Author Question: Ms. M is 38 weeks' gestation and is a G1 P0. At 10 pm Ms. M has just been informed by the nurse that ... (Read 35 times)

Wadzanai

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Ms. M is 38 weeks' gestation and is a G1 P0. At 10 pm Ms. M has just been informed by the nurse that she is 3 to 4 cm dilated, cervix is 100 effaced, and contractions are every 4 to 5 minutes.
 
  When the nurse tells her the findings from the SVE, Ms. M states that she had been contracting since early that morning and she becomes extremely frustrated stating I should have had this baby by now. What is the best response by the nurse?
  a. Remind her that length of labor for the first child can be 18 to 24 hours
  b. Promote relaxation techniques
  c. Discuss various analgesic options
  d. Tell Ms. M that the provider will be contacted immediately about the slow progress of labor

Question 2

A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner?
 
  a. Presence of chloasma
  b. Presence of severe heartburn
  c. 10-pound weight gain in a month
  d. Patellar reflexes +1



234sdffa

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Answer to Question 1

ANS: b
Women in the latent phase of labor may be frustrated with lack of progress or slow progress of labor and desire companionship and encouragement. The other responses are inappropriate. The nurse should first encourage breathing and relaxation methods as well as provide reassurance, and then contact the provider.

Answer to Question 2

ANS: c
Feedback
a. Chloasma is a normal pregnancy finding.
b. Heartburn is an expected finding during the third trimester.
c. The weight gain may be due to fluid retention. Fluid retention may occur in patients with pregnancy-induced hypertension and in patients with congestive heart failure. The physician should be notified.
d. Although slightly hyporeflexic, patellar reflexes of +1 are within normal limits.



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