medications
The purpose of the medication dinoprostone gel ?
Dinoprostone promotes softening of the cervix.
Rationale: Dinoprostone is used to prepare or soften the cervix for the induction of labor in pregnant clients who are at or near term.
3rd trimester Painless vaginal bleeding
Placenta Previa
This findings indicates that the fetal lungs are mature?
Lecithin/sphingomyelin (L/S) ratio of 2:1
Rationale: An L/S ratio of 2:1 is an indication of fetal lung maturity.
“What is a normal fetal heart rate?
What should be done for a patient who has unrelieved episiotomy pain 8 hr following delivery?
Apply an ice pack to the perineum. Rationale: During the first 24 hr, ice packs and cool water sitz baths should be used. This should reduce edema and reduce discomfort. The client can also apply witch hazel compresses to reduce edema. The nurse should also teach the client to use prescribed creams, sprays, and ointments
What is one expected affect of iron supplements?
"This is expected because of the way iron is broken down during digestion.
"Rationale: Iron supplements turn a client's stools black. In the absence of cramping and abdominal pain, this is an expected finding. The client should be instructed to expect black stools.
What is the desired effect when terbutaline is administered to a 28 wk pregnant client?
Weakened uterine contractions Rationale: Terbutaline is a beta2-adrenergic agonist that acts to relax the uterus. Terbutaline is used to stop a contraction pattern in a client who is at preterm gestation
What should a nurse caring for a client who is experiencing shaking chills during the immediate postpartum period do?
Cover the client with warm blankets. Rationale: Shaking chills often occur immediately postpartum due to the cool birthing room, excess epinephrine production during the birth, and the sudden release of pressure on the pelvic nerves. The nurse should cover the client with a warm blanket following delivery.
what would indicate true labor for a primigravida at 42 weeks of gestation and states that she thinks she is in labor.
Cervical dilation
Rationale: Cervical dilation and effacement are indications of true labor.
Which of the following actions should the nurse take when client’s fundus is boggy and displaced to the right?
Assist the client to the bathroom to void.
Rationale: The nurse should assist the client to the bathroom to void as uterine atony can be caused by bladder distention. A full bladder prevents the uterus from contracting and displaces it to one side.
Which of the medications is contraindicated for this client?
Misoprostol
Rationale: Misoprostol can cause abortion, premature labor, and birth defects. This prescription should be clarified with the provider.
Which information should the nurse include foe a pregnant patient with a prescription for Rho(D) immune globulin?
This medication prevents the formation of Rh antibodies by a woman who is Rh-negative.
Rationale: Giving Rho(D) immune globulin prevents the client's immune system from forming antibodies secondary to exposure to fetal blood during pregnancy or delivery.
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?
Location of the placenta
Rationale: 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 caring for a postpartum client who saturates a perineal pad in 10 min. Which of the following actions should the nurse take first?
Massage the client’s fundus. Rationale: The nurse’s priority action is to increase uterine tone by massaging the client’s fundus. A boggy fundus leads to an increase in uterine bleeding.
what is the primary reason the nurse should avoid performing a pelvic examination in client with placenta previa??
Profound bleeding Rationale: The greatest risk to the client is hemorrhage. The nurse should place the client on pelvic rest, which means no vaginal examinations, no douching, and no vaginal intercourse. This is because any pressure on the placenta could cause its premature separation and life-threatening hemorrhage
Why would a nurse administer methylergonovine IM for a client who had a vaginal delivery earlier that day.
Postpartum hemorrhage
Rationale: Methylergonovine is an oxytocic. It causes uterine contractions to help control postpartum bleeding.
What explanations should the nurse include for a patient in labor about why epidural anesthesia is not initiated until a good labor pattern has been established ?
Given too soon, epidural anesthesia can prolong labor."
Rationale: 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 client had an epidural anesthesia block during the early stages of labor and now her 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?
Place the client in a lateral position.
Rationale: 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 assisting with the admission of a client who is at 39 weeks of gestation and has heavy vaginal bleeding. Which of the following actions should the nurse take?
Prepare for cesarean birth. Rationale: The nurse should begin preparing for a cesarean birth for a client who is full term and has heavy vaginal bleeding. A client who has heavy vaginal bleeding is at risk for hemorrhage and subsequent fetal compromise. Therefore, immediate delivery via cesarean section will likely be advised.
A client in active labor with 7 cm of cervical dilation and 100% effacement, fetus is at 1+ station, and the client’s amniotic membranes are intact, client suddenly states that she needs to push. How should the nurse response?
Have the client pant during the next few contractions. Rationale: Panting is fast, continuous, shallow breathing. It helps a client in labor refrain from pushing before her cervix reaches full dilation
Which findings indicates that it is safe for the nurse to continue the infusion of magnesium sulfate IV 2g/hr for severe preeclampsia ?
Respiratory rate of 16/min Rationale: The client’s respiratory rate should be at least 12/min as a precaution against excessive depression of impulses at the myoneural junction. Based on this finding, the nurse can continue the infusion.
What action should the nurse take for a 38wk gestation client with a positive contraction test?
Prepare the client for admission to the hospital.
Rationale: A positive contraction stress test indicates fetal distress and needs further evaluation. The nurse should prepare the client to be admitted to the hospital
A client’s respiratory rate is 8/min after receiving magnesium sulfate.
Calcium gluconate
Rationale: The nurse should plan to administer calcium gluconate or calcium chloride as the reversal agent for a client who experiences magnesium sulfate toxicity.
what should the nurse do for a client 2 hr following a spontaneous vaginal delivery and notes that the client has saturated two perineal pads with blood in a 30-min period.
Check the consistency of the client’s uterine fundus. Rationale: Although the nurse should expect moderate bleeding in the first 2 hr after delivery, saturating a perineal pad in 15 min or less indicates excessive blood loss. The first action the nurse should take, using the nursing process, is to collect data from the client. Therefore, the nurse should determine the consistency of the client’s fundus first. If it is boggy, fundal massage might control the bleeding.
client who is at 36 weeks of gestation and reports continuous abdominal pain and vaginal bleeding is likely experiencing which of the following complications
Abruptio placentae
Rationale: The nurse should identify that a client experiencing an abruptio placentae will experience abdominal pain, uterine tenderness upon palpation, and vaginal bleeding that can be profuse.