OB Medications
This corticosteroid is administered to pregnant clients at risk for preterm birth to help mature the fetal lungs and reduce the risk of Respiratory Distress Syndrome (RDS) in the newborn.
Betamethasone
This is the most serious, though rare, complication associated with a trial of labor after a previous cesarean (TOLAC) birth and is a major reason continuous fetal monitoring is required.
Uterine Rupture
This rare but severe postpartum mental health disorder is characterized by hallucinations, delusions, disorganized thinking, and a risk of harm to the mother or infant.
Postpartum Psychosis
Before a surgical procedure, this important preoperative action helps identify risks such as blood type compatibility, anemia, infection, and other conditions that may affect anesthesia or treatment decisions.
Obtaining and reviewing laboratory tests (lab results)
Rationale: Preoperative laboratory testing helps identify potential complications and ensures appropriate planning for surgery, anesthesia, and interventions such as blood transfusions.
This type of abortion occurs when all products of conception have been expelled from the uterus, resulting in decreased bleeding, reduced cramping, and no need for surgical removal of remaining tissue.
Complete Abortion
Rationale: In a complete abortion, all products of conception have been expelled. Bleeding and pain typically decrease, the cervix closes, and no retained tissue remains in the uterus. Surgical intervention is usually unnecessary.
This prostaglandin medication is used to soften and dilate the cervix prior to labor induction.
Misoprostol (Cytotec)
This scoring system evaluates cervical dilation, effacement, consistency, position, and fetal station to determine readiness for labor induction.
Bishop Score
This life-threatening complication of pregnancy is characterized by sudden abdominal pain, vaginal bleeding, uterine tenderness, and a rigid, board-like uterus. It can rapidly lead to maternal and fetal distress.
Placental Abruption (Abruptio Placentae)
In this mechanical method of labor induction, the provider inserts a gloved finger through the cervix and sweeps it around the internal cervical opening to separate the membranes from the lower uterine segment without rupturing them, helping stimulate the release of prostaglandins.
Membrane Stripping (Membrane Sweeping)
Rationale: Membrane stripping, also called membrane sweeping, is a nonpharmacologic method used to encourage labor. The procedure separates the amniotic membranes from the lower uterine segment, which stimulates prostaglandin release and may help initiate labor in patients with a favorable cervix.
This postpartum condition is characterized by breast pain, localized redness, swelling, and fever. Treatment includes continued breastfeeding or pumping, warm compresses, adequate fluid intake, and often antibiotic therapy.
Mastitis
Rationale: Mastitis is an infection and inflammation of breast tissue, most commonly occurring in breastfeeding patients. Continued emptying of the breast helps prevent milk stasis and promotes healing. Warm compresses can improve milk flow, while fluids and antibiotics help treat the infection and support recovery.
A client receiving magnesium sulfate develops absent deep tendon reflexes and respiratory depression. Their serum magnesium level is 10 mg/dL. These findings indicate this condition.
Magnesium Toxicity
A patient with hyperemesis gravidarum has signs of severe dehydration and ketonuria. According to priority nursing care, this intervention should be implemented before nutritional therapy.
Intravenous (IV) fluids
Rationale: Hyperemesis gravidarum can cause severe dehydration, electrolyte imbalances, and ketosis due to prolonged vomiting. IV fluids are the priority intervention because they restore circulating volume, improve tissue perfusion, correct dehydration, and help prevent further maternal and fetal complications. Once hydration is stabilized, electrolyte replacement, antiemetics, and nutritional support can be addressed.
This postpartum complication is characterized by a firm, contracted uterus with a steady stream of bright red blood. It is commonly caused by tearing of the cervix, vagina, or perineum during delivery.
Laceration
Rationale: When postpartum bleeding occurs despite a firm, contracted uterus, the nurse should suspect a laceration of the cervix, vagina, or perineum. The bleeding is typically bright red and continuous because it originates from damaged blood vessels in the torn tissue.
This condition occurs when a fetus does not grow at the expected rate during pregnancy and is often caused by placental insufficiency, maternal smoking, poor nutrition, or chronic maternal illness. Affected fetuses typically measure below the 10th percentile for gestational age due to inadequate oxygen and nutrient delivery.
Intrauterine Growth Restriction (IUGR)
Rationale: IUGR occurs when fetal growth is restricted because the fetus is not receiving adequate oxygen or nutrients. Common causes include placental insufficiency, maternal smoking, poor nutrition, hypertension, and other chronic maternal conditions. Unlike some constitutionally small fetuses, IUGR is associated with impaired growth and an increased risk of perinatal complications.
Maternal hyperglycemia can cause excessive fetal insulin production, resulting in excessive fetal growth. Infants with this condition are at increased risk for shoulder dystocia, birth trauma, and neonatal hypoglycemia.
Fetal Macrosomia
Rationale:
Fetal macrosomia refers to excessive fetal growth, commonly associated with maternal diabetes. Excess glucose crosses the placenta and stimulates fetal insulin production. Because insulin acts as a growth hormone, the fetus may become excessively large, increasing the risk of shoulder dystocia, birth injury, cesarean birth, and neonatal hypoglycemia after delivery.
Why not LGA?
Although infants with fetal macrosomia are often classified as large for gestational age (LGA), LGA is a statistical classification based on birth weight above the 90th percentile for gestational age. This question specifically describes the pathophysiologic process of maternal hyperglycemia causing fetal hyperinsulinemia and excessive growth, which is most accurately termed fetal macrosomia.
This medication stops rapidly dividing cells and is commonly used to treat ectopic pregnancy, molar pregnancy, and some medication abortions.
Methotrexate
This sexually transmitted infection is caused by a one-celled protozoan and is commonly associated with frothy, yellow-green vaginal discharge, vaginal irritation, and a foul odor.
Trichomoniasis
Rationale: Trichomoniasis is caused by the protozoan Trichomonas vaginalis. Common manifestations include frothy yellow-green vaginal discharge, vulvovaginal irritation, dysuria, and a characteristic foul-smelling odor. It is typically treated with metronidazole
This postpartum infection commonly occurs after cesarean birth or prolonged labor and presents with fever, uterine tenderness, and foul-smelling lochia. If left untreated, it can progress to peritonitis, septic shock, or a pelvic abscess.
Endometritis
Rationale: Endometritis is an infection of the uterine lining that most commonly occurs after cesarean birth, prolonged labor, prolonged rupture of membranes, or multiple vaginal examinations. Classic findings include fever, uterine tenderness, foul-smelling lochia, and malaise. Prompt antibiotic treatment is necessary to prevent serious complications.
Epigastric or right upper quadrant pain in a patient with severe preeclampsia is often caused by ischemia and swelling of this organ due to vasospasm and endothelial damage. In severe cases, involvement of this organ may be associated with HELLP syndrome and can progress to rupture.
The Liver
Rationale: Epigastric or RUQ pain in severe preeclampsia is a warning sign of liver involvement. Vasospasm and endothelial injury reduce hepatic blood flow, causing ischemia, swelling, and stretching of the liver capsule. Severe hepatic involvement may occur with HELLP syndrome and can lead to hepatic rupture, DIC, and other life-threatening complications.
A nurse is assessing a patient 10 hours after a spontaneous vaginal delivery. Assessment findings include a WBC count of 24,000/mm³ (normal 5,000–10,000/mm³), pulse 90 bpm, blood pressure 138/90 mmHg, and temperature 38.8°C (101.8°F). Which finding requires prompt provider notification?
The temperature of 38.8°C (101.8°F)?
Rationale: The elevated temperature is the finding that requires prompt notification because it may indicate infection. Although the WBC count is elevated, postpartum patients commonly experience leukocytosis (an increase in white blood cells) due to the stress of labor and delivery, and values up to 30,000/mm³ can be expected. The pulse and blood pressure are within acceptable limits for the postpartum period.
This medication is administered to Rh-negative clients to prevent the formation of antibodies against Rh-positive fetal blood cells. It is commonly given at 28 weeks' gestation and within 72 hours postpartum.
RhoGAM
This surgical intervention involves placing purse-string sutures around the cervix to prevent premature dilation and is commonly performed for patients with a history of cervical insufficiency or recurrent second-trimester pregnancy loss.
Cervical Cerclage
A postpartum patient becomes dizzy and lightheaded when standing. Assessment reveals a blood pressure of 90/60 mmHg, heart rate of 110 bpm, a firm uterus, and normal lochia. What is the most likely cause of these findings, and what should the nurse do first?
Orthostatic Hypotension? The nurse should assist the patient back to a sitting or semi-reclining position and monitor vital signs.
Rationale: Orthostatic hypotension is common in the early postpartum period due to fluid shifts and blood loss during delivery. Because the uterus is firm and lochia is normal, postpartum hemorrhage is unlikely. The priority is preventing falls and ensuring patient safety by assisting the patient to a safe position before further assessment.
A pregnant patient with a congenital heart defect is being managed by a multidisciplinary team. Despite stable vital signs, which newly reported symptom would require immediate provider notification because it may indicate early cardiac decompensation?
New onset of nocturnal cough or shortness of breath
Rationale: A new nocturnal cough, increasing shortness of breath, or dyspnea at rest may indicate worsening cardiac function and pulmonary congestion. These symptoms can occur before significant changes in vital signs are detected and should be reported promptly to prevent progression to heart failure. This is especially important during pregnancy because of the increased cardiovascular demands on the heart.
A patient at 34 weeks gestation has a blood pressure of 160/100 mmHg and mild lower-extremity edema. She denies headache, visual disturbances, and epigastric pain. Urinalysis is negative for protein. What is the most likely diagnosis, and why?
Gestational Hypertension. The patient has new-onset hypertension after 20 weeks' gestation without proteinuria or other severe features of preeclampsia.
Rationale: Gestational hypertension is diagnosed when a patient develops hypertension after 20 weeks' gestation without proteinuria or evidence of end-organ dysfunction. Although edema may be present, it is no longer used to diagnose preeclampsia. The absence of proteinuria and severe features such as headache, visual changes, or epigastric pain makes gestational hypertension the most likely diagnosis.
A postpartum patient with a history of chronic hypertension and severe preeclampsia develops uterine atony and excessive bleeding after delivery. The provider orders a uterotonic medication, but one commonly used agent is contraindicated because it can cause significant vasoconstriction and worsen the patient's blood pressure. Identify the medication and explain why it is contraindicated.
Methylergonovine (Methergine)? It is contraindicated in patients with hypertension or preeclampsia because it causes vasoconstriction, which can significantly increase blood pressure and increase the risk of stroke or other hypertensive complications.
In HELLP syndrome, the "H" refers to the destruction of red blood cells, which can lead to anemia and decreased oxygen-carrying capacity.
Hemolysis
Two weeks after delivery, a postpartum patient continues to experience excessive lochia and has a soft, enlarged uterus that remains higher than expected for the postpartum period. The provider suspects retained placental fragments. What condition is the patient experiencing, and how is it commonly treated?
Uterine Subinvolution. Treatment may include uterotonic medications such as oxytocin, treatment of any underlying infection, and removal of retained placental tissue if present.
Rationale: Uterine subinvolution occurs when the uterus fails to return to its pre-pregnancy size at the expected rate. Common causes include retained placental fragments and infection. Findings include prolonged lochia, excessive bleeding, and a larger-than-expected uterus. Treatment focuses on correcting the underlying cause and promoting uterine contraction.
During an amniocentesis performed to assess fetal lung maturity, the provider is evaluating for the presence of a substance produced by type II alveolar cells. Without adequate amounts of this substance, a newborn is at increased risk for respiratory distress syndrome (RDS). Identify the substance and explain its role in fetal respiratory development.
Surfactant. It reduces surface tension within the alveoli, allowing the lungs to expand properly and preventing alveolar collapse after birth.
Rationale: Surfactant is produced by type II alveolar cells and is essential for normal lung function after delivery. By reducing surface tension, it keeps the alveoli open during exhalation, making breathing easier and improving gas exchange. Insufficient surfactant production is a major cause of neonatal respiratory distress syndrome, particularly in preterm infants.
A term newborn delivered by scheduled cesarean birth develops tachypnea shortly after birth. Oxygen saturation remains stable, and symptoms resolve within 72 hours. What is the most likely diagnosis?
Transient Tachypnea of the Newborn (TTN)
Rationale: TTN occurs when fetal lung fluid remains in the lungs after birth, causing tachypnea and mild respiratory distress. It is most common in term or near-term infants and usually improves within a few days with supportive care.