Exam 2: Labor and Delivery

2. The nurse knows that a FHR monitor printout indicates a Category III abnormal fetal heart rate pattern when: a. Baseline variability is minimal or absent with decelerations. b. FHR mirrors the uterine contractions. c. Occasional periodic accelerations occur. d. Baseline variability is 6 to 25 bpm with decelerations

ANS: a Feedback: a. Minimal or absent baseline variability may be an indication of fetal hypoxia. b. This answer describes early decelerations that are not an indication of fetal intolerance of labor. c. Periodic accelerations are a sign of fetal well-being. d. A baseline variability of 6 to 25 bpm is normal.

34. Mrs. H is telling you she feels the urge to push. This is most likely caused by what? a. Low fetal station triggering the Ferguson reflex b. A fetal position of occiput posterior (OP) c. The second stage of labor d. Transition phase

ANS: a Once the cervix is fully dilated and the vertex is low in the pelvis and the woman feels the urge to push, she will involuntarily bear down. This is activated when the presenting part as it descends stretches the pelvic floor muscles and triggers the Ferguson reflex.

17. Contraindications for induction of labor include (Choose all that apply): a. Abnormal fetal position b. Postdated pregnancy c. Pregnancy-induced hypertension d. Placental abnormalities

ANS: a, d Contraindications for induction of labor include abnormal fetal position because of the risk of fetal injury and placental abnormalities because of the risk of hemorrhage. Pregnancy-induced hypertension and placental abnormalities are two of the common indications for induction of labor.

10. The perinatal nurse assists the nursing student who is preparing the patient with oligohydramnios for a fluid infusion into the uterine cavity. This procedure is described as a(n) __________.

ANS: amnioinfusion Pregnancy outcome in patients experiencing variable fetal heart rate decelerations caused by cord compression is improved through the use of amnioinfusion, which is the instillation of normal saline or lactated Ringers solution into the uterine cavity.

10. The perinatal nurse understands that the purpose of combining an opioid with a local anesthetic agent in an epidural is primarily to: a. Increase the total anesthetic volume b. Preserve a greater amount of maternal motor function c. Increase the intensity of the motor and sensory block d. Decrease the number of side effects

ANS: b Combining an opioid with a local anesthetic agent reduces the total amount of anesthetic required and helps to preserve a greater amount of maternal motor function.

6. You are caring for a woman in labor who is 6 cm dilated with a reassuring FHT pattern and regular strong UCs. The fetal heart rate (FHR) should be: a. Monitored continuously b. Monitored every 15 minutes c. Monitored every 30 minutes d. Monitored every 60 minutes

ANS: c. Feedback: a. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is not indicated continuously. b. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is not indicated every 15 minutes. c. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is indicated every 30 minutes. d. Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is indicated every 30 minutes, not every 60 minutes.

24. The perinatal nurse caring for a laboring woman who is receiving an oxytocin infusion documents the following information: rate of __________, frequency and strength of __________, fetal __________, and cervical __________ and __________.

ANS: infusion; contractions; heart rate; dilatation; effacement Oxytocin protocols in many institutions require that the nurse remain at the patients bedside at all times for careful surveillance. The following data should be placed on a flow sheet in the patient record: patients vital signs, fetal heart rate, frequency, duration and strength of contractions, cervical effacement and dilatation, fetal station and lie, rate of oxytocin infusion intake and urine output, and the psychological response of the patient.

13. The best time to give prophylactic antibiotics to the women undergoing cesarean section is: a. One hour before the surgery b. Two hours before the surgery c. Not indicated unless she has an active infection d. At the time the cord is clamped

ANS: a Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes prior to the skin incision.

26. During labor, oxytocin is always administered __________.

ANS: intravenously with an infusion pump During labor, oxytocin can only be administered intravenously via an infusion pump to titrate and regulate the dose for safe administration.

Match term to definition: 56. Third stage of labor 57. Transition phase 58. False labor 59. Latent phase a. Early and slow labor. Can last up to 9 hours. Many women choose to stay home. b. Irregular contractions, with no increase in frequency, intensity, and duration, cause little or no cervical change c. Cervical dilation from 8 to 10 cm, contractions every 1 to 2 minutes. Woman may be panicky and irritable. d. Occurs immediately after the delivery of the fetus. Involves the separation and delivery of the placenta. Can last up to 20 minutes.

ANS: 56. d 57. c 58. b 59. a Third stage of labor: Begins immediately after the delivery of the fetus and involves separation and expulsion of the placenta and membranes Transition phase: Third phase of labor; dilation to 10 cmFalse labor: Irregular contractions with little or no cervical changes Latent phase: First phase of labor; the early and slower part of labor with cervical dilation from 0 to 3 cm

50. The perinatal nurse knows that an early pregnancy loss occurs before __________ weeks, and a late pregnancy loss is one that occurs between 12 and __________ weeks.

ANS: 12; 20 Not all conceptions result in a live-born infant. Of all clinically recognized pregnancies, 10% to 20% are lost, and approximately 22% of pregnancies detected on the basis of hCG assays are lost before the appearance of any clinical signs or symptoms. By definition, an early pregnancy loss occurs before 12 weeks of gestation; a late pregnancy loss is one that occurs between 12 and 20 weeks of gestation.

52. The perinatal nurse knows that nausea and vomiting are common in pregnancy and usually resolve by __________ weeks gestation. The severe form of this condition is __________.

ANS: 16; hyperemesis gravidarum Feedback 1: Nausea and vomiting are a common condition of pregnancy which affect 70% to 85% of pregnant women and usually resolve by the 16th week of gestation. Feedback 2: Hyperemesis gravidarum represents the extreme end of the nausea/vomiting spectrum in terms of severity. Criteria for the diagnosis of hyperemesis gravidarum include persistent vomiting unrelated to other causes, a measure of acute starvation (usually large ketonuria), and some discrete weight loss, most often 5% of the prepregnancy weight.

15. A post-cesarean section client has been ordered to receive 500 mL of 5% dextrose in water every 4 hours. The drop factor of the macrodrip tubing is 10 gtt/mL. To what drip rate should the nurse regulate the IV? __________ gtt/min

ANS: 21 Feedback: 21 gtt/minThe formula for calculating drip rates is: volume multiplied by drop factor = drip ratetime in minutes 500 mL = 10 gtt/cc = 21 gtt/min4 hours = 60 min/hr

18. T/F During an emergency cesarean birth the time-out procedure may be omitted based on the obstetrical emergency.

ANS: False Joint commission guidelines for patient safety necessitate there always be a time-out to prevent wrong patient, wrong site, wrong procedure, and medical errors.

48. T/F - It is critical for the perinatal nurse to learn, as part of the facilitys policies and procedures, to immediately perform a vaginal examination on a woman who presents with vaginal bleeding after 24 weeks gestation.

ANS: False Placenta previa should be suspected in all patients who present with bleeding after 24 completed weeks of gestation. Because of the risk of placental perforation, vaginal examinations are not performed.

19. T/F The perinatal nurse includes the following when explaining the physiology of artificial rupture of membranes to the student nurse: rupture of membranes causes a release of arachidonic acid, which converts to prostaglandins, substances known to stimulate oxytocin in the pregnant uterus.

ANS: True At certain points in the labor, an amniotomy, or artificial rupture of the membranes, may be successful in increasing uterine contractility.

20. T/F The perinatal nurse describes asynclitism to students as a presentation that occurs when the fetal head is turned toward the maternal sacrum or symphysis at an oblique angle.

ANS: True Face and brow presentations are examples of asynclitism (the fetal head is presenting at a different angle than expected). Face and brow presentations hyperextend the neck and increase the overall circumference of the presenting part. These presentations are uncommon and are usually associated with fetal anomalies.

47. T/F - The perinatal nurse observes the placental inspection by the health-care provider after birth. This examination may help to determine whether an abruption has occurred prior to or during labor.

ANS: True Fifty percent of abruptions occur before labor and after the 30th week, 15% occur during labor, and 30% are identified only upon inspection of the placenta after delivery.

49. The perinatal nurse knows that the survival rate for infants born at or greater than 28 to 29 gestational weeks is greater than 90%.

ANS: True With appropriate medical care, neonatal survival dramatically improves as the gestational age increases, with over 50% of neonates surviving at 25 weeks gestation, and over 90% surviving at 28 to 29 weeks of gestation.

10. A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined? a. Transverse fetal lie b. Flexed fetal attitude c. Previous low flap uterine incision d. Positive vaginal candidiasis

ANS: a Feedback: a. A baby in the transverse lie is lying sideways in the uterus. This lie is incompatible physiologically with a vaginal delivery. b. A baby in the flexed fetal attitude is in a physiologic position for a vaginal delivery. c. A previous low flap uterine incision is not incompatible physiologically with a vaginal delivery. d. A positive vaginal Candidiasis culture is not an indication for cesarean birth.

7. Four women are close to delivery on the labor and delivery unit. The nurse knows to be vigilant to the signs of neonatal respiratory distress in which delivery? a. 42-week-gestation pregnancy complicated by intrauterine growth restriction b. 41-week-gestation pregnancy with biophysical profile score of 10 that morning c. 40-week-gestation pregnancy with estimated fetal weight of 3200 grams d. 39-week-gestation pregnancy complicated by maternal cholecystitis

ANS: a Feedback: a. A post-term baby with intrauterine growth restriction (IUGR) is high risk for meconium aspiration syndrome, cold stress syndrome, hypoglycemia, and acidosis. In each case, the baby may exhibit signs of respiratory distress. b. A biophysical profile (BPP) of 10 is a normal finding. c. The normal birth weight is between 2500 and 4000 grams. d. Maternal gallbladder disease does not place the baby in danger of developing respiratory distress.

1. The nurse uses the external electronic fetal heart monitor to evaluate fetal status. The fetal heart tracing shows accelerations. Accelerations in the fetal heart are: a. Associated with fetal well-being and oxygenation b. An indication of potential fetal intolerance to labor c. Never associated with the uterine contraction pattern d. A reason to notify the care provider

ANS: a Feedback: a. Accelerations are a sign of fetal well-being. b. Accelerations are a sign of fetal well-being and are reassuring. c. Accelerations may or may not be associated with uterine contractions. d. Accelerations are reassuring, and there is no need to notify the care provider.

3. Augmentation of labor: a. Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are inadequate b. Relies on more invasive methods when oxytocin and amniotomy have failed c. Is elective induction of labor d. Is an operative vaginal delivery that uses vacuum cups

ANS: a Feedback: a. Augmentation stimulates uterine contractions after labor has started but not progressed appropriately. b. Augmentation uses amniotomy and oxytocin. c. Augmentation stimulates labor. d. Vacuum delivery is not part of augmentation of labor.

9. The perinatal nurse providing care to a laboring woman recognizes a category II, fetal heart rate tracing. The most appropriate initial action is to: a. Assist the laboring woman to a left lateral position b. Decrease the intravenous solution c. Request that the physician/certified nurse-midwife come to the hospital STAT d. Document the fetal heart rate and variability

ANS: a Feedback: a. Because Category II fetal heart rate patterns could deteriorate, they constitute a risk indicator for fetal hypoxia, the nurse should change the womans position to her side to increase oxygen flow to the baby. b. Because Category II fetal heart rate patterns could deteriorate, they constitute a risk indicator for fetal hypoxia, the nurse should increase, not decrease, the IV infusion to increase perfusion through the placenta. c. The scenario described does not require STAT intervention but continued assessment after intrauterine resuscitation interventions. d. Documentation of the FHR is important but not the most important action in this scenario.

13. During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large quantity of bright red bleeding. Her uterine fundus is firm. The nurses most appropriate action is to notify the physician/certified nurse midwife and describe a: a. Need for vaginal assessment and repair b. Requirement for an oxytocin infusion c. Need for further information for the woman/family about forceps d. Requirement for bladder assessment and catheterization

ANS: a Feedback: a. In the presence of a firm fundus and bright red bleeding, after a forceps-assisted birth there is a need for vaginal assessment and there may be a need for repair. b. The fundus is firm, and oxytocin is not indicated. c. There is no indication in this scenario that the family needs more information. d. There is no indication in this scenario that the bladder is contributing to the bleeding.

5. Which statement correctly describes the nurses responsibility related to electronic fetal monitoring? a. Teach the woman and her family about the monitoring equipment and discuss any questions they have. b. Report abnormal findings to the care provider before initiating corrective actions. c. Inform the support person that the nurse will be responsible for all comfort measures when the electronic equipment is in place. d. Document the frequency, duration, and intensity of contractions measured by the external device.

ANS: a Feedback: a. Teaching is an essential part of the nurses role. b. Corrective measures for a non-reassuring fetal heart rate are done before notifying a provider. c. The support person can help to provide comfort measures for women in labor. d. Only an IUPC will measure the intensity of uterine contractions.

12. The perinatal nurse notes a rapid decrease in the fetal heart rate that does not recover immediately following an amniotomy. The most likely cause of this obstetrical emergency is: a. Prolapsed umbilical cord b. Vasa previa c. Oligohydramnios d. Placental abruption

ANS: a Feedback: a. The nurse needs to assess the fetal heart rate immediately before and after the artificial rupture of membranes. Changes such as transient fetal tachycardia may occur and are common. However, other FHR patterns such as bradycardia and variable decelerations may be indicative of cord compression or prolapse. b. Vasa previa is abnormal insertion of the cord into the placenta c. Oligohydramnios is a decreased amount of amniotic fluid. d. Placenta abruption is separation of the placenta from the uterine wall. In this scenario, prolapsed cord is the most likely cause of the abrupt deceleration in the FHR.

11. The physician has ordered intravenous oxytocin for induction for four gravidas. In which of the following situations should the nurse refuse to comply with the order? a. Primigravida with complete placenta previa b. Multigravida with extrinsic asthma c. Primigravida who is 38 years old d. Multigravida who is colonized with group B streptococci

ANS: a Feedback: a. The nurse should refuse to comply with this order because labor is contraindicated for a patient with complete placenta previa. This patient will have to be delivered via cesarean section. b. Induction is not contraindicated for patients with asthma. c. Induction is not contraindicated for patients who are 38 years old. d. Induction is not contraindicated for patients with group B streptococci.

8. A post-cesarean birth woman has been diagnosed with paralytic ileus. Which of the following symptoms would the nurse expect to see? a. Abdominal distension b. Polyuria c. Diastasis recti d. Dependent edema

ANS: a Feedback: a. The nurse would expect to see a distended abdomen in a client with a paralytic ileus. b. Polyuria is unrelated to a paralytic ileus. c. Diastasis recti is unrelated to a paralytic ileus. d. Dependent edema is unrelated to a paralytic ileus.

7. After assessing the FHR tracing shown below, which of the following interventions should the nurse perform? a. Turn the woman on her side. b. Administer oxygen by nasal cannula. c. Encourage the patient to push with each contraction. d. Provide the patient with caring labor support.

ANS: a Feedback: a. The womans position should be changed. The side-lying position is the best. b. If a laboring patient needs oxygen, it should be administered via face mask. c. There is no indication in the scenario that the patient is fully dilated. d. The nurse should not wait to intervene. He or she should intervene as quickly as possible in order to reverse the problem.

6. The nurse is assisting a physician in the delivery of a baby via vacuum extraction. Which of the following nursing diagnoses for the gravida is appropriate at this time? a. Risk for injury b. Colonic constipation c. Risk for impaired parenting d. Ineffective individual coping

ANS: a Feedback: a. There is a risk for injury. For example, the patient could suffer a cervical, vaginal, or perineal laceration. b. A diagnosis of colonic constipation is unrelated to the fact that the baby was delivered by forceps. c. There is nothing in the scenario that implies that the patient is at risk for impaired parenting. d. There is nothing in the scenario that implies that the patient is at risk for ineffective individual coping.

11. Tanya, a 30-year-old woman, is being prepared for an elective cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions Tanya in a supine position. Tanyas blood pressure drops to 90/52, and there is a decrease in the fetal heart rate to 110 bpm. The perinatal nurses best response is to: a. Place a wedge under Tanyas left hip. b. Discontinue Tanyas intravenous administration. c. Have naloxone (Narcan) ready for administration. d. Have epinephrine ready for administration.

ANS: a In the event of severe maternal hypotension, the nurse should place the patient in a lateral position or use a wedge under the hip to displace the uterus, elevate the legs, maintain or increase the IV infusion rate, and administer oxygen by face mask at 10 to 12 L/min, or according to institution protocol.

3. The perinatal nurse teaches the student nurse that deep breathing exercises following a cesarean birth are critical to the prevention of (select all that apply): a. Pneumonia b. Atelectasis c. Abdominal distension d. Increased tidal volume

ANS: a, b Incisional pain and abdominal distension often cause patients to adopt shallow breathing patterns that can lead to decreased gas exchange and a reduced tidal volume. To facilitate adequate lung functions, patients should be taught how to perform pulmonary exercises. Expectoration of secretions and deep breathing help prevent common complications including atelectasis and pneumonia. Abdominal distension and gas pains are common after abdominal surgery and result from delayed peristalsis.

16. Documentation related to vacuum delivery includes which of the following (Choose all that apply): a. Fetal heart rate b. Timing and number of applications c. Position and station of fetal head d. Maternal position

ANS: a, b, c Assessment of fetal heart rate is part of second-stage management, timing and number of applications are part of standard of care related to safe vacuum deliveries, and position and station of fetal head are noted for safe vacuum extraction. Maternal position is not critical to the documentation related to vacuum deliveries.

18. Documentation related to vacuum delivery includes which of the following (Choose all that apply): a. Fetal heart rate b. Timing and number of applications c. Position and station of fetal head d. Maternal position

ANS: a, b, c Assessment of fetal heart rate is part of second-stage management, timing and number of applications are part of standard of care related to safe vacuum deliveries, and position and station of fetal head are noted for safe vacuum extraction. Maternal position is not critical to the documentation related to vacuum deliveries.

15. Hyperstimulation is defined as (Choose all that apply): a. Contractions lasting more than 2 minutes b. Five or more contractions in 10 minutes c. Contractions occurring within 1 minute of each other d. Uterine resting tone below 20 mm/Hg

ANS: a, b, c Contractions lasting more than 2 minutes, five or more contractions in 10 minutes, and contractions occurring within 1 minute of each other describe the criteria for hyperstimulation. Uterine resting tone below 20 mm/Hg reflects normal uterine resting tone.

36. The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include (select all that apply): a. Cocaine use b. Tobacco use c. Previous caesarean birth d. Previous use of medroxyprogesterone (Depo-Provera)

ANS: a, b, c Feedback: a. Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years. b. Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years. c. Placenta previa may be associated with conditions that cause scarring of the uterus such as a prior cesarean section, multiparity, or increased maternal age. d. Previous use of medroxyprogesterone (Depo-Provera) is not a risk factor for placenta previa.

39. The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes (select all that apply): a. Encouraging regular, ongoing prenatal care b. Reporting symptoms of urinary frequency and burning to the health-care provider c. Coming to the labor triage unit if back pain or cramping persist or become regular d. Lying on the right side, withholding fluids, and counting fetal movements if contractions occur every 5 minutes

ANS: a, b, c Feedback: a. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur. b. Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur. c. Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider if symptoms of preterm labor occur. d. Lying on the right side; drinking fluids, not withholding fluids; and counting fetal movements if contractions occur every 5 minutes are recommended if a woman thinks she is contracting.

2. A nurse is caring for a woman who is 4 hours post-cesarean birth for arrest of labor. The labor and operative records indicate that she had premature rupture of membranes followed by 36 hours of labor. Her IV fluid intake for the past 24 hours is 2500 mL. The estimated blood loss is 1500 mL. Based on this data, the woman is at risk for which of the following? (Select all that apply.) a. Fluid volume deficit b. Infection c. Impaired motherinfant attachment d. Falls

ANS: a, b, c, d The woman is at risk for fluid volume deficit related to blood loss and risk for postpartum hemorrhage due to risk of uterine atony. She is at risk for infection related to premature and prolonged rupture of membranes. The woman is at risk for impaired motherinfant attachment related to maternal pain and exhaustion. She is at risk for falls related to anesthesia and orthostatic hypotension.

40. The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes. These risks include (select all that apply): a. Chorioamnionitis b. Abruptio placentae c. Operative birth d. Cord prolapse

ANS: a, b, d Even though maintaining the pregnancy to gain further fetal maturity can be beneficial, prolonged PPROM has been correlated with an increased risk of chorioamnionitis, placental abruption, and cord prolapse.

37. Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks gestation. An appropriate nursing action would be to (select all that apply): a. Assess the fetal heart rate b. Obtain urine for culture and sensitivity c. Assess Kerrys blood pressure and pulse d. Palpate Kerrys abdomen for contractions

ANS: a, b, d Feedback: a. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patients abdomen should be palpated to assess for contractions, and the fetuss heart rate should be monitored. b. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. A urinalysis and urine culture and sensitivity (C & S) should be obtained on all patients who present with signs of preterm labor, and the nurse must remember that signs of UTI often mimic normal pregnancy complaints (i.e., urgency, frequency). The patients abdomen should be palpated to assess for contractions, and the fetuss heart rate should be monitored. c. Assessment of blood pressure and pulse is not an important nursing action in this scenario. d. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patients abdomen should be palpated to assess for contractions, and the fetuss heart rate should be monitored.

17. For the patient with which of the following medical problems should the nurse question a physicians order for beta agonist tocolytics? a. Type 1 diabetes mellitus b. Cerebral palsy c. Myelomeningocele d. Positive group B streptococci culture

ANS: a. Feedback: a. Beta agonists often elevate serum glucose levels. The nurse should question the order. b. Beta agonists are not contraindicated for patients with cerebral palsy. c. Beta agonists are not contraindicated for patients with myelomeningocele. d. Beta agonists are not contraindicated for patients with group B streptococci.

7. A woman you are caring for in labor requests an epidural for pain relief in labor. Included in your preparation for epidural placement is a baseline set of vital signs. The most common vital sign to change after epidural placement: a. Blood pressure, hypotension b. Blood pressure, hypertension c. Pulse, tachycardia d. Pulse, bradycardia

ANS: a. Feedback: a. Blood pressure, hypotension, as up to 40% of women may experience hypotension. Hypotension is defined as systolic BP <100 mm Hg or 20% decrease in BP from preanesthesia levels. Intravenous bolus is typically given to decrease the incidence of hypotension. b. Blood pressure, hypertension is incorrect because hypotension is the common complication after epidural placement. c. Pulse, tachycardia is incorrect because hypotension is the common complication after epidural placement. d. Pulse, bradycardia is incorrect because hypotension is the common complication after epidural placement.

5. A woman is considered in active labor when: a. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. b. Cervical dilation progresses to 3 cm with effacement of 30, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. c. Cervical dilation progresses to 8 cm with effacement of 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.

ANS: a. Feedback: a. Characteristics of this phase are the cervix dilates, on an average, 1.2 cm/hr for primiparous women and 1.5 cm/hr for multiparous women. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%. Fetal descent continues and contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds, and discomfort increases. b. Cervical dilation progresses to 3 cm with effacement of 30, indicating the early or latent phase of labor. c. Cervical dilation progresses to 8 cm with effacement of 80%, indicating the transition phase of labor. d. Cervical dilation of 10 cm with effacement is the end of the first stage of labor.

2. The provision of support during labor has demonstrated that women experience a decrease in anxiety and a feeling of being in more control. In clinical situations, this has resulted in: a. A decrease in interventions b. Increased epidural rates c. Earlier admission to the hospital d. Improved gestational age

ANS: a. Feedback: a. Studies have shown that with a support person, be it a family member, friend, or professional such as a Doula or nurse, the patient experiences a decrease in anxiety and has a feeling of being in more control. This, in turn, results in a decrease in interventions, a significantly lower level of pain, and an enhanced overall maternal satisfaction. b. There is decreased use of pain medication with continuous labor support. c. There is no evidence that continuous labor support results in earlier admission to the hospital. d. There is no evidence that continuous labor support results in improved gestational age for the fetus.

26. A primiparous woman has been admitted at 35 weeks gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis? a. Hematocrit dropped to 28%. b. Platelets increased to 300,000 cells/mm3. c. Red blood cells increased to 5.1 million cells/mm3. d. Sodium dropped to 132 mEq/dL.

ANS: a. Feedback: a. The nurse would expect to see a drop in the hematocrit: The H in HELLP stands for hemolysis. b. The nurse would expect to see low platelets. c. The nurse would expect to see hemolysis. d. The sodium is usually unaffected in HELLP syndrome.

15. Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae? a. Increasing abdominal girth measurements b. Profuse vaginal bleeding c. Bradycardia with an aortic thrill d. Hypothermia with chills

ANS: a. Feedback: a. The nurse would expect to see increasing abdominal girth measurements. b. Profuse vaginal bleeding is rarely seen in placental abruption and is never seen when the abruption is concealed. c. With excessive blood loss, the nurse would expect to see tachycardia. d. The nurse would expect to see a stable temperature.

9. The perinatal nurse is preparing a woman for a scheduled cesarean birth. The woman will be receiving spinal anesthesia for the birth. In order to prevent maternal hypotension, the nurse: a. Assists the woman to lie down in a supine position. b. Administers a rapid intravenous infusion of 500 mL of normal saline. c. Assesses blood pressure and pulse every 5 minutes, three times, before the spinal insertion. d. Encourages frequent cleansing breaths after the patient has been placed in the correct position for the anesthesia administration.

ANS: b Complications that may occur with spinal anesthesia block include maternal hypotension, decreased placental perfusion, and an ineffective breathing pattern. Prior to administration, the patients fluid balance is assessed, and IV fluids are administered to reduce the potential for sympathetic blockade (decreased cardiac output that results from vasodilation with pooling of blood in the lower extremities). Following administration of the anesthetic, the patients blood pressure, pulse, and respirations and fetal heart rate must be taken and documented every 5 to 10 minutes.

8. You are caring for a primiparous woman admitted to labor and delivery for induction of labor at 42 weeks gestation. She asks you to explain the factors that contribute to prolonged labor. The best response would be to state the following: a. Primiparous women are not at risk for dystocia because they usually have small babies. b. Dystocia is related to uterine contractions, the pelvis, the fetus, the position of the mother, and psychosocial response. c. Labor is primarily associated with pelvic abnormalities. d. Dystocia is typically diagnosed prior to labor based on pelvimetry.

ANS: b Feedback: a. Dystocia is not exclusively related to fetal size and being primiparous. b. This is the only correct definition of prolonged labor and dystocia. The success of any labor depends on the complex interrelationship of several factors: fetal size, presentation, position, size and shape of the pelvis, and quality of uterine contractions. c. Pelvic abnormality is the least important contributor to dystocia. d. Dystocia is diagnosed during, not prior to, labor.

8. A nurse is preparing to monitor a patient who is to receive an amnioinfusion. Which of the following actions should the nurse make at this time? a. Attach the patient to an electronic blood pressure cuff. b. Assist in insertion of an internal uterine pressure catheter. c. Attach the patient to an oxygen saturation monitor. d. Perform an amniotic fluid Nitrazine test.

ANS: b Feedback: a. The patients blood pressure will need to be monitored, but a manual cuff is sufficient. b. There is a possibility of uterine rupture during an amnioinfusion. An internal pressure transducer, therefore, must be inserted to monitor the patients intrauterine pressures. c. The womans oxygen saturation levels need not be monitored during the amnioinfusion. d. Because the womans membranes are already ruptured, there is no need for a Nitrazine test to be performed.

4. Your patient is a 28-year-old gravida 2 para 1 in active labor. She has been in labor for 12 hours. Upon further assessment, the nurse determines that she is experiencing a hypotonic labor pattern. Possible maternal and fetal implications from hypotonic labor patterns are: a. Intrauterine infection and maternal exhaustion with fetal distress usually occurring early in labor. b. Intrauterine infection and maternal exhaustion with fetal distress usually occurring late in labor. c. Intrauterine infection and postpartum hemorrhage with fetal distress early in labor. d. Intrauterine infection and ruptured uterus and fetal death.

ANS: b Feedback: a. The risk of hypotonic labor occurs later in labor. b. Hypotonic labor patterns increase risk for infection and maternal exhaustion, with fetal distress occurring late in labor as hypotonic patterns prolong labor. c. There is not an increased risk of postpartum hemorrhage or fetal distress in early labor. d. Hypotonic patterns do not result in rupture of the uterus.

5. A primigravida woman at 42 weeks gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate? a. Perform Nitrazine analysis of the amniotic fluid. b. Report the lack of progress to the obstetrician. c. Place the woman on her left side. d. Ask the doctor for an order for oxytocin.

ANS: b Feedback: a. There is nothing in the scenario that implies that the membranes may have ruptured. b. Little progress has taken place. The Bishop score of a primigravida will need to be 9 or higher before oxytocin will be effective. c. There is nothing in the scenario that implies that the patient needs to be placed on her side. d. The Bishop score of a primigravida will need to be 9 or higher before oxytocin will be effective.

3. As the nurse explains the purpose of the tocotransducer (Toco), which she places on the abdomen, she states that this monitoring device provides an accurate evaluation of which of the following? a. Uterine hypertonus b. Frequency of contractions c. Intensity of contractions d. Progress of labor

ANS: b Feedback: a. Uterine tone is palpated or measured with an intrauterine pressure catheter (IUPC). b. A tocotransducer measures frequency and duration of uterine contractions. c. Contraction strength is palpated or measured with an intrauterine pressure catheter (IUPC). d. Progress of labor is evaluated with a sterile vaginal examination (SVE).

14. During a cesarean section, which action by the nurse is done to prevent compression of the descending aorta and vena cava? a. Right lateral tilt b. Left lateral tilt c. Elevate head of gurney at 30 degrees d. Administration of IV fluid preload of 500 to 1000 mL

ANS: b Positioning of the patient with a left tilt maintains a left uterine displacement to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava due to weight of the gravid uterus.

35. A low-risk patient calls the labor unit and says I need to come in to be checked right now, there were pink streaks on the toilet paper when I went to the bathroom. I think Im bleeding. What response should the nurse say first? a. How much blood is there? b. You sound concerned, what other labor symptoms do you have? c. Dont worry that sounds like a mucus plug. d. Does it burn when you urinate?

ANS: b The nurse is using reflection to acknowledge the womans concerns and asks for further assessment. The womans fear must first be acknowledged and then other questions or comments can be made.

27. A labor nurse is caring for a patient, 39 weeks gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question? a. Type and cross-match her blood. b. Insert an internal fetal monitor electrode. c. Administer an oral stool softener. d. Assess her complete blood count.

ANS: b. Feedback: a. It would be appropriate to type and cross-match the patient for a blood transfusion. b. This action is inappropriate. When a patient has a placenta previa, nothing should be inserted into the vagina. c. To prevent constipation, it is appropriate for a patient to take a stool softener. d. It is appropriate to monitor the patient for signs of anemia.

23. A woman at 10 weeks gestation is diagnosed with gestational trophoblastic disease (hydatidiform mole). Which of the following findings would the nurse expect to see? a. Platelet count of 550,000/mm3 b. Dark brown vaginal bleeding c. White blood cell count 17,000/mm3 d. Macular papular rash

ANS: b. Feedback: a. The nurse would not expect to see an elevated platelet count. b. The nurse would expect to see dark brown vaginal discharge. c. The nurse would not expect to see an elevated white blood cell count. d. The nurse would not expect to see a rash.

4. The mechanism of labor known as cardinal movements of labor are the positional changes that the fetus goes through to best navigate the birth process. These cardinal movements are: a. Engagement, Descent, Flexion, Extension, Internal rotation, External rotation, Expulsion b. Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion c. Engagement, Flexion, Internal rotation, Extension, External rotation, Descent, Expulsion d. Engagement, Flexion, Internal rotation, Extension, External rotation, Flexion, Expulsion

ANS: b. Feedback: a. The order of the cardinal movements is incorrect. b. Engagement occurs when the greatest diameter of the fetal head passes through the pelvic inlet. Engagement can occur late in pregnancy or early in labor. Descent is the movement of the fetus through the birth canal during the first and second stages of labor. Flexion is when the chin of the fetus moves toward the fetal chest. Flexion occurs when the descending head meets resistance from maternal tissues. This movement results in the smallest fetal diameter to the maternal pelvic dimensions. It typically occurs early in labor. Internal rotation is the movement, the rotation of the fetal head, that aligns the long axis of the fetal head with the long axis of the maternal pelvis. It occurs mainly during the second stage of labor. Extension is the movement facilitated by resistance of the pelvic floor, causing the presenting part to pivot beneath the pubic symphysis and the head to be delivered. This occurs during the second stage of labor. External rotation is when the sagittal suture moves to a transverse diameter and the shoulders align in the anteroposterior diameter. The sagittal suture maintains alignment with the fetal trunk as the trunk navigates through the pelvis. Expulsion is the movement that occurs when the shoulders and remainder of the body are delivered. c. The order of the cardinal movements is incorrect. d. The order of the cardinal movements is incorrect.

31. Ms. M is 38 weeks gestation and is a G1 P0. At 10 pm Ms. M has just been informed by the nurse that she is 3 to 4 cm dilated, cervix is 100% effaced, and contractions are every 4 to 5 minutes. When the nurse tells her the findings from the SVE, Ms. M states that she had been contracting since early that morning and she becomes extremely frustrated stating I should have had this baby by now. What is the best response by the nurse? a. Remind her that length of labor for the first child can be 18 to 24 hours b. Promote relaxation techniques c. Discuss various analgesic options d. Tell Ms. M that the provider will be contacted immediately about the slow progress of labor

ANS: b. Women in the latent phase of labor may be frustrated with lack of progress or slow progress of labor and desire companionship and encouragement. The other responses are inappropriate. The nurse should first encourage breathing and relaxation methods as well as provide reassurance, and then contact the provider.

33. It would be most important for a nurse caring for a mother and the infant in the fourth stage of labor to do which of the following? A. Assess and massage the fundus every 15 minutes or more often if needed B. Massage the uterus continuously C. Administer oxytocin per protocol D. Assess the patient for a distended bladder a. A, C b. A, C, D c. C, D d. all of the above

ANS: b. A, C, D The fourth stage of labor immediately follows the delivery of the placenta. The nurse should be assessing the fundus every 15 minutes for position, tone, and location. The provider may order oxytocin at this stage, and the nurse should assist the woman to the bathroom if she has a distended bladder which could interfere with the contraction of the uterus.

53. The perinatal nurse explains to the student nurse who is assessing the abdomen of a 32-week pregnant woman with placenta previa that it would not be unusual to find the fetus in a __________ or __________ position.

ANS: breech; transverse Placenta previa is an implantation of the placenta in the lower uterine segment, near or over the internal cervical os. This condition accounts for 20% of all antepartal hemorrhages. Leopold maneuvers often reveal the fetus to be in a breech or oblique position or transverse lie because of the abnormal location of the placenta.

4. Early decelerations are probably caused by: a. Decreased maternalfetal exchange b. Umbilical cord occlusion c. Momentary increase in intracranial pressure due to head compression d. Compression of umbilical cord

ANS: c Feedback: a. Decreased maternalfetal exchange results in late decelerations. b. Umbilical cord occlusion results in variable deceleration or bradycardia. c. Early decelerations are related to increased intracranial pressure due to head compression. d. Compression of the umbilical cord results in variable decelerations.

5. A nurse is preparing a woman in early labor for an urgent cesarean birth related to breech presentation. Select the best nursing action for reducing the couples anxiety levels. a. Explain the reason for the need for a cesarean section. b. Inform parents that their baby is in distress. c. Ask the couple to share their concerns .d. Reassure the couple that both the woman and baby are in no danger.

ANS: c Feedback: a. Explaining the reason she is having a cesarean birth is helpful but may not address their concerns. b. It is important to acknowledge that the baby is stable, but this response does not allow the couple to share their concerns that may be causing an increase in anxiety. c. By asking the couple to share their concerns, the nurse can address these concerns. d. Reassuring the couple that the woman and baby are in no danger is correct, but it is not the best answer because it does not allow the couple to verbalize their concerns.

14. The perinatal nurse is providing care to Carol, a 28-year-old multiparous woman in labor. Upon arrival to the birthing suite, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as strong. Carol states she labored for 1 hour at home. As the nurse assists Carol from the assessment area to her labor and birth room, Carol states that she is feeling some rectal pressure. Carol is most likely experiencing: a. Hypertonic contractions b. Hypotonic contractions c. Precipitous labor d. Uterine hyperstimulation

ANS: c Feedback: a. Hypertonic contractions result in little cervical change. b. Hypotonic contractions result in little cervical change. c. Contrary to both hypertonic and hypotonic labor, precipitate labor contractions produce very rapid, intense contractions. A precipitous labor lasts less than 3 hours from the beginning of contractions to birth. Patients often progress through the first stage of labor with little or no pain and may present to the birth setting already advanced into the second stage of labor. d. Patients with precipitous labor often progress through the first stage of labor with little or no pain and may present to the birth setting already advanced into the second stage of labor. Precipitous labor contractions produce very rapid, intense contractions.

1. During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action? a. Increase oxytocin infusion rate per physicians protocol. b. Stop oxytocin infusion immediately. c. Maintain present oxytocin infusion rate and continue to assess. d. Decrease oxytocin infusion rate by 2 mU/min and report to physician.

ANS: c Feedback: a. Increasing the oxytocin infusion could result in uterine hyperstimulation. b. The uterine contraction pattern is normal, and oxytocin infusion should be maintained, not stopped. c. Correct. Maintain present oxytocin infusion rate and continue to assess is the correct response, as this question describes a normal uterine contraction pattern. d. The uterine contraction pattern is normal, and oxytocin infusion should be maintained, not stopped or decreased.

13. A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following findings? a. Patellar and biceps reflexes of +4 b. Urinary output of 50 mL/hr c. Respiratory rate of 10 rpm d. Serum magnesium level of 5 mg/dL

ANS: c Feedback: a. Magnesium sulfate has been ordered because the patient has severe pregnancy-induced hypertension. Patellar and biceps reflexes of +4 are symptoms of the disease. b. The urinary output must be above 25 mL/hr. c. The drop in respiratory rate may indicate that the patient is suffering from magnesium toxicity. The nurse should report the finding to the physician. d. The therapeutic range of magnesium is 4 to 7 mg/dL.

6. The nurse is caring for a woman, G2 P1001, 40 weeks gestation, in labor.A 12 P.M. assessment revealed: cervix 4 cm, 80% effaced, 3 station, and fetal heart 124 with moderate variability.5 p.m. assessment: cervix 6 cm, 90% effaced, 3 station, and fetal heart 120 with minimal variability.10 a.m. assessment: cervix 8 cm, 100% effaced, 3 station, and fetal heart 124 with absent variability.Based on the assessments, which of the following should the nurse conclude? a. Descent is progressing well. b. Woman is carrying a small-for-gestational age fetus. c. Baby is potentially acidotic. d. Woman should begin to push with the next contraction.

ANS: c Feedback: a. The baby has not descended since admission. The station is still 3. b. The baby may be macrosomic. Because the baby is not descending, the baby may be too large to traverse through the pelvis. c. The variability is decreasing. This is an indication that the fetus is in distress. d. The woman is only 8 cm dilated. She should not begin to push until she has reached 10 cm dilation. Plus, the fetal station is still 3.

38. The perinatal nurse knows that tocolytic agents are most often used to (select all that apply): a. Prevent maternal infection b. Prolong pregnancy to 40 weeks gestation c. Prolong pregnancy to facilitate administration of antenatal corticosteroids d. Allow for transport of the woman to a tertiary care facility

ANS: c, d Feedback: a. Tocolytics are not used to treat maternal infection. b. Tocolytics are generally only effective in delaying delivery for several days. c. Presently, it is believed that the best reason to use tocolytic drugs is to allow an opportunity to begin the administration of antenatal corticosteroids to accelerate fetal lung maturity. d. Delaying the birth provides time for maternal transport to a facility equipped with a neonatal intensive care unit.

1. Which of the following is a medical indication for a cesarean birth? (Select all that apply.) a. Maternal blood pressure of 130/90 b. Cervical dilation of 1.5 cm per hour during the active phase of labor c. Late deceleration of the fetal heart rate with minimal variability d. Complete placenta previae. Arrest of fetal descent

ANS: c, d, e A maternal blood pressure of 130/90 may be an indication of mild PHI which is not a medical indication for cesarean birth. Cervical dilation of 1.5 cm/minutes is within normal limits for cervical changes during the active phase. Late decelerations combined with minimal variability in the fetal heart rate reflect fetal intolerance of labor and are an indication for cesarean birth. A complete placenta previa covers the internal os necessitating a cesarean birth. Arrest of fetal descent indicates cephalopelvic disproportion.

21. A woman at 32 weeks gestation is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will identify which of the following as a positive patient care outcome? a. Rise in serum creatinine b. Drop in serum protein c. Resolution of thrombocytopenia d. Resolution of polycythemia

ANS: c. Feedback: a. A rise in serum creatinine indicates that the kidneys are not effectively excreting creatinine. It is a negative outcome. b. A drop in serum protein indicates that the kidneys are allowing protein to be excreted. This is a negative outcome. c. Resolution of thrombocytopenia is a positive sign. It indicates that the platelet count is returning to normal. d. Polycythemia is not related to HELLP syndrome. Rather one sees a drop in red cell and platelet counts with HELLP. A positive sign, therefore, would be a rise in the RBC count.

8. The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4/70/1 station. She tells you she has fluid running down her leg. Your priority nursing intervention is to: a. Assess the color, odor, and amount of fluid. b. Assist your patient to the bathroom. c. Assess the fetal heart rate. d. Call the care provider.

ANS: c. Feedback: a. Although assessing the color, odor, and amount of fluid is appropriate, the priority nursing action is to assess the FHR because of the risk of umbilical cord prolapse with rupture of membranes. b. The fluid is probably related to rupture of membranes rather than the patient needing to go to the bathroom to urinate. c. Assessing the fetal heart rate is the first priority because of the risk of umbilical cord prolapse with rupture of membranes. d. Although you may call the care provider, the priority nursing action is to assess the FHR because of the risk of umbilical cord prolapse with rupture of membranes.

30. A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner? a. Presence of chloasma b. Presence of severe heartburn c. 10-pound weight gain in a month d. Patellar reflexes +1

ANS: c. Feedback: a. Chloasma is a normal pregnancy finding. b. Heartburn is an expected finding during the third trimester. c. The weight gain may be due to fluid retention. Fluid retention may occur in patients with pregnancy-induced hypertension and in patients with congestive heart failure. The physician should be notified. d. Although slightly hyporeflexic, patellar reflexes of +1 are within normal limits.

16. A woman who has had no prenatal care was assessed and found to have hydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings? a. Pyelonephritis b. Pregnancy-induced hypertension c. Gestational diabetes d. Abruptio placentae

ANS: c. Feedback: a. Pyelonephritis does not lead to the development of hydramnios or macrosomia. b. Pregnancy-induced hypertension does not lead to the development of hydramnios or macrosomia. c. Untreated gestational diabetics often have hydramnios and often deliver macrosomic babies. d. Abruptio placentae does not lead to the development of hydramnios or macrosomia.

1. In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the __________ of labor. a. Passenger b. Passage c. Powers d. Psyche

ANS: c. Feedback: a. The passenger refers to the fetus. b. The passage refers to the pelvis and birth canal. c. Powers refer to the contractions. d. Psyche refers to the response of a woman to labor.

25. A woman who is admitted to labor and delivery at 30 weeks gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour? a. Temperature b. Pulse c. Respiratory rate d. Blood pressure

ANS: c. Feedback: a. The temperature should be monitored, but it is not the most important vital sign. b. The pulse rate should be monitored, but it is not the most important vital sign. c. The respiratory rate is the most important vital sign. Respiratory depression is a sign of magnesium toxicity. d. The blood pressure should be monitored, but it is not the most important vital sign.

24. After an education class, the nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that additional teaching about sexually transmitted infection (STI) control issues is needed? a. I could get an STI even if I just have oral sex. b. Girls over 16 are less likely to get STDs than younger girls. c. The best way to prevent an STI is to use a diaphragm. d. Girls get human immunodeficiency virus (HIV) easier than boys do.

ANS: c. Feedback: a. This statement is true. Organisms that cause sexually transmitted infections can invade the respiratory and gastrointestinal tracts. b. This statement is true. Young women are especially high risk for becoming infected with sexually transmitted diseases. c. This statement is untrue. The young woman needs further teaching. Condoms protect against STDs and pregnancy. In addition, condoms can be kept in readiness for whenever sex may occur spontaneously. Using condoms does not require the teen to plan to have sex. A diaphragm is not an effective infection-control method. Plus, it would require the teen to plan for intercourse. d. This statement is true. Young women are higher risk for becoming infected with HIV than are young men.

54. The perinatal nurse knows that a __________ hemorrhage is limited to the uterus, and a __________ hemorrhage moves blood toward and through the cervix.

ANS: concealed; revealed Feedback 1: A concealed hemorrhage occurs in 20% of cases and describes an abruption in which the bleeding is confined within the uterine cavity. The most common abruption is associated with a revealed or external hemorrhage, where the blood dissects downward toward the cervix. Feedback 2: The most common abruption is associated with a revealed or external hemorrhage, where the blood dissects downward toward the cervix.

12. The perinatal nurse listens as Chantal describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist Chantal in: a. Her role development in the letting go stage b. Decreasing her ambivalence about her labor and birth c. Understanding her guilt involved in her labor and birth d. Developing more positive feelings about her labor and birth

ANS: d After a cesarean birth, especially when unplanned, nurses must be aware of the myriad of potential psychological issues that may arise. Research suggests that women may perceive cesarean birth to be a less positive experience than a vaginal birth. Unplanned or emergent cesarean deliveries and the experience of cesarean birth may be associated with more negative perceptions of the birthing experience. Allowing Chantal to talk about the experience can help her develop a more positive attitude about her own experience.

9. A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with good variability and no decelerations, TPR 98.6F, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)? a. Bishop score of 5 b. Fetal heart of 152 bpm c. Respiratory rate of 24 rpm d. Contraction frequency of every 2 minutes

ANS: d Feedback a. A Bishop score of 9 or higher indicates that the primigravida womans cervix is ripe. b. A fetal heart rate of 152 is within normal limits for this fetus. c. A respiratory rate of 24 is within normal limits. d. Cervidil should be removed for tachysystole.

12. The perinatal nurse knows that the term to describe a woman at 26 weeks gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is: a. Preeclampsia b. Chronic hypertension c. Gestational hypertension d. Chronic hypertension with superimposed preeclampsia

ANS: d Feedback: a. Preeclampsia is a multisystem, vasopressive disease process that targets the cardiovascular, hematologic, hepatic, and renal and central nervous systems. b. Chronic hypertension is hypertension that is present and observable prior to pregnancy or hypertension that is diagnosed before the 20th week of gestation. c. Gestational hypertension is a nonspecific term used to describe the woman who has a blood pressure elevation detected for the first time during pregnancy, without proteinuria. d. The following criteria are necessary to establish a diagnosis of superimposed preeclampsia: hypertension and no proteinuria early in pregnancy (prior to 20 weeks gestation) and new-onset proteinuria, a sudden increase in proteinurinary excretion of 0.3 g protein or more in a 24-hour specimen, or two dipstick test results of 2+ (100 mg/dL), with the values recorded at least 4 hours apart, with no evidence of urinary tract infection; a sudden increase in blood pressure in a woman whose blood pressure has been well controlled; thrombocytopenia (platelet count lower than 100,000/mmC); and an increase in the liver enzymes alanine transaminase (ALT) or aspartate transaminase (AST) to abnormal levels.

7. A client delivered a 2800-gram neonate 4 hours ago by cesarean section with epidural anesthesia. Which of the following interventions should the nurse perform on the mother at this time? a. Maintain the client flat in bed. b. Assess the clients patellar reflexes. c. Monitor hourly urinary outputs. d. Assess the clients respiratory rate.

ANS: d Feedback: a. The client should be assisted to a position of comfort. b. There is no indication in the scenario that the client must have her reflexes assessed. c. The clients hydration should be monitored postsurgery, but hourly assessments are unnecessary. d. The client has undergone major abdominal surgery. Her respiratory function should be assessed regularly.

6. A nurse is caring for a woman 10 hours post-cesarean birth. She received a dose of intrathecal morphine at the time of the birth. Which of the following assessment data would require immediate intervention? a. Itching of the palms and feet b. Nausea c. Urinary output of 300 mL in the past 4 hours d. Respiratory rate of 10 breaths/minute

ANS: d Feedback: a. This is a side effect of intrathecal morphine which is not life threatening. b. This is a side effect of intrathecal morphine which is not life threatening. c. A urinary output of 300 mL in 4 hours is within normal limits. d. Correct. An adverse effect of intrathecal morphine that requires immediate intervention is respiratory distress.

4. A nurse is admitting a woman for a scheduled cesarean section. Which of the following assessment data should be immediately reported to the physician? a. White cell count of 11,000 b. Hemoglobin of 11 g/dL c. Hematocrit of 33% d. Platelet count of 97,000

ANS: d Feedback: a. This laboratory value is within normal limits for a pregnant woman. b. This laboratory value is within normal limits for a pregnant woman. c. This laboratory value is within normal limits for a pregnant woman. d. Normal range of platelets is 150,000 to 400,000. A low platelet count places the woman at risk for increased bleeding.

2. If the umbilical cord prolapses during labor, the nurse should immediately: a. Type and cross-match blood for an emergency transfusion. b. Await MD order for preparation for an emergency cesarean section. c. Attempt to reposition the cord above the presenting part. d. Apply manual pressure to the presenting part to relieve pressure on the cord.

ANS: d Feedback: a. Type and cross-match is one of the interventions with cord prolapse but not a priority. b. Awaiting MD intervention is not appropriate as umbilical cord prolapse is an obstetrical emergency requiring immediate intervention. c. Once the cord has prolapsed, it cannot be repositioned. d. Apply manual pressure to the presenting part to relieve pressure on the cord represents the first nursing intervention to attempt to improve circulation to the fetus.

32. Ms. P has delivered her first baby 30 minutes ago and the placenta delivered 15 minutes ago. She is attempting to breastfeed her newborn daughter for the first time. Which action by the nurse would NOT be appropriate? a. The nurse is checking the BP every 15 minutes b. The nurse is massaging the fundus vigorously c. The nurse is auscultating the infants heart and lungs while on the mothers chest d. The nurse is leaving the patient unattended for 30 minutes to bond with her newborn

ANS: d. During the fourth stage of labor the mothers should not be left unattended as maternal bleeding needs to be closely monitored.

9. You are in the process of admitting a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to: a. Reassure the patient and rapidly complete the admission. b. Assist your patient to the bathroom to have a bowel movement. c. Assess the fetal heart rate and uterine contractions. d. Perform a vaginal exam.

ANS: d. Feedback: a. Completing the admission paperwork is not a priority when birth may be imminent. b. The urge to have a bowel movement is probably related to fetal descent and complete dilation rather than the patient needing to have a bowel movement. c. Doing a vaginal exam is the first priority as birth may be imminent. d. Perform a vaginal exam to assess the progress of labor. The urge to have a bowel movement and feeling like pushing indicate that birth may be imminent.

10. The Apgar score consists of a rapid assessment of five physiological signs that indicate the physiological status of the newborn and includes: a. Apical pulse strength, respiratory rate, muscle flexion, reflex irritability, and color b. Heart rate, clarity of lungs, muscle tone, reflexes, and color c. Apical pulse strength, respiratory rate, muscle tone, reflex irritability, and color of extremities d. Heart rate, respiratory rate, muscle tone, reflex irritability, and color

ANS: d. Feedback: a. Heart rate, not apical pulse strength, is the criterion for Apgar scoring; muscle tone, not flexion, is assessed. b. Clarity of lungs and reflexes are not assessed as part of Apgar scoring. Neonatal lungs can be congested normally at birth, and reflexes are not assessed. Rather, reflex irritability is assessed, based on response to tactile stimulation. c. Heart rate, not apical pulse strength, is assessed along with respiratory rate, muscle tone, reflex irritability, and color of extremities. d. The Apgar score includes assessment of heart rate based on auscultation, respiratory rate based on observed movement of chest, muscle tone based on degree of flexion and movement of extremities, reflex irritability based on response to tactile stimulation, and color based on observation.

22. A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following? a. High leukocyte count b. Explosive diarrhea c. Fractured pelvis d. Low platelet count

ANS: d. Feedback: a. High leukocyte count is not associated with severe pregnancy-induced hypertension (PIH) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. b. Explosive diarrhea is not associated with severe PIH or HELLP syndrome. c. A fractured pelvis is not associated with severe PIH or HELLP syndrome. d. Low platelet count is one of the signs associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

18. The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? a. The patient with placenta previa b. The patient whose vagina is colonized with group B streptococci c. The patient who is hepatitis B surface antigen positive d. The patient with eclampsia

ANS: d. Feedback: a. Patients with placenta previa are not especially high risk for placental abruption. b. Patients colonized with group B streptococci are not especially high risk for placental abruption. c. Patients who are hepatitis B surface antigen positive are not especially high risk for placental abruption. d. Patients with eclampsia are high risk for placental abruption.

11. The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks gestation in her first pregnancy. She is worried about having her baby too soon, and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: a. Preterm labor b. Term labor c. Back labor d. Braxton-Hicks contractions

ANS: d. Feedback: a. Preterm labor (PTL) is defined as regular uterine contractions and cervical dilation before the end of the 36th week of gestation. Many patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor. b. Term labor occurs after 37 weeks gestation. c. There is no indication in this scenario that this is back labor. d. Braxton-Hicks contractions are regular contractions occurring after the third month of pregnancy. They may be mistaken for regular labor, but unlike true labor, the contractions do not grow consistently longer, stronger, and closer together, and the cervix is not dilated. Some patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor.

19. The nurse is caring for a woman at 28 weeks gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis? a. Human relaxin levels b. Amniotic fluid levels c. Alpha-fetoprotein levels d. Fetal fibronectin levels

ANS: d. Feedback: a. Relaxin levels are rarely assessed. In addition, they are unrelated to the incidence of preterm labor. b. Amniotic fluid levels are not directly related to the incidence of preterm labor. c. Alpha-fetoprotein levels are not related to the incidence of preterm labor. d. A rise in the fetal fibronectin levels in cervical secretions has been associated with preterm labor.

3. When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is: a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact. b. True labor contractions result in increasing anxiety and discomfort, and false labor does not. c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

ANS: d. Feedback: a. Rupture of membranes can occur prior to labor or during labor. b. A womans response to labor may not be reflective of her status in labor but is influenced by expectations and emotional status. c. Loss of the mucus plug can occur prior to the onset of labor. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

29. According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia: a. Take the patients blood pressure every 6 hours b. Encourage the patient to rest on her back c. Notify the physician of urine output greater than 30 mL/hr d. Administer magnesium sulfate according to agency policy

ANS: d. Feedback: a. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The blood pressure is taken every 1 hour or more frequently according to physician orders or institutional protocol. b. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The patient should be encouraged to assume a side-lying position to enhance uterine perfusion. c. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. A urine output less than 30 mL/hr is indicative of oliguria, and the physician must be notified. d. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion.

14. A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? a. Serum potassium level increases b. Diarrhea c. Urticaria d. Complaints of nervousness

ANS: d. Feedback: a. The nurse would not expect to see a rise in the mothers serum potassium levels. b. The beta agonists are not associated with diarrhea. c. The beta agonists are not associated with urticaria. d. Complaints of nervousness are commonly made by women receiving subcutaneous beta agonists.

28. A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see? a. Postpartum hemorrhage b. Neonatal hyperglycemia c. Postpartum oliguria d. Neonatal macrosomia

ANS: d. Feedback: a. The patient is not especially high risk for a postpartum hemorrhage. b. The nurse would expect to see neonatal hypoglycemia, not hyperglycemia. c. The nurse would expect to see postpartum polyuria. d. The nurse would expect to see neonatal macrosomia.

20. Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa? a. During the second stage of labor you will need to bear down. b. You should ambulate in the halls at least twice each day. c. The doctor will likely induce your labor with oxytocin. d. Please promptly report if you experience any bleeding or feel any back discomfort.

ANS: d. Feedback: a. This response is inappropriate. This patient will be delivered by cesarean section. b. This response is inappropriate. Patients with placenta previa are usually on bed rest. c. This response is inappropriate. This patient will be delivered by cesarean section. d. Labor often begins with back pain. Labor is contraindicated for a patient with complete placenta previa.

22. The perinatal nurse prepares for two potential complications that may accompany a precipitous labor and birth: postpartum __________ and a need for neonatal __________.

ANS: hemorrhage; resuscitation Feedback 1: Complications from a precipitate labor pattern result from trauma to maternal tissue and to the fetus because of the rapid descent. Hemorrhage may occur from uterine rupture and vaginal lacerations. The fetus may suffer from hypoxia related to the decreased periods of uterine relaxation between the contractions and intracranial hemorrhage related to the rapid birth. Feedback 2: Complications from a precipitate labor pattern result from trauma to maternal tissue and to the fetus because of the rapid descent. Hemorrhage may occur from uterine rupture and vaginal lacerations. The fetus may suffer from hypoxia related to the decreased periods of uterine relaxation between the contractions and intracranial hemorrhage related to the rapid birth.

25. The perinatal nurse recognizes that the laboring multiparous patient who is attempting a vaginal birth following a previous cesarean birth (VBAC) needs frequent assessments to ensure that there is __________ during her labor.

ANS: progress Women with a previous history of cesarean birth may be offered a trial of labor, although a prompt cesarean birth is recommended at the earliest sign of maternal or fetal compromise.

55. The perinatal nurse encourages Colleen, who has just been discharged from the hospital for intravenous therapy for severe nausea and vomiting, to ensure that she __________ often, eats frequent, __________ meals, and avoids __________ odors.

ANS: rests; small; cookingThe nurse should counsel the woman with nausea and vomiting to avoid foods and sensory stimuli that provoke symptoms (i.e., some women become nauseous when they smell certain foods being prepared) and also to eat small, frequent meals of dry, bland foods and include high-protein snacks in their diet.

17. The Joint Commission Standard states that the __________, __________, and __________ are accurately identified and clearly communicated during the final verification process before the start of any surgical or invasive procedure.

ANS: site; procedure; patient To decrease the risk of surgery or invasive procedure being done on the wrong patient or in the wrong site, a time-out is called, and active communication to verify correct procedure, site, and patient is done just prior to the beginning of surgery or invasive procedure.

27. __________ is contraindicated with shoulder dystocia.

ANS: Fundal pressure Fundal pressure is contraindicated with shoulder dystocia because it may further impact the shoulder and increases risk of fetal injury.

44. A disease characterized by an abnormal placental development that results in the production of fluid-filled grapelike clusters and a vast proliferation of trophoblastic tissue

ANS: Hydatidiform mole/Gestational trophoblastic disease

45. No expulsion of the products of conception, but bleeding and dilation of the cervix such that a pregnancy is unlikely

ANS: Inevitable abortion

42. A pregnancy that ends before 20 weeks gestation

ANS: Miscarriage

41. A condition where the placenta attaches to the lower uterine segment of the uterus

ANS: Placenta previa

43. Specks or spots in the vision where the patient cannot see; blind spots

ANS: Scotoma

21. T/F The perinatal nurse explains to the student nurse that the most frequent fetal risk associated with the use of forceps is cord compression.

ANS: False The most frequent fetal risk associated with the use of forceps is superficial scalp or facial marks that will resolve quickly.

46. Placement of suture to mechanically close a weak cervix

ANS: Cervical cerclage

16. The perinatal nurse knows that the presence of abdominal distension and gas in the post-cesarean birth mother is due to __________.

ANS: delayed peristalsis Delayed peristalsis and constipation commonly occur because of slowed peristalsis associated with pregnancy hormones and childbirth anesthesia. In addition, incisional pain may contribute to a decrease in ambulation which contributes to delayed peristalsis.

51. Mary, a G3 TPAL 0020 woman at 20 weeks gestation, has had a transvaginal ultrasound. Mary has been informed that she has cervical incompetence. The perinatal nurse explains that this diagnosis means that her cervix has __________ without __________ contractions.

ANS: dilated; regular Patients with cervical incompetence usually present with painless dilation and effacement of the cervix, often during the second trimester of pregnancy. The patient frequently gives a history of repeated second trimester losses with no apparent etiology. Incompetent cervix is estimated to cause approximately 15% of all second trimester losses.

23. The perinatal nurse understands that the most appropriate nursing action following an amniotomy is an assessment of the __________ as well as the __________ and __________ of the amniotic fluid.

ANS: fetal heart rate; color; odor The nurse carefully monitors the patient who will undergo an amniotomy. Vital signs, cervical effacement and dilation, station of the presenting part, fetal heart rate, and color and amount of amniotic fluid are assessed.