OB Pharmacology & related interventions NUR III

What are the advantages of administrating PGE 1/2?

!) Reduce the length of labor 2) Decrease the need for Pitocin during induction

What are the Most Common IV Pain Medications Given During Labor according to lecture Powerpoints? Dose? Class?

Stadol (butorphanol tartrate) Nubain (nalbuphine hydrochloride) Fentanyl (sublimaze) butorphanol: 1 - 2 mg IV q 4 hrs, also IM nalbuphine: 10-20 mg IV q 3-6hrs, IM/SQ sublimaze: 50-100 mcg IV q 2hrs, also IM They are all opiod analgesics --- Fentanyl (Sublimaze) is the short acting one

When administrating Prostoglandine (E1 & E2) for help induction or abortion. what adverse effects should we monitor the patient for?

1) GI: N/V, stomach cramp/diarrhea 2) Fever/chills, flushing, HD, hypotention 3) Uterine tachysystole or Hyperstimulation of the uterus 4) Fetal passage of meconium

Generally, the first and most reliable symptom of uterine rupture is ... (1) Other signs may include ... (2)

(1) sudden fetal distress (2)acute and continuous abdominal pain with or without an epidural, vaginal bleeding, hematuria, irregular abdominal wall contour, loss of station in the fetal presenting part, and hypovolemic shock in the woman, fetus, or both

What are the Contraindication in administrating Prostoglandin E1/2? (Saunders & Mosby's Notecards)

1) Active cardiac, hepatic, pulmonary, or kidney disease 2) Acute pelvic inflammatory disease 3) Clients in whom vaginal delivery is not indicated --- or hx of CS/major uterine surgery like removal of uterine fibroid 4) Hx of difficult labor or traumatic labor 5) Mom has fever, infection, Umbilical cord prolapse, Placenta previa, unexplained vaginal bleeding, Regular progressive ctx 6) Fetal malpresentation (Transverse fetal position) ---- or Nonreassuring fetal heart rate pattern ---- or Significant cephalopelvic disproportion

HESI: 1. Pt recieved IV analgesic 20 min ago and the baby is about to be delivered in 10 minutes; what is the nursing intervention? 2. What is the most common cause of maternal death in general anesthesia? how we can prevent it?

1. 20+10=30 min which is IV analgesic peak If baby delivers during peak drug absorption time, notify pediatrician or neonatologist for delivery room assistance and possible use of naloxone (Narcan) for neonate 2. Aspiration of gastric contents into the lung --> Administer drugs to reduce gastric secretions (e.g., famotidine [Pepcid] or clear [nonparticulate]) antacids to neutralize gastric acid.

PowerPoints: 1. When is the best time to administer Ferrous Sulfate? Mosby's Comprehensive: 2. Ferrous sulfate is used in treatment of ... that can also be used as ...

1. After meals to prevent stomach upset 2. anemia --- Antianemic --- prophylactic during pregnancy

HESI: 1. What is the nursing intervention prior to administrating morphine?

1. Check RR and do not administer if respirations <12/min. + have narcotic antagonist available (Narcan).

HESI: 1. Docusate Sodium or ... is given for: 2. adverse reaction of both Bisacodyl (brand name: Doculax) & docustate sodium is: 3. Saunder's: Docusate Sodium is a Emollient laxative meaning that it ..., bysacodyl is a ... laxative 4. Mosby's comprehensive: Colace can also be called a ... agent that ... 5. Ricci: What should be constantly assessed when pt is on docusate?

1. Colace --- constipation or painful defecation due to fourth-degree tear 2. Abdominal cramping (& diarrhea in Ricci) 3. Inhibit absorption of water so fecal mass remains large and soft--- Stimulants (Stimulate motility of large intestine) 4. Bulking --- increase fecal mass and stimulate peristalsis. 5. Stool patterns

Powerpoints: 1. Medications for postpartum hemorrage are: 2. Which postpartum medication should be avoided in pts with asthma? 3. Which postpartum medication should be avoided in pts with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia/eclampsia?

1. Misoprostol (cytotec) --- Prostaglandin antiulcerants Hemabate (carboprost) --- Prostaglandin/oxytocic/uterotonic agents Methergine (methylergonovine maleate) --- Oxytocic/uterotonic agents --- Pitocin 2. Hemabate (carboprost/prostoglandin F2) 3. Methergine (methylergonovine maleate)

HESI: 1. What is the most importatnt risk when giving epidural analgesics? 2. Why analgesia and anesthesia are usually given the midactive phase of labor? 3, Why epidural may cause hypotention? 4. What lab values do the nurse asess for pt requesting epidural?

1. Risk for respiratory depression Saunder's: pruritus, N/V (sign of hypotension) 2. A. If given in the early latent phase of the first stage of labor, it may retard the progress of labor. B. If given late in transition or in the second stage; some may depress the newborn, some may depress CNS and prolong labor and hurt fetus 3. Regional blocks (epidural, caudal, and subarachnoid) cause a temporary interruption of nerve impulses (especially pain) but also cause vasodilation in area below block, causing pooling of blood and hypotension 4. Hgb, Hct, clotting time

Powerpoints: 1. Why NSAIDs are contraindicated during pregnancy? 2. For Cesarean Sections, a ... is used instead of an epidural block

1. They increase risk of pulmonary hypertension in newborns by inhibiting prostaglandins needed to keep open the patent ductus arteriosis in the fetus 2. SPINAL BLOCK

Mosby's Notecards: 1. Ampicilin is a ... penicilin. 2. Which s/s may indicate that the pt has alergies to PCN/ampicilin: 3. After administrating IV PCN/ampicilin nurse: 4. In pt who are receiving IV PCN/ampicin we want to monitor IV site for what adverse reactions?

1. broad spectrum 2. rash, itching, hives, anaphylaxis 3. Monitors patient for 30 minutes when given parenterally; administer epinephrine if anaphylaxis occurs. 4. IV Phlebitis

Saunder's: 1. name opioids: 2. two different types of oxycodone are:

1. heroin, meperidine, morphine, hydromorphone, methadone, oxycodone, hydrocodone, fentanyl 2. Percodan, perkies

HESI: 1. Local anesthesia is used for ... 2. Regional blocks are used for ... are they safe for mother/baby? 3. Regional (esp. epidural and cadual) block is associated with ... regarding to lenght of delivery time 4. BP before epidural block must be: 5. Which statement by the pt may indicate possible injection of analgesic medication into bloodstream. 6. What is the first first signs of hypotension in pt given reginal blocks? 7. The first sign of a block's effectiveness is usually ... 8. In what time intervals we assess BP in pts on injection and continous regional analgesics?

1. pain relief during episiotomy and perineal repair 2. relief of perineal and uterine pain ... Usually safe unless severe hypotension occurs 3. prolonged second stage due to decreased effectiveness of pushing; commonly result in assisted (forceps or vacuum) delivery because of the inability to push effectively during the second stage. 4. >100/70 mm Hg 5. Metallic taste in mouth and ringing in ears denote 6. N/V 7. warmth and tingling in the ball of the foot or the big toe. 8. Determine BP every l-2 min for 15 min after injection and initiate continuous fetal monitoring --- Determine BP every 15 min during continuous regional block infusion

PowerPoint: 1. Antibiotics may be used in ... patients in maternity unit. 2. what are two common Abx that are used in maternity unit? Which route?

1. post c-section 2. Ancef & Ampicillin --- IV

Saunder's: 1. What is the advantage of episural anasthesia? 2. HD is ... in epidural anesthasia. Why? 3. What is the best position for pt on epidural anesthesia?

1. reduces the amount of medication needed to control pain; therefore, the client experiences fewer side effects. 2. caused --- because the dura mater is not penetrated. 3. Side-lying position or place a rolled blanket beneath the right hip to displace the uterus from the vena cava.

HESI: 1. bysacodyl (Duculax) is working withing 5-60min since it is a ... 2. educate the client that bysacodyl (Doculax) should be taken ...

1. stronger suppository 2. only intermittently rather than on a daily basis to avoid dependency and diarrhea

If pt is administered PGE1 (misoprostol) or E2 (dinoprostone) what are safety precautions?

Have oxygen and resuscitative equipment available Fall/injury prevention (hypotention) monitor ctx for hyperstimulation/tachysystole

pitocin dose: Route:

30 units of oxytocin is provided in a 500ml NaCl bag Begin infusion slowly (HESI: high risk for tetany at the beginning) piggy back to allow for prompt DC if needed (HESI) 1-2ml/hour --- increase by 1-2 milliunits q 30 minutes to achieve adequate contraction pattern IV, IM Just know that the Other Book says: oxytocin infusion by diluting 10 units of oxytocin in 1,000 mL of lactated Ringer's solution. Use an infusion pump on a secondary line connected to the primary infusion

19. A client at 10 weeks' gestation elects to have an induced abortion. After receiving oralmifepristone (Mifeprex), she returns to the clinic 2 days later to have misoprostol (Cytotec) insertedvaginally. For when should the nurse schedule a follow-up visit? 1. 4 hours after the procedure 2. 2 weeks after the procedure 3. 4 to 8 days after the procedure 4. 8 to 24 hours after the procedure Mosby's comprehensive

3A follow-up visit4to 8 days later should confirm that the abortion has occurred

What s/s in pt on butorphanol tartrate and nalbuphine (opiod analgesics) is not expected? confusion sedation sweating N/V hypotension sinusoidal-like fetal heart rhythm

All are possible side effects.

... (...) AKA Prostaglandin E2 is in class of ...

Cervidil (dinoprostone) labor inducer

In regarding to ctx in pt on oxytocin during labor, what do you monitor? (HESI)

Contractions should last no longer than 90 seconds to prevent fetal hypoxia

When is the best time to give Pitocin during 3rd stage of labor? Why? (HESI)

Give the oxytocin (Pitocin) after the placenta is delivered because the drug will cause the uterus to contract. If the oxytocic drug is administered before the placenta is delivered, it may result in a retained placenta, which predisposes the client to hemorrhage and infection.

Induction using oxytocin (Pitocin) because of IUGR can increase risk for ... in the newborn.

Hyperbilirubinemia (Excessive accumulation of bilirubin)

... is a condition in which there is a decrease of oxygen to the tissue in spite of adequate blood flow to the tissue.

Hypoxia

Why do we administer oxytocin in pt with hemorrhage during stage 3 of L/D? (Other Book)

It causes the uterine myometrium to contract and helping to constrict the uterine blood vessels, decreasing the amount of vaginal bleeding after delivery

What do you assess in regarding to mom's ctx before administrating misoprostol?

It is contraindicated if mom has more than 6 contractions in a 30 minute period

In what situations we DC oxytocin (Pitocin) if infusing: (HESI)

Late & variable decelerations

Oxytocin (Pitocin) is ... Class: job: Purpose (Mosby's Pharmacology Norecards):

Synthetic version of the hormone already found in the human body Hormones Used to stimulate and strengthen contraindications of the uterus for the purpose of: 1. Inducing term labor 2. Controlling postpartum hemorrhage 3. Managing incomplete or inevitable abortion

HESI: 1. Pt is prescribed ... IM/PO for uterine atony; what is the priority action right before or after administration of med? saunder's: 2. In treatment of postpartum hemorrhage, Ergot alkaloid such as ... is given because it ...

Methergine (methylergonovine maleate) --- Take BP before administration and if 140/90 or above, withhold and notify physician. or carboprost (PGF2) --- can cause fever, bronchospasm, wheezing, HD, and N/V --- Check temperature every 1-2 hr & Auscultate breath sounds frequently 2. Methergine (methylergonovine maleate) --- stimulates uterine muscle, increases the force and frequency of contractions, and produces a firm tetanic contraction of the uterus

Saunders: Prostaglandin E1: Prostaglandin E2:

Misoprostol (Cytotec) intravaginal tablet Dinoprostone vaginal gel, insert, or suppository

WHat do you monitor after administrating of PGE1/misoprostol?

Monitor for signs and symptoms of shock, suchas tachycardia, hypotension, and anxiety

In case of Hemorrhage and Shock in the Postpartum Clients: (saunders)

Position to her side or elevate the right hip; elevate her legs to at least a 30-degree angle. Administer oxygen by nonrebreather face mask or nasal cannula at 8 to 10 L/min. Administer uterotonic medications (e.g., oxytocin, prostaglandins) as prescribed to increase uterine tone

Hormone is produced in: Has role in: role in pregnancy: (Other Book)

Produced in the hypothalamus and released by the posterior pituitary --- its production gradually increases as the fetus matures It plays a role in social bonding, sexual reproduction, childbirth Oxytocine, with the help of the high levels of estrogen, causes the release of propagandist hormones, which play a role in ripening of the cervix. Sucking or touching stimulates the secretion of oxytocin from the posterior pituitary gland --- It causes the muscles around the milk-making glands in your breast to contract & EJECT milk

After deliver, pt c/o pain during breastfeeding, nurse: (Other Book)

Reassure her that this is because oxytocin released by the sucking reflex strengthens the contractions. Mild analgesics can reduce this discomfort.

What do we monitor in pt on Fentanyl (Sublimaze)?

Respiration Hypotention Constipation Urinary retention --- bladder distention

Hormones job in inititaion of labor: (Other Book)

Toward the end of a term pregnancy, levels of progesterone decline and contractions that were previously suppressed by progesterone begin to occur more frequently and with stronger intensity. Increase in sensitivity to oxytocin and release of prostaglandins

What is the effect of opiod analgesics on GU?

Urinary retention and bladder distension

What do you monitor when pt is on pitocin? (HESI)

Use external or internal fetal monitoring, continuously monitor the following: 1. FHR 2. Uterine resting tone 3. ctx frequency, duration, and strength

Would we see order for oxytocin in pt planned for CS? (Mosby's Comprehensive)

Yes, IV infusion for post-Op

If pt has order for disnoprostone/Cervidil/Prostoglandin E2 and Pitocin, how are you administrating them?

You must wait At lest 30 min AFTER REMOVAL of dinoprostone to start pitocin

If pt has order for misoprostol/cytotec/Prostoglandin E1 and Pitocin, how are you administrating them?

You must wait At lest 4hrs AFTER REMOVAL of misoprostol to start pitocin

Why do we avoid the administration of oxytocin in HIV pts? (saunders)

because contractions induced by oxytocin can be strong, causing vaginal tears or necessitating an episiotomy.

How can Pitocin cause fetal Asphyxia? (lack of O2)

by causing placental hypoperfusion and hypotension

Pt recieving butorphanol tartrate and nalbuphine. What is the nursing intervention if pt has hypotension?

maintain the client in a recumbent position (elevate the hip with a wedge pillow or other device

What is the Oxytocin effect on GU? Nurse job? (Other Book)

oxytocin has an antidiuretic effect, resulting in decreased urine flow that may lead to water intoxication --- I&O, bladder distention

Pt on oxytocin complains of a sharp pain accompanied by the abrupt cessation of contractions, what do you suspect? Which pt population are more at this risk? (HESI)

suspect uterine rupture,which is a medical emergency. Immediate surgical delivery is indicated to save the fetus and the mother Women with previous uterine scars are prone to uterine rupture; CS, SX

In which pt population oxytocin must be given with causion? (Mosby's Pharmacology Notecards)

High parity (5 or more) & HTN

Piticin can cause ... in fetus/newborn: (Mosby's Comprehensive)

1) Aphasia (suffocatio) or Anoxia (perinatal, before/after birth, brain injury) 2) Hyperbilirubinemia (hepatic dysfunction) 3) Dysrhythmias (premature ventricular complexes /PVCs], bradycardia)

What are the important considerations in administrating dinoprostone gel/Cervidil/PGE2? (from othe Maternity book)

1) Bring gel to room temperature before administering. 2)Avoid contact with skin. 3) Use STERILE technique to administer. 4) Keep client supine 30 minutes after administering

1. PGE1 misoprostol/cytotec is a ... PGE 2. Class? 3. dinoprostone class?

1. synthetic 2. Aantiulcer agents (Prostaglandin Antiulcerants) 3. Labor Inducers Both are used to stimulate ctx of the uterus, thereby ripening the cervix

Dose and route of Cervidil/dinoprostone/Prostoglandin E2: Dose and route of misoprostol/cytotec/Prostoglandin E1:

10 mg vaginal left for 12 hrs --- after removal if cervix in dilated less than 2cm, then it is not ready for pitocin --- so give second dose of dinoprostone --- wait 30 min after removal to start pitocin 25mcg (1/4 tab) vaginally for ripening q 4 hours, up to 4-5 doses --- wait at least 4hrs before starting pitocin

Saunder's 180: The nurse is reviewing a surgeon's prescription sheet for a preoperative client that states that the client must be nothing by mouth (NPO) after midnight. The nurse should call the surgeon to clarify that which medication should be given to the client and not withheld? 1. Prednisone 2. Ferrous sulfate 3. Cyclobenzaprine 4. Conjugated estrogen

Answer: 1 Rationale: Prednisone is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the ability of the body to withstand stress. When stress is severe, corticosteroids are essential to life. Before and during surgery, dosages may be increased temporarily and may be given parenterally rather than orally. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia. Cyclobenzaprine is a skeletal muscle relaxant. Conjugated estrogen is an estrogen used for hormone replacement therapy in postmenopausal women. These last 3 medications may be withheld before surgery without undue effects on the client

Mosby's Comprehensive 775: A client receiving morphine by patient-controlled analgesia has a respiratory rate of 6 breaths/min. What intervention should the nurse anticipate? 1. Nasotracheal suction 2. Mechanical ventilation 3. Naloxone administration 4. Cardiopulmonary resuscitation

Answer: 3 Naloxone is an opioid (narcotic) antagonist and will reverse respiratory depression caused by opioids. 1, 2, 4 This is not needed; naloxone will correct the respiratory depression

What S/S (side effects) do you monitor for in Pt on oxytocin? How? (Mosby's Pharmacology Notecards)

High HR, Low BP --> monitor VS Premature ventricular contraction --> check ctx & FHR N/V Water intoxication --> Evaluate for excessive water retention --> weight, I&O, LOC, lung sounds --> oxytocin has an antidiuretic effect, resulting in decreased urine flow that may lead to water intoxication --s/s: N, HD

PGE2, Prepidil Gel,Prostin E2 AkA ...

dinoprostone/Prostoglandin E2/Cervidil

Pt full term but not dilated and no signs of effacement, what is the intervention to help her go into labor process?

1) Administer dinoprostone/Prostoglandin E2, Prostin E2, PGE2, /Cervidil/Prepidil Gel to help her cervix rippening (dilate & efface) & start ctx 2) If you remove the gel & cervix is dilated >2cm --> pitocin after 30 min 3) If If you remove the gel & cervix is NOT dilated >2cm --> administer 2nd dose of gel

HESI: 1. pt with hx of CHTN has postpartum hemmorrhage, what is the drug of choice to give her? 2. Pt has an order for methylergonovine and carboprost during labor or before delivery of the placenta; nurse:

1. Methylergonovine is not given to clients with hypertension because of its vasoconstrictive action. Pitocin is given with caution to those with hypertension 2. Never give methylergonovine or carboprost to a client while she is in labor or before delivery of the placenta --- these are for postpartum hemmorage

Peak levels of oxytocin and endorphins is seen in ... The most common adverse effect of oxytocin is ... leading to fetal ... (Other Book)

3rd stage uterine hyperstimulation ... impaired oxygenation

HESI: A. What is the nursing intervention if hypotension occurs in pt on analgesics? B. How can nurse intervent to increase effectiveness of pushing in pt receiving IV analgesics? C. If fetus is in occiput-posterior position, what do we consider befor administrating anesthesia? D. What is the cardinal sign of persistent posterior fetal position? What do we consider about this sign if pt is on anesthasia?

A. 1. Immediately turn client onto left side. 2. Increase IV infusion. 3. Begin O2 at 10 L/min by facemask. 4. Notify health care provider stat and have EPHEDRINE available at bedside. 5. Assess FHR. B. Stop continuous infusion at end of stage I or during transition C. Internal rotation is harder to achieve when the pelvic floor is relaxed by anesthesia; this results in a persistent occiput-posterior position of fetus. D. Cardinal sign=major sign --- Mother cannot tell you she has back pain, which is the cardinal sign of persistent posterior fetal position

289. 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? 1. Provide pain relief measures. 2. Prepare the client for an amniotomy. 3. Promote ambulation every 30 minutes. 4. Monitor the oxytocin infusion closely. (saunders)

Anser: 1 Rationale: Hypertonic uterine contractions are painful, occur frequently, and are uncoordinated. Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern. An amniotomy and oxytocin infusion are not treatment measures for hypertonic contractions; however, these treatments may be used in clients with hypotonic dysfunction. A client with hypertonic uterine contractions would not be encouraged to ambulate every 30 minutes, but would be encouraged to rest

Saunder's 316: The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of a vulvar hematoma. Which assessment finding would best indicate the presence of a hematoma? 1. Changes in vital signs 2. Signs of heavy bruising 3. Complaints of intense pain 4. Complaints of a tearing sensation

Answer: 1 Rationale: Because the client has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure, or a tearing sensation. Changes in vital signs indicate hypovolemia in an anesthetized postpartum client with vulvar hematoma. Option 2 (heavy bruising) may be seen, but vital sign changes indicate hematoma caused by blood collection in the perineal tissues.

Mosby's Comprehensive 755: A client receiving morphine is being monitored by the nurse for signs and symptoms of overdose. Which clinical findings support a conclusion of overdose? Select all that apply. 1. Polyuria 2. Lethargy 3. Bradycardia 4. Dilated pupils 5. Slow respirations

Answer: 2, 3, 5. Morphine does not increase urine output. The CNS depressant effect of morphine causes lethargy. The CNS depressant effect of morphine causes bradycardia. Morphine causes constriction of pupils. The CNS depressant effect of morphine causes bradypnea.

Cervidil (dinoprostone) is used to ...

stimulate ctx --> ripening cervix (Ripen=get mature)

Tx of Hydatidiform Mole: (saunders)

1. Evacuation of the mole is done by vacuum aspiration 2. oxytocin is administered after evacuation to contract the uterus.

In case of Dystocia if pt has hypotonic ctx (short, irregular, weak) what is the tx? (saunders)

Amniotomy + oxytocin infusion

Powerpoints: What are the 2 common medications that are contraindicated during pregnancy?

NSAIDS: ketorolac --- brand name: Toradol Motrin (ibuprofen)

PowerPoints: (1) ... is a laxative suppository to promote bowel movement post delivery, especially for post-surgery clients with gas discomfort or constipation. (2) Dose & route? (3) Educate client to ...

(1) Bisacodyl (brand name: Doculax) (2) suppository given 10 mg PR (per rectum) q 12 hours PRN (3) keep in place atleast 5 minutes --- HESI: Usually effective in 15 min-1 hr --- Ricci: Use stimulant laxatives such as bisacodyl only intermittently rather than on a daily basis to avoid dependency and diarrhea.

HESI: 1. In pts with order for Ancef or ampicilin what do you always asses before administration? Saunder's : 2. what is Pseudomembranous colitis? 3. Pseudomembranous colitis a possible adverse effect of cephalosporins. what s/s in pt may indicate she has Pseudomembranous colitis? 3. What is the nursing intervention?

1. Alergies to cephalosporin & penicillin 2. Pseudomembranous colitis is swelling or inflammation of the large intestine (colon) due to an overgrowth of Clostridioides difficile (C difficile) bacteria. This infection is a common cause of diarrhea after antibiotic use. 3. severe diarrhea, 4. Notify the physician --- In some situations, antibiotic-associated gastrointestinal disturbances such as diarrhea may require contact precautions

In what situations you may stop the infusion of oxytocin & notify the physician? (Mosby's Pharmacology Notecards)

1. If the resting uterine pressure is greater than 15 to 20 mm Hg 2. If cts are longer than 1 minute 3. If ctx frequency is > 2-3 minutes 4. If alteration in fetal heart rhythm/rate occurs (DECAl)

Ricci: 1. for postpartum hemorrhoid comform pt can use: Saunder's: 2. Education regarding to hemorrhoids: 3. Hemorrhoid s/s:

1. Cool witch hazel pads, such as Tucks Pads, can be used. The pads are placed at the rectal area, between the hemorrhoids and the perineal pad. These pads cool the area, help relieve swelling, and minimize itching. 2. a. Soaking in a warm sitz bath b. Sitting on a soft pillow c. Eating high-fiber foods and drinking sufficient fluids to avoid constipation d. Increasing exercise, such as walking 3. Bright red bleeding with defecation, rectal pain/itching

1. How long does it sually take for docustate sodium (Colace) to be effective? 2. How long does it sually take for bysacodil (Doculax) to be effective?

1. PP: takes 3-5 days to take effect --- HESI: 1-3days 2. HESI: in 15 min-1 hr

In case of Hypertonic Contractions or a Nonreassuring Fetal Heart Rate during Oxytocin Infusion: (saunders)

1. Stop the oxytocin infusion. 2. Turn the client on her side, stay with the client, and ask another nurse to contact the health care provider (HCP). 3. Increase the flow rate of the intravenous (IV) solution that does not contain the oxytocin. 4. Administer oxygen, 8 to 10 L/ minute, by snug face mask. 5. Assess maternal vital signs; fetal heart rate and patterns; and frequency, duration, and force of contractions. 6. Document the event, actions taken, and the response.

Mosby's Comprehensive 55: Based on the client's reported pain level, the nurse administers 8 mg of the prescribed morphine. The medication is available in a 10 mg syringe. Wasting of the remaining 2 mg of morphine should be done by the nurse and a witness. Who should be the witness? 1. Nursing supervisor 2. Licensed practical nurse 3. Client's health care provider 4. Designated nursing assistant

Answer: 2 The wasting of controlled substances should be witnessed by two licensed personnel according to federal regulations; this can be done by an RN or LPN. Although the nursing supervisor is licensed and may perform this function, it is not an efficient use of this individual's expertise. Federal regulations do not require the participation by the client's health care provider in this situation. A nursing assistant is not a licensed person who can take responsibility for the wasting of controlled substances.

HESI: IV and IM analgesics onset? peak? duration? What are the nursing interventions regarding to environment of pt on analgesics?

IV Administration: Onset: 5 minutes • Peak: 30 minutes • Duration: 1 hr IM Administration: Onset: within 30 min • Peak: 1-3hr • Duration: 4-6 hrs Decrease environmental stimuli: Darken room, reduce number of visitors, turn off TV.

... (opiod analgesic) can cause CNS depression.

Morphine

Do we administer oxytocin & send pt home? (HESI)

NO, .The client must always be attended and monitored for: 1. FHR 2. Uterine resting tone 3. ctx frequency, duration, and strength: ctx should last no longer than 90 seconds to prevent fetal hypoxia

What would you possibly see in order for pt with fetal death or missedabortion during second trimester in order to TOP?

Prostaglandin E1: Misoprostol (Cytotec) intravaginal tablet Prostaglandin E2: Dinoprostone vaginal gel, insert, or suppository (TOP=termination of pregnancy)

Which hormones maintain pregnancy? How?

Relaxin: Increase in flexibility of the pubic symphysis, permitting the pelvis to expand during delivery & dilation of the cervix, making it easier for the fetus to enter the vaginal canal; suppress the release of oxytocin by the hypothalamus & delay the onset of labor contractions & Progestrone: called the "hormone of pregnancy" because supports endometrium to provide an environment conducive to fetal survival --- Produced by the corpus luteum during the first few weeks of pregnancy and then by the placenta until term --- (1)Initially, causes thickening of the uterine lining in anticipation of implantation of the fertilized ovum --- (2) From then on, it maintains the endometrium, inhibits uterine contractility, and assists in the development of the breasts for lactation

What are the contrdictions to use of oxytocin? (HESI & Mosby's Pharmacology Notecards)

Remember: In Lecture PP just mentioned Tachysystole & Non-reassuring FHR 1. Known cephalopelvic disproportion (CPD) [when a baby's head or body is too large to fit through the mother's pelvis] 2. Floating fetus (Unengaged fetal head) 3. Unfavorable fetal position or presentation 4. Fetal stress/distress (Non-reassuring FHR --> both DECALs + high/low HR) without evidence of imminent delivery 5. Unripe cervix 6. Tachysystole 7. Placenta previa or cord prolapse 8. Prior classical incision into uterus; CS, Sx 9. Active genital herpes infection

Use ... with caution in a client with preexisting opioid dependency, because these medications can precipitate withdrawal symptoms in the client and the newborn.

butorphanol tartrate and nalbuphine

Mosby's Comprehensive: Pt has order for IV carboprost 250 mcg/ml; nurse:

carboprost should never be administered IV, It is IM.

Pt has fetal death or missedabortion during second trimeste what do we administer to expulsion and expel uterine contents?

dinoprostone/Prostoglandin E2, Prostin E2, PGE2, /Cervidil/Prepidil Gel Theses are all the same

Woman with severe ctx asks for oxytocin to help speeding the process of labor, nurse: (Mosby's Pharmacology Notecards)

inform her that oxytocin increases force, frequency, and duration of uterine contractions.

What is the antidote for butorphanol tartrate and nalbuphine. In what situation it is more necessary to have it accessible?

naloxone (Narcan) readily accessible, especially if delivery is expected to occur during peak medication absorption time.

Uterus (myometrium) become more sensitive to oxytocin ... (Other book)

near term

The woman in labor with severe preeclampsia typically receives ... (Other Book)

oxytocin to stimulate uterine contractions and magnesium sulfate to prevent seizure activity.

Why do we start IV Pitosin slowly? (HESI)

The uterus is most sensitive to becoming tetanic at the beginning of the infusion

HESI: Morphine is a ... (1) drug that produce narcosis and have a higher risk for ... (2) butorphanol & nalbuphine are ... (3) have less respiratory depression but ... (4) 5. what is the postpartum complication mostly assossiated with general anesthasia? Nursing intervention?

(1) Agonist narcotic (2) causing maternal and fetal respiratory depression (3) Antagonist (4) must be used with caution in a mother with preexisting narcotic dependency because withdrawal symptoms occur immediately. 5. Postpartum uterine atony (uterus fails to contract after delivery of the baby & can lead to hemorrhage) --- Assess closely for uterine atony; check fundal firmness and uterine contraction.

What medications is given as analgesic through epidural?

(PP) (HESI) fentanyl citrate, morphine

PoerPoint: 1. ... is a stool softener to help prevent straining postpartum especially in clients with tears/lacerations. 2. Dose & roue: 3. Educate client that ...

1. Docusate Sodium (brand name: Colace) 2. Given 50 mg PO q 12 hours 3. medication takes 3-5 days to take effect --- HESI: 1-3days + increase fluid intake

HESI: 1. Pt requesting PO analgesic during labor, nurse: 2. Which route of analgesicsis administration prefered for pt in labor? Why?

1. Explain to her that labor retards gastrointestinal activity and absorption of PO med 2. IV is preferred to IM because the onset and peak occur more quickly and the duration of the drug is shorter.

PowerPoints: Comparing Epidoral & Spinal block: 1. Dose: 2. How many doses: 3. Onset: 4. Causing significant neuromuscluar block 5. Point of administration:

1. Epidural : high (10-20ml) --- Spinal: low (1.5-2ml) 2. Epidural: Multiple --- Spinal: Single 3. Epidural: slow (30min) --- Spinal: fast (5min) 4. Epidural: No --- Spinal: Yes 5. Epidural: various --- Spinal: specific point to avoid damaging spinal cord

PowerPoints: 1. ... is ususally used postpartum to help produce red blood cells to make up for blood loss. 2. Dose & route: HESI: In educationing pt who has an order for Ferrous Sulfate postpartum, nurse tell her that: 3. to increase absorption of this med, it is better if she ... 4. Ferrus sulfate should not be taken with ... which decrease absorption 5. If she has morning sickness 6. her bowl movement and stool changes: 7. Laboratory values should be checked for: 8. Liquid form may be better if drinking with ... to prevent ...

1. Ferrous Sulfate (Iron) 2. Given 325 mg PO after meal q 12 hours 3. takes it with vitamin C source such as orange juice (can mix with a small amount of juice) 4. cereal, eggs, or milk (Google: tea, coffee, dairy, soybean products) 5. Should be taken in the evening 6. can have constipation/diarrhea & stool turn dark green to black --- In case of consti[pation increase fiber and fluid intake 7. increased reticulocytes and rising Hgb and Hct 8. straw to decreases tooth staining since liquid form can stain the teeth

Saunder's: 1. IV phlebitis s/s are ... 2. If s/s of IV phlebitis is observed, nurse:

1. Heat, redness, tenderness at the site, Not swollen or hard, IV infusion sluggish 2. a. remove the IV device immediately (If thrombophlebitis occurs, do not irrigate the IV catheter) b. restart it in the opposite extremity c. notify the HCP if phlebitis is suspected d. apply warm, moist compresses, as prescribed.

Uterine atony occur s when the uterus fails to contract after the delivery of the baby, in this situation, nurse:

1. Massage the boggy uterus to stimulate contractions and expression of any accumulated blood clots 2. Administration of uterotonic drug immediately; Oxytocin (Pitocin) methylergonovine maleate (Methergine) misoprostol (Cytotec; synthetic PGE1) carboprost (Hemabate; derivative of PGF2a)

HESI: 1. Ideal method of pain control postpartum is ... 2. ... is a catheter threaded into epidural space with continuous infusion of ... 3. What is the badverse reactions of morphine?

1. Patient-controlled analgesia (PCA) that usually gives smaller doses of morphine 2. Continuous epidural analgesia --- fentanyl citrate, morphine 3. Fetal narcosis, distress • Hypotension • Itching • Urinary retention • Respiratory depression

What are the pharmacological and mechanical ways of starting elective induction? Mosby's comprehensive

1. Pharmacological a. Prostaglandin: vaginal insertion of E1 (emisoprostol [Cytotec]) or E2 (dinoprostone/Cervidil/Prepidil) to promote cervical softening (ripening) and effacement b. Oxytocin: IV approximately 8 to 12 hours after prostaglandin administration to stimulate contraindications (in lecture pp says 30 min after dinoprostone and 4hrs after misoprotol) 2. Mechanical: a. Artificial rupture of membranes (AROM) (amniotomy) b. Nipple massage to stimulate secretion of oxytocin from posterior pituitary gland

HESI: 1. How do we administer IV analgesics? When? Why at this time? 2. Why would we see order for promethazine and hydroxyzine in pt in labor?

1. Push IV bolus into line slowly, at the beginning of a contraction (i.e., give medication during contraction, when uterine blood vessels are constricted, so less analgesic reaches the fetus 2. Tranquilizers (ataractics and phenothiazines),such as promethazine and hydroxyzine, are used in labor as analgesic-potentiating drugs to decrease the amount of narcotic needed and to decrease maternal anxiety

Mosby's comprehensive: 1. before administrating opiod analgesics make sure ... is/are available. 2. why do we want to administer opiod analgesics before pain becomes severe? 3. what are the possible causes of: a. Prolonged strong contractions b. Taut, board-like abdomen c. Increased pulse and temperature d. Hypertension e. Hypotension f. Bright red vaginal bleeding g. Meconium-stained amniotic fluid h. Abnormal variations in FHR patterns (nonreassuring fetal sign)

1. R support and opioid antagonist naloxone (Narcan) 2. because analgesics are less effective when pain is severe 3. a. tetanic uterus b. abruptio placentae c. infection d. preeclampsia e. effect of epidural or spinal anesthesia f. placenta previa g. breech position or late nonreassuring fetal sign h. nonreassuring fetal sign

HESI: 1. Ketorolac or ... is in ... class 2. What are the adverse effects of Ketorolac? 3. What do you educate pt taking ketorolac? 4. Changes in stool with ketorolac/NSAID? 5. Ricci: Nurse monitor pt on ketorolac/NSAID for:

1. brand: Toradol --- NSAID 2. GI irritation, bleeding • Nausea, vomiting, constipation • Elevated liver enzymes • Prolonged coagulation time • Tinnitus • Thrombocytopenia • Fluid retention • Nephrotoxicity • Blood dyscrasias 3. Teach to take with food or milk to reduce GI symptoms --- watch for signs of bleeding --- avoid alcohol --- to observe for tinnitus --- routine appointments to check liver/ renal labs and CBC 4. tarry stools (melena) 5. Monitor for headache, dizziness, nausea, vomiting, constipation, or diarrhea --- s/s of bleeding, such as bruising, epistaxis, gingival bleeding, or frank or occult blood in urine or stool

HESI: 1. Ancef is a ... medication that can have a ... spectrum and possible adverse reactions such as: Saunder's: 2. Ancef meds:

1. cephalosporin --- broad a. Allergic reactions b. Thrombophlebitis c. GI distress d. Superinfection (infection occurring after or on top of an earlier infection, especially following treatment with broad-spectrum antibiotics) 2. Ancef = CEPHalosporin --- All start with CEF or CEPH --- Ex. cefdinir, cefazolin, cephalexin (Keflex)

1. PR rour of medication means: 2. After administration of bisacodyl, pt c/o burning sensation. Nurse:

1. per rectum 2. educate her that because it is a contact laxative that stimulates rectal mucosa directly, there may be some burning

Lecture: 1. Epidural consists of ... 2. Epidural catheter inserted ... 3. Remains in place ... 4. Stays in a locked box to ... 5. Higher-risk Clients are those who have/are: 6. CONTRAINDICATED if: 7. Adverse effects:

1. ropivacaince/fentanyl 2. through the lumbar (between L3-L4) into the epidural space 3. throughout labor and delivery 4. prevent tampering 5. Higher-risk: A.Obesity B. asthma, OSA, C. cardiac disease, coagulopathy (or bleeding disorder; blood can't coagulate/form clots) D. spinal cord injuries (including scoliosis meaning sideways curvature of the spine) substance abuse E. hx of liver disease 6. CONTRADICATED: A. Client refusal, B. tumor/infection at needle puncture site C. coagulopathy problems (or bleeding disorder; blood can't coagulate/form clots) or Anticoagulant therapy D. Increased ICP (Intracranial pressure; pressure inside skull/brain) D. Hypovolemic shock (antepartum hemorrhage can cause shock) E. Specific med allergies (-caine drugs) F: HESI: CNS disorders, previous back surgery, or spinal anatomic abnormality G: Saunder's: hx of multiple abscesses H: Saunder's: sepsis 7. Hypotension, non-reassuring FHR subsequent to hypotension, slowed second stage of labor, delay in return of bladder sensation, lower back pain

Other Book: 1. Epidural block is usually started after labor is well established, typically ... 2. what is CSE analgesia? 3. What are the advantages of CSE analgesia? 4. What is spinal (intrathecal) pain-management? 5. Advantages & disadvantages of spinal anesthasia?

1. when cervical dilation is greater than 5 cm 2. Combined spinal-epidural --- This technique involves inserting the epidural needle into the epidural space and subsequently inserting a small-gauge spinal needle through the epidural needle into the subarachnoid space. An opioid, without a local anesthetic, is injected into this space. The spinal needle is then removed and an epidural catheter is inserted for later use 3. rapid onset of pain relief (within 3 to 5 minutes) that can last up to 3 hours ---- allows the woman's motor function to remain active ---- Her ability to bear down during the second stage of labor is preserved because the pushing reflex is not lost, and her motor power remains intact --- allows her to ambulate (which she probabely choose not to because of sedation and fatigue) 4. injection of an anesthetic "caine" agent, with or without opioids, into the subarachnoid space (just know that Caine means: Bupivacaine (Marcaine) that is most commonly used---less common use lidocaine (lignocaine), tetracaine, procaine, ropivacaine, levobupivicaine, prilocaine, or cinchocaine) 5. Easy to administer, rapid-onset pain relief, less likely to cause newborn respiratory depression, and do not cause motor blockade --- BUT pain relief is limited by the narcotic's duration of action, which may be only a few hours and not last through the labor + HD

A. What is phlebitis? PowerPoint: B. Post partum pain management medications are: class/route: (8) C. What are the doses of post partum pain management medications?

A. Phlebitis is an inflammation of the vein that can occur from mechanical or chemical (medication) trauma or from a local infection --- can cause the development of a clot (thrombophlebitis). B. 1. Post-surgery only: Morphine IV --- opioid/Narcotic 2. Post-surgery only: Tylenol/Offirmev (generic: acetaminophone) IV --- analgesic 3. Post-surgery only: Ketorolac (brand: Toradol) IV --- NSAID 4. Oxycodone (Percocet) PO --- Opioids 5. Ibuprofen (Motrin) PO --- NSAIDs 6. (Ricci: cool) Witch Hazel "tux" pads PRN perineal/anal discomfort --- topical analgesics/anorectal preparations 7. Dermoplast spray PRN perineal/anal discomfort --- topical anesthetics 8. ICE!!! 3. Morphine --- 1 - 2mg IV q 2 hrs PRN pain Offirmev --- 1000 mg IV q 6 hrs PRN pain ketorolac---15-30 mg IV q 6 hrs PRN pain oxycodone --- 1-2 tab 5/325mg q 4hrs PRN pain Ibuprofen --- 600-800 mg q 6-8hrs PRN pain

Mosby's Comprevensive 336: A client has severe diarrhea, and the health care provider prescribes intravenous fluids, sodium bicarbonate, and an antidiarrheal medication. Which most frequently ordered antidiarrheal drug does the nurse expect the health care provider to prescribe? 1. Bisacodyl (Dulcolax) 2. Psyllium (Metamucil) 3. Loperamide (Imodium) 4. Docusate sodium (Colace)

ANswer: 3 This drug inhibits peristalsis and prolongs transit time by its effect on the nerves in the muscle wall of the intestines. 1 --- This drug is a laxative, not an antidiarrheal; it increases GI motility. 2 --- This is not an antidiarrheal; it is a bulk laxative that promotes easier expulsion of feces. 4 --- This drug corrects constipation, not diarrhea; water and fat are increased in the intestine, permitting easier expulsion of feces

Mosby's Comprehensive 307. After orthopedic surgery, a 15-year-old adolescent reports a pain rating of 5 on a scale of 0 to 10. A nurse administers the prescribed 5 mg of oxycodone every 3 hours prn. Two hours after having been given this medication, the adolescent reports a pain rating of 10 out of 10. What action should the nurse take? 1. Administer another dose of oxycodone within 30 minutes. 2. Report that the adolescent has an apparent idiosyncrasy to oxycodone. 3. Tell the adolescent that additional medication cannot be given for 1 more hour. 4. Request that the health care provider evaluate the need for additional medication

ANswer: 4 The nurse made the assessment that the medication was ineffective in relieving the adolescent's pain for the duration prescribed. This information should be communicated to the health care provider for evaluation. The prescription is for administration every 3 hours; legally it can be given only within these guidelines. There are no data to support this; the amount of medication was probably inadequate for the adolescent's pain tolerance level. The nurse should not ignore the adolescent's need for pain relief.

134. A client's membranes rupture while her labor is being augmented with an oxytocin (Pitocin) infusion. A nurse observes variable decelerations in the fetal heart rate on the fetal monitor strip. What action should the nurse take next? 1. Change the client's position. 2. Take the client's blood pressure. 3. Stop the client's oxytocin infusion. 4. Prepare the client for an immediate birth (Mosby's Comprehensive)

Answer: 1 Variable decelerations usually are seen as a result of cord compression; a change of position will relieve the pressure on the cord. 2--> Variable decelerations are not related to the mother's blood pressure. --> Variable decelerations are not oxytocin related 4 --> This is premature; other nursing measures should be tried first. Reference: Ch 25, Intrapartum Period, Nursing Care During the Intrapartum Period

182. A client at 38 weeks' gestation is admitted for induction of labor. Her membranes ruptured 12 hours ago. There are no other signs of labor. Which medication does the nurse anticipate will be prescribed? 1. Oxytocin (Pitocin) 2. Estrogen (Premarin) 3. Ergonovine (Ergotrate) 4. Progesterone (Prometrium) (Mosby's Comprehensive)

Answer: 1 Oxytocin (Pitocin) is a small polypeptide hormone synthesized in the hypothalamus and secreted from the neurohypophysis (posterior pituitary gland) during parturition or suckling; it promotes powerful uterine contractions and thus is used to induce labor. 2-->Estrogen (Premarin) suppresses the follicle-stimulating and luteinizing hormones, thus helping to maintain the pregnancy. 3-->Ergonovine (Ergotrate) can lead to sustained contractions, which is contraindicated during labor; it may be prescribed in the postpartum period to promote or maintain a contracted uterus. 4-->Progesterone (Prometrium) causes hyperplasia of the endometrium in preparation for implantation of the fertilized ovum; later it helps to maintain the pregnancy. Reference: Ch 26, Induction or Stimulation of Labor, Data Base

Saunder's 299. The nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client required an episiotomy and has several hemorrhoids. What is the priority nursing consideration for this client? 1. Client pain level 2. Inadequate urinary output 3. Client perception of body changes 4. Potential for imbalanced body fluid volume

Answer: 1 Rationale: The priority nursing consideration for a client who delivered 2 hours ago and who has an episiotomy and hemorrhoids is client pain level. Most clients have some degree of discomfort during the immediate postpartum period. There are no data in the question that indicate inadequate urinary output, the presence of client perception of body changes, and potential for imbalanced body fluid volume

Mosby's Comprehensive 119: A nurse is caring for an obese client in early labor. The anesthesiologist discussed several types of analgesia/anesthesia with the client and recommended one. The client requests clarification before signing the consent form. Which type did the anesthesiologist recommend? 1. Epidural anesthesia 2. Oral opioid analgesia 3. Pudendal nerve anesthesia 4. IV infusion of opioid analgesia

Answer: 1 Epidural anesthesia during the first stage of labor decreases metabolic and respiratory demands and is preferred for obese clients. 2, 4 --- Obese women are sensitive to systemic opioids, which predispose them to respiratory depression; oral medications do not have a uniform rate of absorption and are not recommended during labor. 3 --- A pudendal block does not reach the uterus, so contractions are felt; it is used during the second stage of labor.

Mosby's Comprehensive 120: During labor a client who has been receiving epidural anesthesia has a sudden episode of severe nausea, and her skin becomes pale and clammy. What is the nurse's immediate reaction? 1. Turn the client on her side. 2. Notify the health care provider. 3. Check the vaginal area for bleeding. 4. Monitor the fetal heart rate every three minutes.

Answer: 1 Maternal hypotension is a common complication of this anesthesia during labor, and nausea is one of the first clues that this has occurred. Turning the client onto her side will deflect the uterus from putting pressure on the inferior vena cava, which causes a decrease in blood flow. 2 --- If signs and symptoms do not abate after turning on the side, the health care provider should be notified. 3 --- This is not a specific observation after epidural anesthesia; it is part of the general nursing care during labor. 4 --- If the FHR is being monitored, it is a constant process and should be recorded every 15 minutes; if not, the FHR should be checked and recorded every 15 minutes.

270. The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action? 1. Administer oxygen via face mask. 2. Place the mother in a supine position. 3. Increase the rate of the oxytocin intravenous infusion. 4. Document the findings and continue to monitor the fetal patterns. (saunders)

Answer: 1 Rationale: Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8 to 10 L/minute via face mask is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufficiency resulting from stimulation of contractions by this medication. Although the nurse would document the occurrence, option 4 would delay necessary treatment.

Saunder's 340: An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily accessible should respiratory depression occur? 1. Naloxone 2. Morphine sulfate 3. Betamethasone 4. Hydromorphone hydrochloride

Answer: 1 Rationale: Opioid analgesics may be prescribed to relieve moderate to severe pain associated with labor. Opioid toxicity can occur and cause respiratory depression. Naloxone is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine sulfate and hydromorphone hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity

121. A nurse is caring for a primigravida during labor. At 7 cm dilation a prescribed pain medication is administered. Which medication requires monitoring of the newborn for the side effect of respiratory depression? 1. Butorphanol (Stadol) 2. Hydroxyzine (Vistaril) 3. Promethazine (Phenergan) 4. Diphenhydramine (Benadryl) (Mosby's Comp[rehensive)

Answer: 1 Respiratory depression may occur in the newborn because the duration of action of Butorphanol (Stadol) is 3 to 4 hours and circulating blood levels will be high if birth occurs within that time. 2, 3, 4 These are antihistamines that have a sedative effect and are administered early in labor to promote sleep and decrease anxiety.

15. The cervix of a client in labor is dilated 8 cm. She tells a nurse that she has a desire to push and is becoming increasingly uncomfortable. She requests pain medication. How should the nurse respond? 1. Help her to take panting breaths. 2. Prepare the birthing bed for the birth. 3. Assist her out of bed to the bathroom. 4. Administer the prescribed butorphanol (Stadol) (Mosby's Comp[rehensive)

Answer: 1 This is the appropriate breathing technique for the transition phase; it prevents the client from pushing too early. 2. The client is not fully dilated and is not ready to give birth. 3. The client is in active labor; she should be offered a bedpan if she requests to go to the bathroom. 4. Butorphanol (Stadol) should not be administered in this phase of labor because the peak of action lasts up to 1 hour and the duration is 1 to 3 hours; the infant may be born with respiratory depression.

Mosby's Comprehensive 136: A client's membranes spontaneously rupture during active labor. The nurse inspects the perineum and determines that the umbilical cord is not visible. What is the next nursing action? 1. Auscultate the FHR. 2. Time the contractions. 3. Call the health care provider. 4. Obtain the maternal vital signs.

Answer: 1 When the membranes rupture, there is always the possibility of a prolapsed cord leading to fetal compromise, which will manifest itself in a slow FHR. 2 --- This is regularly done before and after the membranes rupture; however, fetal status takes priority. 3 --- This is unnecessary unless there is a marked change in the FHR. 4 --- This is done routinely throughout the labor process; at this time fetal status takes priority

287. 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 4. Administration of oxytocin for induction 5. Potassium level of 3.6 mEq/L (3.6 mmol/L) (saunders)

Answer: 1, 2, 3 Rationale: Risk factors that increase a woman's risk for dysfunctional labor include the following: advanced maternal age, being overweight, electrolyte imbalances, previous difficulty with fertility, uterine OVERSTIMULATION WITH OXYTOCIN, short stature, prior version, masculine characteristics, uterine abnormalities, malpresentations and position of the fetus, cephalopelvic disproportion, maternal fatigue, dehydration, fear, administration of an analgesic early in labor, and use of epidural analgesia. Age 54 is considered advanced maternal age, and a body mass index of 28 is considered overweight. Previous difficulty with infertility is another risk factor for labor dystocia. A potassium level of 3.6 mEq/L (3.6 mm ol/L) is normal and administration of oxytocin alone is not a risk factor; risk exists only if uterine hyperstim - ulation occurs.

Saunder's 287: 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 4. Administration of oxytocin for induction 5. Potassium level of 3.6 mEq/L (3.6 mmol/L)

Answer: 1, 2, 3 Rationale: Risk factors that increase a woman's risk for dysfunctional labor include the following: advanced maternal age, being overweight, electrolyte imbalances, previous difficulty with fertility, uterine overstim ulation with oxytocin, short stature, prior version, masculine characteristics, uterine abnormalities, malpresentations and position of the fetus, cephalopelvic disproportion, maternal fatigue, dehydration, fear, administration of an analgesic early in labor, and use of epidural analgesia. Age 54 is considered advanced maternal age, and a body mass index of 28 is considered overweight. Previous difficulty with infertility is another risk factor for labor dystocia. A potassium level of 3.6 mEq/L (3.6 mm ol/L) is normal and administration of oxytocin alone is not a risk factor; risk exists only if uterine hyperstim - ulation occurs

saunder's 111: A client rings the call light and complains of pain at the site of an intravenous (IV) infusion. The nurse assesses the site and determines that phlebitis has developed. The nurse should take which actions in the care of this client? Select all that apply. 1. Remove the IV catheter at that site. 2. Apply warm moist packs to the site. 3. Notify the health care provider (HCP). 4. Start a new IV line in a proximal portion of the same vein. 5. Document the occurrence, actions taken, and the client's response.

Answer: 1, 2, 3, 5 Rationale: Phlebitis is an inflammation of the vein that can occur from mechanical or chemical (medication) trauma or from a local infection and can cause the development of a clot (thrombophlebitis). The nurse should remove the IV at the phlebitic site and apply warm moist compresses to the area to speed resolution of the inflammation. Because phlebitis has occurred, the nurse also notifies the HCP about the IV complication. The nurse should restart the IV in a vein other than the one that has developed phlebitis. Finally, the nurse documents the occurrence, actions taken, and the client's response.

Mosby's Comprehensive 183. A client at 39 weeks' gestation is admitted for induction of labor. Knowing that several medications are used to induce labor, a nurse identifies those that may be prescribed. Select all that apply. 1. Oxytocin (Pitocin) 2. Misoprostol (Cytotec) 3. Ergonovine (Ergotrate) 4. Carboprost (Hemabate) 5. Dinoprostone (Prepidil)

Answer: 1, 2, 5 Oxytocin (Pitocin) is an oxytocic that initiates or augments uterine contractions; it is used for labor induction. Misoprostol (Cytotec) is a prostaglandin used for cervical ripening and labor induction. Ergonovine (Ergotrate) is an oxytocic used for postpartum or postabortion hemorrhage. Carboprost (Hemabate) is a prostaglandin used for postpartum hemorrhage; also used to induce abortion. Dinoprostone (Prepidil) is used for cervical ripening to induce labor; also used to induce abortion.

243. A pregnant client with a history of rheumatic heart disease since childhood is concerned about the birth of her baby and asks what to expect. What should a nurse explain about the birth? Select all that apply. 1. Labor may be induced. 2. Birth may be midforceps assisted. 3. Birth may be vacuum extraction assisted. 4. Regional anesthesia may be administered. 5. Inhalation anesthesia may be administered. (Mosby's Comprehensive)

Answer: 1, 3, 4 An oxytocin (Syntocinon) infusion is carefully monitored for the gentle induction or augmentation of labor. The health care provider may prefer a vacuum extraction assisted birth to reduce the need to push and to conserve energy. Regional anesthesia relieves the stress of pain, and it does not compromise cardiovascular function. 2-->A midforceps assisted birth is not needed. A low or outlet forceps may be used to reduce the need to push and to conserve energy. 5-->Inhalation anesthesia is contraindicated because it could compromise cardiovascular function. Client Need: Physiological Adaptation; Cognitive Level: Analysis; Integrated Process: Teaching/Learning; Nursing Process: Planning/Implementation; Reference: Ch 26, Heart Disease, Nursing Care

Mosby's Comprehensive 330. A nurse is assessing a client with the diagnosis of hemorrhoids. Which factors in the client's history probably played a role in the development of the client's hemorrhoids? Select all that apply. 1. Constipation 2. Hypertension 3. Eating spicy foods 4. Bowel incontinence 5. Numerous pregnancies

Answer: 1, 5 Straining at stool increases intraabdominal, systemic, and portal venous pressures that promote the development of hemorrhoids. Hypertension does not contribute to the development of hemorrhoids. Spicy foods may irritate hemorrhoids but do not cause them. Bowel incontinence is unrelated to the development of hemorrhoids. The enlarging uterus puts pressure on the inferior vena cava that leads to increased portal venous pressure, causing anorectal varicosities

183. A client at 39 weeks' gestation is admitted for induction of labor. Knowing that several medications are used to induce labor, a nurse identifies those that may be prescribed. Select all that apply. 1. Oxytocin (Pitocin) 2. Misoprostol (Cytotec) 3. Ergonovine (Ergotrate) 4. Carboprost (Hemabate) 5. Dinoprostone (Prepidil) (Mosby's Comprehensive)

Answer: 125 Oxytocin (Pitocin) is an oxytocic that initiates or augments uterine contractions; it is used for labor induction. Misoprostol (Cytotec) is a prostaglandin used for cervical ripening and labor induction. Ergonovine (Ergotrate) is an oxytocic used for postpartum or postabortion hemorrhage. Carboprost (Hemabate) is a prostaglandin used for postpartum hemorrhage; also used to induce abortion. Dinoprostone (Prepidil) is used for cervical ripening to induce labor; also used to induce abortion. Reference: Ch 26, Induction or Stimulation of Labor, Data Base

230. A nurse notifies the health care provider that a client has been admitted to the high-risk unit in her 36th week of gestation. She is bleeding, has severe abdominal pain and a rigid fundus, and is demonstrating signs of shock. For what intervention should the nurse prepare? 1. A high-forceps birth 2. An immediate cesarean birth 3. The insertion of an internal fetal monitor 4. The administration of an oxytocin infusion (Mosby's Comprehensive)

Answer: 2 This is the treatment of choice for complete placental separation (abruptio placentae). The risk for fetal and maternal mortality is too high to delay action. 1-->A high-forceps birth rarely is used because the forceps may further complicate the situation by tearing the cervix. 3, 4-->The fetus would probably expire if this course of action were taken. Reference: Ch 26, Abruptio Placentae, Data Base

Mosby's Comprehensive 732: In the postanesthesia care unit it is reported that the client received intrathecal morphine intraoperatively to control pain. Considering the administration of this medication, what should the nurse include as part of the client's initial 24-hour postoperative care? 1. Assessing the client for tachycardia 2. Monitoring of respiratory rate hourly 3. Administering naloxone every 3 to 4 hours 4. Observing the client for signs of CNS excitement

Answer: 2 Intrathecal morphine can depress respiratory function depending on the level it reaches within the spinal column; hourly assessments during the first 12 to 24 hours will allow for early intervention with an antidote if respiratory depression needs to be corrected. Bradycardia and hypotension occur. This time between doses is too long if the client's respirations are depressed. The recommended adult dosage usually is 0.4 to 2 mg every 2 to 3 minutes, if indicated. Central nervous system depression occurs secondary to hypoxia.

Mosby's Comprehensive 729: A client reports fatigue and dyspnea and appears pale. The nurse questions the client about medications currently being taken. In light of the symptoms, which medication causes the nurse to be most concerned? 1. Famotidine (Pepcid) 2. Methyldopa (Aldomet) 3. Ferrous sulfate (Feosol) 4. Levothyroxine (Synthroid)

Answer: 2 Methyldopa (Aldomet) is an antihypertensive med and associated with acquired hemolytic anemia and should be discontinued to prevent progression and complications. 1 --- Famotidine (Pepcid) is an antacid and antihistamine --- will not cause these symptoms; it decreases gastric acid secretion, which will decrease the risk of gastrointestinal bleeding. 3 --- Ferrous sulfate (Feosol) is an iron supplement to correct, not cause, symptoms of anemia. 4 --- Levothyroxine (Synthroid) is not associated with RBC destruction.

Saunders 278. The nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the electronic fetal monitor, what is the next nursing action? 1. Identify the types of accelerations. 2. Assess the baseline fetal heart rate. 3. Determine the intensity of the contractions. 4. Determine the frequency of the contractions.

Answer: 2 Rationale: Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate can be identified if they occur. The intensity of contractions is assessed by an internal fetal monitor, not an external fetal monitor. Options 1 and 4 are important to assess, but not as the first priority. Fetal heart rate is evaluated by assessing baseline and periodic changes. Periodic changes occur in response to the intermittent stress of uterine contractions and the baseline beat-to-beat variability of the fetal heart rate

Saunder's 338: Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority assessment? 1. Uterine tone 2. Blood pressure 3. Amount of lochia 4. Deep tendon reflexes

Answer: 2 Rationale: Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. Apriority assessment before the administration of the medication is to check the blood pressure. The health care provider needs to be notified if hypertension is present. Although options 1, 3, and 4 may be components of the postpartum assessment, blood pressure is related specifically to the administration of this medication.

Saunder's 108: The nurse is assessing a client's peripheral intravenous (IV) site after completion of a PCN/ampicil/vancomycin infusion and notes that the area is reddened, warm, painful, and slightly edematous proximal to the insertion point of the IV catheter. At this time, which action by the nurse is best? 1. Check for the presence of blood return. 2. Remove the IV site and restart at another site. 3. Document the findings and continue to monitor the IV site. 4. Call the health care provider (HCP) and request that the vancomycin be given orally.

Answer: 2 Rationale: Phlebitis at an IV site can be distinguished by client discomfort at the site and by redness, warmth, and swelling proximal to the catheter. If phlebitis occurs, the nurse should remove the IV line and insert a new IV line at a different site, in a vein other than the one that has developed phlebitis. Checking for the presence of blood return should be done before the administration of vancomycin because this medication is a vesicant. Documenting the findings and continuing to monitor the IV site and calling the HCP and requesting that the vancomycin be given orally do not address the immediate problem. Additionally, there could be indications for the prescription of IV as opposed to oral vancomycin for the client. The HCP should be notified of the complications with the IV site, but not asked for a prescription for oral vancomycin

A client is receiving an IV piggyback oxytocin (Oxytocics/Pitocin) infusion to induce labor. The client experiences three contractions that are 90 seconds long and occur less than 2 minutes apart. List in order of priority the nursing actions that should be taken. 1. ______ Administer oxygen 2. ______ Call the health care provider 3. ______ Interrupt the oxytocin infusion 4. ______ Assess maternal/fetal responses 5. ______ Document fetal/maternal responses (Mosby's Comprehensive)

Answer: 3, 1, 4, 2, 5.

282. The nurse is assisting a client undergoing induction of labor at 41 weeks of gestation. The client's contractions are moderate and occurring every 2-3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline fetal heart rate has been 120 to 122 beats/minute for the past hour. What is the priority nursing action? 1. Notify the health care provider. 2. Discontinue the infusion of oxytocin. 3. Place oxygen on at 8 to 10 L/minute via face mask. 4. Contact the client's primary support person(s) if not currently present. (saunders)

Answer: 2 Rationale: The priority nursing action is to stop the infusion of oxytocin. Oxytocin can cause forceful uterine contractions and decrease oxygenation to the placenta, resulting in decreased variability. After stopping the oxytocin, the nurse should reposition the laboring mother. Notifying the health care provider, applying oxygen, and increasing the rate of the intravenous (IV) fluid (the solution without the oxytocin) are also actions that are indicated in this situation, but not the priority action. Contacting the client's primary support person(s) is not the priority action at this time.

Mosby's Comprehensive 135: Epidural anesthesia was initiated 30 minutes ago for a client in labor. The nurse identifies that the fetus is experiencing late decelerations. List the following nursing actions in order of priority. 1. _____ Increase IV fluids. 2. _____ Reposition client on her side. 3. _____ Reassess fetal heart rate pattern. 4._____ If late decelerations persist notify the health care provider. 5. _____ Document interventions with related maternal/fetal responses.

Answer: 2, 1, 3, 4, 5. 2 --- Repositioning to the side increases uterine blood flow, improves cardiac output, and moves pressure of the uterus off of the vena cava. 1 --- Increasing IV fluids augments uterine blood flow and improves cardiac output. 3 --- Reassessing the FHR pattern enables the nurse to determine if the FHR has returned to a safe level without reflex late decelerations. 4 --- Persistent late decelerations is a nonreassuring fetal sign; the health care provider should be informed. 5 --- Documentation of interventions and client responses includes the information in the client's legal clinical record and provides communication to other care providers.

A client is receiving an IV piggyback infusion of oxytocin (Pitocin) to augment labor. The nurse identifies that there have been three contractions lasting 80 to 90 seconds that are less than 2 minutes apart. There is a specific protocol that is followed in response to this observation. List in order of priority the nursing actions that should be taken. 1. _____ Check the fetal heart rate. 2. _____ Stop the piggyback infusion. 3. _____ Notify the health care provider. 4. _____ Administer oxygen via face mask. 5. _____ Document maternal/fetal responses. 6. _____ Determine if the contractions have diminished (Mosby's Comprehensive)

Answer: 2, 1, 6, 3, 4, 5. 2 The nurse should first stop the oxytocin infusion when tetanic contractions occur; this should relax the uterus and prevent uterine tetany and rupture. 1. The FHR should be checked to determine the effect of the tetanic contractions on the fetus. 6. After the FHR is assessed then the maternal response to the interruption of the infusion should be assessed. 3. Following these measures, the primary care giver should be notified. 4. Fetal well-being will be improved when oxygen is administered. 5. After emergency measures have been taken, the maternal/fetal responses should be documented. Ch 26, Induction or Stimulation of Labor; Nursing Care During the Intrapartum Period

Mosby's Comprehensive 331. A client has a diagnosis of hemorrhoids. Which signs and symptoms does the nurse expect the client to report? Select all that apply. 1. Flatulence 2. Anal itching 3. Blood in stool 4. Rectal pressure 5. Pain when defecating

Answer: 2, 3, 4, 5 Flatulence is unrelated to hemorrhoids. Pruritus occurs as varicosities enlarge and become inflamed. Blood and mucus in the stool occur as varicosities enlarge and become inflamed. Rectal pressure occurs as portal venous pressure increases and varicosities enlarge. Pain occurs when varicosities enlarge and thromboses occur; pain increases on defecation

Mosby's Comprehensive 306. A client has been receiving oxycodone (OxyContin) for moderate pain associated with multiple injuries sustained in a motor vehicle collision. The client has returned three times for refills of the prescription. What behavior, in addition to the client's slurred speech, leads the nurse to suspect opioid intoxication? 1. Mood lability 2. Hypervigilance 3. Constricted pupils 4. Increased respirations

Answer: 3 Constricted pupils is a physical response to opioid intoxication; the pupils will dilate with opioid overdose. Opioids cause apathy or a depressed, sad mood (dysphoria); lability of mood is associated with the use of anabolic-androgenic steroids. Opioids cause drowsiness and psychomotor retardation; alertness is associated with the use of stimulants such as caffeine and amphetamines. Opioids depress the respiratory center of the brain, causing slow, shallow respirations; increases in temperature, pulse, respirations, and blood pressure are associated with cocaine use.

Mosby's Comprehensive 115: Which relationship does the nurse consider reflective of the relationship of naloxone (Narcan) to morphine sulfate? 1. Aspirin to warfarin (Coumadin) 2. Amoxicillin to systemic infection 3. Protamine sulfate to parenteral heparin 4. Enoxaparin (Lovenox) to dalteparin (Fragmin)

Answer: 3 Protamine sulfate is the antidote for heparin overdose and naloxone (Narcan) will reverse the effects of opioids such as morphine. Aspirin and warfarin (Coumadin) both interfere with coagulation. While amoxicillin is used to treat some infections, an infection is not a medication, so amoxicillin (Amoxil) cannot be considered an antidote. Both enoxaparin (Lovenox) and dalteparin (Fragmin) are low molecular weight heparins.

Saunder's 314: The nurse is preparing to care for four assigned clients. Which client is at most risk for hemorrhage? 1. A primiparous client who delivered 4 hours ago 2. A multiparous client who delivered 6 hours ago 3. A multiparous client who delivered a large baby after oxytocin induction 4. A primiparous client who delivered 6 hours ago and had epidural anesthesia

Answer: 3 Rationale: The causes of postpartum hemorrhage include uterine atony; laceration of the vagina; hematoma development in the cervix, perineum, or labia; and retained placental fragments. Predisposing factors for hemorrhage include a previous history of postpartum hemorrhage, placenta previa, abruptio placentae, overdistention of the uterus from polyhydramnios, multiple gestation, a large neonate, infection, multiparity, dystocia or labor that is prolonged, operative delivery such as a cesarean or forceps delivery, and intrauterine manipulation. The multiparous client who delivered a large fetus after oxytocin induction has more risk factors associated with postpartum hemorrhage than the other clients. In addition, there are no specific data in the client descriptions in options 1, 2, and 4 that present the risk for hemorrhage.

334. The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to immediately discontinue the oxytocin infusion? Select all that apply. 1. Fatigue 2. Drowsiness 3. Uterine hyperstimulation 4. Late decelerations of the fetal heart rate 5. Early decelerations of the fetal heart rate (saunders)

Answer: 3, 4 Rationale: Oxytocin stimulates uterine contractions and is a pharmacological method to induce labor. Late decelerations, a nonreassuring fetal heart rate pattern, is an ominous sign indicating fetal distress. Oxytocin infusion must be stopped when any signs of uterine hyperstimulation, late decelerations, or other adverse effects occur. Some health care providers prescribe the administration of oxytocin in 10-minute pulsed infusions rather than as a continuous infusion. This pulsed method, which is more like endogenous secretion of oxytocin, is reported to be effective for labor induction and requires significantly less oxytocin use. Drowsiness and fatigue may be caused by the labor experience. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress

saunders 273: A client arrives at a birthing center in active labor. Following examination, it is determined that her membranes are still intact and she is at a -2 station. The health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy? Select all that apply. 1. Less pressure on her cervix 2. Decreased number of contractions 3. Increased efficiency of contractions 4. The need for increased maternal blood pressure monitoring 5. The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord

Answer: 3, 5 Rationale: Amniotomy (artificial rupture of the membranes) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the progress begins to slow. Rupturing of the membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. Increased monitoring of maternal blood pressure is unnecessary following this procedure. The fetal heart rate needs to be monitored frequently, as there is an increased likelihood of a prolapsed cord with ruptured membranes and a high presenting part

249. A client who has six living children has just given birth. After the expulsion (removal) of the placenta, an infusion of lactated Ringer solution with 10 units of oxytocin (Pitocin) is prescribed. What should the nurse explain to the client when asked why this infusion is needed? 1. "You had a precipitous birth." 2. "This is required for an extramural birth." 3. "It will help expel the retained placental fragments." 4. "Your uterus may have a relaxed tone after multiple pregnancies." (Mosby's Comprehensive)

Answer: 4 Multiple full-term pregnancies and births result in overstretched uterine muscles that do not contract efficiently, and bleeding may ensue. Oxytocin (Pitocin) promotes uterine contractions. 1-->A precipitous birth does not predispose to uterine atony unless there is a complication. 2-->Giving birth outside the birthing area does not predispose the client to uterine atony. 3-->Multiparity does not predispose to retained placental fragments. Reference: Ch 26, Postpartum Bleeding, Data Base

Mosby's Comprehensive 328. A client is experiencing chronic constipation and the nurse discusses how to include more bulk in the diet. The nurse concludes that learning has occurred when the client states, "Bulk in the diet promotes defecation by: 1. irritating the bowel wall." 2. stimulating the intestinal mucosa chemically." 3. acting on the microorganisms in the large intestine." 4. stretching intestinal smooth muscle, which causes it to contract."

Answer: 4 Fiber absorbs water, swells, and consequently stretches the bowel wall, promoting peristalsis, mass movements, and defecation. Smooth muscle tends to contract when stretched because of the reflex activity of stretch receptors. Bulk caused by fiber does not irritate the bowel wall. There is no chemical stimulation. acterial action is not involved in the process by which bulk stimulates defecation

122. A client in active labor becomes very uncomfortable and asks a nurse for pain medication. Nalbuphine (Nubain) is prescribed. How does this medication relieve pain? 1. Produces amnesia 2. Acts as a preliminary anesthetic 3. Induces sleep until the time of birth 4. Acts on opioid receptors to reduce pain (Mosby's Comp[rehensive)

Answer: 4 Nalbuphine (Nubain) is classified as an opioid analgesic and is effective for the relief of pain; there is little or no newborn respiratory depression. 1. Nalbuphine does not induce amnesia. 2. Nalbuphine acts as an analgesic, not an anesthetic. 3. Nalbuphine does not induce sleep.

Saunders 468: A health care provider's prescription reads "ampicillin sodium 125 mg IV every 6 hours." The medication label reads "when reconstituted with 7.4 mL of bacteriostatic water, the final concentration is 1 g/7.4 mL." The nurse prepares to draw up how many milliliters to administer 1 dose? 1. 1.1 mL 2. 0.54 mL 3. 7.425 mL 4. 0.925 mL

Answer: 4 Rationale: Convert 1 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal point 3 places to the right: 1 g ¼ 1000 mg

Saunder's 312: A client in a postpartum unit complains of sudden sharp chest pain and dyspnea. The nurse notes that the client is tachycardic and the respiratory rate is elevated. The nurse suspects a pulmonary embolism. Which should be the initial nursing action? 1. Initiate an intravenous line. 2. Assess the client's blood pressure. 3. Prepare to administer morphine sulfate. 4. Administer oxygen, 8 to 10 L/minute, by face mask.

Answer: 4 Rationale: If pulmonary embolism is suspected, oxygen should be administered, 8 to 10 L/minute, by face mask. Oxygen is used to decrease hypoxia. The client also is kept on bed rest with the head of the bed slightly elevated to reduce dyspnea. Morphine sulfate may be prescribed for the client, but this would not be the initial nursing action. An intravenous

Saunder's 342. Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse should contact the health care provider who prescribed the medication if which condition is documented in the client's medical history? 1. Hypotension 2. Hypothyroidism 3. Diabetes mellitus 4. Peripheral vascular disease

Answer: 4 Rationale: Methylergonovine is an ergot alkaloid used to treat postpartum hemorrhage. Ergot alkaloids are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia, or eclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. Options 1, 2, and 3 are not contraindications related to the use of ergot alkaloids.

292. Fetal distress is occurring with a laboring client. As the nurse prepares the client for a cesarean birth, what is the most important nursing action? 1. Slow the intravenous flow rate. 2. Continue the oxytocin drip if infusing. 3. Place the client in a high Fowler's position. 4. Administer oxygen, 8 to 10 L/minute, via face mask. (saunders)

Answer: 4 Rationale: Oxygen is administered, 8 to 10 L/minute, via face mask to optimize oxygenation of the circulating blood. Option 1 is incorrect because the intravenous infusion should be increased (per health care provider prescription) to increase the maternal blood volume. Option 2 is incorrect because oxytocin stimulation of the uterus is discontinued if fetal heart rate patterns change for any reason. Option 3 is incorrect because the client is placed in the lateral position with her legs raised to increase maternal blood volume and improve fetal perfusion.

156. A client is bleeding excessively after the birth of a neonate. The health care provider orders fundal massage and prescribes an IV infusion containing 10 units of oxytocin (Pitocin) at 100 mL/hr. A nurse's evaluation of the client's responses to these interventions is BP: 135/90 mm Hg; uterus: boggy at 3 cm above the umbilicus and displaced to the right; perineal pad: saturated with bright red lochia. What is the nurse's next action? 1. Increase the infusion rate. 2. Assess for a distended bladder. 3. Continue to perform fundal massage. 4. Continue to assess the blood pressure. (Mosby's Comprehensive)

Answer:2 A displaced and boggy uterus usually is caused by a full bladder; if the bladder is distended, the nurse should have the client void and then reassess the fundus, and if still boggy, massage until firm. 1--> The oxytocin (Pitocin) infusion may need to be increased if voiding and fundal massage are ineffective; however, the health care provider must be notified to change the prescription. 3--> This is necessary if the fundus remains boggy after the client has voided. 4--> This is unnecessary at this time; correcting the boggy fundus is the priority. Ch 25, Intrapartum Period, Nursing Care During the Intrapartum Period

149. For what complication should a nurse monitor a client when an oxytocin (Pitocin) infusion is used to induce labor? 1. Intense pain 2. Uterine tetany 3. Hypoglycemia 4. Umbilical cord prolapse (Mosby's Comprehensive)

Answer:2 Because oxytocin (Pitocin) promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion must be stopped to prevent uterine rupture and fetal compromise. 1-->Intense pain can be associated with strong uterine contractions; this is not a complication. 3--> This is unrelated to uterine contractions. 4--> This is not likely to occur when induction of labor is initiated. Reference: Ch 25, Intrapartum Period, Data Base

157. A nurse is evaluating the effectiveness of fundal massage on a postpartum client 3 hours after giving birth. An IV infusion of 10 units of oxytocin (Pitocin) is infusing at 100 mL/hr. Her blood pressure is 135/90, the uterus is boggy at 3 cm above the umbilicus and displaced to the right, and her perineal pad is saturated with lochia rubra. What should the nurse do next? 1. Massage the fundus again. 2. Notify the health care provider. 3. Assist the client to the bathroom. 4. Increase the IV infusion rate as prescribed. (Mosby's Comprehensive)

Answer:3 Before any other action is taken, the client must empty her bladder. If she is unsuccessful despite measures to promote urination, such as running water, she will need to be catheterized. 1, 4-->This action is useless and may be dangerous unless the bladder is empty. 2--> The health care provider should be notified if the uterus remains boggy and above the umbilicus after the bladder has been emptied and the fundus massaged, if necessary. Reference: Ch 25, Intrapartum Period, Nursing Care During the Intrapartum Period

181. A client is admitted to the birthing unit in active labor. Cervical dilation has progressed from 2 to 3 cm during an 8-hour period. The health care provider determines that she has hypotonic dystocia, and an infusion of oxytocin (Pitocin) is prescribed to augment her contractions. What is the most important nursing action at this time? 1. Checking the perineum for bulging 2. Documenting the fetal heart rate and its variations 3. Preparing the client for an emergency cesarean birth 4. Monitoring the duration and intensity of the contractions (Mosby's Comprehensive)

Answer:4 Oxytocin (Pitocin) increases the intensity and duration of contractions; prolonged (tetanic) contractions will jeopardize the safety of the fetus and necessitate discontinuing the drug. 1-->A bulging perineum indicates that there is complete cervical dilation and birth is imminent; because cervical dilation is only 2 to 3 cm, a bulging perineum is not expected. 2--> This is important throughout labor. 3--> There is no indication at this time that a cesarean birth is necessary. Reference: Ch 26, Dystocia, Nursing Care

314: The nurse is preparing to care for four assigned clients. Which client is at most risk for hemorrhage? 1. A primiparous client who delivered 4 hours ago 2. A multiparous client who delivered 6 hours ago 3. A multiparous client who delivered a large baby after oxytocin induction 4. A primiparous client who delivered 6 hours ago and had epidural anesthesia (saunders)

Answers: 3 Rationale: The causes of postpartum hemorrhage include uterine atony; laceration of the vagina; hematoma development in the cervix, perineum, or labia; and retained placental fragments. Predisposing factors for hemorrhage include a previous history of postpartum hemorrhage, placenta previa, abruptio placentae, overdistention of the uterus from polyhydramnios, multiple gestation, a large neonate, infection, multiparity, dystocia or labor that is prolonged, operative delivery such as a cesarean or forceps delivery, and intrauterine manipulation. The multiparous client who delivered a large fetus after oxytocin induction has more risk factors associated with postpartum hemorrhage than the other clients. In addition, there are no specific data in the client descriptions in options 1, 2, and 4 that present the risk for hemorrhage.

Can Hydromorphone hydrochloride and meperidine hydrochloride be administered in early labor? Late labor? (Saunder's)

Not in early labor because it may slow the labor process Not administered in advanced labor (within 1 to 4 hours of expected birth); if the medication is not adequately removed from the fetal circulation, respiratory depression can occur

Pt with hx of CS comes at 4o wks for induction, order for Prostoglandin E1/E2, what do you consider?

They can cause uterine hyper stimulation and rupture

What is Dystocia? Risk factors? (saunders)

difficult labor that is prolonged or more painful because of problems caused by ctx, fetus, or bones and tissues of the maternal pelvis. --> fetus may be excessively large, malpositioned, or in an abnormal presentation. Risk factors that increase a woman's risk for dysfunctional labor include the following: The OLD/obese/short mom asked for Analgesic, excessive and epidural analgesia, OVERSTIMULATION WITH OXYTOCIN. She is is now fatigue, dehydrated, electrolyte imbalances & scared because baby is too large with malpresentations/position --- so, cephalopelvic disproportion she had previous difficulty with fertility and uterine abnormalities.

What is the danger of ctx that last more than 90 sec? (HESI)

fetal hypoxia

Nurse is monitoring VS in pt on butorphanol tartrate and nalbuphine. In what situation she should withhold the medication and contact the HCP?

if respirations are 12 breaths/minute or less

Ricci: Identified GBS carriers receive IV antibiotic prophylaxis ... at the onset of labor or ruptured membranes

penicillin G or ampicillin