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After being in labor several hours with no progress the patient diagnosed with CPD and must have a c/s. the patient is worried that she will not be able to have any future children vaginally. After sharing this info with her care provider, the nurse would anticipate should would receive what type of incision?
- A. Transverse
- B. Vertical
- C. Low vertical
- D. Pfannenstiel
Correct Answer: B
Rationale: The correct answer is B: Vertical incision. In cases of CPD (cephalopelvic disproportion) where labor is not progressing and a cesarean section is necessary, a vertical incision is typically performed. This type of incision allows for better access to the uterus and is preferred in emergency situations like CPD. A transverse incision (choice A) is commonly used in elective c-sections but may not provide enough access in cases of CPD. Low vertical (choice C) is not ideal for CPD as it limits visibility and access. Pfannenstiel incision (choice D) is a horizontal incision placed low on the abdomen and is typically used in elective c-sections, not specifically for CPD cases.
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A nurse is caring for a client who is postpartum and received methylergonovine. Which of the following findings indicates that the medication was effective?
- A. Fundus firm to palpation
- B. Increase in blood pressure
- C. Increase in lochia
- D. Report of absent breast pain .
Correct Answer: A
Rationale: Step 1: Methylergonovine is a uterotonic drug used to prevent or treat postpartum hemorrhage by causing uterine contractions.
Step 2: Fundus firmness indicates effective contraction of the uterus, helping to control bleeding.
Step 3: A firm fundus also suggests proper involution of the uterus, a crucial process in postpartum recovery.
Step 4: Increase in blood pressure (B) is not a desired effect of methylergonovine and could indicate adverse reactions.
Step 5: Increase in lochia (C) could suggest excessive bleeding or incomplete uterine contraction.
Step 6: Absence of breast pain (D) is not directly related to the effectiveness of methylergonovine in controlling postpartum bleeding.
The nurse is preparing a postpartum client for discharge. Which instruction is most important?
- A. Avoid breastfeeding if you feel tired.
- B. Report foul-smelling lochia to your doctor.
- C. Resume all physical activity immediately.
- D. Stop taking your prenatal vitamins after discharge.
Correct Answer: B
Rationale: The correct answer is B: Report foul-smelling lochia to your doctor. This instruction is crucial because foul-smelling lochia can indicate an infection, which requires immediate medical attention to prevent complications. Reporting this to the doctor promptly ensures timely treatment.
A: Avoid breastfeeding if you feel tired - Incorrect. Breastfeeding is important for the baby's nutrition and bonding, regardless of the mother's fatigue.
C: Resume all physical activity immediately - Incorrect. Gradual resumption of physical activity is recommended to allow the body to heal properly.
D: Stop taking your prenatal vitamins after discharge - Incorrect. Prenatal vitamins are beneficial for postpartum recovery and breastfeeding, so stopping them abruptly is not advisable.
Induction of labor is planned for 31-year-old primigravida 39 weeks. She has insulin dependent diabetes. Which nursing action is more important?
- A. Begin Pitocin 4h after Cytotec (thin the cervix first)
- B. Administer 100mcg Cytotec q2h(no)
- C. Place vaginal gel and ambulate patient 1h
- D. Prepare to induce labor after administering tap water enema
Correct Answer: A
Rationale: The correct answer is A: Begin Pitocin 4h after Cytotec. This is the most important nursing action because it follows the recommended protocol for inducing labor in a diabetic patient. Cytotec is used to thin the cervix, and waiting 4 hours before starting Pitocin reduces the risk of uterine hyperstimulation, which can be dangerous for the mother and baby. Administering Cytotec every 2 hours (choice B) can increase the risk of hyperstimulation. Placing vaginal gel and ambulating the patient (choice C) may not be appropriate in this case as the patient has diabetes. Preparing to induce labor after administering a tap water enema (choice D) is not a priority compared to ensuring a safe induction process for a diabetic patient.
A nurse is reviewing a laboratory results for a client who is at 33 weeks of gestation and has preeclampsia. Which of the following laboratory results should the nurse report to the provider?
- A. BUN 35 mg/dL
- B. Hgb 15 mg/dL
- C. Bilirubin 0.6 mg/dL
- D. Hct 37%
Correct Answer: A
Rationale: The correct answer is A: BUN 35 mg/dL. In preeclampsia, elevated BUN levels indicate impaired kidney function, a serious complication. High BUN can lead to renal damage. Hgb, Hct, and Bilirubin levels are within normal ranges for pregnancy, so they do not indicate a critical issue. Reporting BUN level is crucial for monitoring kidney function and preventing further complications in preeclampsia.
What component of a health history for a wellness exam includes information on lifestyle factors, such as diet, exercise habits, tobacco use, alcohol consumption, and recreational drug use?
- A. chief complaint/reason for visit
- B. gynecologic history
- C. medications and supplements
- D. social history
Correct Answer: D
Rationale: The correct answer is D: social history. This component of a health history focuses on lifestyle factors that can impact a person's overall health and well-being. It includes information on diet, exercise habits, tobacco use, alcohol consumption, and recreational drug use. By understanding these factors, healthcare providers can assess potential risks, provide appropriate counseling, and tailor interventions to promote health.
A: Chief complaint/reason for visit is not the correct answer as it pertains to the specific reason why the patient is seeking medical attention.
B: Gynecologic history is focused on a specific aspect of health related to female reproductive health and is not inclusive of overall lifestyle factors.
C: Medications and supplements focus on the use of medications and supplements and do not cover lifestyle factors such as exercise habits or recreational drug use.