Chapter 17 OB

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information should the nurse include?

"Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures."

Which nursing action should be initiated first when there is evidence of prolapsed cord?

Reposition the woman with her hips higher than her head.

While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient?

Cesarean section delivery

The nurse is teaching a group of pregnant patients about early identification of preterm labor. What signs and symptoms of preterm labor should the nurse include in the teaching?

Increased vaginal discharge Presence of vaginal bleeding Painful uterine contractions (UCs)

Which technique is least effective for the woman with persistent occipito posterior position?

Lie supine and relax

The nurse is teaching a group of pregnant patients about preterm labor and the actions to take if the signs and symptoms of preterm labor develop. Which patient statement indicates the need for further teaching?

"I will lie in the supine position for 1 hour."

Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?

A multiparous woman at 39 weeks of gestation who is expecting twins

During the assessment of a pregnant patient, the nurse finds that the patient has a compressed umbilical cord. What instruction does the nurse expect to receive from the obstetrician?

Administer Ringer's lactate solution into the uterus.

The nurse is caring for a pregnant patient who has been recommended for an external cephalic version. What would the nurse do as part of the procedure?

Administer terbutaline (Brethine) intravenously.

A pregnant patient is administered misoprostol (Cytotec) to induce labor. After 8 hours of drug administration, the patient develops diarrhea and vomiting. What does the nurse do to alleviate the symptoms?

Administer terbutaline (Brethine).

The pregnant patient reports severe pain in the midsection of the uterus. Following the assessment, the nurse finds that the patient has frequent uterine contractions (UCs) with cervix dilation up to 2 cm. Which nursing interventions does the nurse perform?

Administers an analgesic to the patient Encourages the patient to take a warm shower Administers zolpidem (Ambien) to the patient

The nurse is caring for a pregnant patient who had an onset of labor during 34 weeks' gestation. What does the nurse expect the primary health care provider (PHP) to prescribe?

Antibiotics Glucocorticoids

What are the causes of indicated preterm labor?

Herpes infection Gestational diabetes Chronic hypertension

Upon reviewing the laboratory reports, the nurse finds that the patient has meconium in the amniotic fluid. What would the nurse infer from this finding? The patient has:

Prolonged pregnancy.

A nurse providing care to a woman in labor should be aware that cesarean birth:

is performed primarily for the health of the mother and fetus.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:

its most important function is to afford the opportunity to administer antenatal glucocorticoids.

A pregnant patient has been administered magnesium sulfate as prescribed. Following the assessment, the nurse reports to the primary health care provider (PHP) that the patient's respiratory rate is 11 breaths/min. Which medication administration can the nurse expect from the PHP?

Calcium gluconate intravenously to the patient

Upon assessment of a pregnant patient, the nurse concludes that the patient is less likely to have a preterm delivery. Which patient clinical finding led the nurse to conclude this?

Cervical length of more than 30 mm

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant?

Cesarean section

The nurse is assessing a pregnant patient and finds that the patient has inflammation around the teeth and bleeding of the gums. What should the nurse tell the patient after the assessment?

"You might be at risk for preterm labor."

The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. What should the nurse infer from the findings? The baby has a high risk of presenting with:

Aspiration pneumonia.

The nurse administers the prescribed nifedipine (Adalat) to a pregnant patient during labor to reduce uterine contractions (UCs). Which nursing action is the most appropriate after the drug administration? Monitoring the:

Blood pressure of the patient

A pregnant patient is suspected to have preterm labor. The nurse is preparing to collect the vaginal discharge for conducting the fetal fibronectin test. What interventions are necessary before collecting the sample to ensure accuracy of the test?

Check for the presence of vaginal bleeding in the patient. Ask about history of sexual intercourse in the past 24 hours. Assess the patient to see if the amniotic membranes have ruptured.

The nurse is preparing to perform a fetal fibronectin test for a pregnant patient. Which intervention should the nurse perform to collect the sample for the test?

Collect the vaginal secretions using a swab.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse?

One fetal movement noted in 1 hour of assessment by the mother

The nurse is preparing to administer terbutaline (Brethine) to a pregnant patient who is in preterm labor. What questions should the nurse ask the patient before drug administration to promote drug safety?

Do you ever have migraine headaches?" "Do you suffer from any cardiac disease?" "Do you have pregnancy-induced diabetes?"

The nurse is caring for an obese patient who gave birth to a child through a cesarean delivery. Which nursing intervention should be performed for providing effective postpartum care?

Drying the wound by using a hair dryer at low setting

If a pregnant patient suspects signs and symptoms of preterm labor, which conditions would lead the patient to go to hospital immediately?

Fluid leakage from vagina Presence of vaginal bleeding Contractions every 10 minutes

The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug?

Follow a strict time interval of 24 hours between two doses.

Which statement is most likely to be associated with a breech presentation?

High rate of neuromuscular disorders

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor?

Incomplete uterine relaxation

The nurse is preparing to administer dexamethasone (Decadron) to a pregnant patient. Which nursing intervention should the nurse perform for safe administration of the drug?

Inform the patient that it will be painful. Assess blood glucose levels in the patient. Administer the drug by intramuscular injection.

A pregnant patient has been administered terbutaline (Brethine) as prescribed. The nurse finds that the patient has a heart rate of 140 beats/min and complains of chest pain. What is the best nursing action in this situation?

Inform the primary health care provider (PHP).

The nurse is caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient?

Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped.

The nurse is caring for a 32-year-old pregnant patient who had an onset of labor during 40 weeks' gestation. Following the labor, the nurse finds that the newborn has a low birth weight (LBW). What explanation will the nurse give to the patient as to the etiology of the newborn's LBW?

Intrauterine growth restriction (IUGR)

The nurse observes that a pregnant patient who is taking terbutaline (Brethine) treatment has a heart rate of 135 beats/min. Which medication administration does the nurse expect the primary health care provider (PHP) to order?

Intravenous (I.V.) propranolol (Inderal)

A pregnant patient experienced preterm labor at 30 weeks' gestation. Upon assessing the patient, the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn?

Magnesium sulfate to the pregnant patient

A pregnant patient who is in preterm labor has been prescribed dexamethasone (Decadron). What benefit of the drug would the nurse identify in the patient?

Maturation of fetal lungs

The fetal fibronectin test of a pregnant patient is positive, and her cervical length is found to be 32 mm. What will the nurse interpret from these observations regarding the patient's pregnancy status?

Normal gestational labor

During the first stage of labor, a pregnant patient complains of having severe back pain. What would the nurse infer about the patient's clinical condition from the observation?

Occipitoposterior position of the fetus

The primary health care provider (PHP) reports that the baby of a patient may have an injury resulting from shoulder dystocia during labor. What patient clinical condition should the nurse infer from the report?

Postterm pregnancy

The nurse observes that a pregnant patient at 36 weeks' gestation who is in labor has a cervical dilation of 5 cm with membranes intact. Which nursing intervention is the most appropriate in this situation?

Prepare to administer intravenous magnesium sulfate (Epsom salt).

During the second phase of labor in a pregnant patient, the nurse finds that the shoulders of the baby are not able to be delivered. The nurse informs the primary health care provider (PHP) who advises to perform the McRoberts maneuver to deliver the shoulders of the baby. What intervention should the nurse perform during the McRoberts maneuver?

Presenting part at a station of -3

During the active phase of labor, the nurse prepares for the insertion of an intrauterine pressure catheter (IUPC) to a pregnant patient. What patient clinical presentation would be the reason for this intervention?

Reduced uterine contractions (UCs)

A pregnant patient is receiving tocolytic therapy with magnesium sulfate. Under which patient circumstance would the nurse suggest to discontinue the therapy?

Respiratory rate is 10 breaths/min.

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity?

Respiratory status Level of consciousness Deep tendon reflexes

The nurse is teaching about the use of primrose oil to a pregnant patient. Which statement would the nurse include in the teaching? "Primrose oil helps:

Ripen the cervix."

The nurse is assessing a pregnant patient with multifetal gestation. Upon reviewing the medical history, the nurse finds that the patient had preterm delivery during the first pregnancy. What will the nurse do to prevent preterm delivery in the patient during the second pregnancy?

Suggest that the patient avoids smoking and consuming alcohol.

During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis?

Teach gentle lower extremity exercises to the patient.

A pregnant patient was given a tocolytic drug to prevent preterm delivery. After observing that the patient has a history of migraine headaches, the primary health care provider (PHP) instructs the nurse to stop administering the drug. Which tocolytic drug was the patient most likely taking?

Terbutaline (Brethine)

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect?

Terbutaline sulfate (Brethine)

The nurse hears the fetal heart tones by placing a fetoscope above the umbilicus of a pregnant patient. What would the nurse infer from this assessment?

The lower extremities of the fetus will be observed initially during birth.

The nurse observes that a pregnant patient has a high temperature and a foul smell of amniotic fluid during labor. Which possible complications would the nurse find in the patient and in the neonate after the delivery?

The neonate may have pneumonia. The patient may have a pelvic abscess The neonate may have bacteremia and sepsis.

The nurse finds that the umbilical cord in a pregnant patient who is in labor has prolapsed, following the rupture of membranes. Which positions are suitable for the patient to promote fetal perfusion?

Trendelenburg Modified Sims' Knee-chest position

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth?

Unstable coronary artery disease Previous cesarean birth Placenta previa