Shared Flashcard Set

Details

NCLEX 3000 - OB Ante, Intrapartum, Preeclampsia
Questions, Antepartum, Intrapartum, Preeclampsia, Meds
39
Nursing
Undergraduate 4
12/10/2009

Additional Nursing Flashcards

 


 

Cards

Term

A client with pregnancy-induced hypertension (PIH) receives magnesium sulfate, 4 g in 50% solution I.V. over 20 minutes. What is the purpose of administering magnesium sulfate to this client.

 

a. to lower blood pressure

b. to prevent seizures

c. to inhibit labor

d. to block dopamine receptors

Definition

B. Mag sulfate is given to prevent and control seizures in clients with PIG. Mag sulfate has no effect on labor or dopamine receptors.

 

Beta adrenergic blockers and centrally acting blockers are used ot lower blood pressure

Term

At 15 weeks' gestations, a client is scheduled for a serum alpha-fetoprotein (AFP) test. Which maternal hx finding best explains the need for this test?

 

a. family hx of spina bifida in a sister

b. family hx of down's syndrome on father's side

c. hx of gestational diabetes during a previous pregnancy

d. hx of spotting during the 1st month of the current pregnancy

Definition
A. An abnormally high AFP level in the client's serum or amniotic fluid suggests a neural tube defect such as spina bifida. A family hx of such defects increase the risk of carrying a fetus with a nerual tube defect. Althrough a low AFP level has been correlated with Down's, it isn't the most accurate indicator. No known correlations exists b/t g. diabetes or early vaginal spotting and a certain AFP level at 15 to 20 weeks' gestation.
Term
A pregnant client asks the nurse whether she can take castor oil for her constipation. How should a nurse respond?
Definition

"No, it can initiate premature uterine contractions."

 

Term

Initial client assessment information includes:

BP - 160/110 mmHg, Pulse - 88 bpm, RR - 22 bpm, reflexes +3/+4 w/ 2 beat clonus. Urine specimen reveals +3 negative sugar, & ketones. 

Based on these findings, the nurse would expect the client to have which complaints?

 

a. headache, blurred vision, facial and extremity swelling

b. abdominal pain, urinary frequency, and pedal edema

c. diaphoresis, nystagmus, and dizziness

d. lethargy, chest pain, and SOB

Definition

a. headache, blurred vision, and facial and extremity swelling

 

ct. is showing signs of preeclampsia

Term
Pre-eclampsia (aka toxemia and PIH) consists of what symptoms?
Definition

HTN

 proteinuria

edema

Term
Pre-eclampsia can become severe pre-eclampsia with what symptoms?
Definition

very high HTN

 visual disturbances

failing kidneys

elevated liver enzymes.

Term
Pre-eclamsia can evolve into eclampsia with what fatal symptom?
Definition
Seizures
Term

 

Pre-eclampsia can evolve into HELLP.

What are the symptoms of HELLP?

Definition

hemolysis (H)

elevated liver enzymes (EL)

low platelet count (LP)

Term
Why is magnesium sulfate used for pre-eclampsia and eclampsia?
Definition
to prevent severe pre-eclampsia from becoming eclampsia
Term
What are some of the most common side effects of magnesium sulfate?
Definition

Flushing

Nausea

Vomiting

Palpitations

Headache

General muscle weakness

Lethargy

Constipation

Term

What are some of the complications of magnesium sulfate(sometimes occurring with magnesium overdose)?


Note: Make sure kidneys are fully functioning. (By Blood Test) Severe pre-eclampsia sometimes can cause a woman's kidneys to fail, increase risk of a magnesium sulfate overdose. A blood test can check the level of magnesium in your body.

Definition

Cardiac arrest

Pulmonary edema

Chest pain

Cardiac conduction defects

Low blood pressure

Low calcium

Increased urinary calcium

Visual disturbances

Decreased bone density

Respiratory depression

Muscular hyperexcitability

Term

Why is magnesium sulfate used in treating preterm labor?

 

http://www.twinslist.org/magsulfate.html

Definition

When a woman experiences preterm labor, sometimes she is given magnesium sulfate, which is thought to relax the muscles of the uterus

 

Sometimes, a woman will then be put on a different preterm labor drug like terbutaline or nifedipine and  sent home. Some women who far from term and whose condition is precarious may be kept on mag sulfate for longer periods of time - sometimes weeks and months.

Term

When administering mag sulfate to a client with preeclampsia, the nurse understands that this drug is given to do which of the following?

 

a. prevent seizures

b. reduce blood pressure

c. slow the process of labor

d. increase diuresis

Definition

a. prevent seizures - the chemical makeup of magnesium is like calcium and will act like calcium in the body. The magnesium will block seizure activity in a hyperstimulated neurologic system by interfering with signal transmission at the neural musculature junction.

 

Reducing blood pressure, slowing labor, and increased diuresis are secondary affects of magnesium.

Term

Which of the following is the most serious adverse affect associated with oxytocin administration during labor?

 

a. tetanic contractions

b. elevated blood pressure

c. early decelerations of FHR

d. water intoxication

Definition

a. tetanic contractions - are most serious adverse effect associated with oxytocin. When tetanic contractions occur, the fetus is at high risk for hypoxia and the mother is at risk for uterine rupture.

 

The client may be at risk for pulmonary edema if large amounts of oxytocin were given. This drug can increase BP too. BUT, pulmonary edema and HTN aren't the most serious adverse effects. Early decelerations of FHR aren't associated with oxytocin.

Term

A client in labor receives epidural anesthesia. The nurse should assess carefully for which adverse reaction to the anesthetic agent?

 

a. hypotensive crisis

b. fetal tachycardia

c. renal toxicity

d. increased beat-to-beat variability in the FHR

Definition

a. hypotensive crisis - may occur after epidural anesthesia administration as the anesthetic agent spreads through the spinal canal, blocking sympathetic innervations.

 

Other s/s of hypotensive crisis with epidural anesthesia include fetal BRADYCARDIA & DECREASED beat-to-beat variability in FHR.

 

URINE RETENTION, not toxicity, may occur during postpartum period.

Term

A client is in the second stage of labor. during this stage, how frequently should the nurse assess her uterine contractions?

 

a. every 5 minutes

b. every 15 minutes

c. every 30 minutes

d. every 60 minutes

Definition
b. every 15 minutes
Term

The cervix is not completely dilated and the client has a strong urge to push. The nurse-midwife tells her not to push yet. What is the rationale for this instruction?

 

a. early pushing may cause edema and impede fetal descent

b. the nurse-midwife isn't ready to assist her

c. the fetus hasn't rotated into the proper position

d. pushing at this time may cause rupture of the membranes

Definition
A. Pushing bfore the cervix is completely dilated may cause edema and tissue damage and may impede fetal descent.
Term

The gonorrhea culture is positive in a pregnant mom. What is the significance of this finding?

 

a. may cause neural tube defect in fetus

b. may cause an eye infection in the neonate

c. may cause acute liver changes in the fetus

d. may cause anemia in neonate

Definition
b. gonorrhea in the cervix may cause neonatal eye infection during delivery
Term
The nurse is caring for a client who is in labor. The physician still isn't present. After the baby's head is delivered, which nursing intervention would be most appropriate?
Definition

checking for the umbilical cord around the baby's neck

 

If it is, it should be gently lifted over the baby's head.

Term

In the 1st stage of labor, a client with a full-term pregnancy has an electronic fetal monitor (EFM) in place. Which EFM pattern suggests adequate uteroplacental-fetal perfusion?

 

a. persistent fetal bradycardia

b. variable decelerations

c. average variability

d. late decelerations

Definition

c. average variability - 6 to 10 bpm accurately predicts adequate uteroplacental-fetal perfusion.

 

Persistant bradycardia may indicate hypoxia, arrhythmias, or umbilical cord compression. Variable decelerations suggest umbilical cord compression. Late decelerations may reflect decreased blood flow and oxygen to the intervillous spaces during contractions.

Term
What are the cardinal movements of labor?
Definition

fetal descent, flexion, internal rotation, extension, external rotation, and expulsion

 

movements of the fetus during labor and delivery

Term
If a nurse notes that the amniotic fluid is port-wine-colored, what would that indicate?
Definition
abruptio placentae
Term

The physician orders I.V. administration of oxytocin. Why must the nurse monitor the client's fluid intake and output closely during oxytocin administration?

 

a. oxytocin causes water intoxication

b. oxytocin causes excessive thirst

c. oxytocin is toxic to the kidneys

d. oxytocin has a diuretic effect

Definition

the nurse should monistor I/Os b/c prolonged oxytocin infusion make cause severe water intoxication, leading to seizures, coma, and death

 

excess thirst results fromt he work of labor and limited oral fluid intake, not oxytocin

 

oxytocin has no diuretic effects. It actuallyhas  antidiuretic effects

Term
A 32 y.o. multipara is admitted to the birthing room after her initial examination reveals her vervix to be at 8 cm., completely effaced, and at 0 station. What phase of labor is she in?
Definition

transitional phase

 

transition is 8-10 cm

active is 4-7 cm

latent is 0-3 cm

Term
Late in the 1st stage of labor, a client receives a spinal block to relieve discomfort. A short time later, her husband tells the nurse that his wife feels dizzy and is complaining of numbess around her lips. What do the client's symptoms suggest?
Definition
anesthesia overdose - dizziness, circumoral numbness, and slurred speech indicate this
Term
When should oxytocin be discontinued?
Definition
when contractions occur less than 2 minutes apart or last longer than 90 seconds
Term
What is diabetic ketoacidosis?
Definition

A complication of diabetes that occurs when (glucose) is not available as a fuel source by the body and fat is used instead.

 

Byproducts of fat breakdown, called ketones, build up in the body.

Term
What are the s/s of diabetic ketoacidosis?
Definition

Fatigue

Frequent urination or thirst for a day or more

Fruity breath (breath odor)

Mental stupor that may progress to coma

Muscle stiffness or aching

Nausea and vomiting

Rapid breathing

Shortness of breath

Term
What is the tx for diabetic ketoacidosis?
Definition

Goal: to correct the high blood glucose level by giving more insulin.

 

Goal: to replace fluids/electrolytes lost through excessive urination and vomiting.

Term

What condition would place the client at risk for disseminated intravascular coagulation? (DIC)

 

a. intrauterine fetal death

b. placenta accreta

c. dysfunctional labor

d. premature rupture of the membranes

Definition
A. Intrauterine fetal death, abruptio placentae, septic shock, and amniotic fluid embolism may trigger normal clotting mechanisms; if clotting factors are depleted, DIC may occur.
Term
A client is to have an epidural block to relieve labor pain. The nurse anticipates that the anesthesiologist will inject the anesthetic agent into the:
Definition
area between the dura mater and the ligamentum flavum in the lumbar region of the spinal column
Term

When assessing the fetal heart rate tracing, the nruse assesses the FHR at 170 bpm.

 

This rate is considered fetal tachycadia if what occurs?

Definition
Tachycardia is defined as a FHR greater than 160 bpm for more than 10 minutes
Term

When assessing a pregnant client with a hx of cardiac dysfunction, the nurse discovers that the client has been taking propranolol (Inderal) to tx HTN.

 

During labor, the nurse should stay alert for which adverse effect of this drug?

Definition
Uterine Hypertonus and Preterm Labor
Term

The physician decides to artificially rupture the membranes. Following this procedure, the nurse checks the fetal heart tones for which of the following reasons?

 

a. to determine fetal well-being

b. to assess for prolapsed cord

c. to assess fetal position

d. to prepare for an imminent delivery

Definition
B. To assess for prolapsed cord. After amniotomy, the nurse should assure that the cord isn't prolapsed and that the baby tolerated the procedure well. The most effective way to do is to check the fetal heart rate.
Term
The physician prescries etiodcaine (duranest) to a client in active labor. Why does she prescribe this over other local anesthetic agents?
Definition
Etidocaine is least likely to cross the placenta.
Term

A client is admitted to the labor and delivery department in preterm labor. To help manage preterm labor, the nurse would expect to administer:

a. ritodrine (Yutopar)

b. bromocriptine (Parlodel)

c. magnesium sulfate

d. betamethasone (Celestone)

Definition

A. Ritodrine - reduces frequency and intensity of uterine contractions by stimulating B2 receptors in the uterine smooth muscle. It is the drug of choice when trying to inhibit labor.

 

Bromocriptine is used to inhibit lactation in the postpartum period. Mag sulfate is an anticonvulsant and treats PIH HTN. Betamethasone is used to stimulate fetal pulmonary surfactant.

Term

A ct with moderate PIH is a poor candidate for regional anesthesia during labor and delivery. If she were to get this form of anesthesia, she might experience:

 

a. hypotension

b. hypertension

c. seizures

d. renal toxicity

Definition
PIH, uteroplacental perfusion may be inadequate and gas exchange may be poor. Regional anesthesia increaes the risk of hypotension resulting from sympathetic blockade, possibly cuasing fetal and maternal hypoxia.
Term

During a childbirth education class, a nurse-educator discusses pain control techniques used during labor and delivery. Which technique most effectively helps a client cope with the pain of uterine contractions?

 

a. controlled breathing

b. distraction

c. cutaneous stimulation

d. hypnosis

Definition

c. cutaneous stimulation - used by the client or coach (effleurage) creates organized, controlled sensory input that reduces local irritability. The client concentrates on the sensation of light fingertip stroking on the abdomen or back, rather than the pain of the contraction, to help counteract the perception of pain.

 

Controlled breathing is mainly used to enhance relaxation, but is less effective than cutaneous stimulation.

Term
Ritodrine and other beta-adrenergic agonists may cause what symptoms?
Definition
tachycardia, hypotension, bronchial dilation, increased plasma volume, increased CO, arrhythmias, MI, reduced urine output, restlessness, headache, n/v
Supporting users have an ad free experience!