OB 17, 18, 19, 20, 23

A nurse anesthetist is explaining an epidural procedure to a client who agrees that this is the best way to help suppress her pain. What is the role of the nurse before, during, and after administration of an epidural? (select all that apply) 1 - admin a bolus of IV fluids prior to epidural insertion 2 - position the client in the lithotomy position for catheter insertion 3 - have oxygen and suction ready in the event of respiratory depression 4 - palpate the client's bladder for distention and insert indwelling foley cath if necessary 5 - encourage the client to ambulate to the bathroom every 1-2 hr to void

1, 3, 4

A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions that are every 3 to 5 mins, which are becoming stronger. A vag exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client states that she wants pain meds at this time. Which of the following interventions should the nurse suggest to the client at this time? (select all that apply) 1 - Patterned breathing techniques 2- Insertion of indwelling urinary catheter 3 - Butorphanol (stadol) 2 mg IV as prescribed 4 - Application of heat or cold 5 - Distraction or focal point

1, 3, 4, 5

A nurse is caring for a client who is at 42 weeks of gestation and is admitted to the labor and delivery unit. During an ultrasound, it is noted that the fetus is large for gestational age. The nurse reviews the prescription from the primary care provider to begin an amnioinfusion. The nurse knows that an amnioinfusion is indicated for which of the following reasons? (select all that apply) 1 - oligohydramnios 2 - hydramnios 3 - fetal cord compression 4 - hydration 5 - meconium is in amniotic fluid

1, 3, 5

A nurse is caring for a client who has meconium stained fluid. Which of the following solutions does the nurse anticipate the provider to prescribe for an amnioinfusion? (select all that apply) 1 - lactated ringer's solution 2 - dextrose 5% in lactated ringer's 3 - dextrose 5% in 0.9% sodium chloride 4 - 0.45% sodium chloride 5 - 0.9% sodium chloride

1, 5 instillation of isotonic solution is prescribed

A client reports that her contractions started about 2 hr ago, did not go away when she had 2 glasses of water and rested, and became stronger since she started walking. She tells the nurse that the contractions occur every 10 min and last about half a minute. She hasn't had any fluid leak from her vagina; however, she did think she saw some blood when she wiped after voiding. Based on these reports, the nurse should recognize that the client is experiencing A braxton hicks contractions B rupture of membranes C fetal descent D true contractions

D true contractions do not go away with water or walking

A nurse is caring for a client in active labor. When last examined 2 hr ago, the client's cervix was 3 cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states "my water broke." The monitor reveals a FHR of 80-85/min and the nurse performs a vag exam, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. Which of the following actions should the nurse perform first? A place the client in trendelenburg position B apply pressure to the presenting part with her finger C give the client 10 L of oxygen via a face mask D call for assistance

D all other interventions should be done after calling for assistance

A nurse is caring for a client in labor. The client experiences hypotension and fetal bradycardia. Which of the following nursing actions should the nurse implement? (select all that apply) 1 - administer an ephedrine IV bolus 2 - place the client in side-lying position 3 - increase IV fluids 4 - administer O2 via face mask 5 - administer naloxone (narcan)

1, 2, 3, 4

A nurse is providing care for a client who is in active labor. Her cervix is dilated to 5 cm and her membranes are intact. The FHR and uterine contractions are being monitored by an external electronic fetal monitor. The nurse notes a FHR of 115 to 125/min with occasional increases up to 150 to 155/min that lasts for 25 seconds, and have beat-to-beat variability of 20/min. There is no slowing of FHR from the baseline. The nurse should recognize that this client is exhibiting signs of which of the following? (select all that apply) 1 - moderate variability 2 - FHR accelerations 3 - no FHR decels 4 - Normal baseline FHR 5 - fetal tachycardia

1, 2, 3, 4

The nurse should be aware that which of the following are risk factors for dysfunctional labor? (select all that apply) 1 - short stature 2 - cephalopelvic disproportion 3 - fetal microsomia 4 - fetal malpresentation 5 - maternal fatigue

1, 2, 4, 5

A client and her partner have not taken prepared childbirth classes prior to labor. When should the nurse provide the client and couching partner education during the labor process? A the first stage, latent phase B the first stage, active phase C the first stage, transition phase D the 2nd stage of labor

A

In addition to oxytocin (pitocin) administration, what other methods of augmenting or inducing labor shoudl a nurse anticipate? A cervical ripening B amnioinfusion C cesarean birth D episiotomy

A

Which of the following is the initial nursing action the nurse should take when late decels appear on the fetal monitor? A reposition pt in left lateral position B apply fetal scalp electrode C increase the IV fluid rate D perform vag exam to assess dilation

A

A nurse applies an external fetal monitor and tocotransducer to monitor the FHR and contractions of a client who is in labor. The FHR is around 140/min. Contractions are every 8 min and 30 to 40 seconds in duration. The nurse performs a vaginal exam and finds the cervix is 2 cm dilated, 50% effaced, and the fetus is at -2 station. Which of the following stages and phases of labor is this client experiencing? A the first stage, latent phase B the first stage, active phase C the first stage, transition phase D the second stage of labor

A Stage 1, Latent phase - cervix dilates from 0-3cm and contraction duration is from 30-45 seconds.

A nurse is caring for a client in active labor. Her vaginal exam 1 hour ago showed that she was 3 cm dilated, 50% effaced, and had a -3 station. Her membranes ruptured spontaneously. The nurse should assess her for which of the following signs? A prolapsed cord B premature rupture of membranes C infection D fetal tachycardia

A always assess for prolapsed cord when membranes rupture

A client in the L&D unit has been in labor for 12 hr. Her membranes are still intact. The primary care provider has decided to perform an amniotomy in an effort to facilitate the progress of labor. The nurse performs the sterile vaginal examination to ensure which of the following prior to the performance of the amniotomy? A fetal engagement B fetal lie C fetal attitude D fetal position

A it is imperative that fetus is engaged at 0 station and at the level of the maternal ischial spines to prevent prolapse of umbilical cord.

A client who is primigravida and at 39 weeks of gestation comes to the birthing unit with her partner because she has been having regular contractions. She states that her "water broke." Which of the following is the priority assessment the nurse should perform at this time? A FHR monitoring B vaginal exam C nitrazine paper test D Leopold Maneuvers

A most important to assess FHR to ensure there is no fetal distress. Do paper test after FHR is assessed.

Episodic accelerations of the FHR from baseline should be interpreted by the nurse as indicative of A intact CNS response to fetal movement B fetal response to maternal fever C fetal distress requiring intervention D fetal hypoxia requiring maternal oxygen

A referred to as "baseline variability" - normal fetal response

A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to help facilitate normal labor process? A hands and knees B lithotomy C trendelenburg D supine with a rolled towel under one hip

A may help fetus rotate from a posterior to an anterior position

A client in the labor and delivery unit is in the 2nd stage of labor. Her labor has been progressing well without complications and she is expected to deliver vaginally in 20 min. The primary care provider is preparing to administer lidocaine (xylocaine) for pain relief and perform an episiotomy. The nurse knows that this type of regional anesthetic block will likely be used with which of the following? A pudendal block B epidural block C spinal block D paracervical block

A pudendal block is a transvag injection of local anesthetic to the area in front of pudendal nerve that anesthetizes the perineum, vulva, and rectal areas.

A nurse is caring for a client who is being induced for labor and is being monitored by an external electronic fetal monitor. The nurse notes that the FHR variability is decreased and resembles a straight line. The mother has not had any pain medication. Which of the following should occur first for an internal scalp electrode to be applied? A dilation B rupture of membranes C effacement D engagement

B

If contractions are too long of a duration or do not have complete relaxation or uterine tone in between contractions, the adverse effect will be A prolonged labor B reduced fetal oxygen supply C impairment of cervical dilation D increased maternal stress

B

Which of the following positions should a nurse place a client prior to a c-section birth? A trendelenburg with the lower ext elevated B L lateral side-lying with head elevated C prone with a wedge under R hip D supine with a wedge under R hip

D supine, on her back. Placing wedge under one of her hips will tilt the client so that she will not have vena cava compression.

A client is in the transition phase of labor and feels that she needs to have a BM with the peak of contractions. Which of the following is an appropriate nursing intervention? A assist client to the bathroom B prepare for an impending delivery C prepare to remove fecal impaction D encourage the client to take deep cleansing breath

B

A nurse is caring for a client who is receiving oxytocin (pitocin)for induction of labor and has an intrauterine pressure catheter (IUPC) placed to monitor uterine contractions. For which of the following contraction patterns should the nurse discontinue the infusion of oxytocin? A frequency of every 2 min B duration of 90 to 120 seconds C intensity of 60 to 90 mm hg D resting tone of 15 mm hg

B discontinue if 1) hyperstimulation occurs with contx freq more often than every 2 min 2) contx duration > 90 seconds 3) contx intensity results with pressure > 90 mm hg 4) uterine resting tone > 20 mm hg between contx and showing no relaxation of uterus between contractions

A client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. The nurse's first nursing action after establishing that the fluid is amniotic fluid should be to A assess the amniotic fluid for meconium B monitor FHR for distress C dry the client and make her comfortable D monitor the client's uterine contractions

B greatest risk is umbilical cord prolapse, leading to fetal distress. First action is to monitor FHR for distress.

While conducting an admission history for a client who is at 39 weeks of gestation, the client tells the nurse that she has been leaking fluid from her vagina for 2 days. The nurse knows that this client is at risk for A cord prolapse B infection C postpartum hemorrhage D hydramnios

B rupture of membranes exceeding 24 hr before delivery increases risk that infectious organisms will enter vagina and then to uterus.

A nurse is caring for a client who is in active labor. The client reports low back pain. The nurse suspects that the pain is persistent occiput posterior presentation. Which of the following nonpharmacological nursing interventions should best alleviate this pain? A abdominal effleurage B sacral counterpressure C hydrotherapy if not contraindicated D back rub and massage

B application of steady pressure to the lower back to counteract pressure exerted on spinal nerves by fetus

A nurse is caring for a client who is in labor. Which of the following should the nurse assess for following placement of an epidural? A tachycardia in the fetus B hypotension in the mother C facial edema in the mother D irregular heartbeats in the fetus

B monitor for adverse effects of epidural analgesia - hypotension

A nurse is caring for a client who is at 42 weeks of gestation and in active labor. The nurse should understand that the fetus is at risk for which of the following? A intrauterine growth restriction B hyperglycemia C meconium aspiration D polyhydramnios

C

A nurse is caring for a client who is primipara and in active labor. The client received meperidine (demerol) 50 mg IV for pain 30 min prior to precipitous delivery. Which of the following meds should the nurse be prepared to administer? A Naloxone (narcan) to mother B promethazine (phenergan) to mother C naloxone (narcan) to neonate D promethazine (phenergan) to neonate

C

Which of the following medications should the nurse anticipate will be necessary to administer preceding an external version for a client who has Rh negative blood and did not receive adequate prenatal care? A prostaglandin gel B magnesium sulfate C Rh0(D) immune globulin (RhoGAM) D Oxytocin (pitocin)

C

A nurse is palpating the client's bladder and is encouraging her to void every 1 to 2 hr during labor predominantly because A full bladder increases risk for fetal trauma B full bladder increases risk for bladder infections C distended bladder will be traumatized by frequent pelvic exams D distended bladder reduces pelvic space needed for birth

D reduces pelvic space, impedes fetal descent, and places bladder at risk for trauma

A client who is delivering in a birthing center is in the 2nd stage of labor and is having no complications. Intermittent auscultation of the FHR and uterine palpation of contractions is being performed to monitor FHR patterns. The nurse should assess the FHR every A 60 mins B 30 mins C 15 mins D 5 mins

C low risk women should be assessed every 15 mins. High risk should be every 5 mins.

A nurse is caring for a client who is in active labor and becomes nauseous and vomits. The client is also very irritable and feels that she needs to have a BM. She states, "I've had enough. I can't do this anymore. I want to go home right now." The nurse knows that these signs indicate the client is in the A second stage of labor B fourth stage of labor C transition stage of labor D latent stage of labor

C transition phase - pt becomes irritable, feels rectal pressure that can feel similar to needing to have BM, and can become nauseous with emesis.

A nurse is caring for a client admitted to the L&D unit. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe? A precipitate labor B premature rupture of membranes C postmaturity syndrome D prolapsed umbilical cord

D

A nurse is reviewing the fetal monitor tracing of a client who is in active labor. The nurse knows that a fetus receives more oxygen during which of the following? A peak of uterine contraction B increment of the uterine contraction C decrement of the uterine contraction D relaxation between uterine contractions

D