OB Evolve

A nurse is caring for four mother-baby couplets on the postpartum unit. Which new mother is at the greatest risk for postpartum hemorrhage? a. A primipara who has given birth to an 8-lb baby b. A grand multipara who experienced a labor that lasted 1 hour c. A multipara whose placental separation occurred 10 minutes after she gave birth d. A primipara who received epidural anesthesia throughout the birthing experience

B Increased parity contributes to an increased incidence of uterine atony because the uterine muscle may not contract effectively, leading to postpartum hemorrhage; it is not uncommon for a grand multipara to have a labor that lasts 1 hour. A primipara should maintain a well-contracted uterus; with only one pregnancy, the uterus usually maintains its tone. Expulsion of the placenta 10 minutes after the birth of the fetus is expected and will not affect the tone of the uterus. Uterine atony is not a major problem associated with epidural anesthesia.

A pregnant client has a positive group B Streptococcus (GBS) test at 36 weeks' gestation. What is the priority instruction that the nurse will include in the client's teaching plan? a. "Go straight to the outpatient area of the maternity unit for a nonstress test." b. "You'll need to schedule visits twice a week with your healthcare provider until you deliver." c. "Your baby will have to spend at least 3 days in the neonatal intensive care unit because of this infection." d. "This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding."

D A client who has a positive result on GBS screening will need to be treated with an intravenous antibiotic, often penicillin or ampicillin, throughout the labor process to prevent transmission of the infection to the neonate. Vertical transfer of GBS to the neonate during labor is associated with higher rates of neonatal morbidity and mortality. Untreated, the risk to the neonate is high, and with transmission, the infant will need to be cared for in the neonatal intensive care unit. There is no need for an increase in the frequency of prenatal visits or nonstress testing as a result of a positive GBS finding.

A client in labor is receiving an oxytocin (Pitocin) infusion. Which intervention is a priority for the nurse when repetitive late decelerations of the fetal heart rate are observed?

The infusion should be stopped because it is the likely source of fetal compromise. Administering oxygen may not be necessary if late decelerations cease with other interventions. ***Placing the client on the left side should be done after the oxytocin infusion is discontinued. The client's blood pressure may be checked, but this is not the priority.

cystocele

hernia of the bladder into the vagina

rectocele

pouching of the rectum into the vagina