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A patient who is 37 weeks pregnant and has gestational diabetes is admitted to the labor and delivery unit for induction. The patient is placed on an external fetal monitor and receives an epidural anesthesia. Which action should the nurse take to identify a potential side effect of the epidural?
Monitor the patient's blood pressure.
After teaching a class about relieving leg cramps during pregnancy, a nurse evaluates the effectiveness of the instructions. Which of these comments, if made by the participants, would require FURTHER instruction?
· When I get a leg cramps in the middle of the night, my husband presses on my knee and pushes my foot toward my leg
· Sometimes when I'm sitting at my typewriter, I get a horrible leg cramp. First, I stand and bear weight on my leg in the middle of the night
· I take a heating pad to bed with me so that I can use it if I get a leg cramp in the middle of the night
· When I get a leg cramp while sitting at my desk, I flex my knee and extend my foot
The fourth comment would require further education. With leg cramps, the leg should be straightened and toes should be flexed toward the shin.
A client who is scheduled for a cesarean delivery has the following written preoperative orders. Which should the nurse question?
· Nothing by mouth after midnight
· Atropine sulfate 0.4mg IM on call
· Indwelling urinary catheter to be inserted in the morning
· Cleansing enema this evening
The order for a cleansing enema in the evening should be discussed with the physician. A cleansing enema is not usually done prior to a cesarean section.
A client who is G1P0 is receiving IV oxytocin injection for labor augmentation. Because of the effects of Pitocin, a nurse should assess the client for which of these adverse effects of Pitocin?
· Bradypnea and diarrhea
· Insomnia and tachycardia
· Hypotension and diuresis
· Headache and water intoxication
With doses of 20mU/min on above, oxytocin exerts an antidiuretic effect decreases free water exchange in the kidney, and markedly decreases urine output. Blood pressure initially may decrease, but after prolonged administration, the blood pressure increases above the baseline. Oxytocin does not cause bradycardia, diarrhea, insomnia, or tachycardia.
A pregnant woman who has tested positive for the human immunodeficiency virus (HIV) is near term, and expresses the desire to breast-feed her newborn. What should a nurse advise the patient about breast-feeding?
· Take her anti-retroviral medication each morning before breastfeeding
· Breastfeed exclusively in order to pass antibodies on to the infant
· Use formula since breastfeeding is not recommended for mothers who are HIV positive
· Avoid breastfeeding with cracked nipples
Breastfeeding accounts for up to 20-40% of mother-to-child HIV transmissions. Thus, HIV infected women are encouraged to formula feed their infants.
When a client's cervix is 9cm dilated, the woman says to the nurse "I really want something for pain." The client has an order for IM narcotic analgesic. Which of these statements is accurate about the effect a narcotic analgesic may have if it is given at this time?
· The effect on the fetal CNS may cause neonatal respiratory distress
· The effect on smooth muscles may intervene with uterine contractility
· The hypotensive effect may cause fetal hypotension
· The bradycardic effect may increase the chance of placental insufficiency
Narcotic analgesics cause CNS depression. If narcotic analgesics are given to the client too close to the time of delivery, the neonate will be delivered with respiratory depression.
A primagradiva who is at 40 weeks gestation is admitted to the labor and delivery unit in active labor. To facilitate the progress of the client's labor, which nursing action should be included in her nursing care?
· Encourage her to apply downward pressure on her uterus during contractions
· Encourage her to void at frequent intervals
· Have her ambulate every 30 minutes until she is completely dilated
· Have her inhale some oxygen with each contraction
There's something about sitting on a toilet in labor that seems to work wonders. Whether actually using the toilet or just sitting on it, the position is known to be helpful in active labor and transition.
Epidural anesthesia can cause
Hypotension which can affect placental blood flow and fetal oxygenation
preeclampsia is characterized by
hypertension, edema and proteinuria
Deep tendon reflexes can be affected by
Magnesium
a medication used to prevent seizures in patients with preeclampsia
Magnesium Sulfate
A patient is receiving magnesium sulfate.Which side effect should the nurse monitor for with this patient?
Decreased Respirations it can slow down or stop breathing
Babinski reflex
big toe bends upward and the other toes fan out when the sole of the foot is stroked.
A nurse is caring for a patient who is in labor and is placed on a monitor.How should the nurse determine the duration of contractions?
Count the time from the beginning of one contraction to the end of the same contraction.
A nurse is caring for a patient being evaluated for sexually transmitted infection (STI).A negative rapid plasma reagin (RPR) indicates that a patient is probably not infected with which STI?
Syphilis
When a client has placenta previa, a nurse should plan to monitor the mother for which of these manifestations?
· The height of the clients fundus
· The characteristics of the clients vaginal discharge
· Whether the umbilical cord can be seen at the vaginal introitus
· Whether the clients uterus is developing a retraction ring
The characteristics of the client's vaginal discharge should be monitored by the nurse if the client has placenta previa. Discharge/bleeding will indicate worsening placenta previa.
Which of these nursing measures should a nurse take immediately following amniotomy?
· Auscultating the fetal heart rate
· Starting IV fluids on the client
· Observing the client for vaginal bleeding
· Obtaining the clients vital signs
Immediately after an amniotomy, the fetal heart rate should be auscultated fir variable decelerations because of the potential umbilical prolapse. Uterine activity and the color, consistency, odor, and amount of amniotic fluid should also be assessed and documented.
Which of these desired outcomes would be expected 12-24 hours after administration of low dose magnesium sulfate to a client who is experiencing preterm labor?
· Cessation of uterine contractions
· Increase in blood pressure
· Increase in the ability to relax
· Absence of dizziness and headache
The desired outcome 12-24 hours after administration of low dose magnesium sulfate is the cessation of uterine contractions.
When comparing the prenatal nutritional needs of adolescents with that of a 25 y/o pregnant client, the nurse should be aware that the pregnant adolescents need more of which of these nutrients?
· Iron
· Calcium
· Ascorbic acid
· Vitamin B12
Pregnant adolescents require an additional 1,300mg of calcium to meet the requirements of both her growth and the fetus. Iron, ascorbic acid, and vitamin b12 needs are not increased in pregnant adolescents.
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