NCM 109
A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred?
Forceps delivery
A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education?
"I need to avoid exercise because of the negative effects of insulin production."
A prenatal nurse is providing instructions to a group of pregnant client regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions?
"I need to drink unpasteurized milk only."
A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education?
"I will maintain strict bedrest throughout the remainder of pregnancy."
A nursing instructor asks a nursing student who is preparing to assist with the assessment of a pregnant client to describe the process of quickening. Which of the following statements if made by the student indicates an understanding of this term?
"It is the fetal movement that is felt by the mother."
Which of the following symptoms occurs with a hydatidiform mole?
"Snowstorm" pattern on ultrasound with no fetus or gestational sac
A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client.
-Monitor renal function and cardiac function closely -Keep calcium gluconate on hand in case of a magnesium sulfate overdose -Monitor deep tendon reflexes hourly -Monitor I and O's hourly -Notify the physician if urinary output is less than 30 ml per hour
A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse takes.
-Stop of Pitocin infusion -Perform a vaginal examination -Check the client's blood pressure and heart rate -Administer oxygen by face mask at 8 to 10 L/min
A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus is at (-1) station. The nurse determines that the fetal presenting part is:
1 cm above the ischial spine
The 4 "T's" of PPH are: 1. Trauma 2. Toxins 3. Travel 4. Tissue 5. Threads 6. Thrombin 7. Tears 8. Tone
1, 4, 6 & 8
A nurse is caring for a client in labor who is receiving Pitocin by IV infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued?
A fetal heart rate of 90 beats per minute
A nurse explains the purpose of effleurage to a client in early labor. The nurse tells the client that effleurage is:
Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus
To be considered a PPH, what would the estimated blood loss have to be for a C-section?
> 1000 ML
A nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The physician has documented the presence of a Goodell's sign. The nurse determines this sign indicates:
A softening of the cervix
A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client's complaint of vaginal bleeding?
Abruptio placentae
During a prenatal examination, the nurse draws blood from a young Rh negative client and explain that an indirect Coombs test will be performed to predict whether the fetus is at risk for:
Acute hemolytic disease
In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must:
Administer RhoGAM within 72 hours
A nurse in the labor room is caring for a client in the active phases of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The most appropriate nursing action is to:
Administer oxygen via face mask
The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is:
An increase in blood volume
A nurse is monitoring a new mother in the PP period for signs of hemorrhage. Which of the following signs, if noted in the mother, would be an early sign of excessive blood loss?
An increase in the pulse from 88 to 102 BPM
Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include:
An increase of 300 calories a day
A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for:
Any bleeding, such as in the gums, petechiae, and purpura.
A nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the monitor, the initial nursing assessment is which of the following?
Assessing the baseline fetal heart rate
A client is admitted to the birthing suite in early active labor. The priority nursing intervention on admission of this client would be:
Auscultating the fetal heart
Rho (D) immune globulin (RhoGAM) is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the medication if the woman states that it will protect her next baby from which of the following?
Being affected by Rh incompatibility
A client who is gravida 1, para 0 is admitted in labor. Her cervix is 100% effaced, and she is dilated to 3 cm. Her fetus is at +1 station. The nurse is aware that the fetus' head is:
Below the ischial spines
After doing Leopold's maneuvers, the nurse determines that the fetus is in the ROP position. To best auscultate the fetal heart tones, the Doppler is placed:
Below the umbilicus on the right side
Methergine or Pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the:
Blood pressure
What types of trauma during labour and birth would lead to PPH risk?
C-Section
The antagonist for magnesium sulfate should be readily available to any client receiving IV magnesium. Which of the following drugs is the antidote for magnesium toxicity?
Calcium gluconate
The nurse teaches a pregnant woman to avoid lying on her back. The nurse has based this statement on the knowledge that the supine position can:
Cause decreased placental perfusion
The nurse is aware than an adaptation of pregnancy is an increased blood supply to the pelvic region that results in a purplish discoloration of the vaginal mucosa, which is known as:
Chadwick's sign
A nurse in the delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn, the nurse assists in delivering the placenta. Which observation would indicate that the placenta has separated from the uterine wall and is ready for delivery?
Changes in the shape of the uterus
A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse's first action is to:
Clean and maintain an open airway
The nurse observes the client's amniotic fluid and decides that it appears normal, because it is:
Clear, almost colorless, and containing little white specks
A nurse is beginning to care for a client in labor. The physician has prescribed an IV infusion of Pitocin. The nurse ensures that which of the following is implemented before initiating the infusion?
Continuous electronic fetal monitoring
An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for:
Delivery of the fetus
Clients with gestational diabetes are usually managed by which of the following therapies?
Diet
A client with a missed abortion at 29 weeks gestation is admitted to the hospital. The client will most likely be treated with:
Dinoprostone (Prostin E.)
A nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate?
Document the findings and tell the mother that the monitor indicates fetal well-being
At what stage of labor is the mother is advised to bear down?
During a uterine contraction
A 21-year old client, 6 weeks' pregnant is diagnosed with hyperemesis gravidarum. This excessive vomiting during pregnancy will often result in which of the following conditions?
Electrolyte imbalance
A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)?
Elevated blood pressure
A nurse is caring for a client in the second stage of labor. The client is experiencing uterine contractions every 2 minutes and cries out in pain with each contraction. The nurse recognizes this behavior as:
Fear of losing control
A nurse is performing an assessment of a primipara who is being evaluated in a clinic during her second trimester of pregnancy. Which of the following indicates an abnormal physical finding necessitating further testing?
Fetal heart rate of 180 BPM
A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate a need to contact the physician?
Fetal heart rate of 180 beats per minute
A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is:
G5 T2 P1 A1 L4
A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa?
Hemorrhage
Upon assessment the nurse found the following: fundus at 2 fingerbreadths above the umbilicus, last menstrual period (LMP) 5 months ago, fetal heart beat (FHB) not appreciated. Which of the following is the most possible diagnosis of this condition?
Hydatidiform mole
A client arrives at a birthing center in active labor. Her membranes are still intact, and the nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client that after this procedure, she will most likely have:
Increased efficiency of contractions
A nurse midwife is performing an assessment of a pregnant client and is assessing the client for the presence of ballottement. Which of the following would the nurse implement to test for the presence of ballottement?
Initiating a gentle upward tap on the cervix
What types of trauma during labour and birth would lead to PPH risk?
Instrumental assisted birth (vacuum or forceps)
What types of trauma during labour and birth would lead to PPH risk?
Lacerations of the cervix or vaginal wall
When uterine rupture occurs, which of the following would be the priority?
Limiting hypovolemic shock
Which measure would be least effective in preventing postpartum hemorrhage?
Massage the fundus every hour for the first 24 hours following birth
A nurse is developing a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan of care. The nurse prioritizes the plan of care and selects which of the following nursing interventions as the highest priority?
Monitoring fetal heart rate
A 26-year old multigravida is 14 weeks' pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, "What does the alpha-fetoprotein test indicate?" The nurse bases a response on the knowledge that this test can detect:
Neural tube defects
A nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 BPM. Which of the following nursing actions is most appropriate?
Notify the physician or nurse midwife
A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician's orders and would question which order?
Obtain equipment for a manual pelvic examination
A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the physician's orders and would expect to note which of the following prescribed treatments for this condition?
Oxytocin (Pitocin) infusion
A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a Doppler ultrasound device. The nurse most accurately determines that the fetal heart sounds are heard by:
Palpating the maternal radial pulse while listening to the fetal heart rate
Methergine or pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client's medical history?
Peripheral vascular disease
Which of the following conditions is common in pregnant women in the 2nd trimester of pregnancy?
Physiologic anemia
A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action?
Place the client in Trendelenburg's position
A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of:
Placental separation
A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes that the client's hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following?
Postpartum infections
When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased:
Production of estrogen
A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The priority nursing intervention would be to:
Provide pain relief measures
At 38 weeks gestation, a client is having late decelerations. The fetal pulse oximeter shows 75% to 85%. The nurse should:
Reposition the catheter, recheck the reading, and if it is 55%, keep monitoring
A pregnant client is receiving magnesium sulfate therapy for the control of preeclampsia. A nurse discover that the client is encountering toxicity from the medication in which of the following assessment?
Respirations of 10 breaths per minute.
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?
Respirations of 10 per minute
A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse?
Respiratory rate of 10 BPM
A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if:
Seizures do not occur
An expected cardiopulmonary adaptation experienced by most pregnant women is:
Shortness of breath on exertion
A maternity nurse is preparing to care for a pregnant client in labor who will be delivering twins. The nurse monitors the fetal heart rates by placing the external fetal monitor:
So that each fetal heart rate is monitored separately
A client in labor is transported to the delivery room and is prepared for a cesarean delivery. The client is transferred to the delivery room table, and the nurse places the client in the:
Supine position with a wedge under the right hip
A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation?
Swelling of the calf in one leg
Which of the following terms applies to the tiny, blanched, slightly raised end arterioles found on the face, neck, arms, and chest during pregnancy?
Telangiectasias
A nurse is caring for a client in labor. The nurse determines that the client is beginning in the 2nd stage of labor when which of the following assessments is noted?
The cervix is dilated completely
A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician?
The client complains of a headache and blurred vision
The physician asks the nurse the frequency of a laboring client's contractions. The nurse assesses the client's contractions by timing from the beginning of one contraction:
To the beginning of the next contraction
Atonic bleeding is due to a lack of tone in the uterus.
True
A pregnant woman at 32 weeks' gestation complains of feeling dizzy and lightheaded while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to:
Turn the woman on her side.
Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage?
Urine retention
A client is admitted to the L & D suite at 36 weeks' gestation. She has a history of C-section and complains of severe abdominal pain that started less than 1 hour earlier. When the nurse palpates tetanic contractions, the client again complains of severe pain. After the client vomits, she states that the pain is better and then passes out. Which is the probable cause of her signs and symptoms?
Uterine rupture
Which of the following complications is most likely responsible for a delayed postpartum hemorrhage?
Uterine subinvolution
A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present?
Uterine tenderness/pain
During the period of induction of labor, a client should be observed carefully for signs of:
Uterine tetany
A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction?
Variable decelerations
At a prenatal visit at 36 weeks' gestation, a client complains of discomfort with irregularly occurring contractions. The nurse instructs the client to:
Walk around until they subside
All of the products of conception are expelled.
complete
Which of the following conditions is associated with elevated serum chloride levels?
eclampsia
Any of the 5 spontaneous abortions occurring with 3 consecutive pregnancies. This condition is a result of weakened cervix that dilates in the 2nd trimester, and expels the fetus. This condition is call INCOMPLETE CERVIX.
habitual
Some of the products are expelled, but the placenta remains attached. Heavy bleeding and cramping doesn't subside until entire placenta is removed.
incomplete
Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged?
maternal and fetal blood are never exchanged
Embryo or fetus dies but isn't expelled. It's often discovered by the physician when no FHT is present. Fetus must be expelled within 6wks or DIC and/or infections can occur.
missed
Bleeding and cramping occur with the cervix closed and membranes intact.
threatened
