The laboring patient is being augmented with oxytocin and is experiencing contractions every 3-4 minutes lasting 60 seconds. The patient's fetal heart rate is ranging from 130-140 beats per minute (BPM) with moderate variability of 6-10 beats per minute. No decelerations are noted. Which action by the nurse is most appropriate?

Insert an internal fetal scalp electrode monitor

Contact the doctor at once and reposition the patient

Document the finding in the patient's medical record

Discontinue the IV fluid containing Pitocin (oxytocin)

Answer and Explanation

The Correct Answer is C

A. Insert an internal fetal scalp electrode monitor. There is no indication for an internal fetal monitor, as the external monitoring shows a reassuring fetal heart rate pattern with moderate variability and no decelerations. Internal monitoring is typically used when external monitoring is inadequate or when fetal distress is suspected.

B. Contact the doctor at once and reposition the patient. There is no fetal distress or abnormal contraction pattern requiring immediate physician intervention. The fetal heart rate is within the normal range (110-160 bpm), and moderate variability indicates adequate oxygenation.

C. Document the finding in the patient's medical record. This is the correct action because the assessment findings indicate a well-oxygenated fetus and a normal labor progression. Contractions every 3-4 minutes lasting 60 seconds are within the expected range for oxytocin augmentation, and no abnormalities are present.

D. Discontinue the IV fluid containing Pitocin (oxytocin). There is no need to stop the oxytocin infusion, as the contraction pattern is appropriate, and there are no signs of uterine tachysystole or fetal distress.

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Correct Answer is A

Explanation

A. The patient's blood pressure dropped from 160/120 to 130/90. Hydralazine is an antihypertensive medication used to lower blood pressure in conditions such as eclampsia. A reduction in blood pressure indicates that the medication is achieving its intended effect of controlling hypertension, reducing the risk of complications like stroke or organ damage.

B. The patient states that her headache is gone. While headaches are a symptom of severe hypertension, their resolution does not directly confirm the effectiveness of hydralazine. Other factors, such as pain relief or improved postpartum recovery, could contribute to headache relief.

C. The patient's postoperative weight has dropped from 155 to 144 pounds. Postpartum weight loss is expected due to fluid shifts and loss of pregnancy-related fluids, but it is not a direct measure of hydralazine’s effectiveness. The medication does not act as a diuretic or weight-loss agent.

D. The patient has had no seizures since delivery. While hydralazine helps lower blood pressure, preventing seizures in eclamptic patients is primarily managed with magnesium sulfate, not hydralazine. The absence of seizures is important but does not indicate the specific effectiveness of this antihypertensive medication.

A. There is progressive resistance to the effects of insulin B. Pregnancy fosters the development of carbohydrate cravings. C. Hypoinsulinemia develops early in the first trimester D. Glucose levels decrease to accommodate fetal growth.

Correct Answer is A

Explanation

A. There is progressive resistance to the effects of insulin. During pregnancy, placental hormones (such as human placental lactogen, estrogen, and progesterone) cause increasing insulin resistance. This ensures that glucose remains available for fetal growth. However, in gestational diabetes, the pancreas cannot compensate with increased insulin production, leading to hyperglycemia.

B. Pregnancy fosters the development of carbohydrate cravings. While some pregnant individuals experience cravings, this is not a defining cause of gestational diabetes. The condition results from hormonal changes leading to insulin resistance, not dietary habits alone.

C. Hypoinsulinemia develops early in the first trimester. Gestational diabetes is not caused by a deficiency of insulin (hypoinsulinemia) but by insulin resistance. In fact, insulin production often increases, but it is insufficient to overcome the resistance caused by placental hormones.

D. Glucose levels decrease to accommodate fetal growth. In a normal pregnancy, glucose levels remain stable, and the fetus actively takes glucose from maternal circulation. However, in gestational diabetes, maternal glucose levels rise due to insulin resistance, increasing the risk of fetal overgrowth (macrosomia).

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Naxlex Comprehensive Predictor Exams

A patient is 3 days post c-section delivery for eclampsia. The client is receiving hydralazine (Apresoline). Which of the following would indicate that the medication is effective?

Correct Answer is A

Explanation

The nurse would include which of the following statements when describing the pathophysiology of gestational diabetes?

Correct Answer is A

Explanation

The nurse discovers a loop of the umbilical cord protruding through the vagina when preparing to perform a vaginal examination. The priority intervention is to:

When working with a woman who has just experienced a fetal demise you should offer supportive care, give her the opportunity to grieve, and provide for a chaplain to come in if the patient wants one. You know that the Chaplain is non-denominational and can also provide comforting words.

A primigravida who is 28 weeks pregnant visits the clinic fearing she is experiencing preeclampsia. Which of the following assessments would the nurse make to confirm or negate these thoughts? Select all that apply.

The nurse is assessing a patient who has severe preeclampsia. The assessment finding that should be reported to the physician is:

A patient has been admitted to the emergency department with a suspected diagnosis of ectopic pregnancy. How should the nurse explain this condition to the patient?

A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary health care practitioner?

A client is receiving (Pitocin) oxytocin to induce labor. The nurse should monitor for which of the following adverse maternal effects?

A woman who is 26 weeks pregnant has just found out that she has gestational diabetes. Which of the following therapies will most likely be ordered first for this patient?