Why should a pregnant client avoid the supine position?
The supine position increases BP
The supine position causes contractions
The supine position reduces uterine blood flow
The supine position causes nausea
The Correct Answer is C
Supine hypotensive syndrome occurs when the gravid uterus exerts pressure on the inferior vena cava and descending aorta. This mechanical compression reduces venous return to the maternal heart, subsequently decreasing cardiac output and systemic perfusion. Obstruction of these major vessels compromises the hemodynamic stability of both mother and fetus.
A. The supine position increases BP: In reality, this position typically causes a precipitous drop in maternal blood pressure due to reduced stroke volume. While some patients may experience a brief compensatory heart rate increase, the primary vascular effect is systemic hypotension. It does not cause a hypertensive state in the pregnant patient.
B. The supine position causes contractions: Uterine activity is generally independent of maternal posture, although severe hypotension could theoretically cause fetal distress that triggers labor. However, there is no direct physiological link between lying flat and the initiation of uterine contractions. Positioning is managed for vascular reasons rather than labor prevention.
C. The supine position reduces uterine blood flow: Compression of the aorta and iliac arteries directly impairs placental perfusion, potentially leading to fetal bradycardia or late decelerations. Maternal hypotension further reduces the pressure gradient necessary for efficient gas exchange at the intervillous space. Avoiding this position is critical for maintaining fetal oxygenation.
D. The supine position causes nausea: While some women may feel nauseated due to sudden hypotension and reduced cerebral blood flow, this is a subjective symptom rather than the primary medical concern. The core risk is the vascular compromise to the fetus. Clinical teaching focuses on the circulatory risks rather than gastrointestinal discomfort.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","E"]
Explanation
Hyperemesis gravidarum is a pathological state of intractable vomiting resulting in ketonuria, dehydration, and significant electrolyte depletion. The clinical management aims to restore hemodynamic stability and suppress the overactive emetic reflex. Interventions focus on maintaining metabolic homeostasis and preventing Wernicke’s encephalopathy through thiamine and fluid replacement.
A. Antiemetics: Pharmacological management using pyridoxine, doxylamine, or ondansetron is necessary to interrupt the vomiting cycle. These medications act on the chemoreceptor trigger zone or vestibular system to reduce nausea. Effective suppression of emesis allows for the gradual reintroduction of oral nutrition and hydration.
B. Fluid restriction: Restricting fluids is contraindicated and dangerous for a client already suffering from intravascular dehydration. Adequate hydration is the cornerstone of therapy to prevent renal failure and maintain uteroplacental perfusion. Restricting intake would exacerbate tachycardia and orthostatic hypotension.
C. Avoid triggers: Identifying and eliminating environmental stimuli like strong odors, flickering lights, or specific textures reduces sensory input to the emetic center. Behavioral modification is a non-pharmacological necessity to prevent recurrent episodes of nausea. This helps stabilize the gastric mucosa and CNS.
D. IV fluids: Intravenous rehydration with isotonic crystalloids is the priority intervention for clients unable to tolerate oral intake. This corrects volume deficits and replenishes depleted electrolytes like potassium and chloride. It is essential for reversing metabolic alkalosis caused by loss of gastric acid.
E. Small frequent meals: Once vomiting is controlled, consuming low-fat, high-carbohydrate snacks every 2 to 3 hours prevents an empty stomach. Maintaining stable blood glucose levels minimizes gastric contractions and acid irritation. This dietary strategy supports weight gain and fetal development.
Correct Answer is C
Explanation
Once the head is delivered, the nurse or midwife must immediately assess for the presence of an umbilical cord wrapped around the fetal neck. If a nuchal cord is present and tight, it can cause fetal hypoxia during the delivery of the shoulders. Identifying and managing this risk is a critical safety step.
A. Prevent hemorrhage: Stopping the delivery process does not prevent postpartum hemorrhage; in fact, the third stage of labor must be completed for the uterus to contract and stop bleeding. Hemorrhage management primarily focuses on uterine atony after the placenta is delivered.
B. Start oxytocin: Oxytocin is typically administered after the delivery of the shoulders or the placenta to promote uterine contraction. Starting it while the head is out but the body is still in the canal could cause uterine hyperstimulation, potentially trapping the fetus or causing trauma.
C. Check for nuchal cord: The provider slides a finger along the fetal neck to feel for the cord. If found, it is either slipped over the head or clamped and cut to allow the rest of the body to be born safely. This prevents cord compression during the final expulsive efforts.
D. Assess placenta: The placenta is not assessed until the entire neonate has been delivered and the umbilical cord has been clamped. It remains attached to the uterine wall during the birth of the fetus. Assessing the placenta too early is clinically impossible and irrelevant to the delivery of the body.
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