Nursing Care During Labor & Delivery (Test 2) Questions With Complete Solution

Nursing Care During Labor & Delivery (Test 2) Questions With Complete Solution nursing assessment - Answer-upon admission to L/D: -review prenatal records; note any risk factors and areas of concern/need -obtain admission data (age, GTPAL, EDC, ROM) true vs false labor fetal activity current meds/allergies prenatal problems bloody show vs bleeding onset of labor/pattern of UC CB prep/birth plan feeding method pediatrician choice last food/fluid ingested last void/BM recent sleep patterns client/family concerns or questions physical exam physical exam data - Answer-abdominal exam (lie, presentation, fundal height, FHR, UC) EFM or FHR and UC pattern vital signs pelvic exam for dilation, effacement, station, fetal position presence of amniotic fluid, character -fern test, nitrizine, Amnisure presence of bleeding bladder status fern test - Answer-posterior vaginal swab is allowed to dry on a glass slide and then viewed with a low power microscope fern pattern is observed wide: cervical mucus thin: amniotic fluid used to indicate leaking membranes nitrazine swab - Answer-pH test used to determine if membranes have ruptured normal vaginal environment is acidic (yellow swab) amniotic fluid is much less acidic, often neutral (blue swab) AmniSure - Answer-chemical test used to determine if membranes have ruptured/leaked reads like a pregnancy dipstick 1 line = control (the test worked) 2 lines = positive for amniotic fluid Which nursing assessments should be done upon admission to labor? SATA a. current fetal activity b. due date of baby c. status of membranes d. gravida status - Answer-a, b, c, and d A laboring woman has a distended bladder. Her nurse advises her to void regularly for what reason? SATA a. a full bladder strengthens contractions b. an empty bladder facilitates descent c. an empty bladder provides for comfort d. a full bladder increases risk of hemorrhage - Answer-b and c Nursing care during Stage 1 (early labor)