NUR 221 Exam 2 Questions with Correct Answers Verified by Experts| Latest Update
Nursing interventions for variable decelerations The usual priority is as follows: 1.
Discontinue oxytocin if infusing.
2. Change maternal position (side to side, knee chest).
3. Administer oxygen at 10 L/min by nonrebreather face mask.
4. Notify physician or nurse-midwife.
5. Assist with vaginal or speculum examination to assess for cord prolapse.
6. Assist with amnioinfusion if ordered.
7. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected.
Prolonged deceleration A visually apparent decrease (may be either gradual or abrupt) in
FHR of at least 15 beats/min below the baseline and lasting more than 2 minutes but less than
10 minutes
duration time from beginning of a contraction to the end of same contraction
Frequency time from beginning of one contraction to the beginning of the next contraction
Category I FHR Normal.
- baseline rate 110-116 bpm
- baseline FHR variablility: moderate
- late or variable decelerations: absent
- early decelerations: present or absent
Category II FHR Category II FHR tracings include all FHR tracings not categorized as category
I or category III. Examples of category II tracings include any of the following: •
Baseline rate • Bradycardia not accompanied by absent baseline variability • Tachycardia •
Baseline FHR variability • Minimal baseline variability • Absent baseline variability not
accompanied by recurrent decelerations • Marked baseline variability • Accelerations • No
,acceleration produced in response to fetal stimulation • Periodic or episodic decelerations •
Recurrent variable decelerations accompanied by minimal or moderate baseline variability •
Prolonged decelerations (≥2 minutes but <10 minutes) • Recurrent late decelerations with
moderate baseline variability • Variable decelerations with other characteristics such as slow
return to baseline, "overshoots," or "shoulders"
Category III FHR Category III FHR tracings include the following: • Absent baseline variability
and any of the following: • Recurrent late decelerations • Recurrent variable decelerations •
Bradycardia • Sinusoidal pattern
Labetalol Beta Blocker used to treat Hypertension, and chest pain by slowing the heart rate
and opening up blood vessels to improve blood flow and lower blood pressure. Taken PO. no
more than 80mg a dose not to exceed 300mg/day side effects include; dizziness, tingling scalp
or skin, lightheadedness, excessive tiredness, headache, upset stomach, stuffy nose. serious
effects; SOB or wheezing, swelling of feet and lower legs, sudden weight gain, chest pain,
CANNOT give to people chronic heart failure, congestive heart failure or asthma.
Stadol (butorphanol tartrate)
opiate agonist-antagonist
don't give to narcotic - dependent mothers - will cause withdrawal used to treat moderate to
severe pain, used as part of anesthesia for surgery, or during early labor (if childbirth is
expected to be more than 4 hours away) given IV small doses 1 to 2 mg. is also a sedative.
Nubain (Nalbuphine) -Narcotic. Kicks in within 2-3 minutes. Lasts 10 or so hours.
-Pain relief and relaxation during labor; labor pain; postoperative pain after C-section; can
precipitate withdrawal symptoms if pt has opioid dependency
Hydrolazine vasodilator, Peripheral arterioles: to decrease muscle tone, decrease peripheral
resistance; hypothalamus and medullary vasomotor center for minor decrease in sympathetic
tone. Maternal effects;Headache, flushing, palpitations, tachycardia, some decrease in
uteroplacental blood flow, increase in heart rate and cardiac output, increase in oxygen
consumption, nausea and vomiting. Fetal effects: Tachycardia; late decelerations and
bradycardia if maternal diastolic pressure <90 mm Hg. Nursing indications: Assess for effects of
, medication; alert woman (family) to expected effects of medication; assess blood pressure
frequently because precipitous drop can lead to shock and perhaps placental abruption; if
giving multiple doses, wait at least 20 minutes after the first dose is given to administer an
additional dose to allow time to assess the effects of the initial dose; assess urinary output;
maintain bed rest in lateral position with side rails up; use with caution in presence of maternal
tachycardia.
Duramorph, Astramorph morphine sulfate
opioid analgesic CII used in spinal and epidural anesthesia
Ibuprofen (Motrin) Nonsteroidal Anti-inflammatory
Norco (hydrocodone/APAP) Narcotic analgesic combo
moderate to severe pain
Pitocin (oxytocin) -Stimulate uterine smooth muscle; induce labor, control post-partum
bleeding.
-S/E: seizure, hypotension, increased uterine motility, painful contractions, decreased uterine
blood flow, hyponatremia.
↑BP
-Titrate 1 to 2 mU in 3 ml of fluids uterine rupture, severe hypoxia, Tachysystolie raise every 20-
30 goal contraction 2-3 min.
Cytotec induces labor, PGE1 is used for preinduction cervical ripening (ripen the cervix
before oxytocin induction of labor when the Bishop score is 4 or less) and to induce labor or
abortion (abortifacient agent); it has not yet been approved by the FDA for cervical ripening or
labor induction (i.e., this is an off-label use for obstetrics). • It should not be used if the woman
has a history of previous cesarean birth or other major uterine surgery. Misoprostol is available
either as a 100- or a 200-mcg tablet. Therefore, tablets must be broken to prepare the correct
dose. This preparation should take place in the pharmacy to ensure accurate doses. •
Recommended initial dose is 25 mcg. Insert intravaginally into the posterior vaginal fornix using
the tips of index and middle fingers without the use of a lubricant. Repeat every 4 hours or until
Nursing interventions for variable decelerations The usual priority is as follows: 1.
Discontinue oxytocin if infusing.
2. Change maternal position (side to side, knee chest).
3. Administer oxygen at 10 L/min by nonrebreather face mask.
4. Notify physician or nurse-midwife.
5. Assist with vaginal or speculum examination to assess for cord prolapse.
6. Assist with amnioinfusion if ordered.
7. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected.
Prolonged deceleration A visually apparent decrease (may be either gradual or abrupt) in
FHR of at least 15 beats/min below the baseline and lasting more than 2 minutes but less than
10 minutes
duration time from beginning of a contraction to the end of same contraction
Frequency time from beginning of one contraction to the beginning of the next contraction
Category I FHR Normal.
- baseline rate 110-116 bpm
- baseline FHR variablility: moderate
- late or variable decelerations: absent
- early decelerations: present or absent
Category II FHR Category II FHR tracings include all FHR tracings not categorized as category
I or category III. Examples of category II tracings include any of the following: •
Baseline rate • Bradycardia not accompanied by absent baseline variability • Tachycardia •
Baseline FHR variability • Minimal baseline variability • Absent baseline variability not
accompanied by recurrent decelerations • Marked baseline variability • Accelerations • No
,acceleration produced in response to fetal stimulation • Periodic or episodic decelerations •
Recurrent variable decelerations accompanied by minimal or moderate baseline variability •
Prolonged decelerations (≥2 minutes but <10 minutes) • Recurrent late decelerations with
moderate baseline variability • Variable decelerations with other characteristics such as slow
return to baseline, "overshoots," or "shoulders"
Category III FHR Category III FHR tracings include the following: • Absent baseline variability
and any of the following: • Recurrent late decelerations • Recurrent variable decelerations •
Bradycardia • Sinusoidal pattern
Labetalol Beta Blocker used to treat Hypertension, and chest pain by slowing the heart rate
and opening up blood vessels to improve blood flow and lower blood pressure. Taken PO. no
more than 80mg a dose not to exceed 300mg/day side effects include; dizziness, tingling scalp
or skin, lightheadedness, excessive tiredness, headache, upset stomach, stuffy nose. serious
effects; SOB or wheezing, swelling of feet and lower legs, sudden weight gain, chest pain,
CANNOT give to people chronic heart failure, congestive heart failure or asthma.
Stadol (butorphanol tartrate)
opiate agonist-antagonist
don't give to narcotic - dependent mothers - will cause withdrawal used to treat moderate to
severe pain, used as part of anesthesia for surgery, or during early labor (if childbirth is
expected to be more than 4 hours away) given IV small doses 1 to 2 mg. is also a sedative.
Nubain (Nalbuphine) -Narcotic. Kicks in within 2-3 minutes. Lasts 10 or so hours.
-Pain relief and relaxation during labor; labor pain; postoperative pain after C-section; can
precipitate withdrawal symptoms if pt has opioid dependency
Hydrolazine vasodilator, Peripheral arterioles: to decrease muscle tone, decrease peripheral
resistance; hypothalamus and medullary vasomotor center for minor decrease in sympathetic
tone. Maternal effects;Headache, flushing, palpitations, tachycardia, some decrease in
uteroplacental blood flow, increase in heart rate and cardiac output, increase in oxygen
consumption, nausea and vomiting. Fetal effects: Tachycardia; late decelerations and
bradycardia if maternal diastolic pressure <90 mm Hg. Nursing indications: Assess for effects of
, medication; alert woman (family) to expected effects of medication; assess blood pressure
frequently because precipitous drop can lead to shock and perhaps placental abruption; if
giving multiple doses, wait at least 20 minutes after the first dose is given to administer an
additional dose to allow time to assess the effects of the initial dose; assess urinary output;
maintain bed rest in lateral position with side rails up; use with caution in presence of maternal
tachycardia.
Duramorph, Astramorph morphine sulfate
opioid analgesic CII used in spinal and epidural anesthesia
Ibuprofen (Motrin) Nonsteroidal Anti-inflammatory
Norco (hydrocodone/APAP) Narcotic analgesic combo
moderate to severe pain
Pitocin (oxytocin) -Stimulate uterine smooth muscle; induce labor, control post-partum
bleeding.
-S/E: seizure, hypotension, increased uterine motility, painful contractions, decreased uterine
blood flow, hyponatremia.
↑BP
-Titrate 1 to 2 mU in 3 ml of fluids uterine rupture, severe hypoxia, Tachysystolie raise every 20-
30 goal contraction 2-3 min.
Cytotec induces labor, PGE1 is used for preinduction cervical ripening (ripen the cervix
before oxytocin induction of labor when the Bishop score is 4 or less) and to induce labor or
abortion (abortifacient agent); it has not yet been approved by the FDA for cervical ripening or
labor induction (i.e., this is an off-label use for obstetrics). • It should not be used if the woman
has a history of previous cesarean birth or other major uterine surgery. Misoprostol is available
either as a 100- or a 200-mcg tablet. Therefore, tablets must be broken to prepare the correct
dose. This preparation should take place in the pharmacy to ensure accurate doses. •
Recommended initial dose is 25 mcg. Insert intravaginally into the posterior vaginal fornix using
the tips of index and middle fingers without the use of a lubricant. Repeat every 4 hours or until
