley bulb at 39 weeks 1 day due to complications. She's a G1P0, and her SVE 2 hours ago was 6/80/-1. The provider is at the bedside to perform an amniotomy to artificially rupture the membranes (AROM) to augment Mia's labor, and you're at the bedside to assist. Once the AROM has occurred, you note the FHR is bradycardic, and the provider tells you to call an emergent cesarean section. What is the pregnancy complication you expect the provider to diagnosis?

Umbilical Cord Prolapse

Amal, 28 years old, is a G3P1102. She has a history of one uncomplicated vaginal delivery with her first pregnancy and a cesarean section performed due to the infant being intrauterine growth retardation (IUGR) with her last delivery 3 years ago. Now with her third pregnancy, she has chosen to trial of labor after cesarean (TOLAC) and arrived on the unit 14 hours ago in spontaneous labor. The provider ordered oxytocin to augment her labor due to minimal cervical change 3 hours ago. Amal's husband has run up to the nurse's station, yelling that Amal is not responding to him and is pale. Upon entering the room, you note minimal variability and a baseline of 98 on the fetal heart monitor (FHM), and Amal appears cyanotic and is moaning but unresponsive. Her vital signs are blood pressure 87/45 mm Hg, heart rate 135 bpm, oxygen saturation 91%, respirations 28. What intrapartal complication is Amal experiencing?

Uterine Rupture

Georgina and her husband, both 33 years old, became pregnant through in vitro fertilization (IVF) and are now 32 weeks and 3 days along in their first pregnancy. Georgina is in obstetrics (OB) triage with complaints of moderate, painless vaginal bleeding after intercourse this morning. The bleeding has stopped, but after performing an ultrasound, the provider has ordered Georgina to be admitted to the antepartum unit until she is 35 weeks' gestation and then will be delivered via cesarean section. What complication was diagnosed by the provider?

Vasa Previa

A woman diagnosed with pregestational diabetes is discussing her diagnosis with the nurse at her first prenatal appointment. What anticipatory guidance would the nurse provide this patient?

Watch for signs and symptoms of preterm labor

A patient at 30 weeks' gestation was just diagnosed with gestational diabetes. She asks the nurse how the diabetes will affect her baby. What is the best response from the nurse? High blood sugar for several days after birth might be larger than expected at birth If you follow your diet and control your blood sugar, there would not be any problem for the baby Baby is at increased risk of genital anomalies

Your baby might be larger than expected at birth Rationale: Macrosomia is a complication due to fetal hyperinsulinemia

The nurse is caring for a gravid patient who is carrying twins. Which complications would the nurse monitor the patient for?

Pre-eclampsia, Gestational Diabetes, Abruptio Placentae, Cardiomyopathy