OB Exam 2 joscircus 326 Questions with Verified Answers
The charge nurse is assessing several postpartum clients. Which client has the greatest risk
... [Show More] for postpartum hemorrhage?
1. The client who was overdue and delivered vaginally
2. The client who delivered by scheduled cesarean delivery
3. The client who had oxytocin augmentation of labor
4. The client who delivered vaginally at 36 weeks - CORRECT ANSWER Answer: 3
Explanation: 3. Uterine atony is a cause of postpartal hemorrhage. A contributing factor to uterine atony is oxytocin augmentation of labor.
The client is undergoing an emergency cesarean birth for fetal bradycardia. The client's partner has not been allowed into the operating room. What can the nurse do to alleviate the partner's emotional distress?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Allow the partner to wheel the baby's crib to the newborn nursery.
2. Allow the partner to be near the operating room where the newborn's first cry can be heard.
3. Have the partner wait in the client's postpartum room.
4. Encourage the partner to be in the nursery for the initial assessment.
5. Teach the partner how to take the client's blood pressure. - CORRECT ANSWER Answer: 1, 2, 4
Explanation: 1. Effective measures include allowing the partner to take the baby to the nursery.
2. Effective measures include allowing the partner to be in a place near the operating room, where the newborn's first cry can be heard.
4. Effective measures include involving the partner in postpartum care in the recovery room.
What would be a normal cervical dilatation rate in a first-time mother ("primip")?
1. 1.5 cm per hour
2. Less than 1 cm cervical dilatation per hour
3. 1 cm per hour
4. Less than 0.5 cm per hour - CORRECT ANSWER Answer: 1
Explanation: 1. Dilatation in a "multip" is about 1.5 cm per hour.
The nurse has admitted a woman with cervical insufficiency. The nurse is aware that causes of this condition include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Congenital factors
2. Intercourse during pregnancy
3. Infection
4. Increased uterine volume
5. Past cervical surgeries - CORRECT ANSWER Answer: 1, 3, 4, 5
Explanation: 1. Congenitally incompetent cervix may be found in women exposed to diethylstilbestrol (DES) or those with a bicornuate uterus.
3. Infection or trauma can cause acquired cervical incompetence.
4. Cervical insufficiency can occur in multiple-gestation pregnancies.
5. Previous elective abortion or cervical manipulation can lead to cervical insufficiency.
Which of the following is a common barbiturate used in labor?
1. Seconal
2. Valium
3. Phenergan
4. Vistaril - CORRECT ANSWER 1. Seconal
The laboring client is at 7 cm, with the vertex at a +1 station. Her birth plan indicates that she and her partner took Lamaze prenatal classes, and they have planned on a natural, unmedicated birth. Her contractions are every 3 minutes and last 60 seconds. She has used relaxation and breathing techniques very successfully in her labor until the last 15 minutes. Now, during contractions, she is writhing on the bed and screaming. Her labor partner is rubbing the client's back and speaking to her quietly. Which nursing diagnosis should the nurse incorporate into the plan of care for this client?
1. Fear/Anxiety related to discomfort of labor and unknown labor outcome
2. Pain, Acute, related to uterine contractions, cervical dilatation, and fetal descent
3. Coping: Family, Compromised, related to labor process
4. Knowledge, Deficient, related to lack of information about normal labor process and comfort measures - CORRECT ANSWER Answer: 2
Explanation: 2. The client is exhibiting signs of acute pain, which is both common and expected in the transitional phase of labor.
The nurse is admitting a client to the birthing unit. What question should the nurse ask to gain a better understanding of the client's psychosocial status?
1. "How did you decide to have your baby at this hospital?"
2. "Who will be your labor support person?"
3. "Have you chosen names for your baby yet?"
4. "What feeding method will you use for your baby?" - CORRECT ANSWER Answer: 2
Explanation: 2. The expectant mother's partner or support person is an important member of the birthing team, and assessments of the couple's coping, interactions, and teamwork are integral to the nurse's knowledge base. The nurse's physical presence with the laboring woman provides the best opportunity for ongoing assessment.
How would the nurse best analyze the results from a client's sonogram that shows the fetal shoulder as the presenting part?
1. Breech, transverse
2. Breech, longitudinal
3. Breech, frank
4. Vertex, transverse - CORRECT ANSWER Answer: 1
Explanation: 1. A shoulder presentation is one type of breech presentation, and is also called a transverse lie.
The nurse determines the fundus of a postpartum client to be boggy. Initially, what should the nurse do?
1. Document the findings.
2. Catheterize the client.
3. Massage the uterine fundus until it is firm.
4. Call the physician immediately. - CORRECT ANSWER Answer: 3
Explanation: 3. The nurse would massage the uterine fundus until it is firm by keeping one hand in position and stabilizing the lower portion of the uterus. With one hand used to massage the fundus, the nurse would put steady pressure on the top of the now-firm fundus and to see if she was able to express any clots.
The nurse is assessing a client before administering an analgesic. What are some of the factors the nurse should consider?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. The client is willing to receive medication after being advised about it.
2. The client's vital signs are stable.
3. The partner agrees to use of the medication.
4. The client has no known allergies to the medication.
5. The client is aware of the contraindications of the medication. - CORRECT ANSWER Answer: 1, 2, 4, 5
Explanation: 1. Medication should be explained to the client before it is administered.
2. Vital signs need to be stable before any analgesic medication is administered.
4. Ask the client about allergies before administering any medications.
5. Clients should always be aware of the contraindications of the medication.
A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered least adequate for vaginal childbirth?
Note: Credit will be given only for all correct choices and no incorrect choices.
Select all that apply.
1. Android
2. Anthropoid
3. Gynecoid
4. Platypelloid
5. Lambdoidal suture - CORRECT ANSWER Answer: 1, 4
Explanation: 1. In the android and platypelloid types, the pelvic diameters are diminished. Labor is more likely to be difficult (longer) and a cesarean birth is more likely.
4. In the android and platypelloid types, the pelvic diameters are diminished. Labor is more likely to be difficult (longer) and a cesarean birth is more likely.
The nurse is admitting a client to the labor and delivery unit. Which aspect of the client's history requires notifying the physician?
1. Blood pressure 120/88
2. Father a carrier of sickle-cell trait
3. Dark red vaginal bleeding
4. History of domestic abuse - CORRECT ANSWER Answer: 3
Explanation: 3. Third-trimester bleeding is caused by either placenta previa or abruptio placentae. Dark red bleeding usually indicates abruptio placentae, which is life-threatening to both mother and fetus.
A client is admitted to the labor and delivery unit with contractions that are regular, are 2 minutes apart, and last 60 seconds. She reports that her labor began about 6 hours ago, and she had bloody show earlier that morning. A vaginal exam reveals a vertex presenting, with the cervix 100% effaced and 8 cm dilated. The client asks what part of labor she is in. The nurse should inform the client that she is in what phase of labor?
1. Latent phase
2. Active phase
3. Transition phase
4. Fourth stage - CORRECT ANSWER Answer: 3
Explanation: 3. The transition phase begins with 8 cm of dilatation, and is characterized by contractions that are closer and more intense.
The client tells the nurse that she has come to the hospital so that her baby's position can be changed. The nurse would begin to organize the supplies needed to perform which procedure?
1. A version
2. An amniotomy
3. Leopold maneuvers
4. A ballottement - CORRECT ANSWER Answer: 1
Explanation: 1. Version, or turning the fetus, is a procedure used to change the fetal presentation by abdominal or intrauterine manipulation.
The nurse is admitting a client for a cerclage procedure. The client asks for information about the procedure. What is the nurse's most accurate response?
1. "A stitch is placed in the cervix to prevent a spontaneous abortion or premature birth."
2. "The procedure is done during the third trimester."
3. "Cerclage is always placed after the cervix has dilated and effaced."
4. "An uncomplicated elective cerclage may is done on inpatient basis." - CORRECT ANSWER Answer: 1
Explanation: 1. This is the correct description of cerclage.
Dystocia encompasses many problems in labor. What is the most common?
1. Meconium-stained amniotic fluid
2. Dysfunctional uterine contractions
3. Cessation of contractions
4. Changes in the fetal heart rate - CORRECT ANSWER Answer: 2
Explanation: 2. The most common problem is dysfunctional (or uncoordinated) uterine contractions that result in a prolongation of labor.
The nurse is caring for a postpartum client who is experiencing afterpains following the birth of her third child. Which comfort measure should the nurse implement to decrease her pain?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Offer a warm water bottle for her abdomen.
2. Call the physician to report this finding.
3. Inform her that this is not normal, and she will need an oxytocic agent.
4. Administer a mild analgesic to help with breastfeeding.
5. Administer a mild analgesic at bedtime to ensure rest. - CORRECT ANSWER Answer: 1, 4, 5
Explanation: 1. A warm water bottle placed against the low abdomen may reduce the discomfort of afterpains.
4. The breastfeeding mother may find it helpful to take a mild analgesic agent approximately 1 hour before feeding her infant.
5. An analgesic agent such as ibuprofen is also helpful at bedtime if the afterpains interfere with the mother's rest.
The nurse is assisting a multiparous woman to the bathroom for the first time since her delivery 3 hours ago. When the client stands up, blood runs down her legs and pools on the floor. The client turns pale and feels weak. What would be the first action of the nurse?
1. Assist the client to empty her bladder
2. Help the client back to bed to check the fundus
3. Assess her blood pressure and pulse
4. Begin an IV of lactated Ringer's solution - CORRECT ANSWER Answer: 2
Explanation: 2. Massaging the fundus is the top priority because of the excessive blood loss. If the fundus is not firm, gentle fundal massage is performed until the uterus contracts.
3) A client in labor is requesting pain medication. The nurse assesses her labor status first, focusing on which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Contraction pattern
2. Amount of cervical dilatation
3. When the labor began
4. Whether the membranes are intact or ruptured
5. Fetal presenting part - CORRECT ANSWER Answer: 1, 2, 5
Explanation: 1. The client should have a good contraction pattern before receiving an analgesic.
2. The nurse should evaluate the amount of cervical dilatation before analgesic medication is administered.
5. If normal parameters are absent or if nonreassuring maternal or fetal factors are present, the nurse may need to complete further assessments with the physician/CNM.
The nurse is caring for laboring clients. Which women are experiencing problems related to a critical factor of labor?
Note: Credit will be given only for all correct choices and no incorrect choices.
Select all that apply.
1. Woman at 7 cm, fetus in general flexion
2. Woman at 3 cm, fetus in longitudinal lie
3. Woman at 4 cm, fetus with transverse lie
4. Woman at 6 cm, fetus at -2 station, mild contractions
5. Woman at 5 cm, fetal presenting part is right shoulder - CORRECT ANSWER Answer: 3, 4, 5
Explanation: 3. A transverse lie occurs when the cephalocaudal axis of the fetal spine is at a right angle to the woman's spine and is associated with a shoulder presentation and can lead to complications in the later stages of labor.
4. Station refers to the relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis. If the presenting part is higher than the ischial spines, a negative number is assigned, noting centimeters above zero station. A -2 station is high in the pelvis. Contractions should be strong to cause fetal descent. Mild contractions will not move the baby down or open the cervix. This client is experiencing a problem between the maternal pelvis and the presenting part.
5. When the fetal shoulder is the presenting part, the fetus is in a transverse lie and the acromion process of the scapula is the landmark. This type of presentation occurs less than 1% of the time. This client is experiencing a problem between the maternal pelvis and the presenting part.
The nurse is working with a pregnant adolescent. The client asks the nurse how the baby's condition is determined during labor. The nurse's best response is that during labor, the nurse will do which of the following?
1. Check the client's cervix by doing a pelvic exam every 2 hours.
2. Assess the fetus's heart rate with an electronic fetal monitor.
3. Look at the color and amount of bloody show that the client has.
4. Verify that the client's contractions are strong but not too close together. - CORRECT ANSWER Answer: 2
Explanation: 2. This statement best answers the question the client has asked.
Usually, the family is advised to arrive at the birth setting at the beginning of the active phase of labor or when which of the following occur?
Note: Credit will be given only if all correct and no incorrect choices are selected.
Select all that apply.
1. Rupture of membranes (ROM)
2. Increased fetal movement
3. Decreased fetal movement
4. Any vaginal bleeding
5. Regular, frequent uterine contractions (UCs) - CORRECT ANSWER Answer: 1, 3, 4, 5
Explanation: 1. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when the membranes rupture.
3. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there is decreased fetal movement.
4. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there is any vaginal bleeding.
5. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there are regular, frequent uterine contractions.
The nurse would expect a physician to prescribe which medication to a postpartum client with heavy bleeding and a boggy uterus?
1. Methylergonovine maleate (Methergine)
2. Rh immune globulin (RhoGAM)
3. Terbutaline (Brethine)
4. Docusate (Colace) - CORRECT ANSWER Answer: 1
Explanation: 1. Methylergonovine maleate is the drug used for the prevention and control of postpartum hemorrhage.
A client is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. What is this client at risk for?
1. Gestational diabetes
2. Placenta previa
3. Abruptio placentae
4. Placenta accreta - CORRECT ANSWER Answer: 3
Explanation: 3. Abruptio placentae is more frequent in pregnancies complicated by smoking, premature rupture of membranes, multiple gestation, advanced maternal age, cocaine use, chorioamnionitis, and hypertension.
Risk factors for tachysystole include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Cocaine use
2. Placental abruption
3. Low-dose oxytocin titration regimens
4. Uterine rupture
5. Smoking - CORRECT ANSWER Answer: 1, 2, 4
Explanation: 1. Cocaine use is a risk factor for tachysystole.
2. Placental abruption is a risk factor for tachysystole.
4. Uterine rupture is a risk factor for tachysystole.
A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, why will terbutaline be administered?
1. To provide analgesia
2. To relax the uterus
3. To induce labor
4. To prevent hemorrhage - CORRECT ANSWER Answer: 2
Explanation: 2. Terbutaline is administered to achieve uterine relaxation.
A client is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse should anticipate the physician requesting which medications?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Methergine
2. Coumadin
3. Misoprostol
4. Serotonin reuptake inhibitors (SSRIs)
5. Nonsteroidal anti-inflammatory drugs - CORRECT ANSWER Answer: 1, 3
Explanation: 1. Methergine is commonly used orally for postpartum hemorrhage.
3. Misoprostol is commonly used rectally for postpartum hemorrhage.
The client has experienced a postpartum hemorrhage at 6 hours postpartum. After controlling the hemorrhage, the client's partner asks what would cause a hemorrhage. How should the nurse respond?
1. "Sometimes the uterus relaxes and excessive bleeding occurs."
2. "The blood collected in the vagina and poured out when your partner stood up."
3. "Bottle-feeding prevents the uterus from getting enough stimulation to contract."
4. "The placenta had embedded in the uterine tissue abnormally." - CORRECT ANSWER Answer: 1
Explanation: 1. Uterine atony (relaxation of the uterus) is the leading cause of early postpartum hemorrhage, accounting for over 50% of postpartum hemorrhage cases.
A postpartum client has inflamed hemorrhoids. Which nursing intervention would be appropriate?
1. Encourage sitz baths.
2. Position the client in the supine position.
3. Avoid stool softeners.
4. Decrease fluid intake. - CORRECT ANSWER Answer: 1
Explanation: 1. Encouraging sitz baths is the correct approach because moist heat decreases inflammation and provides for comfort.
The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the client's chart requires immediate intervention?
1. Previous birth by cesarean
2. Frank breech ballotable
3. 37 weeks, complete breech
4. Failed ECV last week - CORRECT ANSWER Answer: 1
Explanation: 1. Any previous uterine scar is a contraindication to ECV. Prior scarring of the uterus may increase the risk of uterine tearing or uterine rupture.
A woman has been having contractions since 4 a.m. At 8 a.m., her cervix is dilated to 5 cm. Contractions are frequent, and mild to moderate in intensity. Cephalopelvic disproportion (CPD) has been ruled out. After giving the mother some sedation so she can rest, what would the nurse anticipate preparing for?
1. Oxytocin induction of labor
2. Amnioinfusion
3. Increased intravenous infusion
4. Cesarean section - CORRECT ANSWER Answer: 1
Explanation: 1. Oxytocin is the drug of choice for labor augmentation or labor induction and may be administered as needed for hypotonic labor patterns.
The nurse is caring for a client at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (PPROM). Which statement indicates that the client needs additional teaching?
1. "If I were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured."
2. "If I develop a urinary tract infection in my next pregnancy, I might rupture membranes early again."
3. "If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy."
4. "If I have aminocentesis, I might rupture the membranes again." - CORRECT ANSWER Answer: 3
Explanation: 3. There is no evidence that bed rest in a subsequent pregnancy decreases the risk for PPROM.
A woman in active labor is given nalbuphine hydrochloride (Nubain) 14 mg IV for pain relief. Half an hour later, her respirations are at 8 per minute. The physician would likely order which medication for this client?
1. Narcan
2. Reglan
3. Benadryl
4. Vistaril - CORRECT ANSWER Answer: 1
Explanation: 1. Narcan is useful for respiratory depression caused by nalbuphine (Nubain).
The client presents to the labor and delivery unit stating that her water broke 2 hours ago. Barring any abnormalities, how often would the nurse expect to take the client's temperature?
1. Every hour
2. Every 2 hours
3. Every 4 hours
4. Every shift - CORRECT ANSWER Answer: 3
Explanation: 3. Maternal temperature is taken every 4 hours unless it is above 37.5°C. If elevated, it is taken every hour.
During the initial intrapartal assessment of a client in early labor, the nurse performs a vaginal examination. The client's partner asks why this pelvic exam needs to be done. The nurse should explain that the purpose of the vaginal exam is to obtain information about which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Uterine contraction pattern
2. Fetal position
3. Presence of the mucous plug
4. Cervical dilation and effacement
5. Presenting part - CORRECT ANSWER Answer: 4, 5
Explanation: 4. The vaginal examination of a laboring client obtains information about the station of the presenting part and the dilation and effacement of the cervix.
5. The vaginal examination of a laboring client obtains information about the fetal presenting part.
The charge nurse has received the shift change report. Which client requires immediate intervention?
1. Woman at 6 cm undergoing induction of labor, strong contractions every 3 minutes
2. Woman at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation
3. Woman at 10 cm and fetus at +2 station experiencing a strong expulsion urge
4. Woman at 3 cm screaming in fear because her mother died during childbirth - CORRECT ANSWER Answer: 4
Explanation: 4. This client is most likely fearful that she will die during labor because her mother died during childbirth. This client requires education and a great deal of support, and is therefore the top priority.
An analgesic medication has been administered intramuscularly to a client in labor. How would the nurse evaluate if the medication was effective?
1. The client dozes between contractions.
2. The client is moaning during contractions.
3. The contractions decrease in intensity.
4. The contractions decrease in frequency. - CORRECT ANSWER Answer: 1
Explanation: 1. If the client dozes between contractions, the analgesic is effective. Analgesics decrease discomfort and increase relaxation.
Premonitory signs of labor include which of the following?
Note: Credit will be given only for all correct choices and no incorrect choices.
Select all that apply.
1. Braxton Hicks contractions
2. Cervical softening and effacement
3. Weight gain
4. Rupture of membranes
5. Sudden loss of energy - CORRECT ANSWER Answer: 1, 2, 4
Explanation: 1. A premonitory sign of labor includes Braxton Hicks contractions.
2. A premonitory sign of labor includes cervical softening and effacement.
4. A premonitory sign of labor includes rupture of membranes.
A client has just arrived in the birthing unit. What steps would be most important for the nurse to perform to gain an understanding of the physical status of the client and her fetus?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Check for ruptured membranes and apply a fetal scalp electrode.
2. Auscultate the fetal heart rate between and during contractions.
3. Palpate contractions and resting uterine tone.
4. Assess the blood pressure, temperature, respiratory rate, and pulse rate.
5. Perform a vaginal exam for cervical dilation, and perform Leopold maneuvers. - CORRECT ANSWER Answer: 2, 3
Explanation: 2. Fetal heart rate auscultation gives information about the physical status of the fetus.
3. Contraction palpation provides information about the frequency, duration, and intensity of the contractions.
The nurse is orienting a new graduate nurse to the labor and birth unit. Which statement indicates that teaching has been effective?
1. "When a client arrives in labor, a urine specimen is obtained by catheter to check for protein and ketones."
2. "When a client arrives in labor, she will be positioned supine to facilitate a normal blood pressure."
3. "When a client arrives in labor, her prenatal record is reviewed for indications of domestic abuse."
4. "When a client arrives in labor, a vaginal exam is performed unless birth appears to be imminent." - CORRECT ANSWER Answer: 4
Explanation: 4. Unless delivery seems imminent because the client is bearing down or contractions are very close and strong, the vaginal exam is performed after the vital signs are obtained.
A client was admitted to the labor area at 5 cm with ruptured membranes about 14 hours ago. What assessment data would be most beneficial for the nurse to collect?
1. Blood pressure
2. Temperature
3. Pulse
4. Respiration - CORRECT ANSWER Answer: 2
Explanation: 2. Rupture of membranes places the mother at risk for infection. The temperature is the primary and often the first indication of a problem.
The nurse is assessing a client who has been diagnosed with an early postpartum hemorrhage. Which findings would the nurse expect?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. A boggy fundus that does not respond to massage
2. Small clots and a moderate amount of lochia rubra on the pad
3. Decreased pulse and increased blood pressure
4. Hematoma formation or bulging/shiny skin in the perineal area
5. Rise in the level of the fundus of the uterus - CORRECT ANSWER Answer: 1, 4, 5
Explanation: 1. A boggy fundus indicates that the uterus is not contracted and will continue to bleed.
4. Shiny or bulging skin could indicate the presence of a hematoma.
5. The uterine cavity can distend with up to 1000 mL or more of blood causing the fundus to rise.
A woman is scheduled to have an external version for a breech presentation. The nurse carefully reviews the client's chart for contraindications to this procedure, including which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Station -2
2. 38 weeks' gestation
3. Abnormal fetal heart rate and tracing
4. Previous cesarean section
5. Rupture of membranes - CORRECT ANSWER Answer: 3, 4, 5
Explanation: 3. An abnormal fetal heart rate or tracing would be a contraindication to performing a version. A nonreassuring FHR pattern might indicate that the fetus is already stressed and other action needs to be taken.
4. A previous cesarean is a contraindication for version.
5. Rupture of membranes is a contraindication for version because of insufficient amniotic fluid.
The nurse assesses the postpartum client who has not had a bowel movement by the third postpartum day. Which nursing intervention would be appropriate?
1. Encourage the new mother, saying, "It will happen soon."
2. Instruct the client to eat a low-fiber diet.
3. Decrease fluid intake.
4. Obtain an order for a stool softener. - CORRECT ANSWER Answer: 4
Explanation: 4. Obtaining an order for a stool softener is the correct intervention by the third day. In resisting or delaying the bowel movement, the woman may cause increased constipation and more pain when elimination finally occurs.
Nonreassuring fetal status often occurs with a tachysystole contraction pattern. Intrauterine resuscitation measures may become warranted and can include which of the following measures?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Position the woman on her right side.
2. Apply oxygen via face mask.
3. Call for anesthesia provider for support.
4. Increase intravenous fluids by at least 700 mL bolus.
5. Call the physician/CNM to the bedside. - CORRECT ANSWER Answer: 2, 3, 4
Explanation: 2. The nurse would apply oxygen via face mask.
3. The nurse would call for anesthesia provider for support.
4. The nurse would increase intravenous fluids by at least 500 mL bolus.
A client is having contractions that last 20-30 seconds and that are occurring every 8-20 minutes. The client is requesting something to help relieve the discomfort of contractions. What should the nurse suggest?
1. That a mild analgesic be administered
2. An epidural
3. A local anesthetic block
4. Nonpharmacologic methods of pain relief - CORRECT ANSWER Answer: 4
Explanation: 4. For this pattern of labor, nonpharmacologic methods of pain relief should be suggested. These can include back rubs, providing encouragement, and clean linens.
A client arrives in the labor and delivery unit and describes her contractions as occurring every 10-12 minutes, lasting 30 seconds. She is smiling and very excited about the possibility of being in labor. On exam, her cervix is dilated 2 cm, 100% effaced, and -2 station. What best describes this labor?
1. Second phase
2. Latent phase
3. Active phase
4. Transition phase - CORRECT ANSWER Answer: 2
Explanation: 2. In the early or latent phase of the first stage of labor, contractions are usually mild. The woman feels able to cope with the discomfort. The woman is often talkative and smiling and is eager to talk about herself and answer questions.
The nurse is preparing to assess a laboring client who has just arrived in the labor and birth unit. Which statement by the client indicates that additional education is needed?
1. "You are going to do a vaginal exam to see how dilated my cervix is."
2. "The reason for a pelvic exam is to determine how low in the pelvis my baby is."
3. "When you check my cervix, you will find out how thinned out it is."
4. "After you assess my pelvis, you will be able to tell when I will deliver." - CORRECT ANSWER Answer: 4
Explanation: 4. An experienced labor and birth nurse can estimate the time of delivery based on the cervix, fetal position, station, and contraction pattern. However, during a pelvic exam, no information is obtained about contractions. The nurse will not have enough information following the cervical exam to estimate time of birth.
The client presents to the labor and delivery unit stating that her water broke 2 hours ago. Indicators of normal labor include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Fetal heart rate of 130 with average variability
2. Blood pressure of 130/80
3. Maternal pulse of 160
4. Protein of +1 in urine
5. Odorless, clear fluid on underwear - CORRECT ANSWER Answer: 1, 2, 5
Explanation: 1. Fetal heart rate (FHR) of 110-160 with average variability is a normal indication.
2. Maternal vital sign of blood pressure below 140/90 is a normal indication.
5. Fluid clear and without odor if membranes ruptured is a normal indication.
The nurse is making client assignments for the next shift. Which client is most likely to experience a complicated labor pattern?
1. 34-year-old woman at 39 weeks' gestation with a large-for-gestational-age (LGA) fetus
2. 22-year-old woman at 23 weeks' gestation with ruptured membranes
3. 30-year-old woman at 41 weeks' gestation and estimated fetal weight 7 pounds 8 ounces
4. 43-year-old woman at 37 weeks' gestation with hypertension - CORRECT ANSWER Answer: 1
Explanation: 1. A risk factor for hypotonic uterine contraction patterns includes a large-for-gestational-age (LGA) fetus.
The nurse admits into the labor area a client who is in preterm labor. What assessment finding would constitute a diagnosis of preterm labor?
1. Cervical effacement of 30% or more
2. Cervical change of 0.5 cm per hour
3. 2 contractions in 30 minutes
4. 8 contractions in 1 hour - CORRECT ANSWER Answer: 4
Explanation: 4. 8 contractions in a 60 minute period does define a diagnosis of preterm labor.
A laboring client's obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed?
1. Maternal temperature, BP, and pulse
2. Estimation of fetal birth weight
3. Fetal presentation, position, and station
4. Biparietal diameter - CORRECT ANSWER Answer: 3
Explanation: 3. Before an amniotomy is performed, the fetus is assessed for presentation, position, station, and FHR.
The nurse has received the end-of-shift report on the postpartum unit. Which client should the nurse see first?
1. Woman who is 2nd day post-cesarean, moderate lochia serosa
2. Woman day of delivery, fundus firm 2 cm above umbilicus
3. Woman who had a cesarean section, 1st postpartum day, 4 cm diastasis recti abdominis
4. Woman who had a cesarean section, 1st postpartum day, hypoactive bowel sounds all quadrants - CORRECT ANSWER Answer: 2
Explanation: 2. This client is the top priority. The fundus should not be positioned above the umbilicus after delivery. If the fundus is in the midline but higher than expected, it is usually associated with clots within the uterus.
) The nurse is caring for a postpartum client who is at risk for developing early postpartum hemorrhage. What interventions would be included in the plan of care to detect this complication?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
1. Weigh perineal pads if the client has a slow, steady, free flow of blood from the vagina.
2. Massage the uterus every 2 hours.
3. Maintain vascular access.
4. Obtain blood specimens for hemoglobin and hematocrit.
5. Encourage the client to void if the fundus is displaced upward or to one side. - CORRECT ANSWER Answer: 1, 4
Explanation: 1. Weighing the perineal pads will indicate whether the client is bleeding more than anticipated.
4. The nurse reviews hemoglobin and hematocrit levels when available, and compares them to the admission baseline.
Two hours after an epidural infusion has begun, a client complains of itching on her face and neck. What should the nurse do?
1. Remove the epidural catheter and apply a Band-Aid to the injection site.
2. Offer the client a cool cloth and let her know the itching is temporary.
3. Recognize that this is a common side effect, and follow protocol for administration of Benadryl.
4. Call the anesthesia care provider to re-dose the epidural catheter. - CORRECT ANSWER Answer: 3
Explanation: 3. Itching is a side effect of the medication used for an epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus.
The client has been pushing for 3 hours, and the fetus is making a slow descent. The partner asks the nurse whether pushing for this long is normal. How should the nurse respond?
1. "Your baby is taking a little longer than average, but is making progress."
2. "First babies take a long time to be born. The next baby will be easier."
3. "The birth would go faster if you had taken prenatal classes and practiced."
4. "Every baby is different; there really are no norms for labor and birth." - CORRECT ANSWER Answer: 1
Explanation: 1. Establishing rapport and a trusting relationship and providing information that is true is best response.
The client is being admitted to the birthing unit. As the nurse begins the assessment, the client's partner asks why the fetus's heart rate will be monitored. After the nurse explains, which statement by the partner indicates a need for further teaching?
1. "The fetus's heart rate will vary between 110 and 160."
2. "The heart rate is monitored to see whether the fetus is tolerating labor."
3. "By listening to the heart, we can tell the gender of the fetus."
4. "After listening to the heart rate, you will contact the midwife." - CORRECT ANSWER Answer: 3
Explanation: 3. Fetal heart rate is not a predictor of gender.
The client has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of contractions occurring every 5 minutes. What is the nurse's best response to the client?
1. "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress."
2. "When your perineal body thins out, your cervix will begin to dilate much faster than it is now."
3. "What did you expect? You've only had contractions for a few hours. Labor takes time."
4. "The hormones that cause labor to begin are just getting to be at levels that will change your cervix." - CORRECT ANSWER Answer: 1
Explanation: 1. With each contraction, the muscles of the upper uterine segment shorten and exert a longitudinal traction on the cervix, causing effacement. Effacement is the taking up (or drawing up) of the internal os and the cervical canal into the uterine side walls.
During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. What would the nurse's priority action be?
1. To help the fetal head descend faster
2. To use gravity and manipulation to relieve compression on the cord
3. To facilitate dilation of the cervix with prostaglandin gel
4. To prevent head compression - CORRECT ANSWER Answer: 2
Explanation: 2. The top priority is to relieve compression on the umbilical cord to allow blood flow to reach the fetus. It is because some obstetric maneuvers to relieve cord compression are complicated that cesarean birth is sometimes necessary. [Show Less]