Exam 2 HR Intrapartum Questions

A nurse has been assigned to circulate during the cesarean section of triplets. Which of the following actions should the nurse take before the birth of the babies? Select all that apply. 1. Count the number of sterile sponges. 2. Document the time of the first incision. 3. Notify the pediatric staff. 4. Perform a sterile scrub. 5. Assemble the sterile instruments.

1. The circulating nurse should count the sterile sponges. This is done together with the scrub nurse. 2. The circulating nurse must document in the medical record all key events that occur during the surgery, including the time of the fi rst incision. 3. The circulating nurse should notify the pediatric staff. There should be one resuscitation team assembled in the delivery room for each baby who will be delivered. TEST-TAKING TIP: The circulating nurse is responsible for coordinating the activity in the operating room. He or she is the only member of the team who is able to move freely throughout the room to make telephone calls, obtain needed supplies, maintain the documentation record, and so on. When multiple babies are being birthed, he or she is especially important. The more babies who are birthed at once—for example, twins, triplets—the more vulnerable the babies are at birth. Multiple-gestation babies are often born preterm and small for gestational age. There must be a resuscitation team available for each baby in case emergent care is needed.

A client who has been diagnosed with severe pre-eclampsia is being administered magnesium sulfate via IV pump. Which of the following medications must the nurse have immediately available in the client's room? 1. Calcium gluconate. 2. Morphine sulfate. 3. Naloxone (Narcan). 4. Meperidine (Demerol).

1. The nurse must have calcium gluconate in the client's room. TEST-TAKING TIP: Calcium gluconate is the antidote for magnesium sulfate toxicity. It is very important that the test taker know that, if needed, calcium gluconate must be administered very slowly. If calcium gluconate is administered rapidly, the client may experience sudden convulsions.

A client just spontaneously ruptured membranes. Which of the following factors makes her especially at high risk for having a prolapsed cord? Select all that apply. 1. Breech presentation. 2. Station -3. 3. Oligohydramnios. 4. Dilation 2 cm. 5. Transverse lie.

1. When a baby is in the breech presentation, there is increased risk of prolapsed cord. 2. The presenting part is floating, which increases the risk of prolapsed cord. 5. When a baby is in the transverse lie, there is increased risk for prolapsed cord. TEST-TAKING TIP: Once the membranes have ruptured, there are several situations that can increase the possibility of the cord prolapsing; that is, when the cord slips past the baby and becomes the presenting part. The baby then compresses the cord, preventing the baby from being oxygenated. The situations include malpresentations, such as breech and shoulder presentations. A shoulder presentation is the same as a transverse lie. Additional situations that are at high risk for cord prolapse are hydramnios, premature rupture of membranes, and negative fetal station.

A woman, G3 P2002, is 6 cm dilated. The fetal monitor tracing shows recurring deep late decelerations. The woman's doctor informs her that the baby must be delivered by cesarean section. The woman refuses to sign the informed consent. Which of the following actions by the nurse is appropriate? 1. Strongly encourage the woman to sign the informed consent. 2. Prepare the woman for the cesarean section. 3. Inform the woman that the baby will likely die without the surgery. 4. Provide the woman with ongoing labor support.

4. At this point the appropriate action for the nurse to take is to continue providing labor support. If accepted, emergency interventions, such as providing oxygen by face mask and repositioning the client, would also be indicated. TEST-TAKING TIP: If the client's practitioner is convinced that surgery is the only appropriate intervention, he or she could get a court order to mandate the woman to accept surgery. The nurse's role at this point, however, is to provide the client with care in a nonthreatening, compassionate manner. The nurse must acknowledge and accept the client's legal right to refuse the surgery.

A primigravid client received Cervidil (dinoprostone) for induction 8 hours ago. The Bishop score is now 10. Which of the following actions by the nurse is appropriate? 1. Perform nitrazine analysis of amniotic fl uid. 2. Report abnormal fi ndings to the obstetrician. 3. Place the woman on her side. 4. Monitor for onset of labor.

4. The nurse should monitor this client for the onset of labor. TEST-TAKING TIP: The Bishop score indicates the inducibility of the cervix of a client. Five signs are assessed—cervical position, cervical dilation, cervical effacement, cervical station, and cervical consistency—each receiving a value of 0, 1, 2, or 3. A total score is calculated; the maximum Bishop score is 15. A primigravida's cervix is considered inducible when her Bishop score is 9 or higher. A multigravida's cervix is considered inducible when her Bishop score is 5 or higher.

A 40-week-gestation client has an admitting platelet count of 90,000 cells/mm 3 and a hematocrit of 29%. Her laboratory values 1 week earlier were platelet count 200,000 cells/mm 3 and hematocrit 37%. Which additional abnormal laboratory value would the nurse expect to see? 1. Decreased serum creatinine level. 2. Elevated red blood count (RBC). 3. Decreased alkaline phosphatase. 4. Elevated alanine transaminase (ALT).

4. The nurse would expect to see an elevated ALT. TEST-TAKING TIP: This is a diffi cult, critical-thinking question. This client is exhibiting signs of HELLP syndrome (low platelets and hemolysis). Even though severe pre-eclampsia is not a part of the HELLP constellation, a client in severe pre-eclampsia would have poor renal function (elevated serum creatinine level). With hemolysis, the nurse would expect to see a drop in the RBC count and, with a damaged liver, an elevated alkaline phosphatase level as well as an elevated ALT level.

A 40-week-gestation woman has received Cytotec (misoprostol) for cervical ripening. For which of the following signs/symptoms should the nurse carefully monitor the client? 1. Diarrhea and back pain. 2. Hypothermia and rectal pressure. 3. Urinary retention and rash. 4. Tinnitus and respiratory distress.

1. A common side effect of Cytotec is diarrhea and labor contractions are often first felt in the back. TEST-TAKING TIP: Cytotec (misoprostol) is a synthetic prostaglandin medication used to ripen the cervix for induction. Gastrointestinal side effects are commonly seen when prostaglandin is used, because the gastrointestinal system is adjacent to the vagina where the medication is inserted. In addition, the nurse must be watchful for signs of labor.

A labor nurse is caring for a client, 38 weeks' gestation, who has been diagnosed with symptomatic placenta previa. Which of the following orders by the primary healthcare provider should the nurse question? 1. Begin oxytocin drip rate at 0.5 milliunit/min. 2. Assess fetal heart rate every 10 minutes. 3. Weigh all vaginal pads. 4. Assess hematocrit and hemoglobin.

1. An order for oxytocin administration should be questioned. TEST-TAKING TIP: Because the stem states that this woman has symptomatic placenta previa, the test taker can conclude that the woman is bleeding vaginally. It would be appropriate to monitor the fetal heart for any signs of distress, to weigh pads to determine the amount of blood loss, and to assess the hematocrit and hemoglobin to check for anemia. Labor, however, is contraindicated, because vaginal delivery is contraindicated.

To reduce possible side effects from a cesarean section under general anesthesia, clients are routinely given which of the following medications? 1. Antacids. 2. Tranquilizers. 3. Antihypertensives. 4. Anticonvulsants.

1. Antacids are routinely administered presurgically to cesarean section clients. TEST-TAKING TIP: Progesterone is a muscle relaxant. Because pregnant women have elevated levels of progesterone, their cardiac sphincters are relaxed. They are at especially high risk, therefore, for vomiting during surgery. To decrease the acidity of the vomitus in case of aspiration, gravid women are routinely given antacids presurgically.

A client with a complete placenta previa is on the antepartum clinical unit in preparation for delivery. Which of the following should the nurse include in a teaching session for this client? 1. Coughing and deep breathing. 2. Phases of the first stage of labor. 3. Lamaze labor techniques. 4. Leboyer hydrobirthing.

1. Because the client will have a cesarean section with anesthesia, the woman should be taught coughing and deep- breathing exercises for the postoperative period. TEST-TAKING TIP: When a client has a complete placenta previa, the placenta has attached to the uterine lining so that it fully covers the internal cervical os. If the woman were to go through labor, during dilation and effacement the villi of the placenta would incrementally be exposed, leading the client to bleed profusely. The baby would exsanguinate and die. The only safe way to deliver the baby, therefore, is via cesarean section.

The nurse is admitting four full-term primigravid clients to the labor and delivery unit. The nurse requests pre-cesarean section orders from the healthcare practitioner for which of the clients? The client who has: Select all that apply. 1. Cervical cerclage. 2. FH 156 with beat-to-beat variability. 3. Maternal blood pressure of 90/60. 4. Full effacement. 5. Active herpes simplex 2.

1. Cervical cerclage, a stitch encircling the cervix, is incompatible with vaginal delivery. 5. Active herpes simplex 2 is an absolute indicator for a cesarean delivery. TEST-TAKING TIP: The test taker must be able to differentiate in which circumstances a full-term, otherwise healthy woman, would be unable to deliver vaginally. There are a few absolute indicators for cesarean section: maternal infection with active herpes simplex 2 and HIV/AIDS; malpresentation—for example, horizontal lie and breech; previous uterine surgery—for example, myomectomy and a vertical cesarean scar; some fetal anomalies—for example, hydrocephalus and meningomyelocele; and other physical conditions, including cervical cerclage in place, obstructive lesions in the lower gynecological system, and complete placenta previa. The test taker should become familiar with each of these.

Which of the following signs/symptoms would the nurse expect to see in a woman with abruptio placentae? 1. Increasing fundal height measurements. 2. Pain-free vaginal bleeding. 3. Fetal heart accelerations. 4. Hyperthermia with leukocytosis.

1. Fundal heights increase during pregnancy approximately 1 cm per week. When a placental abruption occurs, the height increases hour by hour. TEST-TAKING TIP: When a placenta abrupts, it separates from the uterine wall. As a result, a pool of blood appears behind the placenta. The pool of blood takes up space, leading to an increase in the size of the uterus. The fundal height increases as the uterine size increases.

The physician has ordered oxytocin (Pitocin) for induction for 4 gravidas. In which of the following situations should the nurse refuse to comply with the order? 1. Primigravida with a transverse lie. 2. Multigravida with cerebral palsy. 3. Primigravida who is 14 years old. 4. Multigravida who has type 1 diabetes.

1. Induction is contraindicated in transverse lie. TEST-TAKING TIP: A baby in the transverse lie is in a scapular presentation. The baby is incapable of being birthed vaginally. Whenever a vaginal birth is contraindicated, induction is also contraindicated.

A client has just entered the labor and delivery suite with ruptured membranes for 2 hours, fetal heart rate of 146, contractions every 5 minutes × 60 seconds, and a history of herpes simplex type 2. She has no observable lesions. After notifying the doctor of the admission, which of the following is the appropriate action for the nurse to take? 1. Check dilation and effacement. 2. Prepare the client for surgery. 3. Place the bed in Trendelenburg position. 4. Check the biophysical profile results.

1. It is appropriate for the nurse to assess the client's dilation and effacement. TEST-TAKING TIP: Although cesarean deliveries are recommended to be performed when a client has an active case of herpes simplex, surgical delivery is not indicated when no lesions are present. Clients who have histories of herpes with no current outbreak, therefore, are considered to be healthy laboring clients who may deliver vaginally

A baby is entering the pelvis in the vertex presentation and in the extended attitude. The nurse determines that which of the following positions is consistent with this situation? 1. Left mentum anterior (LMA). 2. Left sacral posterior (LSP). 3. Right scapular transverse (RScT). 4. Right occiput posterior (ROP).

1. LMA position is consistent with the information in the scenario. TEST-TAKING TIP: To conceptualize the relationship among attitude, presentation, and position, the test taker must first thoroughly understand the three concepts. The vertex presentation is a head-down presentation; both occipital and mentum presentations are vertex presentations. When the attitude is extended in a head-down presentation, the front of the head or the face is the presenting part, whereas when the head is flexed, the back of the head, or occiput, is presenting. When the scapula is presenting, the baby is lying sideways in utero, called transverse lie.

The nurse is caring for a laboring gravida who is 43 weeks pregnant. For which of the following should the nurse carefully monitor this client and fetus? 1. Late decelerations. 2. Hyperthermia. 3. Hypotension. 4. Early decelerations.

1. This baby is at high risk for the development of late fetal heart decelerations. TEST-TAKING TIP: The test taker must attend to all important information in the question. The gestational age of this fetus is 43 weeks. The baby and placenta, therefore, are both postdates. Placental function usually deteriorates after 40 weeks' gestation. Because late decelerations result from poor uteroplacental blood fl ow, the nurse should monitor this client carefully for late decelerations.

A client, 42 weeks' gestation, is admitted to the labor and delivery suite with a diagnosis of acute oligohydramnios. The nurse must carefully observe this client for signs of which of the following? 1. Fetal distress. 2. Dehydration. 3. Oliguria. 4. Jaundice.

1. The nurse should carefully monitor the client for fetal distress. TEST-TAKING TIP: Oligohydramnios is often seen in post-term pregnancies. When the placenta begins to deteriorate, the hydration of the baby drops. Because the predominant component of amniotic fluid is fetal urine, when the baby is dehydrated, the quantity of amniotic fluid drops. Fetal distress can occur because of two factors: cord compression, because there is insufficient fluid to cushion the umbilical cord, and uteroplacental insufficiency, because the placenta is functioning suboptimally.

A client with a fetal demise is admitted to labor and delivery in the latent phase of labor. Which of the following behaviors would the nurse expect this client to exhibit? 1. Crying and sad. 2. Talkative and excited. 3. Quietly doing rapid breathing. 4. Loudly chanting songs.

1. The nurse would expect the client to be crying and sad. TEST-TAKING TIP: A client in the latent phase of labor who is carrying a healthy fetus is likely to be talkative and excited, but a woman whose fetus has died is likely to be crying and sad throughout her labor. Clients in the latent phase usually are performing slow chest breathing.

The nurse is assisting in the delivery of a baby via vacuum extraction. Which of the following nursing diagnoses for the gravida is appropriate at this time? 1. Risk for impaired skin integrity. 2. Risk for body image disturbance. 3. Risk for impaired parenting. 4. Risk for ineffective sexuality pattern.

1. The woman is at risk of impaired skin integrity. TEST-TAKING TIP: Clients who are delivered by vacuum extraction are at high risk for lacerations. Their skin integrity, therefore, is at risk. The other nursing diagnoses are not applicable.

A client is in labor and delivery with a diagnosis of HELLP syndrome. The nurse notes the following blood values: Prothrombin time (PT) 99 sec (normal 60 to 85 sec) Partial thromboplastin time (PTT) 30 sec (normal 11 to 15 sec) For which of the following signs/symptoms would the nurse monitor the client? 1. Pink-tinged urine. 2. Early decelerations. 3. Patellar reflexes +1. 4. Blood pressure 140/90.

1. This client has likely developed disseminated intravascular coagulation (DIC). The nurse should watch for pink-tinged urine. TEST-TAKING TIP: The test taker must be familiar with the implications of standard blood tests like PT and PTT. Even if the nurse did not know that clients who are diagnosed with HELLP syndrome are at high risk for DIC, he or she should know that clients with prolonged PT and PTT times are at high risk for spontaneous bleeds.

The nurse in the obstetrician's office is caring for four 25-week-gestation prenatal clients who are carrying singleton pregnancies. With which of the following clients should the nurse carefully review the signs and symptoms of preterm labor (PTL)? Select all that apply. 1. 38-year-old in an abusive relationship. 2. 34-year-old whose first child was born at 32 weeks' gestation. 3. 30-year-old whose baby has a two-vessel cord. 4. 26-year-old with a history of long menstrual periods. 5. 22-year-old who smokes 2 packs of cigarettes every day.

1. This client is at high risk for PTL because she is over 35 years of age and in an abusive relationship. 2. A previous preterm delivery places a client at increased risk of preterm labor. 5. A woman who smokes cigarettes is at high risk for preterm labor. TEST-TAKING TIP: Even though medical and psychosocial histories are not absolute predictors of preterm labor, there are a number of factors that have been shown to place clients at risk, including pregnancy history of multiple gestations; previous preterm deliveries; cigarette smoking and/or illicit drug use; a number of medical histories like diabetes and hypertension; and social issues like adolescent pregnancy and domestic violence.

The nurse turns off the oxytocin (Pitocin) infusion after a period of tachysystole. Which of the following outcomes indicates that the nurse's action was effective? 1. Intensity moderate. 2. Frequency every 3 minutes. 3. Duration 130 seconds. 4. Attitude flexed.

2. A frequency pattern of every 3 minutes is ideal. TEST-TAKING TIP: This question is asking the test taker to evaluate an expected outcome. When a nurse intervenes, he or she is expecting a positive outcome. In this situation, the nurse is determining whether or not the action has reversed the tachysystole that developed from oxytocin administration. The normal contraction frequency is evidence of a positive outcome. (In some instances, the term "hyperstimulation" may be used in place of "tachysystole.")

A laboring woman, who has developed an apparent amniotic fluid embolism, is not breathing and has no pulse. In addition to calling for assistance, which of the following actions by the nurse, who is alone with the patient, is appropriate at this time? 1. Perform cardiac compressions and breaths in a 15 to 2 ratio. 2. Provide chest compressions at a depth of at least 2 inches. 3. Compress the chest at the lower 1 / 2 of the sternum. 4. Provide rescue breaths over a 10-second time frame.

2. Chest compressions should be delivered at a depth of at least 2 inches and no more than 2.4 inches. TEST-TAKING TIP: The American Heart Association frequently revises cardiopulmonary resuscitation (CPR) guidelines. The preceding responses refl ect the 2015 guidelines. The test taker should make sure that he or she is familiar with current protocols. In addition to these responses, it is important for the rescuer to perform manual displacement of the uterus toward the left to decrease the compression of the gravid uterus on the aorta and vena cava

A physician has given a nurse a verbal order to apply cricoid pressure. Which of the following is the likely indication for the action? 1. Forceps delivery. 2. Endotracheal tube insertion. 3. Epidural insertion. 4. Third stage of labor.

2. Cricoid pressure is indicated during endotracheal intubation. TEST-TAKING TIP: When a client is being intubated, there is a possibility that the stomach contents will be regurgitated. When the vomiting occurs, the client may aspirate the contents. Because the contents are highly acidic, the trachea and lung fi elds can become damaged. Cricoid pressure helps to reduce the potential for respiratory aspiration of the stomach contents.

During a vaginal delivery, the obstetrician declares that a shoulder dystocia has occurred. Which of the following actions by the nurse is appropriate at this time? 1. Administer oxytocin intravenously per doctor's orders. 2. Flex the woman's thighs sharply toward her abdomen. 3. Apply oxygen using a tight-fitting face mask. 4. Apply downward pressure on the woman's fundus.

2. Flexing the woman's hips sharply toward her abdomen, called McRoberts maneuver, is appropriate. TEST-TAKING TIP: Flexing the woman's hips sharply toward her abdomen increases slightly the diameter of the pelvic outlet and straightens the pelvic curve, both of which often enable the practitioner to successfully deliver the baby. It is especially important to note that fundal pressure is contraindicated because it may actually magnify the problem by wedging the shoulders into the pelvis even more deeply. Suprapubic pressure, on the other hand, is often helpful in assisting with the delivery.

The fetal monitor tracing of a laboring woman who is 9 cm dilated shows recurring late decelerations to 100 bpm. The nurse notes a moderate amount of greenish-colored amniotic fluid gush from the vagina after a practitioner performs an amniotomy. Which of the following nursing diagnoses is appropriate at this time? 1. Risk for infection related to rupture of membranes. 2. Risk for fetal injury related to possible intrauterine hypoxia. 3. Risk for impaired tissue integrity related to vaginal irritation. 4. Risk for maternal injury related to possible uterine rupture.

2. Green amniotic fluid in the presence of late decelerations is indicative of fetal distress. TEST-TAKING TIP: Late decelerations are related to poor uteroplacental blood fl ow. As a result of the poor blood fl ow, the fetus is being poorly oxygenated and nourished. Amniotic fluid becomes green tinged in the presence of meconium. Meconium is expelled in utero when the fetal anal sphincter relaxes. Sphincters relax when the body is hypoxic. The nurse, therefore, must conclude that the fetus is at high risk for injury related to intrauterine hypoxia.

In which of the following clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion? 1. Placental abruption. 2. Meconium-stained fluid. 3. Polyhydramnios. 4. Late decelerations.

2. It would be appropriate for a healthcare practitioner to order an amnioinfusion when a client's amniotic fluid is meconium stained. TEST-TAKING TIP: Amnioinfusion is the instillation of intravenous fl uid into the uterine cavity through intravenous tubing inserted via the vagina. It may be ordered if the amniotic fl uid is meconium stained. The infusion would dilute the concentration of meconium to decrease the potential of the baby aspirating large quantities of meconium at birth.

Which of the following physical findings would lead the nurse to suspect that a client with severe pre-eclampsia has developed HELLP syndrome? Select all that apply. 1. +3 pitting edema. 2. Petechiae. 3. Jaundice. 4. +4 deep tendon reflexes. 5. Elevated specific gravity.

2. Petechiae may develop when a client is thrombocytopenic, one of the signs of HELLP syndrome. 3.Hyperbilirubinemia develops when red blood cells hemolyze, one of the changes that may develop as a result of liver necrosis. Jaundice is a symptom of hyperbilirubinemia. Also, elevated liver function tests (EL) are a manifestation of HELLP syndrome. TEST-TAKING TIP: The test taker must be able to discriminate between symptoms of severe pre-eclampsia and HELLP syndrome. If the nurse remembers what each of the letters in HELLP stands for, he or she can determine which of the responses is correct.

The nurse is caring for a 30-week-gestation client whose fetal fibronectin (fFN) levels are positive. It is essential that she be taught about which of the following? 1. How to use a blood glucose monitor. 2. Signs of preterm labor. 3. Signs of pre-eclampsia. 4. How to do fetal kick count assessments.

2. Positive fetal fibronectin levels are seen in clients who deliver preterm. TEST-TAKING TIP: Fetal fibronectin (fFN) is a substance that is metabolized by the chorion. Although positive during the first half of pregnancy, it is very rare to see positive results between 24 and 34 weeks' gestation unless the client's cervix begins to efface and dilate. It is an excellent predictor of preterm labor (PTL); therefore, many practitioners assess the cervical and vaginal secretions of women at high risk for PTL for the presence of fFN.

A nurse notes a sinusoidal fetal heart pattern while analyzing a fetal heart tracing of a newly admitted client. Which of the following actions should the nurse take at this time? 1. Encourage the client to breathe with contractions. 2. Notify the practitioner. 3. Increase the intravenous infusion. 4. Encourage the client to push with contractions.

2. Sinusoidal patterns are related to Rh isoimmunization, fetal anemia, severe fetal hypoxia, or a chronic fetal bleed. They also may occur transiently as a result of Demerol (meperidine) or Stadol (butorphanol) administration. Because this client has just been admitted, medication administration is not a likely cause. The healthcare practitioner should be notified. TEST-TAKING TIP: Sinusoidal fetal heart patterns exhibit no variability and have a uniform wave-like pattern (see below). The nurse would note no periods when the heart rate appears normal. The fetus is in imminent danger. The practitioner must be notifi ed as soon as possible so that he or she can determine the appropriate intervention.

A woman, 39 weeks' gestation, is admitted to the delivery unit with vaginal warts from human papillomavirus (HPV). Which of the following actions by the nurse is appropriate? 1. Notify the healthcare practitioner for a surgical delivery. 2. Follow standard infectious disease precautions. 3. Notify the nursery of the imminent delivery of an infected neonate. 4. Wear a mask whenever the perineum is exposed.

2. Standard precautions are indicated in this situation. TEST-TAKING TIP: Although HPV is a sexually transmitted infection and it can be contracted by the neonate from the mother, the Centers for Disease Control and Prevention do not recommend that cesarean section be performed merely to prevent vertical transmission of HPV (see www.cdc.gov/std/HPV/STDFact -HPV.htm).

Which of the following is the appropriate nursing care outcome for a woman who suddenly develops an amniotic fluid embolism during her labor? 1. Client will be infection-free at discharge. 2. Client will exhibit normal breathing function at discharge. 3. Client will exhibit normal gastrointestinal function at discharge. 4. Client will void without pain at discharge.

2. The appropriate nursing care outcome is that the client survives and is breathing normally at discharge. TEST-TAKING TIP: At the time of placental separation or during stage 1 of labor, a small amount of amniotic fl uid sometimes seeps into the mother's bloodstream via the chorionic villi. With the contraction of the uterus, the fl uid is shunted into the peripheral circulation and forced into the woman's lung fi elds. If there is meconium or other foreign material in the fl uid, the woman's prognosis declines. Women who experience forceful, rapid labors are especially at risk for this life-threatening complication.

A nurse is monitoring the labor of a client who is receiving IV oxytocin (Pitocin) at 6 mL per hour. Which of the following clinical signs would lead the nurse to stop the infusion? 1. Change in maternal pulse rate from 76 to 98 bpm. 2. Change in fetal heart rate from 128 to 102 bpm. 3. Maternal blood pressure of 150/100. 4. Maternal temperature of 102.4°F.

2. The baseline fetal heart rate has dropped over 20 bpm. This finding warrants that the oxytocin be stopped. TEST-TAKING TIP: The test taker must determine which of the vital signs is unsafe in the presence of oxytocin. Oxytocin increases the contractility of the uterine muscle. When the muscle contracts, the blood supply to the fetus is diminished. A drop in fetal heart rate, therefore, is indicative of poor oxygenation to the fetus and is unsafe in the presence of oxytocin.

The nurse identifies the following nursing diagnosis for a client undergoing an emergency cesarean section: Risk for ineffective individual coping related to emergency procedure. Which of the following nursing interventions would be appropriate in relation to this diagnosis? 1. Apply antiembolic boots bilaterally. 2. Explain all procedures slowly and carefully. 3. Administer an antacid per medical doctor orders. 4. Monitor the fetal heart and maternal vital signs.

2. The nurse should explain all procedures slowly and carefully. TEST-TAKING TIP: Whenever a question is asked, the test taker must attend to the content of the question. All of the responses are appropriate in relation to cesarean deliveries, but only response 2 is related to the diagnosis of risk for ineffective individual coping.

A known drug addict is in active labor. She requests pain medication. Which of the following actions by the nurse is appropriate? 1. Encourage the woman to refrain from taking medication to protect the fetus. 2. Notify the physician of her request. 3. Advise the woman that she can receive only an epidural because of her history. 4. Assist the woman to do labor breathing.

2. The nurse should notify the healthcare practitioner of the client's request. TEST-TAKING TIP: The test taker should be aware of two important facts: Pain is the fi fth vital sign as identifi ed by The Joint Commission, and actions must be taken to reduce drug abusers' pain in the same manner that non-drug abusers' pain is managed. Although it is strongly discouraged for women to take illicit drugs when pregnant, the nurse must maintain his or her caring philosophy and provide unbiased care to addicted clients.

An obstetrician declares at the conclusion of the third stage of labor that a woman is diagnosed with placenta accreta. The nurse would expect to see which of the following signs/symptoms? 1. Hypertension. 2. Hemorrhage. 3. Bradycardia. 4. Hyperthermia.

2. The nurse would expect the woman to hemorrhage. TEST-TAKING TIP: A placenta accreta is present when the chorionic villi attach directly to or invade through the myometrium of the uterus. There is no way, therefore, for the placenta to separate from the uterine wall. Hemorrhage results. It is not uncommon for a hysterectomy to have to be performed to save the woman's life.

The nurse is caring for an eclamptic client. Which of the following is an important action for the nurse to perform? 1. Check each urine for presence of ketones. 2. Pad the client's bed rails and headboard. 3. Provide visual and auditory stimulation. 4. Place the bed in the high Fowler position.

2. The side rails of an eclamptic client's bed should be padded. TEST-TAKING TIP: Eclamptic clients have had at least one seizure. To protect them from injury during any potential subsequent seizures, the nurse should pad the headboard and the side rails of the client's bed.

The physician has ordered Prepidil (dinoprostone) for four gravidas at term. The nurse should question the order for which of the women? 1. Primigravida with Bishop score of 4. 2. Multigravida with late decelerations. 3. G1 P0000 contracting every 20 minutes × 30 seconds. 4. G6 P3202 with blood pressure 140/90 and pulse 92.

2. This client's fetus is already showing signs of fetal distress. Induction increases the risk of fetal injury. TEST-TAKING TIP: It is important to remember that although the fetus of a pregnant woman may be at term, it is not always safe for labor contractions to be stimulated. Although Prepidil is not directly used for induction, it is an agent that promotes cervical ripening in preparation for labor. A baby who is exhibiting signs of poor uteroplacental blood fl ow may be compromised further by the addition of the medication.

A full-term client, contracting every 15 min × 30 sec, has had ruptured membranes for 20 hours. Which of the following nursing interventions is contraindicated at this time? 1. Intermittent fetal heart auscultation. 2. Vaginal examination. 3. Intravenous fl uid administration. 4. Nipple stimulation.

2. Vaginal examination is contraindicated. TEST-TAKING TIP: The client in this scenario is at risk of an ascending infection from the vagina to the uterine body because she has prolonged rupture of membranes. Any time a vaginal examination is performed, the chance of infection rises. Nipple stimulation is appropriate because endogenous oxytocin will be released, which would augment the client's weak labor pattern.

A client, G3 P2002, 40 weeks' gestation, who has vaginal candidiasis, has just been admitted in early labor. Which of the following should the nurse advise the woman? 1. She may need a cesarean delivery. 2. She will be treated with antibiotics during labor. 3. The baby may develop thrush after delivery. 4. The baby will be isolated for at least one day.

3. "Thrush" is the term given to oral candidiasis, which the baby may develop after delivery. TEST-TAKING TIP: Candida can be transmitted to a baby during delivery as well as postdelivery via the mother's hands. Initially, the baby will develop thrush, but eventually the mother may notice a bright pink diaper rash on the baby. Also, if she is breastfeeding her baby, she may develop a yeast infection of the breast that is very painful. The mother with candidiasis should be advised to wash her hands carefully after toileting to minimize the possibility of transmission to the neonate.

During the delivery of a macrosomic baby, the woman develops a fourth-degree laceration. How should the nurse document the extent of the laceration in the woman's medical record? 1. Into the musculature of the buttock. 2. Through the urinary meatus. 3. Through the rectal sphincter. 4. Into the head of the clitoris.

3. A fourth-degree laceration extends through the rectal sphincter. TEST-TAKING TIP: One of the many complications that can occur with the delivery of a macrosomic baby is a perineal laceration. If the laceration is extensive and it extends through the rectal sphincter, it is defined as a fourth degree. As a result, this client is at high risk for the development of a vaginal- rectal fi stula.

After a multiparous woman has been in active labor for 15 hours, an ultrasound is done. The results state that the obstetric conjugate is 10 cm and the suboccipitobregmatic diameter is 10.5 cm. Which of the following labor findings is related to these results? 1. Full dilation of the cervix. 2. Full effacement of the cervix. 3. Station of -3. 4. Frequency every 5 minutes.

3. A high station is consistent with the data in the scenario. TEST-TAKING TIP: The dimensions noted in the stem are consistent with a diagnosis of cephalopelvic disproportion because the anterior-posterior diameter of the pelvis (obstetric conjugate) is smaller than the diameter of the baby's head (suboccipitobregmatic). When the fetal head is larger than the maternal pelvis, the baby is unable to descend.

Three 30-week-gestation clients are on the labor and delivery unit in preterm labor. For which of the clients should the nurse question a doctor's order for beta agonist tocolytics? 1. A client with hypothyroidism. 2. A client with breast cancer. 3. A client with cardiac disease. 4. A client with asthma.

3. A history of cardiac disease would place a client who is to receive a beta agonist medication at risk. The nurse should question this order. TEST-TAKING TIP: The test taker should remember that beta agonists stimulate the "fight-or-flight" response. The client's heart rate will increase precipitously, and there is a possibility that the potassium levels of the client may fall. These side effects place the client with heart disease at risk of heart failure and/or dysrhythmias. The client is also at high risk for pulmonary edema, so lung fi eld assessments should be done regularly.

The labor nurse has just received a shift report on four gravid patients. Which of the patients should the nurse assess first? 1. G5 P2202, 32 weeks, placenta previa, today's hemoglobin 11.6 g/dL. 2. G2 P0101, 39 weeks, type 2 diabetic, blood glucose (15 minutes ago) 85 mg/dL. 3. G1 P0000, 32 weeks, placental abruption, fetal heart (5 minutes ago) 120 bpm. 4. G2 P1001, 39 weeks, Rh-negative, today's hematocrit 31%.

3. A placental abruption is a life-threatening situation for the fetus. It has been 5 minutes since the client was assessed. This is the nurse's priority. TEST-TAKING TIP: In this question, the test taker must discriminate among four situations to discern which is the highest priority. Although a client with placenta previa is at high risk for bleeding, it is very likely that if she did start to bleed spontaneously, she would notify the nurse. A client who has a placental abruption, however, is already in a life- threatening situation, both for her fetus and for herself.

There are four clients in the labor suite. Each client's labor is being augmented with oxytocin (Pitocin). Which of the women should the nurse monitor carefully for the potential of uterine rupture? 1. Age 15, G3 P0020, in active labor. 2. Age 22, G1 P0000, eclampsia. 3. Age 25, G4 P3003, last delivery by cesarean section. 4. Age 32, G2 P0100, fi rst baby died during labor.

3. A woman, no matter what her age, who has had a previous cesarean section and whose labor is being augmented with oxytocin, is at risk for uterine rupture. TEST-TAKING TIP: When babies are birthed via cesarean section, the surgeon must create an incision through the uterine body. The muscles of the uterus have, therefore, been ligated and a scar has formed at the incision site. Scars are not elastic and do not contract and relax the way muscle tissue does. A vaginal birth after cesarean (VBAC) section can be performed only if the woman had a low flap (Pfannenstiel) incision in the uterus during her previous cesarean section.

A client with an internal fetal monitor catheter in place has just received IV butorphanol (Stadol) for pain relief. Which of the following monitor tracing changes should the nurse anticipate? 1. Early decelerations. 2. Late decelerations. 3. Diminished short- and long-term variability. 4. Accelerations after contractions.

3. Absent variability would be expected as a result of Stadol administration. TEST-TAKING TIP: Variability is an indicator of fetal well-being. It refl ects the competition between the sympathetic and the parasympathetic nervous systems' effects on the fetal heart rate. When the CNS is depressed from the administration of a narcotic analgesic, therefore, the nurse should expect to see diminished variability.

A labor nurse is caring for a client, 30 weeks' gestation, who is symptomatic from a complete placenta previa. Which of the following physician orders should the nurse question? 1. Administer betamethasone (Celestone) 12 mg IM daily times 2. 2. Maintain strict bedrest. 3. Assess cervical dilation. 4. Regulate intravenous (Ringer's lactate: drip rate to 150 mL/hr).

3. An order to assess the woman's cervical dilation should be questioned. TEST-TAKING TIP: If the nurse were to assess the cervical dilation of a client with complete previa, he or she could puncture the placenta. Vaginal examinations are absolutely contraindicated with a diagnosis of complete placenta previa. Betamethasone is administered to promote maturation of the baby's lungs.

A 30-year-old, G2 P0010, in preterm labor, is receiving nifedipine (Procardia). Which of the following maternal assessments noted by the nurse must be reported to the healthcare practitioner immediately? 1. Heart rate of 100 bpm. 2. Wakefulness. 3. Audible rales. 4. Daily output of 2,000 mL.

3. Audible rales should be reported to the healthcare practitioner. TEST-TAKING TIP: The presence of audible rales is indicative of pulmonary edema, a serious side effect related to the medication. The pulmonary edema may be caused by the development of congestive heart failure. Whenever a client is on nifedipine, the nurse should regularly monitor the client's lung fields.

The nurse is assessing the Bishop score on a postdates client. Which of the following measurements will the nurse assess? Select all that apply. 1. Gestational age. 2. Rupture of membranes. 3. Cervical dilation. 4. Fetal station. 5. Cervical position.

3. Cervical dilation is part of the Bishop score. 4. Fetal station is part of the Bishop score. 5. Cervical position is part of the Bishop score. TEST-TAKING TIP: The Bishop score is calculated to determine the inducibility of the cervix. Although gestational age and rupture of the membranes may be indications for calculating the score, neither has a direct impact on the inducibility of the cervix.

A preterm labor client, 30 weeks' gestation, who ruptured membranes 4 hours ago is being given IM dexamethasone (Decadron). When she asks why she is receiving the drug, the nurse replies: 1. "To help to stop your labor contractions." 2. "To prevent an infection in your uterus." 3. "To help to mature your baby's lungs." 4. "To decrease the pain from the contractions."

3. Decadron is a steroid that hastens the maturation of the fetal lung fields. TEST-TAKING TIP: Steroids (either IM betamethasone or IM dexamethasone) are given over a 2-day period to mothers in preterm labor. The medications have been shown to hasten the development of surfactant in the lung fields of fetuses. Babies whose mothers have received one of the medications experience fewer respiratory complications.

The nurse is caring for two post-cesarean section clients in the postanesthesia suite. One of the clients had her surgery under spinal anesthesia, while the other client had her surgery under epidural anesthesia. Which of the following is an important difference between the two types of anesthesia that the nurse should be aware of? 1. The level of the pain relief is lower in spinals. 2. Placement of the needle is higher in epidurals. 3. Epidurals do not fully sedate motor nerves. 4. Spinal clients complain of nausea and vomiting.

3. Epidurals do not fully sedate the motor nerves of the client. Epidural clients are capable of moving their lower extremities even when fully pain-free. TEST-TAKING TIP: The single most important difference between epidural and spinal anesthesia is the depth of needle insertion. Epidural anesthesia is administered into the epidural space. This is outside of the spinal canal. The anesthesia, therefore, is not in direct contact with the spinal nerves. In contrast, spinal anesthesia, instilled into the spinal canal, is in direct contact with the spinal nerves. All of the spinal nerves of spinal anesthesia clients are anesthetized, including motor nerves. Spinal anesthesia clients are paralyzed until the anesthesia is metabolized by the body.

The results from a fetal blood sampling test are reported as pH 7.22. The nurse interprets the results as: 1. The baby is severely acidotic. 2. The baby must be delivered as soon as possible. 3. The results are equivocal, warranting further sampling. 4. The results are within normal limits.

3. Further testing is indicated. TEST-TAKING TIP: Some practitioners perform fetal scalp sampling when there is a decrease in fetal heart variability. A normal fetal pH is defi ned as 7.25 to 7.35. An acidotic fetus has a pH that is less than 7.2. When the pH is between 7.2 and 7.25, the value is considered to be equivocal with a need for further testing. Usually interventions are instituted— oxygen applied, position changed, IV fl uid increased—and another sampling is done in 10 to 15 minutes.

The healthcare practitioner performed an amniotomy 5 minutes ago on a client, G3 P1011, 40 weeks' gestation, -4 station, and ROP position. The fetal heart rate is 140 with variable decelerations. The fluid is green tinged and smells musty. The nurse concludes that which of the following situations is present at this time? 1. The fetus is post-term. 2. The presentation is breech. 3. The cord is prolapsed. 4. The amniotic fluid is infected.

3. It is likely that the cord is prolapsed because the amniotomy was performed when the presenting part was not yet engaged and because variable decelerations are seen on the FH monitor. TEST-TAKING TIP: The likelihood of a prolapsed cord occurring during an amniotomy increases when the fetal presenting part is in negative station. As the amniotic fluid is released from the uterus during the rupture of membranes, the cord can slip and precede the fetus. At that time, variable decelerations are seen on the electronic fetal monitor tracing because the cord is being compressed by the presenting part.

Which of the following laboratory values should the nurse report to the physician as being consistent with the diagnosis of HELLP syndrome? 1. Hematocrit 48%. 2. Potassium 5.5 mEq/L. 3. Platelets 75,000. 4. Sodium 130 mEq/L.

3. Low platelets are consistent with the diagnosis of HELLP syndrome. TEST-TAKING TIP: HELLP is the acronym for a serious complication of pregnancy and labor and delivery. The letters represent the following information: H, hemolysis; EL, elevated liver enzymes; LP, low platelets. When a client has HELLP syndrome, the nurse would, therefore, expect to see low hemoglobin and hematocrit levels, high aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, and low platelets, as seen in the scenario.

A 28-week-gestation client with intact membranes is admitted with the following findings: Contractions every 5 min × 60 sec, 3 cm dilated, 80% effaced. Which of the following medications will the obstetrician likely order? 1. Oxytocin (Pitocin). 2. Ergonovine (Methergine). 3. Magnesium sulfate. 4. Morphine sulfate.

3. Magnesium sulfate is a tocolytic agent. It would be appropriate for this medication to be administered at this time. TEST-TAKING TIP: The client in the scenario is exhibiting signs that meet the criteria for preterm labor. The test taker should deduce, therefore, that a tocolytic agent may be ordered in this situation. The only tocolytic agent included in the choices is magnesium sulfate.

A delirious patient is admitted to the hospital in labor. She has had no prenatal care and vials of crack cocaine are found in her pockets. The nurse monitors this client carefully for which of the following intrapartal complications? 1. Prolonged labor. 2. Prolapsed cord. 3. Abruptio placentae. 4. Retained placenta.

3. Placental abruption is associated with maternal illicit drug use. TEST-TAKING TIP: Crack cocaine is a powerful vasoconstrictive agent. The chorionic villi atrophy as a result of the vasoconstrictive effects of the drug. Placental abruption, when the placenta detaches from the decidual lining of the uterus, is therefore of particular concern.

A woman is to receive Prepidil (dinoprostone gel) for labor induction. The nurse should be prepared to administer the medication via which of the following routes? 1. Intravenously. 2. Orally. 3. Endocervically. 4. Rectally

3. Prepidil is administered endocervically. TEST-TAKING TIP: Prostaglandins, hormone- like substances that mediate a wide range of physiological functions, do so locally. Prepidil, therefore, is administered adjacent to the cervix where it acts to soften the cervix in preparation for dilation and effacement.

A woman has been in the second stage of labor for 21⁄2 hours. The fetal head is at +4 station and the fetal heart is showing mild late decelerations. The obstetrician advises the woman that the baby will be delivered with forceps. Which of the following actions should the nurse take at this time? 1. Obtain a consent for the use of forceps. 2. Encourage the woman to push between contractions. 3. Assess the fetal heart rate after each contraction. 4. Advise the woman to refuse the use of forceps.

3. The FH should always be assessed after each contraction during stage 2. Plus, this baby is especially at risk because the stage is prolonged and the physician is using forceps for delivery. TEST-TAKING TIP: This is an excellent example of a medically indicated use of forceps. The woman is likely fatigued from pushing for over 2 hours, the presenting part is at the pelvic fl oor, and the baby is showing signs of fetal distress. It would be advisable to deliver this baby in a timely fashion. The use of forceps should result in a speedy delivery.

36 When monitoring a fetal heart rate with moderate variability, the nurse notes V-shaped decelerations to 80 from a baseline of 120. One occurred during a contraction, another occurred 10 seconds after the contraction, and a third occurred 40 seconds after yet another contraction. The nurse interprets these findings as resulting from which of the following? 1. Metabolic acidosis. 2. Head compression. 3. Cord compression. 4. Insufficient uteroplacental blood fl ow.

3. The contractions described in the scenario result from cord compression (variable decelerations). TEST-TAKING TIP: First, the test taker should be able to interpret fetal heart tracings both visually and verbally. This includes baseline data as well as acceleration and deceleration changes. Second, the test taker should know the etiology of each of the tracings. Third, the test taker should know the appropriate nursing intervention related to each tracing.

A nurse is caring for a gravid client who is G1 P0000, 35 weeks' gestation. Which of the following would warrant the nurse to notify the woman's healthcare practitioner that the client is in preterm labor? Select all that apply. 1. Contraction frequency every 15 minutes. 2. Effacement 10%. 3. Dilation 3 cm. 4. Cervical length of 2 cm. 5. Contraction duration of 30 seconds.

3. The dilation of 3 cm is indicative of preterm labor. 4. A cervical length of 2 cm is indicative of preterm labor. TEST-TAKING TIP: Preterm labor is defi ned as labor before 37 0 /7 weeks' gestation with 3 or more contractions occurring within a 30-minute period PLUS cervical change of one of the following: cervical effacement greater than 80%, cervical dilation greater than 1 cm, or cervical length of less than 2.5 cm. The change in cervical length is diagnosed by transvaginal ultrasound.

Immediately prior to an amniotomy, the external fetal heart monitor tracing shows 145 bpm with early decelerations. Immediately following the procedure, an internal tracing shows a fetal heart rate of 90 bpm with variable decelerations. A moderate amount of clear, amniotic fluid is seen on the bed linens. The nurse concludes that which of the following has occurred? 1. Placental abruption. 2. Eclampsia. 3. Prolapsed cord. 4. Succenturiate placenta.

3. The drop in fetal heart rate with variable decelerations indicates that the cord has likely prolapsed. TEST-TAKING TIP: Variable decelerations are caused by cord compression. Variable decelerations and a precipitous drop in the fetal heart baseline are indirect indications that the cord is being compressed, resulting in decreased oxygenation to the fetus.

A woman with severe pre-eclampsia, 38 weeks' gestation, is being induced with IV oxytocin (Pitocin). Which of the following would warrant the nurse to stop the infusion? 1. Blood pressure 160/110. 2. Frequency of contractions every 3 minutes. 3. Duration of contractions of 130 seconds. 4. Fetal heart rate 156 with early decelerations.

3. The duration of the contractions is prolonged. The baby will be deprived of oxygen. TEST-TAKING TIP: Not only is this client receiving oxytocin, but she is also pre- eclamptic. Pre-eclampsia is a vasoconstrictive disease state. The likelihood of poor placental perfusion is already high. When the contraction duration is also prolonged, the fetus is at high risk of becoming hypoxic.

A 29-week-gravid client is admitted to the labor and delivery unit with vaginal bleeding. To differentiate between placenta previa and abruptio placentae, the nurse should assess which of the following? 1. Leopold maneuver results. 2. Quantity of vaginal bleeding. 3. Presence of abdominal pain. 4. Maternal blood pressure.

3. The most common difference between placenta previa and placenta abruption is the absence or presence of abdominal pain. TEST-TAKING TIP: Because at least some of the blood from a placental abruption is trapped behind the placenta, women with that complication usually complain of intense, unrelenting pain. But because the blood from a symptomatic placenta previa fl ows freely through the vagina, the bleeding from that complication is virtually pain-free.

A client, whose baby is exhibiting signs of erythroblastosis fetalis, is admitted to the labor and delivery unit. The nurse would expect to see which of the following fetal heart monitor tracings? 1. Marked fetal heart variability. 2. Prolonged fetal heart accelerations. 3. Sinusoidal fetal heart pattern. 4. Periodic variable decelerations.

3. The nurse would expect to see a sinusoidal fetal heart pattern. TEST-TAKING TIP: A sinusoidal fetal heart pattern, as seen next, is an undulating pattern exhibiting no signs of normality. The pattern is seen when the fetus is markedly anemic, as in erythroblastosis fetalis.

A woman who is hepatitis B-surface antigen positive is in active labor. Which action by the nurse is appropriate at this time? 1. Obtain an order from the obstetrician to prepare the client for cesarean delivery. 2. Obtain an order from the obstetrician to administer intravenous ampicillin during labor and the immediate postpartum. 3. Obtain an order from the pediatrician to administer hepatitis B immune globulin and hepatitis B vaccine to the baby after birth. 4. Obtain an order from the pediatrician to place the baby in isolation after delivery.

3. Within 12 hours of birth, the baby should receive both the fi rst injection of hepatitis B vaccine and hepatitis B immune globulin (HBIG). TEST-TAKING TIP: Although this is a woman who is in labor, the nurse must anticipate the needs of the neonate after delivery. Because it is recommended that the baby receive the medication within a restricted time frame, it is especially important for the nurse to be proactive and obtain the physician's order

A client, G4 P1021, has been admitted to the labor and delivery suite for induction of labor. The following assessments have been made: Bishop score of 2, fetal heart rate of 156 with good variability and no decelerations, TPR 98.6°F, P 88, R 20, BP 120/80, negative obstetric history. Cervidil (dinoprostone) has been inserted. Which of the following fi ndings would warrant the removal of the prostaglandin? 1. Bishop score of 4. 2. Fetal heart rate of 152. 3. Respiratory rate of 24. 4. Contraction frequency of 1 minute.

4. A contraction frequency of 1 minute, even with a short duration, would warrant the removal of the medication. TEST-TAKING TIP: A frequency of 1 minute (an example of tachysystole), even if the duration were 30 seconds, would mean that there were only 30 seconds when the uterine muscle was relaxed. This short amount of time would not provide the placenta with enough time to be suffi ciently perfused. Fetal bradycardia is a likely outcome to such a short frequency period.

A client is on magnesium sulfate for severe pre-eclampsia. The nurse must notify the attending physician regarding which of the following findings? 1. Patellar and biceps reflexes of +3. 2. Urinary output of 30 mL/hr. 3. Respiratory rate of 16 rpm. 4. Serum magnesium level of 9 g/dL.

4. A serum magnesium level of 9 g/dL is dangerously high. The healthcare practitioner should be notified. TEST-TAKING TIP: When magnesium sulfate is being administered, the nurse should monitor the client for adverse side effects including respiratory depression, oliguria, and depressed reflexes. When the magnesium level is above 7 g/dL, toxic effects can be seen.

A nurse is caring for four laboring women. Which of the women will the nurse carefully monitor for signs of abruptio placentae? 1. G2 P0010, 27 weeks' gestation. 2. G3 P1101, 17 years of age. 3. G4 P2101, cancer survivor. 4. G5 P1211, cocaine abuser.

4. Cocaine is a powerful vasoconstrictive agent. It places pregnant clients at high risk for placental abruptions. TEST-TAKING TIP: It is very important that the test taker not read into any question or response. In the preceding question, all four of the women have had complicated pregnancies. The test taker should not presume the cause of the complications when they are not stated but rather look for the answer that does absolutely place the client at high risk for the abruption.

The nurse is to intervene when caring for a laboring client whose baby is exhibiting signs of fetal distress. Which of the following actions should the nurse take? 1. Administer oxygen via nasal cannula. 2. Place the client in high Fowler position. 3. Remove the internal fetal monitor electrode. 4. Increase the intravenous infusion rate.

4. Increasing the IV rate helps to improve perfusion to the placenta. TEST-TAKING TIP: Because the fetus is being oxygenated via the placenta, it is essential that in cases of fetal distress, the amount of oxygen perfusing the placenta be maximized. That requires high concentrations of oxygen being administered via mask, blood volume being increased by increasing the IV drip rate, and cardiac blood return being maximized by positioning the client on her side to remove pressure from the aorta and the vena cava.

A woman, G3 P1010, is receiving oxytocin (Pitocin) via IV pump at 3 milliunits/ min. Her current contraction pattern is every 3 minutes × 45 seconds with moderate intensity. The fetal heart rate is 150 to 160 bpm with moderate variability. Which of the following interventions should the nurse take at this time? 1. Stop the infusion. 2. Give oxygen via face mask. 3. Change the client's position. 4. Monitor the client's labor.

4. It is appropriate to monitor the woman's labor. TEST-TAKING TIP: Even if the test taker were unfamiliar with a normal contraction pattern—as seen in the stem of the question—if he or she knew that the fetal heart pattern is normal, the test taker could deduce the correct answer. Three of the responses infer that the nurse should take action because of a complication. Only response 4 indicates that the nurse should continue monitoring the labor. In this situation, the one response that is different from the others is the correct answer.

A woman is scheduled to have an external version for a breech presentation. The nurse carefully assesses the client's chart knowing that which of the following is a contraindication to this procedure? 1. Station -2. 2. 38 weeks' gestation. 3. Reactive NST. 4. Previous cesarean section.

4. Previous cesarean section is a contraindication for external version. TEST-TAKING TIP: During external version, the healthcare practitioner moves the fetus from a malpresentation—usually breech—to a vertex presentation. To accomplish the movement, the physician manually palpates the fetus externally through the mother's abdominal and uterine walls. Because significant stress is placed on the uterine body, the presence of a cesarean scar is a contraindication to the procedure.

Which of the following situations should the nurse conclude is a vaginal delivery emergency? 1. Third stage of labor lasting 20 minutes. 2. Fetal heart dropping during contractions. 3. Three-vessel cord. 4. Shoulder dystocia.

4. Shoulder dystocia is an obstetric emergency. TEST-TAKING TIP: "Dystocia" means "diffi cult delivery." A shoulder dystocia, therefore, refers to diffi culty in delivering a baby's shoulders. This is an obstetric emergency because the dystocia occurs in the middle of the delivery when the head has been delivered but the shoulders remain wedged in the pelvis. In addition, the baby's life is threatened because the baby is unable to breathe and umbilical cord fl ow is often dramatically reduced during this phase of the delivery. If the baby is delivered successfully, the baby should be assessed for nerve palsies from traction placed on the baby's head during the delivery of the shoulders.

A client is scheduled for an external version. The nurse would expect to prepare which of the following medications to be administered prior to the procedure? 1. Oxytocin (Pitocin). 2. Ergonovine (Methergine). 3. Betamethasone (Celestone). 4. Terbutaline (Brethine).

4. Terbutaline (Brethine) is a smooth, muscle-relaxing agent. It would be administered prior to an external version. TEST-TAKING TIP: It is important that the uterine muscle not impede the physician's manipulations during an external version. To facilitate the movement, therefore, a muscle relaxant is administered. Terbutaline is one relaxing agent that is used by obstetricians.

A nurse administers magnesium sulfate via infusion pump to an eclamptic woman in labor. Which of the following outcomes indicates that the medication is effective? 1. Client has no patellar reflex response. 2. Urinary output is 30 mL/hr. 3. Respiratory rate is 16 rpm. 4. Client has no grand mal seizures.

4. The absence of seizures is an expected outcome related to magnesium sulfate administration. TEST-TAKING TIP: Eclamptic clients have seized. Magnesium sulfate is ordered and administered to these clients because it is an anticonvulsant. An expected outcome of its administration, therefore, is that the client will have no more seizures.

A woman, G3 P2002, 42 weeks' gestation, is admitted to the labor suite for induction. A biophysical profile (BPP) report on the client's chart states BPP score of 6 of 10. The nurse should monitor this client carefully for which of the following? 1. Maternal hypertension. 2. Maternal hyperglycemia. 3. Increased fetal heart variability. 4. Late fetal heart decelerations.

4. The baby is at high risk for late fetal heart decelerations secondary to a postmature placenta. TEST-TAKING TIP: A BPP of 8 or lower indicates that the fetus is in jeopardy. The five assessments that constitute the BPP are nonstress test (NST), fetal movement, fetal breathing, amniotic fluid volume, and fetal tone. Each assessment is given a score of 0 or 2.

A client telephones the labor and delivery suite and states, "My bag of waters just broke and it smells funny." Which of the following responses would be appropriate for the nurse to make at this time? 1. "Have you notified your doctor of the smell?" 2. "The bag of waters always has an unusual odor." 3. "Your labor should start very soon." 4. "Have you felt the baby move since the membranes broke?"

4. The most important information needed by the nurse should relate to the health and well-being of the fetus. Fetal movement indicates that the baby is alive. TEST-TAKING TIP: There are two concerns in this scenario: the fact that the membranes just ruptured and the smell of the fl uid. The nurse should, therefore, consider two possible problems: possible prolapsed cord, which may occur as a result of the rupture of the amniotic sac, and possible infection, which may be indicated by the smell. Normal fetal movement will give the nurse some confi dence that the cord is not prolapsed. This is the fi rst question that should be asked. Then, the client should be encouraged to go to the hospital to be assessed for possible infection, signs of labor, and direct fetal assessment.

A client, G3 P2002, is immediately postexternal version. The nurse monitors this client carefully for which of the following? 1. Decreased urinary output. 2. Elevated blood pressure. 3. Severe occipital headache. 4. Variable fetal heart decelerations.

4. The nurse should monitor the client carefully for variable fetal heart decelerations. TEST-TAKING TIP: The umbilical cord can become compressed during an external version. Variable decelerations are caused by umbilical cord compression. If the cord were to become compressed, the nurse would note variable decelerations on the fetal heart monitor tracing.

A nurse is caring for four clients on the labor and delivery unit. Which of the following actions should the nurse take first? 1. Check the blood sugar of a gestational diabetic. 2. Assess the emotional status of a client who is post-spontaneous abortion. 3. Assess the patellar reflexes of a client with mild pre-eclampsia. 4. Check the fetal heart rate of a client who just ruptured membranes.

4. The priority action for this nurse is to assess the fetal heart rate of a client who has just ruptured membranes. The nurse is assessing for prolapsed cord, which is an obstetric emergency. TEST-TAKING TIP: Identifying the priority action is the most diffi cult thing that nurses must do. The nurse must determine which of the situations is most life threatening. Of the four preceding choices, prolapsed cord is life threatening to the fetus. None of the other situations, as stated in the question, is as important.

A nurse is monitoring a client who is receiving an amnioinfusion. Which of the following assessments is critical for the nurse to make to prevent a serious complication related to the procedure? 1. Color of the amniotic fluid. 2. Maternal blood pressure. 3. Cervical effacement. 4. Uterine resting tone.

4. The uterine resting tone should be carefully monitored with an internal pressure electrode during amnioinfusion. TEST-TAKING TIP: Because fluid is being instilled into the uterine cavity, there is potential for the fluid to overload the space. As a result, the uterine resting tone will increase dramatically with the potential that the uterus could rupture. It is critically important, therefore, that the nurse monitor the resting tone throughout the procedure.

A client is receiving terbutaline (Brethine) for preterm labor. Which of the following findings would warrant stopping the infusion? Select all that apply. 1. Change in contraction pattern from q 2 min × 90 sec to q 3 min × 30 sec. 2. Change in fetal heart pattern from no decelerations to early decelerations. 3. Change in beat-to-beat variability from minimal to moderate. 4. Change in fetal heart rate from 160 bpm to 210 bpm. 5. Change in the amniotic sac from intact to ruptured.

4. When the fetal heart rate pattern is greater than 200 bpm, the medication should be stopped. 5. Terbutaline is contraindicated when the membranes have ruptured prematurely. TEST-TAKING TIP: Terbutaline, a beta agonist, stimulates the "fight-or-flight" response in the mother and in the fetus. The fetal heart rate, therefore, increases in response to the medication. When the rate is too high, however, there is insufficient time for the blood to enter the heart, which leads to a drop in cardiac output.

The nurse is caring for four women who are in labor. The nurse is aware that he or she will likely prepare which of the women for cesarean delivery? Select all that apply. 1. Fetus is in the left sacral posterior position. 2. Placenta is attached to the posterior portion of the uterine wall. 3. Fetus has been diagnosed with meningomyelocele. 4. Client is hepatitis B surface antigen positive. 5. The lecithin/sphingomyelin ratio in the amniotic fluid is 1.5:1.

1. The baby in the LSP position is in a breech presentation. Most breech babies are delivered by cesarean section. 3. The meningomyelocele sac could easily rupture during a vaginal delivery. When a fetus has been diagnosed with the defect, a cesarean is usually performed. TEST-TAKING TIP: Although it is recommended that cesarean section be performed when a mother is affected by two viral illnesses—herpes simplex type 2 (only when active lesions are present) and HIV/AIDS—it is not recommended in the presence of other viral diseases. Hepatitis B is a very serious viral disease, but vertical transmission rates are not significantly different between those babies who are born vaginally and those babies who are born by cesarean section.

A woman in active labor received Nubain (nalbuphine hydrochloride) 14 mg IV for pain relief. One-half hour later her respirations are 8 rpm. The nurse reports the respiratory rate to the physician. Which of the following medications would be appropriate for the physician to order at this time? 1. Narcan (naloxone). 2. Reglan (metoclopramide). 3. Benadryl (diphenhydramine). 4. Vistaril (hydroxyzine).

1. The nurse would expect to administer Narcan to the client. TEST-TAKING TIP: Nubain is an opioid analgesia. It has markedly depressed the client's respiratory response. Narcan is an opioid antagonist. It is likely that the physician will order Narcan to be administered at this time.

A woman, 32 weeks' gestation, contracting every 3 min × 60 sec, is receiving magnesium sulfate. For which of the following maternal assessments is it critical for the nurse to monitor the client? 1. Low urinary output. 2. Temperature elevation. 3. Absent pedal pulses. 4. Retinal edema.

1. The urinary output should be carefully monitored. TEST-TAKING TIP: Even though this client is receiving magnesium sulfate to treat preterm labor and not pre-eclampsia, the medication still has the same side effects. Magnesium sulfate is excreted through the kidneys. If the urinary output drops, the concentration of magnesium sulfate can rise in the bloodstream. Because at toxic levels the client can experience respiratory depression and cardiac compromise, it is very important for the nurse carefully to monitor the client's urinary output.

The nurse is monitoring a woman, G2 P1001, 41 weeks' gestation, in labor. A 12 p.m. assessment revealed: cervix, 4 cm; 80% effaced; -3 station; and FH 124 with moderate variability. A 5 p.m. assessment: cervix, 6 cm; 90% effaced; −3 station; and FH 120 with moderate variability. A 10 p.m. assessment: cervix, 8 cm; 100% effaced; −3 station; and FH 124 with moderate variability. Based on the assessments, which of the following should the nurse conclude? 1. Labor is progressing well. 2. The woman is likely carrying a macrosomic fetus. 3. The baby is in fetal distress. 4. The woman will be in second stage in about five hours.

2. Because the presenting part is not descending into the birth canal, the nurse can logically conclude that the baby may be macrosomic. TEST-TAKING TIP: The test taker must carefully analyze the results of the three vaginal examinations. The fetal heart rate is virtually unchanged: The rate is within normal limits and the variability is normal. There is no sign of fetal distress. The dilation and effacement are changing, but the lack of progressive descent of the presenting part is unexpected. When babies are too big to fi t through a client's pelvis, they fail to descend. That is the conclusion that the nurse should make from the findings.

A doctor orders a narcotic analgesic for a laboring client. The nurse notes that there are late decelerations on the electronic fetal monitor tracing. Which of the following situations would lead a nurse to hold the medication? 1. Contraction pattern is every 3 min × 60 sec. 2. Fetal monitor tracing shows late decelerations. 3. Client sleeps between contractions. 4. The blood pressure is 150/90.

2. Late decelerations are indicative of uteroplacental insufficiency and indicate fetal distress. It is inappropriate to administer a central nervous system (CNS) depressant to the mother at this time. TEST-TAKING TIP: Analgesics are central nervous system (CNS) depressants. They not only depress the CNS of the mother, reducing her pain, but also depress the CNS of the baby. It is inappropriate to administer a depressant to a mother whose fetus is already exhibiting signs of distress. First, the variability of the baseline would be diminished, preventing the nurse from assessing that very important indicator of fetal well- being. And if the baby were to be delivered via cesarean section, the baby would likely be depressed and in need of resuscitation.

A client is admitted in labor with spontaneous rupture of membranes 24 hours earlier. The fl uid is clear and the fetal heart rate is 124 with moderate variability. Which assessment is most important for the nurse to make at this time? 1. Contraction frequency and duration. 2. Maternal temperature. 3. Cervical dilation and effacement. 4. Maternal pulse rate.

2. Maternal temperature is the highest priority. TEST-TAKING TIP: The uterine cavity is a sterile space and the vaginal vault is an unsterile space. When membranes have ruptured over 24 hours, there is potential for pathogens to ascend into the uterine cavity and infection to result. Elevated temperature is a sign of infection.

A woman being induced with oxytocin (Pitocin) is contracting every 3 min × 30 seconds. Suddenly the woman becomes dypsneic and cyanotic and begins to cough up bloody sputum. Which of the following nursing interventions is of highest priority? 1. Check blood pressure. 2. Assess fetal heart rate. 3. Administer oxygen. 4. Stop oxytocin infusion.

3. The nurse's priority action is to administer oxygen. TEST-TAKING TIP: This client is exhibiting the classic signs of an amniotic fl uid embolism. At this point, the baby's health is secondary because the mother is in a life-threatening situation. The nurse must apply oxygen and call a code immediately.

The nurse is admitting a 38-week-gestation client in labor. The nurse is unable to find the fetal heartbeat with a Doppler. Which of the following comments by the nurse would indicate that the nurse is in denial? 1. "I'll keep trying until I find the heartbeat." 2. "I am sure it is the machine. If I change the battery, I'm sure it will work." 3. "I am so sorry. I am not able to find your baby's heartbeat." 4. "Sometimes I really hate these machines."

1. This is an example of the stage of denial. TEST-TAKING TIP: It is essential that the test taker be familiar with the concepts of grief and mourning. Everyone who is caring for a couple who experiences a fetal or neonatal loss, as well as the couple themselves, will progress through the stages of grief. It is important to realize that grieving is individual and that the stages of grief are never experienced in a linear fashion. Healthcare staff progress rapidly through the stages, whereas the couple's grief is likely to be delayed.

An induction of a 42-week gravida with IV oxytocin (Pitocin) is begun at 0900 at a rate of 0.5 milliunit per minute. The woman's primary physician orders: Increase the oxytocin drip by 0.5 milliunit per minute every 10 minutes until contractions are every 3 minutes × 60 seconds. The nurse refuses to comply with the order. Which of the following is the rationale for the nurse's action? 1. Fetal distress has been noted in labors when oxytocin dosages greater than 2 milliunits per minute are administered. 2. The relatively long half-life of oxytocin can result in unsafe intravascular concentrations of the drug. 3. It is unsafe practice to administer oxytocin intravenously to a woman who is carrying a postdates fetus. 4. A contraction duration of 60 seconds can lead to fetal compromise in a baby who is postmature.

2. The practitioner should increase the dosage of oxytocin at a minimum time interval of every 30 minutes. TEST-TAKING TIP: The half-life (the time it takes half of a medication to be metabolized by the body) of oxytocin is relatively long—about 15 minutes. And at least 3 half-lives usually elapse before therapeutic responses are noted. Increasing the infusion rate too rapidly, therefore, can lead to hyperstimulation of the uterine muscle and consequent fetal distress.

A client, 39 weeks' gestation, fetal heart baseline at 144 bpm, tells the admitting labor and delivery room nurse that she has had to wear a pad for the past 4 days "because I keep leaking urine." Which of the following is an appropriate action for the nurse to perform at this time? 1. Palpate the woman's bladder to check for urinary retention. 2. Obtain a urine culture to check for a urinary tract infection. 3. Assess the fluid with nitrazine and see if the paper turns blue. 4. Percuss the woman's uterus and monitor for ballottement.

3. The fluid should be assessed with nitrazine paper. TEST-TAKING TIP: Nitrazine paper is another name for litmus paper. It detects the pH of fl uid. Amniotic fl uid is alkaline, whereas urine is acidic. If the paper turns a dark blue, the nurse can conclude that the membranes have ruptured and that the woman is leaking amniotic fl uid, not urine.

A client, 38 weeks' gestation, is being induced with IV oxytocin (Pitocin) for hypertension and oligohydramnios. She is contracting q 3 min × 60 to 90 seconds. She suddenly complains of abdominal pain accompanied by signifi cant fetal heart bradycardia. Which of the following interventions should the nurse perform fi rst? 1. Turn off the oxytocin infusion. 2. Administer oxygen via face mask. 3. Reposition the patient. 4. Call the obstetrician.

1. Whenever there is marked fetal bradycardia and oxytocin is running, the nurse should immediately turn off the oxytocin drip. TEST-TAKING TIP: Oxytocin stimulates the contractility of the uterine muscle. When the muscle is contracted, the blood fl ow to the placenta is reduced. Whenever there is evidence of fetal compromise and oxytocin is being infused, the intravenous should be stopped immediately to maximize placental perfusion.

A physician writes the following order—Administer ampicillin 1 g IV q 4 h until delivery—for a newly admitted laboring client with ruptured membranes. The client had positive vaginal and rectal cultures for group B streptococcal bacteria at 36 weeks' gestation. Which of the following is a rationale for this order? 1. The client is at high risk for chorioamnionitis. 2. The baby is at high risk for neonatal sepsis. 3. The bacteria are sexually transmitted. 4. The bacteria cause puerperal sepsis.

2. Babies are susceptible to neonatal sepsis from vertical transmission of the bacteria. TEST-TAKING TIP: At approximately 36 weeks' gestation, pregnant women are cultured for group B strep. If they culture positive, standard protocol is to administer a broad-spectrum antibiotic IV q 4 hours from the time their membranes rupture until delivery. That action markedly decreases the vertical transmission of the bacteria to neonates.

A physician has notified the labor and delivery suite that four clients will be admitted to the unit. The client with which of the following clinical findings would be a candidate for an external version? 1. +3 station. 2. Left sacral posterior position. 3. Flexed attitude. 4. Rupture of membranes for 24 hours.

2. LSP position is a breech presentation. It may be appropriate for a physician to perform an external version prior to this delivery. TEST-TAKING TIP: If a baby is in the breech presentation, the version would have to be performed before the baby had engaged. Once the baby is well established in the true pelvis, it is at high risk for the baby to be moved.

The primary practitioner for a 38 1 / 7 week gravid client calls the labor and delivery suite to schedule an induction for the next day. The client is having no medical or pregnancy complications. Which of the following responses by the nurse would be appropriate? 1. "At what time would you like to begin the induction?" 2. "What is the client's Bishop score?" 3. "I am sorry but the client will not be able to be induced tomorrow." 4. "I will have the prostaglandin induction medication prepared."

3. The nurse should refuse to schedule the induction for the next day. full-term pregnancy as 39 0 /7 through 40 6 /7 weeks' gestation. Pregnancies between 37 0 /7 and 38 6 /7 weeks' gestation are defi ned as early term. Unless medically indicated, to provide the fetus with optimal intrauterine maturation, ACOG advises that inductions not be performed until pregnancies reach at least 38 0 /7 weeks' gestation, and AWHONN recommends that pregnancies

Four women request to labor in the hospital bathtub. In which of the following situations is the procedure contraindicated? Select all that apply. 1. Woman during transition. 2. Woman during second stage of labor. 3. Woman receiving oxytocin for induction. 4. Woman with meconium-stained fluid. 5. Woman with fetus in the occiput posterior position.

3. Women undergoing induction should not labor in a water bath. During induction, the fetus should be monitored continually by electronic fetal monitoring. 4. Meconium-stained amniotic fl uid may indicate fetal distress. Continuous electronic fetal monitoring would, therefore, be indicated. TEST-TAKING TIP: Hydrotherapy is an excellent complementary therapy for the laboring woman. The warm water is relaxing and many women fi nd that their pain is minimized. Induction and continuous electronic fetal monitoring, however, are incompatible with the intervention.

A client enters the labor and delivery suite. It is essential that the nurse note the woman's status in relation to which of the following infectious diseases? Select all that apply. 1. Hepatitis B. 2. Rubeola. 3. Varicella. 4. Group B streptococcus. 5. HIV/AIDS.

1. The client's hepatitis B status should be assessed. 4. The client's group B streptococcus status should be assessed. 5. The client's HIV/AIDS status should be assessed. TEST-TAKING TIP: There are several infectious diseases that affect care given during pregnancy, labor and delivery, postpartum, and in the newborn nursery. The hepatitis B status must be assessed to notify the nursery for care needed by the baby. Group B strep status must be assessed to administer needed antibiotics to the mother during labor and to monitor the baby's status in the newborn nursery. The HIV/AIDS status must be assessed to administer needed antiviral medications to the mother in labor and/ or to the baby postdelivery. HIV/AIDS is also an indication for cesarean section delivery. The nurse should also assess for the presence in the perineal area of active herpes simplex 2 lesions. Active herpes simplex lesions are an indication for cesarean section delivery.

A client had an epidural inserted 2 hours ago. It is functioning well, the client is hemodynamically stable, and the client's labor is progressing as expected. Which of the following assessments is highest priority at this time? 1. Assess blood pressure every 15 minutes. 2. Assess pulse rate every 1 hour. 3. Palpate bladder. 4. Auscultate lungs.

3. The client's bladder should be palpated. TEST-TAKING TIP: There are three very important reasons the client's bladder should be assessed. First, clients receive at least 1 liter of fluid immediately before the insertion of an epidural. Within a 2-hour period, it is likely that the woman's bladder has become full. Second, clients are unable to feel when they need to urinate with an epidural in place. Third, a full bladder can impede fetal descent.

A 38-week-gestation woman is in labor and delivery with a painful, board-like abdomen and progressively larger serial girth measurements. Which of the following assessments is appropriate at this time? 1. Fetal heart rate. 2. Cervical dilation. 3. White blood cell count. 4. Maternal lung sounds.

1. A fetal heart check is the appropriate assessment. TEST-TAKING TIP: The clinical scenario is indicative of a placental abruption. Because the only oxygenation available to the fetus is via the placenta, the appropriate action by the nurse at this time is to determine the well-being of the fetus. The nurse should also assess the client's pulse rate. An elevated maternal pulse rate is indicative of marked blood loss.

Immediately after a woman spontaneously ruptures her membranes, the nurse notes a loop of the umbilical cord protruding from the woman's vagina. Which of the following actions should the nurse perform first? 1. Put the client in the knee-chest position. 2. Assess the fetal heart rate. 3. Administer oxygen by tight face mask. 4. Telephone the obstetrician with the findings.

1. The first action the nurse should take is to place the woman in the knee-chest position. TEST-TAKING TIP: The weight of the fetus on the prolapsed cord can rapidly result in fetal death. Therefore, the nurse must act quickly to relieve the pressure on the cord. Additional actions that can take pressure off the cord are placing the client in the Trendelenburg position and pushing the head off the cord with a gloved hand. This situation is an obstetric emergency.

A client is on terbutaline (Brethine) via subcutaneous pump for preterm labor. The nurse auscultates the fetal heart rate at 100 beats per minute via Doppler. Which of the following actions should the nurse perform next? 1. Assess the maternal pulse while listening to the fetal heart rate. 2. Notify the healthcare provider. 3. Stop the terbutaline infusion. 4. Administer oxygen to the mother via face mask.

1. The nurse should assess the fetal heart and the maternal pulse simultaneously. TEST-TAKING TIP: Because the medication should increase both the mother's and fetus's heart rates, it is likely that the fetal monitor is mistakenly registering the maternal pulse rather than the fetal heart rate. If the pulsations are the same when the radial pulse of the mother and the fetal heart are monitored simultaneously, the nurse can determine that, indeed, the mother's pulse rate is being monitored.

A laboring client has been diagnosed with a hypercoagulability syndrome. Which of the following medications would the nurse expect the primary healthcare provider to order? 1. Heparin (heparin). 2. Coumadin (warfarin). 3. Amicar (aminocaproic acid). 4. DDAVP (desmopressin acetate).

1. The nurse would expect the primary healthcare provider to order Heparin (heparin). TEST-TAKING TIP: Clients who are hypercoagulable are patients whose blood tends to clot. During pregnancy, because of the increased clotting factors produced naturally, clients with hypercoagulability are especially at high risk for heart attack and stroke. Both Coumadin and Heparin prevent the blood from clotting, but Coumadin crosses the placenta, whereas Heparin does not. To prevent complications in the fetus, Heparin is the drug of choice during pregnancy.

A client has been diagnosed with water intoxication after having received IV oxytocin (Pitocin) for over 24 hours. Which of the following signs/symptoms would the nurse expect to see? 1. Confusion, drowsiness, and vomiting. 2. Hypernatremia and hyperkalemia. 3. Thrombocytopenia and neutropenia. 4. Paresthesias, myalgias, and anemia.

1. These are the classic signs of water intoxication. TEST-TAKING TIP: Clients who receive oxytocin over a long period of time are at high risk for water intoxication. The oxytocin molecule is similar in structure to the antidiuretic hormone (ADH) molecule. The body retains fl uids in response to the medication much the same way it would in response to ADH. The nurse, therefore, should carefully monitor intake and output when clients are induced with oxytocin.

A client's assessments reveal that she is 4 cm dilated and 80% effaced with a fetal heart tracing showing frequent late decelerations, minimal variability, and strong contractions every 3 minutes, each lasting 90 seconds. The nursing management of the client should be directed toward which of the following goals? 1. Completion of the first stage of labor. 2. Delivery of a healthy baby. 3. Safe pain medication management. 4. Prevention of a vaginal laceration.

2. The nurse's goal at this point must be the delivery of a healthy baby. TEST-TAKING TIP: Nursing goals may change repeatedly during a client's labor. The nurse must assess the woman's progress in relation to the health and well-being of the fetus. As long as the baby is responding well, the nurse's focus should relate to maternal comfort and care. Once fetal compromise is noted, however, nursing actions often shift.

A client is in active labor. Which of the following assessments would warrant immediate intervention? 1. Maternal Pa CO2 of 40 mm Hg. 2. Alpha-fetoprotein values of 2 times normal. 3. 3 fetal heart accelerations during contractions. 4. Fetal scalp sampling pH of 7.19.

4. A fetal scalp pH of 7.19 is indicative of an acidotic fetus. TEST-TAKING TIP: The test taker must read all four responses before choosing the best one. Although answer 2 includes a value that is not normal, it does not describe a situation that requires the nurse to take immediate action. A fetal scalp sampling pH below 7.2, however, is of immediate concern.

A pregnant woman, G3 P2002, had her two other children by cesarean section. Which of the following situations would mandate that this delivery also be by cesarean? 1. The woman refuses to have a regional anesthesia. 2. The woman is postdates with intact membranes. 3. The baby is in the occiput posterior position. 4. The previous uterine incisions were vertical.

4. The presence of vertical incisions in the uterine wall is an absolute indication for a cesarean delivery. TEST-TAKING TIP: The muscle tissue that contracts during labor is located in the fundal region of the uterus. A vertical incision into the uterus ligates fundal tissue. The scar that forms from the incision is nonelastic, putting the client at risk of uterine rupture. Having had a previous vertical uterine incision, therefore, is an absolute indicator for future cesarean delivery. Albeit not an absolute indicator, some physicians also encourage clients who have had low-flap (Pfannenstiel) incisions into the uterus to have all subsequent children delivered via cesarean section. (It is important to note that the type of incision that the surgeon used to open the skin is not necessarily the type of incision used to open the uterus.)

An anesthesiologist informs the nurse that a woman scheduled for cesarean section will have the procedure under general anesthesia with postoperative patient- controlled analgesia rather than under continuous epidural infusion. Which of the following would warrant this decision? 1. The woman has a history of drug addiction. 2. The woman is allergic to morphine sulfate. 3. The woman is a thirteen-year-old adolescent. 4. The woman has had surgery for scoliosis.

4. A history of scoliosis surgery is a contraindication for epidural anesthesia. TEST-TAKING TIP: Scoliosis is a defect in the growth of the thoracic and lumbar spine. The surgery is, therefore, performed on the vertebrae of the spinal column. Any spinal surgery is a contraindication to the administration of regional anesthesia.

During a nurse's shift, the fetal heartbeat patterns on five fully dilated clients showed minimal variability and late decelerations. The primary healthcare practitioners all requested forceps to speed the deliveries. In which of the situations should the nurse have refused to provide the delivery forceps? Select all that apply. 1. Maternal history of asthma. 2. Right occiput posterior position at +4 station. 3. Transverse fetal lie. 4. Mentum presentation and -1 station. 5. Maternal history of cerebral palsy.

3. A baby in transverse lie is physically incapable of delivering vaginally. 4. It is not appropriate to deliver the baby who is at -1 station with forceps. The baby has yet to engage. TEST-TAKING TIP: It is unsafe to use forceps to deliver a baby when the baby's station is above +2. When the baby is above that station, it is unknown whether or not there is sufficient room in the pelvis for the baby to pass. If there should be too little space, very serious fetal complications could arise, including fractured skull and subdural hematoma.