Lippincott Maternal Health

During the first hour after a precipitous birth, the nurse should monitor a muliparous client for signs and symptoms of which of the following? A. Postpartum Blues B. Uterine Atony C. Intrauterine infection D. Urinary Tract infection

B. Uterine Atony

* A pregnant woman with cardiac disease is most at risk for cardiac decompensation with resulting damages to her fetus when her blood volume is peaking at? A. 12 to 16 weeks of gestation B. 20 to 24 weeks of gestation C. 28 to 32 weeks of gestation D. 36 to 40 weeks of gestation

C. 28 to 32 weeks of gestation

When caring for a neonate with 4,564 g (10 lb ,1 oz) born vaginally to a mother with diabetes, the nurse should assess the neonate for fracture of the? A. Clavicle B. Skull C. Wrist D. Ribcage

A. Clavicle

A nurse is preparing a list of self care instructions for a postpartum client who was diagnosed with mastitis. Which of the following instructions would be included on the list? Select all that apply A. Wear a supportive bra B. Rest during the acute phase C. Maintain a fluid intake of at least 3000 mL D. Encourage breast feeding E. Take the prescribed antibiotics until the soreness subsides

A. Wear a supportive bra B. Rest during the acute phase C. Maintain a fluid intake of at least 3000 mL D. Encourage breast feeding

* The parents of a 29 week gestation infant asks the nurse, " Why does he have that tube in his mouth?" the best response of the nurse is, "The tube is a feeding tube. He needs to be fed this way because:" A. He does not have a sucking reflex B. His sucking , swallowing, and breathing are not coordinated C. His stomach cannot digest formula D. He needs extra fluids to prevent dehydration

B. His sucking , swallowing, and breathing are not coordinated

The nurse is reviewing the chart of a multigravida client at 39 weeks gestation with suspected HELLP syndrome. The nurse should notify the health care provider about which of the following test results? A. Platelets 200,000 mm3 B. Lactate dehydrogenase (LDH) greater than 200 U/L C. Uric acid 3 mg/dL D. Aspartate aminotransferase (AST) 15 U/L

B. Lactate dehydrogenase (LDH) greater than 200 U/L

A nurse notices repetitive late decelerations on the fetal heart monitor. The best initial actions by the nurse include: A. Prepare for birth, reposition the client, and begin pushing B. Reposition the client, apply oxygen, and increase IV fluids C. Perform a sterile vaginal exam, increase IV fluids, and apply oxygen D. Notify the provider, explain findings to the patient

B. Reposition the client, apply oxygen, and increase IV fluids

Following an epidural and placement of internal monitors, a clients labor is augmented. Contractions are lasting greater than 90 seconds and occurring ever 1.5 minutes. The uterine resting tone is greater than 20 mm mercury with an abnormal fetal heart rate and pattern. Which of the following actions should the nurse take? A. Notify the health care provider B. Turn off the oxytocin infusion C. Turn the client to her left side D. Increase the maintenance IV fluids

B. Turn off the oxytocin infusion

The nurse is admitting a primigravida client at 37 weeks gestation who has been diagnosed with preeclampsia to the labor and birth area. Which of the following client care rooms is most appropriate for this client? A. A brightly lit private room at the end of the hall from the nurses station B. A semiprivate room midway down the hall from the nurses station C. A darkened private room as close to the nurses station as possible D. A private room with many windows that is near the operating room

C. A darkened private room as close to the nurses station as possible

While a client is being admitted to the birthing unit she states, " My water broke last night, but my labor started two hours ago". Which of the following is a concern? Select all that apply. A. Maternal vital signs : T 99.5 (37.5) HR 80, RR 24 BP 130/80 mm Hg B. Blood and mucus on perineal pad C. Baseline fetal heart rate of 140 with a range between 110 and 160 with contractions D. Peri-pad stained with green fluid E. The client states " This baby wants out, he keeps kicking me".

C. Baseline fetal heart rate of 140 with a range between 110 and 160 with contractions D. Peri-pad stained with green fluid E. The client states " This baby wants out, he keeps kicking me".

A client is admitted at 30 weeks gestation with contractions every 3 minutes. her cervix is 1 to 2 cm dilated and 75% effaced. Following a 4 g bolus dose, IV magnesium sulfate is infusing at 2 g/hr. How will the nurse know that the medication is having the intended effect? A. Contractions will increase in frequency, leading to birth B. The client will maintain a respiratory rate greater than 12 breaths/min C. Contractions will decrease in frequency, intensity, and duration D. The client will maintain blood pressure readings of 120/80 mm Hg

C. Contractions will decrease in frequency, intensity, and duration

The nurse is receiving shift report on four clients on an antenatal unit. Which of the four clients should the nurse focus on first? A. A hyperemisis client with emesis four times in the past 12 hours B. A 30 Week gestation patient with preterm labor on oral nifedipine and having no contractions in 6 hours C. A 35 week gestation mother with severe pre-eclampsia started on a maintenance dose of magnesium sulfate 1 hour ago D. A 33 week gestation client with placenta previa who began to feel pelvic pressure during change of shift report

D. A 33 week gestation client with placenta previa who began to feel pelvic pressure during change of shift report

During admission a multigravida in early active labor acts somewhat euphoric and tells the nurse that she smoked some crack cocaine before coming to the hospital. In addition to fetal heart rate assessment, the nurse should monitor the client for symptoms of which of the following? A. Placenta Previa B. Ruptured uterus C. Maternal hypotension D. Abruptio Placentae

D. Abruptio Placentae

A client delivered a 9 pound, 10 ounce infant assisted with forceps. When the nurse performs the second 15 minute assessment, the client complains or increasing perineal pain and a lot of pressure. What action should the nurse take? A. Put an ice pack on the clients perineum, reassuring the client that this is normal B. Call for assistance C. Assess the fundus for firmness D. Assess the perineum for a hematoma

D. Assess the perineum for a hematoma

A client is induced with oxytocin. The fetal heart rate is showing accelerations lasting 15 seconds and exceeding the baseline with fetal movement. What action associated with this finding should the nurse take? A. Turn the client to her left side B. Administer oxygen via facemask at 10 to 12 L/min C. Notify the healthcare provider of the situation D. Document fetal well being

D. Document fetal well being

A client at 33 weeks gestation is admitted in preterm labor. She is given betamethasone 12 mg IM every 24 hours x2. What is the expected outcome of this drug therapy? A. The contractions will end within 24 hours B. The client will give birth to a neonate without infection C. The client will give birth to a full term neonate D. The neonate will be born with mature lungs

D. The neonate will be born with mature lungs

A client presents to the OB triage unit with a report of bright red vaginal bleeding that has saturated a peri pad over the last hour. The nurse observes the fetal heart rate with baseline of 130 decreasing to 100 for 60 seconds and then returning to 130. There are no contractions present. Which are the priority interventions/ A. Ask client time of last oral intake and prepare to start an IV B. Continue to observe monitor and perform Leopolds maneuver C. Apply oxygen by face mask and perform sterile vaginal exam D. Place client in hands and knees position and call primary health provider

A. Ask client time of last oral intake and prepare to start an IV

A primigravida client at 39 weeks gestation comes to the birthing unit with her partner because she's been having regular contractions. She states that her "water broke." What is the nurse's priority assessment? A. Assess the frequency of uterine contractions B. Place the client in a side lying position C. Determine whether the membranes have ruptured D. Prepare the client for an amniotomy

A. Assess the frequency of uterine contractions

A full term client is admitted for an induction of labor. The health care provider has assigned a score of 10. Which drug would the nurse anticipate administering to this client? A. Oxytocin 30 units in 500 mL D5W B. Prostaglandin gel 0.5 mg C. Misoprostol 50 mcg PO D. Dinoprostone 10 mg

A. Oxytocin 30 units in 500 mL D5W

A client at 4 weeks postpartum tells the nurse that she can't cope any longer and is overwhelmed by her newborn. The baby has old formula on her clothes and under the neck. The mother does not remember when she last bathed the baby and states that she does not want to care for the infant. The nurse should encourage the client an her husband to call their health care provider because the mother should be evaluated further for? A. Postpartum blues B. Postpartum depression C. Poor bonding D. Infant abuse

B. Postpartum depression

The primary health care provider determines that outlet forceps are needed to assist in the birth of a primigravida client in active labor with a large for gestational size fetus. The nurse reinforces the primary health care providers explanation for using forceps based on the understanding about which of the following concerning the location of the fetal skull? A. It is engaged past the inlet B. It is at +1 station C. It is visible at the perineal floor D. It has reached the level of the ischial spines

C. It is visible at the perineal floor

A 30 year old multigravida client at 8 weeks gestation has a history of insulin dependent diabetes since age 20. When explaining about the importance of blood glucose control during pregnancy, the nurse should tell the client that which of the following will occur regarding the clients insulin needs during the first trimester? A. They will increase B. They will decrease C. They will remain constant D. They will be unpredictable

C. They will remain constant

A male neonate born at 36 weeks gestation is admitted to the neonatal intensive care nursery with a diagnosis of probable fetal alcohol syndrome (FAS). The mother visits the nursery soon after the neonate is admitted. Which of the following instructions should the nurse expect to include when developing the teaching plan for the mother about FAS? A. Withdrawal symptoms usually do not occur until 7 days postpartum B. Large for gestational age size is common with this condition C. Facial deformities associated with FAS can be corrected by plastic surgery D. Symptoms of withdrawal include tremors, sleeplessness and seizures

D. Symptoms of withdrawal include tremors, sleeplessness and seizures

A multigravida client at 39 weeks gestation diagnosed with insulin dependent diabetes is admitted for induction of labor with oxytocin. Which of the following should the nurse include in the teaching plan of possible disadvantage of this procedure? A. Urinary frequency B. Maternal hypoglycemia C. Preterm birth D. Neonatal jaundice

B. Maternal hypoglycemia

A primigravida is experiencing a prolonged second stage of labor with a fetus suspected of weighing over 4 kg. Which of the following interventions is the most important? A. Preparing for a vacuum-assisted birth B. Administering an IV fluid bolus C. Preparing for an emergency cesarean birth D. Performing the McRoberts Maneuver

D. Performing the McRoberts Maneuver

While caring for a neonate of a woman with diabetes soon after birth, the nurse has fed the newborn formula to prevent hypoglycemia. The nurse checks the neonates blood glucose level and it is 60 mg/dL (3.3 mmol/L), but the neonate continues to exhibit jitteriness and tremors. The nurse should first: A. Request an order for a blood calcium level B. Administer glucose intravenously based on infant glucose level C. Take the neonates temperature and place him in the radiant warmer D. Refeed the infant to continue to increase the blood glucose level

D. Refeed the infant to continue to increase the blood glucose level

A primigravida client at 30 weeks gestation gas been admitted to the hospital with premature rupture of the membranes without contraction. Her cervix is 2 cm dilated and 50% effaced. The nurse should assess the clients? A. Red blood cell count B. Degree of discomfort C. Urinary output D. Temperature

D. Temperature

The health care provider has performed an amniotomy on a laboring client. Which of the following details must be included in the documentation of this procedure? Select all that apply. A. Time of rupture B. Color and clarity of fluid C. Fetal heart rate and pattern before and after the procedure D. Size of amnio-hook used during the procedure E. Odor and amount of fluid

A. Time of rupture B. Color and clarity of fluid C. Fetal heart rate and pattern before and after the procedure E. Odor and amount of fluid

A 16 year old primigravida client admitted at 38 weeks gestation with severe preeclampsia is given intravenous magnesium sulfate and lactated ringers solution. The nurse should obtain which of the following information? A. Urinary output every 8 hours B. Deep tendon reflexes every 4 hours C. Respiratory rate every hour D. Blood pressure every 6 hours

C. Respiratory rate every hour

A multigravida client in active labor at term is diagnosed with polyhydramnios. The primary health care provider has instructed the client about possible neonatal complications related to the polyhydramnios. the nurse determines that the client has understood the instructions when the client states that polyhydramnios is associated with which of the following in the fetus or neonate? A. Renal dysfunction B. Intrauterine growth retardation C. Pulmonary hypoplasia D. Gastrointestinal disorders

D. Gastrointestinal disorders

A 31 year old multigravida client at 39 weeks gestation admitted tot he hospital in active labor is receiving intravenous lactated ringers solution and a continuous epidural anesthetic. During the first hour after administration of the anesthetic, the nurse should monitor the client for: A. Hypotension B. Diaphoresis C. Headache D. Tremors

A. Hypotension

A woman experienced a miscarriage at 10 weeks gestation and had a dilatation and curettage. She states that she is just fine and wants to go home as soon as possible. When assessing her responses to her loss, she tells the nurse that she had purchased some baby things and had picked out a name. Based on the assessment of her responses, what nursing intervention would be most appropriate? A. Ask her what the name she had picked out for her baby B. Ready the woman for discharge C. Notify pastoral care to offer her a blessing D. Ask her if she would like to see what was obtained from her D & C

A. Ask her what the name she had picked out for her baby

A client is admitted with suspected abruptio placentae. The nurse should assess the client for which of the following signs and symptoms? Select all that apply A. Bleeding that is concealed or apparent B. Abdominal rigidity C. Painful abdomen D. Large placenta E. Bleeding that stops immediately

A. Bleeding that is concealed or apparent B. Abdominal rigidity C. Painful abdomen

The nurse in the labor and birth area receives a telephone call from the emergency room announcing that a multigravida client in active labor is being transferred tot he labor area. The client has had no prenatal care. When the client arrives by stretcher, she say, "I think the baby's coming...Help!". The fetal skull is crowing. The nurse should obtain which of the following information first? A. Estimated date of birth B. Amniotic fluid C. Gravida and parity D. Prenatal history

A. Estimated date of birth

The nurse is assessing a multigravida client at 12 weeks gestation who has been admitted to the emergency department with sharp right sided abdominal pain and vaginal spotting. Which of the following should the nurse obtain about the clients history? Select all that apply A. History of sexually transmitted diseases B. Number on sexual partners C. Last menstrual period D. Cesarean section E. Contraceptive use

A. History of sexually transmitted diseases B. Number on sexual partners C. Last menstrual period E. Contraceptive use

A female neonate born vaginally at term with a cleft lip and cleft palate is admitted to the regular nursery. Which of the following actions should the nurse do the first time that the parents visit the neonate in the nursery? A. Explain the surgical interventions that will be performed B. Stress that the defect is not life threatening C. Emphasize the neonates normal characteristics D. Reassure the parents about the success rate of the surgery

C. Emphasize the neonates normal characteristics

A multigravida client is receiving oxytocin augmentation. When the clients cervix is dilated to 6 cm, her membranes rupture spontaneously with meconium-stained amniotic fluid. Which of the following actions should the nurse do first? A. Increase the rate of oxytocin infusion B. Turn the client to a knee to chest position C. Asses cervical dilation and effacement D. Monitor the fetal heart rate continuously

D. Monitor the fetal heart rate continuously

A client has experienced a postpartum hemorrhage. The primary health care provider verbally ordered carboprost tromethamine (Hemabate) 0.25 mg IM stat at the time of the hemorrhage and this was given by the nurse. The primary healthcare provider put a prescription into the electronic medical record for 0.25 mg carboprost tromethamine IV stat. When seeing the prescription, how should the nurse administering the carboprost tromethamine respond? A. Ask the charge nurse to have a discussion with the primary healthcare provider about the prescription B Initiate an incident report C. Call the primary health care provider, discuss the prescription and request revision if heard correctly D. Wait until the primary health care provider returns to the unit and discuss the situation in person

C. Call the primary health care provider, discuss the prescription and request revision if heard correctly

A neonate is admitted to the neonatal intensive care unit for observation with a diagnosis of probable meconium aspiration syndrome (MAS). The neonate weighs 10 lb, 4 oz (4,650 g) and is at 41 weeks gestation. Which of the following would be the priority problem? A. Impaired skin integrity B. Hyperglycemia C. Risk for impaired parent infant child attachment D. Impaired gas exchange

D. Impaired gas exchange

When caring for a multiparous client who is human immunodeficiency virus (HIV) positive and asking to breast feed her neonate as soon as possible, which of the following instructions about breast milk should the nurse include in the teaching plan? A. It may help prevent the spread of the HIV virus B. It contains antibodies that can protect the neonate from HIV C. It can be beneficial for the bonding process D. It has been found to contain the retrovirus HIV

D. It has been found to contain the retrovirus HIV

A primigravida client at 38 weeks gestation is admitted to the labor suite in active labor. The clients physical assessment reveals a chlamydial infection. The nurse explains that if the infections left untreated, the neonate may develop which of the following? A. Conjunctivitis B. Heart Disease C. Harlequin sign D. Brain damage

A. Conjunctivitis

A multigravida client is admitted to the hospital with a diagnosis of ectopic pregnancy. The nurse anticipates that because the clients fallopian tube has not yet ruptured, which of the following may be prescribed? A. Progestin contraceptives B. Medroxyprogesterone C. Methotrexate D. Dyphyline

C. Methotrexate

The nurse determines that the newborn is hypoglycemic based on which of the following findings? Select all that apply. A. A blood glucose reading of less than 30 mg/dL B. Family history of insulin dependent diabetes C. Internal fetal monitor tracing D. Irregular respirations, tremors, and hypothermia E. Large for gestational age

A. A blood glucose reading of less than 30 mg/dL D. Irregular respirations, tremors, and hypothermia

The nurse is planning care for a group of pregnant clients. Which of the following clients should be preferred to a health care provider immediately? A. A woman at 32 weeks gestation and is pre-eclamptic with +3 proteinuria B. A woman who is 37 weeks gestation and has insulin dependent diabetes experiencing two to three hyperglycemic episodes weekly C. A woman who is at 10 weeks gestation, is having nausea and vomiting, and has +1 ketones in her urine D. A woman at 15 weeks gestation who reports she has not felt fetal movement

A. A woman at 32 weeks gestation and is pre-eclamptic with +3 proteinuria

A multigravida client at 34 weeks gestation with premature rupture of the membranes tests positive for group B streptococcus. The client is having contractions every 4 to 6 minutes. Her vital signs are as follows: blood pressure 120/80 mm Hg, Temp 100F (37.8 C) pulse 100 bpm, RR 18 breaths/min which of the following would the nurse expect the primary health care provider to prescribe? A. Intravenous penicillin B. Intravenous gentamicin sulfate C. Intramuscular betamethasone D. Intramuscular cefaclor

A. Intravenous penicillin

As a nurse begins her shift on the obstetrical unit, there are several new admissions. The client with which of the following conditions would be a candidate for induction? A. Preeclampsia B. Active Herpes C. Face presentation D. Fetus with late decelerations

A. Preeclampsia

The nurse is attempting to resuscitate a neonate. Thirty second of chest compressions have been completed. The neonates heart rate remains less than 60 bpm. Epinephrine is given. What is the expected outcome to a neonate who has received epinephrine during resuscitation? A. Increased urine output B. A normal heart rate C. Pain relief D. Sedation

B. A normal heart rate

A multigravida client is admitted at 4 cm dilation and requesting pain medication. The nurse gives the client nalbuphine (Nubain) 15 mg. Within 5 minutes, the client tells the nurse she feels like she needs to have a bowel movement. The nurse should: A. Have naloxone hydrochloride available in the birthing room B. Complete a vaginal examination to determine dilation, effacement, and station C. Prepare for birth D. Document the clients relief due to pain medication

B. Complete a vaginal examination to determine dilation, effacement, and station

The labor and birth room nurse has received a telephone call from the emergency room indicating that a multigravida client in early labor and diagnosed with probable placenta previa will be arriving soon. In preparation for the clients arrival, the nurse anticipates that the primary health care provider will prescribe which of the following? A. Whole blood replacement B. Continuous blood pressure monitoring C. Internal fetal heart monitoring D. An immediate cesarean birth

B. Continuous blood pressure monitoring

A multigravida client that is diagnosed with chronic hypertension is now in preterm labor at 34 weeks gestation. The primary health care provider has prescribed magnesium sulfate at 3g/hr. Which assessment finding indicates that the intended therapeutic effect has occurred? A. Decrease in fetal heart rate accelerations B. Decrease in the frequency and number of contractions C. Decrease in maternal blood pressure D. Decrease in maternal respiratory rate

B. Decrease in the frequency and number of contractions

The nurse should do which of the following actions first when admitting a multigravida client at 36 weeks gestation with a probably diagnosis of abruptio placentae? A. Prepare the client for a vaginal examination B. Obtain a brief history from the client C. Insert a large gauge intravenous catheter D. Prepare the client for an ultrasound scan

C. Insert a large gauge intravenous catheter

A plan of care for an infant who is experiencing symptoms of drug withdrawal should include which of the following? A. Administering chloral hydrate for sedation B. Feeding every 4-6 hours to allow extra rest C. Swaddling the infant snugly and holding him or her tightly D. Playing soft music during feeding

C. Swaddling the infant snugly and holding him or her tightly

Two hours ago, a neonate at 38 weeks gestation and weighing 3,175 g (7lb) was born to a primiparous client who tested positive for betahemolytic Streptococcus. Which of the following would alert the nurse to notify the primary health care provider? A. Alkalosis B. Increased muscle tone C. Temperature instability D. Positive Babinskis reflex

C. Temperature instability

A 27 year old primigravida client with insulin dependent diabetes at 34 weeks gestation undergoes a stress test, the results of which are documented as reactive. The nurse should tell the client that the test results indicate which of the following? A. A contraction stress is necessary B. The non stress test should be repeated C. Chronic villus sampling is necessary D. There is evidence of fetal well being

D. There is evidence of fetal well being

The primary health care provider prescribes an amnioinfusion for a primigravida client at term who is diagnosed with oligohydramnios. Which of the following should the nurse include in the clients teaching plan about the purpose of this procedure? A. To decrease the frequency and severity of variable decelerations B. To minimize the possibility of fetal metabolic alkalosis C. To increase the fetal heart rate accelerations during a contraction D. To raise the amniotic fluid index to more than 15 cm

D. To raise the amniotic fluid index to more than 15 cm

A mother is visiting her neonate in the neonatal intensive care unit. Her baby is fussy and the mother wants to know what to do. In order to quiet a sick neonate, which of the following can the nurse teach the mother to do? A. Bring in toys for distraction B. Place a musical mobile over the crib C. Stroke the neonates back D. Use constant, gentle touch

D. Use constant, gentle touch

The nurse is administering intravenous magnesium sulfate as prescribed for a client at 34 weeks gestation with severe preeclampsia. Which of the following are desired outcomes of this therapy? Select all that apply. A. T. 98 (36.7), P 72, RR 14 B. Urinary output less than 30 mL/hr C. BP of less than 140/90 D. Magnesium level = 5.6 mg/dL (2.8 mmol/L) E. Fetal hear rate with decelerations

A. T. 98 (36.7), P 72, RR 14 B. Urinary output less than 30 mL/hr D. Magnesium level = 5.6 mg/dL (2.8 mmol/L)

When developing the plan of care for a multiparous client in active labor who receives an epidural anesthetic, which of the following would the nurse anticipate that the primary health care provider will prescribe if the client develops moderate hypotension? A. Ephedrine B. Epinephrine C. Methylergonovine D. Atropine sulfate

A. Ephedrine

A nurse is reviewing a clients maternal prenatal record and notes that the mother used narcotics during her pregnancy. A primary nursing intervention when caring for a drug exposed neonate is to: A. Asses vital signs including blood pressure every hour B. Minimize environmental stimuli C. Place the infant in a well lighted area for observation D. Provide stimulation to increase adaptation to the environment

B. Minimize environmental stimuli

The nurse is discussing kangaroo care with the parents of a premature neonate. The nurse should tell the parents that the advantages of kangaroo care include which of the following? Select all that apply. A. Enhanced bonding B. Increased IQ C. Improved physiologic stability D. Decreased length of stay in the neonatal intensive care unit E. Improved breast feeding

A. Enhanced bonding C. Improved physiologic stability D. Decreased length of stay in the neonatal intensive care unit E. Improved breast feeding

A multigravida laboring client has an extensive documented history of drug addiction. Her last reported usage was 5 hours ago. She is 2cm dilated with contractions every 3 minutes of moderate intensity. The primary health care provider prescribes nelbuphone 15 mg slow IV push for pain relief followed by an epidural when the client is 4 cm dilated. Within 10 minutes of receiving the nalbuphine, the client states she thinks she is going to have her baby now. Of the following drugs available at the time of the birth, which should the nurse avoid using this client in this situation? A. 1% lidocaine B. Naloxone hydrochloride C. Local anesthetic D. Pudendal block

B. Naloxone hydrochloride

A 39 Year old multigravida client at 39 weeks gestation admitted to the hospital in active labor has been diagnosed with class II heart disease. To ensure cardiac emptying and adequate oxygenation during labor, the nurse plans to encourage the client to do which of the following? A. Request local anesthesia for vaginal birth B. Remain in a side lying position with the head elevated C. Avoid the use of analgesics for the labor pain D. Breath slowly after each contraction

B. Remain in a side lying position with the head elevated