Maternity Ch. 17

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? 1 "You might be at risk for preterm labor." 2 "Your baby might have spina bifida." 3 "You may be at risk of having a miscarriage." 4 "Your baby might have delayed tooth eruption."

"You might be at risk for preterm labor." According to research, the patients who have periodontal diseases like gingivitis, inflammation around the teeth, and bleeding of gums may have an increased risk of preterm labor. Down syndrome and hypothyroidism would cause a delay in tooth eruption in the infant. Periodontal diseases would not cause miscarriage, because it does not affect fetal development. Spina bifida results from a deficiency of folate, not from maternal periodontal diseases.

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? 1 Vaginal delivery 2 Vacuum-assisted delivery 3 Cesarean section delivery 4 Forceps-assisted delivery

Cesarean section delivery Foul odor from the vaginal discharge, combined with maternal fever, indicates that the patient has chorioamnionitis. Cesarean delivery is preferred for the patients with chorioamnionitis. Vacuum-assisted delivery is helpful in case of prolonged labor when the mother is not sufficiently capable to bear down the fetus. Vaginal delivery is not possible in this condition because of the increased risk of chorioamnionitis and prolonged labor. Forceps-assisted delivery is useful in case of fetal malpresentation of the head and in case of insufficient efforts by the patient to bear down.

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? 1 Incomplete uterine relaxation 2 Maternal fatigue and exhaustion 3 Maternal sedation with narcotics 4 Administration of tocolytic drugs

Incomplete uterine relaxation A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases fetal oxygen supply. Maternal fatigue usually does not decrease uterine blood flow. Maternal sedation will sedate the fetus but should not decrease blood flow. Tocolytic drugs decrease contractions. This will increase uterine blood flow.

Which technique is least effective for the woman with persistent occipitoposterior position? 1 Squat 2 Lie supine and relax 3 Sit or kneel, leaning forward with support 4 Rock the pelvis back and forth while on hands and knees

Lie supine and relax Lying supine increases discomfort. The woman typically complains of severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum. Squatting aids both rotation and fetal descent. A sitting or kneeling position may help the fetal head to rotate to occipitoanterior. Rocking the pelvis encourages rotation from occipitoposterior to occipitoanterior.

Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. 4 Reposition the woman with her hips higher than her head.

Reposition the woman with her hips higher than her head. The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority.

While caring for a patient who is treated with terbutaline (Brethine), the nurse tries to reduce pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant? 1 Suggesting that the patient lie on her side 2 Infusing Ringer's lactate solution intravenously 3 Increasing the terbutaline (Brethine) concentration 4 Encouraging drinking a full glass of water periodically

Suggesting that the patient lie on her side The nurse should suggest that the patient lie on her side, because this enhances placental perfusion and reduces the pressure on the cervix. Ringer's lactate solution is infused when amniotic fluid levels are lowered in a pregnant patient. Water intake prevents dehydration during labor, but it does not reduce pressure on the cervix. Nurses should not increase the terbutaline (Brethine) concentration. This may cause adverse effects and can be fatal to the mother and the fetus.

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? 1 Teach gentle lower extremity exercises to the patient. 2 Suggest that the patient lie in the supine position in bed. 3 Provide a calm and soothing atmosphere to the patient. 4 Give tocolytic medications as per the physician's prescription.

Teach gentle lower extremity exercises to the patient. The health care provider may recommend reduced activity or complete bed rest for the patient experiencing preterm labor, depending on the severity of the symptoms. As a result, the patient may be at risk for thrombophlebitis due to limited activity. The nurse should teach the patient how to perform gentle exercises of the lower extremities. Suggesting that the patient lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the patient lie in a side-lying position to help enhance placental perfusion. The nurse can provide a calm and soothing atmosphere to facilitate coping so as to reduce the patient's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the patient to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis.

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: 1 uterine contractions occurring every 8 to 10 minutes. 2 a fetal heart rate (FHR) of 180 with absence of variability. 3 the woman needing to void. 4 rupture of the woman's amniotic membranes.

a fetal heart rate (FHR) of 180 with absence of variability. An FHR of 180 with absence of variability is non-reassuring. The oxytocin should be discontinued immediately and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The woman needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is non-reassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the woman's membranes have ruptured.

A nurse providing care to a woman in labor should be aware that cesarean birth: 1 is declining in frequency in the United States. 2 is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier patients do. 3 is performed primarily for the health of the mother and fetus. 4 can be either elected or refused by women as their absolute legal right.

is performed primarily for the health of the mother and fetus. The most common indications for cesarean birth are to preserve the health of the mother and fetus. Cesarean births are increasing in the United States. Women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean birth is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

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? 1 "Because this is a repeat procedure, you are at the lowest risk for complications." 2 "Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." 3 "Because this is your second cesarean birth, you will recover faster." 4 "You will not need preoperative teaching because this is your second cesarean birth."

"Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." Physiologic and psychological recovery from a cesarean birth is multifactorial and individual to each woman each time. Maternal and fetal risks are associated with every cesarean birth. Preoperative teaching should always be performed regardless of whether the woman has already had this procedure.

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: 1 Shoulder dystocia. 2 Umbilical cord prolapse. 3 Aspiration pneumonia. 4 Brachial plexus injury.

Aspiration pneumonia. Some babies may pass meconium even before birth, thus staining the amniotic fluid green. This meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk of meconium aspiration syndrome, which may cause respiratory depression. Meconium-stained amniotic fluid does not increase the risk of shoulder dystocia. Shoulder dystocia is common when there is fetopelvic disproportion as a result of excessive fetal size or maternal pelvic abnormalities. Umbilical cord prolapse is an obstetric emergency where the umbilical cord lies below the presenting part of the fetus. Brachial plexus injury is common in babies when the vaginal delivery takes place despite shoulder dystocia.

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? 1 Dextrose solution intravenously to the patient 2 Calcium gluconate intravenously to the patient 3 Ringer's lactate solution intravenously to the patient 4 Increased doses of magnesium sulfate to the patient

Calcium gluconate intravenously to the patient A respiratory rate of 11 breaths/min in the patient who is administered magnesium sulfate indicates magnesium toxicity. Administering calcium gluconate can counteract this. Ringer's lactate solution would help in reduced amniotic fluid levels, but it does not reduce the effect of magnesium sulfate. Dextrose solution is given for the treatment of maternal ketoacidosis. Magnesium sulfate should be discontinued when the respiratory levels are lowered in the pregnant 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? 1 Previous cesarean birth 2 Preexisting diabetes mellitus 3 Cervical length of more than 30 mm 4 Symptoms of chronic hypertension

Cervical length of more than 30 mm The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself in terms of effacement and dilation. Patients having cervical length of more than 30 mm would not have preterm labor, even if they have symptoms of preterm labor. A previous cesarean birth may not rule out the risk of preterm delivery. Chronic hypertension and preexisting diabetes mellitus may not increase the risk of preterm labor.

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? 1 Internal version 2 Vaginal delivery 3 Cesarean section 4 External cephalic version

Cesarean section Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.

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? 1 Preterm labor 2 Maternal age 3 Diabetic condition of the patient 4 Intrauterine growth restriction (IUGR)

Intrauterine growth restriction (IUGR) The LBW of the newborn is the result of IUGR, a condition of inadequate fetal growth. It may be caused by various conditions, such as gestational hypertension that interferes with uteroplacental perfusion. Interference with uteroplacental perfusion limits the flow of nutrients into the fetus and causes the LBW. The onset of labor is at 40 weeks' gestation, so it is not a preterm labor. The patient's age is normal for pregnancy and therefore is not a reason for the LBW of the child. Infants born to patients with diabetes would have a high birth weight, not a low one.

Which technique is least effective for the woman with persistent occipito posterior position? 1 Squat 2 Lie supine and relax 3 Sit or kneel, leaning forward with support 4 Rock the pelvis back and forth while on hands and knees

Lie supine and relax Lying supine increases discomfort. The woman typically complains of severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum. Squatting aids both rotation and fetal descent. A sitting or kneeling position may help the fetal head to rotate to occipito anterior. Rocking the pelvis encourages rotation from occipito posterior to occipito anterior.

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? 1 Oligohydramnios 2 Chorioamnionitis 3 Frank breech presentation 4 Occipitoposterior position of the fetus

Occipitoposterior position of the fetus If a pregnant patient has severe back pain during the first stage of labor, it indicates that the fetus is in occipitoposterior position. In this position, the fetal head (occiput) exerts pressure and presses against the sacrum of the patient. Oligohydramnios, chorioamnionitis, and frank breech presentation are not associated with typical backache in pregnant women. Oligohydramnios is the presence of low amniotic fluid volume in the pregnant woman. Chorioamnionitis is a bacterial infection of the amniotic cavity, which results in high maternal fever and a foul amniotic fluid odor. If flexed hips and extended knees of fetus are observed, then it is called frank breech presentation (malpresentation).

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? 1 Fetal heart rate of 116 beats/min 2 Cervix dilated 2 cm and 50% effaced 3 Score of 8 on the biophysical profile 4 One fetal movement noted in 1 hour of assessment by the mother

One fetal movement noted in 1 hour of assessment by the mother Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a woman at 42 weeks of gestation. A score of 8 on the BPP is a normal finding in a pregnancy at 42 weeks.