Chapter 13/14 questions

Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia? A. Difficulty breathing B. Staggering gait C. Decreased level of consciousness D. Intense pain

Difficulty breathing

The nurse is assisting a client through labor, monitoring her closely now that she has received an epidural. Which finding should the nurse prioritize to the anesthesiologist? A. Dry, cracked lips B. Urinary retention C. Rapid progress of labor D. Inability to push

Inability to push

A 19-year-old female presents in advanced labor. Examination reveals the fetus is in frank breech position. The nurse interprets this finding as indicating: A. The buttocks are presenting first with both legs extended up toward the face. B. The fetus is sitting cross-legged above the cervix. C. One leg is presenting. D. One arm is presenting.

A. The buttocks are presenting first with both legs extended up toward the face.

Which client statement is anticipated after immediately receiving an intrathecal injection of pain medication? A. "I have no pain now." B. "I feel cramping but no sharp pain." C. "I feel a dull achiness around my abdomen." D. "I still have intense pain. The medication is not working."

"I have no pain now."

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem? A. Variable decelerations B. Prolonged decelerations C. Early decelerations D. Accelerations

B. Prolonged decelerations

A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client? A. Accidental intrathecal block B. Respiratory depression C. Postdural puncture (spinal) headache D. A failed block

respiratory depression

A pregnant woman at 37 weeks' gestation calls the clinic to say she thinks that she is in labor. The nurse instructs the woman to go to the health care facility based on the client's report of contractions that are: A. Occurring in the abdomen and groin. B. Lasting about 30 seconds. C. Occurring about every 5 minutes. D. Relieved by walking.

C. Occurring about every 5 minutes.

A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture? A. Bloody fluid B. Clear to straw-colored fluid C. Greenish fluid D. Cloudy white fluid

Clear to straw-colored fluid

The nurse is caring for a client at 39 weeks' gestation who is noted to be at 0 station. The nurse is correct to document which? A. The client is fully effaced. B. The fetus is floating high in the pelvis. C. The fetus is in the true pelvis and engaged. D. The fetus has descended down the birth canal.

The fetus is in the true pelvis and engaged.

A client who is in the transition phase reports her pain medication last given 3 hours ago has worn off. She asks if she can have another dose of the meperidine. How should the nurse respond to the request? "Since it has been over 3 hours, you should be able to have more of the medication." "It is too early as the medication should be given only every 4 hours." "Your phase of labor makes giving another dose unsafe." "I will get permission from your health care provider."

"Your phase of labor makes giving another dose unsafe."

During a prenatal visit a pregnant client asks the nurse how to tell whether the contractions she is having are true contractions or Braxton Hicks contractions. Which description should the nurse mention as characteristic of true contractions? Select all that apply. A. Begin irregularly but become regular and predictable B. Felt first in lower back and sweep around to the abdomen in a wave C. Increase in duration, frequency, and intensity D. Begin and remain irregular E. Felt first abdominally and remain confined to the abdomen and groin F. Often disappear with ambulation or sleep

A. Begin irregularly but become regular and predictable B. Felt first in lower back and sweep around to the abdomen in a wave C. Increase in duration, frequency, and intensity

A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply. A. increase in heart rate B. increase in blood pressure C. increase in respiratory rate D. slight decrease in body temperature E. increase in gastric emptying and pH

A. increase in heart rate B. increase in blood pressure C. increase in respiratory rate

A nurse is explaining to a pregnant client about the changes occurring in the body in preparation for labor. Which hormone would the nurse include in the explanation as being responsible for causing the pelvic connective tissue to become more relaxed and elastic? A. relaxin B. progesterone C. oxytocin D. prolactin

A. relaxin

The nurse is preparing a young couple for the upcoming birth of their child, and the mother expresses concern for needing pain medications and the effects on the fetus. When counseling the couple about pain relief, the nurse would incorporate which information in the teaching about measures to help to decrease the requests for pain medication? A. Continuous support through the labor process helps decrease the need for pain medication. B. Sitting in a hot tub helps decrease the need for pain medication. C. A quick epidural can replace the need for pain medication. D. Lying on an ice pack can help decrease the need for pain medication.

Continuous support through the labor process helps decrease the need for pain medication.

The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which process? A. engagement B. descent C. restitution D.crowning

Crowning