What nursing intervention is performed for preeclampsia?

Correct Answer: A

Rationale: A: Assessing deep tendon reflexes for hyperreflexia is the correct nursing intervention for preeclampsia because hyperreflexia is a common sign of worsening preeclampsia. This assessment helps in early detection of neurological complications such as eclampsia, which is a severe form of preeclampsia characterized by seizures. Prompt identification of hyperreflexia allows for timely intervention to prevent further complications. B: Providing frequent IV fluid boluses is not the appropriate intervention for preeclampsia. In fact, excessive fluid administration can exacerbate hypertension and lead to fluid overload, putting the patient at risk for pulmonary edema. Careful fluid management is crucial in managing preeclampsia, but it should be done judiciously and based on the patient's fluid status. C: Educating the laboring person that preeclampsia is only a concern for pregnancy, not labor, is incorrect. Preeclampsia is a serious pregnancy complication characterized by high blood pressure and signs of damage to other organ systems. It can occur before, during, or after labor, and it requires close monitoring and management throughout the perinatal period to ensure the safety of both the parent and the baby. D: Discouraging pain medication in order to assess for a headache is not a recommended nursing intervention for preeclampsia. Headaches are a common symptom of preeclampsia, and pain management should be provided to alleviate discomfort and improve the patient's overall well-being. Delaying pain relief can lead to unnecessary suffering and does not contribute to the assessment and management of preeclampsia.

Correct Answer: A

Rationale: Malnutrition during pregnancy is associated with fetal growth restriction. This is because when a pregnant woman does not consume enough essential nutrients, the developing fetus may not receive adequate nourishment for optimal growth and development. This can lead to low birth weight, small for gestational age, or intrauterine growth restriction. Choice B, fetal macrosomia, is incorrect because this condition refers to a baby being significantly larger than average at birth. This is typically associated with maternal diabetes or excessive weight gain during pregnancy, not malnutrition. Choice C, group B strep, is incorrect because this is a type of bacterial infection that can be passed from a mother to her baby during childbirth. It is not directly related to maternal malnutrition during pregnancy. Choice D, precipitous birth, is incorrect because this term refers to an unusually quick labor and delivery, which can occur regardless of the mother's nutritional status during pregnancy. In summary, malnutrition during pregnancy is associated with fetal growth restriction due to the lack of essential nutrients for proper fetal development. It is important for pregnant women to maintain a balanced diet to support the health and growth of their baby.

Correct Answer: A

Rationale: Vacuum extractors are commonly used during vaginal deliveries to assist with the extraction of the baby. One potential complication of vacuum extractor use is a cephalohematoma, which is the collection of blood between the skull bone and its fibrous covering. This can occur due to the pressure exerted on the baby's head during the extraction process, leading to a localized swelling. Choice B, face presentation, is not a fetal complication of vacuum extractor use. Face presentation refers to the position of the baby's head during delivery, where the face presents first instead of the top of the head. This is a different issue unrelated to vacuum extraction. Choice C, fetal growth restriction, is also not a fetal complication of vacuum extractor use. Fetal growth restriction occurs when a baby does not grow at the expected rate inside the womb, leading to a smaller than average size. This is a result of various factors such as maternal health, placental issues, or genetic factors, rather than vacuum extraction. Choice D, scalp fracture, is not a common complication of vacuum extractor use. While it is possible for a scalp fracture to occur during a difficult delivery, it is not specific to vacuum extraction. Scalp fractures are more commonly associated with the use of forceps or other instruments during delivery, rather than vacuum extraction. In summary, the correct answer is A (cephalohematoma) because it is a recognized fetal complication of vacuum extractor use. Face presentation (B), fetal growth restriction (C), and scalp fracture (D) are not directly related to vacuum extraction and do not typically result from its use.

Correct Answer: D

Rationale: Vasa previa is the condition where the umbilical cord vessels cross the cervix. This can be a dangerous situation during pregnancy and delivery because the vessels are not protected by Wharton's jelly or the umbilical cord itself, making them vulnerable to rupture and fetal hemorrhage if the membranes rupture before delivery. This condition is a medical emergency that requires immediate intervention to prevent harm to the baby. Placenta previa, on the other hand, is a condition where the placenta implants low in the uterus and covers part or all of the cervix. This can cause painless bleeding in the third trimester and can lead to complications during delivery, but it is not specifically related to the umbilical cord vessels crossing the cervix. Placenta cervix is not a recognized medical term and does not describe any specific condition related to the umbilical cord or placenta. Velamentous insertion is a condition where the umbilical cord inserts into the fetal membranes rather than directly into the placenta. This can also lead to complications during delivery, but it does not involve the umbilical cord vessels crossing the cervix. In summary, vasa previa is the correct answer because it specifically describes the condition where the umbilical cord vessels cross the cervix, putting the baby at risk for serious complications. Placenta previa, placenta cervix, and velamentous insertion are incorrect because they do not involve this specific anatomical situation.

Correct Answer: A

Rationale: Category III FHR tracings indicate abnormal fetal heart rate patterns that require immediate evaluation and intervention. In this case, delivery should occur within 15 minutes to prevent potential adverse outcomes for the fetus. Choice B (30 minutes) is incorrect because waiting an additional 15 minutes could lead to further deterioration of the fetal condition, increasing the risk of hypoxic injury or even fetal demise. Choice C (45 minutes) is also incorrect as it exceeds the recommended timeframe for delivery with a Category III FHR tracing. Waiting this long could result in significant harm to the fetus due to inadequate oxygenation. Choice D (60 minutes) is the furthest from the correct answer and poses the highest risk to the fetus. Delaying delivery for an hour with a Category III FHR tracing could have catastrophic consequences, including irreversible brain damage or stillbirth. In summary, the correct answer is A (15 minutes) because prompt delivery is crucial in cases of Category III FHR tracings to optimize fetal outcomes and minimize the risk of complications.