Chapter 11
A pregnant client is scheduled for labor induction because she is significantly past her due date. What is this procedure called?
What is induction of labor?
This process describes the uterus returning toward its nonpregnant size after birth.
What is involution?
This type of diabetes occurs when pregnancy-related hormonal changes make it more difficult for the body to process blood glucose efficiently.
What is gestational diabetes?
A pregnant client at 34 weeks reports sudden, dark-red vaginal bleeding accompanied by severe abdominal pain. On assessment, the nurse notes a rigid, board-like abdomen and fetal distress.
What pregnancy complication should the nurse suspect?
What is Abruptio placentae (placental abruption).
A postpartum client's uterus is boggy and she is experiencing heavy vaginal bleeding. What is the most likely cause and what should be done?
What is uterine atony and fundal massage?
The nurse is performing a Ballard assessment. Which two categories are evaluated?
What are neuromuscular maturity and physical maturity?
A client with a previous classical uterine incision is being evaluated for induction of labor. Why would the nurse question this plan?
What is a history of a classical uterine incision is a contraindication to induction?
A postpartum client has dark-red vaginal drainage during the first several days after birth. What is this drainage called?
What is lochia rubra?
A pregnant client with cardiovascular disease reports increasing fatigue and shortness of breath. The nurse notes tachycardia, neck vein distention, and peripheral edema.
Which additional finding would require the nurse to be especially concerned about worsening cardiac status?
What is Orthopnea, nocturnal cough, dizziness/fainting, or chest pain.
An Rh-negative woman gives birth to an Rh-positive newborn. Which medication may be administered after delivery to prevent Rh sensitization?
What is anti-D immune globulin/Rho(D) immune globulin?
The nurse remembers the four major causes of postpartum hemorrhage with this mnemonic: Tone, Tissue, Trauma, and this fourth T.
What is Thrombin?
A newborn is born at 35 weeks' gestation. How should the nurse classify this newborn?
hat is a late-preterm newborn?
During an assisted birth, the nurse recognizes that the newborn has facial bruising and the mother has significant perineal pain. Which type of delivery is associated with these potential complications?
What is forceps-assisted delivery?
The nurse assesses a postpartum client's fundus each day. Approximately how far should the fundal height descend each day?
What is approximately one fingerbreadth per day?
A pregnant client has poorly controlled diabetes. The fetus is estimated to be above the 90th percentile for gestational age. What complication does this finding indicate?
What is macrosomia?
A client presents with painless vaginal bleeding during pregnancy. Which condition should the nurse suspect when the placenta is located over or near the cervical opening?
What is placenta previa?
A woman is 3 days postpartum and is tearful, emotionally labile, and experiencing temporary sadness. Her symptoms are expected to resolve within approximately 2 weeks. What is this condition?
What are postpartum blues?
A newborn weighs 4,200 g at term. The newborn is at increased risk for which complication immediately after birth?
What is hypoglycemia?
Increased risk for birth trauma, shoulder dystocia, and cesarean delivery in LGA newborns.
A woman attempting VBAC suddenly develops fetal bradycardia, severe abdominal pain, and vaginal bleeding. What life-threatening complication should the nurse suspect?
What is uterine rupture?
A breastfeeding client asks why she is experiencing stronger uterine cramping during feedings. What is the best explanation?
What is breastfeeding increases the duration and intensity of afterpains?
A pregnant client with epilepsy is prescribed antiepileptic medication and asks why preconception planning and folic acid supplementation are emphasized. The nurse explains that pregnancy can increase risks to both the client and fetus.
Which nursing intervention is the highest priority for reducing fetal risk?
Encourage high-dose folic acid supplementation before and throughout pregnancy to help prevent neural tube defects.
A client receiving magnesium sulfate for preeclampsia has a sudden decrease in deep tendon reflexes. The nurse also notes increasing lethargy.
What complication should the nurse suspect, and what medication should be anticipated as the antidote?
What is Magnesium sulfate toxicity; calcium gluconate.
A postpartum woman develops unilateral leg edema, warmth, redness, and calf tenderness. What complication should the nurse suspect, and what is the priority concern?
What is deep vein thrombosis (DVT), with concern for progression to a pulmonary embolism?
A newborn is delivered through greenish-black amniotic fluid and develops grunting, nasal flaring, retractions, and cyanosis. What condition should the nurse suspect?
What is meconium aspiration syndrome (MAS)?
A client at 41 weeks' gestation is admitted to the labor unit. Which condition is a common indication for induction of labor?
What is postdate pregnancy?
A postpartum client states, "I haven't had my period yet, so I know I can't become pregnant." How should the nurse respond?
What is ovulation can occur before the return of menstruation, so pregnancy is possible even when menses have not resumed?
A pregnant client is diagnosed with an STI and tells the nurse, “I don't have any symptoms, so I'm not worried about the baby.” The nurse explains that some STIs may be asymptomatic but can still cause complications during pregnancy and affect the newborn.
What is the appropriate teaching the nurse should provide?
The client should understand that STIs can be asymptomatic while still causing pregnancy complications and being transmitted to the newborn. Treatment and follow-up testing are important.
A client with preeclampsia suddenly reports severe right upper-quadrant/epigastric pain, persistent headache, visual disturbances, nausea, and vomiting. Laboratory results reveal hemolysis, elevated liver enzymes, and a platelet count below 100,000/µL.
What complication is the nurse most concerned about, and why does this require immediate attention?
What is HELLP syndrome. HELLP represents Hemolysis, Elevated Liver enzymes, and Low Platelet count. It is a severe complication of preeclampsia and can lead to DIC, liver rupture, stroke, and maternal death.
A woman is 3 days postpartum following a nonelective cesarean birth. She reports increasing lower abdominal pain and malaise. Her temperature is 101°F (38.3°C), heart rate is elevated, and the uterus is tender.
What complication should the nurse suspect?
What is Endometritis?
A newborn exposed to substances during pregnancy is irritable, tremulous, hyperactive, tachypneic, and has a high-pitched cry. The newborn also has poor feeding and vomiting. What condition should the nurse suspect, and what nursing intervention is appropriate?
What is neonatal withdrawal, and the nurse should provide supportive care, frequent feedings, monitoring of weight and I&O, and reduction of environmental stimulation?