Semester 3 Unit 3 exam**

Phases of labor

Stage 1 = cervical dilation •*Latent phase* of labor is characterized by cervical dilation of 0-3cm and contractions every 5-30 min, each lasting 30-45 seconds. •*Active phase* of labor is characterized by cervical dilation of 4-7cm and contractions every 3-5 mins, each lasting 40 to 70 seconds. •*Transition phase* of labor is characterized by a cervical dilation of 8-10cm and contractions every 2-3 mins, each lasting 45 to 90 seconds. •*Descent phase* of labor is characterized by active pushing with contractions every 1-2 mins, each lasting for 90 seconds. Stage 2 = expulsion of fetus Stage 3 = expulsion of placenta stage 4 = maternal homeostatic stabilization

Oxytocin (Pitocin)

Stimulates smooth muscle to contract. Helps in birthing process/ expel placenta. Uterus for sperm movement cranially. Udder for milk letdown.

Can HCG test detect miscarriage?

The disappearance of HCG from urine is exponential, with a half-life value of 1.3 days. A urine pregnancy test with a sensitivity of 1 IU/ml wil nearly always be negative in the course of 2 weeks after abortion. A positive test 4 weeks after abortion indicates an incomplete abortion or persistent trophoblast.

spontaneous abortion

when the fetus and placenta deliver before the 28th week of pregnancy; commonly called a miscarriage

Methylergonovine (Methergine)

*class*: oxytocic *Indication* treatment of post-partum hemorrhage *Action*: stimulates uterine muscles causing uterine contraction *Nursing Considerations*: -can cause hypertension, cramps, nausea, vomiting, dyspnea - monitor BP, heart rate, uterine response - assess calcium levels - effectiveness ↓ with hypocalcemia - monitor uterine bleeding and notify physician of any changes

Clomiphene citrate (Clomid)

- induces ovulation by altering estrogen and stimulating follicular growth to produce a mature ovum. - taken on Fifth day of her cycle to stimulate ovulation near the fourteenth day of the menstrual cycle - May result in multiple pregnancies

Breech position/birth

-Frank: legs are extended straight upward -Complete: extension of the legs across the anterior surface of the body -Footling: one or both feet presenting

dilation and curettage (D&C)

widening of the cervical canal with a dilator and scraping of the uterine endometrium with a curette

The nurse in a newborn nursery is monitoring a preterm newborn for respiratory distress syndrome. Which assessment findings should alert the nurse to the possibility of this syndrome? Select all that apply. 1.Cyanosis 2.Tachypnea 3.Hypotension 4.Retractions 5.Audible grunts 6.Presence of a barrel chest

1,2,4,5 A newborn infant with respiratory distress syndrome may present with clinical signs of cyanosis, tachypnea or apnea, nasal flaring, chest wall retractions, or audible grunts. Hypotension and a barrel chest are not clinical manifestations associated with respiratory distress syndrome.

Which are modes of heat loss in the newborn? Select all that apply. 1. Radiation 2. Urination 3. Convection 4. Conduction 5. Evaporation

1. Radiation 3. Convection 4. Conduction 5. Evaporation

The nurse is performing Apgar scoring for a newborn infant immediately after birth. The nurse notes that the heart rate is greater than 100 beats/min, the respiratory effort is good, muscle tone is active, the newborn infant sneezes when suctioned by the bulb syringe, and the skin color is pink. On the basis of these findings, the nurse should document which Apgar score?

10

fetal heart rate

120-160 bpm

Newborn temperature

36.5° (97.7°) to 37.2° C ( 98.9°) axillary The newborn is at risk for hypothermia and hyperthermia until thermoregulation (ability to produce heat and maintain normal body temperature) stabilizes. If the newborn becomes chilled (cold stress), oxygen demands can increase and acidosis can occur.

A just delivered newborn is dried immediately by the nurse in the delivery area. The nurse thoroughly dries the newborn to prevent heat loss by which mechanism? 1. Radiation 3. Convection 4. Conduction 5. Evaporation

5. Evaporation

The nurse is checking a newborn's 1-minute Apgar score based on the following assessment. The heart rate is 160 beats/minute; he has positive respiratory effort with a vigorous cry; his muscle tone is active and well flexed; he has a strong gag reflex and cries with stimulus to the soles of his feet; his body is pink, with his hands and feet cyanotic. Which is the newborn's 1-minute Apgar score?

9

Tocolytics

Act on uterine muscle to cease contractions. Used to stop preterm labor. Terbutaline sulfate (Brethine), ritodrine HCl (Yutopar), nifedipine (Procardia), magnesium sulfate

imminent abortion

A spontaneous abortion that cannot be prevented. Bleeding and cramping increase, internal cervical os dilates, membranes may rupture

A primigravida at 34 weeks' gestation tells the nurse that she is beginning to experience some lower back pain. What should the nurse recommend that the client do? Select all that apply. A. Wear low-heeled shoes. B. Wear a maternity girdle during waking hours. C. Sleep flat on her back with her feet elevated. D. Perform pelvic tilt exercises several times a day. E. Take an ibuprofen (Motrin) tablet at the onset of back pain.

A. Wear low-heeled shoes. D. Perform pelvic tilt exercises several times a day. Low-heeled shoes help maintain her center of gravity to counterbalance the gravid uterus. Pelvic tilt exercises help relieve lower backaches, are easily learned, and can be done without any equipment. A maternity girdle is not routinely recommended. Sleeping flat during this stage of pregnancy decreases venous return, impedes respiration, and puts pressure on the vena cava, which can cause uteroplacental insufficiency. Nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin) should be avoided during pregnancy, and the prescription of medications is beyond the scope of nursing practice.

Postcoital test (PCT)

An examination that evaluates the cervical mucus, sperm motility, sperm-mucus interaction, and the sperm's ability to negotiate the cervical mucus barrier. Also called Sims-Huhner test.

Which drug has an effect opposite to that of misoprostol? 1. Nifedipine 2. Mifepristone 3. Indomethacin 4. Dinoprostone

Answer: 3. Indomethacin Misoprostol is a prostaglandin derivative that is used to induce uterine contractions and promote abortion. Indomethacin is used to maintain a pregnancy in preterm labor by inhibiting prostaglandin activity, which is the converse of misoprostol's effects. Nifedipine is a calcium channel blocker used to maintain a pregnancy in preterm labor. Mifepristone is a progesterone antagonist used along with misoprostol to induce abortion. Dinoprostone is a prostaglandin derivative used to dilate the opening of the cervix.

APGAR

Appearance (all pink, pink and blue, blue (pale) Pulse (>100, <100, absent) Grimace (cough, grimace, no response) Activity (flexed, flaccid, limp) Respirations (strong cry, weak cry, absent)

pregnancy in which the fetus has died in utero but products of conception are retained in utero for several weeks and there is a delay in expelling the fetus is known as what type of miscarriage? A. threatened B. missed C. inevitable D. complete

B. missed

occiput anterior (OA)

Back of the skull toward the chest - Most favorable position - Most common position

A client in active labor becomes very uncomfortable and asks a nurse for pain medication. Nalbuphine is prescribed. How does this medication relieve pain? A. By producing amnesia B. By acting as a preliminary anesthetic C. By inducing sleep until the time of birth D. By acting on opioid receptors to reduce pain

D. By acting on opioid receptors to reduce pain Nalbuphine is classified as an opioid analgesic and is effective in relieving pain; it induces little or no newborn respiratory depression. Nalbuphine does not induce amnesia, act as an anesthetic, or induce sleep.

incomplete abortion

Expulsion of the fetus with retained placenta before 20 weeks' gestation.

FFN

Fetal Fibronectin: - A protein produced during pregnancy and the basis of a test for preterm delivery. Fetal fibronectin (fFN) functions as "glue" attaching the fetal sac to the uterine lining. The presence of fFN during weeks 22-34 of a high-risk pregnancy, along with symptoms of labor, suggests that the "glue" is disintegrating ahead of schedule and raises the possibility of a preterm delivery.

What is a result of hypothermia in the newborn? • Shivering to generate heat • Decreased oxygen demands • Increased glucose demands • Decreased metabolic rate

Increased glucose demands In hypothermia, the basal metabolic rate (BMR) is increased in an attempt to compensate, thus requiring more glucose.

Stadol (butorphanol tartrate)

L&D, alalgesic, management of severe pain with labor. relieve pain when given in the first stage of labor

non-shivering thermogenesis

Occurs primarily in neonates where vascular brown tissue is metabolized for heat production

I have patient who delivered a twin pregnancy at term. Should I note her in her chart to be a para 1 or para 2?

Para OR Parity is the number of completed pregnancies beyond 20 weeks gestation (whether viable or nonviable). The number of fetuses delivered does not determine the parity. A woman who has been pregnant once and delivered twins after 20 weeks would be noted to be a Gravid 1 Para 1.

A baby's skin is covered with a waxy, cheese-like substance called vernix, which protects the skin from amniotic fluid. Vernix prevents a baby's skin from chaffing in the womb. Lanugo helps protect the skin and makes it easier for vernix to adhere to a baby's skin.

This thin, soft hair, called lanugo, is common: All fetuses grow it in the womb. It usually disappears by 36 to 40 weeks gestation, which explains why babies born early are especially likely to have it.

threatened abortion

Uterine bleeding at 18 weeks' gestation; no products expelled; cervical os closed without dilation

VEAL CHOP

V- Variable C- Cord Comphression E- Early Decels H- Head Compression A- Accelerations O - OK L-Late Decels P - Placenta

The physician prescribes clomiphene citrate (Clomid) for a woman who has been having difficulty getting pregnant. When teaching the client about this drug's potential side effects, which of the following would the nurse include in the teaching plan? " CHOICES a.) Multiple pregnancies. b.) Increase in spontaneous abortions. c.) Increase in fibrocystic breast disease. d.) Increase in congenital anomalies

a.) Multiple pregnancies.

Disseminated Intravascular Coagulation (DIC)

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues

missed abortion

death of a fetus or embryo within the uterus that is not naturally expelled after death

Teratogenic drugs

drugs known to cause developmental defects

Contraction Assessment

frequency duration intensity

surfacant

given to newborn via tracheal tube preventing alveoli from collapsing, respiratory distress syndrome

Misoprostol (Cytotec)

prostaglandin causes contractions and bleeding to empty your uterus

A client who underwent treatment for infertility gave birth to triplets. She often complained of breast pain during the infertility treatment. Which drug may have been administered to the client for infertility treatment? A. Estradiol B. Haloperidol C. Clomiphene D. Promethazine

C. Clomiphene Clomiphene is an ovarian stimulant that may cause multiple pregnancies. Breast pain is an adverse effect of clomiphene. Estradiol helps to reduce postmenopausal hot flashes. Haloperidol and promethazine are contraindicated while using clomiphene.

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: 1. the examiner's hand should be placed over the fundus before, during, and after contractions 2. the frequency and duration of contractions are measured in seconds for consistency 3. contraction intensity is given a judgment number of 1 to 7 by the nurse and client together 4. the resting tone between contractions is described as either placid or turbulent

1. the examiner's hand should be placed over the fundus before, during, and after contractions The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: 1. visceral 2. referred 3. somatic 4. afterpain

2. referred Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early after birth period is uterine. This pain is very similar to that experienced in the first stage of labor.

The nurse in the newborn nursery is preparing to complete an initial assessment on a newborn infant who was just admitted to the nursery. The nurse should place a warm blanket on the examining table to prevent heat loss in the infant caused by which method? 1. Radiation 2. Convection 3. Conduction 4. Evaporation

3. Conduction

The nurse assisted with the birth of a newborn. Which nursing action is most effective in preventing heat loss by evaporation? 1. Warming the crib pad 2. Closing the doors to the room 3. Drying the infant with a warm blanket 4. Turning on the overhead radiant warmer

3. Drying the infant with a warm blanket

The nurse in the delivery room is performing an assessment on a newborn to determine the Apgar score. The nurse notes a heart rate of 92, a weak cry, some flexion of extremities, grimacing with stimulation, and pink body with blue extremities. On the basis of this score, what should the nurse determine? 1. The newborn requires vigorous resuscitation. 2. The newborn is adjusting well to extrauterine life. 3. The newborn requires some resuscitative interventions. 4. The newborn is having some difficulty adjusting to extrauterine life

3. The newborn requires some resuscitative interventions

The partner of a primigravida who has been in active labor for about 6 hours asks the nurse, "How much longer will this take? She's having a lot of back pain, and she's so uncomfortable." How should the nurse respond? A. "It shouldn't be much longer now." B. "Take a short break while I take over." C. "Let me show you how to apply back pressure." D. "Everything is progressing nicely, just as expected."

C. "Let me show you how to apply back pressure." Counterpressure against the sacrum during contractions affords some relief from the discomfort of back pain. It is difficult to predict the duration of labor for any client. Telling the coach to leave is not a response to the situation; the coach should be included in providing comfort to the client. Telling the client that everything is progressing nicely is false reassurance; the data do not indicate that labor is progressing as expected.

A newborn is delivered via spontaneous vaginal delivery. On reception of the crying newborn, the nurse's priority is to perform which action? 1. Determine Apgar score. 2. Auscultate the heart rate. 3. Thoroughly dry the newborn. 4. Take the newborn's rectal temperature.

3. Thoroughly dry the newborn.

The nurse's priority action when observing early deceleration indicating expected head compression during contractions is to: 1. notify the health care provider 2. assist with vaginal examination to assess for cord prolapse 3. change maternal position 4. assist with amnioinfusion

3. change maternal position The usual priority is as follows: 1. Change maternal position (side to side, knee chest). 2. Discontinue oxytocin if infusing. 3. Administer oxygen at 8 to 10 L/min by nonrebreather face mask. 4. Notify physician or nurse-midwife. 5. Assist with vaginal or speculum examination to assess for cord prolapse. 6. Assist with amnioinfusion if ordered. 7. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected

A pregnant woman is administered medication to treat preterm labor that requires a prescription for calcium gluconate to counter the effects of the drug. Which drug was administered? A. Nifedipine B. Indomethacin C. Betamethasone D. Magnesium sulfate

D. Magnesium sulfate Magnesium sulfate is used to prevent preterm labor in pregnant women with hypertension. To reduce magnesium toxicity caused, calcium gluconate should also be prescribed to counter the effects of this drug. Nifedipine is a calcium channel blocker that inhibits myometrial activity by blocking the calcium influx. Indomethacin is a nonsteroidal antiinflammatory agent used along with sucralfate to protect the stomach. Betamethasone is a corticosteroid used when preterm labor is not maintained by other treatments and delivery is proceeding.

Cephalic presentations

Vertex. Most common, smallest diameter of head presents to maternal pelvis Military. Head extended and flexed, top of head presents. AKA Sinciput presentation Brow. Brow is first part going thru maternal pelvis Face. Hyper extension of head entering pelvis first

Nalbuphine (Nubain)

opioid agonist It's Morphine w/o the hypotensive effect induces little or no newborn respiratory depression. Nalbuphine does not induce amnesia, act as an anesthetic, or induce sleep.

(power points) the nurse knows that placing the naked newborn on mom's bare chest and covering both with a blanket/towel does what

reduces conduction and radiation heat loss enhances newborn temperature control enhances maternal infant interaction

transverse position

the baby lies crosswise in the uterus, or when the baby's head is so large it has trouble moving through the birth canal

Dinoprostone (Cervidil)

-cervical ripening; produces contractions, dilation & effacement of cervix, initiate labor or expulsion of fetus. indicated for uterine evacuation in cases of miscarriage -S/E: abnormal contractions, warmth in vagina, back pain, amniotic fluid embolism, fever

Gestational Age Assessment

-Performed within 2 to 12 hr of birth Newborn Measurements and New Ballard Scale Gestational age estimation and baseline to assess growth and development. *development of skin creases on the sole of the foot occurs in late intrauterine life and that after birth this is a helpful clinical sign to determine gestational age. Until 36 weeks of gestation there are only one or two transverse skin creases on the anterior part of the sole. -AGA - Appropriate for gestational age -LGA - Large for gestational age: above 90th percentile -SGA - Small for gestational age: below 10th percentile

Newborn heat loss

-evaporation: drying the newborn prevents heat loss via evaporation (liquid converts to vapor) -convection: maintain an ambient room temp of 75.2 degree (flow of heat from the body surface to a cooler ambient air) -conduction: using a protective cover prevents contact with the scale -radiation: place the newborn's bassinet away from the outside windows (loss of heat from the body surface to a cooler, solid surface not in direct contact with newborn but in relative proximity)

risk factors for preterm labor

hx of preterm labor multiple gestation (twins, multiples) AMA (advanced maternal age HTN African American hx of genital tract infection hx of miscarriage socioec. status personal stress uterine anomaly IVF smoking, drugs underweight, overweight lack of prenatal care

causes of spontaneous abortion

main: congenital anomalies and implantation defect... maternal illness like Type 1 DM, advancing maternal age, premature cervical dilation, chronic maternal infection, maternal malnutrition, trauma or injury, substance use,

nociceptive pain

type of pain that occurs when there is damage to body tissue. A patient may experience this type of pain with a physical injury, such as a fracture or laceration. It is further categorized as being somatic or visceral pain and it can be referred from its original location and felt in another area of the body.

amniocentesis

the sampling of amniotic fluid using a hollow needle inserted into the uterus, to screen for developmental abnormalities in a fetus.

How can magnesium sulfate be used for pregnant women?

used in pregnancy to prevent seizures due to worsening preeclampsia, to slow or stop preterm labor, and to prevent injuries to a preterm baby's brain. administered with the use of an infusion pump Therapeutic level: 5-8 mg/dl (>9mg toxic) Side effects for mother: Flushing or hot flashes Feeling tired and lethargic Nausea and vomiting Dizziness Blurred vision Muscle weakness Depressed respiration Seizures *To reduce magnesium toxicity caused, calcium gluconate should also be prescribed to counter the effects of this drug.

To prevent heat loss by conduction during physical examination of a newborn infant, which action should the nurse implement? 1. Dry the newborn's head thoroughly. 2. Turn the thermostat in the room to 70°F. 3. Place the newborn near the nursery window. 4. Place a warm blanket on the examining table before placing the newborn on the table.

4. Place a warm blanket on the examining table before placing the newborn on the table.

A client with a history of three spontaneous abortions is now at 16 weeks' gestation and attending the high-risk prenatal clinic. She expresses concerns about remaining at home during this pregnancy. Which questions will elicit responses most helpful to the nurse developing the client's plan of care? Select all that apply. A. "Do you have a support system available to help you?" B. "Have you been told about the status of your pregnancy?" C. "Do you know the causes related to spontaneous abortions?" D. "Are you aware of how a healthy lifestyle affects a pregnancy?" E. "What are the characteristics of an impending spontaneous abortion?"

A. "Do you have a support system available to help you?" B. "Have you been told about the status of your pregnancy?" The availability of support persons is important when the client is deciding how to try to maintain the pregnancy. Knowing the status of her pregnancy is helpful to the nurse planning her care. If the status is not known, the nurse can correct any misconceptions and assist the client in focusing on reality while helping ease her anxiety. The causes of spontaneous abortion are not always known; theoretic knowledge of the causes will not help the client maintain her pregnancy. Questions about the interrelationship of lifestyle and a healthy pregnancy may add to the client's anxiety; they are not relevant at this time. Questioning the client's knowledge of an impending spontaneous abortion may add to the client's anxiety; after three abortions the client probably knows what to expect before a spontaneous abortion.

The nurse is caring for a couple during their initial visit to a fertility clinic after being unable to conceive for 2 years. Which of the following assessment questions would be appropriate to determine an alternate cause of infertility? A. "Do you use any lubrication during intercourse?" B. "Can both of you reach orgasm at the same time?" C. "What type of birth control did you use in the past?" D. "Are you consistent in the manner in which you have intercourse?

A. "Do you use any lubrication during intercourse?" Some lubricants act as a spermicide; they should be avoided, or only a recommended one should be used. A female orgasm is not necessary for conception; simultaneous orgasms is not a relevant question. The type of birth control before the couple began trying to conceive 2 years ago is not relevant at this time; some hormonal contraceptives should be discontinued 6 to 18 months before trying to conceive. Consistency in the manner of intercourse usually is not relevant to conception, although a change in position may be recommended

A client in active labor is considering combined spinal-epidural analgesia. She states that she is concerned about her ability to walk after receiving this type of analgesia. What is the most accurate response by the nurse? A. "This analgesia gives you pain relief without compromising your ability to ambulate." B. "The analgesia will require you to remain in bed, but you'll be able to move from side to side." C. "You may experience slight weakness, but someone will be at your side when you're ambulating." D. "Someone will help you ambulate every couple of hours before you're given another dose of the analgesia."

A. "This analgesia gives you pain relief without compromising your ability to ambulate." Because the spinal nerve receptors are sensitive to opioids, small quantities are needed to produce analgesia; therefore the client's ability to ambulate without assistance is not jeopardized. Bed rest is not required. The analgesia does not cause weakness. The client's ability to ambulate without assistance is not jeopardized. The analgesia lasts for more than 2 hours; there is no need to ambulate before a dose is given.

A pregnant client who has type 2 diabetes and a history of three spontaneous abortions is scheduled for a contraction stress test. Before the test she begins to cry while answering the nurse's questions regarding her previous pregnancies. She states, "I know it's my diabetes. This baby will never live. It's all my fault." What is the best response by the nurse? A. "This must be very stressful for you." B. "Diabetes is a difficult disease to manage during pregnancy." C. "This baby will live because it is being very closely monitored." D. "I know you're worried, but getting upset can alter your test results.

A. "This must be very stressful for you." By acknowledging the situation is stressful for the client, the nurse empathizes with the client and keeps the lines of communication open without being judgmental. Stating that diabetes is a difficult disease to manage during pregnancy does not address the client's feelings and may increase the client's anxiety. Stating that the baby will live constitutes false reassurance; close monitoring does not guarantee a live baby. Stating that getting upset can alter test findings denies the client's right to emotions and may evoke more feelings of guilt about her obstetric history.

Which physiologic characteristics of newborns affect drug dosage considerations? Select all that apply. A. A newborn's less regulated body temperature B. Immature liver and kidneys C. Thick and less permeable skin D. Lungs with weaker mucous barriers E. Bacteria-killing acid in the stomach

A. A newborn's less regulated body temperature B. Immature liver and kidneys D. Lungs with weaker mucous barriers The body temperature of newborns is less regulated and dehydration occurs easily. This characteristic affects the drug dose consideration in newborns. Metabolism and excretion are impaired in pediatric clients due to an immature liver and kidneys. The lungs in pediatric clients have weak mucous barriers; this characteristic also affects the drug dosage considerations in newborns. A newborn's skin is thin and more permeable. The newborn has no acid in the stomach to kill the bacteria; therefore, drug absorption from the gastrointestinal tract is affected, thus impacting drug dosage considerations.

Nurse is caring for a client in preterm labor who is receiving a course of corticosteroids to promote fetal lung maturity. What test may be used to most accurately determine fetal lung maturity? A. Amniocentesis B. Ultrasonography C. Radioreceptor assay D. Chorionic villus sampling

A. Amniocentesis The presence of phosphatidylglycerol and a 2:1 lecithin/sphingomyelin ratio in the amniotic fluid confirm fetal lung maturity. Ultrasonography cannot be used to determine fetal lung maturity. The radioreceptor assay is a test used to determine whether the client is pregnant; it is done very early in pregnancy. Chorionic villus sampling, a diagnostic screening test, is done between the eighth and twelfth weeks of pregnancy to determine fetal chromosomal status.

A client gives birth to a full-term male with an 8/9 Apgar score. What should the immediate nursing care of this newborn include? A. Assessing respirations, keeping him warm, and identifying him B. Applying an antibiotic to the eyes, administering vitamin K, and bathing him C. Aspirating the oropharynx, rushing him to the nursery, and stimulating him often D. Weighing him, placing him in a crib, and waiting until the mother is ready to hold him

A. Assessing respirations, keeping him warm, and identifying him Establishing a patent airway, diminishing cold stress, and identifying the newborn are the priorities. Application of eye prophylaxis and administration of vitamin K are often delayed to allow the parents to bond with the infant; a bath at this time will increase the risk of cold stress. Aspirating the oropharynx, rushing him to the nursery, and stimulating him frequently are measures appropriate for a compromised newborn; an 8/9 Apgar score is indicative of a healthy newborn. Weighing him, placing him in a crib, and waiting until the mother is ready to hold him are not the priority care for a newborn.

A pregnant woman reports upper back pain and frequent and painful urination. Upon diagnosis, the client has a urinary tract infection and is treated with nitrofurantoin. Which teratogenic effect is likely to occur in the infant? A. Cleft palate B. Tooth anomalies C. Neural tube defects D. Ebstein anomaly

A. Cleft palate Nitrofurantoin may cause cleft palate in fetuses. The use of drug tetracyclines may cause tooth anomalies in fetuses. Ebstein anomaly may be caused by the use of the drug lithium. Neural tube defects may be caused by valproic acid.

Which drug does the nurse anticipate to be prescribed to a client seeking treatment for infertility? A. Clomiphene B. Misoprostol C. Dinoprostone D. Methylergonovine

A. Clomiphene Clomiphene causes the maturation of ovarian follicles, which leads to ovulation. This drug is used to promote fertility. Misoprostol and dinoprostone are prostaglandins that cause uterine muscle contractions. Methylergonovine is an ergot alkaloid used to reduce postpartum uterine hemorrhage.

A client and her partner are working together to achieve an unmedicated birth. The client's cervix is now dilated to 7 cm, and the presenting part is low in the midpelvis. What should the nurse instruct the partner to do that will alleviate the client's discomfort during contractions? A. Deep-breathe slowly. B. Perform pelvic rocking. C. Use the panting technique. D. Begin patterned, paced breathing.

A. Deep-breathe slowly. Slow, deep breathing expands the spaces between the ribs and raises the abdominal muscles, giving the uterus room to expand and preventing painful pressure of the uterus against the abdominal wall. Pelvic rocking is used to relieve pressure from back labor. Panting is used to halt or delay the expulsion of the infant's head before complete dilation has occurred. Patterned, paced breathing is used during the transition phase of the first stage; the client has not yet reached this phase.

(powerpoint) How is pain classified (select all that apply) A. Duration B. Characteristics C. Etiology D. Source/location

A. Duration ( acute or chronic) C. Etiology (nociceptive or neuropathic) D.Source/location (somatic or visceral)

A nurse in the fertility clinic is instructing a client who will be using progesterone gel vaginally in the treatment of luteal phase infertility. When discussing the side effects of progesterone, what should the nurse tell the client to expect? A. Enlarged, tender breasts B. Increased vaginal secretions C. Additional facial and body hair D. Decreased basal body temperature

A. Enlarged, tender breasts The hormonal influence of progesterone during the luteal phase of the menstrual cycle contributes to breast enlargement and tenderness. Vaginal secretions decrease, not increase, with the administration of progesterone. Loss of hair, not additional facial and body hair, is a side effect associated with the administration of progesterone. An increase, not decrease, in basal body temperature is associated with the administration of progesterone.

The nurse is providing care to a multiparous client in active labor. The client is requesting something for the pain. What is the nurse's priority intervention? A. Examining the client's cervix for dilation and effacement B. Determining the client's options by assessing the prescriptions in the chart C. Asking her whether she prefers an epidural or something in her intravenous line D. Evaluating the fetal monitoring strip to determine the frequency and duration of contractions

A. Examining the client's cervix for dilation and effacement Evaluating the client's cervical dilation and effacement determines her progress in labor and reveals whether it is safe to administer analgesia or anesthesia. Assessment is the initial step of the nursing process. Options for pain management would be determined after dilation has been assessed. The client may be asked about her preferred method of analgesia, but that should be done after her degree of dilation has been determined. The stem of the question indicated that the client is in active labor; information on the fetal monitoring strip regarding contractions will not add to the assessment data.

After 18 months of unsuccessful attempts at conception by a client, primary infertility related to anovulatory cycles is diagnosed. Clomiphene citrate is prescribed. When will the nurse instruct the client to take clomiphene? A. Fifth day of her cycle B. Last day of her period C. Third day after her period begins D. Sixteenth day of her cycle

A. Fifth day of her cycle The objective is to stimulate ovulation near the fourteenth day of the menstrual cycle, and this is achieved by taking the medication on the fifth through the ninth days; there is an increase in two pituitary gonadotropins, luteinizing hormone and follicle-stimulating hormone, with subsequent ovarian stimulation. On the third day after the cycle there are insufficient hormones for clomiphene to be effective. The sixteenth day of the cycle is also too late for clomiphene to be effective.

Neonates have difficulty maintaining their body temperature; however, their bodies have several mechanisms to help them do so. Which ones should a nurse remember when caring for the newborn? Select all that apply. A. Flexed fetal position B. Hepatic insulin stores C. Brown fat metabolism D. Peripheral vasoconstriction E.Parasympathetic nervous system

A. Flexed fetal position C. Brown fat metabolism D. Peripheral vasoconstriction Full-term neonates maintain a flexed fetal position, which conserves heat. Deposition of brown fat begins at 28 weeks' gestation and continues for the rest of the pregnancy; when the newborn's body becomes cool, the sympathetic nervous system stimulates the breakdown of brown fat, which releases heat as a by-product. Peripheral vasoconstriction helps conserve heat by keeping the central core warm and preventing heat from dissipating. Insulin is not stored in the liver and is not involved with maintenance of neonatal body temperature. The sympathetic, not parasympathetic, nervous system is involved in thermoregulation.

The nurse is caring for a client who has had a spontaneous abortion. Which complication should the nurse assess this client for? A. Hemorrhage B. Dehydration C. Hypertension D. Subinvolution

A. Hemorrhage Hemorrhage may result if placental tissue is retained or uterine atony occurs. There is no indication that the client has been deprived of fluids. Hypotension, not hypertension, may occur with postabortion hemorrhage. Subinvolution is more likely to occur after a full-term birth

A woman has been administered clomiphene as part of a treatment for infertility. What assessments indicate that the drug is working effectively? Select all that apply. A. Increased estrogens B. Increased ovarian stimulation C. Increased luteinizing hormone D. Decreased follicle-stimulating hormone E. Decreased gonadotropin-releasing hormone

A. Increased estrogens B. Increased ovarian stimulation C. Increased luteinizing hormone Clomiphene acts by stimulating the hypothalamus in the treatment for infertility. This drug indirectly increases the levels of estrogens, which causes ovarian stimulation due to the increase in the levels of luteinizing hormone. Stimulation of the hypothalamus by clomiphene indirectly increases the level of follicle-stimulating hormone via the increased production of gonadotropin-releasing hormone from the hypothalamus

After a newborn has skin-to-skin contact with the mother, the nurse places the newborn under a radiant warmer. Which complication is the nurse attempting to prevent? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis Uncorrected cold stress increases anaerobic glycolysis, which increases acid production, resulting in metabolic acidosis. Metabolic acidosis, not metabolic alkalosis, occurs when a neonate is stressed by cold. Cold stress causes a metabolic, not a respiratory, problem; metabolic acidosis, not respiratory acidosis, occurs. Cold stress causes a metabolic, not a respiratory, problem; metabolic acidosis, not respiratory alkalosis, occurs.

A woman reports irregular menses and weight gain. Upon diagnosis, the woman has low hormone levels and is treated with infertility drugs to conceive. Which nursing interventions would be beneficial to this client? Select all that apply. A. Monitor vital signs. B. Encourage the client to track her medications in a journal. C. Recommend the self-administration of oral drugs. D. Recommend the long-term use of indomethacin orally. E. Administer oral drugs to the client when the client wakes up along with six glasses of water.

A. Monitor vital signs. B. Encourage the client to track her medications in a journal. C. Recommend the self-administration of oral drugs. The nurse should monitor the client's vital signs to minimize the risk of hypotension. Journal tracking of medication helps to ensure the regular administration of the drug. Self-administration of oral drugs at home should be encouraged, and proper instructions regarding the administration should be provided to ensure rational use of the drug. The nurse should not advise the long-term oral use of indomethacin because it may cause birth defects. The administration of oral drugs upon rising with six glasses of water is the nursing intervention for administration of oral bisphosphonates in the treatment of osteoporosis.

A patient has come to the healthcare clinic complaining of pain in his left arm after an injury. Which describes the characteristics of nociceptive pain? Select all that apply. A. Nociceptive pain may be localized to the area of injury B. Nociceptive pain develops after an injury to the central nervous system C. Nociceptive pain is categorized as being either somatic or visceral pain D. Nociceptive pain is typically causes an increase in sympathetic activiety E. Nociceptive pain can be referred pain

A. Nociceptive pain may be localized to the area of injury C. Nociceptive pain is categorized as being either somatic or visceral pain E. Nociceptive pain can be referred pain Rationale: Nociceptive pain describes a type of pain that occurs when there is damage to body tissue. A patient may experience this type of pain with a physical injury, such as a fracture or laceration. It is further categorized as being somatic or visceral pain and it can be referred from its original location and felt in another area of the body.

The nurse is reevaluating a newborn who had an axillary temperature of 97° F (36.1° C) and was placed skin to skin with the mother. The newborn's axillary temperature is still 97° F (36.1° C) after 1 hour of skin-to-skin contact. Which intervention should the nurse implement next? A. Placing the newborn under a radiant warmer in the nursery B. Checking the newborn for a wet diaper and then continue the skin-to-skin contact C. Leaving the newborn in skin-to-skin contact and rechecking the temperature in 1 hour D. Double-wrapping the newborn in warm blankets and returning the newborn to a crib by the mother's bedside

A. Placing the newborn under a radiant warmer in the nursery The newborn's temperature should be kept in the normal range of 97.7° F to 99.5° F (36.5° C to 37.5° C). A hypothermic temperature that has not improved in 1 hour with the use of skin-to-skin contact requires additional measures. The infant should be placed under a radiant warmer for a short time until the temperature returns to the normal range. Continuing skin-to-skin contact would not resolve the problem of hypothermia. Double-wrapping the newborn in warm blankets and leaving the newborn at the bedside would not be an adequate means of resolving the hypothermia.

(powerpoints) Treatment goal for patient/couple with infertility issues. (select all that apply) A. Provide the couple with accurate information about human reproduction, infertility treatments, and prognosis for pregnancy B. Assist in identifying the cause of infertility C. Discuss the use of antidepressants D.Provide emotional support E. Guide and educate about forms of treatment

A. Provide the couple with accurate information about human reproduction, infertility treatments, and prognosis for pregnancy B. Assist in identifying the cause of infertility D.Provide emotional support E. Guide and educate about forms of treatment

A tocolytic was administered to a woman to inhibit labor and maintain pregnancy. Which nursing interventions would be beneficial to this client? Select all that apply. A. The drug should not be administered on a long term basis. B. The drug should be continued after the contractions subside. C. The client's vital signs and fetal heart rate should be monitored regularly. D. The dose and route of administration should be determined. E. The client should be placed in the right lateral recumbent position.

A. The drug should not be administered on a long term basis. C. The client's vital signs and fetal heart rate should be monitored regularly. D. The dose and route of administration should be determined. Long-term use of tocolytics may cause birth defects; therefore, tocolytics should not be administered on a long-term basis. The vital signs and fetal heart rate should be monitored regularly and closely to detect any abnormalities. The dose and route of administration should be determined to avoid inaccurate dosing. The drug should be discontinued after contractions cease. The client should be placed in the left lateral recumbent position to increase blood flow to the fetus and to increase renal blood flow.

The nurse who works in a birthing unit understands that newborns may have impaired thermoregulation. Which nursing interventions may help prevent heat loss in the newborns? Select all that apply. A. The nurse keeps the newborn covered in warm blankets. B. The nurse keeps the newborn under the radiant warmer. C. The nurse places the newborn on the mother's abdomen. D. The nurse measures the newborn's temperature regularly. E. The nurse encourages the mother to feed the newborn well to maintain the fluid balance.

A. The nurse keeps the newborn covered in warm blankets. B. The nurse keeps the newborn under the radiant warmer. C. The nurse places the newborn on the mother's abdomen. Newborns have impaired thermoregulation due to immaturity of the body systems. Therefore, the nurse performs interventions to prevent heat loss in the newborn. Covering the newborn with warm blankets helps to prevent heat loss. The nurse keeps the newborn under the radiant warmer to help maintain the body temperature. Placing the newborn on the mother's abdomen helps to promote warmth through skin-to-skin contact. Regular measurement of temperature may help in assessing any significant change; however, it may not help prevent heat loss. Ensuring that the newborn is fed well does not help to prevent heat loss.

Which breathing technique should the nurse instruct the client to use as the head of the fetus is crowning? A. Shallow B. Blowing C. Slow chest D. Modified paced

B. Blowing Blowing forcefully through the mouth controls the strong urge to push and allows for a controlled birth of the head. A shallow breathing pattern does not help control expulsion of the fetus. Slow chest breathing is used during the latent phase of the first stage of labor; it is not helpful in overcoming the urge to push. Modified paced breathing is used during active labor when the cervix is dilated 3 to 7 cm; it is not helpful in overcoming the urge to push.

Which medication is indicated for evacuation in case of a miscarriage? A. Clomiphene B. Dinoprostone C. Magnesium sulfate D. Methylergonovine

B. Dinoprostone Dinoprostone is a prostaglandin E 2 abortifacient and cervical ripening drug, which is indicated for uterine evacuation in cases of miscarriage. Clomiphene is indicated for female infertility in some clients. Magnesium sulfate is used to treat pregnancy-induced hypertension. Methylergonovine is used to treat postpartum uterine atony and hemorrhage.

Which drug is used to prevent preterm labor? A. Oxytocin B. Nifedipine C. Raloxifene D. Clomiphene

B. Nifedipine Nifedipine is used to prevent preterm labor because it inhibits myometrial activity by blocking the influx of calcium. Oxytocin may be used to induce labor. Raloxifene is used to prevent postmenopausal osteoporosis. Clomiphene is used to cause ovulation.

Hysterosalpingography (HSG) is performed to determine whether a client has a tubal obstruction. The nurse explains to the client that infertility caused by a defect in the tube is most often related to what? A. A tubal injury B. Past infection C. A fibroid tumor D. A congenital anomaly

B. Past infection Past pelvic infections may result in tubal occlusions, most of which are caused by post infection adhesions. Although tubal injury is possible, tubal infections are more common. Fibroid tumor is a benign tumor of the uterus and does not affect the tube. Tubal congenital anomalies are rare; uterine anomalies are more common.

The client is unable to become pregnant after she has had one full-term pregnancy. The nurse should develop a plan of care for which health problem? A. Primary infertility B. Secondary infertility C. Unexplained infertility D. Combined factor infertility

B. Secondary infertility Rationale: Secondary infertility is the term for couples that have had one pregnancy but are unable to conceive again. Primary infertility describes the inabilityto conceive even once. Unexplained and combined factorinfertility are not terms used when discussing fertility.

The nurse is caring for a client in the first stage of labor. Which position is the least desirable for the client if she is experiencing lower back pain? A. Sitting B. Supine C. Knee-chest D. Left side-lying

B. Supine Low back pain is aggravated when the client is in the supine position because of increased pressure from the fetus as the head rotates. A sitting position relieves back pain. The knee-chest position is an alternate position that a client may choose to use when laboring. The left side-lying position relieves back pain.

Which statements relate to preterm labor? Select all that apply. A. A premature baby has good cognitive development. B. The treatment for preterm labor includes bed rest and hydration. C. Preterm labor before the 20th week is indicative of a nonviable fetus. D. It is not desirable to stop the delivery in the case of preterm labor. E. Preterm labor refers to uterine contractions progressing to delivery before the 27th week of pregnancy.

B. The treatment for preterm labor includes bed rest and hydration. C. Preterm labor before the 20th week is indicative of a nonviable fetus. D. It is not desirable to stop the delivery in the case of preterm labor. E. Preterm labor refers to uterine contractions progressing to delivery before the 27th week of pregnancy. Bed rest and hydration are nonpharmacological interventions for treating preterm labor. Early labor pains before 20th week are indicative of a nonviable fetus and should generally be uninterrupted. A preterm labor may result in neonatal death, so pregnancy should be maintained to prevent neonatal death. The substantial uterine contractions before the 37th week of gestation leads to preterm labor. Preterm labor has significant poorer cognitive effects on premature babies.

A client who has been pregnant for 5 months experiences a spontaneous abortion after an accident. The client tells the nurse that she feels depressed over the loss of her son. She describes how he would have looked and how bright he would have been. What is the client demonstrating? A. Panic level of anxiety B. Typical grief syndrome C. Pathological grief reaction D. Diminished ability to test reality

B. Typical grief syndrome The client is grieving the loss of a fantasized child; talking about it is part of the typical grief reaction. The client is sad, not out of control or immobilized. The client is coping with the loss effectively. The client recognizes the loss, but is lamenting what could have been.

A multipara is admitted to the birthing room in active labor. Her temperature is 98° F (36.7° C), pulse 70 beats/min, respirations 18 breaths/min, and blood pressure 126/76 mm Hg. A vaginal examination reveals a cervix that is 90% effaced and 7 cm dilated with the vertex presenting at 2+ station. The client is complaining of pain and asks for medication. Which medication should be avoided because it may cause respiratory depression in the newborn? A. Naloxone (Narcan) B. Lorazepam (Ativan) C. Meperidine (Demerol) D. Promethazine (Phenergan)

C. Meperidine (Demerol) **Meperidine (Demerol) is an opioid that can cause respiratory depression in the neonate if administered less than 4 hours before birth.

At 12 weeks' gestation a client with a history of several spontaneous abortions says to the nurse, "Every day I wonder whether I'll be able to have this baby." How should the nurse respond? A. "I can understand why you're worried; however, you'll have other chances in the future to get pregnant." B. "You're getting the best of care. Please tell me about the problems with your previous pregnancies." C. "It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time." D. "Your pregnancy has lasted past the time when most early spontaneous abortions occur. I think you'll be able to continue the pregnancy."

C. "It's understandable for you to be worried that you won't be able to carry this pregnancy to term. You've had a difficult time." Affirming the validity of the client's concerns acknowledges her fearful feelings. It also permits further communication. Assuring the client that she will have other chances to get pregnant in the future does not acknowledge the client's feelings; it also instills fear by implying that the current pregnancy may not go to term, even though there is no evidence to indicate this. Asking the client to talk about the problems with her prior pregnancies does not acknowledge her feelings of fear and changes the focus of the conversation. Telling the client that she should be able to continue the pregnancy is false assurance and does not address the client's feelings.

Which statement by a client being treated for infertility indicates the need for additional teaching? A. "I should come back for a postcoital test 1-2 days before I expect to ovulate." B. "I should schedule my hysterosalpingogram for the week after ovulation." C. "We should abstain for 14 days prior to coming back for the sperm penetration test." D. "I should schedule my endometrial biopsy for the last week of my menstrual cycle."

C. "We should abstain for 14 days prior to coming back for the sperm penetration test." The sperm penetration test, which tests for the ability of sperm to penetrate an egg, should be performed after 2-7 days of abstinence. Having a post-coital test before ovulation is not useful. A hypersalpingogram would be scheduled in the proliferative phase before ovulation to avoid early pregnancy or secretory changes in endometrium after ovulation, which could obstruct dyepassage. Endometrial biopsy should not be scheduled earlier than 10 to 12 days after ovulation to accurately detect effects of progesterone and endometrial sensitivity.

A client in labor is experiencing discomfort because her fetus is in the occiput posterior position. Which nursing action will help relieve this discomfort? A. Positioning her on the left side B. Using effleurage on her abdomen C. Applying pressure against her sacrum D. Placing her in the semi-Fowler position

C. Applying pressure against her sacrum Counterpressure over the sacral area helps relieve the pain caused by the pressure of the fetal head in the posterior position. Although helpful for placental perfusion, positioning the client on her left side is not the best action for reducing pain caused by the pressure of the fetal head in the posterior position. Massaging the abdomen with the fingertips (effleurage) does not relieve the painful pressure in the lower back. The semi-Fowler position causes additional discomfort because the sacrum is inaccessible and counterpressure cannot be applied to the sacral area.

A pregnant client has labor pains. However, the nurse finds that the client's cervix is not dilated. Which drug should be administered to the client to promote labor? A. Oxytocin B. Nifedipine C. Dinoprostone D. Methylergonovine

C. Dinoprostone Dinoprostone induces cervical ripening. This action helps in the induction of labor at term. Oxytocin enhances labor when uterine contractions are weak and ineffective. Nifedipine is a calcium channel blocker used to maintain pregnancy during preterm labor. Methylergonovine reduces postpartum hemorrhage.

A client who has just experienced her second spontaneous abortion expresses anger toward the practitioner, the hospital, and the "rotten nursing care." When assessing the situation, the nurse concludes that the client may be using which coping mechanism? A. Denial B. Projection C. Displacement D. Reaction formation

C. Displacement The client's anger about the miscarriage is shifted to the staff and the hospital because she is unable to cope with her loss at this time. The client is neither ignoring nor refusing to recognize reality. The client is not attributing unacceptable or undesirable thoughts or feelings to another; nor is she exhibiting a behavior pattern opposite to what she feels.

A woman who is infertile is diagnosed with primary ovarian failure. Which fertility drug regimen may be prescribed to treat infertility? A. Clomiphene B. Menotropins C. Estrogens and progestins D. Choriogonadotropin alfa

C. Estrogens and progestins Exogenous administration of estrogens or progestins is used to treat infertility associated with primary ovarian failure. The administration of clomiphene, menotropins, and choriogonadotropin alfa cannot stimulate the ovaries to increase the levels of estrogens or progestins.

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. How does the nurse, using the GTPAL format, document the client's obstetric history? A. G4 T3 P2 A1 L4 B. G5 T2 P2 A1 L4 C. G5 T2 P1 A1 L4 D. G4 T3 P1 A1 L4

C. G5 T2 P1 A1 L4 The acronym GTPAL represents gravidity, term births, preterm births, abortions, and living children; G5 T2 P1 A1 L4 indicates that the client has had five pregnancies (twins count as one pregnancy and the current pregnancy counts as one); two term births; one preterm birth (the twins); one abortion; and four living children. G4 T3 P2 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one, not two, preterm birth; one abortion; and four living children. G5 T2 P2 A1 L4 indicates that there were five pregnancies; two term births; twins counted as one, not two, preterm births; one abortion; and four living children. G4 T3 P1 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one preterm birth; one abortion; and four living children.

A client at 22 weeks' gestation asks the nurse how to prevent back pain as her pregnancy progresses. What does the nurse suggest that she wear? A. Maternity girdle B. Support stockings C. Low-heeled shoes D. Loose-fitting clothing

C. Low-heeled shoes Low-heeled supportive shoes help maintain the body's center of gravity over the hips, limiting arching of the back that compensates for the increased weight in the abdominal area. Maternity girdles are no longer recommended. Support stockings may be helpful for a woman with varicose veins or ankle edema; however, wearing them does not prevent back pain. Loose-fitting clothing is more comfortable, but has no effect on back pain.

A client undergoes a cesarean birth because of cephalopelvic disproportion. What care is needed for this client in addition to the routine nursing care given to all postpartum clients during the first 24 hours? A. Encouraging early ambulation B. Assessing the fundus gently but firmly C. Checking vital signs for evidence of shock D. Administering the prescribed pain medication

D. Administering the prescribed pain medication Because of increased pain and increased flatus, clients who have had cesarean births require more pain medication than do women who have vaginal births. Early ambulation is encouraged for all postpartum clients. Although this may be difficult because of the incision, palpating the fundus is a necessary part of postpartum care. Vital signs are checked routinely in all postpartum clients.

A nurse is teaching a childbirth preparation class. Which information regarding discomfort during labor should the nurse be certain to include in her teaching? A. Labor should be mostly pain free and uneventful. B. Breathing techniques will be taught to prevent the need for medication. C. Medication is given to women who experience painful labor contractions. D. Comfort measures are available when the discomfort of contractions becomes excessive.

D. Comfort measures are available when the discomfort of contractions becomes excessive. Classes in preparation for parenthood should help couples develop realistic expectations of the labor process, including associated discomfort and ways of dealing with it. Stating that labor should be mostly pain free and uneventful is false reassurance; contractions are uncomfortable, and there is no guarantee that the birthing process will be uneventful. Breathing techniques may not be enough for some women to limit the discomfort of contractions. The focus should not be on pain; comfort measures should be attempted first before medication is used.

Ten minutes after administering nalbuphine via intravenous piggyback to a primigravida in active labor, the nurse notes a fetal heart rate of 132 with minimal variability. The client states that the pain is more tolerable and she is able to use her breathing techniques more effectively. Contractions continue every 2 to 3 minutes and are of 60 seconds' duration. What is the nurse's next action? A. Reposition the client on the left side to increase placental perfusion. B. Administer oxygen via mask to minimize apparent fetal compromise. C. Have an opioid antagonist available to be administered to the infant at the time of birth. D. Document the findings, including the stable fetal heart rate variability after administering the opioid infusion.

D. Document the findings, including the stable fetal heart rate variability after administering the opioid infusion. A common side effect of an opioid analgesic is decreased fetal heart rate variability. Because the fetal heart rate and the length and duration of the contractions remain stable and the analgesic appears to be effective, the only nursing action is to document the findings. Repositioning the client is not necessary because the data do not indicate decreased placental perfusion. It is not necessary to administer oxygen because the data do not indicate fetal compromise. Naloxone, an opioid antagonist, may need to be administered to the newborn, but the present data do not indicate that this is necessary.

The nurse is caring for a client who has had a spontaneous abortion. The client asks why spontaneous abortions occur. The nurse responds that they are most commonly caused by what? A. Physical trauma B. Unresolved stress C. Congenital defects D. Embryonic defects

D. Embryonic defects Approximately 75% of all spontaneous abortions take place between 8 and 12 weeks' gestation and reveal embryonic defects. Though possible, physical trauma rarely causes an abortion. Unresolved stress is rarely associated with spontaneous abortions. Congenital defects are asymptomatic during pregnancy and do not usually cause abortion.

Immediately after birth, a newborn is dried before being placed in skin-to-skin contact with the mother. What type of heat loss does this intervention prevent? A.Radiation B.Convection C. Conduction D. Evaporation

D. Evaporation Evaporative heat loss is a result of the conversion of moisture into vapor, which is avoided when the newborn is dried. Radiation is the loss of heat to colder solid surfaces that are not in direct contact. Convective heat loss is a result of contact of the exposed skin with cooler surrounding air currents. Conductive heat loss is a result of direct skin contact with a cold solid object.

Which nursing assessment is important to recognize to determine the causative factors in a client with a history of spontaneous abortions? A. Use of sex hormones B. Use of contraceptive pills C. Presence of heart problems D. History of alcohol consumption

D. History of alcohol consumption Alcohol consumption during pregnancy may cause fetal abnormalities and increase the risk of spontaneous abortions. The presence of heart problems may not cause spontaneous abortions. The use of sex hormones in pregnancy may cause fetal abnormalities. Contraceptive pills may inhibit the ovulation process, but they rarely affect the embryo.

A female client is undergoing treatment for infertility. After therapy with clomiphene the client comes for follow-up visits and no results are seen. What further treatment does the nurse anticipate administering? A. Estrogen B. Progesterone C. Human growth hormone D. Human chorionic gonadotropin

D. Human chorionic gonadotropin Clomiphene is used to induce pregnancy by triggering ovulation. If the desired result is not obtained, the second alternative is to administer human chorionic gonadotropin and gonadotropin-releasing hormone to stimulate ovulation. A combination of estrogen and progesterone is generally administered to treat female clients who have a gonadotropin deficiency. Human growth hormone injections are administered to treat adults with growth hormone deficiency.

What is the focus of nursing care for a newborn with respiratory distress syndrome (RDS)? A. Tapping the toes to stimulate respirations B. Turning the infant frequently to prevent apnea C. Maintaining oxygen concentration at 40% to support respiration D. Keeping the infant warm to maintain body temperature at 98° F (37° C)

D. Keeping the infant warm to maintain body temperature at 98° F (37° C) A warm environment is most important, because if the neonate has to maintain body temperature it will further compromise physical status by increasing metabolic activity and oxygen demand. Frequent turning and stimulation are both is contraindicated, because increased activity increases oxygen demands. The oxygen percentage will vary with the neonate's Po 2 values; the concentration of oxygen should never be set at a fixed amount.

A 30-week-pregnant woman reports low backache and abdominal cramps. Which drug may be prescribed if the client is suspected of having preterm labor? A. Methylergonovine B. Mifepristone C. Calcium gluconate D. Magnesium sulfate

D. Magnesium sulfate Low backache and abdominal cramps in a pregnant woman may indicate labor; however, labor pains may not be safe if the gestation is not at full term. Magnesium sulfate may be prescribed to prevent preterm labor. Methylergonovine is prescribed to reduce postpartum uterine hemorrhage. Mifepristone may cause an elective termination of pregnancy. Calcium gluconate may be prescribed to reverse magnesium toxicity.

A pregnant woman reports severe headaches, chest pain, and fatigue. Upon diagnosis, the woman has hypertension. Which drug can be prescribed to reduce hypertension? A. Lithium B. Miglitol C. Calcium gluconate D. Magnesium sulfate

D. Magnesium sulfate Magnesium sulfate can be prescribed for pregnancy-induced hypertension. Lithium is used to treat body water retention. Miglitol is used to decrease blood sugar levels. Calcium gluconate is used to relieve magnesium toxicity associated with magnesium sulfate.

An expectant couple asks the nurse about the cause of low back pain during labor. The nurse replies that this pain occurs most often when the fetus is positioned how? A. Breech B. Transverse C. Occiput anterior D. Occiput posterior

D. Occiput posterior Persistent occiput posterior positioning causes intense back pain, the result of fetal compression of the sacral nerves. The breech position is not associated with back pain. The transverse position is not associated with back pain. Occiput anterior, the most common fetal position, generally does not cause back pain.

On admission to the nursery a newborn is found to be experiencing cold stress. What is the nurse's immediate goal at this time? A. Minimize shivering B. Prevent hyperglycemia C. Limit oxygen consumption D. Prevent metabolism of fat stores

D. Prevent metabolism of fat stores If the newborn is cold there is increased brown fat metabolism (nonshivering thermogenesis), which increases levels of fatty acids in the blood, predisposing the infant to acidosis. Newborns do not shiver. Hypoglycemia, not hyperglycemia, may occur because the newborn's glycogen reserves are depleted rapidly when under stress. Although oxygen consumption increases during cold stress, limiting oxygen consumption is not the priority; increased fat metabolism is more serious.

A laboring client has asked the nurse to help her use a nonpharmacologic strategy for pain management. Name the sensory simulation strategy. A. Gentle massage of the abdomen B. Biofeedback-assisted relaxation techniques C. Application of a heat pack to the lower back D. Selecting a focal point and beginning breathing techniques

D. Selecting a focal point and beginning breathing techniques Use of a focal point and breathing techniques are sensory simulation strategies. Heat and massage are cutaneous stimulation strategies; biofeedback-assisted relaxation is a cognitive strategy.

The nurse is interviewing a 41-year-old woman who is being seen in the infertility clinic for her first visit. She and her husband have been married for 3 years and have not used any form of contraception during this time. Neither the woman nor her husband has children from previous relationships. She asks the nurse what test or treatment will be done first. What should the nurse inform her that she and her husband should expect? A. A laparoscopy B. The start of fertility medication C. A hysteroscopy D. Semen analysis

D. Semen analysis Semen analysis is painless, is less costly than other interventions, and provides important information regarding the male partner's fertility. Fertility medication would not be initiated until an evaluation of ovulatory function had been completed. Simpler evaluations and therapies are completed before more complex efforts such as surgical procedures like laparoscopy and hysteroscopy are performed.

While assessing a newborn, the nurse notes that the infant's skin is mottled. What should the nurse's primary intervention be? A. Administer oxygen B. Offer an oral feeding C. Notify the practitioner D. Warm the environment

D. Warm the environment Mottling results from hypothermia; the newborn should be wrapped, placed under a radiant warmer, or given to the mother for skin-to-skin contact. Mottling is a phenomenon that usually indicates a decreasing temperature; the newborn requires warming, not oxygenation or medical attention. Feeding will not increase the newborn's temperature.

GTPAL system

G = gravidity (# of times pregnant) T = term (38-42 weeks) P = preterm birth (20-37 weeks) A = abortion (< 20 weeks) L = living children ex: woman who is pregnant now, has 2 children, one born @ 38 weeks, one @ 42 weeks = 32002

Occiput posterior (OP)

back of the skull toward the back -more painful than OA Persistent occiput posterior positioning causes intense back pain, the result of fetal compression of the sacral nerves.