In order to reassure and educate pregnant clients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that:
Increased urinary output makes pregnant women less susceptible to urinary infection.
Renal (kidney) function is more efficient when the woman assumes a supine position.
Increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty.
Using diuretics during pregnancy can help keep kidney function regular.
The Correct Answer is C
Choice A rationale
Increased urinary output is typical, but pregnant women are actually more susceptible to urinary tract infections (UTIs) due to the mechanical compression of the ureters by the enlarging uterus, which causes urinary stasis or delayed emptying. Furthermore, the hormonal effects of progesterone lead to relaxation and dilation of the ureters, which also contributes to urine flow impedance and increases UTI risk.
Choice B rationale
The supine position, particularly after the first trimester, actually causes the enlarging uterus to compress the vena cava and the aorta. This compression decreases renal blood flow and can lead to a reduction in glomerular filtration rate (GFR) and overall kidney function, often causing supine hypotensive syndrome. The side-lying position is better for renal efficiency.
Choice C rationale
This is the correct explanation. Hormonal changes initially increase bladder sensitivity. As pregnancy progresses, the uterus grows out of the pelvis and then again descends, increasing pressure on the bladder. This compression, combined with increased fluid volume and GFR, stimulates the urge to urinate frequently, even when the bladder is not full.
Choice D rationale
Using diuretics during pregnancy is generally contraindicated and should be avoided. Diuretics decrease plasma volume, which is already naturally increased in pregnancy, and can compromise placental perfusion by reducing maternal blood flow to the placenta. This can lead to fetal growth restriction or other complications and is not a safe way to regulate kidney function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Fetal well-being is primarily assessed by evaluating the fetal heart rate (FHR) pattern, particularly its relationship to uterine contractions (UCs). The FHR response, including the presence of accelerations, moderate variability, and the absence of concerning decelerations, reflects the fetus's ability to tolerate the physiologic stress of labor.
Choice B rationale
An FHR above 110 beats/min alone does not confirm well-being; the normal range is 110 to 160 beats/min, and rates above this may indicate fetal tachycardia. The pattern of the FHR, including variability and periodic changes, is more critical than a single rate value for assessing well-being.
Choice C rationale
Maternal pain control is important for the woman's comfort and ability to cope with labor, but it is not a direct measure of fetal well-being or oxygenation status. Fetal assessment relies on objective measures of the fetal physiologic response to the stress of labor.
Choice D rationale
While the absence of late decelerations is a reassuring component, well-being requires a comprehensive assessment of the entire FHR tracing. This includes evaluating the baseline rate (110-160 beats/min), variability (moderate is ideal, 6 to 25 beats/min), and the presence of accelerations or non-reassuring decelerations.
Correct Answer is D
Explanation
Choice A rationale
Determining when the last meal was eaten is important for assessing aspiration risk, especially if an emergency cesarean section is needed, which is a key safety measure. However, this is a secondary concern to establishing the fetal status. Fetal well-being is the highest priority upon admission for a woman in labor, as indicated by monitoring the fetal heart rate.
Choice B rationale
Ascertaining whether the membranes have ruptured is necessary because rupture of membranes increases the risk of infection (chorioamnionitis) and can be associated with cord prolapse. While critical for infection control and assessing the risk of cord prolapse, this action does not take priority over the immediate evaluation of fetal status and oxygenation through heart auscultation.
Choice C rationale
Obtaining a comprehensive obstetric history (parity, previous birth experiences, complications, etc.) is essential for planning care and identifying risk factors. This information helps the nurse and provider anticipate potential complications during labor and delivery. However, it is an administrative and data-gathering task that can be performed after the immediate assessment of the maternal and fetal status.
Choice D rationale
Auscultating the fetal heart is the highest priority upon admission of a laboring patient. This action immediately assesses the current fetal status, specifically the heart rate and its pattern, which are the most critical indicators of fetal oxygenation and well-being. Any signs of fetal distress, such as a nonreassuring heart rate pattern, require immediate intervention and supersede all other admission tasks.
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