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The nurse is preparing to administer a vaginal prostaglandin preparation to ripen the cervix of her patient. With which patient should the nurse question the use of vaginal prostaglandin as a cervical ripening agent?
- A. The patient who has a Bishop's score of 5
- B. The patient who is at 42 weeks of gestation
- C. The patient who had a previous low transverse cesarean birth
- D. The patient who had previous surgery in the upper uterus
Correct Answer: D
Rationale: The correct answer is D because a patient with previous surgery in the upper uterus is at risk for uterine rupture with prostaglandin use. Previous surgery in the upper uterus may weaken the uterine wall, increasing the risk of complications such as uterine rupture during cervical ripening.
A: Bishop's score of 5 indicates a moderate readiness for induction, making vaginal prostaglandin appropriate.
B: 42 weeks of gestation is considered post-term, where cervical ripening is often needed.
C: Previous low transverse cesarean birth is not a contraindication for prostaglandin use for cervical ripening.
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The nurse is teaching a childbirth education class. Which information regarding excessive pain in labor should the nurse include in the session?
- A. It usually results in a more rapid labor.
- B. It has no effect on the outcome of labor.
- C. It is considered to be a normal occurrenc
- D. It may result in decreased placental perfusion.
Correct Answer: D
Rationale: The correct answer is D because excessive pain in labor can lead to increased maternal stress, which may result in decreased placental perfusion, compromising oxygen and nutrient delivery to the fetus. This can have serious implications for the baby's well-being. Choices A, B, and C are incorrect because excessive pain in labor does not necessarily lead to a more rapid labor, has an effect on the labor outcome by potentially impacting placental perfusion, and is not considered a normal occurrence that should be disregarded.
A nursing priority during admission of a laboring patient who has not had prenatal care is
- A. obtaining admission labs.
- B. identifying labor risk factors.
- C. discussing her birth plan choices.
- D. explaining importance of prenatal car
Correct Answer: B
Rationale: The correct answer is B: identifying labor risk factors. This is a priority because it helps in assessing potential complications and planning appropriate care. Obtaining admission labs (A) can be important but not the top priority. Discussing birth plan choices (C) can wait until after assessing risk factors. Explaining the importance of prenatal care (D) is not the immediate concern during labor admission. Identifying labor risk factors is crucial for ensuring the safety and well-being of both the mother and the baby.
Which assessment finding is an indication of hemorrhage in the recently delivered postpartum patient?
- A. Elevated pulse rate
- B. Elevated blood pressure
- C. Firm fundus at the midline
- D. Saturation of two perineal pads in 4 hours
Correct Answer: D
Rationale: The correct answer is D. Saturation of two perineal pads in 4 hours is an indication of hemorrhage postpartum. This is because excessive bleeding after delivery can lead to soaking through pads quickly. A: Elevated pulse rate can be a sign of shock but not specific to hemorrhage. B: Elevated blood pressure is not a typical sign of hemorrhage. C: A firm fundus at the midline is a normal finding postpartum and not indicative of hemorrhage.
You are preparing a patient for epidural placement by a nurse anesthetist in the LDR. Which interventions should be included in the plan of care? (Select all that apply.)
- A. Administer a bolus of 500 to 1000 mL of D normal saline prior to catheter placement.
- B. Have ephedrine availableN aUt bR eSdsI idNeG duTrB in. g C caOthM eter placement.
- C. Monitor blood pressure of patient frequently during catheter insertion and for the first 15 minutes of epidural administration.
- D. Insert a Foley catheter prior to epidural catheter placement.
Correct Answer: A
Rationale: The correct answer is A because administering a bolus of 500 to 1000 mL of D5 normal saline prior to catheter placement helps prevent hypotension, a common side effect of epidural anesthesia. This bolus helps maintain adequate fluid volume, which is crucial for hemodynamic stability during the procedure.
Choice B is incorrect because having ephedrine available is not a necessary intervention for preparing a patient for epidural placement.
Choice C is incorrect because while monitoring blood pressure is important during epidural administration, it should be done continuously rather than just for the first 15 minutes.
Choice D is incorrect because inserting a Foley catheter is not a routine intervention for epidural catheter placement and is not directly related to the procedure's success or safety.
Nausea and vomiting are common discomforts in labor. When treating with promethazine, what must the nurse do when administering this medication?
- A. Administer subcutaneously.
- B. Never administer with an opioid.
- C. Dilute before IV administration.
- D. Never administer in first stage labor.
Correct Answer: C
Rationale: The correct answer is C: Dilute before IV administration. Promethazine is a vesicant and can cause tissue damage if not properly diluted before IV administration. Diluting the medication helps reduce the risk of phlebitis and tissue irritation. Administering it subcutaneously (A) can cause pain and irritation at the injection site. Administering with an opioid (B) can increase the risk of respiratory depression. Administering promethazine in first stage labor (D) is generally safe, but diluting before IV administration is still necessary to prevent adverse effects.