NSG 452 exam 4 ob summer

The postpartum nurse is providing instructions to a client after delivery of a healthy newborn. Which time frame should the nurse relay to the client regarding the return of bowel function?

3 days postpartum

273. The nurse is providing instructions regarding treatment of hemorrhoids to a client who is in the second trimester of pregnancy. Which statement by the client indicates a need for further instruction?

4. "I should apply heat packs to the hemorrhoids to help the hemorrhoids shrink." Measures that provide relief from hemorrhoids include avoiding constipation and straining during bowel movements; applying ice packs to reduce the hemorrhoidal swelling; gently replacing the hemorrhoids into the rectum; using stool softeners, ointments, or sprays as prescribed; and assuming certain positions to relieve pressure on the hemorrhoids. Heat packs increase the blood flow to the area and worsen the discomfort from hemorrhoids.

The nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has saturated a perineal pad in 1 hour. How should the nurse respond to this finding initially?

Contact the obestericn (OB) and inform him or her of this finding.

The postpartum nurse is providing instructions to the mother of a newborn with hyperbilirubinemia who is being breast-fed. The nurse should provide which most appropriate instruction to the mother?

Continue to breast-feed every 2 to 4 hours.

An ultrasound is performed on a client with suspected abruptio placentae, and the results indicate that a placental abruption is present. Which intervention should the nurse prepare the client for?

Delivery of the fetus

The nurse is assessing a newborn after circumcision and notes that the circumcised area is red with a small amount of bloody drainage. Which nursing action is most appropriate?

Document the findings.

The postpartum nurse is assessing a client who delivered a healthy infant by cesarean section forsigns and symptoms of superficial venous thrombosis.Which sign should the nurse note if superficial venous thrombosis were present?

Enlarged, hardened veins

The postpartum nurse is taking the vital signs of a client who delivered a healthy newborn 4 hours ago. The nurse notes that the client's temperature is 100.2 ° F. What is the priority nursing action?

Increase hydration by encouraging oral fluids.

A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. The nurse determines that she is experiencing Braxton Hicks contractions. On the basis of this finding, which nursing action is appropriate?

Inform the client that these contractions are common and may occur throughout the pregnancy.

The nurse is providing instructions about measures to prevent postpartum mastitis to a client who is breast-feeding her newborn.Which client statement would indicate a need for further instruction?

"I should wash my nipples daily with soap and water."

Which statement reflects a new mother's understanding of the teaching about the prevention of newborn abduction?

"I will ask the nurse to attend to my infant if I am napping and my husband is not here."

The nurse has provided discharge instructions to a client who delivered a healthy newborn by cesarean delivery. Which statement made by the client indicates a need for further instruction?

"I will begin abdominal exercises immediately."

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction?

"I will maintain strict bed rest throughout the remainder of the pregnancy."

Interventions for Preterm Labor (PTL)

► Stop labor; treat infection, restrict activity, ► Bed rest in lateral position ► Monitor fetal status ► Fluids ► Indomethacin, magnesium sulfate, nifedipine, terbutaline (tocolytics stop contraction)

Risk factors: Preterm Labor (PTL)

► UTI's, STI's and vaginal infections ► High blood pressure, fever above 101F during pregnancy ► Bladder and kidney infections ► Mothers who have had preterm babies ► Polyhydramnios, multibabies, fall abuse car accident, prostaglandins & smoking

The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement?

"I will need to increase my insulin dosage during the first 3 months of pregnancy."

The nurse prepares to administer a vitamin K injection to a newborn, and the mother asks the nurse why her infant needs the injection. What best response should the nurse provide?

"Newborns are deficient in vitamin K, and this injection prevents your newborn from bleeding."

The nurse is providing postpartum instructions to a client who will be breast-feeding her newborn. The nurse determines that the client has understood the instructions if she makes which statement( s)? Select all that apply.

1. "I should wear a bra that provides support." **2. "Drinking alcohol can affect my milk supply." **3. "The use of caffeine can decrease my milk supply." ** 6. "I plan on having bottled water available in the refrigerator so I can get additional fluids easily."**

265. A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding?

1. A normal test result Contraction stress test results may be interpreted as negative (normal), positive (abnormal), or equivocal. A negative test result indicates that no late decelerations occurred in the fetal heart rate, although the fetus was stressed by three contractions of at least 40 seconds' duration in a 10-minute period. Options 2, 3, and 4 are incorrect interpretations

The nurse should assess for which probable signs of pregnancy? Select all that apply.

1. Ballottement 2. Chadwick's sign 3. Uterine enlargement 4. Positive pregnancy test

The nurse in a newborn nursery is monitoring a preterm newborn for respiratory distress syndrome. Which assessment findings would alert the nurse to the possibility of this syndrome?

1. Cyanosis 2. Tachypnea 4. retractions 5. Audible grunts

275. The nurse is describing cardiovascular system changes that occur during pregnancy to a client and understands that which finding would be normal for a client in the second trimester?

1. Increase in pulse rate Between 14 and 20 weeks' gestation, the pulse rate increases about 10 to 15 beats/ minute, which then persists to term. Options 2, 3, and 4 are incorrect. During pregnancy, the blood pressure usually is the same as the prepregnancy level, but then gradually decreases up to about 20 weeks of gestation. During the second trimester, systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Constipation may occur as a result of decreased gastrointestinal motility or pressure of the uterus. During pregnancy, there is an accelerated production of red blood cells.

264. The nurse has performed a nonstress test on a pregnant client and is reviewing the fetal monitor strip. The nurse interprets the test as reactive. How should the nurse document this finding?

1. Normal A reactive nonstress test is a normal result. To be considered reactive, the baseline fetal heart rate must be within normal range (120 to 160 beats/ minute) with good long-term variability. In addition, two or more fetal heart rate accelerations of at least 15 beats/ minute must occur, each with a duration of at least 15 seconds, in a 20-minute intervalS

The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? Select all that apply. 1. Proteinuria 2. Hypertension 3. Low-grade fever 4. Generalized edema 5. Increased pulse rate 6. Increased respiratory rate

1. Proteinuria 2. Hypertension 4. Generalized edema

The nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply.

1. Wear a supportive bra. 2. Rest during the acute phase. 3. Maintain a fluid intake of at least3000 mL/day. 4. Continue to breast-feed if the breasts are not too sore.

The nurse is monitoring a client who is in the active stage of labor. The nurse documents that the client is experiencing labor dystocia. The nurse determines that which risk factors in the client's history placed her at risk for this complication? Select all that apply.

1.Age 54 2.Body mass index of 28 3.Previous difficulty with fertility

The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment findings indicate to the nurse that the client is at risk for contracting human immunodeficiency virus (HIV)? Select all that apply.

1.The client has a history of intravenous drug use. 2.The client has a significant other who is heterosexual. 3.The client has a history of sexually transmitted infections.

A patient with toxic shock syndrome is to receive clindamycin 900 mg IV over 60 minutes. The clindamycin is diluted in 100 mL of normal saline. The nurse will infuse ____________________ mL/hr.

100ml/hr

270. A pregnant client calls a clinic and tells the nurse that she is experiencing leg cramps that awaken her at night. What should the nurse tell the client to provide relief from the leg cramps?

2. "Bend your foot toward your body while extending the knee when the cramps occur." Leg cramps occur when the pregnant client stretches her leg and plantar flexes her foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping. Options 1, 3, and 4 are not measures that provide relief from leg cramps.

272. The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." Which statement by the client indicates a need for further instructions?

2. "I need to lie flat on my back to perform the procedure."

263. A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin, colorless vaginal drainage. The nurse should make which statement to the client?

2. "The vaginal discharge may be bothersome, but is a normal occurrence." Leukorrhea begins during the first trimester. Many clients notice a thin, colorless or yellow vaginal discharge throughout pregnancy. Some clients become distressed about this condition, but it does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, the client may use panty liners, but she should not wear tampons because of the risk of infection. If the client uses panty liners, she should change them frequently

274. The nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. Which instruction should the nurse provide?

2. Wash the breasts with warm water and keep them dry. The pregnant client should be instructed to wash the breasts with warm water and keep them dry. The client should be instructed to avoid using soap on the nipples and areolar area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses cause discomfort. The client is instructed to wear soft-textured clothing to decrease nipple tenderness and to use breast pads inside the bra to prevent leakage through the clothing if colostrum is a problem.

268. A health care provider has prescribed transvaginal ultrasonography for a client in the first trimester of pregnancy and the client asks the nurse about the procedure. How should the nurse respond to the client?

3. "The probe that will be inserted into the vagina will be covered with a disposable cover and coated with a gel." Transvaginal ultrasonography allows clear visibility of the uterus, gestational sac, embryo, and deep pelvic structures, such as the ovaries and fallopian tubes. The client is placed in a lithotomy position and a transvaginal probe, encased in a disposable cover and coated with a gel that provides lubrication and promotes conductivity, is inserted into the vagina. The client may feel more comfortable if she is allowed to insert the probe. The procedure takes about 10 to 15 minutes. Options 2 and 4 identify components of abdominal ultrasound.

262. The nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide?

3. An informed consent needs to be signed before the procedure. Because amniocentesis is an invasive procedure, informed consent needs to be obtained before the procedure. After the procedure, the client is instructed to rest, but may resume light activity after the cramping subsides. The client is instructed to keep the puncture site clean and to report any complications, such as chills, fever, bleeding, leakage of fluid at the needle insertion site, decreased fetal movement, uterine contractions, or cramping. Amniocentesis is an outpatient procedure and may be done in a health care provider's private office or in a special prenatal testing unit. Hospitalization is not necessary after the procedure.

266. A pregnant client tells the nurse that she has been craving "unusual foods." The nurse gathers additional assessment data and discovers that the client has been ingesting daily amounts of white clay dirt from her backyard. Laboratory studies are performed and the nurse determines that which finding indicates a physiological consequence of the client's practice?

3. Hemoglobin 9.1 g/ dL Pica practices often lead to iron deficiency anemia, resulting in a decreased hemoglobin level. The laboratory values in options 1, 2, and 4 are normal for the pregnant client.

The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and notes that the fundal height is 30 cm. How should the nurse interpret this finding?

3. The client is measuring normal for gestational age.

The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply.

3.A gravida II who has just been diagnosed with dead fetus syndrome 5.A primigravida at 29 weeks of gestation who was recently diagnosed with severe preeclampsia

The nurse is assessing a newborn who was born to a mother who is addicted to drugs. Which assessment finding would the nurse expect to note during the assessment of this newborn?

3.Irritability 4. Constant crying 5.Difficult to comfort

276. The clinic nurse is providing instructions to a pregnant client regarding measures that assist in alleviating heartburn. Which statement by the client indicates an understanding of the instructions?

4. "I should avoid eating foods that produce gas and fatty foods." Lying down is likely to lead to reflux of stomach contents, especially immediately after a meal. The client should be instructed to avoid spices, along with salt, because spices trigger heartburn. Salt produces edema. The client should be encouraged to eat between-meal snacks and should be instructed that to control heartburn, eating smaller, more frequent portions is preferred over eating three large meals. The client also should limit or avoid gas-producing and fatty foods.

269. The nurse has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which statement by the client indicates a need for further instructions?

4. "I should wear knee-high hose, but I should not leave them on longer than 8 hours." Varicose veins often develop in the lower extremities during pregnancy. Any constrictive clothing, such as knee-high hose, impedes venous return from the lower legs and places the client at risk for developing varicosities. The client should be encouraged to wear support hose or panty hose. Flat nonslip shoes with proper support are important to assist the pregnant woman to maintain proper posture and balance and to minimize falls.

The nurse is preparing to care for a newborn receiving phototherapy. Which interventions should be included in the plan of care? Select all that apply.

4. Monitor skin temperature closely. **5. Reposition the newborn every 2 hours. **6. Cover the newborn's eyes with eye shields or patches. **

The nurse is performing an assessment on a client diagnosed with placenta previa. Which assessment findings should the nurse expect to note? Select all that apply.

4.Bright red vaginal bleeding 5.Soft, relaxed, nontender uterus 6.Fundal height may be greater than expected for gestational age

The clinic nurse reviews information about four patients who are requesting Pap testing. Which patient needs to be scheduled first?

A 25-year-old patient who has never had a pelvic examination

A group of patients is assigned to an RN-LPN/LVN team. The LPN/LVN should be assigned to provide patient care and administer medications to which patient?

A 36-year-old patient with chronic kidney failure who will need a subcutaneous injection of epoetin alfa

18-A-2 A 36-year-old female client has her initial prenatal primary health care provider visit a 9 weeks gestation. Which prenatal care activities would the nurse likely include in today's visit? select all that apply

A. Provide nutrition education B. Obtain a midstream urinalysis C. Send a blood sample for a complete for a complete blood count (CBC) F.Assist the primary health care provider in collecting specimens for vaginal culture H. Enter a prescription to obtain the client's blood typing

Fetal distress is occurring with a woman in labor. As the nurse prepares her for a cesarean birth, what other intervention should the nurse implement?

Administer oxygen at 8 to 10 L/min via face mask.

The nurse is monitoring a client in the immediatepostpartum period for signs of hemorrhage.Which sign, if noted, would be an early sign of excessiveblood loss?

An increase in the pulse rate from 88 to 102beats/minute

The nurse obtains the health history of a 37-year-old woman who is requesting contraceptive therapy. Which information about the patient will have the most impact on the choice of contraceptive?

Cigarette smoking of a pack/day

The nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client had a midline episiotomy and has several hemorrhoids. What is the priority nursing consideration for this client?

Client pain level

The nurse in a neonatal intensive care nursery (NICU) receives a telephone call to prepare for the admission of a 43-week gestation newborn with Apgar scores of 1 and 4. In planning for admission of this newborn, what is the nurse's highest priority?

Connect the resuscitation bag to the oxygen outlet.

Three days after undergoing a pelvic exenteration procedure, a patient reports dizziness after experiencing a sudden "giving" sensation along her abdominal incision. The nurse finds that the wound edges are open, and loops of intestine are protruding. Which action should the nurse take first?

Cover the wound with saline-soaked dressings.

The nurse assisted with the delivery of a newborn. Which nursing action is most effective in preventing heat loss by evaporation?

Drying the infant with a warm blanket

The nurse is performing an assessment on a pregnant client with a diagnosis of severe preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis?

Evidence of bleeding, such as in the gums, petechiae, and purpura

the nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client's chart?

G = 2, T = 1, P = 0, A = 0, L = 1

A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Blood pressure is 104/62 mm Hg, oxygen saturation is 92%, and the patient reports pain at a level 8 (on a scale of 0 to 10). Which action prescribed by the health care provider will the nurse implement first?

Give oxygen at 4 L/min per nasal cannula.

The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with a placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa?

Hemorrhage

Näegele's rule

His rule adds nine months and seven days to the first day of the last menstrual period. Add 277-280 days

The postpartum nurse is taking the vital signs of a client who delivered a healthy infant 4 hours ago. The nurse notes that the client's temperature is 100.2° F. What is the priority nursing action? 1.Document the findings. 2.Retake the temperature in 15 minutes. 3.Notify the health care provider (HCP). Increase hydration by encouraging oral fluids

Increase hydration by encouraging oral fluids

A nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss?

Increase in the pulse rate from 88 to 102 bpm

A patient with sickle cell disease is admitted with splenic sequestration. The blood pressure is 86/40 mm Hg, and heart rate is 124 beats/min. Which of these actions will the nurse take first?

Infuse normal saline at 250 mL/hr.

The nurse is assessing a client who is 6 hours postpartum after delivering a full-term healthy newborn. The client complains to the nurse of feelings of faintness and dizziness. Which nursing action would be most appropriate?

Instruct the client to request help when getting out of bed.

A pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss, and fatigue. After assessment of the client, tuberculosis is suspected. A sputum culture is obtained and identifies Mycobacterium tuberculosis. Which instruction should the nurse include in the client's teaching plan?

Isoniazid plus rifampin will be required for 9 months.

A client arrives at the clinic for the first prenatal assessment. She tells the nurse that the first day of her last normal menstrual period was October 19, 2020. Using Näegele's rule, which expected date of delivery should the nurse document in the client's chart?

July 26, 2021

The nurse is planning care for a newborn of a mother with diabetes mellitus. What is the priority nursing consideration for this newborn?

Maintaining safety because of low blood glucose levels

The nurse develops a plan of care for a woman with human immunodeficiency virus infection(HIA) and her newborn. The nurse should include which intervention in the plan of care?

Maintaining standard precautions at all times while caring for the newborn

A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. After locating the fundus, the nurse notes that the uterus feels soft and boggy. Which nursing intervention would be most appropriate?

Massage the fundus until it is firm.

The nurse is preparing a plan of care for a newborn with fetal alcohol syndrome. The nurse should include which priority intervention in the plan of care?

Monitor the newborn's response to feedings and weight gain pattern.

The nurse has created a plan of care for a client experiencing dystocia and includes several nursing actions in the plan of care. What is the priority nursing action?

Monitoring the fetal heart rate

The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the health care provider's prescriptions and should question which prescription?

Obtain equipment for a manual pelvic examination.

Which of these patients who have just arrived at the emergency department should the nurse assess first?

Patient with hemophilia A who is experiencing thigh swelling after a fall

The nurse is reviewing the primary health care provider's (PHCP's) prescriptions for a client admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which prescription should the nurse question?

Perform a vaginal examination every shift.

The nurse in a birthing room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which assessment finding should alert the nurse to a compromise?

Persistent nonreassuring fetal heart rate

A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action?

Place the client in Trendelenburg's position

The nurse administers erythromycin ointment (0.5%) to the eyes of a newborn and the mother asks the nurse why this is performed. Which explanation is best for the nurse to provide about neonatal eye prophylaxis?

Prevents an infection called ophthalmia neonatorum from occurring after delivery in a newborn born to a woman with an untreated gonococcal infection

The nurse in a labor room is preparing to care for a client with hypertonic uterine contractions. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. What is the priority nursing action?

Provide pain relief measures.

The nurse is planning to admit a pregnant client who is obese. In planning care for this client, which potential client needs should the nurse anticipate? Select all that apply.

Routine administration of subcutaneous heparin may be prescribed. 3.An overbed lift may be necessary if the client requires a cesarean section. 4.Less frequent cleansing of a cesarean incision, if present, may be prescribed. 5.Thromboembolism stockings or sequential compression devices may be prescribed.

The nurse is working in the postanesthesia care unit caring for a 32-year-old patient who has just arrived after undergoing dilation and curettage to evaluate infertility. Which assessment finding should be immediately communicated to the surgeon?

Sharp, continuous, level 8 abdominal pain (on a scale of 0 to 10)

After a precipitous delivery, the nurse notes that the new mother is passive and touches her newborn infant only briefly with her fingertips.What should the nurse do to help the woman process the delivery?

Tell the mother that it is important to hold the newborn infant.

The nurse is caring for four 1-day postpartum clients. Which client would require further nursing action?

The client with lochia that is red and has a foul-smelling odor.

Part 3 /// 18A-1 GTPAL Gravida Term Parity Abortions Living children

The client's gravida is 4 and her parity is 3. The number of term deliveries is 1, the number of preterm deliveries is 2 the number of aborted deliveries is 0 , and the number of living children is 3. The client's estimated date of delivery is September 19, 2020 .

The nurse is teaching a postpartum client about breast-feeding. Which instruction should the nurse include?

The diet should include additional fluids.

The nurse evaluates the ability of a hepatitis B-positive mother to provide safe bottle-feeding to her newborn during postpartum hospitalization. Which maternal action best exemplifies the mother's knowledge of potential disease transmission to the newborn?

The mother washes and dries her hands before and after self-care of the perineum and asks for a pair of gloves before feeding.

A 68-year-old patient who is ready for discharge from the emergency department has a new prescription for nitroglycerin 0.4 mg sublingual as needed for angina. Which patient information has the most immediate implications for teaching?

The patient uses sildenafil several times weekly for erectile dysfunction.

A patient is admitted to the intensive care unit with disseminated intravascular coagulation associated with a gram-negative infection. Which assessment information has the most immediate implications for the patient's care?

The patient's oxygen saturation is 87%.

The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present?

Uterine tenderness

The nurse in a maternity unit is providing emotional support to a client and her husband who are preparing to be discharged from the hospital after the birth of a dead fetus. Which statement made by the client indicates a component of the normal grieving process?

We want to attend a support group." A support group can help the parents work through their pain by nonjudgmental sharing of feelings.

The nurse is reviewing the complete blood count for a patient who has been admitted for knee arthroscopy. Which value is most important to report to the health care provider before surgery?

White blood cell count of 16,000/mm3 (16 × 109/L)

CCRT activation depends on

a. _accuracy__ of staff observations b. _judgment__ of patient's condition c. ___diligence__ in measurement of vitals d. calling for help __ in a timely fashion.

What did the study by Subbe & Bellamo (2017) find as a result of computer-integrated CCRT criteria?

a. vitals signs in EMR show abnormal. b. CCRT increased survivability from 21/1000 to 24/2400 c. trend to decrease false calls and increase survivability for 2-4

What challenges are listed as barriers to prompt CCRT activation?

a. why doesn't more staff call. b. alarm fatigue c. busy ward multiple patients/task overload d. ward physician expertise

A 36-year-old female client has her initial prenatal primary health care provider visit a 9 weeks gestation. The nurse completes initial assessment Know no allergies Sertraline(Zoloft)daily, Acetaminophen, and naproxen sodium(Aleve) as need for headaches T 98.6 RR 14 HR 76 BP 132/78 timing of initial visit 9 weeks Previous term delivery(s) Previous preterm delivery(s) Estimated date of delivery(EDD) Height 66 in (167.64 cm) Daily sertraline (Zoloft) Acetaminophen PRN 4 pain Naproxen PRN 4 pain

all Expected beside BP 132/78, Previous preterm delivery(s), Naproxen(Aleve) PRN 4 pain, Sertraline(Zoloft)daily

Preterm Labor (PTL)

begins before the 37th week of pregnancy. ► This occurs due to uterine contractions that cause the cervix to open earlier than normal.

What is the definition of "Failure to Rescue?"

hospital deaths after adverse events. It is number 2 in healthcare that show what happens to pt. in healthcare.

The home health care nurse is monitoring a pregnant client who is at risk for preeclampsia. at each home care visit, the nurse assesses the client for which sign of preeclampsia?

hypertension

Signs of Preterm Labor (PTL)

► Painful menstrual-like cramps ► Dull low backaches ► Pelvic pressure or heaviness ► Leaking of water from vagina ► Uterine contractions ► Change in character or amount of vaginal fluid

Third trimester bleeding ► Placenta previa-

❖ Placenta low in uterine cavity ► Types ► Marginal - approaches, but does not cover cervical opening ► Partial - covers most of cervical opening ► Complete - completely covers cervical opening ► Seen most frequently in older women and those who have had repeated pregnancy in rapid succession ► ***Painless bleeding, >20 weeks no contractions Treatment <37 weeks rest is the best monitoring the H&H

Third trimester bleeding Abruption placenta-

❖ Premature separation of the placenta ► Types ► Marginal separation ► Covert (concealed hemorrhage) ► Complete separation ► Seen often in patients with PIH, chronic hypertension, and cocaine abuse ► Signs and symptoms ► Active bleeding, strong, cramp abdominal pain, strong abdomen ► R/F trauma, drugs (cocaine) HTN, previous previa, abdominal trauma ► Both previa and abruption placenta usually present with shock and vaginal bleeding ► For both placenta previa and abruption placenta, the most important thing upon presentation is: DO NOT EXAMINE VAGINALLY

The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching?

"I should avoid exercise because of the negative effects on insulin production."

The nurse is providing instructions to a maternity client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse?

"I should drink adequate fluids and increase my intake of high-fiber foods."

A stillborn baby was delivered in the birthing suite a few hours ago. After the delivery, the family remained together, holding and touching the baby. Which statement by the nurse would further assist the family in their initial period of grief?

"What can I do for you?"

The nurse is providing instructions to a pregnant client with human immunodeficiency virus (HIV) infection regarding care to the newborn after delivery. The client asks the nurse about the feeding options that are available. Which response should the nurse make to the client?

"You will need to bottle-feed your newborn."

267. A pregnant client asks the nurse about the types of exercises that are allowable during pregnancy. The nurse should tell that client that which exercise is safest?

1. Swimming Non- weight-bearing exercises are preferable to weight-bearing exercises during pregnancy. Exercises to avoid are shoulder standing and bicycling with the legs in the air because the knee-chest position should be avoided. Competitive or high-risk sports such as scuba diving, water skiing, downhill skiing, horseback riding, basketball, volleyball, and gymnastics should be avoided. Non- weight-bearing exercises such as swimming are allowable.

271. A rubella titer result of a 1-day postpartum client is less than 1: 8, and a rubella virus vaccine is prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine? Select all that apply. 1. Breast-feeding needs to be stopped for 3 months. 2. Pregnancy needs to be avoided for 1 to 3 months. ** 3. The vaccine is administered by the subcutaneous route. ** 4. Exposure to immunosuppressed individuals needs to be avoided. ** 5. A hypersensitivity reaction can occur if the client has an allergy to eggs. ** 6. The area of the injection needs to be covered with a sterile gauze for 1 week.

2, 3, 4, 5 Rationale: Rubella vaccine is administered to women who have not had rubella or women who are not serologically immune. The vaccine may be administered in the immediate postpartum period to prevent the possibility of contracting rubella in future pregnancies. The live attenuated rubella virus is not communicable in breast milk; breast-feeding does not need to be stopped. The client is counseled not to become pregnant for 1 to 3 months after immunization as specified by the health care provider because of a possible risk to a fetus from the live virus vaccine; the client must be using effective birth control at the time of the immunization. The client should avoid contact with immunosuppressed individuals because of their low immunity toward live viruses and because the virus is shed in the urine and other body fluids. The vaccine is administered by the subcutaneous route. A hypersensitivity reaction can occur if the client has an allergy to eggs because the vaccine is made from duck eggs. There is no useful or necessary reason for covering the area of the injection with a sterile gauze.

coat

Color Odor Amount Time

The nurse provides health teaching for a 36-year-old female client during her initial prenatal primary health care provider visit at 9 weeks gestation. Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided During the client's first trimester , routine prenatal visits will be every ___1____week(s) The primary health care provider will prescribe an ultrasound to check for fetal____2___ that could indicate fetal anomalies. The client can expect to hear the heartbeat during the second trimester and feel fetal __3___ after 16 weeks . A noninvasive way to monitor the___4__ of the fetus is by measuring the____5____height and is done at every visit after___6___weeks' gestation but may have a ___7____ margin of error

4 anatomy Movements Growth fundal 20 2 During the client's first trimester , routine prenatal visits will be every 4 week(s) The primary health care provider will prescribe an ultrasound to check for fetal anatomy that could indicate fetal anomalies. The client can expect to hear the heartbeat during the second trimester and feel fetal Movements after 16 weeks . A noninvasive way to monitor the Growth of the fetus is by measuring the fundal height and is done at every visit after 20 weeks' gestation but may have a 2 margin of error

The nurse notes hypotonia, irritability, and a poor sucking reflex in a full-term newborn on admission to the nursery. The nurse suspects fetal alcohol syndrome and is aware that which additional sign would be consistent with this syndrome?

Abnormal palmar creases

Preterm cont meds

Betamethasone ► Increase production of surfactant increasing fetal maturity used 28- 32 weeks ► Pulmonary edema sodium & fluid rete ► High blood glucose in DM patient ► Admins IM Indomethacin ► Do not use in pt with bleeding tendencies, peptic ulcer or oligo Magnesium sulfate ► Intravenous pump ► Monitor for seizures ► Monitor RR and reflexes ► Calcium gluconate Antidote Nifedipine ► Hypotension and tachy Terbutaline ► Can cause cardiac problems

The mother of a newborn calls the clinic and reports that when cleaning the umbilical cord, she noticed that the cord was moist and that discharge was present. What is the most appropriate nursing instruction for this mother?

Bring the infant to the clinic.

When performing a postpartum assessment on a client, a nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which nursing action is most appropriate?

Notify the health care provider.

The home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the health care provider(PHCP)?

The client complains of a headache and blurred vision.

The nurse is performing an assessment on a client who has just been told that a pregnancy test is positive. Which assessment finding indicates that the client is at risk for preterm labor?

The client has a history of cardiac disease.