Maternity Final Pt. 3
A 26-year-old multigravida is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this patient?
"Carry hard candy (or other simple sugar) when exercising."
A client is 12 weeks pregnant with her first baby. She has class III cardiac disease. She states that she had been taking sodium Warfarin (Coumadin), but her physician changed her to heparin (Hepalean). She asks the nurse why this was done. The nurse's response should be:
"Heparin is safer because it does not cross the placenta"
Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa?
"Please promptly report if you experience any bleeding or feel any back discomfort."
The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful?
"Pregnancy affects insulin production, so I'll need to make adjustments in my diet."
A patient with Class III cardiac disease is in labor with regional anesthesia. The fetal heart rate tracing is reassuring. She is now fully dilated, but has no urge to push. Her support person asks why the nurse is discouraging pushing. The nurse's response should be:
"We are encouraging laboring down to limit cardiac workload of second stage as well as minimizing maternal exhaustion"
A 32 year old multipara is 26 weeks pregnant. Her previous births include two large-for-gestational age babies and one unexplained stillbirths. Which test would the nurse anticipate as being most definitive in diagnosing gestational diabetes?
A 75 gram, three-hour glucose tolerance test.
A student nurse, during her observation experience in labor, is aware that she may be caring for laboring women with cardiac disease. Medications she should become familiar with include (select all that apply)
Anticoagulants. Thiazide diuretics and furosemide. Antiarrhythmic.
A nurse suspects that a client may be developing disseminated intravascular coagulation (DIC). The woman has a history of a placental abruption during birth. Which finding would help to support the nurse's suspicion?
Appearance of petechiae, bleeding gums.
The nurse uses the external fetal heart monitor to evaluate fetal status. The fetal heart tracing shows accelerations. Accelerations in the fetal heart are:
Associated with fetal well-being and oxygenation
The nurse is caring for a woman, G2 P1001, 40 weeks gestation, in labor. A 12 P.M. assessment revealed: cervix 4 cm, 80% effaced, -3 station, and fetal heart 124 with average variability. 5 P.M. assessment: cervix 6 cm, 90% effaced, -3 station and fetal heart 120 with minimal variability.10 A.M. assessment: cervix 8 cm, 100% effaced, -3 station and fetal heart 124 with flat baseline. Based on the assessments, which of the following should the nurse conclude?
Baby is in fetal distress.
Why may a patient with preeclampsia have an elevated hematocrit?
Because her intravascular fluid moves to extracellular spaces due to a decrease in plasma colloid osmotic pressure.
A pregnant patient is admitted to the emergency department with bleeding. The nurse realizes that the patient might have placenta previa. Which sign would be suggestive of placenta previa?
Bright red vaginal bleeding.
What medication should be readily available as an antidote for magnesium sulfate?
Calcium gluconate.
Hyperstimulation is defined as:
Contractions lasting more than 2 minutes. Five or more contractions in 10 minutes. Contractions occurring within 1 minute of each other.
A primigravida presents to labor and delivery at 36 weeks gestation complaining of severe uterine tenderness and decreased fetal movement. What other clinical indicators would lead the nurse to suspect abruption placenta?
Dark red vaginal bleeding and a board like rigid abdomen.
If the patient had HELLP syndrome, which lab results would the nurse expect her to exhibit?
Decreased hemoglobin and hematocrit (H&H), elevated liver enzymes, platelet count <100,000 mm3.
What is the pathophysiology responsible for a client who complains of a pounding headache and exhibits brisk DTRs?
Decreased perfusion and arteriolar spasms.
A client is diagnosed with preeclampsia and is now receiving IV magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?
Deep tendons reflexes 2+
Identify the hallmark of placenta previa that differentiates it from abruptio placenta.
Insidious onset of painless vaginal bleeding
A pregnant woman who has diabetes mellitus is in the high-risk OB clinic for a checkup. The nurse notes that her hemoglobin A1C (HbA1C) is 5%. Which action by the nurse is most appropriate?
Document the findings in the patient's chart.
You are caring for a primiparous woman admitted to labor and delivery for induction of labor at 42 weeks gestation. She asks you to explain the factors that contribute to prolonged labor. The best response would be to state the following:
Dystocia is related to uterine contractions, the pelvis, the fetus, position of the mother, and psychosocial response.
The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome?
Elevated liver enzymes.
A women who has had no prenatal care presented to the labor and birth unit. Upon exam, she is found to have hydramnios. The client preceded to give birth to a 4500 gram infant. Which of the following complications of pregnancy was likely to contribute to these findings?
Gestational diabetes
The primiparous patient is at 42 weeks' gestation. Which order should the nurse question?
Have the patient return to the clinic in 1 week. Begin nonstress test now.
A client is admitted with preeclampsia to the labor and birthing suite. Her blood pressure is 140/90, she has 2+ protein in the urine, and edema of the hands and face. As part of the admissions history, the nurse should ask the client about:
Headache, visual disturbances, edema, and abdominal pain.
A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia?
Hyperreflexia.
After delivery of the newborn, it is determined that there is a placenta percreta. Which intervention should the nurse anticipate?
Hysterectomy.
Your patient is a 28-year-old gravida 2 para 1 in active labor. She has been in labor for 12 hours. Upon further assessment, the nurse determines that she is experiencing a hypotonic labor pattern. Possible maternal and fetal implications from hypotonic labor patterns are:
Intrauterine infection and maternal exhaustion with fetal distress usually occurring late in labor.
What is the cause of the epigastric pain that sometimes occurs with severe preeclampsia?
Liver distention.
A woman is in the second trimester of pregnancy. Her blood pressure is 148/92, she has edema of the hands and feet, and her urine protein is 1+ dipstick. These data are indicative of:
Mild preeclampsia.
The need for insulin in the diabetic woman in labor is monitored closely. Typical nursing management would include:
Monitoring blood glucose level every 1-2 hours and covering insulin needs with short acting insulin
When assessing fetal heart rate, the nurse finds a heart rate of 175 bpm, accompanied by a absent variability and recurrent late decelerations. Which of the following would the nurse do next?
Notify the health care provider, initiate uteroplacental resuscitation interventions, and anticipate expeditious surgical birth if the FHR pattern does not resolve.
The perinatal nurse is caring for a preeclampsia patient at 35 weeks' gestation. The patient's newest laboratory results include the following: platelet count 98,000/mm3 and RBC 3.1 million/µL. What action by the nurse is most appropriate?
Notify the health-care provider immediately.
The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse anticipates interventions and assessments focusing on which of the following because of recommendations related to increased risks of multiple gestation?
Oligohydramnios. Gestational diabetes. Elective cesarean birth.
A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting severe abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What is the next priority assessment that the nurse should make?
Palpate the fundus, and check fetal heart rate.
You are in the process of admitted a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to:
Perform a vaginal exam.
A gravida 7, para 6 woman is in the hospital only 15 minutes when she begins to deliver precipitously. The fetal head begins to deliver as you walk into the labor room. Your best action would be to
Place a hand gently on the fetal head to guide delivery.
The nurse is caring for a laboring client. To identify the duration of a contraction, the nurse should:
Start timing from the beginning of one contraction to the completion of the same contraction.
In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the ____________ of labor.
Powers
The perinatal nurse is providing care to Carol, a 28-year-old multiparous woman in labor. Upon arrival to the birthing suite, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as "strong." Carol states she labored for 1 hour at home. As the nurse assists Carol from the assessment area to her labor and birth room, Carol states that she is feeling some rectal pressure. Carol is most likely experiencing:
Precipitous labor
The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include: Select All answers that apply.
Previous induced surgical abortion Tobacco use Previous caesarean birth
The severity of cardiac disease and ability to function during pregnancy has been standardized by the WHO according to the risk of maternal morbidity and mortality. An individual with cardiac disease that results in slight limitation of physical activity who is comfortable at rest and has only a small increase in risk of maternal mortality would be classified as:
Risk Class II.
A woman in labor is at risk for abruptio placentae. Which of the following assessments would most likely lead you to suspect that this has happened?
Sharp fundal pain and discomfort between contractions.
A client with severe preeclampsia who has a BP of 170/110 mm Hg, a pulse of 108 beats per minute, and respirations of 24 per minute is placed on IV magnesium sulfate therapy. Eight hours later her BP is 150/110, the pulse if 98, and respirations are 10, and there is absence of the knee-jerk reflex. The nurse should:
Stop the infusion of magnesium sulfate and notify the physician.
Barbara is a diabetic primigravida who has been on insulin for only the last year. She has been told that her insulin needs will increase during pregnancy. This statement is probably based on the fact that
The placenta produces a hormone that decreases the effectiveness of maternal insulin.
The nurse educator is describing the different classifications of abruptio placentae to a group of students, explaining that in a complete abruptio placentae:
There is massive vaginal bleeding in the presence of almost total placental separation.
Which of the following findings is indicative of the HELLP syndrome, which sometimes complicates severe preeclampsia?
Thrombocytopenia.
A patient with hypertension who is receiving intravenous magnesium sulfate therapy has requested an epidural anesthetic. The perinatal nurse should first review the patient's complete blood count results for evidence of a decreased platelet count.
True
Jennie's sister rings the call bell and yells, "Come quickly, Mary is shaking all over." The nurse determines that Jennie is experiencing an eclamptic seizure. Which nursing intervention takes priority?
Turn Mary onto her side and place a pillow behind her to stabilize position.
The most common cause for a variable deceleration is:
Umbilical cord compression.
Early decelerations are thought to e a result of:
Vagal nerve stimulation related to head compression
A nurse is reviewing the fetal heart rate pattern and observes abrupt decreases in FHR below the baseline, appearing as a U or W shape. The nurse interprets these changes as reflecting which of the following?
Variable decelerations.
