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If a woman's fundus is soft 30 minutes after birth, the nurse's first action should be to
- A. massage the fundus.
- B. take the blood pressure
- C. increase blood supply to the hands and feet.
- D. notify the physician or nurse-midwif
Correct Answer: A
Rationale: The correct answer is A: massage the fundus. After childbirth, a soft fundus indicates uterine atony, which can lead to postpartum hemorrhage. Massaging the fundus helps stimulate contractions and reduce bleeding, promoting uterine tone. This intervention is crucial in preventing complications. Taking blood pressure (B) is important but not the priority in this situation. Increasing blood supply to the hands and feet (C) is not relevant to addressing uterine atony. Notifying the physician or nurse-midwife (D) can be done after initiating immediate intervention to manage the soft fundus.
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Which patient will most likely have increased anxiety and tension during labor?
- A. Gravida 2 who refused any medication
- B. Gravida 2 who delivered a stillborn baby last year
- C. Gravida 1 who did not attend prepared childbirth classes
- D. Gravida 3 who has two children younger than 3 years
Correct Answer: B
Rationale: The correct answer is B. A patient who delivered a stillborn baby last year is more likely to experience increased anxiety and tension during labor due to previous traumatic experience. This can trigger fear and worry about the current pregnancy outcome, leading to heightened emotional distress.
Incorrect Choices:
A: Refusing medication does not necessarily correlate with increased anxiety during labor.
C: Not attending childbirth classes may result in lack of knowledge but does not directly relate to increased anxiety during labor.
D: Having two children younger than 3 years may cause stress but does not specifically indicate increased anxiety during labor.
The fetus is in an occiput posterior position. What position can the nurse assist the laboring person into that may encourage the fetus to find the occiput anterior position?
- A. squatting
- B. shower
- C. hands and knees
- D. semi-Fowler
Correct Answer: C
Rationale: The correct answer is C: hands and knees. This position can help rotate the fetus from occiput posterior to occiput anterior by allowing gravity to assist in the rotation. Placing the laboring person on hands and knees can help the baby's head shift towards the front, facilitating a more optimal birthing position. Squatting and shower may provide comfort but may not directly encourage the fetus to rotate. Semi-Fowler position may not be as effective in promoting the desired fetal positioning compared to hands and knees.
A laboring patient is 10 cm dilated; however, she does not feel the urge to push. The nurse understands that according to laboring down, the advantages of waiting until an urge to push are which of the following? (Select all that apply.)
- A. Less maternal fatigue
- B. Less birth canal injuries
- C. Decreased pushing time
- D. Faster descent of the fetus
Correct Answer: A
Rationale: The correct answer is A: Less maternal fatigue. Waiting for the urge to push during laboring down helps conserve the mother's energy and prevents exhaustion. Pushing without the urge can lead to ineffective pushing efforts, increasing maternal fatigue.
Incorrect choices:
B: Less birth canal injuries - Pushing without the urge may increase the risk of birth canal injuries due to ineffective pushing efforts.
C: Decreased pushing time - Pushing without the urge may actually prolong pushing time as the efforts may be less effective.
D: Faster descent of the fetus - Pushing without the urge may not necessarily result in faster descent of the fetus and can lead to prolonged labor.
The process of labor places significant metabolic demands on the obstetric patient. Which physiologic findings would be expected?
- A. Decreased maternal blood pressure as a result of stimulation of alpha receptors
- B. Uterine vasoconstriction as a result of stimulation of beta receptors
- C. Increased maternal demand for oxygen
- D. Increased blood flow to placenta because of catecholamine release
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct:
1. Labor is a physically demanding process that requires increased energy expenditure.
2. Increased uterine activity during labor leads to higher oxygen consumption by the mother.
3. Maternal demand for oxygen increases to meet the metabolic needs of both the mother and the fetus.
4. Adequate oxygen supply is crucial to support the increased workload during labor.
Summary:
A: Incorrect. Labor typically leads to increased blood pressure due to sympathetic activation, not decreased.
B: Incorrect. Uterine vasoconstriction is not expected during labor as it needs adequate blood supply for contractions.
D: Incorrect. Catecholamine release during labor can lead to vasoconstriction, not increased blood flow to the placenta.
The nurse is preparing a patient for a cesarean birth scheduled to be performed under general
- A. Which should the nurse plan to administer, if ordered by the health care provider, to prevent aspiration of gastric contents? (Select all that apply.)
- B. Citric acid (Bicitr
- C. Bromocriptine (Parlodel)
- D. Ranitidine (Zanta
Correct Answer: B
Rationale: The correct answer is B: Citric acid (Bicitr). Citric acid helps decrease the acidity of gastric contents, reducing the risk of aspiration during general anesthesia. Citric acid works as an antacid and helps neutralize stomach acid, which can help prevent complications during surgery.
Incorrect choices:
A: This choice is incorrect because it does not address the prevention of aspiration of gastric contents.
C: Bromocriptine is a medication used to treat conditions like hyperprolactinemia and Parkinson's disease. It is not indicated for preventing aspiration during surgery.
D: Ranitidine is an H2 blocker used to reduce stomach acid production. While it can help with heartburn and acid reflux, it is not typically used to prevent aspiration during surgery.