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.
What is the term for a nonstress test in which there are two or more fetal heart rate accelerations of 15 or more beats per minute (BPM) with fetal movement in a 20-minute period?
a. Positive
b. Negative
c. Reactive
d. Nonreactive
C. Reactive
Rationale: The nonstress test (NST) is reactive (normal) when there are two or more fetal heart rate accelerations of at least 15 BPM (each with a duration of at least 15 seconds) in a 20-minute period. A positive result is not used with an NST. The contraction stress test (CST) uses positive as a result term. A negative result is not used with an NST. The CST uses negative as a result term. A nonreactive result means that the heart rate did not accelerate during fetal movement.
A patient at 36 weeks gestation is undergoing a nonstress (NST) test. The nurse observes the fetal heart rate baseline at 135 beats per minute (bpm) and four nonepisodic patterns of the fetal heart rate reaching 160 bpm for periods of 20 to 25 seconds each. How will the nurse record these findings?
A. NST positive, nonreassuring
B. NST negative, reassuring
C. NST reactive, reassuring
D. NST nonreactive, nonreassuring
C. NST Reactive, reassuring
Rationale: The presence of at least three accelerations of at least 15 beats, over at least 15 seconds, over a duration of at least 20 minutes, is considered reactive and reassuring. Nonreactive testing reveals no or fewer accelerations over the same or longer period. The NST test is not recorded as positive or negative.
if the FHR accelerates at least 15/min (10/min prior to 32 weeks) for at least 15 seconds (10 seconds prior to 32 weeks) and occurs two or more times during a 20 min period.
What is this reactive or non reactive?
Reactive
test does NOT demonstrate at least two qualifying accelerations in a 20-min window.
What is this reactive or non reactive?
NON reactive.
A pregnant patient is on magnesium sulfate. What should the nurse monitor for if performing an NST?
Monitor for adverse effect of nonreactive NST.
The nurse is assessing a patient in her 37th week of pregnancy for the psychological responses commonly experienced as birth nears. Which psychological responses should the nurse expect to evaluate? (Select all that apply.)
A. The patient is excited to see her baby.
B. The patient has not started to prepare the nursery for the new baby.
C. The patient expresses concern about how to know if labor has started.
D. The patient and her spouse are concerned about getting to the birth center in
E. The patient and her spouse have not discussed how they will share household tasks.
A. The patient is excited to see her baby
C. the patient expresses concern about how labor has started
D. the patient and her spouse are concerned about getting to the birth center in time
Rationale: As birth nears, the expectant patient will express a desire to see the baby. Most pregnant patients are concerned with their ability to determine when they are in labor. Many couples are anxious about getting to the birth facility in time for the birth. As birth nears, a nesting behavior occurs, which means getting the nursery ready. Not preparing the nursery at this stage is not a response that the nurse should expect to assess. Negotiation of tasks is done during this stage. Discussion regarding the division of household chores is not a response that the nurse should expect to assess at this stage.
A nurse in a clinic is caring for a client who is at 39 weeks of gestation and who asks about the signs that precede the onset of labor. Which of the following should the nurse identify as a sign that precedes labor?
A. Decreased vaginal discharge
B. A surge of energy
C. Urinary retention
D. Weight gain of 0.5 to 1.5 kg
B. A surge of energy
i: Prior to the onset of labor, the pregnant client experiences a surge of energy.
A nurse in a clinic is reviewing the medical records of a group of clients who are pregnant. The nurse should anticipate the provider will order a maternal serum alpha-fetoprotein (MSAFP) screening for which of the following clients?
A. A client who has mitral valve prolapse
B. A client who has been exposed to AIDS
C. All of the clients
D. A client who has a history of preterm labor.
C. All of the clients
i: MSAFP is a screening tool to detect open spinal and abdominal wall defects in the fetus. This maternal blood test is recommended for all pregnant woman.
Physiologic changes preceding labor (premonitory signs)
- Backache
- Weight loss
- Lightening
- Contractions
- Increased vaginal discharge or bloody show
- Energy burst
- GI changes
- Cervical ripening
- Rupture of membranes
The nurse detects hypotension in a laboring patient after an epidural. Which actions should the nurse plan to implement? (Select all that apply.)
A. Encourage the patient to drink fluids.
B. Place the patient in a Trendelenburg position.
C. Administer a normal saline bolus as prescribed.
D. Administer oxygen at 8 to 10 L/minute per face mask.
E. Administer IV ephedrine in 5- to 10-mg increments as prescribed
C. Administer a normal saline bolus as prescribed.
D. Administer oxygen at 8 to 10 L/minute per face mask.
E. Administer IV ephedrine in 5- to 10-mg increments as prescribed
Rationale: If hypotension occurs after an epidural has been placed, techniques such as a rapid nondextrose IV fluid bolus, maternal repositioning, and oxygen administration are implemented. If those interventions are ineffective, IV ephedrine in 5- to 10-mg increments can be prescribed to promote vasoconstriction to raise the blood pressure. The patient in active labor should not be encouraged to drink fluids. In a Trendelenburg position, the body is flat, with the feet elevated. This would not be a position to use for a pregnant patient.
Which of the following behaviors would be applicable to a nursing diagnosis of “risk for injury” in a patient who is in labor?
A. Length of second-stage labor is 2 hours.
B. Patient has received an epidural for pain control during the labor process.
C. Patient is using breathing techniques during contractions to maximize pain relief.
D. Patient is receiving parenteral fluids during the course of labor to maintain
hydration.
B. Patient has recieved an epidural for pain control during the labor process.
Rationale: A patient who has received medication during labor is at risk for injury as a result of altered sensorium, so this presentation is applicable to the diagnosis. A length of 2 hours for the second stage of labor is within the range of normal. Breathing techniques help maintain control over the labor process. Fluids administered during the labor process are used to prevent potential fluid volume deficit.
A nurse is caring for a client who is in labor and has an epidural anesthesia block. The client’s blood pressure is 80/40 mmHg, and the fetal heart rate is 140/min. Which of the following is the priority nursing action?
A. Elevate the client’s legs.
B. Monitor vital signs every 5 min.
C. Notify the provider.
D. Place the client in a lateral position.
D. Place the client in a lateral position.
i: Based on Maslow’s hierarchy of needs, the client should be moved to a lateral position or a pillow placed under one of the client’s hips to relieve pressure on the inferior vena cava and improve the blood pressure.
A nurse is assessing a client in labor who has had epidural anesthesia for pain relief. Which of the following findings should the nurse identify as a complication from the epidural block?
A. Vomiting
B. Tachycardia
C. Respiratory depression
D. Hypotension
D. Hypotension
i: Maternal hypotension is an adverse effect of epidural anesthesia. The nurse should administer an IV fluid bolus prior to the placement of the epidural catheter to decrease the likelihood of this complication.
To improve placental blood flow immediately after the injection of an epidural anesthetic, the nurse should
A. give the woman oxygen.
B. turn the woman to the right side.
C. decrease the intravenous infusion rate.
D. place a wedge under the woman’s right hip.
D. Place a wedge under the womans right hip
Rationale: Tilting the woman’s pelvis to the left side relieves compression of the vena cava and compensates for a lower blood pressure without interfering with dispersal of the epidural medication. Oxygen administration will not improve placental blood flow. The woman needs to maintain the supine position for proper dispersal of the medication. Placing a wedge under the hip will relieve compression of the vena cava. The intravenous infusion rate needs to be increased to prevent hypotension.
A patient in active labor requests an epidural for pain management. What is the nurse’s most appropriate intervention at this juncture?
A. Assess the fetal heart rate pattern over the next 30 minutes.
B. Take the patient’s blood pressure every 5 minutes for 15 minutes.
C. Determine the patient’s contraction pattern for the next 30 minutes.
D. Initiate an IV Infusion of lactated ringers solution at 2000 ml/hour over 30 minutes
D. Initiate an IV Infusion of lactated ringers solution at 2000 ml/hour over 30 minutes
Rationale: Rapid infusion of a nondextrose IV solution, often warmed, such as lactated Ringer’s or normal saline, before initiation of the block fills the vascular system to offset vasodilation. Preload IV quantities are at least 500 to 1000 mL infused rapidly. Vasodilation with corresponding hypotension can reduce placental perfusion and is most likely to occur within the first 15 minutes after the initiation of the epidural. Determining the fetal heart rate every 30 minutes is the standard of care. The patient is in active labor, which indicates a contraction pattern resulting in cervical dilation.
A nurse is caring for a client who is receiving opioid epidural analgesia during labor. Which of the following findings is the nurse’s priority?
A. The client reports weakness of the lower extremities.
B. Blood pressure 80/56 mmHg
C. Temperature 38.2C / 100.8F
D. The client reports perfuse itching.
B. Blood pressure 80/56 mmHg
i: When using the airway, breathing, circulation approach to client care, the nurse’s priority finding is a blood pressure of 80/56, which indicates hypotension. The client’s blood pressure is not adequate to sustain uteroplacental perfusion and oxygen to the fetus, which can lead to respiratory distress and possibly death.
A nurse is caring for a client during the first trimester of pregnancy. After reviewing the client’s blood work, the nurse notices she does not have immunity to rubella. Which of the following times should the nurse understand is recommended for rubella immunization?
A. Shortly after giving birth
B. In the third trimester
C. Immediately
D. During her next attempt to get pregnant
A. Shortly after giving birth
i: The rubella immunization should be offered to the client following birth, preferably prior to discharge from the hospital. This prevents the client from contracting rubella during the current or subsequent pregnancies, which would put her fetus at risk for rubella syndrome
A nurse is caring for an antepartum client whose laboratory findings indicate a negative rubella titer. Which of the following is the correct interpretation of this data?
A. The client is not experiencing a rubella infection at this time.
B. The client is immune to the rubella virus.
C. The client requires a rubella vaccination at this time.
D. The client requires a rubella immunization following delivery.
D. The client requires a rubella immunization following delivery.
i: A negative rubella titer indicates that the client is susceptible to the rubella virus and needs vaccination following delivery. Immunization during pregnancy is contraindicated because of possible injury to the developing fetus. Following rubella immunization, the client should be cautioned not to conceive for 1 month.
Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae?
a. Saturated perineal pad in 1 hour
b. Pain level 0 on a scale of 0 to 10
c. Cervical dilation at 2 cm
d. Fetal heart rate at 160 b
b. Pain level 0 on a scale of 0 to 10
What is the classic sign of placenta previa?
sudden onset of painless uterine bleeding during second or third trimester
Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication?
A. Drowsiness
B. Urinary output of 20 ml/hr
C. Normal deep tendon reflexes
D. Respiratory rate of 10 to 12 breaths per minute.
C. Normal deep tendon reflexes.
Rationale: Magnesium sulfate is administered for preeclampsia to reduce the risk of seizures from cerebral irritability. Hyperreflexia (deep tendon reflexes above normal) is a symptom of cerebral irritability. If the dosage of magnesium sulfate is effective, reflexes should decrease to normal or slightly below normal levels. Drowsiness is another sign of CNS depression from magnesium toxicity. A urinary output of 20 mL/hour is inadequate output. A respiratory rate of 10 to 12 breaths per minute is too slow and could be indicative of magnesium toxicity.
A nurse is caring for a client who is in preterm labor and is receiving magnesium sulfate. The client begins to show indications of magnesium sulfate toxicity. Which of the following medications should the nurse prepare to administer?
A. Protamine sulfate
B. Naloxone
C. Calcium gluconate
D. Flumazenil
C. Calcium gluconate
The nurse ahould discontinue the magnesium sulfate infusion immediately and prepare to administer calcium glucomate to reverse effects of magnesium sulfate to orevent fardiac and respiratory arrest
Signs of magnesium toxicity include the following:
- Respiratory rate of less than 12 breaths per minute (hospitals may specify a rate <14 breaths per minute)
- Urinary output less than 30 ml an hour
- Maternal pulse oximeter reading lower than 95%
- Absence of deep tendon reflexes
- Sweating, flushing
- Altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented)
- Hypotension
The nurse is monitoring a patient with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.)
A. Cool, clammy skin
B. Altered sensorium
C. Pulse oximeter reading of 95%
D. Respiratory rate of less than 12 breaths per minute
E. Absence of deep tendon reflexes
B. Altered sensorium
D. Respiratory Rate…
E. Absence of deep tendon reflex
A nurse is assessing a client at 35 gestation who is receiving magnesium sulfate via continuous IV infusion for severe pre-eclampsia. Which of the following findings should the nurse report to the provider?
A. Deep tendon reflex 2+
B. Blood pressure 150/96 mmHg
C. Urine output 20mL/hr
D. Respiratory rate 16/min
C. Urinary output 20mL/hr
The nurse should report urine output of 20mL/hr because this can indicate inadequate renal perfusion increasing the risk if magnesium sulfate toxicity
A nurse is assessing a client who is receiving magnesium sulfate as a treatment for preeclampsia. Which of the following clinical findings is the nurse’s priority?
A. Respirations
B. Urinary output 40 mL in 2 hr
C. Reflexes +2
D. Fetal heart rate 158/min
B. Urinary output 40 mL in 2 hour
Urinary output is critical to the excretion of magnesium from the body. The nurse should discontinue magnesium sulfate if the hourly output is <30mL/hr
A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply.)
A. Respirations fewer than 12/min
B. Urinary output less than 30 mL/hr
C. Hyperreflexic deep-tendon reflexes
D. Decreased level of consciousness
E. Flushing and sweating
ABD
A nurse is administering magnesium sulfate IV for seizure prophylaxis to a client who has severe preeclampsia. Which of the following indicates magnesium sulfate toxicity? Select all that apply.
A. Respirations < 12/min
B. UOP < 25 mL/hr
C. Hyperreflexic DTR
D. Decreased LOC
E. Flushing and sweating
A, B, D - RR < 12/min, UOP < 25mL/hr, Decreased LOC
A labor and birth nurse receives a call from the laboratory regarding a preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patient’s magnesium level is 7.6 mg/dL. What is the nurse’s priority action?
a. Stop the infusion of magnesium.
b. Assess the patient’s respiratory rate.
c. Assess the patient’s deep tendon reflexes.
d. Notify the health care provider of the magnesium level.
B. Assess the patients respiratory rate
The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetus has which condition?
A. Hemophilia
B. Sickle cell anemia
C. A neural tube defect
D. Abnormal lecithin-to-sphingomyelin ratio
C. A neural tube defect
A patient who smokes one pack of cigarettes daily has a positive pregnancy test. The nurse will explain that smoking during pregnancy increases the risk of which condition?
A. Congenital anomalies
B. Death before or after birth
C. Neonatal hypoglycemia
D. Neonatal withdrawal syndrome
B. Death before or after birth
Rationale: Smoking during pregnancy increases the risk for spontaneous abortion, low birth weight, abruptio placentae, placenta previa, preterm birth, perinatal mortality, and SIDS. Smoking does not appear to cause congenital anomalies, hypoglycemia, or withdrawal syndrome.
Which effect is a common response to both smoking and cocaine use in the pregnant patient?
a. Vasoconstriction
b. Increased appetite
c. Increased metabolism
d. Changes in insulin metabolism
A. Vasoconstriction
Rationale: Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Smoking and cocaine use do not increase appetite, change insulin metabolism, or increase metabolism.
Which is the most dangerous effect on the fetus of a patient who smokes cigarettes while pregnant?
A. Intrauterine growth restriction
B. Genetic changes and anomalies
C. Extensive central nervous system damage
D. Fetal addiction to the substance inhaled
A. Intrauterine growth restriction
Rationale: The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes normally will not cause genetic changes or extensive central nervous system damage. Addiction is not a normal concern with the neonate.
A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. The nurse locates the fetal heart tones above the client’s umbilicus at midline. The nurse should suspect that the fetus is in which of the following positions?
A) cephalic
B) transverse
C) posterior
D) frank breech
D) frank breech
.A nurse in a provider’s office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption?
A. Cocaine use
B. Hypertension
C. Blunt force trauma
D. Cigarette smoking
B. Hypertension
Rationale: Maternal hypertension, either chronic or related to pregnancy, is the most common risk factor for placental abruption.
A nurse is caring for a client who is in labor. Which of the following nursing actions reflects application of the gate control theory of pain?
A. Administer prescribed analgesic medication.
B. Encourage the client to rest between contractions.
C. Massage the client’s back.
D. …
C. Massage the client’s back.
Rationale: The gate control theory of pain is based on the concept of blocking or preventing the transmission of pain signals to the brain by using distraction techniques such as massage.
A laboring patient has asked the nurse to assist her in utilizing a cutaneous stimulation strategy for pain management. The nurse would
A. assist her into the shower.
B. apply a heat pack to lower back.
C. help her to create a relaxing mental scene.
D. encourage cleansing breaths and slow-paced breathing.
B. apply a heat pack to lower back
A relaxation technique that can be used during the childbirth experience to decrease maternal pain perception is
A. using increased environmental stimulation as a method of distraction.
B. restricting family and friends from visiting during the labor period to keep the
patient focused on breathing techniques.
C. medicating the patient frequently to reduce pain perception.
D. Assisting the patient in breathing methods aimed at taking control of pain perception based on the contraction patterns
D. Assisting the patient in breathing methods aimed at taking control of pain perception based on the contraction patterns
Rationale: Relaxation techniques are aimed at incorporating mind and body activities to maintain control over pain. Additional environmental stimuli may have the opposite effect and increase patient anxiety, which will affect pain perception. Restricting visitors may have the opposite effect, leading to increased anxiety because of isolation. Medicating a patient may not decrease pain perception but may place the patient at risk for adverse reactions and/or complications of pregnancy related to medications.
Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?
A. Narcotics
B. Spinal block
C. Epidural anesthesia
D. Breathing and relaxation techniques
D. Breathing and relaxation techniques
Rationale: Nonpharmacologic methods of pain management may be the best option for a woman in advanced labor. At 8 cm cervical dilation there is probably not enough time remaining to administer spinal anesthesia or epidural anesthesia. A narcotic given at this time may reach its peak at about the time of birth and result in respiratory depression in the newborn.
The nurse is teaching a childbirth education class. Which information regarding excessive pain in labor should the nurse include in the session?
a. It usually results in a more rapid labor.
b. It has no effect on the outcome of labor.
c. It is considered to be a normal occurrence.
d. It may result in decreased placental perfusion.
d. It may result in decreased placental perfusion.
Rationale: When experiencing excessive pain, the woman may react with a stress response that diverts blood flow from the uterus and the fetus. Excessive pain may prolong the labor because of increased anxiety in the woman. It may affect the outcome of the labor, depending on the cause and the effect on the woman. Pain is considered normal for labor. However, excessive pain may be an indication of other problems and must be assessed.
Which fetal position may cause the laboring patient increased back discomfort?
A. Left occiput anterior
B. Left occiput posterior
C. Right occiput anterior
D. Right occiput transverse
B. Left occiput posterior
Rationale: In the left occiput posterior position, each contraction pushes the fetal head against the mother’s sacrum, which results in intense back discomfort. Back labor is seen mostly when the fetus is in the posterior position.
A nurse on the labor and delivery unit is caring for a client who is having a difficult, prolonged labor with severe backache. Which of the following contributing causes should the nurse identify?
A.
Fetal position is persistent occiput posterior.
B.
Fetal attitude is in general flexion.
C.
Fetal lie is longitudinal
D.
Maternal pelvis is gynecold.
A. Fetal position is persistent occiput posterior.
The nurse is instructing a client about an amniocentesis, which is scheduled at 15 weeks of gestation period which of the following should be included in the teaching?
A. The test will be performed if your baby’s heart beat is heard
B. This test will determine if your baby’s lung are mature
C. This test requires the presence of amniotic fluid
D. After the test, you be given Rhogam since you are RH positive.
This test requires the presence of amniotic fluid
Explanation: Adequate amniotic fluid is required for testing which is not available until after 14 weeks gestation
Client at 15 weeks gestation is undergoing amniocentesis. Which conditions are tested for? Select all that apply.
Rh incompatibility
Cephalopelvic disproportion
Abnormalities in fetal chromosomes
Neural tube defects
Fetal gender
Abnormalities in fetal chromosomes
Neural tube defects
Fetal gender
The patient presenting at 38 weeks’ gestation, gravida 1, para 0, vaginal exam 4 cm, 100% effaced, +1 station vertex. What is the most likely intervention for this fetal heart rate pattern?
A. Continue oxytocin (Pitocin) infusion.
B. Contact the anesthesia department for epidural administration.
C. Change maternal position.
D. Administer Narcan to patient and prepare for immediate vaginal delivery.
C. Change maternal position.
Rationale: Late decelerations indicate fetal compromise (uteroplacental insufficiency) and are considered to be a significant event requiring immediate assessment and intervention. Of all the options listed, changing maternal position may increase placental perfusion. In the presence of late decelerations, Pitocin infusion should be stopped. Contacting anesthesia for epidural administration will not solve the existing problem of late decelerations. There are no data to support the administration of Narcan and because patient is still in early labor, birth is not imminent.
Nursing interventions of Late deacellerations
- Place client in side lying position
- Insert IV if there’s none and increase rate of IV fluids
- Discontinue oxytocin if being infused
- Administer O2 8-10 L/min
- Elevate legs
Rh incompatibility can occur if the patient is Rh-negative and the
A. fetus is Rh-negative.
B. fetus is Rh-positive.
C. father is Rh-positive.
D. father and fetus are both Rh-negative.
B. Fetus is RH positive
Rationale: For Rh incompatibility to occur, the mother must be Rh-negative and her fetus Rh- positive. If the fetus is Rh-negative, the blood types are compatible and no problems should occur. The father’s Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh-negative, the blood type with the mother is compatible. The father’s blood type does not enter into the problem.
Fraternal twins are delivered by your Rh-negative patient. Twin A is Rh-positive and twin B is Rh- negative. Prior to administering Rho(D) immune globulin (RhoGAM), the nurse should determine the results of the
A. direct Coombs test of twin A.
B. direct Coombs test of twin B.
C. indirect Coombs test of the mother.
D. transcutaneous bilirubin level for both twins.
C. indirect coombs test of the mother
An expectant mother, diagnosed with oligohydramnios, asks the nurse what this condition means for the baby. Which statement should the nurse provide for the patient?
A. Oligohydramnios can cause poor fetal lung development.
B. Oligohydramnios means that the fetus is excreting excessive urine.
C. Oligohydramnios could mean that the fetus has a gastrointestinal blockage.
D. Oligohydramnios is associated with fetal central nervous system abnormalities.
.
A. Oligohydramnios can cause poor fetal lung development.
Rationale: Because an abnormally small amount of amniotic fluid restricts normal lung development, the fetus may have poor fetal lung development. Oligohydramnios may be caused by a decrease in urine secretion. Excessive amniotic fluid production may occur when the gastrointestinal tract prevents normal ingestion of amniotic fluid. Excessive amniotic fluid production may occur when the fetus has a central nervous system abnormality
A patient with polyhydramnios is admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless; however, the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next?
A. Perform Leopold maneuvers.
B. Perform a vaginal examination.
C. Apply warm saline soaks to the vagina.
D. Place the patient in a high Fowler position.
B. perform a vaginal examination
When reviewing the prenatal record of a patient at 42 weeks’ gestation, the nurse recognizes that induction of labor is based upon which indication
a. reduced amniotic fluid volume.
b. cervix 2 cm at last prenatal visit.
c. fundal height measured at the xyphoid process.
d. 1-lb weight gain at each of the last two weekly visits.
ANS: A
Reduced amniotic fluid volume (oligohydramnios) often accompanies placental insufficiency and can result in fetal hypoxia. Lack of adequate amniotic fluid can result in umbilical cord compression; cervix 2 cm at last prenatal visit, fundal height measured at the xyphoid process, and 1-lb weight gain at each of the last two weekly visits are normal prenatal findings for a 42-week gestation.
A nurse is reviewing the medical record of a client who is at 39 weeks of gestation and has polyhydramnios. Which of the following findings should the nurse expect?
1) Fundal height of 34 cm (13.4 in)
2) Total pregnancy weight gain of 3.6 kg (8 lb)
3) Gestational hypertension
4) Fetal gastrointestinal anomaly
Fetal gastrointestinal anomaly
The nurse is teaching prenatal patients about avoiding substances or conditions that can harm the fetus. Which should the nurse include in the teaching session? (Select all that apply.)
a. Elimination of use of alcohol
b. Avoidance of supplemental folic acid replacement
c. Stabilization of blood glucose levels in a diabetic patient with insulin
d. Avoidance of nonurgent radiologic procedures during the pregnancy
E. Avoidance of maternal hyperthermia to temperatures of 37.8C (100F) or higher
ANS: A,C,D,E
The best action is for the pregnant woman to eliminate use of nontherapeutic drugs and substances such as alcohol. A woman who has diabetes should try to keep her blood glucose levels normal and stable before and during pregnancy for the best possible fetal outcomes. Nonurgent radiologic procedures may be done during the first 2 weeks after the menstrual period begins, before ovulation occurs. Exposure to temperatures of 37.8C (100F) or higher is not advised for the pregnant patient. Folic acid supplements should be taken. All women of childbearing age should take at least 0.4 mg (400 mcg) of folic acid daily before and after conception because this has been found to reduce the incidence of neural tube defects by 50% to 70%.
A 29-year-old client has gestational diabetes. The nurse is teaching her about managing her glucose levels. Which therapy would be most appropriate for this client?
long-acting insulin
glucagon
oral hypoglycemic drugs
diet
diet
Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Long-acting insulin usually is not needed for blood glucose control in the client with gestational diabetes. Oral hypoglycemic drugs are usually not given during pregnancy and would not be the first option. Glucagon raises blood glucose and is used to treat hypoglycemic reactions.
A G2P1 woman with type 1 diabetes is determined to be at 8 weeks’ gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control?
Plenty of rest
Oral hypoglycemic agents
Vitamin supplements
Exercise
Exercise
A nurse in a hospital is caring for a client who is at 38 weeks of gestation and has a large amount of painless, bright red vaginal bleeding. The client is placed on a fetal monitor indicating a regular fetal heart rate of 138/min and no uterine contractions. The client’s vital signs are: blood pressure 98/52 mm Hg, heart rate 118/min, respiratory rate 24/min, and temperature 36.4 degrees celsius (97.6 degrees Fahrenheit). Which of the following is the priority nursing action?
A. Insert an indwelling urinary catheter.
B. Initiate IV access.
C. Witness the signature for informed consent for surgery.
D. Prepare the abdominal and perineal areas
B
A nurse is collecting data from a client who is in her third trimester of pregnancy. When monitoring for indications of preeclampsia, the nurse should ask the client if she has which of the following manifestations?
a) Difficulty breathing
b) Persistent headaches
c) Joint pain
d) Loss of appetite
Persistent headaches
When assessing a client for preeclampsia, the nurse should ask about the presence of visual disturbances such as blurred vision. Other indications of preeclampsia include persistent emesis, facial edema, severe headaches, and muscular irritability. Preeclampsia is pregnancy-induced hypertension that requires a thorough assessment and close monitoring to reduce the risk for injury to the client and her fetus.
Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication?
A. Drowsiness
B. Urinary output of 20 mL/hour
C. Normal deep tendon reflexes
D. Respiratory rate of 10 to 12 breaths per minute
C. Normal Deep tendon reflexes
A nurse is caring for a client who is at 36 weeks of gestation and has suspected placenta previa. For which of the following findings should the nurse monitor the client?
- Painless red vaginal bleeding
- Increasing abdominal pain with a non-relaxed uterus
- Abdominal pain with scant red vaginal bleeding
- Intermittent abdominal pain following passage of bloody mucus
Painless red vaginal bleeding
With placenta previa, the placenta implants in the lower part of the uterus, partly or completely obstructing the cervical os, or outlet to the vagina. Clients who have placenta previa have sudden, painless vaginal bleeding, typically in the third trimester.
A nurse is collecting data from a client who is at 35 weeks of gestation. Which of the following findings should the nurse report to the provider?
a. 2+ deep tendon reflexes
b. Hypotension
c. Polyuria
d. Blurred vision
Blurred vision
The nurse should report blurred vision to the provider, as this can indicate possible preeclampsia and requires further assessment.
A nurse is caring for a client who might have a hydatidiform mole. The nurse should monitor the client for which of the following findings?
Fetal heart rate irregularities
Whitish vaginal discharge
Excessive uterine enlargement
Rapidly dropping human chorionic gonadotropin (hCG) levels
Excessive uterine enlargement
A nurse is caring for a client who has consented to an amniocentesis for genetic cell analysis. The client asks why she can’t have the test before 14 weeks of gestation. Which of the following responses should the nurse make?
A.
The fetus is not mature enough until this time.
B.
This is when the heartbeat is first audible.
C.
There is not enough amniotic fluid until this time.
D.
The genetic results will not be accurate until this time.
C. “There is not enough amniotic fluid until this time.”
Amniocentesis requires adequate amniotic fluid for testing, which is not available until about 14 weeks of gestation.
A nurse is assisting in the plan of care for a client who is pregnant and has phenylketonuria (PKU). Which of the following actions should the nurse include in the plan of care?
Reinforce teaching about a protein-free diet.
Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?
A. Determining cervical dilation and effacement
B. Monitoring FHR and maternal vital signs
C. Observing vaginal bleeding or leakage of amniotic fluid
D. Determining frequency, duration, and intensity of contractions
A. Determining cervical dilation and effacement
.
iron intake in pregnant woman.
The recommendation for iron intake during pregnancy is higher than that for women who are not pregnant. For women who are pregnant, it is 27 mg/day. For women who are not pregnant, it is 15 mg/day for women younger than 19 years old and 18 mg/day for women between the ages of 19 and 50 years old.
IRON INTAKE ALMOST DOUBLES IN PREGNANCY*****
The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be
A. progressive uterine contractions with cervical change.
B. lightening.
C. rupture of membranes.
D. passage of the mucous plug (operculum).
progressive uterine contractions with cervical change.
A nurse is caring for a client who is in labor and assists the provider who performs an amniotomy. Which of the following is the priority action by the nurse following the procedure?
a. Monitor the client’s temperature.
b. Assess the fetal heart rate.
c. Assess the odor of the amniotic fluid.
d. Provide clean, dry underpads.
B. assess the fetal heart rate
A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is “not really sure if she is in labor or not.” Which of the following should the nurse recognize as a sign of true labor?
a. Rupture of the membranes
b. Changes in the cervix
c. Station of the presenting part
d. Pattern of contractions
b. Changes in the cervix
A nurse is providing teaching about nutrition to a client at her first prenatal visit. Which of the following statements by the nurse should be included in the teaching?
a. “You will need to increase your calcium intake during breastfeeding.”
b. “Prenatal vitamins will meet your need for increased vitamin D during pregnancy.”
c. “Vitamin E requirements decline during pregnancy due to the increase in body fat.”
d. “You will need to double your intake of iron during pregnancy.”
d. “You will need to double your intake of iron during pregnancy.”
A nurse in a prenatal clinic is caring for a client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?
A)Rapid decline in human chorionic gonadotropin (hCG) levels
B)Profuse, clear vaginal discharge
C)Irregular fetal heart rate
D)Excessive uterine enlargement
D)Excessive uterine enlargement
A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client?
A) Temperature
B) Fetal heart rate
C) Bowel sounds
D) Respiratory rate
D. Respiratory Rate.
Magnesium sulfate is typically administered to a client in preterm labor to achieve the tocolytic (uterine relaxation) effect. Magnesium sulfate depresses the function of the central nervous system, causing respiratory depression. Baseline assessment of respiratory status, checking the respiratory rate frequently, and reassessment of respiratory status with each change in dosage of magnesium sulfate is the primary focus when assessing the client. There is a narrow margin between what is considered a therapeutic dose and a toxic dose of magnesium sulfate.
Which of the following findings on a prenatal visit at 10 weeks might lead the nurse to suspect a hydatidiform mole?
A)Complaint of frequent mild nausea
B) Blood pressure of 120/84 mm Hg
C) History of bright red spotting 6 weeks ago
D)Fundal height measurement of 18 cm
D)Fundal height measurement of 18 cm
A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. Which of the following would the nurse expect to include in the clients plan of care?
A) Clear liquid diet
B) Total parenteral nutrition
C) Nothing by mouth
D) Administration of labetalol
C) Nothing by mouth
A nurse is caring for a client who is at 22 weeks of gestation and has been unable to control her gestational diabetes mellitus with diet and exercise. The nurse should anticipate a prescription from the provider for which of the following medications for the client?
A. Acarbose
B. Repaglinide
C. Insulin
D. Glipizide
C. Insulin
Rationale: There are currently no oral hypoglycemic agents that are FDA approved for use in pregnant women. Over the years limited research has been conducted on certain oral hypoglycemic agents with varying results. A few studies have demonstrated effectiveness and safety associated with glyburide and less commonly metformin. However, the most recent ACOG guidelines (as of Feb. 2018) recommend use of insulin in pregnant women when pharmacological treatment is indicated. Approximately 20% of clients who have gestational diabetes mellitus will require insulin. Insulin lowers blood glucose levels without harming the fetus.
A nurse is planning care for a newborn who has a new diagnosis of phenylketonuria (PKU). Which of the following actions should be included in the plan of care?
Initiate a controlled low-protein diet.
Educate parents on blood glucose monitoring.
Administer thyroid hormone replacement.
Obtain a blood sample for blood type.
Initiate a controlled low-protein diet.
PKU is managed by eliminating phenylalanine from the diet. It is found in most natural food proteins, such as milk and infant formulas. A special low-protein, amino-acid formula that is low in phenylalanine is initiated and included in the plan of care.
A nurse is providing teaching to a client who is pregnant and has phenylketonuria (PKU). Which of the following foods should the nurse instruct the client to eliminate from her diet?
Peanut butter
Potatoes
Apple juice
Broccoli
Peanut butter
A nurse is caring for a client who has preeclampsia and is being treated with magnesium sulfate IV. The client’s
respiratory rate is 10/min and deep-tendon reflexes are absent. Which of the following actions should the nurse
take?
A. Discontinue the medication infusion.
B. Prepare for an emergency cesarean birth.
C. Assess maternal blood glucose.
D. Place the client in Trendelenburg position.
A. Discontinue the medication infusion.
Rationale: Magnesium toxicity is manifested by bradypnea (respiratory rate less than 12/min) and absent deep tendon reflexes. The magnesium sulfate infusion should be discontinued and calcium gluconate administered via IV.
abruptio placenta signs and symptoms
dark red vaginal bleeding
contractions with hypertonicity
fetal distress
clinical findings of hypovolemic shock
sudden onset of intense localized uterine pain
Which maternal condition should be considered a contraindication for the application of internal monitoring devices?
A: unruptured membranes
B: cervix dilated to 4 cm
C: fetus has known heart defect
D: maternal HIV
A: unruptured membranes
To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4 cm would permit the insertion of fetal scalp electrodes and an intrauterine catheter. A compromised fetus should be monitored with the most accurate monitoring devices. An internal electrode should not be placed if the patient has hemophilia, maternal HIV, or genital herpes.
When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated?
A. Reposition the patient.
B. Apply a fetal scalp electrode.
C. Record this normal pattern.
D. Administer oxygen by nasal cannula.
C. Record this normal pattern.
What is the physiologic reason for vascular volume increasing by 40% to 60% during pregnancy?
A. Prevents maternal and fetal dehydration
B. Eliminates metabolic wastes of the mother
C. Provides adequate perfusion of the placenta
D. Compensates for decreased renal plasma flow
C. Provides adequate perfusion of the placentae
Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?
A. Determining cervical dilation and effacement
B. Monitoring FHR and maternal vital signs
C. Observing vaginal bleeding or leakage of amniotic fluid
D. Determining frequency, duration, and intensity of contractions
A. Determining cervical dilation and effacement
Physiologic anemia often occurs during pregnancy due to
A. inadequate intake of iron.
B. the fetus establishing iron stores.
C. dilution of hemoglobin concentration.
D. decreased production of erythrocytes.
C. dilution of hemoglobin concentration.
You are performing assessments for an obstetric patient who is 5 months pregnant with her third child. Which finding would cause you to suspect that the patient was at risk?
A. Patient states that she doesn’t feel any Braxton Hicks contractions like she had in her prior pregnancies.
B. Fundal height is below the umbilicus.
C. Cervical changes, such as Goodell’s sign and Chadwick’s sign, are present.
D. She has increased vaginal secretions.
B. Fundal height is below the umbilicus.
What is the term for a nonstress test in which there are two or more fetal heart rate accelerations of 15 or more beats per minute (BPM) with fetal movement in a 20-minute period?
a. Positive
b. Negative
c. Reactive
d. Nonreactive
C. reactive
The nurse is reviewing the instructions given to a patient at 24 weeks’ gestation for a glucose challenge test (GCT). The nurse determines that the patient understands the teaching when she makes which statement?
A. “I have to fast the night before the test.”
B. “I will drink a sugary solution containing 100 g of glucose.”
C. “I will have blood drawn at 1 hour after I drink the glucose solution.”
D. “I should keep track of my baby’s movements between now and the test.”
C. “I will have blood drawn at 1 hour after I drink the glucose solution.”
A high-risk labor patient progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via cesarean birth. Which finding in the immediate postoperative period indicates that the patient is at risk of developing HELLP syndrome?
A. Platelet count of 50,000/mcL
B. Liver enzyme levels within normal range
C. Negative for edema
D. No evidence of nausea or vomiting
A. Platelet count of 50,000/mcL
positive signs of pregnancy
fetal heart sounds,
Visualization of fetus by ultrasound,
Fetal movement palpated by an experienced examiner
presumptive signs
SUBJECTIVE:
Amenorrhea,
Fatigue,
N/V,
Urinary frequency,
Breast changes,
Quickening - slight fluttering movements of the fetus,
Uterine enlargement,
Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after the placenta has been delivered?
a. Oxytocin (Pitocin)
b. Magnesium sulfate
c. Vitamin K
d. Dopamine
a. Oxytocin (Pitocin)
Uterine stimulants, primarily oxytocin, given in low-dose infusions after delivery of the fetus and placenta, help stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. Magnesium sulfate is given to treat eclampsia and preeclampsia. Vitamin K is given to prevent hemorrhage. Dopamine is given to treat hypotension.
What medication is used to soften the cervix?
misoprostol
Immediately prior to amniotomy, the external fetal heart monitor tracing shows 145 bpm with early decelerations. Immediately following the procedure, an internal tracing shows a fetal heart rate of 120 with variable decelerations. A moderate amount of clear amniotic fluid is seen on the bed linens. The nurse concludes that which of the following has occurred?
A Placental abruption
B Eclampsia
C Prolapsed cord
D Succenturate placenta
prolapsed cord
what to assess before an amniotomy?
monitor FHR prior to and immediately following AROM to assess for cord prolapse
characteristics of true labor
■ Contractions:
» May begin irregularly, but become regular in frequency
» Stronger, last longer, and are more frequent
» Felt in lower back, radiating to abdomen
» Walking can increase contraction intensity
» Continue despite comfort measures
■ Cervix (assessed by vaginal exam):
» Progressive change in dilation and effacement
» Moves to anterior position
» Bloody show
■ Fetus:
» Presenting part engages in pelvis
When does the nurse assess the amniotic fluid and what are the characteristics that should be observed?
◯ Assessment of amniotic fluid is completed once the membranes rupture
■ Should be watery, clear, and pale- to straw-yellow in color.
■ Odor should not be foul.
■ Volume is between 500 and 1,200 mL.
■ Nitrazine paper should be used by a nurse to confirm that amniotic fluid is present.
Impending signs of labor
A. baby drops down
B. cervical change starts to happen - losing
C. soften and dilate - bloody show
D. water breaks
E. baby comes out
Backache
Weight loss
Lightening
Contractions
Increased vaginal discharge or bloody show
Energy burst
GI Changes
Cervical ripening
Rupture of membranes
Assessment of amnitotic fluid
This energy burst is a sign of impending labor. It is commonly referred to as?
nesting
A patient asks the nurse how she can tell if labor is real. Which information should the nurse provide to this patient? (Select all that apply.)
A. In true labor, the cervix begins to dilate.
B. In true labor, the contractions are felt in the abdomen and groin.
C. In true labor, contractions often resemble menstrual cramps during early labor.
D. In true labor, contractions are inconsistent in frequency, duration, and intensity in
the early stages.
e. In true labor your contractions tend to increase in frequency, duration, and intensity with walking.
A, C, E
Rationale: In true labor, the cervix begins to dilate, contractions often resemble menstrual cramps in the early stage, and labor contractions increase in frequency, duration, and intensity with walking. False labor contractions are felt in the abdomen and groin and the contractions are inconsistent in frequency, duration, and intensity.
The nurse is planning care for a patient during the fourth stage of labor. Which interventions should the nurse plan to implement? (Select all that apply.)
A. Offer the patient a warm blanket.
B. Place an ice pack on the perineum.
C. Massage the uterus if it is boggy.
D. Delay breastfeeding until the patient is rested.
E. Explain to the patient that the lochia will be light pink in color.
A, B, C
VEAL CHOP
Variable
Early decels
Acceleration
Late Decels
Chord Compression
Head Compression
OK
Placenta Previa
Hyperemisis gravidarum findings:
excessive vomiting for prolonged peridods
dehydration with possible electrolyte imbalance
weight loss
increase pulse rate
decreased blood pressire
poor skin turgor and dry mucous memberanes
hyperemesis gravidarum risk factors
maternal age younger than 30
multifetal gestation
gestational trophoblastic disease
clinical hyperthyroid disorders
diabetes
GI disorders
family history of hyperemesis
hyperemesis gravidarum nursing care
monitor i&o
monitor weight
have client remain NPO until vomitting stops
Oxytocin (Pitocin) therapeutic use
Induction of labor
1. Enhancement of labor
2. Delivery of the placenta
3. Management of postpartum hemorrhage
4. Stress testing
COMPLICATIONS: Uterine rupture, uterine tachysystole placental abruption, water intoxication
**Monitor blood pressure, RR, Pulse every 30-60 min and with every dosage change Carefully monitor uterine contractions
A 25-year-old primigravida patient is in the first stage of labor. She and her husband have been holding hands and breathing together through each contraction. Suddenly, the patient pushes her husband’s hand away and shouts, “Don’t touch me!” This behavior is most likely
a. a sign of abnormal labor progress.
b. an indication that she needs analgesia.
c. normal and related to hyperventilation.
d. common during the transition phase of labor.
ANS: D
The transition phase of labor is often associated with an abrupt change in behavior, including increased anxiety and irritability. This change of behavior is an expected occurrence during the transition phase. If she is in the transitional phase of labor, analgesia may not be appropriate if the birth is near. Hyperventilation will produce signs of respiratory a
