Need Help with these OB Questions Please

[2CatLover]

hi everyone,

we were given 30 questions to answer each as a group consensus. these are 3 that we are really battling with and could use some expert input please!

a 17-year-old primigravida is 28 weeks gestation and has gained 6 pounds since 4 weeks ago at her last prenatal visit. the most important nursing action is to:

• caution her to avoid salty foods and return in 2 weeks
  
• advise to cut down on fast foods that are high in fat
  
• recommend she stay home from school for a few days to reduce stress
  
• assess blood pressure, presence of edema, and urine for protein.
  

the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant is: (choose all that apply)

• stillbirth
  
• behavioral problems
  
• fetal addiction to the substance inhaled
  
• intauterine growth retardation
  

a woman who has had a previous cesarean birth is in active labor, when suddenly complains of pain between her scapulae. which of the following actions should the nurse take? (select all that apply)

• assess the patient's vital signs for tachycardia, and falling blood pressure.
  
• observe for abnormally high uterine resting tone
  
• assist the client into a supine position
  
• notify the physician immediately
  

as a group we are split between: # 1 a or d for the answer we all agree this is possible preeclampsia.

#2 a lot of us feel it's a b & d only others feel it's all a, b, c, & d

#3 a for sure with d? is the symptom of "pain between her scapulae" a symptom of uterine rupture or is it possibly a symptom of something else?

thanks in advance for any help anyone can provide

2catlover

[Forever Sunshine, ASN, RN]

1. D.. it asked for the MOST IMPORTANT.. nursing action. while you would also tell her to avoid salt . its most important to assess for those symptoms

2. D.. im not sure if any of the others apply

3. A..then D

[matilda123]

I agree,

1. D

2. D

3. A,D

[babyktchr, BSN, RN]

number 2 is all of the above.

[rbytsdy]

Pain between the scapula is not a typical sign of uterine rupture. You'd be looking for abdominal pain that is different from contraction pain or that doesn't go away between contractions, pain at the incision site, lady partsl bleeding and fetal heart rate decels.

[AOX4RN, MSN, RN, NP]

1. D.. it asked for the MOST IMPORTANT.. nursing action. while you would also tell her to avoid salt . its most important to assess for those symptoms

Why would you tell her to avoid salt?

[Key_]

Water follows salt. If you have a lot of salt in your body then you will retain water, thus gaining weight, increasing edema and blood pressure, etc.

[paper1225]

As an ob nurse, I would agree with the first response-D,D and A for the last question!

[AOX4RN, MSN, RN, NP]

Water follows salt. If you have a lot of salt in your body then you will retain water, thus gaining weight, increasing edema and blood pressure, etc.

There is a difference between avoiding salt and restricting salt intake (salt to taste) which is why I asked the original responder why she said to avoid salt. Avoiding salt in pregnancy (no longer recommended), even in the presence of elevated blood pressure and proteinuria, can upset the fluid balance of the body and create additional problems (including edema and elevated blood pressure)

Besides, the question the student was asking about only dealt with a six pound weight gain in a 17 year old primip, not one with elevated BP and proteinuria. It's more likely she spent the last week eating junk with her friends and needs counseling on that after ruling out abnormal findings in choice D.

[ro67sif]

Well, I 'm not an OB nurse, I 'm still studying for the NCLEX exam. I would say D for # 1, A and D for #2 and A and B for # 3 ( it is not specific for uterine rupture, so I think the nurse should first assess further ). Please, when you have the correct answers, tell them to us. Good luck.

[Mrs Brown, RN]

1. ALWAYS assess first!

2. All of the above (although the way that ? is worded I'm wondering why they say choose all that apply...if you're looking for THE most important one, but whatever right)

3. definitely assess first, then notify the dr.