Silvestri, 3/e, ISBN 1-1460-0052-6Chapter 023 (edited file)—"Labor and Delivery and Associated Complications"10/14/08, Page 3 of 9,1 Figure(s), 1 Table(s), 8 Box(es)
abdominal pain.Test-Taking Strategy: Use the process of elimination. Thinking about what one would expect tooccur when the placenta separates will assist in eliminating options 1 and 2. Option 4 iseliminated because of the words “sudden, sharp.” Review the signs of placental separation if you had difficulty with this question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data collectionContent Area: Maternity/IntrapartumReference: Leifer, G. (2005).
(9th ed.). Philadelphia: W.B. Saunders, pp. 128,386.5. A nurse is assisting in caring for a client with abruptio placenta. While caring for the client,the nurse notes that the client begins to develop signs of shock. The nurse would first:1. Turn the client onto her side.2. Monitor the maternal pulse.3. Monitor urinary output.4. Monitor the maternal blood pressure.Answer: 1Rationale: With a client in shock, the nurse would want to increase perfusion to the placenta. Asimple way to do this, requiring no equipment, would be to turn the mother on her side. Thiswould increase blood flow to the placenta by relieving pressure from the gravid uterus on thegreat vessels. The nurse would immediately contact the registered nurse would then contact the physician. The other options would follow quickly.Test-Taking Strategy: Note the key word,
. Eliminate options 2 and 4 because they aresimilar. Recalling that positioning will affect the status of blood flow will assist in directing youto option 1 from the remaining options. Review care of the client in shock if you had difficultywith this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Delegating/PrioritizingReference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005).
(2nd ed.). St. Louis: Elsevier, p. 629.6. A client being prepared for a cesarean delivery is brought to the delivery room. Tomaintain optimal perfusion of oxygenated blood to the fetus, the nurse places the client in a:1. Trendelenburg position2. Semi-Fowler’s position3. Supine position with a wedge under the right hip4. Prone positionAnswer: 3Rationale: Vena cava and descending aorta compression by the pregnant uterus impede bloodreturn from the lower trunk and extremities, therefore decreasing cardiac return, cardiac output,and blood flow to the uterus and subsequently to the fetus. The best position to prevent thiswould be side-lying, with the uterus displaced off the abdominal vessels. Positioning for