Post-Administration Monitoring for Magnesium Sulfate
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Questions and Answers

What should the nurse monitor after administering magnesium sulfate to a pregnant patient?

  • Respiratory rate and deep tendon reflexes (correct)
  • Urine output and glucose levels
  • Temperature and pulse rate
  • Blood pressure and fetal heart rate

What condition is characterized by seizures not caused by a cerebral disorder during pregnancy-induced hypertension?

  • Eclampsia (correct)
  • HELLP syndrome
  • Preeclampsia
  • Gestational diabetes

What action should a patient take if they miss two consecutive menstrual periods while on oral contraceptives?

  • Call the doctor for a prescription refill
  • Continue taking the contraceptives as scheduled
  • Increase the dosage of contraceptive pills
  • Discontinue the contraceptive and take a pregnancy test (correct)

What is a late symptom in a patient with preeclampsia that requires immediate medical intervention?

<p>Epigastric pain (B)</p> Signup and view all the answers

What should a patient do if they miss two doses of their oral contraceptive?

<p>Double the dose for 2 days and use an additional birth control method for 1 week (B)</p> Signup and view all the answers

What is the correct position to relieve supine hypotension during labor?

<p>Patient turned on her left side (B)</p> Signup and view all the answers

During which phase of labor is the cervix dilated between 8 to 10 cm?

<p>Transition phase (A)</p> Signup and view all the answers

What marks the beginning of the second stage of labor?

<p>Full cervical dilation (B)</p> Signup and view all the answers

What is the correct definition of 'engagement' in the context of fetal descent?

<p>Presenting part is engaged in the pelvic inlet (A)</p> Signup and view all the answers

What does a fetal station of 0 indicate?

<p>The presenting part is at the pelvic inlet (A)</p> Signup and view all the answers

What is the primary reason to consider any vaginal bleeding during pregnancy a complication?

<p>It may signify a placental problem (B)</p> Signup and view all the answers

What is the main purpose of the fourth stage of labor?

<p>To stabilize the mother’s physical and emotional state (C)</p> Signup and view all the answers

What should be done if the umbilical cord cannot be loosened from around the neonate’s neck at delivery?

<p>Cut the cord between two clamps (D)</p> Signup and view all the answers

What is the normal length of the uterus at term?

<p>12.5 inches (32 cm) (D)</p> Signup and view all the answers

What must occur before internal fetal monitoring can be initiated?

<p>The amniotic membranes must be ruptured. (C)</p> Signup and view all the answers

How is the intensity of a labor contraction assessed?

<p>By examining the indentability of the uterine wall. (D)</p> Signup and view all the answers

What is the resting phase between contractions during labor?

<p>At least 30 seconds (A)</p> Signup and view all the answers

What characterizes a reactive nonstress test?

<p>Two or more fetal heart rate accelerations of 15 beats/minute in 20 minutes (C)</p> Signup and view all the answers

What type of placenta previa covers the cervical os completely?

<p>Complete placenta previa (B)</p> Signup and view all the answers

Which phase is NOT part of a uterine contraction?

<p>Latent (D)</p> Signup and view all the answers

What is the priority for the care of a neonate during an extramural delivery?

<p>Maintaining a patent airway (D)</p> Signup and view all the answers

What is defined as engagement in the context of labor?

<p>The largest diameter of the presenting part passing through the pelvic inlet. (A)</p> Signup and view all the answers

When should the administration of oxytocin be stopped?

<p>When contractions last for 90 seconds or longer (C)</p> Signup and view all the answers

Which symptom is typically associated with abruptio placentae?

<p>Severe abdominal pain (A)</p> Signup and view all the answers

What type of discharge occurs 4 to 7 days after childbirth?

<p>Lochia serosa (D)</p> Signup and view all the answers

Which nursing intervention is appropriate for a patient with placenta previa?

<p>Positioning the patient on her left side (D)</p> Signup and view all the answers

What is a consequence often seen in teenage mothers regarding neonate weight?

<p>Their neonates are more likely to have low birth weights. (A)</p> Signup and view all the answers

What is the risk for a multiparous woman immediately after delivery compared to a primiparous woman?

<p>Higher susceptibility to bleeding (D)</p> Signup and view all the answers

How is preeclampsia defined concerning blood pressure?

<p>Blood pressure of 140/95 mmHg on two occasions 6 hours apart (D)</p> Signup and view all the answers

What is a significant outcome of interrupted blood flow to the placenta?

<p>Increased fetal partial pressure of arterial carbon dioxide (A)</p> Signup and view all the answers

What should be monitored closely if a pregnant patient receives a spinal block before delivery?

<p>Patient's blood pressure (B)</p> Signup and view all the answers

What should the nurse suggest to a postpartum patient experiencing gas pain and flatulence?

<p>Ambulation (A)</p> Signup and view all the answers

What is the primary purpose of administering oxytocin (Pitocin) after the delivery of the placenta?

<p>To promote uterine involution (B)</p> Signup and view all the answers

Which of these is not a classic symptom of preeclampsia?

<p>Painless bleeding (C)</p> Signup and view all the answers

What differentiates abruptio placentae from placenta previa?

<p>Presence of pain (B)</p> Signup and view all the answers

What condition is Methylergonovine (Methergine) used to prevent?

<p>Postpartum hemorrhage from uterine atony (C)</p> Signup and view all the answers

Which statement accurately reflects the FDA drug categorization system for pregnancy?

<p>Category C drugs may be beneficial despite potential risks. (C)</p> Signup and view all the answers

What does a positive acetone result in a pregnant patient typically indicate?

<p>Inadequate caloric intake (A)</p> Signup and view all the answers

What is the initial nursing action after the amniotic membranes rupture?

<p>Assess the fetal heart rate (B)</p> Signup and view all the answers

Which of the following is a common reason for cesarean birth?

<p>Malpresentation of the fetus (D)</p> Signup and view all the answers

What complication might arise after an amniocentesis?

<p>Spontaneous abortion (B)</p> Signup and view all the answers

What is crowning during labor?

<p>Head of the fetus appears at the vulvovaginal ring (B)</p> Signup and view all the answers

What is a potential consequence of a distended bladder after delivery?

<p>Subinvolution of the uterus (C)</p> Signup and view all the answers

What is a potential risk of not administering Rho(D) immune globulin (RhoGAM) to an Rh-negative primigravida after delivery of an Rh-positive neonate?

<p>Fetal anomalies in future pregnancies (A)</p> Signup and view all the answers

Flashcards

Supine Hypotension

A condition that occurs during labor when a pregnant woman lies on her back, causing compression of the inferior vena cava and aorta, leading to decreased blood flow to the heart and decreased blood pressure.

Transition Phase of Labor

The final stage of the first stage of labor, characterized by rapid cervical dilation from 8 to 10 cm, intense contractions occurring every 2-3 minutes, and lasting for 60 seconds.

First Stage of Labor

The period of labor that starts with the onset of true labor contractions and ends with the complete dilation of the cervix (10 cm).

Second Stage of Labor

The stage of labor that begins with full cervical dilation (10 cm) and ends with the delivery of the baby.

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Third Stage of Labor

The stage of labor that starts after the baby's birth and ends with the delivery of the placenta.

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Fourth Stage of Labor

The period of time lasting up to 4 hours after the delivery of the placenta, during which the mother's physical and emotional state stabilizes.

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True Labor vs. False Labor

True labor is characterized by regular, rhythmic contractions, abdominal discomfort, progressive descent of the fetus, bloody show, and progressive effacement and dilation of the cervix. False labor does not have these characteristics.

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Fetal Station

The location of the presenting part of the fetus in relation to the ischial spines of the pelvis. It is measured in centimeters above or below the ischial spine.

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Engagement

The largest diameter of the presenting part (usually the head) has passed through the pelvic inlet.

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Amniotomy

Artificial rupture of the amniotic membranes (the bag of waters).

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Contraction Phases

The three phases of a uterine contraction: Increment (contraction builds), Acme (peak of contraction), Decrement (contraction fades).

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Contraction Intensity

The firmness of the uterine muscle during a contraction. Can be mild (soft), moderate (firm), or strong (board-like).

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Contraction Frequency

The time between the beginning of one contraction and the beginning of the next, measured in minutes.

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Internal Fetal Monitoring

Placing a small electrode on the presenting part of the fetus (scalp or buttocks) to monitor the baby's heart rate. Requires cervical dilation of at least 2 cm, ruptured membranes, and the presenting part at station -1 or lower.

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True Conjugate

The smallest inlet measurement of the pelvis. To estimate, subtract 1.5 cm from the diagonal conjugate.

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Postpartum Involution

The process of the uterus returning to its normal size and position after childbirth.

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Cervical Suturing

A procedure to reinforce a weak cervix and prevent preterm labor.

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Drug Categories for Pregnancy

The FDA classifies drugs based on their potential risks to the fetus during pregnancy.

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Mechanics of Delivery

The stages of labor, including engagement, descent, rotation, and expulsion of the baby.

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Contraction Duration

The length of time from when a contraction begins to when it ends, measured in seconds.

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Fetal Demise

The death of a fetus after it has reached a stage where it could potentially survive outside the womb.

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Amniocentesis Risks

A procedure to sample amniotic fluid carries potential risks for the mother and baby.

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RhoGAM for Rh-Negative Mothers

A medication given to prevent Rh sensitization and future complications in Rh-negative mothers.

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Extramural Delivery Priorities

When a baby is born outside of a hospital, the main priorities are maintaining a clear airway, helping the baby breathe, monitoring vital signs, and keeping the baby warm.

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Oxytocin Administration Limit

The medication oxytocin (Pitocin) is stopped if contractions last for 90 seconds or longer to prevent potential harm to the baby.

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Rubella Immunization Postpartum

If a pregnant woman's rubella titer is low, she should get vaccinated after giving birth to protect future pregnancies.

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Maternal Hypotension Cause

Low blood pressure in the mother is a possible side effect of spinal block anesthesia.

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Rh Factor Before Amniocentesis

The mother's Rh factor should be checked before an amniocentesis procedure is performed.

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Early Maternal Age and Pregnancy

Young mothers are more likely to experience cephalopelvic disproportion, where the baby's head is too large for the mother's pelvis.

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Prolapsed Umbilical Cord Risk

When the amniotic sac breaks on its own, there's a higher chance of the umbilical cord coming out before the baby.

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Magnesium Sulfate Use

Magnesium sulfate is administered to pregnant patients with hypertension or preterm labor, and nurses must monitor the patient's respiratory rate and deep tendon reflexes.

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Eclampsia: Seizures in Pregnancy

Eclampsia is characterized by seizures in a pregnant patient with pregnancy-induced hypertension, not caused by a cerebral disorder.

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Epigastric Pain in Preeclampsia

Epigastric pain is a late symptom of preeclampsia and requires immediate medical intervention.

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Preeclampsia Progression

Preeclampsia can progress to eclampsia, which is characterized by seizures and may lead to coma.

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HELLP Syndrome

HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a rare complication of pregnancy-induced hypertension.

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Nonstress Test (NST)

A test used to assess fetal well-being during pregnancy by monitoring fetal heart rate patterns. It is considered "reactive" if two or more accelerations of 15 beats/minute above baseline occur within 20 minutes.

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Placenta Previa

A condition where the placenta is positioned low in the uterus, partially or completely covering the cervical opening. This can cause painless vaginal bleeding.

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Abruptio Placentae

A serious condition where the placenta detaches prematurely from the uterine wall, causing bleeding, pain, and potentially a board-like abdomen.

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Preeclampsia

A condition that develops during pregnancy, characterized by high blood pressure, swelling, and protein in the urine. It can be severe, leading to complications.

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Classic Preeclampsia Triad

The three main symptoms of preeclampsia: high blood pressure, swelling (edema), and protein in the urine.

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Complete Placenta Previa

A type of placenta previa where the placenta completely blocks the cervical opening.

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Partial Placenta Previa

A type of placenta previa where the placenta covers only part of the cervical opening.

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Pain in Placenta Conditions

A key difference between abruptio placentae and placenta previa is the presence of pain. Abruptio placentae causes pain, while placenta previa causes painless bleeding.

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Study Notes

Labor and Delivery

  • During labor, to alleviate supine hypotension (nausea, vomiting, paleness), position the patient on her left side.
  • The transition phase of the first stage of labor involves cervical dilation of 8-10 cm and contractions occurring every 2-3 minutes, lasting 60 seconds.
  • The first stage of labor begins with the onset of labor and ends with 10 cm cervical dilation.
  • The second stage starts with full cervical dilation and ends with the newborn's birth.
  • The third stage begins after birth and ends with placenta expulsion.
  • The fourth stage (postpartum stabilization) lasts up to 4 hours after placenta delivery. This time is crucial for the mother's physical and emotional recovery from childbirth.
  • True labor is characterized by regular rhythmic contractions, abdominal discomfort, progressive fetal descent, bloody show, and cervical effacement and dilation. False labor is not associated with these characteristics.
  • "Floating" means that the presenting part of the fetus is not engaged in the pelvic inlet and is freely movable above it.
  • "Engagement" signifies that the largest diameter of the presenting part has passed through the pelvic inlet.
  • Fetal stations describe the presenting part's location relative to the ischial spine: -1, -2, -3, -4, or -5 are above the ischial spine; +1, +2, +3, +4, or +5 are below; 0 is at the level of the ischial spine.
  • Station -5 is at the pelvic inlet.
  • Any vaginal bleeding during pregnancy should be considered a complication until determined otherwise.
  • During delivery, if the umbilical cord is entangled around the neonate's neck, it must be clamped with two clamps and cut between them.
  • Side-lying is often the most comfortable position during the first stage of labor.
  • Amniotomy is the artificial rupture of the amniotic membranes.
  • Uterine contractions have three phases: increment, acme, and decrement.
  • Contraction intensity can be graded as mild (slightly tense), moderate (moderately tense), or strong (board-like).
  • Contraction frequency is measured in minutes, starting from the beginning of one contraction to the start of the next.

Fetal Monitoring and Other Considerations

  • Fetal monitoring assesses fetal well-being during labor.
  • If fetal distress is suspected, fetal blood pH may be evaluated through a scalp sample.
  • Massaging the uterus aids placental delivery and uterine contraction stimulation.
  • Checking fetal heart tones is often the nurse's first action when admitting a patient in active labor.
  • Nitrazine paper is used to detect amniotic fluid.
  • A pregnant patient typically gains 2-5 pounds in the first trimester and slightly less (0.5 kg per week) in the subsequent trimesters.
  • A precipitate labor lasts approximately 3 hours and concludes with the neonate's delivery.
  • For excessive uterine bleeding, 0.2 mg of methylergonovine (Methergine) is administered intravenously (IV) over 1 minute, while the patient's blood pressure and uterine contractions are monitored.
  • Braxton Hicks contractions are felt in the abdomen and do not lead to cervical changes.
  • True labor contractions are in the abdomen and back and result in cervical dilation and effacement.
  • Fetal hypoxia is indicated by late decelerations; the nurse must position the patient on her left side, administer supplemental oxygen, and notify the physician.
  • Oxytocin (Pitocin) stimulates powerful uterine contractions and needs close monitoring to prevent maternal/fetal distress.
  • Molding refers to how the fetal head changes shape to facilitate passage through the birth canal.
  • If a woman experiences sudden hypotension during labor, increase the IV fluid rate as prescribed.
  • Early decelerations during fetal monitoring are a sign of head compression during labor.
  • Postpartum, oxytocin (Pitocin) can be added to the IV solution to promote uterine involution and lactation if necessary. Cervical suturing is typically performed between weeks 14 and 18 of gestation to reinforce an incompetent cervix.

Additional Considerations

  • Teenage mothers are more likely to have low-birth-weight newborns due to late prenatal care and nutritional deficiencies.
  • The anteroposterior (diagonal conjugate) is the narrowest diameter of the pelvic inlet.
  • Labor contractions typically have at least 30 seconds of resting phase in between.
  • The uterus increases in length from 6.3 cm before pregnancy to 32 cm at term.
  • The true conjugate (smallest inlet measurement) is estimated by subtracting 1.5 cm from the diagonal conjugate (typically 12 cm).
  • The intertuberous diameter is the smallest outlet measurement in the pelvis.

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Description

This quiz focuses on the critical monitoring tasks that nurses must perform after administering magnesium sulfate to pregnant patients. Ensure you are familiar with the signs and symptoms to observe, as well as potential side effects and complications.

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