Nokea
The nurse in the post-delivery unit is encouraging skin-to-skin contact for a mother and neonate after cesarean delivery. Which action, if noticed by the nurse, requires immediate intervention by the nurse?
- A. Mother is sitting up with the neonate prone on her chest.
- B. Mother is supine with the neonate prone on her chest.
- C. The neonate is prone on mother’s chest and facing to the side.
- D. Neonate is prone with mother resting in semi-Fowler’s position.
Correct Answer: B
Rationale: B is the correct answer because having the mother in a supine position with the neonate prone on her chest can potentially increase the risk of neonatal suffocation or accidental injury due to the baby slipping off. This position restricts the baby's ability to breathe properly and may lead to adverse outcomes.
A: Sitting up with the neonate prone on her chest allows for better supervision and support for the baby's breathing.
C: The neonate facing to the side is a safe position for skin-to-skin contact and breastfeeding.
D: Neonate resting in semi-Fowler's position is a safe and comfortable position that allows for proper breathing and bonding between mother and baby.
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What is a complication of uterine rupture?
- A. DIC
- B. nuchal cord
- C. polyhydramnios
- D. oligohydramnios
Correct Answer: A
Rationale: The correct answer is A: DIC (Disseminated Intravascular Coagulation). Uterine rupture can lead to severe bleeding, causing DIC. This is because the release of blood into the abdomen triggers the body's clotting system, resulting in the consumption of clotting factors and platelets. This can lead to widespread clotting in small blood vessels and ultimately result in bleeding disorders.
Summary:
- B: Nuchal cord is when the umbilical cord is wrapped around the baby's neck, not directly related to uterine rupture.
- C: Polyhydramnios is excessive amniotic fluid, not a direct complication of uterine rupture.
- D: Oligohydramnios is decreased amniotic fluid, not a direct complication of uterine rupture.
The nurse is monitoring a patient who has been in prolonged labor. Which assessment finding will result in the nurse notifying the health care provider about the development of an emergent situation requiring a cesarean delivery?
- A. Maternal blood pressure indicative of hypotension
- B. Maternal exhaustion from prolonged uterine activity
- C. Recognition of a Category II fetal heart rate pattern
- D. Increased maternal temperature related to infection
Correct Answer: C
Rationale: The correct answer is C: Recognition of a Category II fetal heart rate pattern. This indicates fetal distress and potential compromise to the baby's well-being, necessitating immediate intervention like a cesarean delivery to prevent adverse outcomes. A: Maternal hypotension may require intervention but is not an emergent indication for a cesarean section. B: Maternal exhaustion can be managed with support and rest, not an immediate indication for cesarean delivery. D: Maternal fever may indicate infection but does not necessarily require cesarean delivery unless it poses a significant risk to the baby.
What type of dystocia should the nurse prepare for if she palpates prominent ischial spines during the vaginal exam?
- A. pelvic dystocia
- B. fetal dystocia
- C. contraction dystocia
- D. uterine dystocia
Correct Answer: A
Rationale: The correct answer is A: pelvic dystocia. Prominent ischial spines indicate a contracted pelvis, which can obstruct the baby's passage during labor, leading to pelvic dystocia. Pelvic dystocia involves the bony pelvis causing difficulty in the descent of the fetus. Choices B, C, and D are incorrect because fetal dystocia refers to issues related to the fetus, contraction dystocia involves ineffective contractions, and uterine dystocia pertains to abnormalities of the uterus itself, none of which are indicated by prominent ischial spines.
When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern?
- A. Early decelerations
- B. Variable decelerations
- C. Nonperiodic accelerations
- D. Increase in baseline variability
Correct Answer: B
Rationale: The correct answer is B: Variable decelerations. When the mother's membranes rupture during active labor, variable decelerations should be observed in the fetal heart rate. This is because the rupture of membranes can lead to umbilical cord compression, causing variable decelerations in the fetal heart rate pattern. Variable decelerations are characterized by abrupt and visually apparent decreases in heart rate variability.
A: Early decelerations are usually associated with head compression during contractions and are benign.
C: Nonperiodic accelerations are not a typical pattern seen in response to ruptured membranes during labor.
D: An increase in baseline variability is a positive sign and does not specifically indicate the occurrence of variable decelerations related to umbilical cord compression.
A new client is seen at the prenatal clinic and says she thinks she is pregnant. The first day of her last menstrual period was April 1, 2014. What is her EDB?
- A. December 30, 2014
- B. January 1, 2015
- C. January 8, 2015
- D. December 8, 2014
Correct Answer: A
Rationale: The correct answer is A: December 30, 2014. To calculate the Estimated Date of Birth (EDB), you add 9 months and 7 days to the first day of the last menstrual period. In this case, April 1, 2014 + 9 months is January 1, 2015, and then adding 7 days gives December 30, 2014 as the EDB. This calculation takes into account the typical 40-week gestational period of a pregnancy. Choices B, C, and D are incorrect because they do not consider the full 40-week gestational period from the last menstrual period.