OB

4 Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. It is used to halt preterm labor contractions and also for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels

The maternity nurse is caring for a pregnant client with no history of preeclampsia who is receiving a magnesium sulfate infusion. Why is this client receiving this infusion? 1. To contract the uterus 2. To treat hypotension 3. To reverse extreme muscle weakness 4. To halt preterm labor contractions

4 The best sources of folic acid are liver; kidney, pinto, lima, and black beans; and fresh dark-green leafy vegetables. Other good sources of folic acid are orange juice, peanuts, refried beans, and peas. Milk is high in calcium. Chicken and steak are high in protein.

The nurse instructs a pregnant client about foods that are high in folic acid. Which item does the nurse tell the client is the best source of folic acid? 1. Milk 2. Steak 3. Chicken 4. Lima beans

4 If the client has been given an epidural opioid, the nurse should monitor the client's respiratory status closely. If the Spo2 falls below 95%, the nurse instructs the client to take several deep breaths to increase the level. Although the finding would be documented, action is required to increase the oxygen saturation level. It is not necessary to contact the primary health care provider. If the deep breaths fail to increase the oxygen saturation level, the primary health care provider is notified and may prescribe oxygen.

The nurse is monitoring a client who was given an epidural opioid for a cesarean birth. The nurse notes that the client's oxygen saturation on pulse oximetry (Spo2) is 92%. What should the nurse do first? 1. Documents the findings 2. Contacts the primary health care provider 3. Administers 100% oxygen by way of face mask 4. Instructs the client to take several deep breaths

2 Treatment includes the application of oil (e.g., mineral oil) to the area to help soften the lesions followed by gentle removal of the scaly lesions with a comb before the head is shampooed. Seborrheic dermatitis, a chronic inflammation of the scalp or other areas of the skin, is characterized by yellow, scaly, oily lesions. It sometimes results when parents do not wash over the anterior fontanel carefully for fear that they will hurt the infant. The nurse should teach the mother how to shampoo the scalp and explain that she will not damage the fontanel with normal gentle shampooing. The scalp should be rinsed well to remove all soap, which could cause irritation.

The nurse is providing instructions to a mother of an infant with seborrheic dermatitis (cradle cap) about the treatment of the condition. What does the nurse tell the mother to do? 1. Avoid the use of shampoo on the infant's scalp 2. Apply oil to the affected area on the infant's scalp 3. Wash the infant's scalp daily, using only tepid water 4. Shampoo the infant's scalp, avoiding the anterior fontanel area

4 For the first 3 days following childbirth, lochia consists almost entirely of blood, with small particles of decidua and mucus, and is called lochia rubra because of its red color. The amount of blood decreases by about the fourth day, at which time the lochia changes from red to pink or brown-tinged; this stage is called lochia serosa. By about the 11th day, the erythrocyte component of lochia has decreased and the discharge becomes white or cream-colored. This final stage is known as lochia alba. Lochia alba contains leukocytes, decidual cells, epithelial cells, fat, cervical mucus, and bacteria. It is present in most women until the third week after childbirth but may persist for as long as 6 weeks. Lochia alba is a normal finding during the postpartum course, and no intervention is required, so the other options are incorrect.

A client who delivered a healthy newborn 11 days ago calls the clinic and tells the nurse that she is experiencing a white vaginal discharge. What does the nurse tell the client? 1. To perform a vaginal douche 2. To come to the clinic for a checkup 3. That this is an indication of an infection 4. That this is a normal postpartum occurrence

3 Calcium gluconate is the antidote to magnesium sulfate because it antagonizes the effects of magnesium at the neuromuscular junction. It should be readily available whenever magnesium is administered. Vitamin K is the antidote in cases of hemorrhage induced by the administration of oral anticoagulants such as warfarin sodium (Coumadin). Protamine sulfate is the antidote in cases of hemorrhage induced by the administration of heparin. Naloxone hydrochloride is administered to treat opioid-induced respiratory depression.

A client with preeclampsia who is receiving magnesium sulfate in an intravenous infusion exhibits signs of magnesium toxicity. The nurse immediately prepares for the administration of: 1. Vitamin K 2. Protamine sulfate 3. Calcium gluconate 4. Naloxone hydrochloride

3 Because the client delivered her baby just 12 hours ago, the most appropriate nursing action is to encourage the intake of oral fluids.A temperature of 38° C (100.4° F) is common during the 24 hours after childbirth. It may be the result of dehydration or normal postpartum leukocytosis. If the increased temperature persists for longer than 24 hours or exceeds 38° C, infection is a possibility, and the fever is reported to the primary health care provider or nurse midwife.

The nurse is monitoring a client who delivered a healthy newborn 12 hours ago. The nurse takes the client's temperature and notes that it is 38° C (100.4° F). What is the most appropriate nursing action? 1. Contact the primary healthcare provider 2. Recheck the temperature in 1 hour 3. Encourage the intake of oral fluids 4. Tell the client that antibiotics will be prescribed

2 A prenatal rubella antibody screen is performed in every pregnant woman to determine whether she is immune to rubella, which can cause serious fetal anomalies. If she is not immune, rubella vaccine is offered after childbirth to keep her from contracting rubella during subsequent pregnancies. The vaccine is a live virus, and defects might occur in the fetus if the vaccine were administered during pregnancy or if the mother were to become pregnant soon after it was administered. Administering a rubella vaccine immediately places the fetus at risk. Telling the client that she does not need to be concerned about being exposed to rubella is incorrect, because the possibility of exposure, which could be harmful to the fetus, does exist.

A rubella antibody screen is performed on a pregnant client, and the results indicate that the client is not immune to rubella. What does the nurse tell the client to do? 1. A rubella vaccine must be administered immediately 2. A rubella vaccine must be administered after childbirth 3. She will not contract rubella if she is exposed to the disease 4. She does not need to be concerned about being exposed to rubella

3 Low-fat foods and easily digested carbohydrates such as fruit, breads, cereals, rice, and pasta provide important nutrients and help prevent a low blood glucose level, which can cause nausea. Soups and other liquids should be taken between meals to avoid distending the stomach and triggering nausea. Sitting upright after meals reduces gastric reflux. Additionally, food portions should be small and foods with strong odors should be eliminated from the diet, because food smells often incite nausea.

The home care nurse is instructing a client with hyperemesis gravidarum about measures to ease the nausea and vomiting. What does the nurse tell the client to do? 1. Eat foods high in calories and fat 2. Lie down for at least 20 minutes after meals 3. Eat carbohydrates such as cereals, rice, and pasta 4. Consume primarily soups and liquids at mealtimes

3. After massaging a boggy fundus until it is firm, the nurse presses the fundus to expel clots from the uterus. The nurse must also keep one hand pressed firmly just above the symphysis (over the lower uterine segment) the entire time. Removing the clots allows the uterus to contract properly. Providing pressure over the lower uterine segment prevents uterine inversion. Having the client void before uterine assessment will not prevent uterine inversion. Telling the woman to bear down while the nurse performs fundal message and asking the client to take slow, deep breaths during fundal assessment also will not prevent uterine inversion.

The nurse is assessing the uterine fundus of a client who has just delivered a baby and notes that the fundus is boggy. The nurse massages the fundus, and then presses to expel clots from the uterus. To prevent uterine inversion during this procedure, what should the nurse do? 1. Have the client void before the uterine assessment 2. Tell the woman to bear down during fundal message 3. Simultaneously provide pressure over the lower uterine segment 4. Ask the client to take slow, deep breaths during fundal assessment

4 Magnesium sulfate is effective in preventing seizures (eclampsia) if diuresis occurs within 24 to 48 hours of the start of the infusion. As part of the therapeutic response, renal perfusion is increased and the client is free of visual disturbances, headache, epigastric pain, clonus (the rapid rhythmic jerking motion of the foot that occurs when the client's lower leg is supported and the foot is sharply dorsiflexed), and seizure activity. Hyperreflexia indicates cerebral irritability. Clonus is normally not present. The therapeutic magnesium level is 4 to 8 mg/dL (1.64 to 3.29 mmol/L). Reflexes range from 1+ to 2+ but should not be absent.

The nurse is caring for a client with preeclampsia who is receiving a magnesium sulfate infusion to prevent eclampsia. Which finding indicates to the nurse that the medication is effective? 1. Clonus is present. 2. Magnesium level is 10 mg/dL (4.11 mmol/L). 3. Deep tendon reflexes are absent. 4. The client experiences diuresis within 24 to 48 hours.