Maternity Exam 8

1) Risk factors for tachysystole include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Cocaine use B) Placental abruption C) Low-dose oxytocin titration regimens D) Uterine rupture E) Smoking

Answer: A, B, D Explanation: A) Cocaine use is a risk factor for tachysystole. B) Placental abruption is a risk factor for tachysystole. C) High-dose oxytocin titration regimens are a risk factor for tachysystole. D) Uterine rupture is a risk factor for tachysystole. E) Smoking is not risk factor for tachysystole.

1) A client is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. What is this client at risk for? A) Gestational diabetes B) Placenta previa C) Abruptio placentae D) Placenta accreta

Answer: C Explanation: A) Gestational diabetes is not an issue with this client. B) Placenta previa is not an issue with this client. C) Abruptio placentae is more frequent in pregnancies complicated by smoking, premature rupture of membranes, multiple gestation, advanced maternal age, cocaine use, chorioamnionitis, and hypertension. D) Placenta accreta is not an issue with this client.

1) The client has delivered a 4200 g fetus. The physician performed a midline episiotomy, which extended into a third-degree laceration. The client asks the nurse where she tore. Which response is best? A) "The episiotomy extended and tore through your rectal mucosa." B) "The episiotomy extended and tore up near your vaginal mucous membrane." C) "The episiotomy extended and tore into the muscle layer." D) "The episiotomy extended and tore through your anal sphincter."

Answer: D Explanation: A) A fourth degree laceration is through the rectal mucosa. B) A first degree laceration is through the vaginal mucous membrane. C) A second degree laceration involves skin and muscle. D) A third degree laceration includes the anal sphincter.

Answer: B Explanation: B) The mediolateral episiotomy begins in the midline of the posterior fourchette (to avoid incision into the Bartholin gland) and extends at a 45-degree angle downward to the right or left (the direction depending on the handedness of the clinician).

1) The healthcare provider of a laboring patient is considering a mediolateral episiotomy. On the following diagram, identify where this incision should be made. A) A B) B C) C D) D

Answer: D Explanation: D) The knee-chest position is used to relieve cord compression during a cord prolapse emergency. The supine, side-lying, or lithotomy positions are not beneficial to the fetus in cord prolapse.

1) During an intrapartum vaginal examination the following is assessed. In which position should the patient be placed at this time? A) Supine B) Side-lying C) Lithotomy D) Knee-chest

Answer: C Explanation: C) This diagram demonstrates complete separation with massive vaginal bleeding. In central separation the placenta separates centrally, and the blood is trapped between the placenta and the uterine wall. Entrapment of the blood results in concealed bleeding. In marginal separation blood passes between the fetal membranes and the uterine wall and escapes vaginally. Separation begins at the periphery of the placenta; this marginal sinus rupture may or may not become more severe. Anticipated separation is not a type of placental separation.

1) A pregnant patient is diagnosed with premature separation of the placenta. The nurse provides the patient with the following diagram. What amount of placenta separation is this patient experiencing? A) Central B) Marginal C) Complete D) Anticipated

Answer: B Explanation: B) Cerclage is a surgical procedure in which a stitch is placed in the cervix to prevent a spontaneous abortion or premature birth. After placement, the string is tightened and secured anteriorly. This procedure is not used to correct marginal placenta previa, reduce the risk of developing central abruptio placentae, or help with fetal rotation for delivery.

1) A pregnant patient is scheduled to have the procedure depicted in the diagram performed. What should the nurse explain is the purpose for this procedure? A) Correct marginal placenta previa B) Prevent preterm cervical dilatation and pregnancy loss C) Reduce the risk of developing central abruptio placentae D) Assist the fetus to rotate into the appropriate position for delivery

Answer: A Explanation: A) On vaginal examination of a breech presentation the nurse may feel the anal sphincter. The tissue of the fetal buttocks feels soft. In a shoulder presentation the nurse may feel the acromion process as the fetal presenting part. In the occiput face presentation the nurse may palpate the nose. In the occiput brow presentation the nurse may palpate the forehead.

1) During an intrapartum vaginal examination the following is palpated. In which type of presentation is this fetus? A) Breech B) Shoulder C) Occiput face D) Occiput brow

Answer: C Explanation: C) A lower uterine segment vertical incision (Sellheim) is preferred for multiple gestations. The lower uterine segment transverse incision (Kerr) is the most commonly used and easiest to repair, has less blood loss, and is less likely to rupture with future pregnancies.

1) A patient is scheduled to have the following type of incision for a cesarean birth. What advantage should the nurse explain to the patient that this type of incision has? A) Easier to repair B) Less blood loss C) Expedites delivery of multiple fetuses D) Less likely to rupture with future pregnancies

Answer: A Explanation: A) Many practitioners choose to deliver any nonvertex presentation via cesarean birth. In 20% of cases, twin A is nonvertex and requires a cesarean birth. Approximately 40% of twins present in a vertex/vertex presentation. More than 80% of twins in vertex/vertex presentation are born vaginally. Since the patient will need a cesarean birth, spinal block and continuous lumbar epidural will not be indicated.

1) A patient pregnant with twins late in the 3rd trimester has an ultrasound that shows the position of the fetuses as follows. What should the nurse expect will be planned for this patient? A) Cesarean birth B) Vaginal delivery C) Spinal block during labor D) Continuous lumbar epidural

Answer: B Explanation: B) During uterine contractions, traction is applied to the forceps in a downward and outward direction to follow the birth canal. Upward, midline, or towards the left or right do not follow the direction of the birth canal.

1) Forceps are being used to deliver the fetus of a laboring patient, as identified in the diagram. In which direction should the healthcare provider use the forceps to guide the fetus for delivery? A) Upward and outward B) Downward and outward C) Midline and towards the left D) Midline and toward the right

Answer: A Explanation: A) The diagram is of a partial placenta previa. The internal o s is partially covered by the placenta. In total placenta previa the internal o s is covered completely by the placenta. In marginal placenta previa the edge of the placenta is at the margin of the internal o s. In low-lying placenta previa the placenta is implanted in the lower segment but does not reach the o s, although it is in close proximity of it.

1) The nurse is preparing teaching material for a pregnant patient with the following type of placenta previa. What information should the nurse provide the patient about this health problem? A) Internal o s is partially covered by the placenta B) Internal o s is covered completely by the placenta C) Edge of the placenta is at the margin of the internal o s D) Placenta is implanted in the lower segment but does not reach the o s

1) What is required for any woman receiving oxytocin (Pitocin)? A) C P R B) Continuous electronic fetal monitoring C) Administering oxygen by mask D) Nonstress test

Answer: B Explanation: A) C P R is not required for a woman receiving oxytocin. B) Continuous electronic fetal monitoring (E F M) is required for any woman receiving oxytocin (Pitocin). C) Administering oxygen by mask is not required for a woman receiving oxytocin. D) Nonstress test is not required for a woman receiving oxytocin.

1) A patient in preterm labor is prescribed magnesium sulfate 6 grams intravenous infusion now, followed by 5 grams per hour. The pharmacy prepares an infusion of 500 m L lactated Ringer's solution with 100 grams of magnesium sulfate. If the patient receives the loading dose and 3 hours of the medication, how many total m L of the infusion did the patient receive?

Answer: 105 m L Explanation: The solution is 100 grams/500 m L or 1 gram in every 5 m L of solution. If the loading dose is 6 grams, then the patient received 6 grams × 5 m L =30 m L. For each hourly dose of 5 grams, the patient received 5 grams × 5 m L = 25 m L. Since the patient received the dose of 5 grams for 3 hours, then the patient received 25 m L × 3 = 75 m L. With the loading dose of 30 m L plus the three hours of infusion equaling 75 m L, the patient received 105 m L of the infusion.

1) The home health nurse is visiting a client at 18 weeks who is pregnant with twins. Which nursing action is most important? A) Teach the client about foods that are good sources of protein. B) Assess the client's blood pressure in her upper right arm. C) Determine whether the pregnancy is the result of infertility treatment. D) Collect a cervicovaginal fetal fibronectin (fF N) specimen.

Answer: A Explanation: A) A daily intake of 4000 k c a l (minimum) and 135 g protein is recommended for a woman with normal-weight twins. B) Blood pressure can be assessed in either arm. C) The cause of the multifetal pregnancy does not impact nursing care. D) Preterm labor is not diagnosed until 20 weeks. This client is only at 18 weeks. Fetal fibronectin (f F N) testing is not indicated at this time.

1) A woman is admitted to the birth setting in early labor. She is 3 c m dilated, -2 station, with intact membranes and F H R of 150 beats/min. Her membranes rupture spontaneously, and the F H R drops to 90 beats/min with variable decelerations. What would the initial response from the nurse be? A) Perform a vaginal exam. B) Notify the physician. C) Place the client in a left lateral position. D) Administer oxygen at 2 L per nasal cannula.

Answer: A Explanation: A) A drop in fetal heart rate accompanied by variable decelerations is consistent with a prolapsed cord. The nurse would assess for prolapsed cord via vaginal examination. B) The vaginal exam should be done before the physician is notified. C) Repositioning the client will not relieve the decreased heart rate if the cord is compromised. D) Administering oxygen will not relieve the decreased heart rate if the cord is compromised.

1) While caring for a client admitted to the birthing unit, the nurse suspects that the client may be experiencing a uterine rupture. Which assessment finding should the nurse expect to appear first? A) Nonreassuring fetal heart rate B) Constant abdominal pain C) Loss of fetal station D) Cessation of contractions

Answer: A Explanation: A) A nonreassuring fetal heart rate is commonly the earliest warning sign of a possible uterine rupture. B) Constant abdominal pain is a finding that may be present, but is not commonly the earliest sign of uterine rupture. C) Loss of fetal station is a finding that may be present, but is not commonly the earliest sign of uterine rupture. D) Cessation of contractions is a finding that may be present, but is not commonly the earliest sign of uterine rupture.

1) The nurse on the birthing unit is caring for a client who has an amputated cervix and is about to undergo a cerclage procedure. Which type of cerclage procedure should the nurse anticipate? A) Abdominal cerclage B) Rescue cerclage C) Emergency cerclage D) Elective cerclage

Answer: A Explanation: A) An abdominal cerclage approach may be required for women with an amputated cervix. B) A rescue cerclage is one that is placed for emergent reasons, when dilatation and effacement have already occurred. C) An emergency cerclage is one that is placed for emergent reasons, when dilatation and effacement have already occurred. D) An elective, or cervical, cerclage will not be performed for a client who has an amputated cervix.

1) The nurse is caring for a client experiencing a uterine rupture. Which outcome demonstrates that the plan of care has been effective for the client? A) The mother remains hemodynamically stable throughout emergency cesarean birth. B) The mother has additional knowledge regarding the problems, implications, and treatment plans. C) The F H R remains in normal range with supportive measures. D) The family is able to cope successfully with fetal or neonatal anomalies, if they exist.

Answer: A Explanation: A) An emergency cesarean birth is warranted in the case of a client experiencing a uterine rupture. Hemodynamic stability is a major goal of interventions performed for a client with a uterine rupture. B) Knowledge deficit is not a priority nursing diagnosis for a client experiencing a uterine rupture. C) In the case of a uterine rupture, fetal heart rate anomalies are often already present. D) Uterine rupture is not indicative of fetal or neonatal anomalies.

1) The nurse is scheduling a client for an external cephalic version (E C V). Which finding in the client's chart requires immediate intervention? A) Previous birth by cesarean B) Frank breech ballotable C) 37 weeks, complete breech D) Failed E C V last week

Answer: A Explanation: A) Any previous uterine scar is a contraindication to E C V. Prior scarring of the uterus may increase the risk of uterine tearing or uterine rupture. B) There is no contraindication to E C V for this client. C) E C V is not attempted until 36 or 37 weeks. There is no contraindication for E C V for this client. Although this client is less likely to have a successful ECV this week if it was unsuccessful last week, there is no contraindication to attempting the procedure

1) The nurse has received end-of-shift reports in the high-risk maternity unit. Which client should the nurse see first? A) The client at 26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement B) The client at 30 weeks' gestation with placenta previa whose fetal monitor strip shows late decelerations C) The client at 35 weeks' gestation with grade I abruptio placentae in labor who has a strong urge to push D) The client at 37 weeks' gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

Answer: A Explanation: A) Assessment of the woman with placenta previa must be ongoing to prevent or treat complications that are potentially lethal to the mother and fetus. Painless, bright red vaginal bleeding is the best diagnostic sign of placenta previa. This client is the highest priority. B) Late decelerations are an abnormal finding, but put only the fetus at risk. This client is not the highest priority. C) Grade I abruptio placentae creates slight vaginal bleeding. The urge to push indicates that delivery is near. This client is not the highest priority. D) Although pregnancy-induced hypertension puts a woman at risk for developing abruptio placentae, there is no indication that this client is experiencing this complication. This client is not the highest priority.

1) The nurse knows that a baby born to a mother who had oligohydramnios could show signs of which of the following? A) Respiratory difficulty B) Hypertension C) Heart murmur D) Decreased temperature

Answer: A Explanation: A) Because there is less fluid available for the fetus to use during fetal breathing movements, pulmonary hypoplasia may develop. B) Hypertension has no relation to oligohydramnios. C) Heart murmur has no relation to oligohydramnios. D) Decreased temperature has no relation to oligohydramnios.

1) On assessment, a laboring client is noted to have cardiovascular and respiratory collapse and is unresponsive. What should the nurse suspect? A) An amniotic fluid embolus B) Placental abruption C) Placenta accreta D) Retained placenta

Answer: A Explanation: A) Cardiovascular and respiratory collapse are symptoms of an amniotic fluid embolus and cor pulmonale. B) Placental abruption does not have any of these symptoms. C) Placenta accreta does not have any of these symptoms. D) Retention of the placenta beyond 30 minutes after birth is termed retained placenta and does not have any of these symptoms.

1) A laboring client's obstetrician has suggested amniotomy as a method for creating stronger contractions and facilitating birth. The client asks, "What are the advantages of doing this?" What should the nurse cite in response? A) Contractions elicited are similar to those of spontaneous labor. B) Amniotomy decreases the chances of a prolapsed cord. C) Amniotomy reduces the pain of labor and makes it easier to manage. D) The client will not need an episiotomy.

Answer: A Explanation: A) Contractions after amniotomy are similar to those of spontaneous labor. B) A disadvantage of amniotomy is the increased chance of prolapsed cord, especially if the fetal presenting part is not well applied against the cervix. C) A disadvantage of amniotomy is that it can increase pain and make labor more difficult to manage. D) There is no correlation between amniotomy and episiotomy.

1) In succenturiate placenta, one or more accessory lobes of fetal villi have developed on the placenta, with vascular connections of fetal origin. What is the gravest maternal danger? A) Cord prolapse B) Postpartum hemorrhage C) Paroxysmal hypertension D) Brachial plexus injury

Answer: B Explanation: A) Cord prolapse is not considered a danger of succenturiate placenta. B) The gravest maternal danger is postpartum hemorrhage if this minor lobe is severed from the placenta and remains in the uterus. C) Paroxysmal hypertension is a symptom of autonomic dysreflexia. D) Brachial plexus injury is an injury due to improper or excessive traction applied to the fetal head during birth.

1) The client gave birth to a 7 pound, 14 ounce female 30 minutes ago. The placenta has not yet delivered. Manual removal of the placenta is planned. What should the nurse prepare to do? A) Start an I V of lactated Ringer's. B) Apply anti-embolism stockings. C) Bottle-feed the infant. Send the placenta to pathology

Answer: A Explanation: A) In women who do not have an epidural in place, intravenous sedation may be required because of the discomfort caused by the procedure. An I V is necessary. B) Anti-embolism stockings are used after major surgery that leads to immobility, thus increasing the risk of embolism. However, anti-embolism stockings are not needed for this client. C) The client's partner or family member, or a nursery nurse, can feed the infant. Preparation for manual removal of the placenta is a higher priority at this time. D) The placenta might be sent to pathology after it is removed, but preparing the client for manual removal of the placenta now is a higher priority.

1) A woman has been having contractions since 4 a.m. At 8 a.m., her cervi × is dilated to 5 c m. Contractions are frequent, and mild to moderate in intensity. Cephalopelvic disproportion (C P D) has been ruled out. After giving the mother some sedation so she can rest, what would the nurse anticipate preparing for? A) Oxytocin induction of labor B) Amnioinfusion C) Increased intravenous infusion D) Cesarean section

Answer: A Explanation: A) Oxytocin is the drug of choice for labor augmentation or labor induction and may be administered as needed for hypotonic labor patterns. B) Amnioinfusion would not change the ineffective labor pattern. C) Increasing the I V infusion would not change the ineffective labor pattern. D) Because C P D has been ruled out, a cesarean section is not anticipated.

1) The nurse knows that a contraindication to the induction of labor is which of the following? A) Placenta previa B) Isoimmunization C) Diabetes mellitus D) Premature rupture of membranes

Answer: A Explanation: A) Placenta previa is a contraindication to the induction of labor. B) Isoimmunization is an indication for induction. C) Diabetes mellitus is an indication for induction. D) Premature rupture of membranes is an indication for induction.

1) A client is admitted to the birth setting in early labor. She is 3 c m dilated, -2 station, with intact membranes, and F H R of 150 b p m. Her membranes rupture spontaneously, and the F H R drops to 90 b p m with variable decelerations. What would the nurse's initial response be? A) Perform a vaginal exam B) Notify the physician C) Place the client in a left lateral position D) Administer oxygen at 2 L per nasal cannula

Answer: A Explanation: A) Prolapsed umbilical cord can occur when the membranes rupture. The fetus is more likely to experience variable decelerations because the amniotic fluid is insufficient to keep pressure off the umbilical cord. A vaginal exam is the best way to confirm. B) A vaginal exam should be performed before the physician is notified. C) Positioning will not relieve the decreased heart rate if the cord is compromised. D) Oxygen will not relieve the decreased heart rate if the cord is compromised.

1) The nurse is performing a vaginal exam on a client who was admitted to the birthing unit after her membranes ruptured, and discovers a cord prolapse. Which intervention is priority at this time? A) Pushing the presenting fetal part upward B) Administering oxygen C) Initiating intravenous fluid D) Inserting an indwelling bladder catheter

Answer: A Explanation: A) Pushing the presenting fetal part upward is a life-saving measure that relieves pressure on the umbilical cord and supports fetal gas exchange. B) Administering oxygen is performed, but at a later time. C) Initiating intravenous fluid is performed, but at a later time. Inserting an indwelling bladder catheter may be later used to fill the woman's bladder and relieve pressure on the umbilical cord, but this should not be done in place of pushing the presenting fetal part upward

1) The nurse is reviewing charts of clients who underwent cesarean births by request in the last two years. The hospital is attempting to decrease costs of maternity care. What findings contribute to increased healthcare costs in clients undergoing cesarean birth by request? A) Increased abnormal placenta implantation in subsequent pregnancies B) Decreased use of general anesthesia with greater use of epidural anesthesia C) Prolonged anemia, requiring blood transfusions every few months D) Coordination of career projects of both partners leading to increased income

Answer: A Explanation: A) Repeat cesarean births are associated with greater risks, including increased incidence of abnormal placentation in subsequent pregnancies and increased risk of mortality secondary to surgery, which would contribute to increased healthcare costs. B) Which anesthesia method is used is not a significant factor in healthcare costs of cesarean birth by request. C) Prolonged anemia is not a complication of cesarean birth by request. D) The income of the couple does not affect healthcare costs directly.

1) The nurse is teaching a class on vaginal birth after cesarean (V B A C). Which statement by a participant indicates that additional information is needed? A) "Because the scar on my belly goes down from my navel, I am not a candidate for a V B A C." B) "My first baby was in a breech position, so for this pregnancy, I can try a V B A C if the baby is head-down." C) "Because my hospital is so small and in a rural area, they won't let me attempt a V B A C." D) "The rate of complications from V B A C is lower than the rate of complications from a cesarean."

Answer: A Explanation: A) Skin incision is not indicative of uterine incision. Only the uterine incision is a factor in deciding whether V B A C is advisable. The classic vertical incision was commonly done in the past and is associated with increased risk of uterine rupture in subsequent pregnancies and labor. B) Nonrecurring conditions such as any non-vertex presentation might make V B A C a viable option as long as this pregnancy is vertex. C) For a V B A C to be safely attempted, the facilities must have in-house anesthesia personnel available for emergency cesarean births if warranted. Many small and rural hospitals do not have surgical and anesthesia staff available at night or on weekends and holidays, and therefore do not allow clients to have V B A Cs. D) The incidence of uterine rupture is 0.1% to 0.7%.

1) The client presents for cervical ripening in anticipation of labor induction tomorrow. What should the nurse include in her plan of care for this client? A) Apply an internal fetal monitor. B) Monitor the client using electronic fetal monitoring. C) Withhold oral intake and start intravenous fluids. D) Place the client in an upright, sitting position.

Answer: B Explanation: A) An internal fetal monitor cannot be applied until adequate cervical dilatation has occurred and the membranes are ruptured. B) The client should be monitored using electronic fetal monitoring for at least 30 minutes and up to 2 hours after placement to assess the contraction pattern and the fetal status. C) Until labor begins, there is no rationale for withholding oral intake. D) The client is placed in a reclining position and bed rest is maintained to prevent the medication from leaking from the vagina.

1) While performing a uterine assessment on a client in the birthing unit, the nurse notes a loss of fetal station and a change in uterine shape. The client reports constant abdominal pain, uterine tenderness, and is exhibiting signs of shock. Which condition should the nurse suspect? A) Uterine rupture B) Anaphylactoid syndrome of pregnancy C) Circumvallate placenta D) Breech presentation

Answer: A Explanation: A) The assessment findings are consistent with uterine rupture, which may also include a nonreassuring fetal heart rate, hematuria, and cessation of contractions. B) Anaphylactoid syndrome of pregnancy is characterized by shortness of breath, hypoxia, cyanosis, and cardiovascular and respiratory collapse. C) Circumvallate placenta may result in antepartum hemorrhage, prematurity, and abnormal bleeding during or following the third stage of labor. Assessment findings consistent with breech presentation include palpation of the fetal sacrum in the lower part of the maternal abdomen and fetal heart tones present above the umbilicus on auscultation

1) What is one of the most common initial signs of nonreassuring fetal status? A) Meconium-stained amniotic fluid B) Cyanosis C) Dehydration D) Arrest of descent

Answer: A Explanation: A) The most common initial signs of nonreassuring fetal status are meconium-stained amniotic fluid and changes in the fetal heart rate (F H R). B) Cyanosis is not a common sign of nonreassuring fetal status. C) Dehydration is not a common sign of nonreassuring fetal status. D) Arrest of descent is not a common sign of nonreassuring fetal status.

1) What is the most significant maternal risk factor for preterm birth? A) Previous preterm birth B) Smoking C) Stress D) Substance abuse

Answer: A Explanation: A) The most significant maternal risk factor for preterm birth is a previous preterm birth. B) Modifiable risk factors, such as smoking, substance abuse, stress, alcohol use, and other behavioral factors are not the most significant maternal risk factors for preterm birth. C) Modifiable risk factors, such as smoking, substance abuse, stress, alcohol use, and other behavioral factors are not the most significant maternal risk factors for preterm birth. D) Modifiable risk factors, such as smoking, substance abuse, stress, alcohol use, and other behavioral factors are not the most significant maternal risk factors for preterm birth.

1) After being in labor for several hours with no progress, a client is diagnosed with C P D (cephalopelvic disproportion), and must have a cesarean section. The client is worried that she will not be able to have any future children vaginally. After sharing this information with her care provider, the nurse would anticipate that the client would receive what type of incision? A) Transverse B) Infraumbilical midline C) Classic D) Vertical

Answer: A Explanation: A) The transverse incision is made across the lowest and narrowest part of the abdomen and is the most common lower uterine segment incision. B) The infraumbilical midline incision is a type of vertical incision, which carries an increased risk of uterine rupture with subsequent pregnancy, labor, and birth. C) The classic vertical incision, which is made into the upper uterine segment, was the method of choice for many years but is nearly never performed in modern obstetrics. It carries an increased risk of uterine rupture with subsequent pregnancy, labor, and birth. D) The classic vertical incision, which is made into the upper uterine segment, was the method of choice for many years but is nearly never performed in modern obstetrics. It carries an increased risk of uterine rupture with subsequent pregnancy, labor, and birth.

1) A client admitted to the birthing unit with placenta previa asks the nurse, "What is the cause of my condition?" Which statement should be included in the nurse's response? A) "The placenta is improperly implanted in the lower uterus." B) "The placenta has separated prematurely." C) "The placenta has grown too large." D) "The placenta has prolapsed and is being compressed."

Answer: A Explanation: A) This statement correctly describes placenta previa, when the placenta implants low in the uterus or over the cervix. B) This statement describes abuptio placentae, another placental complication. C) Placenta previa is not when the placenta has grown too large; this statement should not be used by the nurse. D) Placenta previa is not when the placenta becomes prolapsed and is being compressed; this statement should not be used by the nurse.

1) The client tells the nurse that she has come to the hospital so that her baby's position can be changed. The nurse would begin to organize the supplies needed to perform which procedure? A) A version B) An amniotomy C) Leopold maneuvers D) A ballottement

Answer: A Explanation: A) Version, or turning the fetus, is a procedure used to change the fetal presentation by abdominal or intrauterine manipulation. B) Amniotomy is the artificial rupture of membranes. C) Leopold maneuvers are a series of palpations performed to determine fetal position. D) Ballottement occurs when the fetus floats away and then returns to touch an examiner's hand during a vaginal exam.

1) A 26-year-old client is having her initial prenatal appointment. The client reports to the nurse that she suffered a pelvic fracture in a car accident 3 years ago. The client asks whether her pelvic fracture might affect her ability to have a vaginal delivery. What response by the nurse is best? A) "It depends on how your pelvis healed." B) "You will need to have a cesarean birth." C) "Please talk to your doctor about that." D) "You will be able to delivery vaginally."

Answer: A Explanation: A) Women with a history of pelvic fractures may also be at risk for cephalopelvic disproportion (C P D). B) Not all clients will be able to deliver vaginally, but not all will need cesarean birth. C) It is not therapeutic to tell a client to talk to someone else. Not all clients will be able to deliver vaginally, but not all will need cesarean birth

1) A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, why will terbutaline be administered? A) To provide analgesia B) To relax the uterus C) To induce labor D) To prevent hemorrhage

Answer: B Explanation: A) Terbutaline has no analgesic effect. B) Terbutaline is administered to achieve uterine relaxation. C) Terbutaline does not induce labor. D) Terbutaline does not prevent hemorrhage.

1) A client is admitted to the labor and delivery unit in active labor. What nursing diagnoses might apply to the client with suspected abruptio placentae? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Fluid Volume, Deficient, related to hypovolemia secondary to excessive blood loss B) Tissue Perfusion: Peripheral, Ineffective, related to blood loss secondary to uterine atony following birth C) Anxiety related to concern for own personal status and the baby's safety D) Knowledge, Deficient related to lack of information about inherited genetic defects E) Alteration in Respiratory Function related to blood loss

Answer: A, B, C Explanation: A) Maternal and perinatal fetal mortality are concerns due to hypoxia. B) Maternal and perinatal fetal mortality are concerns due to blood loss. C) This mother would be anxious for herself and her baby. D) Abruptio placentae is a premature separation of the placenta, not a genetic abnormality. E) Respiratory function is not related to the blood loss. Also, this is not a nursing diagnosis.

1) The nurse is caring for a client who is about to receive an amnioinfusion. For which complication(s) should the nurse monitor the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Umbilical cord prolapse B) Amniotic fluid embolism C) Uterine rupture D) Amnionitis E) Abruptio placentae

Answer: A, B, C Explanation: A) Umbilical cord prolapse is a rare, but serious risk factor for the client receiving an amnioinfusion. B) Amniotic fluid embolism is a rare, but serious risk factor for the client receiving an amnioinfusion. C) Uterine rupture is a rare, but serious risk factor for the client receiving an amnioinfusion. D) The presence of amnionitis is a contraindication to amnioinfusion, but is not a condition that results from amnioinfusion. E) The presence of abruptio placentae is a contraindication to amnioinfusion, but is not a condition that results from amnioinfusion.

1) The nurse is performing an assessment on a client in the birthing unit who has acquired cervical insufficiency. Which other finding(s) may contribute to the client's condition? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Inflammation B) Infection C) Cervical trauma D) Cone biopsy E) H P V positivity

Answer: A, B, C, D Explanation: A) Acquired cervical insufficiency may be related to inflammation. B) Acquired cervical insufficiency may be related to infection. C) Acquired cervical insufficiency may be related to cervical trauma. D) Acquired cervical insufficiency may be related to cone biopsy. E) Acquired cervical insufficiency is not related to H P V positivity.

1) The nurse is performing a comprehensive assessment on a client admitted to the birthing unit with abruptio placentae. Which finding(s) contribute(s) to this condition? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) History of domestic violence B) Presence of uterine fibroids C) Alcohol consumption during pregnancy D) Hypertension E) Gestational diabetes mellitus

Answer: A, B, C, D Explanation: A) Domestic violence contributes to the development of abruptio placentae. B) The presence of fibroids contributes to the development of abruptio placentae. C) Alcohol consumption contributes to the development of abruptio placentae. D) Maternal hypertension is the most common cause of abruptio placentae. E) Gestational diabetes mellitus is not considered a finding that contributes to abruptio placentae.

1) The nurse on the birthing unit is collecting the obstetric history of a client at risk for cervical insufficiency. Which findings increase the client's risk for this condition? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Multiple gestations B) Previous preterm births C) Progressively earlier births with each subsequent pregnancy D) Cervical manipulation E) Prolonged labors

Answer: A, B, C, D Explanation: A) Multiple gestations increase the risk for cervical insufficiency. B) Previous preterm births increase the risk for cervical insufficiency. C) Progressively earlier births with each subsequent pregnancy increase the risk for cervical insufficiency. D) Cervical manipulation increases the risk for cervical insufficiency. E) Short labors, not prolonged labors, increase the risk for cervical insufficiency.

1) The client is undergoing an emergency cesarean birth for fetal bradycardia. The client's partner has not been allowed into the operating room. What can the nurse do to alleviate the partner's emotional distress? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Allow the partner to wheel the baby's crib to the newborn nursery. B) Allow the partner to be near the operating room where the newborn's first cry can be heard. C) Have the partner wait in the client's postpartum room. D) Encourage the partner to be in the nursery for the initial assessment. E) Teach the partner how to take the client's blood pressure.

Answer: A, B, D Explanation: A) Effective measures include allowing the partner to take the baby to the nursery. B) Effective measures include allowing the partner to be in a place near the operating room, where the newborn's first cry can be heard. C) The nurse should involve the partner in postpartum care in the recovery room, not have the partner wait in the client's postpartum room. D) Effective measures include involving the partner in postpartum care, such as being present for the initial assessment. E) The nurse must take the blood pressure as part of assessing the client.

1) A client was admitted to the labor area at 5 c m with ruptured membranes about 14 hours ago. What assessment data would be most beneficial for the nurse to collect? A) Blood pressure B) Temperature C) Pulse D) Respiration

Answer: B Explanation: A) Blood pressure can assist in the diagnosis of infection, but is not the primary vital sign. B) Rupture of membranes places the mother at risk for infection. The temperature is the primary and often the first indication of a problem. C) Pulse can assist in the diagnosis of infection, but is not the primary vital sign. Respirations can assist in the diagnosis of infection, but are not the primary sign

1) When caring for a laboring client with oligohydramnios, what should the nurse be aware of? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Increased risk of cord compression B) Decreased variability C) Labor progress is often more rapid than average D) Presence of periodic decelerations E) During gestation, fetal skin and skeletal abnormalities can occur

Answer: A, B, D, E Explanation: A) During the labor and birth, the lessened amounts of fluid reduce the cushioning effect for the umbilical cord, and cord compression is more likely to occur. B) The nurse should evaluate the E F M tracing for the presence of nonperiodic decelerations or other nonreassuring signs (such as increasing or decreasing baseline, decreased variability, or presence of periodic decelerations). C) Labor progress may be slower, not faster, than average due to the decreased amniotic fluid volume. Fetal movement can be impaired as a result of inadequate amniotic fluid volume. D) The nurse should evaluate the E F M tracing for the presence of nonperiodic decelerations or other nonreassuring signs (such as increasing or decreasing baseline, decreased variability, or presence of periodic decelerations). E) During the gestational period, fetal skin and skeletal abnormalities may occur because fetal movement is impaired as a result of inadequate amniotic fluid volume.

1) During labor, the client at 4 c m suddenly becomes short of breath, cyanotic, and hypoxic. The nurse must prepare or arrange immediately for which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Intravenous access B) Cesarean delivery C) Immediate vaginal delivery D) McRoberts maneuver E) A crash cart

Answer: A, B, E Explanation: A) When an amniotic fluid embolism is suspected, intravenous access is obtained as quickly as possible. B) Shortness of breath, cyanosis, and hypoxia are symptoms of an amniotic fluid embolus, which necessitates immediate cesarean delivery. C) The client is only 4 c m, so vaginal delivery will not take place immediately. D) McRoberts maneuver is used with shoulder dystocia. E) The chances of a code are high, so the crash cart needs to be available.

1) What are the primary complications of placenta accreta? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Maternal hemorrhage B) Insomnia C) Failure of the placenta to separate following birth of the infant D) Autonomic dysreflexia E) Shoulder dystocia

Answer: A, C Explanation: A) The primary complications of placenta accreta are maternal hemorrhage and failure of the placenta to separate following birth of the infant. B) Insomnia is not a complication of placenta accreta. C) The primary complications of placenta accreta are maternal hemorrhage and failure of the placenta to separate following birth of the infant. D) Autonomic dysreflexia is a rare complication that can occur in women with a spinal cord injury. E) The most significant complication in macrosomia is shoulder dystocia.

1) The nurse is admitting a client who was diagnosed with hydramnios. The client asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Rh sensitization B) Postmaturity syndrome C) Renal malformation or dysfunction D) Maternal diabetes E) Large-for-gestational-age infants

Answer: A, D Explanation: A) Hydramnios is associated with R h sensitization. B) Postmaturity is associated with oligohydramnios. C) Renal malformation or dysfunction is associated with oligohydramnios. D) Hydramnios is associated with maternal diabetes. E) Large-for-gestational-age infants are not associated with hydramnios.

1) The nurse knows that the Bishop scoring system for cervical readiness includes which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Fetal station B) Fetal lie C) Fetal presenting part D) Cervical effacement E) Cervical softness

Answer: A, D, E Explanation: A) Fetal station is one of the components evaluated by the Bishop scoring system. B) Fetal lie is not one of the components evaluated by the Bishop scoring system. C) The presenting part is not one of the components evaluated by the Bishop scoring system. D) Cervical effacement is one of the components evaluated by the Bishop scoring system. E) Cervical consistency is one of the components evaluated by the Bishop scoring system.

1) The client delivered 30 minutes ago. Her blood pressure and pulse are stable. Vaginal bleeding is scant. The nurse should prepare for which procedure? A) Abdominal hysterectomy B) Manual removal of the placenta C) Repair of perineal lacerations D) Foley catheterization

Answer: B Explanation: A) Abdominal hysterectomy is not required. B) Retention of the placenta beyond 30 minutes after birth is termed retained placenta. Manual removal of the placenta is then performed. C) Repair of perineal lacerations would not ensue until after the placenta was delivered. D) There is no indication of urinary retention that requires a Foley catheter.

1) The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring client who will have a forceps delivery. Which action or assessment finding requires intervention? A) Regional anesthesia is administered via pudendal block. B) The client is instructed to push between contractions. C) Fetal heart tones are consistently between 110 and 115. D) The client's bladder is emptied using a straight catheter.

Answer: B Explanation: A) Adequate anesthesia must be given for the type of forceps procedure anticipated. Low forceps may be done with a pudendal block; however, midforceps or a rotation of more than 45 degrees requires an epidural, spinal-epidural, or general anesthesia. B) During the contraction, as the forceps are applied, the woman should avoid pushing. C) Fetal heart tones between 110 and 115 are normal. No intervention is needed. D) The maternal bladder should be emptied.

1) The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The physician requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth? A) Elation, euphoria, and talkativeness B) A sense of failure and loss C) Questions about whether or not to circumcise D) Uncertainty surrounding the baby's name

Answer: B Explanation: A) Elation, euphoria, and talkativeness are expected after birth. B) Clients who participate in childbirth classes that stress the normalcy of birth may feel a sense of loss or failure if an intervention is used during their labor or birth. C) Decisions on circumcision and naming are often encountered after birth, and are not correlated with the use of intervention. D) Decisions on circumcision and naming are often encountered after birth, and are not correlated with the use of intervention.

1) The physician has determined the need for forceps. The nurse should explain to the client that the use of forceps is indicated because of which of the following? A) Her support person is exhausted B) Premature placental separation C) To shorten the first stage of labor D) To prevent fetal distress

Answer: B Explanation: A) Exhaustion of the support person is not an indication for use of forceps. B) Fetal conditions indicating the need for forceps include premature placental separation, prolapsed umbilical cord, and nonreassuring fetal status. C) Forceps may be used electively to shorten the second stage of labor and spare the woman's pushing effort, or when regional anesthesia has affected the woman's motor innervation, and she cannot push effectively. D) Indications for the use of forceps include premature placental separation and a nonreassuring fetal heart rate. Using forceps does not prevent fetal distress.

1) The nurse is admitting a client with possible hydramnios. When is hydramnios most likely suspected? A) Hydramnios is most likely suspected when there is less amniotic fluid than normal for gestation. B) Hydramnios is most likely suspected when the fundal height increases disproportionately to the gestation. C) Hydramnios is most likely suspected when the woman has a twin gestation. D) Hydramnios is most likely suspected when the quadruple screen comes back positive.

Answer: B Explanation: A) Hydramnios occurs when there is more amniotic fluid than normal for gestation. B) Hydramnios should be suspected when the fundal height increases out of proportion to the gestational age. C) Hydramnios is not suspected simply because of a twin gestation. D) A positive quadruple screen is not indicative of hydramnios.

1) The client at 38 weeks' gestation has been diagnosed with oligohydramnios. Which statement indicates that teaching about the condition has been effective? A) "My gestational diabetes might have caused this problem to develop." B) "When I go into labor, I should come to the hospital right away." C) "This problem was diagnosed with blood and urine tests." D) "Women with this condition usually do not have a cesarean birth."

Answer: B Explanation: A) Hydramnios, not oligohydramnios, is associated with such maternal disorders as diabetes. B) The incidence of cord compression and resulting fetal distress is high when there is an inadequate amount of amniotic fluid. The client with oligohydramnios should come to the hospital in early labor. C) Oligohydramnios is diagnosed when the largest vertical pocket of amniotic fluid visible on ultrasound examination is 5 c m or less. D) The fetus is continually monitored during labor and birth. In the event that the fetal heart rate tracing is nonreassuring, late decelerations occur, and birth is not imminent, a cesarean birth may be performed.

1) The need for forceps has been determined. The client's cervix is dilated to 10 c m, and the fetus is at +2 station. What category of forceps application would the nurse anticipate? A) Input B) Low C) Mid D) Outlet

Answer: B Explanation: A) Input is not a term associated with the use of forceps. B) Low forceps are applied when the leading edge of the fetal head is at +2 station. C) Midforceps are applied when the fetal head is engaged. D) Outlet forceps are applied when the fetal skull has reached the perineum.

1) If oligohydramnios occurs in the first part of pregnancy, the nurse knows that there is a danger of which of the following? A) Major congenital anomalies B) Fetal adhesions C) Maternal diabetes D) Rh sensitization

Answer: B Explanation: A) Major congenital anomalies are associated with hydramnios. B) If oligohydramnios occurs in the first part of pregnancy, there is a danger of fetal adhesions (one part of the fetus may adhere to another part). C) Maternal diabetes is associated with hydramnios. Rh sensitization is associated with hydramnios

1) Dystocia encompasses many problems in labor. What is the most common? A) Meconium-stained amniotic fluid B) Dysfunctional uterine contractions C) Cessation of contractions D) Changes in the fetal heart rate

Answer: B Explanation: A) Meconium-stained amniotic fluid is a sign of nonreassuring fetal status. B) The most common problem is dysfunctional (or uncoordinated) uterine contractions that result in a prolongation of labor. C) Cessation of contractions is a symptom of possible uterine rupture. D) Changes in the fetal heart rate (F H R) are a sign of nonreassuring fetal status.

1) The nurse should anticipate the labor pattern for a fetal occiput posterior position to be which of the following? A) Shorter than average during the latent phase B) Prolonged as regards the overall length of labor C) Rapid during transition D) Precipitous

Answer: B Explanation: A) Overall labor is often prolonged, not shorter. B) Occiput posterior (O P) position of the fetus is the most common fetal malposition and occurs when the head remains in the direct O P position throughout labor. This can prolong the overall length of labor. C) Overall labor is often prolonged, not more rapid. D) Overall labor is often prolonged, not precipitous.

1) Slowly removing some amniotic fluid is a treatment for hydramnios. What consequence can occur with the withdrawal of fluid? A) Preterm labor B) Prolapsed cord C) Preeclampsia D) Placenta previa

Answer: B Explanation: A) Preterm labor is not a known consequence of amniotic fluid reduction. B) A needle or a fetal scalp electrode is used to make a small puncture in the amniotic sac. There is a risk that the force of the fluid could make a larger hole in the amniotic sac, thus increasing the risk of a prolapsed cord. C) Preeclampsia is not a known consequence of amniotic fluid reduction. D) Placenta previa would not be a result of amniotic fluid reduction.

1) What type of forceps are designed to be used with a breech presentation? A) Midforceps B) Piper C) Low D) High

Answer: B Explanation: A) The criterion for midforceps application is that the fetal head must be engaged, but the leading edge of the fetal skull is above a plus 2 (+2) station. B) Piper forceps are designed to be used with a breech presentation. They are applied after the birth of the body, when the fetal head is still in the birth canal and assistance is needed. C) The criterion for low forceps application is that the leading edge of the fetal skull must be at a station of plus 2 (+2) or below, but not on the pelvic floor. D) High forceps are not indicated in current obstetric practice.

1) During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. What would the nurse's priority action be? A) To help the fetal head descend faster B) To use gravity and manipulation to relieve compression on the cord C) To facilitate dilation of the cervix with prostaglandin gel D) To prevent head compression

Answer: B Explanation: A) The fetal head's descent would put additional pressure on the umbilical cord and reduce blood flow and oxygenation to the fetus. B) The top priority is to relieve compression on the umbilical cord to allow blood flow to reach the fetus. It is because some obstetric maneuvers to relieve cord compression are complicated that cesarean birth is sometimes necessary. C) Further dilatation of the cervix is unnecessary in light of a possible cesarean section. D) Head compression is not a concern in the case of prolapsed umbilical cord. The cord is what is compressed.

1) The physician/C N M opts to use a vacuum extractor for a delivery. What does the nurse understand? A) There is little risk with vacuum extraction devices. B) There should be further fetal descent with the first two "pop-offs." C) Traction is applied between contractions. D) The woman often feels increased discomfort during the procedure.

Answer: B Explanation: A) The risk of complications rises with the use of a vacuum extraction device. B) If more than three "pop-offs" occur (the suction cup pops off the fetal head), the procedure should be discontinued. C) The physician/C N M applies traction in coordination with uterine contractions, not between contractions. D) If adequate regional anesthesia has been administered, the woman feels only pressure during the procedure.

1) The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance? A) "A small cup will be put onto the baby's head, and a gentle suction will be applied." B) "I can stop pushing and just rest if the vacuum extractor is used." C) "The baby's head might have some swelling from the vacuum cup." D) "The vacuum will be applied for a total of ten minutes or less."

Answer: B Explanation: A) The vacuum extractor is a small cup-shaped device that is applied to the fetal scalp. B) Vacuum extraction is an assistive delivery. The physician/C N M applies traction in coordination with uterine contractions. C) The vacuum extractor might leave some swelling ("chignon") on the scalp where the device is placed. D) Research indicates that negative suction applied for more than 10 minutes is associated with a greater incidence of scalp injury.

1) A fetal weight is estimated at 4490 grams in a client at 38 weeks' gestation. Counseling should occur before labor regarding which of the following? A) Mother's undiagnosed diabetes B) Likelihood of a cesarean delivery C) Effectiveness of epidural anesthesia with a large fetus D) Need for early delivery

Answer: B Explanation: A) There is a possibility of undiagnosed diabetes, but that is not the current concern because the client is close to delivery. B) The likelihood of a cesarean delivery with a fetus over 4000 grams is high. This should be discussed with the client before labor. C) The weight of the fetus has no bearing on the effectiveness of epidural anesthesia. D) The client is already at term, so it is too late to discuss an early delivery.

1) During labor, the fetus was in a brow presentation, but after a prolonged labor, the fetus converted to face presentation and was delivered vaginally with forceps assist. What should the nurse explain to the parents? A) The infant will need to be observed for meconium aspiration. B) Facial edema and head molding will subside in a few days. C) The infant will be given prophylactic antibiotics. D) Breastfeeding will need to be delayed for a day or two.

Answer: B Explanation: A) There is no mention of meconium-stained fluid that would cause the nurse to assess for meconium aspiration. B) Any facial edema and head molding that result from the use of forceps at birth will subside in a few days. C) There is no reason to place the infant on antibiotics. D) There is no reason to delay breastfeeding.

1) The healthcare provider asks for forceps to aid in the delivery of a fetus that is engaged, but the leading edge is at +1. Which type of forceps should be handed to the healthcare provider for this delivery?

Answer: B Explanation: The criterion for midforceps application is that the fetal head must be engaged (largest diameter of the head reaches or passes through the pelvic inlet), but the leading edge (presenting part) of the fetal skull is above a plus 2 (+2) station (for example, +1, 0, —1, —2). When midforceps are used, the goal is to apply traction and, frequently, to rotate the head and facilitate the vaginal birth. Kielland forceps are used for midforceps rotations. Elliot and Simpson forceps are used as outlet forceps. Piper forceps are used to provide traction and flexion of the after-coming head of a fetus in breech presentation.

1) A woman has been in labor for 16 hours. Her cervi × is dilated to 3 c m and is 80% effaced. The fetal presenting part is not engaged. The nurse would suspect which of the following? A) Breech malpresentation B) Fetal demise C) Cephalopelvic disproportion (C P D) D) Abruptio placentae

Answer: C Explanation: A) A breech presentation would not prevent the presenting part from becoming engaged. B) Fetal demise would not prevent the presenting part from becoming engaged. C) Cephalopelvic disproportion (C P D) prevents the presenting part from becoming engaged. D) Abruptio placentae has specific complications; however, it would not prevent engagement of the presenting part.

1) When counseling a newly pregnant client at 8 weeks' gestation with twins, the nurse teaches the woman about the need for increased caloric intake. What would the nurse tell the woman that the minimum recommended intake should be? A) 2500 k c a l and 120 grams protein B) 3000 k c a l and 150 grams protein C) 4000 k c a l and 135 grams protein D) 5000 k c a l and 190 grams protein

Answer: C Explanation: A) 2500 k c a l and 120 grams protein is less than the recommended caloric and protein intake for a twin-gestation pregnancy. B) 3000 k c a l and 150 grams protein is lower in calories but higher in protein than is recommended for a twin-gestation pregnancy. C) 4000 k c a l and 135 grams protein is the recommended caloric and protein intake in a twin-gestation pregnancy. D) 5000 k c a l and 190 grams protein is more than recommended caloric and protein intake for a twin-gestation pregnancy.

1) The nurse is planning an in-service educational program to talk about disseminated intravascular coagulation (D I C). The nurse should identify which conditions as risk factors for developing D I C? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Diabetes mellitus B) Abruptio placentae C) Fetal demise D) Multiparity E) Preterm labor

Answer: B, C Explanation: A) Diabetes does not cause the release of thromboplastin that triggers D I C. B) As a result of the damage to the uterine wall and the retroplacental clotting with covert abruption, large amounts of thromboplastin are released into the maternal blood supply, which in turn triggers the development of disseminated intravascular coagulation (D I C) and the resultant hypofibrinogenemia. C) Perinatal mortality associated with abruptio placentae is approximately 25%. If fetal hypoxia progresses unchecked, irreversible brain damage or fetal demise may result. D) Multiparity does not cause the release of thromboplastin that triggers D I C. E) Preterm labor does not cause the release of thromboplastin that triggers D I C.

1) Under which circumstances would the nurse remove prostaglandin from the client's cervix? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Contractions every 5 minutes B) Nausea and vomiting C) Uterine tachysystole D) Cardiac tachysystole E) Baseline fetal heart rate of 140-148

Answer: B, C, D Explanation: A) Contractions every 5 minutes are consistent with the plan of induction. B) A reason to remove prostaglandin from a client's cervix is the presence of nausea and vomiting. C) A reason to remove prostaglandin from a client's cervix is uterine tachysystole. D) A reason to remove prostaglandin from a client's cervix is cardiac tachysystole. E) This is a good heart rate and would not warrant removing the prostaglandin.

1) Nonreassuring fetal status often occurs with a tachysystole contraction pattern. Intrauterine resuscitation measures may become warranted and can include which of the following measures? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Position the woman on her right side. B) Apply oxygen via face mask. C) Call the anesthesia provider for support. D) Increase intravenous fluids by at least 500 m L bolus. E) Call the physician/C N M to the bedside.

Answer: B, C, D Explanation: A) The nurse would position the woman on her left side. B) The nurse would apply oxygen via face mask. C) The nurse would call the anesthesia provider for support. D) The nurse would increase intravenous fluids by at least 500 m L bolus. E) The nurse would not call the physician/C N M to the bedside.

1) The nurse knows that the maternal risks associated with postterm pregnancy include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Polyhydramnios B) Maternal hemorrhage C) Maternal anxiety D) Forceps-assisted delivery E) Perineal damage

Answer: B, C, D, E Explanation: A) Polyhydramnios is not associated with postterm pregnancy. B) Maternal symptoms and complications in postterm pregnancy may include maternal hemorrhage. C) Maternal symptoms and complications in postterm pregnancy may include maternal anxiety. D) Maternal symptoms and complications in postterm pregnancy may include an operative vaginal birth with forceps or vacuum extractor. E) Maternal symptoms and complications in postterm pregnancy may include perineal trauma and damage.

1) Maternal risks of occiput posterior (O P) malposition include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Blood loss greater than 1000 m L B) Postpartum infection C) Anal sphincter injury D) Higher rates of vaginal birth E) Instrument delivery

Answer: B, C, E Explanation: A) Blood loss greater than 500 m L is a maternal risk of O P. B) Postpartum infection is a maternal risk of O P. C) Anal sphincter injury is a maternal risk of O P. D) Higher rates of cesarean birth are a maternal risk of O P. E) Instrument delivery is a maternal risk of O P.

1) Risk factors for labor dystocia include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Tall maternal height B) Labor induction C) Small-for-gestational-age (S G A) fetus D) Malpresentation E) Prolonged latent phase

Answer: B, D, E Explanation: A) Short maternal height, not tall, is a risk factor of dystocia. B) Labor induction is a risk factor of dystocia. C) Large-for-gestational-age (F G A) fetus, not small, is a risk factor of dystocia. D) Malpresentation is a risk factor of dystocia. E) Prolonged latent phase is a risk factor of dystocia.

1) Amniotomy as a method of labor induction has which of the following advantages? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) The danger of a prolapsed cord is decreased. B) There is usually no risk of hypertonus or rupture of the uterus. C) The intervention can cause a decrease in pain. D) The color and composition of amniotic fluid can be evaluated. E) The contractions elicited are similar to those of spontaneous labor.

Answer: B, D, E Explanation: A) The danger of a prolapsed cord is increased once the membranes have ruptured, especially if the fetal presenting part is not firmly pressed down against the cervix. B) There is usually no risk of hypertonus or rupture of the uterus, and this is an advantage of amniotomy. C) The intervention can cause an increase in pain, making labor more difficult to manage. D) The color and composition of amniotic fluid can be evaluated, and this is an advantage of amniotomy. E) The contractions elicited are similar to those of spontaneous labor, and this is an advantage of amniotomy.

1) Induction of labor is planned for a 31-year-old client at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important? A) Administer 100 mcg of misoprostol (Cytotec) vaginally every 2 hours. B) Place dinoprostone (Prepidil) vaginal gel and ambulate client for 1 hour. C) Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec). D) Prepare to induce labor after administering a tap water enema.

Answer: C Explanation: A) 100 mcg every 2 hours is too much medication administered too frequently. B) The client must remain recumbent for 2 hours after administration of dinoprostone (Prepidil) vaginal gel, during which time she is continuously monitored. C) Pitocin should not administered less than 4 hours after the last Cytotec dose. D) Enemas are not routinely used in labor. This order is not expected.

1) The client requires vacuum extraction assistance. To provide easier access to the fetal head, the physician cuts a mediolateral episiotomy. After delivery, the client asks the nurse to describe the episiotomy. How does the nurse respond? A) "The episiotomy goes straight back toward your rectum." B) "The episiotomy is from your vagina toward the urethra." C) "The episiotomy is cut diagonally away from your vagina." D) "The episiotomy extends from your vagina into your rectum."

Answer: C Explanation: A) A midline episiotomy is straight back from the vagina toward the rectum. B) Episiotomies are not cut anteriorly toward the urethra. C) A mediolateral episiotomy is angled from the vaginal opening toward the buttock. It begins in the midline of the posterior fourchette and extends at a 45-degree angle downward to the right or left. D) Extension into the rectum is a fourth-degree laceration.

1) A client in her second trimester is complaining of spotting. Causes for spotting in the second trimester are diagnosed primarily through the use of which of the following? A) A non-stress test B) A vibroacoustic stimulation test C) An ultrasound D) A contraction stress test

Answer: C Explanation: A) A non-stress test is used to assess the well-being of the fetus. B) A vibroacoustic stimulation test is used to assess the well-being of the fetus. C) Indirect diagnosis is made by locating the placenta via tests that require no vaginal examination. The most commonly employed diagnostic test is the transabdominal ultrasound scan. A contraction stress test is used to assess the well-being of the fetus

1) What is the most significant cause of neonatal morbidity and mortality? A) A) Amenorrhea B) B) Posttraumatic stress disorder C) C) Prematurity D) D) Endometriosis

Answer: C Explanation: A) Amenorrhea the absence of menses in a woman and does not affect neonatal morbidity or mortality. B) Posttraumatic stress disorder does not affect neonatal morbidity or mortality. C) The most significant cause of neonatal morbidity and mortality is prematurity and its associated complications such as respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage. D) Endometriosis is a condition of a woman characterized by the presence of endometrial tissue outside the uterine cavity, and it does not affect neonatal morbidity or mortality.

1) What would be a normal cervical dilatation rate in a first-time mother ("primip")? A) 1.5 c m per hour B) Less than 1 c m cervical dilatation per hour C) 1 c m per hour D) Less than 0.5 c m per hour

Answer: C Explanation: A) Dilatation in a "multip" is about 1.5 c m per hour. B) Less than 1 c m cervical dilatation per hour is prolonged labor. C) Cervical dilatation in a first-time mother is just over 1 c m per hour. D) Dystocia is a rate of cervical dilatation of less than 0.5 c m per hour.

1) Major perineal trauma (extension to or through the anal sphincter) is more likely to occur if what type of episiotomy is performed? A) Mediolateral B) Episiorrhaphy C) Midline D) Medical

Answer: C Explanation: A) Major perineal trauma is more likely to occur if a midline episiotomy is performed. B) Episiorrhaphy is the repair of the episiotomy. C) Major perineal trauma is more likely to occur if a midline episiotomy is performed. The major disadvantage is that a tear of the midline incision may extend through the anal sphincter and rectum. D) Medical is not a type of episiotomy.

1) A laboring client's obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed? A) Maternal temperature, B P, and pulse B) Estimation of fetal birth weight C) Fetal presentation, position, station, and heart rate D) Biparietal diameter

Answer: C Explanation: A) Maternal vital signs do not affect the decision to perform an amniotomy. B) Fetal birth weight does not affect the decision to perform an amniotomy. C) Before an amniotomy is performed, the fetus is assessed for presentation, position, station, and F H R. D) Biparietal diameter does not affect the decision to perform an amniotomy.

1) The nurse is caring for a client at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (P P R O M). Which statement indicates that the client needs additional teaching? A) "If I were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured." B) "If I develop a urinary tract infection in my next pregnancy, I might rupture membranes early again." C) "If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy." D) "If I have amniocentesis, I might rupture the membranes again."

Answer: C Explanation: A) Multifetal gestation increases the risk for P P R O M. B) A urinary tract infection (U T I) increases the risk for P P R O M. C) There is no evidence that bed rest in a subsequent pregnancy decreases the risk for P P R O M. D) Amniocentesis increases the risk for P P R O M.

1) A client is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (V B A C) with this pregnancy. Which statement indicates that the client requires more information about V B A C? A) "I can try a vaginal birth because my uterine incision is a low segment transverse incision." B) "The vertical scar on my skin doesn't mean that the scar on my uterus goes in the same direction." C) "There is about a 90% chance of giving birth vaginally after a cesarean." D) "Because my hospital has a surgery staff on call 24 hours a day, I can try a V B A C there."

Answer: C Explanation: A) Only low segment transverse uterine incisions are recommended for attempting a V B A C. B) Abdominal skin incisions and uterine incisions are not always the same. C) Women whose previous cesarean was performed because of nonrecurring indications have been reported to have approximately a 60% to 80% chance of success with V B A C. VBAC should be attempted only in facilities that have in-house anesthesia personnel available for emergency cesarean births if warranted

1) The client is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the client asks for another. What is the best response from the nurse? A) "I'll get you one right away." B) "You only need to use one ice pack." C) "You need to leave it off for at least 20 minutes and then reapply." D) "I'll bring you an extra so that you can change it when you are ready."

Answer: C Explanation: A) Providing an additional ice pack before 20 minutes have passed would increase the perineal edema. B) More than one ice pack must be used in order to apply ice for 20 minutes on followed by 20 minutes off. C) For optimal effect, the ice pack should be applied for 20 to 30 minutes and removed for at least 20 minutes before being reapplied. D) An ice pack that is provided now for use in 20 minutes would melt before being used.

1) If the physician indicates a shoulder dystocia during the delivery of a macrosomic fetus, how would the nurse assist? A) Call a second physician to assist. B) Prepare for an immediate cesarean delivery. C) Assist the woman into McRoberts maneuver. D) Utilize fundal pressure to push the fetus out.

Answer: C Explanation: A) The vaginal delivery of a macrosomic fetus does not require a second physician. B) Although a cesarean might be necessary, it would not be an immediate need. C) The McRoberts maneuver is thought to change the maternal pelvic angle and therefore reduce the force needed to extract the shoulders, thereby decreasing the incidence of brachial plexus stretching and clavicular fracture. D) Fundal pressure should not be performed, because this can further wedge the shoulder against the suprapubic bone.

1) The client demonstrates understanding of the implications for future pregnancies secondary to her classic uterine incision when she states which of the following? A) "The next time I have a baby, I can try to deliver vaginally." B) "The risk of rupturing my uterus is too high for me to have any more babies." C) "Every time I have a baby, I will have to have a cesarean delivery." D) "I can only have one more baby."

Answer: C Explanation: A) This client will not be able to deliver vaginally in future pregnancies. B) There could be a risk of uterine rupture if the client were allowed to labor with the next pregnancy. C) A classic uterine incision is made in the upper uterine segment and is associated with an increased risk of rupture in subsequent pregnancy, labor, and birth. Therefore, subsequent deliveries will be done by cesarean. D) The number of subsequent pregnancies is not limited to one.

1) The client has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal? A) The head is delivered after eight "pop-offs" during contractions. B) A cephalohematoma is present on the fetal scalp. C) The location of the vacuum is apparent on the fetal scalp after birth. Positive pressure is applied by the vacuum extraction during contractions

Answer: C Explanation: A) Use of the vacuum extraction for eight contractions is too many. If more than three "pop-offs" occur, the procedure should be discontinued. B) A cephalohematoma is a complication of vacuum extraction birth and is not an expected finding. C) The parents need to be informed that the caput (chignon) on the baby's head will disappear within 2 to 3 days. D) Negative pressure is suction, which is needed to facilitate the birth.

1) The client at 30 weeks' gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes which of the following? A) Limiting vaginal exams to only one per 24-hour period. B) Evaluating the fetal heart rate with an internal monitor. C) Monitoring for blood loss, pain, and uterine contractibility. D) Assessing blood pressure every 2 hours.

Answer: C Explanation: A) Vaginal exams are contraindicated because the exam can stimulate bleeding. B) Fetal heart rate monitoring will be done with an external, not internal, fetal monitor. C) Blood loss, pain, and uterine contractibility need to be assessed for client comfort and safety. D) Blood pressure measurements every 2 hours are unnecessary.

1) A fetus has a brow cephalic presentation. Which head shape should the nurse expect when the infant is delivered?

Answer: C Explanation: C) In a brow presentation the head is molded forward. Choice 1 is an occiput anterior presentation. Choice 2 is an occiput posterior presentation. Choice 4 is face presentation.

1) True postterm pregnancies are frequently associated with placental changes that cause a decrease in uterine-placental-fetal circulation. Complications related to alterations in placenta functioning include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Increased fetal oxygenation B) Increased placental blood supply C) Reduced nutritional supply D) Macrosomia E) Risk of shoulder dystocia

Answer: C, D, E Explanation: A) Decreased, not increased, fetal oxygenation is a complication related to alternations in placenta functioning. B) Reduced, not increased, placental blood supply is a complication related to alternations in placenta functioning. C) Reduced nutritional supply is a complication related to alternations in placenta functioning. D) Macrosomia is a complication related to alternations in placenta functioning. E) Risk of shoulder dystocia is a complication related to alternations in placenta functioning.

1) Lacerations of the cervi × or vagina may be present when bright red vaginal bleeding persists in the presence of a well-contracted uterus. The incidence of lacerations is higher among which of the following childbearing women? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Over the age of 35 B) Have not had epidural block C) Have had an episiotomy D) Have had a forceps-assisted or vacuum-assisted birth E) Nulliparous

Answer: C, D, E Explanation: A) The incidence of lacerations is higher among childbearing women who are younger. B) The incidence of lacerations is higher among childbearing women who have had an epidural block. C) The incidence of lacerations is higher among childbearing women who undergo an episiotomy. D) The incidence of lacerations is higher among childbearing women who undergo forceps-assisted or vacuum-assisted birth. E) The incidence of lacerations is higher among childbearing women who are nulliparous.

1) The client is at 42 weeks' gestation. Which order should the nurse question? A) Obtain biophysical profile today. B) Begin nonstress test now. C) Schedule labor induction for tomorrow. D) Have the client return to the clinic in 1 week.

Answer: D Explanation: A) A biophysical profile is a commonly used assessment for the postterm fetus. B) The nonstress test is a commonly used assessment for the postterm fetus. C) Most practitioners consider induction at 41 gestational weeks to reduce maternal and fetal-newborn risks associated with postterm pregnancy. D) Many practitioners use twice-weekly testing, providing the amniotic fluid level is normal. One week is too long a period between assessments.

1) The nurse is completing discharge teaching for a client who delivered 2 days ago. Which statement by the client indicates that further information is required? A) "Because I have a midline episiotomy, I should keep my perineum clean." B) "I can use an ice pack to relieve some the pain from the episiotomy." C) "I can take ibuprofen (Motrin) when my perineum starts to hurt." D) "The tear I have through my rectum is unrelated to my episiotomy."

Answer: D Explanation: A) A complication associated with an episiotomy is infection. Perineal hygiene is important when a client has an episiotomy to prevent infection and facilitate healing. B) Pain relief measures may begin immediately after birth with application of an ice pack to the perineum. C) Healing episiotomies can be very painful, and pain medication should be provided for clients experiencing pain. D) This statement is incorrect. The major disadvantage is that a tear of the midline incision may extend through the anal sphincter and rectum.

1) The nurse is caring for a client in active labor. The membranes spontaneously rupture, with a large amount of clear amniotic fluid. Which nursing action is most important to undertake at this time? A) Assess the odor of the amniotic fluid. B) Perform Leopold maneuvers. C) Obtain an order for pain medication. D) Complete a sterile vaginal exam.

Answer: D Explanation: A) Although it is important to assess amniotic fluid for odors, checking the cervi × to assess for cord prolapse is a higher priority. B) This assessment is not called for at this time. C) Pain medication is a low priority at this time. D) Checking the cervi × will determine whether the cord prolapsed when the membranes ruptured. The nurse would assess for prolapsed cord via vaginal examination.

1) After inserting prostaglandin gel for cervical ripening, what should the nurse do? A) Apply an internal fetal monitor. B) Insert an indwelling catheter. C) Withhold oral intake and start intravenous fluids. D) Place the client in a supine position with a right hip wedge.

Answer: D Explanation: A) An internal fetal monitor cannot be applied until adequate cervical dilatation has occurred. B) The client should void on her own and not need a catheter. C) Until labor begins, there is no rationale for withholding all intake. D) After the gel, intravaginal insert, or tablet is inserted, the woman is instructed to remain lying down with a rolled blanket or hip wedge under her right hip to tip the uterus slightly to the left for the first 30 to 60 minutes to maintain the cervical ripening agent in place.

1) The multiparous client at term has arrived to the labor and delivery unit in active labor with intact membranes. Leopold maneuvers indicate the fetus is in a transverse lie with a shoulder presentation. Which physician order is most important? A) Artificially rupture membranes. B) Apply internal fetal scalp electrode. C) Monitor maternal blood pressure every 15 minutes. D) Alert surgical team of urgent cesarean.

Answer: D Explanation: A) Artificial rupture of the membranes is contraindicated with a transverse lie because of the high risk for prolapsed cord. B) An internal fetal scalp electrode cannot be applied until membranes have ruptured. C) The fetus is at risk for hypoxia secondary to prolapsed cord if the membranes rupture. The maternal blood pressure is less important than getting the cesarean under way. D) This is the highest priority because vaginal birth is impossible with a transverse lie. Labor should not be allowed to continue, and a cesarean birth should be done quickly.

1) The nurse admits into the labor area a client who is in preterm labor. What assessment finding would constitute a diagnosis of preterm labor? A) Cervical effacement of 30% or more B) Cervical change of 0.5 c m per hour C) 2 contractions in 30 minutes D) 8 contractions in 1 hour

Answer: D Explanation: A) Cervical effacement of 80% or more would define preterm labor. B) A cervical change of at least 1 c m per hour would define preterm labor. C) Uterine contractions every 5 minutes for 20 minutes would define preterm labor. D) 8 contractions in a 60-minute period does define a diagnosis of preterm labor.

1) The client is having fetal heart rate decelerations. An amnioinfusion has been ordered to alleviate the decelerations. The nurse understands that the type of decelerations that will be alleviated by amnioinfusion is which of the following? A) Early decelerations B) Moderate decelerations C) Late decelerations D) Variable decelerations

Answer: D Explanation: A) Early decelerations require no intervention. B) Moderate is not a descriptor used to identify decelerations. C) Late decelerations are consistent with head compression. Amnioinfusion does not relieve head compression. D) When cord compression is suspected, amnioinfusion (A I) may be considered. A I helps to prevent the possibility of variable decelerations by increasing the volume of amniotic fluid.

1) The nurse examines the client's placenta and finds that the umbilical cord is inserted at the placental margin. The client comments that the placenta and cord look different than they did for her first two births. The nurse should explain that this variation in placenta and cord is called what? A) Placenta accreta B) Circumvallate placenta C) Succenturiate placenta D) Battledore placenta

Answer: D Explanation: A) In placenta accreta, the chorionic villi attach directly to the myometrium of the uterus. B) A circumvallate placenta has a double fold of chorion and amnion that form a ring around the umbilical cord, on the fetal side of the placenta. C) In succenturiate placenta, one or more accessory lobes of fetal villi will develop on the placenta. D) In battledore placenta, the umbilical cord is inserted at or near the placental margin.

1) The client is carrying monochorionic-monoamniotic twins. The nurse teaches the client what this is, and the implications of this finding. The nurse knows that teaching is successful when the client states which of the following? A) "My babies came from two eggs." B) "About two thirds of twins have this amniotic sac formation." C) "My use of a fertility drug led to this issue." D) "My babies have a lower chance of surviving to term than fraternal twins do."

Answer: D Explanation: A) Monochorionic-monoamniotic twins lie in the same amniotic sac. B) About 2% of twins are of this type. C) The majority of twins conceived through in vitro fertilization are fraternal (dizygotic) because multiple fertilized ova are inserted into the uterus, and are not monochorionic-monoamniotic twins. D) Monochorionic-monoamniotic twins are both in one amniotic sac. There is an increased risk of umbilical cords becoming tangled or knotted and a higher incidence of fetal demise.

1) Intervention to reduce preterm birth can be divided into primary prevention and secondary prevention. What does secondary prevention include? A) Diagnosis and treatment of infections B) Cervical cerclage C) Progesterone administration D) Antibiotic treatment and tocolysis

Answer: D Explanation: A) Primary prevention includes diagnosis and treatment of infections, cervical cerclage, and progesterone administration. B) Primary prevention includes diagnosis and treatment of infections, cervical cerclage, and progesterone administration. C) Primary prevention includes diagnosis and treatment of infections, cervical cerclage, and progesterone administration. D) Secondary prevention strategies are antibiotic treatment and tocolysis.

1) In the operating room, a client is being prepped for a cesarean delivery. The doctor is present. What is the last assessment the nurse should make just before the client is draped for surgery? A) Maternal temperature B) Maternal urine output C) Vaginal exam D) Fetal heart tones

Answer: D Explanation: A) The supine position would not cause an abnormality in maternal temperature. B) The supine position would not cause an abnormality in maternal urine output. C) There is no indication that a vaginal exam should be performed. D) Ascertain fetal heart rate (F H R) before surgery and during preparation, because fetal hypoxia can result from aortocaval compression.

1) After delivery, it is determined that there is a placenta accreta. Which intervention should the nurse anticipate? A) 2 L oxygen by mask B) Intravenous antibiotics C) Intravenous oxytocin D) Hysterectomy

Answer: D Explanation: A) Use of oxygen will not assist in the separation of the placenta. B) Use of intravenous antibiotics will not assist in the separation of the placenta. C) Use of intravenous oxytocin will not assist in the separation of the placenta. D) The primary complication of placenta accreta is maternal hemorrhage and failure of the placenta to separate following birth of the infant. An abdominal hysterectomy may be the necessary treatment, depending on the amount and depth of involvement.

1) The spouse of a laboring patient is concerned that the baby is taking too long to be delivered and he has overhead some discussion about using a vacuum. Which diagram should the nurse show the spouse to explain the procedure being discussed?

Answer: D Explanation: D) For vacuum extractor traction the cup is placed on the fetal occiput, creating suction. Traction is applied in a downward and outward direction. Choice 1 is a diagram of a forceps delivery. Choice 2 is a diagram showing locations of episiotomies. Choice 3 is a diagram showing the location of the incision for a classic cesarean section.

1) A patient's placenta it is identified as having a double fold of chorion and amnion that formed a ring around the umbilical cord on the fetal side of the placenta. What should the nurse expect when examining this placenta?

Explanation: B) A circumvallate placenta has a double fold of chorion and amnion that forms a ring around the umbilical cord, on the fetal side of the placenta. Choice 1: In a succenturiate placenta, one or more accessory lobes of fetal villi develops on the placenta. Choice 3: In a battledore placenta, the umbilical cord is inserted at or near the placental margin. Choice 4: In a velamentous insertion of the umbilical cord, the vessels of the umbilical cord divide some distance from the placenta in the placental membranes.

1) A laboring patient is attempting a vaginal birth. An episiotomy has already been performed and the healthcare provider is prepared to extend the episiotomy if necessary. What is this fetus's most likely presentation?

Explanation: C) In a brow presentation, the forehead of the fetus becomes the presenting part and the head is slightly extended instead of flexed, which results in the head entering the birth canal with the widest diameter of the head (occipitomental) foremost. If a vaginal birth is attempted, the woman will probably need an episiotomy and may require extension of the episiotomy at the moment of birth. In a normal cephalic presentation, the occiput is the presenting part, and the head is flexed with the chin on the chest. The military presentation is probably the least difficult for the woman and fetus. In most cases, as soon as the head reaches the pelvic floor, flexion occurs and a vaginal birth results. In a face presentation, the face of the fetus is the presenting part. The fetal neck is hyperextended.