Nokea
The nurse is caring for the pregnant client. The nurse identifies that the use of which street drug places the client at risk for placental abruption?
- A. Heroin
- B. Marijuana
- C. Oxycodone
- D. Cocaine
Correct Answer: D
Rationale: The most commonly used drug that places the pregnant client at risk for placental abruption is cocaine. Stillbirth, preterm labor and birth, and small for gestational age are also associated with cocaine use during pregnancy. Heroin use during pregnancy is associated with intrauterine growth restriction, spontaneous abortion, preterm labor and birth, and stillbirth. Marijuana use during pregnancy is primarily associated with intrauterine growth restriction. Oxycodone (OxyContin) is synthetic morphine, and its use during pregnancy is associated with intrauterine growth restriction, spontaneous abortion, preterm labor and birth, and stillbirth.
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Which of the following is most indicative of the presence of hydatidiform mole?
- A. A blotchy brown discoloration on the face
- B. A positive Chadwick's sign
- C. The presence of ballottement
- D. A uterus that is larger than expected
Correct Answer: D
Rationale: A uterus larger than expected for gestational age is characteristic of hydatidiform mole, a gestational trophoblastic disease.
The client in labor received an epidural anesthesia 20 minutes ago. The nurse assesses that the client’s BP is 98/62 mm Hg and that the client is lying supine. What should the nurse do next?
- A. Increase the lactated Ringer’s infusion rate.
- B. Elevate the client’s legs for 2 to 3 minutes.
- C. Place the bed in 10- to 20-degree Trendelenburg.
- D. Position the client in a left side-lying position.
Correct Answer: D
Rationale: The first action is to place the client in a left side-lying position. This displaces the uterus and alleviates aortocaval compression. Increasing the infusion rate may be implemented if repositioning the client does not correct the hypotension. Elevating the client’s legs for 2 to 3 minutes is done with severe or prolonged hypertension to increase blood return from the extremities. It may be implemented after repositioning to left side, increasing the IV rate, and placing in Trendelenburg position. Placing in 10- to 20-degree Trendelenburg position is usually implemented if the BP does not increase within 1 to 2 minutes after repositioning to left side and increasing the IV flow rate.
The nurse explains that, in addition to increased blood volume, which other condition causes varicose veins during pregnancy?
- A. Impaired venous return
- B. Decreased cardiac output
- C. Altered center of gravity
- D. Impaired kidney function
Correct Answer: A
Rationale: Impaired venous return, due to the uterus compressing veins, causes varicose veins, compounded by increased blood volume.
The nurse is evaluating the 39-weeks-pregnant client who reports greenish, foul-smelling vaginal discharge. Her temperature is 101.6°F (38.7°C), and the FHR is 120 with minimal variability and no accelerations. The client’s group beta streptococcus (GBS) culture is positive. Which interventions should the nurse plan to implement? Select all that apply.
- A. Prepare for cesarean birth due to chorioamnionitis
- B. Start oxytocin for labor induction
- C. Start antibiotics as directed for the GBS infection
- D. Prepare the client for epidural anesthesia
- E. Notify the neonatologist of the client’s status
- F. Administer a cervical ripening agent
Correct Answer: A,C,D,E
Rationale: Because this client is not in labor and chorioamnionitis is possible, a cesarean birth is indicated. The client should be given antibiotics as prescribed to treat the infection. Because epidural anesthesia offers the least risk to the fetus, preparation for epidural anesthesia should begin. The pediatrician or neonatologist should be notified and available for the impending delivery. Starting oxytocin (Pitocin) would prolong the time to delivery. Administering a cervical ripening agent would prolong the time to delivery.
The client has a vaginal delivery of a full-term newborn. Immediately after delivery, the nurse assesses that the client’s perineum and labia are edematous, but she does not have an episiotomy or a perineal laceration. Which intervention should the nurse implement?
- A. Give her an ice pack to apply to the perineum.
- B. Teach her to relax her buttocks before sitting.
- C. Apply warm packs to the affected areas.
- D. Provide a plastic donut cushion for sitting.
Correct Answer: A
Rationale: If perineal edema is present, ice packs should be applied for the first 24 hours. Ice reduces edema and vulvar irritation. The client should be taught to tighten, not relax, her buttocks when sitting. This compresses the buttocks and reduces pressure on the perineum. After 24 hours, heat is recommended to increase circulation to the area. Donut cushions should be avoided because they promote separation of the buttocks and decrease venous blood flow to the area, thus increasing pain.