Maternal Newborn Swift River exam 2023 with 100% correct answers

Susie Smith Ms. Susie Smith, 33 y/o G2P0 at 42 weeks' gestation. She is single with a limited support system. She has just completed a Non-Stress Test (NST) which was interpreted as being Non-Reactive. Her obstetrician has now ordered an Oxytocin-Stimulated Contraction Stress Test (CST). Fetal membranes are intact. Ms. Smith also has a history of hypertension and a previous pregnancy loss at 18 weeks' gestation. She is crying and states "I can't lose another baby". External tocodynamometer and fetal ultrasound transducer remain in place from the NST. Educational Needs - Increased acuity Fall Risk - Increased acuity Health change - Increased acuity Pain level - Normal acuity Physiological Needs - Increased acuity Sensorium Needs - Normal acuity Susie Smith 33 y/o G2P0 at 42 weeks' gestation. She is single with a limited support system. She has just completed a Non-Stress Test (NST) which was interpreted as being Non-Reactive. Her obstetrician has now ordered an Oxytocin-Stimulated Contraction Stress Test (CST). Fetal membranes are intact. Ms. Smith also has a history of hypertension and a previous pregnancy loss at 18 weeks' gestation. She is crying and states "I can't lose another baby". External tocodynamometer and fetal ultrasound transducer remain in place from the NST. Physiological: Acute Pain - False Anxiety - True Bleeding - False Infection, Risk - False Nausea - False Risk for Impaired Fetal Gas Exchange - True Safety: Deficient Knowledge - True Disturbed sensory perception - False Fall, Risk for - True Impaired Maternal Infant Bonding, Risk for - False Maternal Injury, Risk for - True Risk for Ineffective Coping - True Susie Smith Scenario 1 You enter the patient's room. After washing and gloving hands, you identify yourself and the patient, Ms. Susie Smith. Assessment findings: Vital signs: BP 144/90 mmHg, P 88 bpm, R 22 breaths/minute, FHR 134 baseline with moderate variability, no accelerations noted. No visible contractions on monitor tracing. Ms. Smith is teary and asks if her baby is going to be alright. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: 1. Discuss with woman fears about baby health; offer reassurance. 2. Educate woman on oxytocin contraction stress test (CST) procedure. 3. Have woman empty her bladder. 4. Position woman in Semi-Fowlers position with left lateral tilt. 5. Reassess placement of tocodynamoneter and transducer. Susie Smith Scenario 2 Ms. Smith verbalizes understanding of purpose and process of the oxytocin Contraction Stress Test (CST). She appears much calmer and states she is ready to proceed with initiating the test. You assemble the needed supplies at her bedside; a standard concentration of 500 ml Lactated Ringer's with 30 units oxytocin is used. After washing your hands, and donning non-sterile gloves, you are ready to proceed with CST. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: 1. Assess maternal vital signs. 2. Assess FHR baseline and reactivity. 3. Assess monitor tracing for presence of contractions, palpate uterine fundus for contractions. 4. Obtain IV access with #18 gauge IV catheter and begin 1000 ml Lactated Ringer's solution at 125 ml/hour on IV pump. 5. Administer oxytocin intravenously through a secondary line connected to the main line at the proximal port with an IV pump; begin at 1 mu/min per healthcare provider prescription. Susie Smith Scenario 3 30 minutes later, the monitor tracing reveals uterine irritability, but no contractions present. Per healthcare provider order , it is time to increase the rate of the oxytocin. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED: 1. Assess contraction pattern and palpate uterine resting tone. 2. Assess fetal status. 3. Reassess maternal vital signs. 4. Increase oxytocin to 2 mu/minute per healthcare provider order. 5. Educate and reassure the client.