PQ-3OOT: Maternal Newborn P1 Flashcards
A nurse is assisting with the care of a client who is in active labor at 39 weeks of gestation. 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
With a frank breech presentation, the fetal heart is generally above the level of the client’s umbilicus.
A nurse is reinforcing teaching with a client who is at 17 weeks of gestation and is scheduled to have a maternal serum alpha-fetoprotein (MSAFP) determination. Which of the following information should the nurse include?
a. This test will screen for gestational diabetes.
b. This test will screen for neural tube defects.
c. This test will screen for fetal maturity.
d. This test will screen for ABO incompatibility.
b. This test will screen for neural tube defects.
MSAFP measures blood levels of alpha-fetoprotein in the client’s blood. Abnormal levels can indicate a neural tube defect, such as spina bifida, as well as multifetal pregnancies and fetal abdominal wall defects.
A nurse is caring for a client who is pregnant and undergoing a nonstress test. The nurse records the FHR as 130 to 150/min, with no fetal movement for 15 min. Which of the following actions should the nurse take?
a. Encourage the client to walk around and then resume monitoring.
b. Apply vibroacoustic stimulation to the woman’s abdomen.
c. Report the findings to the provider and prepare the client for induction of labor.
d. Turn the client onto her left side.
b. Apply vibroacoustic stimulation to the woman’s abdomen.
This technique is sometimes used with a nonstress test to stimulate a fetal response. A sound source, typically a laryngeal stimulator, is applied to the client’s abdomen over the fetal head for 3 seconds.
A nurse is assisting with the care of a client who is at 32 weeks of gestation and in labor. The client asks the nurse, “Will my baby be okay?” Which of the following responses should the nurse make?
a. “You are far enough along that your baby will be just fine.”
b. “Everyone worries about their baby while they are in labor.”
c. “You must be feeling very scared.”
d. “We have a neonatal unit here equipped to handle emergencies.”
c. “You must be feeling very scared.”
This response illustrates the therapeutic communication technique of restatement. The nurse shows empathy for the client by focusing on the client’s feelings and recognizing that the client is scared about the safety of her newborn. This open-ended statement encourages further communication by the client.
A nurse is reinforcing teaching about common discomforts of pregnancy during the first trimester with a client who is pregnant. Which of the following manifestations should the nurse include in the teaching?
a. Urinary urgency
b. Constipation
c. Supine hypotension
d. Heartburn
a. Urinary urgency
Urinary urgency and frequency are common discomforts occurring during the first trimester. Hormones cause vascular engorgement and altered bladder function. Education should also include regular emptying of the bladder, performing Kegel exercises, and limiting fluid intake prior to bedtime.
A nurse is reinforcing teaching with a client who is in labor about why epidural anesthesia is not initiated until a good labor pattern has been established. Which of the following explanations should the nurse include?
a. “Given too soon, epidural anesthesia can cause fetal depression.”
b. “Given too soon, epidural anesthesia will delay rupture of fetal membranes.”
c. “Given too soon, epidural anesthesia can prolong labor.”
d. “Given too soon, epidural anesthesia can cause maternal hypertension.”
c. “Given too soon, epidural anesthesia can prolong labor.”
Progress in labor slows when clients are given anesthesia before the active phase of labor. The medication depresses the central nervous system, thus it will take longer for the cervix to dilate and efface.
A nurse is reinforcing teaching about fetal development with a group of women who are pregnant. Which of the following statements should the nurse include in the teaching?
a. “The baby’s heartbeat is audible by a Doppler stethoscope at 12 weeks of pregnancy.”
b. ”The sex of the baby is determined by week 8 of pregnancy.”
c. ”Very fine hairs, called lanugo, cover your baby’s entire body by week 36 of pregnancy.”
d. ”You will first feel your baby move by week 24 of pregnancy.”
a. “The baby’s heartbeat is audible by a Doppler stethoscope at 12 weeks of pregnancy.”
The fetal heartbeat is audible by Doppler stethoscope at 12 weeks of gestation.
A nurse is reinforcing teaching with a client who is at 30 weeks of gestation and scheduled for a nonstress test (NST). Which of the following statements by the client indicates a need for further teaching?
a. “I will have to lie on my back during the test.”
b. “The baby’s heart rate will be monitored during the test.”
c. “I need to schedule the test when the baby is usually active.”
d. “I will be able to go to the bathroom during the test as necessary.”
a. “I will have to lie on my back during the test.”
An NST monitors fetal response to uterine contractions. The client is placed in a semi-Fowler’s position to promote uterine perfusion and prevent supine hypotension from the fetus compressing the maternal vena cava.
A nurse is caring for a client who wants to know if it is possible to have a vaginal birth after a cesarean birth (VBAC). Which of the following statements by the nurse is appropriate?
a. “There are so many variables that you’ll have to ask your provider.”
b. “The primary consideration is what type of incision you had.”
c. “It’s too soon for you to be worrying about that now.”
d. “A repeat cesarean section would be safer for both you and your baby.”
b. “The primary consideration is what type of incision you had.”
A transverse incision (also known as a horizontal incision) cuts across the lower, thinner part of the uterus. It is used during most cesarean births and makes a VBAC possible. A vertical incision cuts up and down through the uterine muscles that strongly contract during labor and might cause uterine rupture during a VBAC.
A nurse is assisting with the care of a client who had an epidural anesthesia block during the early stages of labor. The client’s blood pressure is 80/40 mm Hg and the fetal heart recording is 140/min. Which of the following actions should the nurse take first?
a. Elevate the legs.
b. Increase IV fluid rate.
c. Notify the provider.
d. Place the client in a lateral position.
d. Place the client in a lateral position.
The nurse should first turn the client laterally to relieve the pressure on the inferior vena cava and improve the blood pressure.
A nurse is caring for a client who is pregnant and reports constipation. Which of the following recommendations should the nurse make?
a. Regular use of a laxative
b. Maintenance of good posture
c. Increased cellulose and fluid in the diet
d. Regular use of glycerine suppositories
c. Increased cellulose and fluid in the diet
Increasing fiber and fluid and getting regular exercise are simple and effective ways to deal with constipation during pregnancy.
A nurse in a prenatal clinic is caring for a client who is at 38 weeks of gestation and has heavy, red vaginal bleeding, without contractions, that started spontaneously. She is in no distress and states that she can “feel the baby moving.” The client should undergo an ultrasound to determine which of the following findings?
a. Fetal lung maturity
b. Location of the placenta
c. Rh incompatibility
d. Frequency and duration of contractions
b. Location of the placenta
Painless, spontaneous vaginal bleeding might be an indication of placenta previa. With the ultrasound, the provider can identify the location of the placenta and urgency of the delivery.
A nurse is assisting in the care of a client following an amniotomy who is now in the active phase of the first stage of labor. Which of the following actions should the nurse take?
a. Maintain the client in the lithotomy position.
b. Check the client’s temperature every 4 hr.
c. Remind the client to bear down with each contraction.
d. Encourage the client to empty the bladder every 2 hr.
d. Encourage the client to empty the bladder every 2 hr.
A client in labor should be encouraged to empty her bladder every 2 hr. Bladder distention can impede the descent of the fetus and slow the progression of labor. It also can contribute to uterine atony after delivery, increasing the client’s risk of postpartum hemorrhage.
A nurse is reinforcing teaching about Kegel exercises with a client who is in the third trimester of pregnancy. Which of the following statements by the client indicates an understanding of the teaching?
a. “These exercises will help prevent bladder infections.”
b. ”These exercises will help my pelvic muscles stretch when I give birth.”
c. ”These exercises will help lessen my back aches.”
d. ”These exercises will prevent further stretch marks.”
b. ”These exercises will help my pelvic muscles stretch when I give birth.”
Kegel exercises help strengthen perineal muscles, facilitating stretching and contracting during childbirth.
A nurse is reinforcing teaching with a client who is scheduled for a nonstress test. Which of the following information should the nurse include?
a. The client will receive an ultrasound prior to the test.
b. An IV will be initiated prior to the test.
c. The client will be asked to stimulate her nipples for 5 min during the test.
d. An external fetal monitor will be used to monitor the FHR.
d. An external fetal monitor will be used to monitor the FHR.
During a nonstress test, the client is seated in a semi-reclining position. An external fetal monitor is applied to detect the FHR and uterine contractions. The FHR is monitored for 20 to 30 min. A reactive, or reassuring, FHR is determined to be the presence of two accelerations in a 20-min period, each lasting at least 15 seconds and peaking at least 15 beats/min above the FHR baseline.
A nurse on a labor and delivery unit is assisting in the care of a client who is at 39 weeks of gestation and is in the first stage of labor.
Nurses’ Notes
1200:
Client is 6 cm, 70% effaced and at 0 station, membranes intact. Contractions occurring every 2 to 3 min, strong to palpation. Fetal heart rate is 140 to 145/min with average variability. Fetal heart rate decreases to 100/min with contractions, lasts 15 seconds, returns to baseline within 30 seconds.
Medical History
0530:
Client is a 26-year-old gravida 3 para 2 who is 39 weeks gestation being induced for oligohydramnios. Client has no significant social or medical history. Only complication with this pregnancy is oligohydramnios. Client has previously delivered a 7-pound, 5-ounce infant vaginally without complications. Upon admission client is 1 cm, 40% effaced and -2 station. No bloody show observed. Client will be induced via Foley bulb induction.
Vital Signs
1000:
Blood pressure 122/74 mm Hg
Heart rate 98/min, strong and regular
Respiratory rate 20/min, even and unlabored
Temperature 36.7° C (98.1° F)
Oxygen saturation 99% on room air
Complete the diagram by dragging from the choices below to specify what complication the client is most likely experiencing, 2 actions the nurse should take to address that complication, and 2 parameters the nurse should monitor to assess the client’s progress.
The nurse should turn the client to their left side and administer oxygen at 10 L/min via nonrebreather face mask to promote intrauterine blood flow, cardiac output, and maternal oxygenation because the client is most likely experiencing variable fetal heart rate decelerations. At 1200, the Nurses Note documents fetal heart rate is 140 to 145/min with average variability and fetal heart rate decreases to 100/min with contractions, lasts 15 seconds, returns to baseline within 30 seconds. The nurse should monitor fetal heart rate baseline and fetal heart rate variability because recurrent variable decelerations indicate repetitive disruption in the oxygen supply of the fetus, resulting in hypoxemia, hypoxia, metabolic acidosis, and eventually, metabolic acidemia.
