A nurse is preparing to perform a vacuum extraction for a client who has an obstructed labor due to a face presentation.
Which of the following actions should the nurse take? (Select all that apply.).
Obtain informed consent from the client
Administer prophylactic antibiotics to the client
Apply traction to the vacuum cup during contractions
Release the vacuum cup after every three pulls
Monitor the fetal heart rate continuously.
Correct Answer : A,E
The nurse should obtain informed consent from the client before performing a vacuum extraction, as it is an operative vaginal delivery that carries some risks for the mother and the baby. The nurse should also monitor the fetal heart rate continuously during the procedure, as vacuum extraction can cause fetal distress or scalp injuries.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
This statement indicates a need for further teaching because drinking fluids does not prevent polyhydramnios, which is a condition of having too much amniotic fluid around the baby.In fact, drinking too much fluid may worsen the condition by increasing the blood volume and urine output of the mother.
Correct Answer is ["A","E"]
Explanation
The nurse should obtain informed consent from the client before performing a vacuum extraction, as it is an operative vaginal delivery that carries some risks for the mother and the baby.The nurse should also monitor the fetal heart rate continuously during the procedure, as vacuum extraction can cause fetal distress or scalp injuries.
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