maternity
A pregnant woman at 32 weeks' gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to: A. Assess the woman's blood pressure and pulse. B. Have the woman breathe into a paper bag. C. Raise the woman's legs. D. Turn the woman on her left side.
Correct Answer: D. Turn the woman on her left side. During a fundal height measurement, the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure. Option A: After turning the client on the side, then vital signs can be assessed. Because this phenomenon is so well known, standard practice is for clinicians to avoid placing the woman in supine position for routine examinations and procedures, moving the woman into the left lateral if there are signs of fetal distress in labor, and also advising her to avoid the supine position herself, at least during the day. Option B: Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation. Option C: Raising her legs will not solve the problem since pressure will remain on the major abdominal blood vessels, thereby continuing to impede cardiac output.
A 26-year old multigravida is 14 weeks pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, "What does the alpha-fetoprotein test indicate?" The nurse bases a response on the knowledge that this test can detect: A. Kidney defects B. Cardiac defects C. Neural tube defects D. Urinary tract defects
Correct Correct Answer: C. Neural tube defects. The alpha-fetoprotein test detects neural tube defects and Down syndrome. Alpha-fetoprotein (AFP) is a plasma protein produced by the embryonic yolk sac and the fetal liver. AFP levels in serum, amniotic fluid, and urine functions as a screening test for congenital disabilities, chromosomal abnormalities, as well as some other adult occurring tumors and pathologies. Option A: In some cases, one or both kidneys may fail to develop. In other instances, an abnormality may be present that blocks the outflow of urine. This blockage may cause urine to back up into the kidney, a condition called hydronephrosis, which causes the kidney to appear enlarged on the ultrasound test. Another common abnormality is called reflux. This occurs when a valve-like mechanism at the point where the ureter joins the bladder does not work, allowing urine to wash back up into the kidney. Option B: The baby's heart begins to form immediately after conception and is complete by eight week's gestation. The heart begins as a tube-shaped structure that twists and divides to form the heart and heart valves. A congenital heart defect usually occurs because the heart does not twist or divide normally. Some mothers wonder if drugs, alcohol, or medications contributed to their child's heart defect. In most cases, we don't know why these defects occur. Although, some heart defects can run in families or be related to a disease the mother has, diabetes mellitus, for example. Option D: Common birth defects of the urinary system include hypospadias, obstructive defects of the renal pelvis, and renal agenesis. Hypospadias is characterized by the location of the urethral opening on the underside of the penis. Obstructive defects of the renal pelvis prevent urine from entering the bladder.
A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for preeclampsia. The nurse checks the client for which specific signs of preeclampsia? Select all that apply. A. Elevated blood pressure B. Negative urinary protein C. Facial edema D. Increased respirations E. Polydipsia
Correct Answer: A & C. Elevated blood pressure and facial edema. The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia. Option A: Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher. Option B: In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia. Option C: Edema exists in many pregnant women, but a sudden increase in edema or facial edema is suggestive of preeclampsia. The edema of preeclampsia occurs by a distinct mechanism that is similar to that of angioneurotic edema. Option D: Shortness of breath, a racing pulse, mental confusion, a heightened sense of anxiety, and a sense of impending doom can be symptoms of preeclampsia. If these symptoms are new to you, they could indicate an elevated blood pressure, or more rarely, fluid collecting in your lungs (pulmonary edema). Option E: Primary polydipsia (PP) is a condition where there is excess consumption of fluids leading to polyuria with diluted urine and, ultimately, hyponatremia.
A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Which of the following signs indicates a probable sign of pregnancy? Select all that apply. A. Uterine enlargement B. Fetal heart rate detected by nonelectric device C. Outline of the fetus via radiography or ultrasound D. Chadwick's sign E. Braxton Hicks contractions F. Ballottement
Correct Answer: A, D, E, and F. The probable signs of pregnancy include: Uterine Enlargement Hegar's sign or softening and thinning of the uterine segment that occurs at week 6. Goodell's sign or softening of the cervix that occurs at the beginning of the 2nd month Chadwick's sign or bluish coloration of the mucous membranes of the cervix, vagina, and vulva. Occurs at week 6. Ballottement or rebounding of the fetus against the examiner's fingers of palpation Braxton-Hicks contractions Positive pregnancy test measuring for hCG.
A nurse is reviewing the record of a client in the labor room and notes that the nurse-midwife has documented that the fetus is at (-1) station. The nurse determines that the fetal presenting part is: A. 1 cm above the ischial spine B. 1 fingerbreadth below the symphysis pubis C. 1 inch below the coccyx D. 1 inch below the iliac crest
Correct Answer: A. 1 cm above the ischial spine Station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, is measured in centimeters, and is noted as a negative number above the line and a positive number below the line. At -1 station, the fetal presenting part is 1 cm above the ischial spines. Option B: The doctor will assign a number from -5 to +5 to describe where the baby is in relation to the ischial spines. The ischial spines are bony protrusions located in the narrowest part of the pelvis. During a vaginal exam, the doctor will feel for the baby's head. If the head is high and not yet engaged in the birth canal, it may float away from their fingers. Option C: When the baby's head is level with the ischial spines, the fetal station is zero. Once the baby's head fills the vaginal opening, just before birth, the fetal station is +5. Option D: Usually about two weeks before delivery, the baby will drop into the birth canal. This is called being "engaged." At this point, the baby is at station 0. This drop into the birth canal is called a lightening.
During a prenatal examination, the nurse draws blood from a young Rh-negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for: A. Acute hemolytic disease B. Respiratory distress syndrome C. Protein metabolic deficiency D. Physiologic hyperbilirubinemia
Correct Answer: A. Acute hemolytic disease. When an Rh-negative mother carries an Rh-positive fetus there is a risk for maternal antibodies against Rh-positive blood; antibodies cross the placenta and destroy the fetal RBCs. Option B: Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants. In premature infants, respiratory distress syndrome develops because of impaired surfactant synthesis and secretion leading to atelectasis, ventilation-perfusion (V/Q) inequality, and hypoventilation with resultant hypoxemia and hypercarbia. Option C: Infants with protein metabolism disorders are unable to metabolize certain amino acids and require specialized formulas without the offending amino acid, allowing the baby to receive essential nutrients for growth. Option D: Physiologic jaundice is also referred to as non-pathologic jaundice, and it is mild and transient. This occurs because of differences in the metabolism of bilirubin in the neonatal period leading to an increased bilirubin load.
A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for: A. Any bleeding, such as in the gums, petechiae, and purpura. B. Enlargement of the breasts. C. Periods of fetal movement followed by quiet periods. D. Complaints of feeling hot when the room is cool.
Correct Answer: A. Any bleeding, such as in the gums, petechiae, and purpura. Severe preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D. Option B: Estrogen stimulates growth of the breast duct cells and generates the secretion of prolactin, another hormone. Prolactin stimulates breast enlargement and milk production. Progesterone supports the formation and growth of milk-producing cells within the glands of the breasts. Option C: The first fetal movements which are felt by the mother are called quickening. One function of these movements is to alert the pregnant woman that she has a fetus growing in her uterus. Most providers recommend that pregnant women monitor fetal movements, especially by the third trimester. This can be accomplished by simply instructing the woman to have a general awareness of the fetus and determine if the fetus is moving less than normal on any given day or about the same as other days. Option D: At the beginning of your pregnancy, new hormones are like little workers that help keep everything humming along smoothly. These hormonal changes also raise your body temperature a small amount.
A nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate? A. Document the findings and tell the mother that the monitor indicates fetal well-being. B. Take the mother's vital signs and tell the mother that bed rest is required to conserve oxygen. C. Notify the physician or nurse-midwife of the findings. D. Reposition the mother and check the monitor for changes in the fetal tracing.
Correct Answer: A. Document the findings and tell the mother that the monitor indicates fetal well-being. Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve. Option B: Inform the mother that they are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation. The presence of accelerations is considered a reassuring sign of fetal well-being. Option C: Accelerations are the basis for the nonstress test (NST). The presence of at least two accelerations, each lasting for 15 or more seconds above baseline and peaking at 15 or more bpm, in a 20-minute period is considered a reactive NST. Option D: The FHR is controlled by the autonomic nervous system. The inhibitory influence on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is conveyed by the sympathetic nervous system. Progressive vagal dominance occurs as the fetus approaches term and, after birth, results in a gradual decrease in the baseline FHR. Stimulation of the peripheral nerves of the fetus by its own activity (such as movement) or by uterine contractions causes acceleration of the FHR.
A pregnant woman's last menstrual period began on April 8, 2020, and ended on April 13. Using Naegele's rule her estimated date of birth would be: A. January 15, 2021 B. January 20, 2021 C. July 1, 2021 D. November 5, 2020
Correct Answer: A. January 15, 2021. Naegele's rule requires subtracting 3 months and adding 7 days and 1 year if appropriate to the first day of a pregnant woman's last menstrual period. When this rule was used with April 8, 2020, the estimated date of birth is January 15, 2021. Option B: Determining gestational age is one of the most critical aspects of providing quality prenatal care. Knowing the gestational age allows the obstetrician to provide care to the mother without compromising maternal or fetal status. It allows for the correct timing of management, such as administering steroids for fetal lung maturity, starting ASA therapy with a history of pre-eclampsia in previous pregnancies, starting hydroxyprogesterone caproate (Makena) for previous preterm deliveries. Option C: Naegele's rule, derived from a German obstetrician, subtracts 3 months and adds 7 days to calculate the estimated due date (EDD). Option D: It is prudent for the obstetrician to get a detailed menstrual history, including duration, flow, previous menstrual periods, and hormonal contraceptives. These factors are used to determine the length of her cycles and ovulation period.
Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include: A. A decrease of 200 calories a day. B. An increase of 300 calories a day. C. An increase of 500 calories a day. D. A maintenance of her present caloric intake per day.
Correct Answer: B. An increase of 300 calories a day. This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy. These calories should come from a balanced diet of protein, fruits, vegetables and whole grains. Sweets and fats should be kept to a minimum. A healthy, well-balanced diet can also help to reduce some pregnancy symptoms, such as nausea and constipation. Option A: Whenever possible, eat complex carbohydrates and limit simple carbohydrates. Option C: Protein needs increase considerably during pregnancy and peak during the third trimester. Add a protein-rich food to every meal and snack to ensure enough protein throughout the pregnancy. Option D: Whole grains and legumes, such as dried peas and beans, and other healthy carbs like fruit and starchy vegetables should make regular appearances on the plate. They provide B vitamins and trace minerals, such as zinc selenium, and magnesium. Grains and legumes are full of nutrients, including iron and the various B vitamins: thiamin (vitamin B-1), riboflavin (vitamin B-2), folate, and niacin.
A 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 monitor, the initial nursing assessment is which of the following? A. Identifying the types of accelerations B. Assessing the baseline fetal heart rate C. Determining the frequency of the contractions D. Determining the intensity of the contractions
Correct Answer: B. Assessing the baseline fetal heart rate Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate will be identified if they occur. Options 1 and 3 are important to assess, but not as the first priority. Option A: The FHR recordings may be interpreted as reassuring, nonreassuring or ominous, according to the pattern of the tracing. Reassuring patterns correlate well with a good fetal outcome, while nonreassuring patterns do not. Evaluation of fetal well-being using fetal scalp stimulation, pH measurement, or both, is recommended for use in patients with nonreassuring patterns. Option C: Frequency is based on the time between the start of one contraction and the start of the next contraction. Time the frequency of contractions by noting the time when one contraction starts and the time when the next contraction starts. Option D: The intensity of the contractions can be estimated by touching the uterus. The relaxed or mildly contracted uterus usually feels about as firm as a cheek, a moderately contracted uterus feels as firm as the end of the nose, and a strongly contracted uterus is as firm as the forehead.
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child that was delivered at 37 weeks and tells the nurse that she doesn't have any history of abortion or fetal demise. The nurse would document the GTPAL for this client as: A. G = 3, T = 2, P = 0, A = 0, L =1 B. G = 2, T = 0, P = 1, A = 0, L =1 C. G = 1, T = 1. P = 1, A = 0, L = 1 D. G = 2, T = 0, P = 0, A = 0, L = 1
Correct Answer: B. G = 2, T = 0, P = 1, A = 0, L =1. Pregnancy outcomes can be described with the acronym GTPAL. "G" is Gravidity, the number of pregnancies. "T" is term births, the number of born at term (38 to 41 weeks). "P" is preterm births, the number born before 38 weeks gestation. "A" is abortions or miscarriages, included in "G" if before 20 weeks gestation, included in parity if past 20 weeks AOE. "L" is live births, the number of births of living children. Therefore, a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 37 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1. Option A: Gravida should be 2, term births should be 0, and parity is 1. Option C: Gravida should be 2 and term births should be 0. Option D: Parity should be 1.
A nurse explains the purpose of effleurage to a client in early labor. The nurse tells the client that effleurage is: A. A form of biofeedback to enhance bearing down efforts during delivery. B. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus. C. The application of pressure to the sacrum to relieve a backache. D. Performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest.
Correct Answer: B. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus. Effleurage is a specific type of cutaneous stimulation involving light stroking of the abdomen and is used before a transition to promote relaxation and relieve mild to moderate pain. Effleurage provides tactile stimulation to the fetus. Option A: Women using biofeedback during childbirth reported significantly lower pain: from admission to labor and delivery, at delivery, and 24-hr postpartum. Also, women in the biofeedback group labored an average of 2 hr less and used 30% fewer medications. The results of a study suggest that EMG biofeedback may be effective in reducing levels of acute pain experienced by childbearing women. Option C: Low back pain in pregnancy is generally ascribed to the many changes in load and body mechanics that occur during the carrying of a child. It is normal to gain between 20 and 40 pounds during pregnancy. This clearly shifts the body's center of gravity anteriorly and increases the moment arm of forces applied to the lumbar spine. Option D: The primary hormones involved include estrogen, progesterone, and oxytocin. Oxytocin is one of the most widely studied hormones involved in uterine contractions. It decreases Ca2+ efflux, by inhibiting the Ca2+/ATPase of the myometrial cell membrane which pumps calcium from the inside to the extracellular space, and increases Ca2+ influx, as well as causes the release of Ca2+ from the SR via IICR.
A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction? A. Early decelerations B. Variable decelerations C. Late decelerations D. Short-term variability
Correct Answer: B. Variable decelerations Variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus. Pressure on the cord initially occludes the umbilical vein, which results in an acceleration (the shoulder of the deceleration) and indicates a healthy response. This is followed by occlusion of the umbilical artery, which results in a sharp downslope. Finally, the recovery phase is due to the relief of the compression and the sharp return to the baseline, which may be followed by another healthy brief acceleration or shoulder Option A: Early decelerations result from pressure on the fetal head during a contraction. This type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction. Thus, it has the characteristic mirror image of the contraction Option C: Late decelerations are an ominous pattern in labor because it suggests uteroplacental insufficiency during a contraction. A late deceleration is a symmetric fall in the fetal heart rate, beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction has ended. The descent and return are gradual and smooth. Regardless of the depth of the deceleration, all late decelerations are considered potentially ominous. Option D: Short-term variability refers to the beat-to-beat range in the fetal heart rate. The FHR is under constant variation from the baseline. This variability reflects a healthy nervous system, chemoreceptors, baroreceptors, and cardiac responsiveness. Prematurity decreases variability; therefore, there is little rate fluctuation before 28 weeks. Variability should be normal after 32 weeks.
A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client. A. Monitor maternal vital signs every 2 hours. B. Notify the physician if respirations are less than 18 per minute. C. Monitor renal function and cardiac function closely. D. Keep calcium gluconate on hand in case of a magnesium sulfate overdose. E. Monitor deep tendon reflexes hourly. F. Monitor I and O's hourly. G. Notify the physician if urinary output is less than 30 ml per hour.
Correct Answer: C, D, E, F, and G. Option A: BP should be assessed with the goal of maintaining the diastolic BP at less than 110 mm Hg with administration of antihypertensive medications as needed (eg, hydralazine, labetalol, nifedipine). Option B: When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Option C: Cardiac and renal function are monitored closely. Eclampsia-associated renal abnormalities can include decreases in glomerular filtration rate, renal plasma flow, and uric acid clearance as well as proteinuria. Eclampsia is associated with cardiovascular derangements such as generalized vasospasm, increased peripheral vascular resistance, and increased left ventricular stroke work index. Pulmonary capillary wedge pressure (PCWP) may vary from low to elevated. Importantly, central venous pressure (CVP) may not correlate with PCWP in patients with severe preeclampsia or eclampsia. Option D: Calcium gluconate is kept on hand in case of magnesium sulfate overdose because calcium gluconate is the antidote for magnesium sulfate toxicity. Option E: Deep tendon reflexes are assessed hourly. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Although brisk or hyperactive reflexes are common during pregnancy, clonus is a sign of neuromuscular irritability that usually reflects severe preeclampsia. Option F: Monitor fluid intake and urine output, maternal respiratory rate, and oxygenation, as indicated, and continuously monitor fetal status. Pulmonary arterial pressure monitoring is rarely indicated but may be helpful in patients who have evidence of pulmonary edema or oliguria/anuria. Option G: The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.Source:
A prenatal nurse is providing instructions to a group of pregnant clients regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions? A. "I need to cook meat thoroughly." B. "I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat." C. "I need to drink unpasteurized milk only." D. "I need to avoid contact with materials that are possibly contaminated with cat feces."
Correct Answer: C. "I need to drink unpasteurized milk only." All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Everyone, including immunocompetent patients, should be educated about toxoplasmosis risk factors and ways to minimize the risks. Preventing toxoplasmosis is particularly important in seronegative immunocompromised patients and in pregnant women. Option A: Avoid eating raw meat, unpasteurized milk, and uncooked eggs, oysters, clams, and mussels. Rarely, infection by tachyzoites occurs from ingestion of unpasteurized milk or by direct entry into the bloodstream through a blood transfusion or laboratory accident. Transmission can also occur via ingestion of tissue cysts (bradyzoites) in undercooked or uncooked meat or through transplantation of an organ that contains tissue cysts. (Slaughterhouse workers and butchers may be at increased risk of infection.) In Europe and the United States, pork is the major source of T gondii infection in humans. Option B: Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption. Option D: Avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sandboxes, and garden soil. T gondii oocysts are ingested in material contaminated by feces from infected cats. Oocysts may also be transported to food by flies and cockroaches. When T gondii is ingested, bradyzoites are released from cysts or sporozoites are released from oocysts, and the organisms enter gastrointestinal cells. Host cell receptors consisting of laminin, lectin, and SAG1 are involved in T gondii tachyzoite attachment and penetration. Tachyzoites multiply, rupture cells, and infect contiguous cells. They are transported via the lymphatics and are disseminated hematogenously throughout the tissues.
A nurse in the labor room is caring for a client in the active phases of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The most appropriate nursing action is to: A. Place the mother in the supine position. B. Document the findings and continue to monitor the fetal patterns. C. Administer oxygen via face mask. D. Increase the rate of Pitocin IV infusion.
Correct Answer: C. Administer oxygen via face mask. Late decelerations are due to uteroplacental insufficiency as the result of decreased blood flow and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore oxygen is necessary. Option A: The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned to her side to displace pressure of the gravid uterus on the inferior vena cava. Option B: The findings should be documented after an intervention has been done. Option D: An intravenous Pitocin infusion is discontinued when a late deceleration is noted. Most Pitocin related birth injury cases involve variable and late decelerations. When the fetal monitor shows late decelerations, it is often a sign that the baby is in distress because the contractions are preventing oxygen from adequately transferring between the uterus and placenta.
A nurse is caring for a pregnant client with preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from preeclampsia to eclampsia, the nurse's first action is to: A. Administer magnesium sulfate intravenously B. Assess the blood pressure and fetal heart rate. C. Clean and maintain an open airway. D. Administer oxygen by face mask.
Correct Answer: C. Clean and maintain an open airway. The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased. Option A: In this case, the doctor may prescribe magnesium sulfate as well as medications to help reduce blood pressure. Magnesium sulfate therapy is used to prevent seizures in women with preeclampsia. It can also help prolong a pregnancy for up to two days. Option B: Preeclampsia is when the blood pressure, or the force of blood against the walls of the arteries, becomes high enough to damage the arteries and other blood vessels. Damage to the arteries may restrict blood flow. It can produce swelling in the blood vessels in the brain and to the growing baby. If this abnormal blood flow through vessels interferes with the brain's ability to function, seizures may occur. Option D: The initial treatment for eclampsia includes maintaining oxygen delivery to both mother and fetus, minimizing the risk of aspiration, treating the seizure, and controlling hypertension.
A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is: A. G4 T3 P2 A1 L4 B. G5 T2 P2 A1 L4 C. G5 T2 P1 A1 L4 D. G4 T3 P1 A1 L4
Correct Answer: C. G5 T2 P1 A1 L4. 5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children. A good starting point is to ask about the number of children the patient has given birth to. Next, sensitively ask about miscarriages, stillbirths, ectopics and terminations. Option A: Gravida should be 5, term births should be 3, and parity should be 1. Gravidity is the total number of pregnancies, regardless of outcome. Option B: Parity should be 1. Parity is the total number of pregnancies carried over the threshold of visibility. Option D: Gravida should be 5, and term births should be 2
A client arrives at a prenatal clinic for the first prenatal assessment. The client tells a nurse that the first day of her last menstrual period was September 19th, 2013. Using Naegele's rule, the nurse determines the estimated date of confinement as: A. July 26, 2013 B. June 12, 2014 C. June 26, 2014 D. July 12, 2014
Correct Answer: C. June 26, 2014. Accurate use of Naegele's rule requires that the woman has a regular 28-day menstrual cycle. Add 7 days to the first day of the last menstrual period, subtract three months, and then add one year to that date.
A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of slowing labor. The nurse is reviewing the physician's orders and would expect to note which of the following prescribed treatments for this condition? A. Medication that will provide sedation B. Increased hydration C. Oxytocin (Pitocin) infusion D. Administration of a tocolytic medication
Correct Answer: C. Oxytocin (Pitocin) infusion Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows. Hypotonic labor is an abnormal labor pattern, notable especially during the active phase of labor, characterized by poor and inadequate uterine contractions that are ineffective to cause cervical dilation, effacement, and fetal descent, leading to a prolonged or protracted delivery. Option A: Provided there are no contraindications. Oxytocin is the medication of choice for augmenting contractions. The dosage regimen should be titrated to effect for achieving adequate uterine contractions. However, dosing generally does not exceed 30milliunit/ minute. The usual protocol is 5units of oxytocin in 500mls of 5% Dextrose intravenous infusion, starting with 10 drops/min and gradually titrating the rate to achieve a contraction rate of at least 3 per minute. Option B: Maintain adequate hydration. Encourage ambulation and avoid supine position. Although these are not proven to improve contractions or prolonged labor due to hypocontractility, they may improve the comfort of the parturient. Option D: A combination of amniotomy and oxytocin augmentation is more effective in the management of hypocontractile labor than amniotomy alone when instituted early in the active phase.
Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy? A. Mastitis B. Metabolic alkalosis C. Physiologic anemia D. Respiratory acidosis
Correct Answer: C. Physiologic anemia. Hemoglobin and hematocrit levels decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production. Option A: Mastitis, which mainly affects breastfeeding women, causes redness, swelling, and pain in one or both breasts. Mastitis is an inflammation of breast tissue that sometimes involves an infection. The inflammation results in breast pain, swelling, warmth, and redness. You might also have fever and chills. Option B: Metabolic alkalosis is uncommon in pregnancy and is most often the result of severe vomiting. If this is present at the time of delivery, transient metabolic derangement in the fetus can occur, potentially requiring additional organ support. Option D: Progesterone levels are increased during pregnancy. Progesterone causes stimulation of the respiratory center, which can lead to respiratory alkalosis. Chronic respiratory alkalosis is a common finding in pregnant women.
A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse? A. Urinary output of 20 ml since the previous assessment B. Deep tendon reflexes of 2+ C. Respiratory rate of 10 BPM D. Fetal heart rate of 120 BPM
Correct Answer: C. Respiratory rate of 10 BPM. Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. Option A: A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. The kidneys face remarkable demands during pregnancy, and it is critical that the practicing nephrologist understands the normal kidney adaptations to pregnancy. GFR rises early to a peak of 40% to 50% that of prepregnancy levels, resulting in lower levels of serum creatinine, urea, and uric acid. There is a net gain of sodium and potassium, but a greater retention of water, with gains of up to 1.6 L. Option B: Deep tendon reflexes of 2+ are normal. With preeclampsia, a woman's reflexes become unusually active. Increasing blood pressure will lead to increasing hyperreflexia until uncontrollable seizures eventually result. Testing for this change is difficult in the field setting; in a clinic setting an overactive patellar response is a good indicator. Option D: The fetal heart rate is WNL for a resting fetus. Current international guidelines recommend for the normal fetal heart rate (FHR) baseline different ranges of 110 to 150 beats per minute (bpm) or 110 to 160 bpm.
A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if: A. Ankle clonus is noted. B. The blood pressure decreases. C. Seizures do not occur. D. Scotomas are present.
Correct Answer: C. Seizures do not occur. For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Seizures were a half or a third less likely to recur after treatment with magnesium. Maternal mortality was also lower in women allocated magnesium rather than phenytoin or diazepam, although this did not achieve statistical significance. Recent Cochrane reviews, however, indicated a significant reduction in maternal mortality with magnesium. Option A: Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Although brisk or hyperactive reflexes are common during pregnancy, clonus is a sign of neuromuscular irritability that usually reflects severe preeclampsia. Option B: Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Option D: Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.
A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? A. Three contractions occurring within a 10-minute period B. Increased urinary output C. Adequate resting tone of the uterus palpated between contractions D. A fetal heart rate of 90 beats per minute
Correct Answer: D. A fetal heart rate of 90 beats per minute A normal fetal heart rate is 120-160 BPM. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue to Pitocin. The goal of labor augmentation is to achieve three good-quality contractions in a 10-minute period. Option A: Pitocin (oxytocin injection) is a natural hormone that causes the uterus to contract used to induce labor, strengthen labor contractions during childbirth, control bleeding after childbirth, or induce an abortion. Option B: Oxytocin has an antidiuretic effect and increases the urinary excretion of AQP2 in humans whose urinary concentration mechanism is preserved. Urine volume and free water clearance were decreased, and urine osmolality was increased by the administration of oxytocin or dDAVP in the normal volunteers and CDI patients. Option C: In a normal labor, one contraction every two to three minutes or less than five contractions in a 10 minute period is ideal. A uterus must rest between contractions, having sufficient uterine resting tone (soft to the touch), and uterine resting time (about one minute).
A nurse is caring for a client in the second stage of labor. The client is experiencing uterine contractions every 2 minutes and cries out in pain with each contraction. The nurse recognizes this behavior as: A. Exhaustion B. Valsalva's maneuver C. Involuntary grunting D. Fear of losing control
Correct Answer: D. Fear of losing control Pains, helplessness, panicking, and fear of losing control are possible behaviors in the 2nd stage of labor. In women who have delivered vaginally previously, whose bodies have acclimated to delivering a fetus, the second stage may only require a brief trial, whereas a longer duration may be required for a nulliparous female. Option A: Labour as a life event is characterized by tremendous physiological and psychological changes that require major behavioral adjustments in a short period of time. Option B: Exercise involving the Valsalva maneuver (holding one's breath during exertion) because it can cause increased intra-abdominal pressure. Option C: Labour presents a physical and psychological challenge for women. The latter stages of pregnancy can be a difficult time emotionally. Fear and apprehension are experienced alongside excitement. There are emotions both positive and negative that will affect the woman's birth experience.
A nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 BPM. Which of the following nursing actions is most appropriate? A. Encourage the client's coach to continue to encourage breathing exercises. B. Encourage the client to continue pushing with each contraction. C. Continue monitoring the fetal heart rate. D. Notify the physician or nurse-midwife.
Correct Answer: D. Notify the physician or nurse-midwife. A normal fetal heart rate is 120-160 beats per minute. Fetal bradycardia between contractions may indicate the need for immediate medical management, and the physician or nurse-midwife needs to be notified. Option A: Steps can be taken to help the fetus get more oxygen, such as having the mother change position. If these procedures do not work, or if further test results suggest the fetus has a problem, the ob-gyn or other health care professional may decide to deliver right away. Option B: Uterine contractions also may be monitored with a special tube called an intrauterine pressure catheter that is inserted through the vagina into the uterus. Internal monitoring can be used only after the membranes of the amniotic sac have ruptured. Option C: Fetal heart rate monitoring may help detect changes in the normal heart rate pattern during labor. If certain changes are detected, steps can be taken to help treat the underlying problem. Fetal heart rate monitoring also can help prevent treatments that are not needed.
A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a Doppler ultrasound device. The nurse most accurately determines that the fetal heart sounds are heard by: A. Noting if the heart rate is greater than 140 BPM. B. Placing the diaphragm of the Doppler on the mother's abdomen. C. Performing Leopold's maneuvers first to determine the location of the fetal heart. D. Palpating the maternal radial pulse while listening to the fetal heart rate.
Correct Answer: D. Palpating the maternal radial pulse while listening to the fetal heart rate. The nurse simultaneously should palpate the maternal radial or carotid pulse and auscultate the fetal heart rate to differentiate the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the fetal heart rate. Option A: As cardiac output increases, the heart rate at rest speeds up from a normal prepregnancy rate of about 70 beats per minute to 80 or 90 beats per minute. During exercise, cardiac output and heart rate increase more when a woman is pregnant than when she is not. Option B: One type of monitor is a Doppler ultrasound device. It's often used during prenatal visits to count the baby's heart rate. It may also be used to check the fetal heart rate during labor. The healthcare provider may also check the baby's heart rate continuously during labor and birth. To do this, the ultrasound probe (transducer) is fastened to the belly. It sends the sounds of the baby's heart to a computer. Option C: Leopold's maneuvers may help the examiner locate the position of the fetus but will not ensure a distinction between the two rates.
A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the client's hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following? A. A loud mouth B. Low self-esteem C. Hemorrhage D. Postpartum infections
Correct Answer: D. Postpartum infections Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Good nutrition is the best way to prevent anemia if the woman is pregnant or trying to become pregnant. Eating foods high in iron content (such as dark green leafy vegetables, red meat, fortified cereals, eggs, and peanuts) can help ensure that she maintains the supply of iron her body needs to function properly. The obstetrician will also prescribe vitamins to ensure that the woman has enough iron and folic acid. Make sure to get at least 27 mg of iron each day. If the woman does become anemic during pregnancy, it can usually be treated by taking iron supplements. Option A: The amount of blood in the body increases by about 20-30 percent, which increases the supply of iron and vitamins that the body needs to make hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen to other cells in the body. Option B: Mild anemia is normal during pregnancy due to an increase in blood volume. More severe anemia, however, can put the baby at higher risk for anemia later in infancy. In addition, if the mother is significantly anemic during the first two trimesters, she is at greater risk for having a preterm delivery or low-birth-weight baby. Being anemic also burdens the mother by increasing the risk of blood loss during labor and making it more difficult to fight infections. Option C: Anemia does not specifically present a risk for hemorrhage. Severe anemia may weaken uterine muscular strength or lower resistance to infectious diseases, contributing to postpartum hemorrhage and subsequent maternal mortality. However, the severity of anemia that places a woman at a greater risk of experiencing postpartum hemorrhage or a debilitating and clinically relevant blood loss has not been investigated. Indeed, the impact of anemia on the extent of blood loss at childbirth and postpartum is not well-understood.
A nurse is caring for a client in labor. The nurse determines that the client is beginning in the second stage of labor when which of the following assessments is noted? A. The client begins to expel clear vaginal fluid. B. The contractions are regular. C. The membranes have ruptured D. The cervix is dilated completely.
Correct Answer: D. The cervix is dilated completely. The second stage of labor begins when the cervix is dilated completely and ends with the birth of the neonate. After cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing efforts. The fetus passes through the birth canal via 7 movements known as the cardinal movements. Option A: The first stage of labor is further subdivided into two phases, which are defined by the degree of cervical dilation. The latent phase is commonly defined as the 0 to 6 cm, while the active phase commences from 6 cm to full cervical dilation. Option B: Although precisely determining when labor starts may be inexact, labor is generally defined as beginning when contractions become strong and regularly spaced at approximately 3 to 5 minutes apart Option C: Rupture of membranes results from a variety of factors that ultimately lead to accelerated membrane weakening. This is caused by an increase in local cytokines, an imbalance in the interaction between matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases, increased collagenase and protease activity, and other factors that can cause increased intrauterine pressure.
A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to: A. Avoid wearing a bra. B. Wash the nipples and areola area daily with soap and massage the breasts with lotion. C. Wear tight-fitting blouses or dresses to provide support. D. Wash the breasts with warm water and keep them dry.
Correct Answer: D. Wash the breasts with warm water and keep them dry. The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. Breasts can become sore in early pregnancy for several reasons, but one of the primary causes is changing hormone levels (such as estrogen, progesterone, and prolactin). Option A: Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Back closures rather than front closures will give you the ability to adjust as necessary. Option B: The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Option C: Tight-fitting blouses or dresses will cause discomfort. The woman might instinctually do everything she can to avoid allowing anything to touch her breasts. For example, if the seatbelt is uncomfortable, adjust the strap that zigzags across the torso so that it runs between the breasts and not across the top of one of them.
A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse takes. Stop Pitocin infusion. Reposition the client. Perform a vaginal examination Check the client's blood pressure and heart rate Administer oxygen by face mask at 8 to 10 L/min
If uterine hypertonicity occurs, the nurse immediately will intervene to reduce uterine activity and increase fetal oxygenation. The nurse would stop the Pitocin infusion and increase the rate of the non-additive solution, check maternal BP for hyper or hypotension, position the woman in a side-lying position, and administer oxygen by snug face mask at 8-10 L/min. The nurse then would attempt to determine the cause of the uterine hypertonicity and perform a vaginal exam to check for a prolapsed cord. Option A: Oxytocin is a natural hormone, which causes the uterus (womb) to have regular, painful contractions and labor to start. It is available as an intravenous (into a vein (IV)) drug and infused slowly to artificially stimulate labor if doctors or midwives feel that it is necessary to accelerate the birth of the baby, or if the mother requests it. Option B: Risks associated with using IV oxytocin to stimulate uterine contractions include the woman having contractions that are too long or too frequent (uterine hyperstimulation), which can lead to changes in the baby's heart rate and the need for an emergency cesarean. Option C: Stopping oxytocin infusion once active labor has started could result in more natural childbirth, particularly if the risk of uterine overstimulation and the need for immediate cesarean section is reduced. Option D: Also, the overall total dose of oxytocin the mother received would be reduced, which could lead to fewer adverse effects (e.g. maternal nausea, vomiting, and headache, or changes to the baby's heart rate). Option E: Discontinuing IV oxytocin probably reduces the risk of women having contractions that become too long or too strong resulting in changes to the baby's heart rate (three trials, 486 women).
