OB Midterm Practice Questions
When performing vaginal examinations on a laboring woman, the nurse should be guided by what principle? A) Cleanse the vulva and perineum before and after the examination as needed. B) Wear a clean glove lubricated with tap water to reduce discomfort. C) Perform the examination every hour during the active phase of the first stage of labor. D) Perform an examination immediately if active bleeding is present.
A* Cleansing will reduce the possibility that secretions and microorganisms will ascend into the vagina to the cervix. Maternal comfort will also be enhanced. Sterile gloves and lubricant must be used to prevent infection. Vaginal examinations should be performed only as indicated to limit maternal discomfort and reduce the risk for transmission of infection, especially with ruptured membranes. Examinations are never done by the nurse if vaginal bleeding is present, because the bleeding could be a sign of placenta previa and a vaginal examination could result in further separation of the low-lying placenta.
The breasts of a woman who is bottle feeding her baby are engorged. The nurse should instruct her to: A) wear a snug, supportive bra. B) allow warm water to sooth the breasts during a shower. C) express milk from breasts occasionally to relieve discomfort. D) place absorbent pads with plastic liners into her bra to absorb leakage.
A* A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Ice packs, fresh cabbage leaves and mild analgesics may also relieve discomfort. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners would keep the nipples and areola moist, leading to excoriation and cracking.
Fetal well-being during labor is assessed by: A) the response of the fetal heart rate to uterine contractions. B) maternal pain control. C) accelerations in the FHR. D) an FHR greater than 110 beats/min.
A* Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110-160 bpm with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Although FHR accelerations and an FHR greater than 110 may be reassuring, they are only two components of the criteria by which fetal well-being is assessed.
A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At present she is at the greatest risk for: A) Hemorrhage B) Infection C) Urinary retention D) Thrombophlebitis
A* Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention or thrombophlebitis than does a normally implanted placenta.
A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1 C, pulse 96, respiratory rate 24, BP 155/112, 3+ deep tendon reflexes, no ankle clonus. The nurse calls the physician, anticipating an order for: A) Hydralazine. B) Magnesium sulfate bolus. C) Diazepam. D) Calcium gluconate.
A* Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of CNS irritability r/t severe preeclampsia, or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as an antidote for magnesium sulfate toxicity. The client is not currently displaying any signs/symptoms of magnesium toxicity.
Which PPH conditions are considered medical emergencies that require immediate treatment? A) Inversion of the uterus and hypovolemic shock. B) Hypotonic uterus and coagulopathies. C) Subinvolution of the uterus and idiopathic thrombocytopenic purpura (ITP) D) Uterine atony and disseminated intravascular coagulation (DIC).
A* Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin; coagulopathies should have been identified prior to delivery and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment; ITP can be safely managed with corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious obstetric complications but are not medical emergencies requiring immediate intervention.
A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is: A) Hypertension B) Hyperemesis gravidarum C) Hemorrhagic complications D) Infections
A* Preeclampsia and eclampsia are two noted, deadly forms of hypertension, which is the most common medical complication of pregnancy. A large percentage of pregnant women have nausea and vomiting, but a relative few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy.
A nurse is caring for a woman with mitral stenosis who is in the active stage of labor. Which action should the nurse take to promote cardiac function? A) Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. B) Prepare the woman for cesarean section because this is the recommended delivery method to sustain hemodynamics. C) Encourage the woman to avoid the use of narcotics or epidural regional analgesia because these measures alter cardiac function. D) Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.
A* The side-lying position with the head and shoulders elevated helps facilitate hemodynamics during labor. A vaginal delivery is the preferred method for a woman with cardiac disease because it sustains hemodynamics better than a cesarean section. The use of supportive care, medications and narcotics or epidural is not contraindicated for a woman with heart disease. Using the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow.
The birth weight of a breastfed newborn was 8 lb 4 oz. On the third day the newborn's weight is 7 lb 12 oz. On the basis of this finding, the nurse should: A) Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs. B) Suggest that the mother switch to bottle feeding because breastfeeding is ineffective in meeting newborn needs for fluid and nutrients. C) Notify the physician because the newborn is being poorly nourished. D) Refer the mother to a lactation consultant to improve her breastfeeding technique.
A* Weight loss of 8 oz falls within the 5-10% expected weight loss from birth weight during the first few days of life. The infant is not undernourished, and the physician does not need to be notified. Breastfeeding is effective, and bottle feeding does not need to be initiated at this time.
In which situations would the use of Methergine or prostaglandin be contraindicated even if the patient was experiencing a postpartum significant bleed? (Select all that apply) A) Patient has delivered twin pregnancies. B) Patient's blood pressure postpartum is 180/90. C) Patient has a history of asthma. D) Patient has a mitral valve prolapse. E) Patient is a grand multip.
B C D Twin pregnancies and grand multiparity are not contraindications to the use of these medications. If a patient is hypertensive or has cardiovascular disease, these medications would not be used. If a patient has a history of asthma, prostaglandin medication would not be used.
Which lab values would be found in a patient diagnosed with preeclampsia? (Select all that apply) A) Hemoglobin 8g/dL B) Platelet count 75,000 C) LDH 100 units/L D) Burr cells E) BUN 25 mg/dL
B C E Thrombocytopenia below 100,000, an increase in LDH, and an increase in BUN would be noted. Hemoglobin levels would be increased, but 8 g/dL reflects a decreased level. Burr cells would not be present in preeclampsia, but would in HELLP syndrome.
The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with 2 plum-sized clots. The nurse's initial action is to: A) Place her on a bedpan to empty her bladder. B) Massage her fundus. C) Call the physician. D) Administer methylergonovine, 0.2 mg IM, which has been ordered prn.
B* A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action is to massage the fundus until firm. The physician can be called or methylergonovine administered after the fundus massage, especially if the fundus does not become or remain firm with massage. There is no indication of distended bladder, so having the woman urinate will not alleviate the problem.
A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: A) a sleepy, sedated affect. B) a respiratory rate of 10 breaths/min. C) deep tendon reflexes of 2+. D) absence of ankle clonus.
B* A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Because magnesium sulfate is a CNS depressant, the client will most likely become sedated when the infusion is initiated. Deep tendon reflexes of 2+ and absence of ankle clonus are normal findings.
A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: A) orthopnea. B) decreasing energy levels. C) moist frequent cough and frothy sputum. D) crackles at bases of the lungs on auscultation.
B* Decreasing energy level (fatigue) is an early finding in heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur in the third trimester, during childbirth, or during the first 48 hours following birth. Orthopnea, moist frequent cough, and crackles appear later, when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema.
The National Institute of Child Health and Human Development recommends that fetal heart rate tracings demonstrate certain characteristics to be described as reassuring or normal (category I). These characteristics include: A) bradycardia not accompanied by baseline variability. B) early decelerations, either present or absent. C) sinusoidal pattern. D) tachycardia.
B* Early decelerations, the absence of late decelerations, and the presence of accelerations indicate a normal category I tracing. Bradycardia not accompanied by variability and fetal tachycardia are considered category II tracing. A sinusoidal pattern is considered an ominous sign and is definitely an abnormal category III tracing.
With regard to systemic analgesics administered during labor, nurses should be aware that: A) Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B) Effects on the fetus and newborn can include decreased alertness and delayed sucking. C) IM administration is preferred over IV administration. D) IV patient-controlled analgesia (PCA) results in increased use of an analgesic.
B* Effects depend on the specific drug given, the dosage, and the timing. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.
A woman gave birth to a 7 lb 3 oz boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious likely consequence of bladder distention is: A) urinary tract infection B) excessive uterine bleeding C) a ruptured bladder D) bladder wall atony
B* Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly. A UTI may result from overdistention of the bladder, but is not the most serious consequence. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.
A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if: A) Blood pressure is reduced to prepregnant baseline. B) Seizures do not occur. C) Deep tendon reflexes become hypotonic. D) Diuresis reduces fluid retention.
B* Magnesium sulfate is a CNS depressant given primarily to prevent seizures. A temporary decrease in blood pressure can occur, but is not the purpose of administering this medication. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.
The most prevalent clinical manifestation of placental abruption (as opposed to placenta previa) is: A) Bleeding. B) Intense abdominal pain. C) Uterine activity. D) Cramping.
B* Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding, uterine activity, and cramping may be present in varying degrees for both placental conditions.
With regard to spinal and epidural (block) anesthesia, nurses should know that: A) this type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births. B) a high incidence of postbirth headache is seen with spinal blocks. C) epidural blocks allow the woman to move freely. D) spinal and epidural blocks are never used together.
B* The headaches may be prevented or mitigated to some degree by a number of methods. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for a spinal headache. Spinal blocks may be used for vaginal births, but the woman must be assisted through labor. Epidural blocks limit the woman's ability to move freely. Combined use of spinal and epidural blocks is becoming increasingly popular.
Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? A) Latent: mild, regular contractions; no dilation; bloody show; duration of 2-4 hours B) Active: moderate, regular contractions; 4-7 cm dilation; duration of 3-6 hours C) Lull: no contractions; dilation stable; duration of 20-60 minutes D) Transition: very strong but irregular contractions; 8-10 cm dilation; duration of 1-2 hours
B* The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6-8 hours. No official lull phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8-10 cm dilation; and a duration of 20-40 minutes.
The nurse knows that the second stage of labor, the descent phase, has begun when: A) the amniotic membranes rupture. B) the cervix cannot be felt during a vaginal examination. C) the woman experiences a strong urge to bear down. D) the presenting part is below the ischial spines.
B* The second stage of labor begins with full cervical dilation. During the active pushing phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Rupture of membranes has no significance in determining the stage of labor. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as at 5 cm dilation.
A woman who is 39 weeks pregnant expresses her fear about her impending labor and how she will manage. The nurse's best response is: A) "Don't worry about it. You'll do fine." B) "It's normal to be anxious about labor. Let's discuss what makes you afraid." C) "Labor is scary to think about, but the actual experience isn't." D) "You may have an epidural. You won't feel anything."
B* This statement allows the woman to share her concerns with the nurse and is a therapeutic communication tool. The statement in A negates the woman's fears. The statement in C also negates the woman's fears and is a false sense of security. The statement in D is not true.
With regard to preeclampsia and eclampsia, nurses should be aware that: A) Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters. B) Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver and brain. C) The causes of preeclampsia and eclampsia are well documented. D) Severe preeclampsia is defined as preeclampsia plus proteinuria.
B* Vasospasms diminish the diameter of blood vessels, which impedes blood flow to all organs. Preeclampsia occurs after week 20 of gestation and can run the duration of the pregnancy. The causes of preeclampsia and eclampsia are unknown, though several have been suggested. Preeclampsia includes proteinuria; severe cases are characterized by greater proteinuria or any of nine other conditions.
With regard to afterbirth pains, nurses should be aware that these pains are: A) caused by mild, continual contractions for the duration of the postpartum period. B) more common in first-time mothers. C) more noticeable in births in which the uterus was overdistended. D) alleviated somewhat when the mother breastfeeds.
C* A large baby or multiple babies overdistend the uterus. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. Breastfeeding intensifies afterbirth pain because it stimulates contractions.
A pregnant woman who is at 18 weeks gestation has an elevated blood pressure of 140/98. Past medical history reveals that the woman has been treated for hypertension. On the basis of this information, the nurse would classify this patient as having: A) Preeclampsia B) Gestational hypertension C) Superimposed preeclampsia D) Chronic hypertension
C* Because this patient already has a medical history of hypertension and is now exhibiting hypertension prior to the 20th week of gestation, she would be considered to have superimposed preeclampsia. Preeclampsia would be the classification of a patient without a history of hypertension who was hypertensive following the 20th week of pregnancy. Gestational hypertension occurs after the 20th week of pregnancy in a patient who was previously normotensive. Even though the patient has chronic hypertension, the fact that she is now pregnant determines that she would be classified as having superimposed preeclampsia.
The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is: A) Cryoprecipitate B) Factor VIII and vWf C) Desmopressin D) Hemabate
C* Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally and intravenously; promotes the release of factor VIII and vWf from storage. Treatment with cryoprecipitate or with plasma products such as factor VIII and vWf is acceptable, but because of the associated risk of possible viruses from donor blood products, other modalities are considered safer. Although the administration of the synthetic prostaglandin in Hemabate is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the client who presents with a bleeding disorder.
Which of the following findings would raise concern for the nurse who is monitoring a postpartum patient who had a spontaneous vaginal delivery of a 10 lb baby boy? A) Lochia rubra with minimal clots expressed on fundal massage. B) Fundus midline and firm with nonpalpable bladder. C) Fundus midline and firm with spurts of bright red blood upon fundal massage. D) Patient reports of mild to moderate cramping and request for pain medication.
C* Even though the fundus is firm and midline, the fact that spurts of blood are evident on fundal massage may indicate that a tear is present. Further investigation is required as this is considered nonlochial bleeding. Lochia rubra with minimal clots expressed on fundal massage would be considered a normal finding, given that the patient had an SVD of a large infant. Fundus midline and firm with nonpalpable bladder would be considered a normal finding. A report of mild to moderate cramping with a request for pain medication would be considered a normal finding in the postpartum period; the cramping is due to uterine contractions as the uterus returns to its normal prepregnancy status.
Fetal bradycardia is most common during: A) maternal hyperthyroidism B) fetal anemia C) viral infection D) tocolytic treatment using ritodrine
C* Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, viral infections, and maternal hypothermia. Maternal hyperthyroidism, fetal anemia and tocolytic treatment will most likely result in fetal tachycardia.
Which statement is NOT accurate regarding the effect of breastfeeding on the family or society at large? A) Breastfeeding requires fewer supplies and less cumbersome equipment. B) Breastfeeding saves families money. C) Breastfeeding costs employers in terms of time lost from work. D) Breastfeeding benefits the environment.
C* Less time is lost from work by breastfeeding mothers, in part because infants are healthier than bottle-fed infants. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment, and it saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Also, breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping or disposal.
Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? A) Endometritis B) Wound infections C) Mastitis D) Urinary tract infections
C* Mastitis is infection in a breast, usually confined to a milk duct. Most women who get it are first-time breastfeeders. Endometritis is the most common postpartum infection. Its incidence is higher after a cesarean birth, not in first-time mothers. Wound infections are also a common postpartum complications. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. UTIs occur in 2-4% of all postpartum women. Risk factors include catheterizations, frequent vaginal exams, and epidural anesthesia.
Nurses should be aware that HELLP syndrome: A) is a mild form of preeclampsia. B) can be diagnosed by a nurse alert to its symptoms. C) is characterized by hemolysis, elevated liver enzymes, and low platelets. D) is associated with preterm labor but not perinatal mortality.
C* The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. It is difficult to identify, because the symptoms often are not obvious. It must be diagnosed based off of lab values. Preterm labor is greatly increased with HELLP syndrome, as is perinatal mortality.
Which description of the phases of the second stage of labor is accurate? A) Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30-45 minutes B) Active phase: overwhelmingly strong contractions, Ferguson reflux activated, duration 5-15 minutes C) Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies D) Transitional phase: woman "laboring down," fetal station is 0, duration is 15 minutes
C* The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on multiple factors. The latent phase is the lull, or "laboring down" period, at the beginning of the second stage. It lasts 10-30 minutes on average. The second stage of labor has no active phase. The transition phase is the final phase in the second stage of labor; contractions are strong and painful.
Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? A) The healthy newborn should be taken to the nursery for a complete assessment. B) After drying, the infant should be given to the mother wrapped in a receiving blanket. C) Skin-to-skin contact of mother and baby should be encouraged. D) The father or support person should encouraged to hold the infant while awaiting delivery of the placenta.
C* The unwrapped infant should be placed on the woman's bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding. Although complete assessment in the nursery is the practice in many facilities, it is neither evidence based nor supportive of family centered care. Handing the mother the blanket-wrapped baby is a common practice and more family friendly than separating mother and baby; however, ideally the baby should be placed on the mother skin to skin. The father or support person is likely also anxious to hold and admire the newborn. This can happen after the infant has been placed skin to skin with the mother and breastfeeding has been initiated.
A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states: A) "True labor contractions will subside when I walk around." B) "True labor contractions will cause discomfort over the top of my uterus." C) "True labor contractions will continue and get stronger even if I relax and take a shower." D) "True labor contractions will remain irregular but become stronger."
C* True labor contractions occur regularly, become stronger, last longer and occur closer together. They may become intense during walking and continue despite comfort measures. Typically, true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen. During false labor, contractions tend to be irregular and felt in the abdomen above the navel. Typically the contractions stop with walking or a change of position.
Which sign does NOT precede the onset of labor? A) A return of urinary frequency as a result of increased bladder pressure. B) Persistent low backache from relaxed pelvic joints. C) Stronger and more frequent uterine (Braxton Hicks) contractions. D) A decline in energy, as the body stores up for labor.
D* A surge of energy is a phenomenon that is common in the days preceding labor. After lightening, a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Prior to the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength; bloody show may be passed.
Postbirth uterine/vaginal discharge, called lochia: A) is similar to a light menstrual period for the first 6-12 hours. B) is usually greater after cesarean births. C) will usually decrease with ambulation and breastfeeding. D) should smell like normal menstrual flow unless an infection is present.
D* An offensive odor usually indicates an infection. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia is usually seen after cesarean births. It usually increases with ambulation and breastfeeding.
To provide adequate postpartum care, the nurse should be aware that postpartum depression with psychotic features: A) is more likely to occur in women with more than two children. B) is rarely delusional and is usually about someone trying to harm her (the mother). C) although serious, is not likely to need psychiatric hospitalization. D) is typified by auditory or visual hallucinations.
D* Hallucinations are present in 25% of women with this disorder; paranoid or grandiose delusions (present in 50%), elements of delirium or disorientation, and extreme deficits in judgment accompanied by high levels of impulsivity may contribue to risks of suicide or infanticide. PPD is more likely to occur in first-time mothers. PPD with psychosis is a psychiatric emergency that requires hospitalization.
On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: A) begin an IV infusion of Ringer's lactate solution. B) assess the woman's vitals. C) call the woman's primary health care provider. D) massage the woman's fundus.
D* The nurse should assess the uterus for atony. Uterine tone must be established to prevent excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action. Blood pressure is not a reliable indicator of impending shock from impending hemorrhage; assessing vital signs should not be the nurse's first action. The physician should be notified after the nurse completes assessment of the woman.
Which finding would be a source of concern if noted during the assessment of a woman at 12 hours postpartum? A) Postural hypotension. B) Temperature of 38 C. C) Bradycardia - pulse rate of 55 bpm. D) Pain in left calf with dorsiflexion of left foot.
D* These findings indicate presence of Homans sign, are suggestive of thrombophlebitis, and should be investigated. Postural hypotension is an expected finding related to circulatory changes after birth. A heart rate of 55 bpm is an expected finding in the initial postpartum period. A temperature of 38 C in the first 24 hours most likely indicates dehydration, which is easily corrected by increasing oral fluid intake.
You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measure should you take? A) Call for help B) Insert a Foley catheter C) Start oxytocin (Pitocin) D) Notify the primary health care provider immediately
D* To relieve an FHR deceleration the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also, if oxytocin is being infused, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately. Although it is always a good idea to have extra help during any unanticipated obstetric event, calling for help is not the most important nursing measure at this time. If the FHR were to continue in an abnormal or nonreassuring pattern, a cesarean section might be warranted. This would require the insertion of a Foley catheter; however, the physician must make that determination. Oxytocin may put additional stress on the fetus.
A woman at 39 weeks of gestation with a hx of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency to every 1-2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: A) Eclamptic seizure. B) Rupture of the uterus. C) Placenta previa. D) Placental abruption.
D* Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta. Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests with hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain, and placenta previa with bright red, painless vaginal bleeding.