During the admission assessment, a laboring patient shares that her last baby was born by cesarean but she would like to try to deliver vaginally this time. Upon further discussion, the nurse learns the birth was an emergency delivery for fetal intolerance to labor. What information is the most important for the nurse to obtain?

The type of uterine incision used for the cesarean.

The client's blood type and Rh status.

The client's response to anesthesia used for the last delivery.

Lab values, especially hemoglobin and hematocrit

Answer and Explanation

The Correct Answer is A

A. The type of uterine incision used for the cesarean. This is the most important information because the type of uterine incision determines whether a trial of labor after cesarean (TOLAC) is safe. A low transverse incision is the safest and has the lowest risk of uterine rupture, while a classical (vertical) incision carries a high risk of rupture and contraindicates vaginal birth after cesarean (VBAC).

B. The client's blood type and Rh status. While blood type and Rh status are important for managing potential complications such as Rh incompatibility, they do not determine the safety of a VBAC attempt. The uterine incision type is the key factor in assessing the risk of uterine rupture.

C. The client's response to anesthesia used for the last delivery. Although anesthesia history is relevant for planning pain management, it is not the most critical factor in determining whether the patient can safely attempt a vaginal delivery after a prior cesarean.

D. Lab values, especially hemoglobin and hematocrit. Hemoglobin and hematocrit levels help assess for anemia or blood loss risk, but they do not affect the safety of a VBAC attempt. The primary concern is uterine integrity, which is determined by the type of previous cesarean incision.

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Correct Answer is D

Explanation

A. Enteral nutrition (TPN) to correct nutritional deficits. Total parenteral nutrition (TPN) is only considered in severe cases where oral and IV hydration fail. The initial treatment focuses on correcting dehydration and electrolyte imbalances before considering more invasive nutritional support.

B. Small frequent meals. While small, frequent meals may help manage nausea in mild cases of pregnancy-related nausea and vomiting, they are not sufficient for treating hyperemesis gravidarum, which involves severe, persistent vomiting leading to dehydration and electrolyte imbalances.

C. Corticosteroids to reduce inflammation. Corticosteroids are not the first-line treatment for hyperemesis gravidarum. They may be used in refractory cases where standard treatments fail, but IV fluids and antiemetics are prioritized initially.

D. IV therapy to correct fluid and electrolyte imbalances. The primary concern in hyperemesis gravidarum is severe dehydration and electrolyte disturbances due to excessive vomiting. IV fluids, often with electrolytes and thiamine, are the first step in stabilizing the patient before introducing oral intake.

A. Obtain equipment to start a 24-hour urine test on the patient. B. Obtain equipment for a manual pelvic exam. C. Prepare to draw blood for a hemoglobin and hematocrit. D. Obtain equipment for external electronic fetal heart rate monitoring. E. Prepare the patient for an ultrasound.

Correct Answer is ["C","D","E"]

Explanation

A. Obtain equipment to start a 24-hour urine test on the patient. A 24-hour urine test is not necessary for placenta previa. It is more commonly used for preeclampsia to assess proteinuria, which is unrelated to placenta previa.

B. Obtain equipment for a manual pelvic exam. A manual pelvic exam is contraindicated in placenta previa because it can cause further disruption of the placenta, leading to severe hemorrhage. Instead, diagnosis should be confirmed using ultrasound.

C. Prepare to draw blood for a hemoglobin and hematocrit. Hemoglobin and hematocrit levels must be monitored due to the risk of maternal hemorrhage in placenta previa. Significant blood loss can lead to anemia and may require blood transfusions.

D. Obtain equipment for external electronic fetal heart rate monitoring. Continuous fetal monitoring is essential in placenta previa to assess for signs of fetal distress. External monitoring is preferred to avoid vaginal examinations, which could worsen bleeding.

E. Prepare the patient for an ultrasound. Ultrasound is the diagnostic test of choice for placenta previa. It helps determine the exact location of the placenta and confirms whether it is covering the cervix. A transabdominal ultrasound is performed first, followed by a transvaginal ultrasound if necessary.

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Naxlex Comprehensive Predictor Exams

The nurse caring for a woman hospitalized for hyperemesis gravidarum would expect that the initial treatment would involve:

Correct Answer is D

Explanation

The nurse is preparing for the admission of a 30 weeks' gestation patient experiencing vaginal bleeding with a suspected diagnosis of placenta previa. In anticipating the patient's needs, which of the following would be most appropriate for the nurse to include? Select all that apply.

Correct Answer is ["C","D","E"]

Explanation

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