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During a routine prenatal visit, a client at 32-weeks gestation reports that urinary frequency has increased during the day as well as at night. The nurse determines the client is having irregular uterine contractions. Which action should the nurse implement?
- A. Collect a urine sample for dipstick analysis.
- B. Ask the client if she had sexual intercourse yesterday.
- C. Obtain a midstream urine specimen for culture.
- D. Determine if she has a change in vaginal discharge.
Correct Answer: C
Rationale: A midstream urine culture diagnoses UTIs, which can cause urinary frequency and uterine irritability, guiding targeted treatment.
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History and Physical:
Nurses' Notes
Flow Sheet
The client is a 26-year-old female gravida 2, para 1, term 1, living 1. She was admitted to the labor and delivery unit with cervical dilation of 4 cm, 70% effacement, and -1 station. Her pregnancy has been uncomplicated, and she has no significant medical history.
A nurse is caring for a 26-year-old female client in the labor and delivery unit. The client is gravida 2, para 1, term 1, living 1, and is admitted with cervical dilation of 4 cm, 70% effacement, and -1 station. The pregnancy has been uncomplicated.
The nurse reviews the client data. Drag the word choices to complete the sentence. Abnormal FHR patterns can result in [Dropdown Group 1], [Dropdown Group 2], and [Dropdown Group 3].
- A. Acidemia.
- B. Hypoxemia.
- C. Hypoxia.
- D. Meconium stool.
- E. Maternal hypotension.
- F. Hypoglycemia.
Correct Answer: A,B,C
Rationale: Abnormal FHR patterns indicate acidemia (low pH), hypoxemia (low blood oxygen), and hypoxia (tissue oxygen deficiency), directly affecting fetal oxygenation.
Abnormal FHR patterns can result in which condition?
- A. Acidemia.
- B. Hypoxia.
- C. Hypoglycemia.
- D. Meconium stool.
- E. Maternal hypotension.
Correct Answer: A,B,D,E
Rationale: Abnormal FHR patterns can lead to acidemia, hypoxia, meconium passage, and maternal hypotension effects, but not directly hypoglycemia.
A diabetic client delivers a full-term large-for-gestational-age (LGA) infant who is jittery. Which action should the nurse take first?
- A. Obtain a blood glucose level.
- B. Feed the infant glucose water (10%).
- C. Administer oxygen.
- D. Decrease environmental stimuli.
Correct Answer: A
Rationale: Obtaining a blood glucose level confirms hypoglycemia as the cause of jitteriness, common in LGA infants of diabetic mothers, guiding treatment.
A primipara presents to the perinatal unit describing rupture of the membranes (ROM) occurring 12 hours prior to coming to the hospital. An oxytocin infusion is begun, and 8 hours later the client's contractions are irregular and mild. Based on this data, the nurse plans to monitor which sign more frequently than for the average laboring client?
- A. Color of amniotic fluid.
- B. Maternal temperature.
- C. Deep tendon reflexes.
- D. Maternal blood pressure.
Correct Answer: B
Rationale: Prolonged ROM increases infection risk, necessitating frequent maternal temperature monitoring to detect chorioamnionitis early.
Which action is most important for the nurse to implement?
- A. Increase IV infusion rate.
- B. Assess the vital signs.
- C. Massage the fundus.
- D. Notify the healthcare provider.
Correct Answer: C
Rationale: Massaging the fundus promotes uterine contraction, critical for controlling postpartum hemorrhage and stabilizing the patient.