Management of Care

The nurse in a prenatal clinic is assessing a woman at 34 weeks' gestation. The client's blood pressure is 166/100 mm Hg and her urine is +3 for protein. She states that she has a severe headache and occasional blurred vision. Her baseline blood pressure was 100/62 mm Hg. Which action would the nurse take in response to these findings? A. Arrange transportation to the hospital. B. Obtain a prescription for an antihypertensive. C. Recheck the blood pressure within 30 minutes. D. Obtain a prescription for acetaminophen to relieve the headache.

A. The client has severe preeclampsia, which develops suddenly with a blood pressure of 160/110 mm Hg or higher and proteinuria of +2 to +3 or more. Severe headache and blurred vision are typical symptoms. The client needs immediate treatment to prevent eclampsia. There is no time to obtain or administer antihypertensive medication. This is an emergency situation; waiting 30 minutes to recheck the blood pressure will put both client and fetus in further danger. Having acetaminophen prescribed to relieve the headache is unsafe and places both client and fetus in jeopardy.

A client in her 36th week of gestation is admitted with vaginal bleeding, severe abdominal pain, a rigid fundus, and signs of impending shock. For which intervention would the nurse prepare? A. A high-forceps birth B. An immediate cesarean birth C. Insertion of an internal fetal monitor D. Administration of an oxytocin infusions.

B The client's signs and symptoms are those of complete placental separation (abruptio placentae) for which an immediate cesarean birth is the ideal treatment. High-forceps birth is rarely used, because the forceps may further complicate the situation by tearing the cervix. The risk for fetal and maternal mortality is too high to delay action, so a fetal monitor would not be inserted. Administration of oxytocin would greatly increase the risk of fetal death.

Which resource or facility has enabled rural hospitals to have increased access to specialist consultations? A. Medicare B. Medicaid C. Telemedicine D. Critical access hospital

C Telemedicine uses advanced technology to connect rural hospitals to specialists for consultation. Many big city health care systems are branching out and merging with rural hospitals to provide better health care. Medicare is a federally administered health insurance program for people 65 years of age or older. Medicaid is a federally funded, state-operated program that provides health insurance to low-income families. Critical access hospitals are rural hospitals with no more than 25 inpatient beds. These hospitals provide emergency care to stabilize clients before they are transferred to a larger hospital.

Which characteristic makes a crisis access hospital (CAH) different from an intensive care unit (ICU)? A. Offers 24-hour emergency care B. Offers health care to acutely ill people C. Provides temporary care for 96 hours or less D. Provides the most expensive health care delivery

C. A CAH is a rural hospital that provides temporary care for 96 hours or less to stabilize clients before they are transferred to a larger hospital. An ICU or a critical care unit is a hospital unit in which clients receive close monitoring and intensive medical care. Both CAH and ICU offer 24-hour emergency care. The CAH and ICU care for acutely ill clients by monitoring them on multiple devices. An ICU is the most expensive health care delivery site, because the nurse cares for only one or two clients at a time.

A pregnant client with severe abdominal pain and heavy bleeding is being prepared for a cesarean birth. Which is the priority intervention? A. Teaching coughing and deep-breathing techniques B. Cleansing the surgical site and administering an enema C. Providing a sterile gown and inserting an indwelling catheter D. Ensuring that an informed consent is obtained and that the client is assessed for medication allergies

D In an emergency surgical situation when invasive techniques are necessary, it is essential to have a signed consent on file as well as a history of the client's known allergies. Teaching coughing and deep-breathing techniques is not a priority in an emergency such as this. In an emergency, cleansing of the surgical site is performed in the operating room; an enema usually is not given before a cesarean, especially to a client who is bleeding, because it may stimulate contractions and worsen the hemorrhage.