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A patient who was diagnosed prenatally as having epidural for pain management. What should the greater than 2,000 mL of amniotic fluid just deliv- nurse be prepared to do? Select all that apply. ered a 9 lb (4,082 g) baby girl. Her nurse is aware
- A. Assess maternal vital signs that she is now at risk for which condition?
- B. Assess FHR
- C. Infection
- D. Assist patient to the bathroom to void
Correct Answer: A
Rationale: A. Assess maternal vital signs: With the delivery of a baby with macrosomia (greater than 4,000 g), the mother is at risk for postpartum hemorrhage due to uterine atony, retained placental fragments, or lacerations. Therefore, assessing maternal vital signs is crucial in detecting any signs of hemorrhage promptly.
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A nurse caring for a client who is at 20 weeks of gestation and has trichomoniasis. Which of the following findings should the nurse expect?
- A. Thick, White Vaginal Discharge
- B. Urinary Frequency
- C. Vulva Lesions
- D. Malodorous Discharge
Correct Answer: D
Rationale: Trichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis. In pregnant individuals, trichomoniasis can result in adverse pregnancy outcomes such as preterm birth and low birth weight. A common symptom of trichomoniasis is a frothy, yellow-green, malodorous vaginal discharge. Therefore, in this client scenario, the nurse should expect to find a malodorous discharge as a result of trichomoniasis. The other options presented are not typically associated with trichomoniasis.
Which assessment finding indicates uterine rupture?
- A. Ctx abruptly stop during labor
- B. Fetal tachycardia occurs
- C. Client becomes dyspneic
- D. Labor progressing unusually quickly
Correct Answer: A
Rationale: Uterine rupture is a rare but serious obstetric emergency that can occur during labor and delivery. One of the key assessment findings indicating uterine rupture is when contractions (ctx) abruptly stop during labor. This abrupt cessation of contractions can be a sign that the uterine muscle has torn due to excessive pressure or force, leading to a disruption in the normal progress of labor. Other signs and symptoms of uterine rupture may include severe abdominal pain, abnormal fetal heart rate patterns, loss of fetal station, and signs of hypovolemic shock in the mother. Immediate intervention and surgical management are required in cases of uterine rupture to ensure the safety of both the mother and the baby.
The nurse is teaching a client with preeclampsia about home care. Which statement indicates understanding?
- A. I should monitor my blood pressure once a week.
- B. I should limit my fluid intake to reduce swelling.
- C. I will report any headache or vision changes immediately.
- D. I can exercise daily to maintain health.
Correct Answer: C
Rationale: Headache and vision changes can signal worsening preeclampsia, requiring prompt medical attention.
A nurse is admitting a client who has a diagnosis of preterm labor. The nurse anticipates a prescription by the provider for which of the following medications? (Select all that apply.)
- A. Prostaglandin E2
- B. Indomethacin
- C. Magnesium sulfate
- D. Methylergonovine
Correct Answer: A
Rationale: A. Prostaglandin E2: Prostaglandin E2 is used to manage preterm labor by helping to ripen the cervix and promote contractions.
The nurse is conducting a prenatal class on the female reproductive system. When a client asks why the fertilized ovum stays in the fallopian tube for 3 days, what is the best response?
- A. It promotes the fertilized ovum's chances of survival.
- B. It promotes the fertilized ovum's exposure to estrogen and progesterone.
- C. It promotes the fertilized ovum's normal implantation in the top portion of the uterus.
- D. It promotes the fertilized ovum's exposure to luteinizing hormone and follicle-stimulating hormone.
Correct Answer: C
Rationale: The delay ensures the ovum reaches the uterus at the right developmental stage for proper implantation in the upper uterine segment.