S2 Test 2 pt 3

Marked edema of the lower extremities is termed

+2 edema

Normal sodium levels

135-145 mEq/L

5. Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester, because they are consuming more sugar. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.

2 and 3 Pregnant women develop increased insulin resistance during the second and third trimesters.

A new nurse is preparing to administer IV potassium to a client with hypokalemia. What action indicates the nurse needs to review this procedure? Notifies the pharmacy of the IV potassium order. Assesses the client's IV site every hour during infusion. Sets the IV pump to deliver 30 mEq of potassium an hour. Double-checks the IV bag against the order with the precepting nurse.

30 mEq IV potassium should not be infused at a rate exceeding 20mEq/hr under any circumstances. This action shows a need for further knowledge. The other actions are acceptable for this high-alert drug.

The nurse practicing in a labor setting knows that the woman most at risk for a uterine rupture is a gravida 3 who has had two low-segment transverse cesarean births 2 who had a low-segment vertical incision for delivery of a 10-pound infant 5 who had two vaginal births and two cesarean births 4 who has had all cesarean births

4 c sections

______________ is the most common postpartum infection.

Endometritis usually begins as a localized infection at the placental site; however, can spread to involve the entire endometrium. Assessment for signs of endometritis may reveal a fever, elevated pulse, chills, anorexia, fatigue, pelvic pain, uterine tenderness or foul-smelling profuse lochia.

The leading cause of life threatening perinatal infections in the United States is ________

GBS This gram-positive bacteria is colonized in the rectum, anus, vagina, and urethra of pregnant and non-pregnant women. UTI, chorioamnionitis, and endometritis can occur during pregnancy. Transmission to the fetus can cause the most serious of infections. GBS testing of all women should be performed at 35 to 37 weeks of gestation and treatment with antibiotics should be initiated if indicated.

13. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the womans latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician, because the lab results are indicative of Eclampsia Disseminated intravascular coagulation HELLP syndrome d. Rh incompatibility

HELLP HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

Hyponatremia S/S

SALT LOSS Stupor/coma Apprehension, headache confusion, depression convulsion, n/v Lethargy Tendon reflexes decreased Limp muscles (weakness) Orthostatic hypotension Seizures/headache Stomach cramping

what to do for postpartum thromboembolic disorders

heparin

Hypokalemia S/S

*7 L's* 1. Lethargy (confusion) 2. Low, shallow respirations (decreased ability to use accessory muscles for breathing) 3. Lethal cardiac dysrhythimias 4. Lots of urine 5. Leg cramps 6. Limp muscles 7. Low BP and heart

Edema of the extremities, face, and sacral area is classified as

+3

Beta blocker ending

-olol

VBAC contraindications

-previous classic C-section uterine scar -placenta previa -history of previous uterine rupture -lack of facilities or equipment to perform an immediate emergency cesarean

ACE inhibitor ending

-pril

Which is the nurse's next action when the fundus of a healthy multipara at 16 weeks' gestation is palpated at one fingerbreadth above the umbilicus? 1 Check for two distinct fetal heart rates. 2 Ascertain the birth weights of the client's other children. 3 Inform the client that she may be mistaken about her due date. 4 Instruct the client about appropriate weight gain during pregnancy

1

Which is the nurse's most critical assessment for a client with preeclampsia during the immediate postpartum period? 1 Vital signs 2 Emotional status 3 Signs of hemorrhage 4 Signs of hypovolemic shock

1 Clients with preeclampsia are at risk for compromised cardiovascular and renal function and are still at risk for seizures in the immediate postpartum period; frequent assessment is vital in the first 48 hours.

Which inference would the nurse draw when crackles are heard while auscultating the lungs of a client admitted with severe preeclampsia? 1 Seizure activity is imminent. 2 Pulmonary edema may have developed. 3 Diaphragmatic function is being impaired by the enlarged uterus. 4 Bronchial constriction was precipitated by the stress of pregnancy

2 Pulmonary edema is associated with severe preeclampsia; as vasospasms worsen, capillary endothelial damage results in capillary leakage into the alveoli. Crackles are not an indication of an impending seizure; signs of an impending seizure include hyperreflexia, developing or worsening clonus, severe headache, visual disturbances, and epigastric pain. Pregnancy does not precipitate bronchial constriction, although the hormones associated with pregnancy can cause nasal congestion. Impaired diaphragmatic function is a discomfort associated with pregnancy that may result in shortness of breath or dyspnea, not crackles.

nurses need to know that when any woman is admitted to the hospital and is _____ to _____ weeks pregnant, she should receive antenatal glucocorticoids unless she has chorioamnionitis. Because these drugs require a 24-hour period to become effective, timely administration is essential.

24-34 All women between 24 and 34 weeks of gestation who are at risk for preterm birth within 7 days should receive treatment with a single course of antenatal glucocorticoids.

Potassium normal levels

3.5-5.0 mEq/L

5. Which patient status is an acceptable indication for serial oxytocin induction of labor? Past 42 weeks gestation Multiple fetuses Polyhydramnios History of long labors

42 weeks Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health.

If the patient's heart rate falls below __ beats/min or if the T waves become spiked, both of which accompany hyperkalemia, respond by notifying the Rapid Response Team.

60

What is the priority nursing assessments for a woman receiving tocolytic therapy with terbutaline? Fetal heart rate, maternal pulse, and blood pressure Maternal temperature and odor of amniotic fluid Intake and output Maternal blood glucose

FHR, pulse, BP All assessments are important, but those most relevant to the medication include the fetal heart rate and maternal pulse, which tend to increase, and the maternal blood pressure, which tends to exhibit a wide pulse pressure.

Hypernatremia S/S

FRIED S.A.L.T. F - Fever (low grade), flushed skin R - Restless (irritable) I - Increased fluid retention and increased BP E - Edema (peripheral and pitting) D - Decreased urinary output, dry mouth S = Skin flushed A = Agitation L = Low-grade fever T = Thirst

Which action should be initiated to limit hypovolemic shock when uterine inversion occurs? Administer oxygen at 31 L/min by nasal cannula. Administer an oxytocic drug by intravenous push. Monitor fetal heart rate every 5 minutes. Restore circulating blood volume by increasing the intravenous infusion rate.

IV rate increase

Hyperkalemia S/S

M.U.R.D.E.R. M - Muscle weakness U - Urine, oliguria, anuria R- Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)

Rapid, thready pulse and elevated hematocrit level occur with

a fluid deficit

23. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is V aginal bleeding Rupture of membranes Presence of abdominal pain Changes in maternal vital signs

abdominal pain Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding.

diabetic ketoacidosis

acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy

atenalol is a __ that can cause __

beta blocker that may cause cold hands and feet

When caring for a postpartum woman experiencing hypovolemic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is Absence of cyanosis in the buccal mucosa Cool, dry skin Diminished restlessness Decreased urinary output

decreased urine

A nurse cares for a client who has a serum potassium of 6.5 mEq/L (6.5 mmol/L) and is exhibiting cardiovascular changes. Which intervention will the nurse implement first? Prepare to administer patiromer by mouth. Provide a heart-healthy, low-potassium diet. Prepare to administer dextrose 20% and 10 units of regular insulin IV push. Prepare the client for hemodialysis treatment.

dextrose and insulin A client with a critically high serum potassium level and cardiac changes would be treated immediately to reduce the extracellular potassium level. Potassium movement into the cells is enhanced by insulin by increasing the activity of sodium-potassium pumps. Insulin will decrease both serum potassium and glucose levels and therefore would be administered with dextrose to prevent hypoglycemia. Patiromer may be ordered, but this therapy may take hours to reduce potassium levels. Dialysis may also be needed, but this treatment will take much longer to implement and is not the first intervention the nurse would implement. Decreasing potassium intake may help prevent hyperkalemia in the future but will not decrease the client's current potassium level.

A nurse is assessing clients for fluid and electrolyte imbalances. Which client will the nurse assess first for potential hyponatremia? A 34 year old who is NPO and receiving rapid intravenous D5W infusions. A 50 year old with an infection who is prescribed a sulfonamide antibiotic. A 67 year old who is experiencing pain and is prescribed ibuprofen. A 73 year old with tachycardia who is receiving digoxin.

dextrose infusion Dextrose 5% in water (D5W) contains no electrolytes. The dextrose is rapidly metabolized when infused, leaving the solution hypotonic. Aggressive ingestion (or infusion) of hypotonic solutions can lead to hyponatremia. Because the client is not taking any food or fluids by mouth (NPO), normal sodium excretion can also lead to hyponatremia.

A nurse teaches a client who is at risk for hyponatremia. Which statement does the nurse include in this client's teaching? "Have you spouse watch you for irritability and anxiety." "Notify the clinic if you notice muscle twitching." "Call your primary health care provider for diarrhea." "Bake or grill your meat rather than frying it."

diarrhea One sign of hyponatremia is diarrhea due to increased intestinal motility. The client would be taught to call the primary health care provider if this is noticed. Irritability and anxiety are common neurologic signs of hypokalemia. Muscle twitching is related to hypernatremia. Cooking methods are not a cause of hyponatremia

__________ is defined as long, difficult, or abnormal labor. It is caused by various conditions associated with the five factors affecting labor.

dystocia

24. Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)? Bleeding time of 10 minutes Presence of fibrin split products Thrombocytopenia Hyperfibrinogenemia

fibrin split products Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the bodys vasculature.

9. To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by Eating six small equal meals per day Reducing carbohydrates in her diet Eating her meals and snacks on a fixed schedule Increasing her consumption of protein

fixed schedule

The most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant is Genetic changes and anomalies Extensive central nervous system damage Fetal addiction to the substance inhaled Intrauterine growth restriction

growth restriction the major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss.

1. Recurrent spontaneous abortion refers to a condition in which a woman experiences three or more consecutive abortions or miscarriages. This is also known as ________ abortion.

habitual

What condition indicates concealed hemorrhage in an abruptio placentae? Decrease in abdominal pain Bradycardia Hard, boardlike abdomen Decrease in fundal height

hard abdomen Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen.

what electrolyte is renal failure associated with

hyperkalemia

Spontaneous termination of a pregnancy is considered to be an abortion if The pregnancy is less than 20 weeks. The fetus weighs less than 1000 g. The products of conception are passed intact. No evidence exists of intrauterine infection.

less than 20 weeks

do loop diuretics or thiazides have more side effects

loop

Edema classified as +1 indicates minimal edema of

lower extremities

Potassium function in body

maintains ICF, nerve function, regulates muscle and heart contractions muscle contraction and nerve impulses

A placenta previa that does not cover any part of the cervix is termed

marginal

An incomplete abortion means that

not all of the products of conception were expelled.

A multiparous woman is admitted to the postpartum unit after a rapid labor and birth of a 4000 g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the woman void and massages her fundus, but her fundus remains difficult to find, and the rubra lochia remains heavy. The nurse should Continue to massage the fundus. Notify the physician. Recheck vital signs. Insert a Foley catheter.

notify physician The uterine muscle can be overstimulated by massage, leading to uterine atony and rebound hemorrhage.

main cause of hypotonic dysfunction

overdistended uterus

20. What data on a patients health history places her at risk for an ectopic pregnancy? Use of oral contraceptives for 5 years Recurrent pelvic infections Ovarian cyst 2 years ago Heavy menstrual flow of 4 days duration

pelvic infection

what is in ICF

potassium, magnesium, and phosphate ions

According to Becks studies, what risk factor for postpartum depression (PPD) is likely to have the greatest effect on the womans condition? Prenatal depression Single-mother status Low socioeconomic status Unplanned or unwanted pregnancy

prenatal depression

A woman who had two previous cesarean births is in active labor, when she suddenly complains of pain between her scapulae. The nurses priority action is to Reposition the woman with her hips slightly elevated. Observe for abnormally high uterine resting tone. c. Decrease the rate of nonadditive intravenous fluid. d. Notify the physician promptly and prepare the woman for surgery.

prepare for surgery Pain between the scapulae may occur when the uterus ruptures, because blood accumulates under the diaphragm. This is an emergency that requires medical intervention.

Which factor is known to increase the risk of gestational diabetes mellitus? Underweight before pregnancy Maternal age younger than 25 years Previous birth of large infant Previous diagnosis of type 2 diabetes mellitus

previous large infant

Misoprostol is contraindicated in women with

previous uterine scar

In planning for home care of a woman with preterm labor, the nurse needs to address which concern? Nursing assessments will be different from those done in the hospital setting. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. Prolonged bed rest may cause negative physiologic effects. Home health care providers will be necessary.

prolonged bed rest is bad Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery.

S/S of fluid overload

rapid/bounding pulse, distended neck veins, HTN, cough, SOB, crackles, HA, restlessness

A nurse is assessing a client who has an electrolyte imbalance related to renal failure. For which potential complications of this electrolyte imbalance does the nurse assess? (Select all that apply.) Reports of palpitations Slow, shallow respirations Orthostatic hypotension Paralytic ileus Skeletal muscle weakness Tall, peaked T waves on ECG

reports of palpitations, skeletal muscle weakness, tall T waves Electrolyte imbalances associated with acute renal failure include hyperkalemia. The nurse would assess for electrocardiogram changes, including tall, peaked T waves, reports of palpitations or "skipped beats," diarrhea, and skeletal muscle weakness in clients with hyperkalemia. The other choices are potential complications of hypokalemia. Respiratory muscles may be affected with lethally high hyperkalemia.

A nurse assesses a client who is prescribed a medication that inhibits aldosterone secretion and release. For which potential complications will the nurse assess? (Select all that apply.) Urine output of 25 mL/hr Serum potassium level of 5.4 mEq/L (5.4 mmol/L) Urine specific gravity of 1.02 g/mL Serum sodium level of 128 mEq/L (128 mmol/L) Blood osmolality of 250 mOsm/kg (250 mmol/kg)

serum potassium 5,4, blood osmolality 250 Aldosterone is a naturally occurring hormone of the mineralocorticoid type that increases the reabsorption of water and sodium in the kidney at the same time that it promotes excretion of potassium. Any drug or condition that disrupts aldosterone secretion or release increases the client's risk for excessive water loss (increased urine output), increased potassium reabsorption, decreased blood osmolality, and increased urine specific gravity. The client would not be at risk for sodium imbalance.

McRoberts maneuver

sharp flexion of the maternal hips that decreases the inclination of the pelvis increasing the AP diameter of the free anterior shoulder subprapubic pressure

Turtle sign is the first sign of

shoulder dystocia and is the fetal head retracting

What is ECF?

sodium, chloride, bicarbonate

What factor found in maternal history should alert the nurse to the potential for a prolapsed umbilical cord? Oligohydramnios Pregnancy at 38 weeks of gestation Presenting part at station 3 Meconium-stained amniotic fluid

station 3 Because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed cord could occur if the membranes rupture.

After administering potassium chloride, a nurse evaluates the client's response. Which signs and symptoms indicate that treatment is improving the client's hypokalemia? (Select all that apply.) Respiratory rate of 8 breaths/min Absent deep tendon reflexes Strong productive cough Active bowel sounds U waves present on the electrocardiogram (ECG)

strong cough, active bowels A strong, productive cough indicates an increase in muscle strength and improved potassium imbalance. Active bowel sounds also indicate that treatment is working.

the perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by Subinvolution of the uterus Defective vascularity of the decidua Cervical lacerations Coagulation disorders

subinvolution

classic signs of thrombophlebitis that appear at the site of the inflammation.

tenderness, heat, and swelling

The woman receiving decreasing doses of magnesium sulfate is often switched to oral

terbutaline

Generalized massive edema (+4) includes accumulation of fluid in

the peritoneal cavity

potassium is a severe ___________ _____________ and is never given by IM or SQ injection. Tissues damaged can become necrotic.

tissue irritant

11. Before the physician performs an external version, the nurse should expect an order for a Tocolytic drug Contraction stress test (CST) Local anesthetic Foley catheter

tocolytic A tocolytic drug will relax the uterus before and during version, making manipulation easier

19. Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? Amniotomy Intravenous Pitocin Transcervical catheter V aginal insertion of prostaglandins

transcervical cath B C D ANS: B Feedback Amniotomy is a surgical method of augmentation and induction. Intravenous Pitocin is a medical method of induction. Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include Laminaria tents, Dilapan and Lamicel. Insertion of prostaglandins is a medical method of induction.

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is Uterine atony Uterine inversion V aginal hematoma V aginal laceration

uterine atony A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding. A vaginal laceration may cause hemorrhage; however, it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

long term instructions for PTL

2-3 quarts of water/fluid daily Empty bladder frequently No sex/nipple stimulation Bed rest

what does sodium do

controls and regulates volume of body fluids muscle contractions and nerve impulses

18. In which situation is a dilation and curettage (D&C) indicated? a. Complete abortion at 8 weeks Incomplete abortion at 16 weeks Threatened abortion at 6 weeks Incomplete abortion at 10 weeks

incomplete at 10 D&C is used to remove the products of conception from the uterus and can be done safely until week 14 of gestation.

routine instruction for s/s of PTL

Lie on L side Drink 2 glasses of water or juice Record contractions for 1 hour If symptoms continue, call dr or go to the hospital You dont have to have all the symptoms to have PTL

21. What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? Complaint of frequent mild nausea Blood pressure of 120/80 mm Hg Fundal height measurement of 18 cm History of bright red spotting for 1 day, weeks ago

18 cm The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy.

Assess respiratory status of a patient with hypokalemia at least every __ hours because respiratory insufficiency is a major cause of death from hypokalemia.

2

A 26-year-old primigravida experiencing severe abdominal pain is brought to the emergency department by ambulance with a suspected ruptured tubal pregnancy. Which is the priority nursing action? 1 Inserting an intravenous (IV) catheter 2 Asking the client to sign a surgical consent form 3 Determining whether a family member is present 4 Ascertaining the first day of the client's last menstrual period

1 The client is at risk for hypovolemic shock resulting from hemorrhage; administration of IV fluids is the priority. Asking the client to sign a surgical consent form, determining whether a family member is present, or ascertaining the first day of the client's last menstrual period is not the priority in an emergency situation.

7. A woman is having her first child. She has been in labor for 15 hours. Two hours ago, her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago, her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? Prolonged latent phase Protracted active phase Secondary arrest Protracted descent

2nd arrest With a secondary arrest of the active phase, the progress of labor has stopped. This patient has not had any anticipated cervical change, indicating an arrest of labor.

A client who is admitted for surgery for a ruptured tubal pregnancy tells the nurse that she has shoulder pain. Which condition is the nurse concerned about based on these manifestations? 1 Anxiety about the diagnosis 2 Cardiac changes from hypovolemia 3 Blood accumulation under the diaphragm 4 Rebound tenderness from the ruptured tube

3 Any blood from the rupture will accumulate, causing phrenic nerve irritation and pain. Shoulder pain is not a response to anxiety; it is a typical symptom of phrenic nerve irritation. The cardiac changes caused by hypovolemia do not cause shoulder pain. A ruptured tube can cause rebound tenderness in the abdomen, not the shoulder.

A client with preeclampsia has delivered and is receiving magnesium sulfate postpartum. Which nursing action is the priorityduring the immediate 4 hours after delivery? 1 Monitoring blood pressure 2 Monitoring urinary output 3 Observing amount of lochia 4 Assessing breast-feeding technique

3 Observing the amount of lochia is a priority during the 4 hours after delivery because of the risk of hemorrhage, which is highest in the immediate postpartum period. This client is at an increased risk of hemorrhage due to both preeclampsia and the use of magnesium sulfate. Monitoring blood pressure is important both to help assess for hemorrhage and to monitor for worsening preeclampsia. Monitoring urinary output is important and is expected to be above 30 mL/hr. Ideally breast-feeding will be instituted in the first hour postpartum, and it is an important nursing role to assess and assist with breast-feeding.

ursing measures that help prevent postpartum urinary tract infection include Promoting bed rest for 12 hours after delivery Discouraging voiding until the sensation of a full bladder is present Forcing fluids to at least 3000 mL/day Encouraging the intake of orange, grapefruit, or apple juice

3000 ml/day Adequate fluid intake of 2500 to 3000 ml/day prevents urinary stasis, dilutes urine, and flushes out waste products.

1. A nurse assesses clients at a family practice clinic for risk factors that could lead to dehydration. Which client is at greatest risk for dehydration? A 36 year old who is prescribed long-term steroid therapy. A 55 year old who recently received intravenous fluids. A 76 year old who is cognitively impaired. An 83 year old with congestive heart failure.

76 year old Older adults, because they have less total body water than younger adults, are at greater risk for development of dehydration. Anyone who is cognitively impaired and cannot obtain fluids independently or cannot make his or her need for fluids known is at high risk for dehydration. The client with heart failure has a risk for both fluid imbalances.

10. When the pregnant diabetic experiences hypoglycemia while hospitalized, the nurse should have the patient Eat 6 saltine crackers. Drink 8 oz of orange juice with 2 tsp of sugar added. Drink 4 oz of orange juice followed by 8 oz of milk. Eat hard candy or commercial glucose wafers.

crackers Crackers provide carbohydrates in the form of polysaccharides. Orange juice and sugar will increase the blood sugar, but not provide a slow-burning carbohydrate to sustain the blood sugar.

29. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves Corticosteroids to reduce inflammation IV therapy to correct fluid and electrolyte imbalances An antiemetic, such as pyridoxine, to control nausea and vomiting Enteral nutrition to correct nutritional deficits

IV

12. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy. Hydramnios occurs approximately twice as often in diabetic pregnancies. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being.

DKA

If nonsurgical treatment for late postpartum hemorrhage is ineffective, which surgical procedure is appropriate to correct the cause of this condition? Hysterectomy Laparoscopy Laparotomy D&C

Dand C D&C allows examination of the uterine contents and removal of any retained placental fragments or blood clots.

Anxiety disorders are the most common mental disorders that affect women. While providing care to the maternity patient, the nurse should be aware that one of these disorders is likely to be triggered by the process of labor and birth. This disorder is A phobia Panic disorder Posttraumatic stress disorder (PTSD) Obsessive-compulsive disorder (OCD)

PTSD In PTSD, women perceive childbirth as a traumatic event. They have nightmares and flashbacks about the event, anxiety, and avoidance of reminders of the traumatic event.

maternal and fetal problems that may occur if pregnancy persists beyond 42 weeks.

Placenta problems. Decreased amniotic fluid. The baby may stop gaining weight, or may even lose weight. Birth injury if the baby is large. stillborn

A nurse is caring for clients with electrolyte imbalances on a medical-surgical unit. Which common causes are correctly paired with the corresponding electrolyte imbalance? (Select all that apply.) Hypomagnesemia—kidney failure Hyperkalemia—salt substitutes Hyponatremia—heart failure Hypernatremia—hyperaldosteronism Hypocalcemia—diarrhea Hypokalemia—loop diuretics

all but last

A nurse is caring for a patient in the active phase of labor. The womans BOW spontaneously ruptures. Suddenly the woman complains of dyspnea and appears restless and cyanotic. Additionally, she becomes hypotensive and tachycardic. The nurse immediately suspects the presence of a(n) _____________.

amniotic fluid embolism or anaphylactoid sydnrome It is characterized by the sudden, acute onset of hypoxia, hypotension or cardiac arrest, and coagulopathy. ASP can occur during labor, birth, or within 30 minutes after birth. This clinical presentation is similar to that observed in patients with anaphylactic or septic shock. In both of these conditions, a foreign substance is introduced into the circulation.

1. Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with Frequent episodes of maternal hypoglycemia Congenital anomalies in the fetus Polyhydramnios Hyperemesis gravidarum

anomalies

A nurse is caring for an older client who exhibits dehydration-induced confusion. Which intervention by the nurse is best? Measure intake and output every 4 hours. Assess client further for fall risk. Increase the IV flow rate to 250 mL/hr. Place the client in a high-Fowler position.

assess for fall risk Dehydration most frequently leads to poor cerebral perfusion and cerebral hypoxia, causing confusion. The client with dehydration is at risk for falls because of this confusion, orthostatic hypotension, dysrhythmia, and/or muscle weakness. The nurse's best response is to do a more thorough evaluation of the client's risk for falls. Measuring intake and output may need to occur more frequently than every 4 hours, but does not address a critical need. The nurse would not adjust the IV flow rate without a prescription or standing protocol. For an older adult, this rapid an infusion rate could lead to fluid overload. Sitting the client in a high-Fowler position may or may not be comfortable but still does not address the most important issue which is safety.

With regard to the care management of preterm labor, nurses should be aware that Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. Braxton Hicks contractions often signal the onset of preterm labor. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

based on gestational age, uterine activity, and progressive cervical changes Gestational age of 20 to 37 weeks, uterine contractions, and a thinning cervix are all indications of preterm labor.

which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth? a. Postpartum depression Postpartum psychosis Postpartum bipolar disorder Postpartum blues

blues Postpartum blues or baby blues is a transient self-limiting disease that is believed to be related to hormonal fluctuations after childbirth.

9. A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake, because A daily consumption of alcohol indicates a risk for alcoholism. She will be at risk for abusing other substances as well. The fetus is placed at risk for altered brain growth. The fetus is at risk for multiple organ anomalies.

brain growth The brain grows most rapidly in the third trimester and is most vulnerable to alcohol exposure during this time. The major concerns are mental retardation, learning disabilities, high activity level, and short attention span.

Birth for the nulliparous woman with a fetus in a breech presentation is usually by Cesarean delivery V aginal delivery Forceps-assisted delivery V acuum extraction

c section Delivery for the nulliparous woman with a fetus in breech presentation is almost always cesarean section. The greatest fetal risk in the vaginal delivery of breech presentation is that the head (largest part of the fetus) is the last to be delivered. The delivery of the rest of the baby must be quick so that the infant can breathe.

Why is adequate hydration important when uterine activity occurs before pregnancy is at term? a. Fluid and electrolyte imbalance can interfere with the activity of the uterine pacemakers. b. Dehydration may contribute to uterine irritability for some women. c. Dehydration decreases circulating blood volume, which leads to uterine ischemia. d. Fluid needs are increased because of increased metabolic activity occurring during contractions.

can cause uterine irritability Intravenous fluids are ordered according to their expected benefit. Adequate hydration promotes urination and decreased risk for infection.

27. Approximately 12% to 26% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? Chromosomal abnormalities Infections Endocrine imbalance Immunologic factors

chromosomes

woman who is 32 weeks pregnant telephones the nurse at her obstetricians office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is Back pain is common at this time during pregnancy because you tend to stand with a sway back. Acetaminophen is acceptable during pregnancy; however, you should not take aspirin. You should come into the office and let the doctor check you. Avoid medication because you are pregnant. Try soaking in a warm bath or using a heating pad on low before taking any medication.

come in and check A prolonged backache is one of the subtle symptoms of preterm labor. Early intervention may prevent preterm birth.

The patient who is being treated for endometritis is placed in Fowlers position because it Promotes comfort and rest Facilitates drainage of lochia Prevents spread of infection to the urinary tract Decreases tension on the reproductive organs

drainage of lochia

26. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that Bed rest and analgesics are the recommended treatment. She will be unable to conceive in the future. A D&C will be performed to remove the products of conception. d. Hemorrhage is the major concern.

hemorrhage The recommended treatment is to remove the pregnancy before hemorrhaging. Severe bleeding occurs if the fallopian tube ruptures.

A nurse is caring for clients with electrolyte imbalances on a medical-surgical unit. Which clinical signs and symptoms are correctly paired with the contributing electrolyte imbalance? (Select all that apply.) Hypokalemia—muscle weakness with respiratory depression Hypermagnesemia—bradycardia and hypotension Hyponatremia—decreased level of consciousness Hypercalcemia—positive Trousseau and Chvostek signs Hypomagnesemia—hyperactive deep tendon reflexes Hypernatremia—weak peripheral pulses

hypokalemia, hypermagnesemia, hyponatremia, hypomagnesemia, hypernatremai Hypokalemia is associated with muscle weakness and respiratory depression. Hypermagnesemia manifests with bradycardia and hypotension. Hyponatremia can present with decreased level of consciousness. Hypomagnesemia can be assessed through hyperactive deep tendon reflexes. Weak peripheral pulses are felt in hypernatremia. Positive Trousseau and Chvostek signs are seen in hypocalcemia.

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? Incomplete uterine relaxation Maternal fatigue and exhaustion Maternal sedation with narcotics Administration of tocolytic drugs

incomplete uterine relaxation A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases fetal oxygen supply. Maternal fatigue usually does not decrease uterine blood flow.Maternal sedation will sedate the fetus but should not decrease blood flow. Tocolytic drugs decrease contractions. This will increase uterine blood flow.

A nurse assesses a client who is admitted for treatment of fluid overload. Which signs and symptoms does the nurse expect to find? (Select all that apply.) Increased pulse rate Distended neck veins Decreased blood pressure Warm and pink skin Skeletal muscle weakness Visual disturbances

increased pulse, distended neck veins, skeletal muscle weakness, visual disturbances Signs and symptoms of fluid overload include increased pulse rate, distended neck veins, increased blood pressure, pale and cool skin, skeletal muscle weakness, and visual disturbances. Decreased blood pressure would be seen in dehydration. Warm and pink skin is a normal finding.

The nurse knows that a measure for preventing late postpartum hemorrhage is to Administer broad-spectrum antibiotics. Inspect the placenta after delivery. Manually remove the placenta. Pull on the umbilical cord to hasten the delivery of the placenta.

inspect placenta If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage.

Glucose metabolism is profoundly affected during pregnancy because: Pancreatic function in the islets of Langerhans is affected by pregnancy. The pregnant woman uses glucose at a more rapid rate than the nonpregnant woman. The pregnant woman increases her dietary intake significantly. Placental hormones are antagonistic to insulin, resulting in insulin resistance.

insulin resistance Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase.

2. A patient who has undergone a D&C for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, that bleeding has been controlled, and that the woman has adequately recovered from the administration of anesthesia. In order to promote an optimal recovery, discharge teaching should include (select all that apply) Iron supplementation Resumption of intercourse at 6 weeks post-procedure Referral to a support group if necessary Expectation of heavy bleeding for at least 2 weeks Emphasizing the need for rest

iron, support, rest The woman should be advised to consume a diet high in iron and protein. For many women, iron supplementation also is necessary. Acknowledge that the patient has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest.

when there is a prolapsed cord how should the mom be positioned

knee to chest

The standard of care for obstetrics dictates that an internal version might be used to manipulate the Fetus from a breech to a cephalic presentation before labor begins Fetus from a transverse lie to a longitudinal lie before cesarean birth Second twin from an oblique lie to a transverse lie before labor begins Second twin from a transverse lie to a breech presentation during vaginal birth

last one Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally. after the 1st twin is born

A nurse is evaluating a client who is being treated for dehydration. Which assessment result does the nurse correlate with a therapeutic response to the treatment plan? Increased respiratory rate from 12 to 22 breaths/min Decreased skin turgor on the client's posterior hand and forehead Increased urine specific gravity from 1.012 to 1.030 g/mL Decreased orthostatic changes when standing

less orthostatic changes The focus of management for clients with dehydration is to increase fluid volumes to normal. When blood volume is normal, orthostatic blood pressure and pulse changes will not occur.

The nurse is caring for a client who has fluid overload. What action by the nurse takes priority? Administer high-ceiling (loop) diuretics. Assess the client's lung sounds every 2 hours. Place a pressure-relieving overlay on the mattress. Weigh the client daily at the same time on the same scale.

lung sounds All interventions are appropriate for the client who is overhydrated. However, client safety is the priority. A client with fluid overload can easily go into pulmonary edema, which can be life threatening. The nurse would closely monitor the client's respiratory status.

3. Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for Macrosomia Congenital anomalies of the central nervous system Preterm birth Low birth weight

macrosomia Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes.

The standard of care for women who are dependent on heroin or other narcotics is ___________ maintenance treatment (MMT).

methadone

A popular preinduction cervical ripening agent that is Food and Drug Administration (FDA) approved for the treatment of peptic ulcers is __________.

misoprostol This synthetic prostaglandin tablet is used primarily for the prevention of peptic ulcers. Because of its low cost, stability, and ease of use, many facilities use this medication for cervical ripening and the induction of labor.

An abortion in which the fetus dies but is retained in the uterus is called _____ abortion.

missed

With an ectopic pregnancy, irritation of the diaphragm may occur on inspiration and manifests as

neck or shoulder pain

Which woman is at greatest risk for early postpartum hemorrhage? A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress A woman with severe preeclampsia on magnesium sulfate whose labor is being induced A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor A primigravida in spontaneous labor with preterm twins

on magnesium sulfate

18. When preparing a woman for a cesarean birth, the nurses care should include Injection of narcotic preoperative medications Full perineal shave preparation Straight catheterization to empty the bladder Administration of an oral antacid

oral antacid General anesthesia may be needed unexpectedly for cesarean birth. An oral antacid neutralizes gastric acid and reduces potential lung injury if the woman vomits and aspirates gastric contents during anesthesia.

Throughout the world the rate of ectopic pregnancy has increased dramatically over the past 20 years. This is believed to be due primarily to scarring of the fallopian tubes as a result of pelvic infection, inflammation, or surgery. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (select all that apply) Pelvic pain Abdominal pain Unanticipated heavy bleeding V aginal spotting or light bleeding Missed period

pelvic, abdomen, vaginal spotting, missed period

A nurse is caring for a client who has the following laboratory results: potassium 2.4 mEq/L (2.4 mmol/L), magnesium 1.8 mEq/L (0.74 mmol/L), calcium 8.5 mEq/L (2.13 mmol/L), and sodium 144 mEq/L (144 mmol/L). Which assessment does the nurse complete first? Depth of respirations Bowel sounds Grip strength Electrocardiography

respirations A client with a low serum potassium level may exhibit hypoactive bowel sounds, cardiac dysrhythmias, and muscle weakness resulting in shallow respirations and decreased handgrips. The nurse would assess the client's respiratory status first to ensure that respirations are sufficient. The respiratory assessment would include rate and depth of respirations, respiratory effort, and oxygen saturation. The other assessments are important but are secondary to the client's respiratory status.

A nurse is assessing a client with hypokalemia, and notes that the client's handgrip strength has diminished since the previous assessment 1 hour ago. What action does the nurse take first? Assess the client's respiratory rate, rhythm, and depth. Measure the client's pulse and blood pressure. Document findings and monitor the client. Call the health care primary health care provider.

respirations In a client with hypokalemia, progressive skeletal muscle weakness is associated with increasing severity of hypokalemia. The most life-threatening complication of hypokalemia is respiratory insufficiency. It is imperative for the nurse to perform a respiratory assessment first to make sure that the client is not in immediate jeopardy. Cardiac dysrhythmias are also associated with hypokalemia. The client's pulse and blood pressure would be assessed after assessing respiratory status. Next, the nurse would call the health care primary health care provider to obtain orders for potassium replacement.

15. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. A diagnosis of Fetal Alcohol Syndrome is made when there are visible markers in each of three categories. Which is not a recognized category for diagnosis of FAS? Respiratory conditions Impaired growth CNS abnormality d. Craniofacial dysmorphologies

respiratory Impaired growth is a visible marker for FAS. A CNS abnormality with neurologic and intellectual impairments is a category used to assist in the diagnosis of FAS. An infant with FAS manifests at least two craniofacial abnormalities such as microcephaly, short palpebral fissures, poorly developed philtrum, thin upper lip or flattening of the maxillary.

7. What is most likely to be a concern for the older mother? The importance of having enough rest and sleep Information about effective contraceptive methods Nutrition and diet planning Information about exercise and fitness

rest The woman who delays childbearing may have unique concerns, one of which is having less energy than younger mothers.

4. In terms of the incidence and classification of diabetes, maternity nurses should know that Type 1 diabetes is most common. Type 2 diabetes often goes undiagnosed. There is only one type of gestational diabetes. Type 1 diabetes may become type 2 during pregnancy.

type 2 underdiagnosed Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not severe.

15. The priority nursing care associated with an oxytocin (Pitocin) infusion is Measuring urinary output Increasing infusion rate every 30 minutes Monitoring uterine response Evaluating cervical dilation

uterine response

Subinvolution of the uterus

uterus remains enlarged with continued lochia discharge and can result in postpartum hemorrhage give oxytocin or methylergonovine causes most late PPH Recognized causes of subinvolution included retained placental fragments and pelvic infection.

18. A common effect of both smoking and cocaine use on the pregnant woman is V asoconstriction Increased appetite Changes in insulin metabolism Increased metabolism

vasoconstriction

After teaching a client who is being treated for dehydration, a nurse assesses the client's understanding. Which statement indicates that the client correctly understood the teaching? "I must drink a quart (liter) of water or other liquid each day." "I will weigh myself each morning before I eat or drink." "I will use a salt substitute when making and eating my meals." d. "I will not drink liquids after 6 p.m. so I won't have to get up at night."

weigh myself One liter of water weighs 1 kg; therefore, a change in body weight is a good measure of excess fluid loss or fluid retention. Weight loss greater than 0.5 lb (0.2 kg) daily is indicative of excessive fluid loss. One liter of fluid a day is insufficient.

11. When helping the mother, father, and other family members actualize the loss of the infant, nurses should Use the words lost or gone rather than dead or died. Make sure the family understands that it is important to name the baby. If the parents choose to visit with the baby, apply lotion to the baby and wrap the infant in a pretty blanket. Set a firm time for ending the visit with the baby so that the parents know when to let go.

wrap baby and lotion Presenting the baby in a nice way stimulates the parents senses and provides pleasant memories of their baby.