L&D preclinical quiz

The vaginal examination is an essential component of labor assessment. It reveals whether the patient is in true labor and enables the examiner to derterine whether membranes have ruptured. This examination is often stressful and uncomfortable for the patient and should be performed only when indicated. Match the correct step with each component of a vaginal examination of the laboring woman.

*Cleanse the perineum and vulva if necessary. *Position the woman to prevent supine hypotension *Use sterile gloves and soluble gel for lubrication. *After obtaining permission, gently insert the index and middle fingers into the vagina. *Determine dilation, presenting part, status of membranes, and characteristics of amniotic fluid. *Explain findings to the patient. *Document findings and report to the provider.

The health care practitioner orders the following medication for a laboring client: Stadol 0.5 mg IV stat for pain. The drug is on hand in the following concentration:Stadol 2 mg/mL. How many mL of medication will the nurse administer? _____ mL

0.25

When during the latent phase of labor should the nurse assess the fetal heart pattern of a low-risk woman, G1 P0000? Select all that apply. 1.After vaginal exams. 2.Before administration of analgesics. 3.Periodically at the end of a contraction. 4.Every ten minutes. 5.Before ambulating

1.After vaginal exams. 2.Before administration of analgesics. 3.Periodically at the end of a contraction. 5.Before ambulating

Which of the following actions would the nurse expect to perform immediately be-fore a woman is to have regional anesthesia? Select all that apply. 1.Assess fetal heart rate. 2.Infuse 1000 cc of Ringer's lactate. 3.Place woman in Trendelenburg position. 4.Monitor blood pressure every 5 minutes for 15 minutes. 5.Have woman empty her bladder

1.Assess fetal heart rate. 2.Infuse 1000 cc of Ringer's lactate 5.Have woman empty her bladder

On examination, it is noted that a full-term primipara in active labor is right occipi-toanterior (ROA), 7 cm dilated, and+3 station. Which of the following should the nurse report to the physician? 1.Descent is progressing well. 2.Fetal head is not yet engaged. 3.Vaginal delivery is imminent. 4.External rotation is complete

1.Descent is progressing well.

Which of the following choices includes the correct order of the cardinal moves of labor? 1.Internal rotation, extension, external rotation. 2.External rotation, descent, extension. 3.Extension, flexion, internal rotation. 4.External rotation, internal rotation, expulsion

1.Internal rotation, extension, external rotation.

While evaluating the fetal heart monitor tracing on a client in labor, the nursenotes that there are fetal heart decelerations present. Which of the following assessments must the nurse make at this time? 1.The relationship between the decelerations and the labor contractions. 2.The maternal blood pressure. 3.The gestational age of the fetus. 4.The placement of the fetal heart electrode in relation to the fetal position

1.The relationship between the decelerations and the labor contractions.

A client enters the labor and delivery suite stating that she thinks she is in labor. Which of the following information about the woman should the nurse note from the woman's prenatal record before proceeding with the physical assessment? Select all that apply. 1.Weight gain. 2.Ethnicity and religion. 3.Age. 4.Type of insurance. 5.Gravidity and parity.

1.Weight gain. 2.Ethnicity and religion. 3.Age. 5.Gravidity and parity.

A client, who is 7 cm dilated and 100% effaced, is breathing at a rate of 30 breathsper minute during contractions. Immediately after a contraction, she complains of tingling in her fingers with some lightheadedness. Which of the following actions should the nurse take at this time? 1.Assess the blood pressure. 2.Have the woman breathe into a bag. 3.Turn the woman onto her side. 4.Check the fetal heart rate

2.Have the woman breathe into a bag.

A client, G2P1001, 5 cm dilated and 40% effaced, has just received an epidural. Which of the following actions is important for the nurse to make at this time? 1.Assess the woman's temperature. 2.Place a wedge under the woman's side. 3.Place a blanket roll under the woman's feet. 4.Assess the woman's pedal pulses

2.Place a wedge under the woman's side.

A woman, G1 P0000, 40 weeks' gestation, entered the labor suite stating that she isin labor. Upon examination it is noted that the woman is 2 cm dilated, 30% effaced,contracting every 12 min x30 sec. Fetal heart rate is in the 140s with good variability and spontaneous accelerations. What should the nurse conclude when re-porting the findings to the primary health care practitioner? 1.The woman is high risk and should be placed on tocolytics. 2.The woman is in early labor and could be sent home. 3.The woman is high risk and could be induced. 4.The woman is in active labor and should be admitted to the unit.

2.The woman is in early labor and could be sent home.

The physician writes the following order for a newly admitted client in labor: Begin a 1000 cc IV of D5 1/2 NS at 150 cc/hr. The IV tubing states that the dropfactor is 10 gtt/cc. Calculate the drip rate._______ gtt/min

25

During the third stage, the following physiological changes occur. Please place the changes in chronological order. 1.Hematoma forms behind the placenta. 2.Membranes separate from the uterine wall. 3.The uterus contracts firmly. 4.The uterine surface area dramatically decreases

3, 4, 1, 2

A client is complaining of severe back labor. Which of the following nursing inter- ventions would be most effective? 1.Assist mother with childbirth breathing. 2.Encourage mother to have an epidural. 3.Provide direct sacral pressure. 4.Use a hydrotherapy tub

3.Provide direct sacral pressure.

A primigravida is pushing with contractions. The nurse notes that the woman's perineum is beginning to bulge and that there is an increase in bloody show. Which of the following actions by the nurse is appropriate at this time? 1.Report the findings to the woman's health care practitioner. 2.Immediately assess the woman's pulse and blood pressure. 3.Provide encouragement during each contraction. 4.Place the client on her side with oxygen via face mask.

3.Provide encouragement during each contraction.

While performing Leopold's maneuvers on a woman in labor, the nurse palpates a hard round mass in the fundal area, a flat surface on the left side, small objects on the right side, and a soft round mass just above the symphysis. Which of the fol-lowing is a reasonable conclusion by the nurse? 1.The fetal position is transverse. 2.The fetal presentation is vertex. 3.The fetal lie is vertical. 4.The fetal attitude is flexed.

3.The fetal lie is vertical.

It is 4 p.m. A client, G1P0000, 3 cm dilated, asks the nurse when the dinner tray will be served. The nurse replies 1."Laboring clients are never allowed to eat." 2."Believe me, you will not want to eat by the time it is the dinner hour. Most women throw up, you know." 3."The dinner tray should arrive in an hour or two." 4."A heavy meal is discouraged. I can get clear fluids for you whenever you would like them, though."

4."A heavy meal is discouraged. I can get clear fluids for you whenever you would like them, though."

The nurse expects to administer an oxytocic (e.g., Pitocin, Methergine) to a woman after expulsion of her placenta to: A) Relieve pain. B) Stimulate uterine contraction C) Prevent infection D) Facilitate rest and relaxation.

B) Stimulate uterine contraction

The nurse knows that the second stage of labor, the descent phase, has begun when: A. the amniotic membranes rupture. B. the cervix cannot be felt during a vaginal examination. C. the woman experiences a strong urge to bear down. D. the presenting part is below the ischial spines.

C. the woman experiences a strong urge to bear down.

A woman who states that she "thinks" she is in labor enters the labor suite. Which of the following assessments will provide the nurse with the most valuable information regarding the client's labor status? 1.Leopold's maneuvers. 2.Fundal contractility. 3.Fetal heart assessment. 4.Vaginal examination

Vaginal Examination