Swift River- Maternal Newborn UPDATED
Questions and CORRECT Answers
Miranda Johnson - CORRECT ANSWER- ✔✔Educational Needs - Increased acuity
Fall Risk - Increased acuity: Related to pregnancy and changes in balance and center of
gravity.
Health change - Increased acuity: Related to active labor and change in health status.
Pain level - Increased acuity: Related to increased pain level of 7-8 out of 10.
Physiological Needs - Increased acuity: Related to active labor, increased pain, and desire for
epidural.
Sensorium Needs - Normal acuity
Miranda Johnson - CORRECT ANSWER- ✔✔Risk for Impaired Urinary Elimination
Risk for Maternal Injury
Deficient knowledge
Risk for Fall
Miranda Johnson - CORRECT ANSWER- ✔✔Scenario 1:
1. Review prenatal record
2. Witness signing of epidural
3. Initiate IV bolus per order
4. Gather epidural medications
5. Monitor patient
Scenario 2:
1. Educate patient
,2. Assess maternal and fetal wellbeing
3. Encourage repositioning
4. Reassess patient's understanding
Scenario 3:
1. Turn epidural pump off.
2. Lower HOB, elevate foot
3. Rapid infusion (bolus)
4. Apply NRB 10L
5. Consider administration of Ephedrine.
Scenario 4:
1. Continually monitor
2. Administer Ephedrine
3. Notify the charge nurse
4. Administer pre-op meds
5. Offer reassurance
Scenario 5:
1. Maintain efficient, timely
2. Thoroughly document
3. Discuss patient load
4. Always sign out
5. NEVER ASSUME ANYTHING
Carly Madison - CORRECT ANSWER- ✔✔Educational Needs - Increased acuity: Status
assessment reports she is a G1 having attended childbirth classes, but first-time mothers
require focused education and reinforcement of concepts learned.
Fall Risk - Normal acuity
, Health change - Normal acuity
Pain level - Increased acuity: Status assessment indicates a pain level of 4/10, desiring an
unmedicated birth.
Physiological Needs - Increased acuity: Status assessment indicates that the client is in labor.
Sensorium Needs - Normal acuity
Carly Madison - CORRECT ANSWER- ✔✔Acute Pain
Anxiety Related to Labor and Birthing Process
Fatigue Related to Energy Expenditure Required for Labor and Coping Skills
Impaired Comfort
Risk for Fluid Volume Deficit
Deficient Knowledge
Maternal Infection
Carly Madison - CORRECT ANSWER- ✔✔Scenario 1:
1. Offer support and explain
2. Assess the FHR
3. Place a clean, dry pad
4. Assist the HCP
5. Reassess the FHR
Scenario 2:
1. Reassure client
2. Assist woman to restroom
3. Encourage use
4. Reassess fetal heart rate
5. Document the updated
Questions and CORRECT Answers
Miranda Johnson - CORRECT ANSWER- ✔✔Educational Needs - Increased acuity
Fall Risk - Increased acuity: Related to pregnancy and changes in balance and center of
gravity.
Health change - Increased acuity: Related to active labor and change in health status.
Pain level - Increased acuity: Related to increased pain level of 7-8 out of 10.
Physiological Needs - Increased acuity: Related to active labor, increased pain, and desire for
epidural.
Sensorium Needs - Normal acuity
Miranda Johnson - CORRECT ANSWER- ✔✔Risk for Impaired Urinary Elimination
Risk for Maternal Injury
Deficient knowledge
Risk for Fall
Miranda Johnson - CORRECT ANSWER- ✔✔Scenario 1:
1. Review prenatal record
2. Witness signing of epidural
3. Initiate IV bolus per order
4. Gather epidural medications
5. Monitor patient
Scenario 2:
1. Educate patient
,2. Assess maternal and fetal wellbeing
3. Encourage repositioning
4. Reassess patient's understanding
Scenario 3:
1. Turn epidural pump off.
2. Lower HOB, elevate foot
3. Rapid infusion (bolus)
4. Apply NRB 10L
5. Consider administration of Ephedrine.
Scenario 4:
1. Continually monitor
2. Administer Ephedrine
3. Notify the charge nurse
4. Administer pre-op meds
5. Offer reassurance
Scenario 5:
1. Maintain efficient, timely
2. Thoroughly document
3. Discuss patient load
4. Always sign out
5. NEVER ASSUME ANYTHING
Carly Madison - CORRECT ANSWER- ✔✔Educational Needs - Increased acuity: Status
assessment reports she is a G1 having attended childbirth classes, but first-time mothers
require focused education and reinforcement of concepts learned.
Fall Risk - Normal acuity
, Health change - Normal acuity
Pain level - Increased acuity: Status assessment indicates a pain level of 4/10, desiring an
unmedicated birth.
Physiological Needs - Increased acuity: Status assessment indicates that the client is in labor.
Sensorium Needs - Normal acuity
Carly Madison - CORRECT ANSWER- ✔✔Acute Pain
Anxiety Related to Labor and Birthing Process
Fatigue Related to Energy Expenditure Required for Labor and Coping Skills
Impaired Comfort
Risk for Fluid Volume Deficit
Deficient Knowledge
Maternal Infection
Carly Madison - CORRECT ANSWER- ✔✔Scenario 1:
1. Offer support and explain
2. Assess the FHR
3. Place a clean, dry pad
4. Assist the HCP
5. Reassess the FHR
Scenario 2:
1. Reassure client
2. Assist woman to restroom
3. Encourage use
4. Reassess fetal heart rate
5. Document the updated
