Maternal Monitoring During Labor

Maternal Monitoring During Labor Related

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The nurse is caring for a pregnant patient who is 35 weeks gestation and reports sharp abdominal pain and decreased fetal movement. What is the nurse's priority action?

  • A. Encourage the patient to drink water and rest in a comfortable position.
  • B. Call the healthcare provider immediately and prepare for further assessment.
  • C. Monitor the fetal heart rate and perform a nonstress test.
  • D. Ask the patient to lie on her left side and wait for symptoms to resolve.
Correct Answer: B

Rationale: The correct answer is B: Call the healthcare provider immediately and prepare for further assessment. This is the priority action because sharp abdominal pain and decreased fetal movement at 35 weeks gestation could indicate a serious complication such as placental abruption or fetal distress. Calling the healthcare provider promptly allows for timely intervention and assessment to ensure the safety of both the mother and the baby. Encouraging the patient to drink water and rest (choice A) may not address the underlying issue. Monitoring fetal heart rate and performing a nonstress test (choice C) may be important but not as immediate as contacting the healthcare provider. Asking the patient to lie on her left side and wait for symptoms to resolve (choice D) delays necessary medical evaluation and intervention.

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A nurse is preparing a laboring person for an epidural. What is the most important intervention before the procedure?

  • A. ensure informed consent
  • B. assist with proper positioning
  • C. check for allergies to anesthesia
  • D. educate on wound care
Correct Answer: C

Rationale: The correct answer is C: check for allergies to anesthesia. Before administering an epidural, it is crucial to check for any allergies to anesthesia to prevent potential allergic reactions. This step ensures the safety and well-being of the laboring person. Informed consent (choice A) is important but not the most critical step before an epidural. Proper positioning (choice B) is essential during the procedure but not the top priority before it. Educating on wound care (choice D) is not directly relevant to preparing for an epidural.

The nurse is providing education to a pregnant patient who is experiencing nausea and vomiting during pregnancy. Which of the following interventions should the nurse recommend?

  • A. Increase fluid intake with large amounts of water at once.
  • B. Eat small, frequent meals and avoid greasy foods.
  • C. Take over-the-counter anti-nausea medications without consulting a doctor.
  • D. Lie flat on your back immediately after eating to prevent reflux.
Correct Answer: B

Rationale: The correct answer is B because eating small, frequent meals and avoiding greasy foods can help manage nausea and vomiting during pregnancy by preventing the stomach from becoming too full or empty. Large amounts of water at once (choice A) can worsen nausea. Taking anti-nausea medications without consulting a doctor (choice C) can be unsafe during pregnancy. Lying flat on your back after eating (choice D) can increase the risk of acid reflux.

Why is pregnancy planning important for women of childbearing age?

  • A. Much organogenesis occurs before the missed period
  • B. Insurance preapproval is required
  • C. No more than 3 pregnancies are recommended
  • D. Pregnancies less than 2 years apart stress the cardiovascular system
Correct Answer: A

Rationale: Organogenesis occurs early in pregnancy, often before a missed period, making early intervention critical for fetal health.

A pregnant person in the first stage of labor experiences rupture of membranes. What is the nurse's priority action?

  • A. Administer an epidural for pain relief.
  • B. Start an IV line and administer antibiotics.
  • C. Document the FHR and time and characteristics of the amniotic fluid.
  • D. Prepare for immediate delivery.
Correct Answer: C

Rationale: The correct answer is C because documenting the fetal heart rate (FHR) and characteristics of amniotic fluid is crucial to assess fetal well-being and monitor for signs of distress. This information helps guide further management decisions. Administering an epidural (A) is not the priority at this stage. Starting an IV line and administering antibiotics (B) may be needed later but not the immediate priority. Preparing for immediate delivery (D) is premature without assessing the fetal status first.

A nurse is assessing a laboring person who is receiving oxytocin for labor induction. What is the most important intervention to prevent uterine hyperstimulation?

  • A. monitor fetal heart rate
  • B. increase fetal monitoring
  • C. administer an epidural
  • D. monitor contractions
Correct Answer: B

Rationale: The correct answer is B: increase fetal monitoring. Monitoring the fetus closely is crucial to detect signs of uterine hyperstimulation, such as non-reassuring fetal heart rate patterns. This allows for timely interventions to prevent fetal distress or hypoxia. Monitoring contractions (choice D) is important but does not directly address fetal well-being. Administering an epidural (choice C) may help manage pain but does not prevent uterine hyperstimulation. While monitoring fetal heart rate (choice A) is important, increasing the frequency of monitoring (choice B) is more specific to detecting complications related to oxytocin-induced uterine hyperstimulation.

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