Nokea
Following a cesarean birth, intrathecal morphine is administered to the patient for postoperative pain management. Of which fact about intrathecal morphine therapy is the nurse aware? Select all that apply.
- A. An anesthesiologist or CRNA administers it intrathecally.
- B. The nurse needs to closely monitor for common side effects.
- C. The drug produces generalized CNS depression.
- D. The recommended dose is 10 to 15 mg.
Correct Answer: B
Rationale: The correct answer is B: The nurse needs to closely monitor for common side effects.
1. Intrathecal morphine can lead to side effects such as respiratory depression, nausea, vomiting, and pruritus.
2. Monitoring for these side effects is crucial for early detection and intervention.
3. Anesthesiologists or CRNAs typically administer intrathecal morphine, not nurses.
4. Intrathecal morphine primarily acts locally at the spinal cord level, not producing generalized CNS depression.
5. The recommended dose of intrathecal morphine is typically much lower than 10-15 mg to avoid overdose and side effects.
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What is a possible complication of oligohydramnios?
- A. fetal macrosomia
- B. preterm labor
- C. placenta previa
- D. fetal growth restriction
Correct Answer: D
Rationale: The correct answer is D: fetal growth restriction. Oligohydramnios refers to low levels of amniotic fluid, which can restrict fetal growth due to decreased cushioning and space for movement. This can lead to complications such as poor fetal nutrition, musculoskeletal abnormalities, and pulmonary hypoplasia. Fetal macrosomia (A) is the opposite of fetal growth restriction, preterm labor (B) is not directly associated with oligohydramnios, and placenta previa (C) is a separate condition involving the placenta's position in the uterus.
The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the facility. Which reasons contribute to the high rates of cesarean births? Select all that apply.
- A. Fetuses in breech position unable to deliver vaginally
- B. Increased number of elective or maternal request cesareans
- C. Incidences of women of older maternal age getting pregnant
- D. Decreasing rate of malpractice litigation with cesarean birth
Correct Answer: B
Rationale: The correct answer is B: Increased number of elective or maternal request cesareans. This is correct because the rise in elective cesarean births, often due to patient preference or convenience, can contribute to the overall high rates of cesarean births.
A: Fetuses in breech position unable to deliver vaginally - This is a valid reason for cesarean births, but it does not address the question about high rates of cesarean births.
C: Incidences of women of older maternal age getting pregnant - While advanced maternal age can be a factor in cesarean births, it is not directly related to the high rates of cesarean births at the facility.
D: Decreasing rate of malpractice litigation with cesarean birth - This is an irrelevant factor in determining the reasons for high rates of cesarean births at the facility.
An emergency cesarean is being implemented. The patient describes tingling in her ears and a metallic taste with the administration of regional anesthesia. The nurse is aware that which incidence has occurred?
- A. Manifestation of maternal respiratory depression related to anesthesia
- B. Inadvertent injection of the anesthetic agent into the maternal bloodstream
- C. Maternal hypotension is occurring related to administration of anesthesia
- D. Expected manifestations related to anesthetic medications are present
Correct Answer: B
Rationale: The correct answer is B: Inadvertent injection of the anesthetic agent into the maternal bloodstream. This is indicated by the patient experiencing tingling in her ears and a metallic taste, which are signs of systemic toxicity from the anesthetic agent. The anesthetic has entered the bloodstream instead of staying localized to the intended area. Other choices are incorrect as A is more related to opioid overdose, C is more related to hypotension, and D implies that these symptoms are normal when they are not.
When evaluating the patient's progress, the nurse knows that four of the five fetal factors that interact to regulate the heart Nrate Rare I(SeGlect Bal.l CthatM apply.) U S N T O
- A. baroreceptors.
- B. adrenal glands.
- C. chemoreceptors.
- D. uterine activity.
Correct Answer: A
Rationale: The correct answer is A: baroreceptors. Baroreceptors are sensory receptors that detect changes in blood pressure and play a role in regulating heart rate. They are one of the fetal factors that interact to regulate heart rate. Adrenal glands (B) primarily regulate stress response, chemoreceptors (C) detect changes in oxygen and carbon dioxide levels, and uterine activity (D) refers to contractions during labor, which are not directly related to regulating fetal heart rate. Thus, A is correct as it directly influences heart rate regulation.
The nurse is concerned that a patient’s uterine activity is too intense and that her obesity is
preventing accurate assessment of the actual intrauterine pressure. Based on this information,
which action should the nurse take?
- A. Reposition the tocotransducer.
- B. Reposition the Doppler transducer.
- C. Obtain an order from the health care provider for a spiral electrod
- D. Obtain an order from the health care provider for an intrauterine pressure catheter.
Correct Answer: D
Rationale: The correct answer is D: Obtain an order from the health care provider for an intrauterine pressure catheter. This is the most appropriate action because an intrauterine pressure catheter provides the most accurate assessment of intrauterine pressure, especially in cases where obesity may interfere with external monitoring methods. Repositioning the tocotransducer (choice A) or Doppler transducer (choice B) may not significantly improve accuracy in this situation. Obtaining an order for a spiral electrod (choice C) is not necessary as it does not directly address the issue of accurate intrauterine pressure assessment.