Exam 3 Review

Late decelerations are present on the monitor strip of a client who received epidural anesthesia 20 minutes ago. What should the nurse do immediately? a. Reposition the client from supine to left lateral. b. Increase the intravenous flow rate from 125 to 150 mL/hr. c. Administer oxygen at a rate of 8 to 10 L/min by way of face mask. d. Assess the maternal blood pressure for a systolic pressure below 100 mm Hg.

a. Reposition the client from supine to left lateral.

The pregnant woman should increase her intake by _____ calories a day

200 calories

A 14-year-old woman is seeking obstetric care. Which of the following vital signs must be monitored very carefully during this woman's pregnancy? 1. Heart rate 2. Respiratory rate 3. Blood pressure 4. Temperature

*3. Blood pressure*

A nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. Folic acid is important for this client because it: 1 Lessens sickling of RBCs 2 Prevents vaso-occlusive crises 3 Decreases cellular oxygen need 4 Compensates for a rapid turnover of red blood cells

*4 Compensates for a rapid turnover of red blood cells* Folic acid is needed to produce heme for hemoglobin.

*Antepartum Care:* FBS

FBS = 60 - 90 mg/dl

A gravid woman with sickle cell anemia is admitted in vaso-occlusive crisis. Which of the following is the priority intervention that the nurse must perform? 1. Administer narcotic analgesics. 2. Apply heat to swollen joints. 3. Place on strict bed rest. 4. Infuse intravenous solution

*4. Administering intravenous fluids is the priority action*

A pregnant woman presents to the emergency department complaining of persistent nausea and vomiting. She is diagnosed with hyperemesis gravidarum. The nurse should include which information when teaching about diet for hyperemesis? (Select all that apply)

*- Eat a high protein snack at bedtime* *- ice cream may stay down better than other food choices* *- eat what sounds good to you even if its not well balanced*

A gravid woman has sickle cell anemia. Which of the following situations could precipitate a vaso-occlusive crisis in this woman? 1. Hypoxia. 2. Alkalosis. 3. Fluid overload. 4. Hyperglycemia.

*1. Hypoxia*

A woman at 40 weeks' gestation is admitted in active labor. After appropriate progress of her labor, the woman asks for and receives epidural analgesia. Once the *epidural catheter has been inserted*, which nursing assessments and interventions should be performed? (Select all that apply) 1. Maintaining intravenous fluid administration 2. Having oxygen available in case of hypotension 3. Checking the bladder for distention every 2 hours 4. Positioning the client supine for ease of monitoring 5. Monitoring fetal heart rate and labor progress per hospital protocol 6. Administering an oxytocin (Pitocin) infusion to maintain the labor pattern

*1. Maintaining intravenous fluid administration* *2. Having oxygen available in case of hypotension* *3. Checking the bladder for distention every 2 hours* *5. Monitoring fetal heart rate and labor progress per hospital protocol* Hypotension is a common problem in the client receiving epidural analgesia. Intravenous fluids can help counter this problem and also provide a vehicle for emergency drug administration. Because sensation below the waist will be compromised, the client may be unaware of bladder distention, a situation that can occur with labor, possibly resulting in trauma to the bladder. Fetal heart tones and the progress of labor should be monitored. Oxygen should be available in case of hypotension occurs as a result of to the epidural block or as emergency care should the anesthetic agent migrate upward. The client should be positioned on her side to prevent vena cava syndrome. Labor may be slowed by the epidural, but it is not essential that a woman receiving an epidural have oxytocin to maintain the labor pattern.

A type 1 diabetic client has developed polyhydramnios. The client should be taught to report which of the following? 1. Uterine contractions. 2. Reduced urinary output. 3. Marked fatigue. 4. Puerperal rash.

*1. Uterine contractions* The client should be taught to observe for signs of preterm labor.

A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary health care practitioner? 1. Presence of striae gravidarum 2. Dyspnea on exertion 3. 4-pound weight gain in a month 4. Patellar reflexes +2

*2. Dyspnea on exertion* A client who is complaining of dyspnea on exertion is likely going into left-sided congestive heart failure.

An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is high risk for which of the following complications of pregnancy? 1. Placenta previa. 2. Gestational diabetes. 3. Abruptio placentae. 4. Chromosomal defects.

*2. Gestational diabetes.* Obese clients are at high risk for gestational diabetes.

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary health care provider is highest priority for the nurse to complete? 1. Obtain complete blood count. 2. Start intravenous fluids 3. Check admission weight 4. Obtain urine for urinalysis

*2. Start intravenous fluids*

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the *earliest sign of decompensation* is most often: A. orthopnea. B. decreasing energy levels. C. moist frequent cough and frothy sputum. D. crackles (rales) at the bases of the lungs on auscultation.

*B. decreasing energy levels*

During a physical assessment of an at-risk patient, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of:

*Cardiac decompensation*

Most common congenital anomalies:

*Cardiac defects*

Poor glycemic control *before conception* & in the *early weeks* of pregnancy is associated primarily w/ what fetal risk?

*Congenital anomalies*

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the base of the lungs, and some pulse irregularity. These are most likely signs of: A. euglycemia. B. rheumatic fever. C. pneumonia. D. cardiac decompensation

*D. cardiac decompensation*

_______ crosses placenta, but _______ does not.

*Glucose crosses placenta* *Insulin does NOT cross placenta*

A woman with severe preeclampsia is being treated with an intravenous infusion of magnesium sulfate. This treatment is considered successful if:

*Seizures do not occur *

Pt's with cardiac disorders are at risk for *cardiac decompensation* What are the s/s of cardiac decompensation?

*dyspnea, crackles, & an irregular weak rapid pulse* rapid respirations, moist frequent cough, generalized edema, increasing fatigue, & cyanosis of lips and nails

Hyperemesis gravidarum is associated with

*hyperthyroidism*, elevated thyroid hormones

Which condition is a *fetus at risk* for if the mother has poor glycemic control *later on* in pregnancy?

*macrosomia* (increased weight)

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms should the nurse expect to observe? (Select all that apply)

- Decreased urinary output & irritability - Ankle clonus & epigastric pain - Platelet count of less than 100,000/mm3 & visual problems

A delirious patient is admitted to the hospital in labor. She has had no prenatal care and vials of crack cocaine are found in her pockets. The nurse monitors this client carefully for which of the following intrapartal complications? 1. Prolonged labor. 2. Prolapsed cord. 3. Abruptio placentae. 4. Retained placenta.

3. Abruptio placentae.

Target blood glucose 2 hr after eating a meal =

< 120 mg/dL

Target blood glucose 1 hr after eating a meal =

< 140 mg/dL

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the:

Degree of glycemic control during pregnancy

What is the most important factor affecting pregnancy outcome in diabetic patients?

Degree of glycemic control during pregnancy *strict maternal glucose control is key to optimal outcome*

*Intrapartum Care:* FBS

FBS = 70 - 90 mg/dl

What dietary instructions does the nurse give a patient who has experienced miscarriage?

Food that are high in iron and protein

Maternal and neonatal risks associated with gestational diabetes mellitus are:

Maternal preeclampsia, fetal macrosomia

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of:

Placental abruption

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion?

Prepare the women for an ultrasound and bloodwork