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When assessing a prenatal client at follow-up prenatal visits during the second trimester, the nurse should anticipate which assessments to be performed at each visit? Select all that apply.
- A. Cervical examination
- B. Weight, height, BMI
- C. Fetal ultrasound
- D. Fundal height
Correct Answer: B
Rationale: The correct answer is B: Weight, height, BMI. During each second-trimester prenatal visit, it is essential to monitor the client's weight, height, and BMI to ensure appropriate maternal and fetal health. Weight gain is a crucial indicator of fetal growth and maternal well-being. Height and BMI can provide insights into the client's nutritional status and overall health.
Explanation of why other choices are incorrect:
A: Cervical examination is typically not performed routinely during second-trimester prenatal visits unless there are specific concerns such as preterm labor risk.
C: Fetal ultrasound is usually scheduled at specific times during pregnancy, not necessarily at every second-trimester visit.
D: Fundal height measurement is important, but it is usually performed starting in the second trimester to assess fetal growth and position, not necessarily at every visit.
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What medication is used for cervical ripening?
- A. amniotomy
- B. Hemabate
- C. misoprostol
- D. progesterone
Correct Answer: C
Rationale: The correct answer is C: misoprostol. Misoprostol is used for cervical ripening in obstetrics due to its ability to soften and dilate the cervix, making it favorable for induction of labor. It is a prostaglandin E1 analogue that helps prepare the cervix for childbirth. Amniotomy (A) is the artificial rupture of membranes and does not directly aid in cervical ripening. Hemabate (B) is a medication used to treat postpartum hemorrhage, not for cervical ripening. Progesterone (D) is a hormone that helps maintain pregnancy and is not used for cervical ripening.
A patient who is expecting her first baby tells the nurse, “I am afraid of the whole birth experience and plan to ask the doctor for a cesarean delivery.” Which response by the nurse is most appropriate?
- A. I will get you some material about how labor pain is managed.
- B. Most women avoid cesarean births unless it is an emergency.
- C. I suggest you talk with the physician and get another opinion.
- D. Cesarean will cause you issues with additional pregnancies.
Correct Answer: B
Rationale: The correct answer is B: Most women avoid cesarean births unless it is an emergency.
Rationale:
1. Cesarean delivery is a major surgery with potential risks and longer recovery time compared to vaginal birth.
2. Most women opt for vaginal birth unless there are medical reasons necessitating a cesarean section.
3. It is important for the nurse to educate the patient on the benefits of vaginal birth and address her fears about the birth experience.
4. Encouraging the patient to consider vaginal birth unless there is a medical emergency aligns with best practices in obstetric care.
Summary:
- Choice A is incorrect because focusing solely on pain management may not address the patient's underlying fear of the birth experience.
- Choice C is incorrect as seeking another opinion may not be necessary if the patient's concerns can be addressed through education and counseling.
- Choice D is incorrect as not all cesarean deliveries lead to complications in subsequent pregnancies.
Decelerations that mirror the contractions are present with each contraction on the monitor strip of a multipara who received epidural anesthesia 20 minutes ago. The nurse should
- A. maintain the normal assessment routine
- B. administer O at 8 to 10 L/minute by face mask.
- C. increase the IV flow rate from 125 to 150 mL/hour.
- D. assess the maternal blood pressure for a systolic pressure below 100 mm Hg.
Correct Answer: A
Rationale: The correct answer is A: maintain the normal assessment routine. Decelerations mirroring contractions in a multipara with epidural anesthesia likely indicate normal physiologic response to labor. There is no indication of fetal distress. Administering O2 (B) is unnecessary as there is no indication of maternal hypoxemia. Increasing IV flow rate (C) is not necessary if there are no signs of hypovolemia. Assessing maternal blood pressure (D) for hypotension is not relevant without other signs of maternal compromise. Maintaining the normal assessment routine ensures ongoing monitoring and evaluation of both mother and baby without unnecessary interventions.
The nurse is reviewing an electronic fetal monitor tracing from a patient in active labor and notes the fetal heart rate gradually drops to 20 beats per minute (bpm) below the baseline and returns to the baseline well after the completion of the patient's contractions. How will the nurse document these findings?
- A. Late decelerations
- B. Early decelerations
- C. Variable decelerations
- D. Proximal decelerations
Correct Answer: B
Rationale: The correct answer is B: Early decelerations. Early decelerations occur in response to fetal head compression during contractions, resulting in a gradual decrease in the fetal heart rate that mirrors the timing of contractions. In this scenario, the fetal heart rate drops to 20 bpm below the baseline during contractions and returns to baseline after contractions, indicating a benign pattern. Late decelerations (choice A) occur after the peak of the contraction and are associated with uteroplacental insufficiency. Variable decelerations (choice C) are abrupt decreases in fetal heart rate without a consistent timing in relation to contractions, often due to cord compression. Proximal decelerations (choice D) are not a recognized classification of decelerations in fetal monitoring.
The nurse is instructing a nursing student on the application of fetal monitoring devices. Which method of assessing the fetal heart rate requires the use of a gel?
- A. Doppler
- B. Fetoscope
- C. Scalp electrode
- D. Tocodynamometer
Correct Answer: A
Rationale: The correct answer is A: Doppler. Doppler requires the use of a gel to enhance the transmission of sound waves for accurate assessment of the fetal heart rate. Gel helps to eliminate air between the Doppler probe and the skin, improving signal quality. Fetoscope (B) is a direct listening device; Scalp electrode (C) and Tocodynamometer (D) do not require gel for fetal heart rate assessment.