OB Chapter 12 Review

The nurse is teaching her client about the methods of electronic fetal monitoring during labor. Her client asks which method has the fewest risks to her baby and allows her the most freedom. What is the most appropriate response by the nurse?

"External monitoring will allow you the most freedom of movement and does not require any invasive procedures for you or your baby."

A client presents to Labor and Delivery for an ultrasound at 16 weeks gestation for vaginal bleeding. She asks the nurse if the procedure will harm her baby. Which is appropriate for the nurse to tell the client?

"Ultrasounds use sound waves to view your baby, not radiation, so the procedure will not harm your baby."

An NST is performed on a client who is G6T3P1A1L4 38 weeks gestation. After the patient has been on the external monitor for 30 minutes, the nurse sees three fetal heart rate accelerations of 15 bpm lasting 5 seconds in association with fetal movement. The nurses documents this findings as which of the following?

A reactive NST. A reactive nonstress test indicates a well-oxygenated fetus.

The nurse is caring for a client with a suspected breech presentation. When the nurse performs Leopold's maneuvers, which maneuvers determine the fetal presentation?

First and third (Pawlik's maneuver). The first maneuver is performed to determine whether the fetal head or buttocks are positioned in the uterine fundus. This maneuver identifies the presenting part and is performed with the clinician facing the woman.

The nurse reports a nonreactive NST to the physician. The physician orders vibroacoustic stimulation. Which does the nurse understand the appropriate application for the vibroacoustic stimulation to be?

Apply the artificial larynx stimulus by the fetal head, Limit the use of the artificial larynx stimulus to 3 times, Do not apply the stimulus during episodes of bradycardia or during a deceleration

The nurse is caring for a 45 year old client who is scheduled to have a chorionic villus sampling. Which information is most important for the nurse to obtain from the client before the procedure?

Blood type and Rh

The nurse assesses uterine contractions using the intrauterine pressure catheter. Which information can be obtained from the IUPC?

Contraction frequency, contraction duration, contraction intensity uterus resting tone

The nurse is preparing to teach a client how to perform daily fetal kick counts. Which instruction is most important for the nurse to give the client?

Call provider if at least three movements are not felt in 1 hour. It is very important for the nurse to discuss with the client how to record fetal movements and when to report concerns.

The nurse is caring for a client in labor with her third baby. She is 39 weeks gestation, 6 cm dilated, 80% effaced, and 0 station, with minimal variability and recurrent variable decelerations. What action is the highest priority for the nurse?

Change maternal position

The nurse is caring for a client who is scheduled to have an amniocentesis. Which intervention is most important for the nurse to perform after the procedure?

Evaluate the need for a RhoD immunoglobulin shot. During the procedure, there is a risk of maternal and fetal blood mixing. If a woman is Rh-negative, she should be given RhoGAM after the amniocentesis to prevent he Rh-negative antibodies from reacting to Rh-positive fetal cells.

The nurse is caring for a client in labor and notices a gradual decrease in the FHR that occurs after the peak of the contractions and returns to baseline 30 seconds after the contraction ends. The nurse is aware that this is which type of periodic change in the FHR?

Late deceleration

The nurse is caring for a client who had a contraction stress test. Which change in assessment requires immediate notifications of the health care provider?

Late decelerations with at least 50% of the contractions

The nurse is caring for a client being monitored for oligohydramnios. The NST is non reactive. Which findings correlate with these results?

Less than 2 accelerations in 20 to 40 minutes

The nurse is admitting a client, who reports, "My water broke, yesterday and I haven't felt my baby move any today." She is 38 weeks with a history of gestational diabetes. Which assessment data is of most concern to the nurse on admission?

Minimal variability and variable decelerations. Variable decelerations mean cord compression and may warrant only turning the patient to her left side. Persistently minimal or absent FHR variability appears to be most significant intrapartum sign of fetal compromise.

The nurse is caring for a pregnant client who was sent to the hospital for a biophysical profile. She is 37 weeks gestation with her second child, has gestational diabetes, and complains of decreased fetal movement for the last 24 hours. Which action should the nurse take first?

Place on fetal monitor. A significant reduction or sudden alteration in fetal movement is an important clinical sign of fetal well-being

The nurse has admitted a client who is 30 weeks gestation with suspected intrauterine growth restriction. The physician has ordered a Doppler blood flow study. What does the nurse suspect if the results show an S/D ratio above the 95th percentile for the gestational age, a ratio above 3, or end-diastolic blood flow that is absent or reversed?

Placental insufficiency.

Which laboratory is important to know when a client is having an amniocentesis?

Rh

The nurse is preparing to assist with the insertion of an intrauterine pressure catheter and a fetal spiral electrode. What is required for proper placement by the practitioner?

Rupture of membranes, Dilated cervix

A client with diabetes mellitus is at 37 weeks gestation. She has had weekly NSTs for the last 3 weeks, and the results have been reactive. This week, the NST was nonreactive for 40 minutes. The nurse anticipates which of the following will be performed for the client based on these results?

Schedule a biophysical profile. A biophysical profile will provide additional information concerning fetal well-being.

The nurses is evaluating a client's response to a contraction stress test. The client performed nipple stimulation and produced 2 contractions in 10 minutes. The fetus demonstrated no late decelerations. The nurse notifies the practitioner regarding which results of the CST?

They are equivocal-unsatisfactory. There are few than 3 in 10 minutes