High-risk intrapartum
an anethesiologist informs the nurse that a woman scheduled for a c 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?
the woman has had surgery for scoliosis
a nurse administers magnesium sulfate via infusion pump to an ecamptic woman in labor. which of the following indicates that the medication is effective?
client has no grand mal seizures
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?
"i'll keep trying until i find the heartbeat"
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 this drug, the nurse should reply:
"to help to mature your baby's lungs"
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?
-38 yo in an abusive relationship -34 yo whose first child was born at 32 weeks gestation -22 yo who smokes 2 packs a day
a client just spontaneously ruptured membranes. which of the following factors makes her especially at high risk for having a prolapsed cord?
-breech presentation -station -3 -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?
late decelerations
a 30 yo G2 P0010 in preterm labor is receiving nifedipine (procardia). which of the following maternal assessments noted by the nurse must be reported to the HCP immediately?
audible rales
the labor nurse has just received a shift report on four gravid patients. which of the patients should the nurse assess first?
G1 P0000, 32 weeks, placental abruption, fetal heart (15 mins ago) 120 bpm
a nurse is caring for four laboring women. which of the women will the nurse carefully monitor for signs of abruptio placenae?
G5 P1211, cocaine abuser
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?
LMA (left mentum anterior)
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?
Terbutaline (Brethine)
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?
a client cardiac disease
a delirious patientis 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 the client carefully for which of the following intrapartal complications?
abruptio placentae
a woman being induced with oxytocin is contracting every 3 min x 30 seconds. suddenly the woman becomes dypsneic and cyanotic, and begins to cough up bloody sputum. which of the following interventions is of the highest priority?
administer oxygen
there are four clients in active labor in the labor suite. which of the women should the nurse carefully monitor for the potential of uterine rupture?
age 25, G4 P3003, last delivery by cesarean section
a labor nurse is caring for a client, 38 weeks' gestation, who has been diagnosed with symptomatic placenta previa. which of the following physician orders should the nurse question?
begin oxytocin drip rate at 0.5 milliunits/min
a nurse is caring for four clients on the labor and delivery unit. which of the following actions should the nurse take first?
check the fetal heart rate of a client who just ruptured membranes
a client who has been diagnosed with severe preeclampsia is being administered magnesium sulfate via IV pump. which of the following medications must the nurse have immediately available in the client's room?
calcium gluconate
a nurse is monitoring the labor of a client who is receiving IV oxytocin 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 103 bpm 3. maternal bp of 150/100 4. maternal temperature of 102.4 F
change is fetal heart rate from 128 to 103 bpm
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 x 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?
check dilation and effacement
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. parasthesias, myalgias, and anemia
confusion, drowsiness, and vomiting
when monitoring a fetal heart rate with moderate variability, the nurse notes V-shaped decelerations to 80 from a baseline of 120. one occurred 40 seconds after yet another contraction. the nurse interprets these findings and a result from which?
cord compression
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?
dehydration
a client's assessments reveal that she is 4 cm dilated and 80% effaced with fetal heart tracing showing frequent late decelerations and strong contractions every 3 minutes, each lasting 90 seconds. the nursing management of the client should be directed towards which of the following goals?
delivery of a healthy baby
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
diarrhea and back pain
a woman, 32 weeks' gestation, contracting every 3 min x 60 sec, is receiving magnesium sulfate. for which of the following maternal assessments is it critical for the nurse to monitor the client?
low urinary output
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 diagnosis is appropriate?
risk for fetal injury related to possible intrauterine irritation
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?
risk for impaired skin integrity
which of the following situations is considered a vaginal delivery emergency?
shoulder dystocia
a client is admitted in labor with spontaneous rupture of membranes 24 hours earlier. the fluid 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?
maternal temperature
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?
"have you felt the baby move since the membranes broke?"
the nurse is admitting four full term primigravid clients to the labor and delivery unit. the nurse requests pre-cesarean section orders from the HCP for which clients?
-cervical cerlage -active herpes simplex 2
the nurse is assessing the Bishop score on a postdates client. which of the following measurements will the nurse assess?
-cervical dilation -fetal station -cervical position
a client is receiving terbutaline (brethine) for preterm labor. which of the following findings would warrant stopping the infusion?
-change in fetal heart rate from 160 bpm to 210 bpm -change in the amniotic sac from intact to ruptured
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?
-count the number of sterile sponges -document the time of the first incision -notify the pediatric staff
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 HCP
-dilation 3 cm -cervical length of 2 cm
which of the following is the appropriate nursing care outcome for a woman who suddenly develops an amniotic fluid embolism during her labor?
client will exhibit normal breathing function at discharge
a woman, G3, P2002, is 6 cm dilated. the fetal monitor tracing shows recurring deep decelerations. the woman's doctor informs her that the baby must be delivered by c section. the woman refuses to sign the informed consent. which of the following actions is appropriate?
provide the woman with ongoing labor support
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?
put the client in the knee-chest position
a client with complete placenta previa is on the antepartum clinical unit in preparation for delivery. which of the following should the nurse include in teaching for this client?
coughing and deep breathing
a client is in active labor. which of the following assessments would warrant immediate intervention?
fetal scalp sampling pH of 7.19
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?
increase intravenous infusion rate
which of the following signs/symptoms would the nurse expect to see in a woman with abruptio placentae?
increasing fundal height measurements
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?
left sacral posterior position
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?
previous cesarean section
the physician has order oxytocin (pitocin) for induction for 4 gravidas. in which of the following situations should the nurse refuse to comply with this 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
primigravida with a transverse lie
a client, 28 weeks' gestation, is being induced with IV oxytocin (pitocin) for hyperension and oligohydramnios. she is contracting q 3 min x 60 to 90 seconds. she suddenly complains of abdominal pain accompanied by significant fetal heart bradycardia. which of the following interventions should the nurse perform first? 1. turn of the oxytocin infusion 2. administer oxygen via face mask 3. reposition the patient 4. call the obstetrician
turn off the oxytocin infusion
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?
uterine resting tone
a full-term client, contracting every 15 min x 30 seconds, had ruptured membranes for 20 hours. which of the following nursing interventions is contraindicated at this time?
vaginal examination
which of the following situations in a fully dilated client is incompatible with a forceps delivery?
-transverse fetal lie -fetal heart rate of 60 bpm at -1 station
four women request to labor in the hospital bathtub. in which of the following situations is the procedure contraindicated?
-woman receiving oxytocin for induction -woman with meconium-stained fluid
the nurse is caring for an eclamptic client. which of the following is an important action for the nurse to perform?
pad the client's bed rails and headboard
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?
-fetus is in the left sacral posterior position -fetus has been diagnosed with meningomyelocele
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?
-hepatitis B -group B streptococcus -HIV/AIDs
which of the following physical findings would lead the nurse to suspect that a client with severe preeclampsia has developed HELLP syndrome?
-petechiae -jaundice
a woman, 39 weeks' gestation, is admitted to the delivery unit with vaginal warts from human papillomavirus. which of the following actions by the nurse is appropriate?
follow standard infectious disease precautions
the nurse turns off the oxytocin infusion after a period of hyperstimulation. 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
frequency every 3 minutes
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?
the baby may develop thrush after delivery
a woman, G3 P2002, 42 weeks gestation, is admitted to the labor suite for induction. a biophysical profile report on the client states BPP score of 6 of 10. the nurse should monitor the client carefully for which of the following?
late fetal heart decelerations
a 28 week gestation client with intact membranes is admitted with following findings: contractions every 5 min x 60, 3 cm dilated, 80% effaced. which of the following meds will the obstetrician likely order?
magnesium sulfate
in which of the following clinical situations would it be approproate for an obstetrician to order a labor nurse to perform amniofusion?
meconium-stained fluid
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 fluid 2. report abnormal findings to the obstetrician 3. place the woman on her side 4. monitor for onset of labor
monitor for onset of labor
a woman, G3 P1010, is receiving oxytocin (pitocin) via IV pump at 3 milliunits/,min. her current contraction pattern is every 3 minutes x 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 her infusion 2. give her oxygen 3. change her position 4. monitor her labor
monitor her labor
the physician has ordered Prepidil (dinoprostone) for four gravidas at term. the nurse should question the order for which woman? 1. primigravida with Bishop score of 4 2. multigravida with late decelerations 3. G1 P0000 contracting every 20 mins x 30 sec 4 G6 P3203 with bp 140/90 and pulse 92
multigravida with late decelerations
a known drug addict is in active labor. she requests pain medication. which of the following actions by the nurse is appropriate?
notify the physician of her request
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?
notify the practitioner
a woman who is hepatitis B-surface antigen positive is in active labor. which action by the nurse is appropriate at this time?
obtain an order from the pediatrician to administer hepatitis B immune globulin and hepatitis B vaccine to the baby after birth
a client has 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?
palpate bladder
a client is in labor and delivery with a diagnosis of HELLP syndrome. the nurse notes the following blood values: PT 99 sec (normal 60-85) and PTT 30 sec (normal 11 to 15) for which of the signs and symptoms would the nurse monitor the client?
pink-tinged urine
which of the following lab values should the nurse report to the physician as being consistent with the diagnosis of HELLP syndrome?
platelets 75,000
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?
presence of abdominal pain
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 120 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?
prolapsed cord
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?
provide chest compressions at a depth of at least 2 inches
A client is on magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician regarding which of the following findings? 1. Patellar and biceps reflexes of +3. 2. 2. Urinary output of 30 cc/hr. 3. Respiratory rate of 16 rpm. 4. Serum magnesium level of 9 gm/dL.
serum magnesium level of 9 gm/dL
the nurse is caring for a 30 week gestation client whose fetal fibronectin levels are positive. it is essential that she be taught about which of the following?
signs of preterm labor
after a multiparous woman has been in labor for 15 hours, an ultrasound is done. the results state the 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?
station of -3
a physician write 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?
the baby is at high risk for neonatal sepsis
the HCP 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?
the cord is prolapsed
a pregnant woman, G3 P2002, had her two other children by c section. which of the following situations would mandate that this delivery also be by c section?
the previous uterine incisions were vertical
a woman has been in the second stage of labor for 3 1/2 hours.s 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?
assess the fetal heart rate after each contraction
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 is an appropriate action for the nurse?
assess the fluid with nitrazine and see if the paper turns blue
a physician has given a nurse a verbal order to apply cricoid pressure. which of the following is the likely indication for the action?
endotracheal tube insertion
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. intrathecally
endocervically
during a vaginal delivery, the obstetrician declares that a shoulder dystocia has occurred. which of the following actions by the nurse is appropriate?
flex the woman's thighs sharply toward her abdomen
a woman in active labor received Nubain 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?
Narcan (naxalone)
a client is on terbutaline (brethine) via subcutaneous pump for preterm labor. the nurse auscultates the fetal heart rate at 100 bpm via doppler. which of the following actions should the nurse perform next?
assess the maternal pulse while listening to the fetal heart rate
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?
crying and sad
an induction of 42-week gravida with IV oxytocin is begun at 0900 at a rate of 0.5 milliunits per minute. the woman's primary physician order: increase the oxytocin drip by 0.5 milliunits per minute every 10 minutes until contractions are every 3 minutes x 60 seconds. the nurse refuses to comply with this order. which of the following is the rationale? 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 undafe practice to administer oxytocin intravenoulsy to a woman who is carrying a postdates fetus 4. a contraction duration of 60 seconds can lead to fetal compromise in a baby that is postmature
the relatively long half-life of oxytocin can result in unsafe intravascular concentrations of the drug
the results from a fecal blood sampling test are reported pH 7.22. the nurse interprets these results as
the results are equivocal, warranting further sampling
a client, G3, P2002, is immediately postexternal version. the nurse monitors this client carefully for which of the following?
variable fetal heart decelerations
the nurse is monitoring a woman, G2 P1001, 41 weeks gestation in labor. A 12 p.m. assessment revealed: cervix 4cm, 98% effaced, -3 station, and FH 124 with moderate variability. At 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 these assessments, what should the nurse conclude?
the woman is likely carrying a macrosomic fetus
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?
through the rectal sphinter
to reduce possible side effects from a cesarean section under general anesthesia, clients are routinely given which of the following medications?
antacids
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?
assess the cervical dilation
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 findings 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
contraction frequency of 1 minute
a client with an internal fetal monitor catheter in place has just received IV butophanol (Stadol) for pain relief. which of the following monitor tracing changes should the nurse anticipate?
diminished short and long term variability
a woman with severe preeclampsia, 38 weeks gestation, is being induced with IV oxytocin. whichc of the following would warrant the nurse to stop the infusion?
duration of contractions 130 seconds
a 4o week gestation client has an admitting platelet count of 90,000 cells/mm3 and a hematocrit of 29%. her lab values 1 week earlier were platelet count of 200,000 cells/mm3 and hematocrit 37%. which additional lab value would the nurse expect to see?
elevated alanine transaminase (ALT)
the nurse is caring for two post-cesarean section clients in the postanethesia suite. one of the clients has her surgery under spinal anethesia, while the other client had her surgery under epidural anethesia. which of the following is an important difference between the two types of anesthesia the nurse should be aware of?
epidurals do not fully sedate motor nerves
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 nursing interventions would be appropriate in relation to this diagnosis?
explain all procedures slowly and carefully
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?
fetal heart rate
a doctor orders a narcotic analgesic for a laboring client. which of the following situations would lead a nurse to hold the medication?
fetal monitor tracing shows late decelerations
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 signs/symptoms?
hemorrhage