OB Midterm Flashcards
A patient is in active labor and is being continuously monitored with a fetal monitor. The patient’s labor has been normal to this point. The patient’s membranes ruptured 1 hour ago, and the fluid was clear. The FHR baseline is 125 bpm. Contractions are occurring every 3 minutes and lasting 60 seconds, and are of moderate intensity with a soft resting tone. On entering the room, the nurse sees the patient lying supine and notices that there has been abrupt slowing in the FHR to 90 bpm during the last two contractions, each episode lasting 30 seconds or less. The patient complains of breathlessness and becomes pale and diaphoretic. What is the most appropriate nursing response?
A. Initiate oxygen therapy at 8 to 10 L/min by face mask and increase nonadditive IV fluid.
B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern.
C. Notify the practitioner and document findings in the patient’s record.
D. Notify the practitioner and prepare for cesarean delivery
B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern.
Which of the following is the priority intervention for a supine patient whose monitor strip shows decelerations that begin after the peak of the contraction and return to the baseline after the contraction ends?
A. Increase IV infusion.
B. Elevate lower extremities.
C. Reposition to left side-lying position.
D. Administer oxygen per face mask at 4 to 6 L/minute.
C. Reposition to left side-lying position
Rationale: Decelerations that begin at the peak of the contractions and recover after the contractions end are caused by uteroplacental insufficiency. When the patient is in the supine position, the weight of the uterus partially occludes the vena cava and descending aorta, resulting in hypotension and decreased placental perfusion. Increasing the IV infusion, elevating the lower extremities, and administering O2 will not be effective as long as the patient is in a supine position.
What do you do if a pregnant patient is laying supine and can’t turn to her side?
Place a wedge under one of the clients hips to tilt the uterus.
Adequate intake of which of the following nutrients has been shown to reduce the risk of neural tube defects?
A) folic acid
B) mercury
C) vitamin D
D) vitamin C
A. Folic Acid
A pregnant patient arrives for her first prenatal visit at the clinic. She informs the nurse that she has been taking an additional 400 mcg of folic acid prior to becoming pregnant. Based on the patient’s history, she has reached 8 weeks’ gestation. Which recommendation would the nurse provide regarding folic acid supplementation?
A. Have the patient continue to take 400 mcg folic acid throughout her pregnancy.
B. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins
C. Have the patient increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy.
D. Schedule the patient to go for an AFP (alpha-fetoprotein) test.
B. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins
The pregnant teen who was prescribed prenatal vitamins at her initial prenatal visit states that she does not like to take them. How should the nurse respond? SATA
A. “Folic acid has been found to be essential for minimizing the risk of neural tube defects.”
B. “You do not have to take these supplements if you think you are healthy enough.”
C. “These medications do the same thing. I will call your doctor to cancel one of your medications.”
D. “You can trust your doctor to know what you need.”
E. You need the supplements because your dietary intake may not be adequate for fetal
development.”
A. Folic acid has been found to be essential..
E. You need the supplements because….
The nurse is reviewing an electronic fetal monitor tracing from a patient in active labor and notes the fetal heart rate gradually drops to 20 beats per minute (bpm) below the baseline and returns to the baseline well after the completion of the patient’s contractions. How will the nurse document these findings?
A. Late decelerations
B. Early decelerations
C. Variable decelerations
D. Proximal decelerations
A. Late decelerations
Rationale: Late decelerations are similar to early decelerations in the degree of FHR slowing and lowest rate (30 to 40 bpm) but are shifted to the right in relation to the contraction. They often begin after the peak of the contraction. The FHR returns to baseline after the contraction ends. The early decelerations mirror the contraction, beginning near its onset and returning to the baseline by the end of the contraction, with the low point (nadir) of the deceleration occurring near the contraction’s peak. The rate at the lowest point of the deceleration is usually no lower than 30 to 40 bpm from the baseline. Conditions that reduce flow through the umbilical cord may result in variable decelerations. These decelerations do not have the uniform appearance of early and late decelerations. Their shape, duration, and degree of fall below baseline rate vary. They fall and rise abruptly (within 30 seconds) with the onset and relief of cord compression, unlike the gradual fall and rise of early and late decelerations. Proximal deceleration is not a recognized term.
What are the causes and complications of late decelerations of FHR?
Uteroplacental insufficiency causing inadequate fetal oxygenation
- Maternal hypotension, placenta previa, abruptio placentae, uterine tachysystole with oxytocin
- Preeclampsia
- Late- or post-term pregnancy
- Maternal diabetes mellitus
What is the best nursing action to implement when late decelerations occur?
a. Reposition the patient to supine
b. Decrease flow of intravenous (IV) fluids
c. Increase oxygen to 10 L/minute
d. Prepare to increase oxytocin drip
c. Increase oxygen to 10 L/minute
Rationale: The major objective of care for late decelerations is to increase maternal oxygen. IV fluids are increased to increase placental perfusion, oxytocin drips are stopped, and the patient is positioned to prevent supine hypotension
The nurse evaluates a pattern on the fetal monitor that appears similar to early decelerations. The deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation?
A. This pattern reflects variable decelerations. No interventions are necessary at this time.
B. Document this Category I fetal heart rate pattern and decrease the rate of the intravenous (IV) fluid.
C. Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction.
D. This deceleration pattern is associated with uteroplacental insufficiency. The nurse
must act quickly to improve placental blood flow and fetal oxygen supply.
D. This deceleration pattern is associated with uteroplacental insufficiency. The nurse
must act quickly to improve placental blood flow and fetal oxygen supply.
Rationale: A pattern similar to early decelerations, but the deceleration begins near the acme of the
contraction and continues well beyond the end of the contraction, describes a late deceleration. Oxygen should be given via a snug face mask. Position the patient on her left side to increase placental blood flow. Variable decelerations are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. This is not a normal pattern, rather it is a Category III tracing, predictive of abnormal fetal acid status at the time of observation. The IV rate should be increased in order to add to the mother’s blood volume. These are late decelerations, not early; therefore interventions are necessary.
What are late decelerations associated with?
Placental insufficiency which can cause -> Hypoxia and Uterine Rupture -> fetal distress
Nursing interventions for fetal late decelerations:
place pt in a side-lying position
-insert an IV catheter and increase the rate of IV infusion -Discontinue oxytocin is being infused
- Administer O2 by mask 8-10 L/min via nonrebreather
- elevate pt legs
- notify hcp
Which data found on a patient’s health history would place her at risk for an ectopic pregnancy?
A. Ovarian cyst 2 years ago
B. Recurrent pelvic infections
C. Use of oral contraceptives for 5 years
D. Heavy menstrual flow of 4 days’ duration
B. Recurrent pelvic infections
Rationale: Infection and subsequent scarring of the fallopian tubes prevent normal movement of the fertilized ovum into the uterus for implantation. Ovarian cysts do not cause scarring of the fallopian tubes. Oral contraceptives do not increase the risk for ectopic pregnancies. Heavy menstrual flow of 4 days’ duration will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies.
Signs and Symptoms of Ectopic Pregnancy
-unilateral stabbing pain and tenderness in the lower abdominal quadrant
- Menses that is delayed 1-2 weeks, lighter than usual, or irregular
- SCANT, DARK RED, OR BROWN vaginal spotting 6-8 weeks after last normal menses; red vaginal bleeding if rupture has occurred
-Referred shoulder pain due to blood in the peritoneal cavity
- findings of hemorrhage and shock (hypotension, tachycardia, pallor, dizziness)
A nurse at a provider’s office is caring for a client who is 28 years of age. After reviewing the client’s current assessment findings, the nurse should identify that the client i experiencing ______________(condition) as evidence by ____________(findings)
Condition:
-abruptio placentae
- acute asthma attack
-pyelonephritis
-ectopic pregnancy
-placenta previa
Findings:
-a history of regular menstrual period
- right lower quadrant abdominal tenderness
-hyperactive bowel sounds
-temperature
-respiratory rate
ectopic pregnancy
right lower quadrant abdominal tenderness
Risk factors of ectopic pregnancy
Any factor that compromises tubal patency
(STI’s,
assistive reproductive technologies,
tubal surgeries,
and contraceptive intrauterine devices)
A 35-year-old female is in labor. The baby is engaged in the pelvis. As the nurse, you know that this means that the fetal station is approximately?
A. +1 B. 0 C. +2 D. -1
B. O
Rationale: When a baby is engaged it means the presenting part of the baby (usually the head) has entered down into the pelvic inlet, and the presenting part is located at the ischial spines, which is fetal station 0.
When the mother’s membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern?
A. Early decelerations
B. Variable decelerations
C. Nonperiodic accelerations
D. Increase in baseline variability
B. Variable Decelerations
Rationale: When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a variable deceleration pattern. Early declarations are considered reassuring; they are not a concern after rupture of membranes. Accelerations are considered reassuring; they are not a concern after rupture of membranes. Increase in baseline variability is not an expected occurrence after the rupture of membranes.
What is the most likely cause for this fetal heart rate pattern?
A. Administration of an epidural for pain relief during labor
B. Cord compression
C. Breech position of fetus
D. Administration of meperidine (Demerol) for pain relief during labor
B. Cord Compression
Rationale: Variable deceleration patterns are seen in response to head compression or cord compression. A breech presentation would not be likely to cause this fetal heart rate pattern. Similarly, administration of medication and/or an epidural would not cause this fetal heart rate pattern.
Use Nägele’s rule to determine the EDD (estimated day of birth) for a patient whose last menstrual period started on April 12.
A. February 19
B. January 19
C. January 21
D. February 7
B. January 19
When a pattern of variable decelerations occur, the nurse should immediately
A. administer O2 at 8 to 10 L/minute.
B Place a wedge under the right hip.
C. increase the IV fluids to 150 mL/hour.
D. position the patient in the knee-chest position.
D. position the patient in a knee chest position
Rationale: Variable decelerations are caused by conditions that reduce flow through the umbilical cord. The patient should be repositioned when the FHR pattern is associated with cord compression. The knee– chest position uses gravity to shift the fetus out of the pelvis to relieve cord compression. Administering oxygen will not be effective until cord compression is relieved. Increasing the IV fluids and placing a wedge under the right hip are not effective interventions for cord compression.
Variable decelerations of FHR Causes/complications
- umbilical cord compression
- short cord
- prolapsed cord
- nuchal cord (around fetal neck)
When a Category II pattern of the fetal heart rate is noted and the patient is lying on her left side, which nursing action is indicated?
A. Lower the head of the bed.
B. Place a wedge under the left hip.
C. Change her position to the right side.
D. Place the mother in Trendelenburg position.
C. Change her position to the right side.
Rationale: A Category II pattern indicates an indeterminate fetal heart rate. Repositioning on the opposite side may relieve compression on the umbilical cord and improve blood flow to the placenta.
Lowering the head of the bed would not be the first position change choice. The woman is already on her left side, so a wedge on that side would not be an appropriate choice. Repositioning to the opposite side is the first intervention. If unsuccessful with improving the FHR pattern, further changes in position can be attempted; the Trendelenburg position might be the choice.
Which patients should get the alpha-fetoprotein test?
All pregnant women should be offered the AFP screening, but it is especially recommended for:
Women who have a family history of birth defects (AMA). Women who are 35 years or older. Women who used possible harmful medications or drugs during pregnancy.