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

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

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

"No, it can initiate premature uterine contractions."

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

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

ct. is showing signs of preeclampsia

HTN

 proteinuria

edema

very high HTN

 visual disturbances

failing kidneys

elevated liver enzymes.

Pre-eclampsia can evolve into HELLP.

What are the symptoms of HELLP?

hemolysis (H)

elevated liver enzymes (EL)

low platelet count (LP)

Flushing

Nausea

Vomiting

Palpitations

Headache

General muscle weakness

Lethargy

Constipation

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.

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

Why is magnesium sulfate used in treating preterm labor?

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

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.

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

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.

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

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.

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

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.

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

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

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

checking for the umbilical cord around the baby's neck

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

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

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.

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

movements of the fetus during labor and delivery

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

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

transitional phase

transition is 8-10 cm

active is 4-7 cm

latent is 0-3 cm

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.

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

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

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

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

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

This rate is considered fetal tachycadia if what occurs?

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?

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

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)

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.

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

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

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.