Chapter 18 - Prioritization, Delegation, and Assignment Q&A 100% Verified 2023

A 30-year-old woman with type 1 diabetes mellitus comes to the clinic for preconception care. What is the *priority* education for her at this time? •Her insulin requirements will likely increase during the second and third trimesters of pregnancy •Infants of mothers with diabetes can be macrosomic, which can result in more difficult delivery and higher likelihood of cesarean section •Breast feeding is highly recommended, and insulin use is not a contraindication •Achievement of optimal glycemic control at this time is of utmost importance in preventing congenital anomalies - •Achievement of optimal glycemic control at this time is of utmost importance in preventing congenital anomalies •The incidence of congenital anomalies is three times higher in the offspring of women with diabetes. Good glycemic control during preconception and early pregnancy significantly reduces this risk and would be the highest priority message to this patient at this point. The other responses are correct but are not of greatest importance at this time. Which task could be appropriately delegated to the unlicensed assistive personnel (UAP) working with the nurse at the obstetric clinic? •Checking the blood pressure of a patient who is 36 weeks' pregnant and reports a headache •Removing the adhesive skin closure strips of a patient who had a cesarean section 2 weeks ago •Giving community resource information and emergency numbers to a prenatal patient who may be experiencing domestic violence •Dispensing a breast pump with instruction to a lactating patient having trouble with milk supply 4 weeks postpartum - •Checking the blood pressure of a patient who is 36 weeks' pregnant and reports a headache •The UAP can check the blood pressure of this patient and report it to the RN. The RN would include this information in her full assessment of the patient, who may be showing signs of preeclampsia. The other tasks listed require nursing assessment, analysis, and planning and should be performed by the RN. Provision of accurate and supportive education about breast feeding and breast pumping supports the Perinatal Core Measure of increasing the percentage of women who exclusively breast-feed. Several patients have just come into the obstetric triage unit. Which patient should the nurse assess *first*? •A 17-year-old gravida 1, para 0 (G1P0) woman at 40 weeks' gestation with contractions every 6 minutes who is crying loudly and is surrounded by anxious family members •A 22-year-old G3P2 woman at 38 weeks' gestation with contractions every 3 minutes who is requesting to go to the bathroom to have a bowel movement •A 32-year-old G4P3 woman at 27 weeks' gestation who noted vaginal bleeding today after intercourse •A 27-year-old G2P1 woman at 37 weeks' gestation who experienced spontaneous rupture of membranes 30 minutes ago but feels no contractions - •A 22-year-old G3P2 woman at 38 weeks' gestation with contractions every 3 minutes who is requesting to go to the bathroom to have a bowel movement •A multiparous patient in active labor with an urge to have a bowel movement will probably give birth imminently. She needs to be the first assessed, the health care provider must be notified immediately, and she must be moved to a safe location for the birth. She should not be allowed up to the bathroom at this time. The other patients all have needs requiring prompt assessment, but the imminent birth takes priority. Vaginal bleeding after intercourse could be caused by cervical irritation or a vaginal infection or could have a more serious cause such as placenta previa. This patient should be the second one assessed. A 19-year-old gravida 1, para 0 patient at 40 weeks' gestation who is in labor is being treated with magnesium sulfate for seizure prophylaxis in preeclampsia. Which are *priority* assessments with this medication? *Select all that apply.* •Check deep tendon reflexes •Observe for vaginal bleeding •Check the respiratory rate •Note the urine output •Monitor for calf pain - •Check deep tendon reflexes •Check the respiratory rate •Note the urine output •Magnesium sulfate toxicity can cause fatal cardiovascular events or respiratory depression or arrest, so monitoring of respiratory rate is of utmost importance. The drug is excreted by the kidneys, and therefore monitoring for adequate urine output is essential. Deep tendon reflexes disappear when serum magnesium is reaching a toxic level. Vaginal bleeding is not associated with magnesium sulfate use. Calf pain can be a sign of a deep vein thrombosis but is not associated with magnesium sulfate therapy. Which action would *best* demonstrate evidence-based nursing practice in the care of a patient who is 1 day postpartum and reporting nipple soreness while breast feeding? •Give the baby a bottle after 5 minutes of nursing to allow soreness to resolve •Assess the mother-baby couplet for nursing position and latch and correct as indicated •Advise the use of a breast pump until nipple soreness resolves •Advise alternating breast and bottle feedings to avoid excess sucking at the nipple - •Assess the motherbaby couplet for nursing position and latch and correct as indicated •It is recommended to avoid artificial nipples and pacifiers while establishing breast feeding unless medically indicated. Improper latch and position are common causes of nipple soreness and can be corrected with assessment and assistance to the mother. This practice supports the Perinatal Core Measure of increasing the percentage of newborns who are fed breast milk only. A 24-year-old gravida 2, para 1 woman is being admitted in active labor at 39 weeks' gestation. What prenatal data would be *most* important for the nurse to address at this time?...