NURSING MISC Amelia Sung post sim

NURSING MISC Amelia Sung post sim Amelia Sung – post sim Ms. Sung's sister asks why there is a step stool in the room. What would be the best response by the nurse? Question CorrectTime Spent - 00:01:23 Your Response: Given the patient's history, the step stool is here in case we need to apply suprapubic pressure to help the baby be delivered. Rationale: The step stool is used so the provider applying suprapubic pressure can be directly over the patient. While a step stool is sometimes used for squatting, that is not the purpose of it being available in this situation. Also, squatting does not help the fetus to engage in the birth canal. Remediation: O'Meara, A. Maternity, Newborn, and Woman's Health Nursing: A Case-Based Approach, pp. 191-193 2The nurse reviews Ms. Sung's labor progress: 0100: 100% effaced, 4 cm dilated, –1 station 0330: 100% effaced, 6 cm dilated, –1 station 0500: 100% effaced, 10 cm dilated, 0 station Which of these findings combined with the patient's history would the nurse report to the provider? Question CorrectTime Spent - 00:00:46 Your Response: 0 station when dilated to 10 cm Rationale: When the cervix is completely dilated (10 cm), the fetus usually is engaged and moving through the pelvis into the birth canal. Combined with this patient's history of shoulder dystocia in her previous pregnancy, the lack of fetal descent is a potential cue, and the provider needs to be informed. Remediation: O'Meara, A. Maternity, Newborn, and Woman's Health Nursing: A Case-Based Approach, pp. 288-291 3Which of the following risk factors for shoulder dystocia are present in Ms. Sung's history and assessment? (Select all that apply) Question CorrectTime Spent - 00:03:05 Your Response: Short maternal stature,Excessive maternal weight gain Rationale: Excessive maternal weight gain and short maternal stature are both risk factors for this patient. A breech position, low BMI, and oligohydramnios are not associated with an increased incidence of shoulder dystocia. Remediation: O'Meara, A. Maternity, Newborn, and Woman's Health Nursing: A Case-Based Approach, p. 193 4Ms. Sung's family asks what can be done to prevent the baby from getting "stuck" like the last baby. Which of the follow is the best response from the nurse? Question CorrectTime Spent - 00:00:51 Your Response: While we cannot prevent shoulder dystocia, we will monitor both mother and fetus and have everything ready if we need to intervene. Rationale: The nurse should be reassuring yet honest. Shoulder dystocia is not preventable, but being prepared for the potential emergency can decrease morbidity and mortality. The other responses are neither therapeutic nor accurate. Remediation: O'Meara, A. Maternity, Newborn, and Woman's Health Nursing: A Case-Based Approach, p. 473 5The fetal head emerges and then stops. The nurse notes that the FHR is 90 bpm with minimal variability. What should the nurse do? (Select all that apply) Question CorrectTime Spent - 00:01:09 Your Response: Document the time of the delivery of the head,Encourage the patient to push,Administer oxygen at 10 L/min by rebreather mask,Make others in the room aware of the change in the FHR Rationale: Documenting the time of the delivery of the head is important. The nurse should encourage the patient to push in an attempt to complete the delivery without additional intervention. Oxygen should be administered per orders based on FHR parameters. The nurse needs to let other providers in the room know about the change in the FHR. McRobert's maneuver and suprapubic pressure are not used until shoulder dystocia has been diagnosed. The length of the second stage of labor is now over 2 hours. The nurse notes the fetal heart rate (FHR) is 110 beats per minute (bpm) with minimal variability, and V-shaped decelerations. The nurse discusses the patient with the provider. What assessment would the nurse include in the situation-background-assessmentrecommendation (SBAR) report to the provider? Question CorrectTime Spent - 00:00:44 Your Response: I am concerned about cord compression. Rationale: SBAR is an organized method for communicating about patient situations and collaborating on a plan. Given the data, the nurse's assessment is possible cord compression resulting in fetal compromise. Shoulder dystocia is not diagnosed until the head emerges. Similarly, McRobert's maneuver is