N201 OB: Pregnancy, Labor, Childbirth, Postpartum- At Risk EAQ

During a childbirth preparation class, the nurse teacher discusses the importance of the "spurt" of energy that occurs before labor. Why is it important to conserve this energy?

Fatigue may influence pain medication requirements

A 17-year-old client at 38 weeks' gestation is being prepared for an emergency cesarean birth because of abruptio placentae and severe fetal compromise. The client received 10 mg of nalbuphine intravenously 30 minutes ago. Because the client is too sedated to sign the consent form, what should the nurse do?

Have the attending primary healthcare provider and the surgeon sign the consent form [because this is a life threatening emergency]

Shortly after giving birth, a client says she feels as though she is bleeding excessively. When checking the fundus, a nurse observes a steady trickle of blood from the vagina. What is the nurse's initial action?

Holding the fundus firmly and gently massaging it

A client who is having her labor induced with oxytocin has internal fetal monitoring in place. Her contractions are occurring every 2 minutes, are lasting 70 seconds, and are reaching 65 mm Hg on an intrauterine pressure catheter. The baseline fetal heart rate is 130 to 140 beats/min with variability of about 15 beats/min. The nurse notices that with the last two contractions the fetal heart rate began to drop during the peak of the contraction to 110 beats/min, where it remained for about 40 seconds before returning to baseline. What type of pattern is this?

Late decelerations

The nurse is assessing several postpartum clients at the very beginning of her shift. Which problem does the nurse identify that might predispose a client to postpartum hemorrhage?

Multifetal pregnancy

A pregnant client has class II cardiac disease. To best plan the client's care, what does the nurse anticipate for the client?

Should be hospitalized if there is evidence of cardiac decompensation

A primigravida is admitted to the emergency department with a sharp, shooting pain in the lower abdomen and vaginal spotting. A ruptured tubal pregnancy is diagnosed. During what week of gestation does this condition most commonly occur?

Six weeks

A woman in labor with no known complications rings the call bell to say she has had a "gush" from her vagina. The nurse identifies a large amount of bright-red blood. In what order should the nurse perform the necessary interventions?

1) Call for help 2)Assess fetal heart tones 3)Increase IV fusion rate 4)Start Oxygen 5)Call health care provider

Which client is at the greatest risk for a postpartum infection?

A woman who requires catheterization after voiding less than 75ml

When checking the cervical dilation of a client in labor, the nurse notes that the umbilical cord has prolapsed. What is the priority nursing action?

Assisting the client into the Trendelenburg position

The nurse is assessing the perfusion and circulatory status of a postpartum client 3 hours after the birth of her second child. Which clinical finding does the nurse expect?

Capillary refill less than three seconds

A pregnant client is diagnosed with gestational hypertension. The client tells the nurse that she has been following the recommended pregnancy diet. What should the nurse teach her about her diet at this time?

Change nothing

A client who is in labor is admitted 30 hours after her membranes ruptured. Which condition is this client at increased risk for?

Chorioamnionitis

The laboratory blood tests of a client at 10 weeks' gestation reveal that she has anemia. The client refuses iron supplements. The nurse teaches her that the best source of iron is liver. What other foods does the nurse encourage the client to eat? Select all that apply.

Dark leafy green vegetables Legumes Dried fruits Ground beef patty [these are foods rich in iron]

The nurse is caring for a pregnant client with type 1 diabetes. Which complication is the result of type 1 diabetes?During the initial prenatal visit of a woman at 23 weeks' gestation, the nurse discovers that she has a history of pica. What is the most appropriate nursing action?

Determine whether the diet is nutritionally adequate

A client with class I heart disease has reached 34 weeks' gestation. Which problem should the nurse anticipate now that the client is in her third trimester?

Dyspnea at rest

A nurse is assessing the effectiveness of a teaching plan regarding self-care and conservative management of gestational hypertension. The nurse confirms that the teaching has been understood when the client notes the importance of what?

Ensuring adequate sodium intake

A pregnant client with sickle cell anemia visits the clinic each month for a routine examination. What additional assessment should be made during every visit? Select all that apply.

Evidence of UTI Presence of hyperemesis gravidarum

A client measuring at 18 weeks' gestation visits the prenatal clinic stating that she is still very nauseated and vomits frequently. Physical examination reveals a brown vaginal discharge and a blood pressure of 148/90 mm Hg. What condition does the nurse suspect the client is experiencing?

Hydatidiform mole

Pregnant women with cardiac problems must be assessed more frequently than is typical. Which physiologic adaptation does the nurse suspect is the result of early decompensation?

Increased fatigue

A 26-year-old primigravida experiencing severe abdominal pain is brought to the emergency department by ambulance with a suspected ruptured tubal pregnancy. What should the nurse's initial action be?

Insert an intravenous (IV) catheter.

The nurse in the prenatal clinic is caring for a pregnant client with well-controlled type 1 diabetes. Which outcome or modality does the nurse anticipate for this client?

Intensive prenatal care

A client tells a nurse that she does not want an episiotomy and would rather tear naturally. What information should be offered to the client regarding each of these birthing methods?

Lacerations are easier to repair than epiostomies

At 37 weeks' gestation a client's membranes spontaneously rupture; however, she does not have any labor contractions. What action is most important in the nursing plan of care for this client?

Monitor for the presence of fever

When reviewing the history of a client admitted in preterm labor during her thirtieth week of gestation, the nurse suspects a risk factor associated with this client's preterm labor. Which risk factor does the nurse suspect?

Multiple urinary tract infections [this is a risk factor for preterm labor]

Laboratory studies reveal that a pregnant client's blood type is O and she is Rh-positive. Problems related to incompatibility may develop in her infant if the infant is what?

Type A or B

A client at 36 weeks' gestation is admitted to the high-risk unit with heavy bleeding because of complete placenta previa. Why does the nurse place the client in a lateral Trendelenburg position?

To prevent shock

A client has a diagnosis of unruptured tubal pregnancy. Which assessment findings correlate with this diagnosis? Select all that apply.

Unilateral abdominal pain History of sexually transmitted infection

A client gives birth vaginally to an infant who weighs 8 lb, 13 oz (3997 g). An ice pack is applied to the perineum to ease the swelling and pain. The client complains, "This pain in my vagina and rectum is excruciating, and my vagina feels so full and heavy." What does the nurse suspect as the cause of the pain?

Vaginal hematoma

The nurse in the prenatal clinic assesses her client for signs of preeclampsia. Which finding, other than increased blood pressure, may indicate preeclampsia?

Weight gain of 6 lbs in one month [in preeclampsia renal blood flow and glomerular filtration rate are decreased result ing in fluid retention causing rapid weight gain]

A multiparous client with a history of gestational hypertension and previous history of abruption is in the transition phase of labor. The electronic fetal monitor shows fetal bradycardia, and a change is seen in the contour of the client's abdomen. What is the nurse's priority intervention?

Alerting others regarding the need for immediate c-section

The nurse is caring for a client during active labor. The recording on the electronic fetal monitor indicates fetal tachycardia. What should the nurse consider as a potential cause of this pattern?

Increased maternal metabolism [probably from maternal fever]

The nurse determines that dietary teaching for a client with mild preeclampsia has been effective when the client makes which statement?

I should follow a diet that contends unrestricted sodium and lots of calories and proteins

A client at 16-weeks' gestation calls the nurse at the prenatal clinic and states that her partner just told her that he has genital herpes. What should the nurse include when teaching the client regarding sexual activity?

Latex or polyurethane condoms must be used when the couple is having intercourse.

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease for what reason?

Morning sickness results in decreased food intake

A client at 24 weeks' gestation arrives at the clinic for a routine examination. She tells the nurse, "I feel puffy all over." In light of this statement, what is the nurse's most important assessment?

Obtain blood pressure

What are the primary nursing interventions when a client is receiving an infusion of magnesium sulfate for severe preeclampsia? Select all that apply.

Restricting visitors Maintaining a quiet environment

A nurse is monitoring a client with severe preeclampsia for the onset of eclampsia. What objective clinical finding indicates an impending seizure?

Rolling of the eyes to one side with a fixed stare

A woman arrives for an appointment at an obstetrics clinic. During the visit the nurse records the following information. Which finding indicates a need for future intervention?

Rubella titer less than 1.8

A primigravida client with type 1 diabetes is attending her first prenatal visit. While discussing changes in insulin needs during pregnancy and after birth, the nurse explains that in light of the client's blood glucose readings she should expect to increase her insulin dosage. Between which weeks of gestation is this expected to occur?

Twenty fourth and twenty eighth week of gestation

A client at 37 weeks' gestation is brought to the emergency department because of sudden abdominal pain. Abruptio placentae is suspected, and the client is transferred to the birthing unit. What should the nurse assess the client for?

Uterine tenderness and increased fetal activity

A 36-year-old primigravida is receiving treatment for preeclampsia at 29 weeks' gestation. In light of the latest information on the client's record, which nursing intervention is of the highest importance at this time?

Notify the health care provider regarding epigastric pain, blurred vision, and headache

Sitz baths are prescribed for a client with an episiotomy during the postpartum period. How do the sitz baths aid the healing process?

Promotes vasodilation [Heat causes vasodilation increasing blood supply to that area ]

A pregnant woman with a history of heart disease visits the prenatal clinic toward the end of her second trimester. Which intervention does the nurse anticipate will be part of this client's care plan?

Prophylactic antibiotics at time of birth

A client with preeclampsia has a prescription for a magnesium sulfate infusion to be initiated. The nurse assesses the client's status to obtain baseline information. Which assessments are necessary? Select all that apply.

Patellar reflex Output of Urine Respiratory Rate