OB EXAM 2
Which statement indicates effective learning regarding the manifestations of true labor? - "Contractions are felt above the navel." - "The cervix is often soft and is felt in the posterior position." - "The fetus is usually not engaged in the pelvis." - "Contractions become more intense with walking."
"Contractions become more intense with walking."
Which nursing instruction would reduce the risk of urinary retention in a client during labor? - "void in a lateral position" - "increase your fluid intake" - "empty your bladder every 4 hours" - "I can show you some techniques to help stimulate voiding"
"I can show you some techniques to help stimulate voiding"
The nurse knows that patient education has been effective when the patient makes which statement about the difference between a tocodynamometer and an intrauterine pressure catheter (IUPC)? - "Only the tocodynamometer shows my uterine activity." - "The tocodynamometer is much more accurate than the IUPC." - "The tocodynamometer is positioned outside my body, while the IUPC is positioned inside my body." - "The tocodynamometer will be connected to my bedside monitor, but the IUPC will not."
"The tocodynamometer is positioned outside my body, while the IUPC is positioned inside my body."
A patient is concerned about the baseline variability in the heart rate of her fetus. Which responses by the nurse describe the significance of baseline variability to the patient? - "Variability is an artifact." - "Variability is a periodic pattern." - "Variability demonstrates that there is adequate oxygenation of the fetus." - "Variability suggests that the fetus is able to adapt to the labor process." - "Variability indicates that the fetus has no congenital abnormalities."
"Variability demonstrates that there is adequate oxygenation of the fetus." "Variability suggests that the fetus is able to adapt to the labor process."
View the fetal monitoring tracing below. What is the frequency of the contractions in this picture in minutes? - 1-2 - 2-4 - 2-3 - 3-4
2-3
What causes early decelerations? - oligohydramnios - uterine tachysystole - cord compression - head compression
head compression
Which response would the nurse provide the patient who asks why oxygen is being given after the nurse identifies a nonreassuring fetal heart rate? - "I will call the health care provider to discuss the new care plan." - "We need to increase the perfusion of the baby's placenta." - "We need to increase your oxygen, which will increase the baby's oxygen." - "Don't worry. This happens all of the time, and everything is fine.
"We need to increase your oxygen, which will increase the baby's oxygen."
When the fetal head is at the level of the ischial spines, this is described as _____ station. - 0 - -2 - +1 - -1
0
Which fetal heart rate is indicative of adequate fetal oxygen supply? - 90 beats/min - 100 beats/min - 130 beats/min - 170 beats/min
130 beats/min
A nurse is caring for a patient in labor who is receiving oxytocin via intravenous infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued? - Three contractions occurring within a 10-minute period - A fetal heart rate of 90 beats/min - A resting uterine tone of 15 mm Hg via the intrauterine pressure catheter - Early decelerations
A fetal heart rate of 90 beats/min
What would the nurse expect when caring for a full-term primigravida who presents for a routine office visit and is not in labor? - A fundal height that measures 30 cm - A fetus that is engaged in the maternal pelvis - A cervix that is already 3 cm dilated - Fetal station of −3
A fetus that is engaged in the maternal pelvis
The nurse is caring for a patient in the second stage of labor. Which patient condition is most likely to result in the need for an episiotomy? - A patient with a history of perineal laceration - A patient receiving oxytocin for induction of labor - A patient whose fetus is experiencing shoulder dystocia - A patient who had an episiotomy during a previous delivery
A patient whose fetus is experiencing shoulder dystocia
Which order during labor augmentation would cause the nurse to question the health care provider? - Administer oxytocin in lactated Ringer solution per protocol. - Administer oxytocin in normal saline per protocol. - Administer oxytocin in dextrose 10% per protocol. - Administer oxytocin intramuscular per protocol.
Administer oxytocin in dextrose 10% per protocol.
A woman is 10 cm dilated and feels occasional rectal pressure at the peak of a contraction, and the fetal station is 0. There is a reassuring fetal heart tracing. Which nursing action is appropriate at this time? - Recheck the cervical dilation to ensure she is 10 cm. - Allow the woman to labor down for passive descent. - Encourage the woman to push with every contraction. - Prepare for cesarean delivery for cephalopelvic disproportion.
Allow the woman to labor down for passive descent.
Which qualities are considered normal when assessing fetal heart rate (FHR)? - FHR variability of <5 beats/min - Baseline FHR of 140 beats/min - FHR variability of 20 beats/min - Baseline FHR of 100 beats/min - Baseline FHR of 170 beats/min
Baseline FHR of 140 beats/min FHR variability of 20 beats/min
A laboring client requests intravenous pain medication. Which finding would alert the nurse that narcotic administration should be withheld? - Cervical exam 6 cm/75%/0 with a reactive fetal heart rate tracing - Category III Fetal heart rate tracing - Fetal tracing is interpreted as a Category I - Moderate fetal heart rate variability with three accelerations noted in 20 minutes
Category III Fetal heart rate tracing
Match the expected event with the stage of labor.
Cervical effacement and dilatation from onset of true labor to complete dilatation - First stage Complete cervical dilatation and effacement to birth of the baby - Second stage Birth of the baby to expulsion of the placenta - Third stage Expulsion of the placenta to physical recovery of mother and infant - Fourth stage
A nurse is beginning to care for a patient in labor. The health care provider has prescribed an intravenous (IV) infusion of oxytocin. The nurse makes sure that which implementations occur before initiation of the infusion? - Placing the patient on complete bed rest - Continuous electronic fetal monitoring - An IV infusion of antibiotics - Making sure that a vial of terbutaline is immediately available - Preparing an IV infusion pump - Placing a code cart at the patient's bedside
Continuous electronic fetal monitoring Making sure that a vial of terbutaline is immediately available Preparing an IV infusion pump
Which assessment findings in the laboring patient would suggest to the nurse that delivery is imminent? - The woman can talk through contractions. - Contractions are 1.5 to 2 minutes apart. - Regular contractions are mild and 7 minutes apart. - Mucous vaginal discharge is bloody. - The woman is experiencing vomiting, nausea, and sweating. - The patient complains of rectal pressure.
Contractions are 1.5 to 2 minutes apart. Mucous vaginal discharge is bloody. The woman is experiencing vomiting, nausea, and sweating. The patient complains of rectal pressure.
Which fetal condition can cause a fetal heart rate (FHR) of <60 beats/min for more than 60 seconds that does not quickly return to baseline? - Cord compression - Fetal head compression - Uteroplacental insufficiency - No compromise; variable decelerations are normal
Cord compression
Which is an effective nursing intervention for a laboring client who is experiencing back labor and complains of intense pain in her lower back? - Counterpressure against the sacrum - Biofeedback - Effleurage - Pant-blow (breaths and puffs) breathing techniques
Counterpressure against the sacrum
A G1/P0 patient arrives for elective induction of labor at 39 weeks and is 1 to 2 cm dilated and 50% effaced. The fetal station is −3 with a posterior and firm cervix. Which order is most appropriate based on this patient's Bishop score? - Discharge to home with follow-up in 1 week at the office. - Administer oxytocin and titrate per protocol. - Assist with amniotomy and initiate oxytocin as prescribed. - Initiate electronic fetal monitoring and insert peripheral intravenous device.
Discharge to home with follow-up in 1 week at the office.
Which nursing actions are appropriate when the fetal monitor shows a pattern of late decelerations? - Discontinue oxytocin. - Provide water to the patient. - Administer oxygen by face mask. - Reposition the patient onto her side. - Continue monitoring and document findings.
Discontinue oxytocin Administer oxygen by face mask. Reposition the patient onto her side.
While monitoring a patient receiving oxytocin for augmentation of labor, the nurse notes tachysystole with recurrent late decelerations and minimal variability on the electronic fetal monitor. Which actions are appropriate? - Discontinue the oxytocin infusion. - Reposition the patient on her side. - Administer an intravenous bolus of fluid per protocol. - Administer 100% oxygen via tight face mask. - Notify the health care provider. - Place the patient in semi-Fowler position and continue to monitor.
Discontinue the oxytocin infusion. Reposition the patient on her side. Administer an intravenous bolus of fluid per protocol. Administer 100% oxygen via tight face mask. Notify the health care provider.
Which deceleration is considered a normal finding? - Variable - Prolonged - Early - Late
Early
A G2/P1 woman presents for evaluation. She is excited, can talk through regular contractions every 7 to 10 minutes, and states that her pain is "manageable." She does not desire epidural anesthesia in labor. The nurse suspects this patient is in which phase of labor? - Transitional labor - Early labor - The second stage of labor - Active labor
Early labor
A patient in labor experiences minimal relief after nonpharmacologic interventions, and she is not coping well in labor. Which action would the nurse take next? - Suggest an epidural. - Educate on the risks and benefits of pharmacologic interventions. - Encourage the patient to ambulate in the room. - Administer the prescribed dose of intravenous pain medication.
Educate on the risks and benefits of pharmacologic interventions.
Which action taken by the patient will reduce discomfort during Leopold maneuvers and make fetal presenting parts easier to feel? - Standing - Lying prone - Emptying the bladder - Pushing or bearing down with contractions
Emptying the bladder
Which solution can the nurse consider to encourage a positive birth experience for the patient and her support person following delivery? - Offer to take the baby to the nursery to promote rest for the patient and the support person. - Encourage the family to talk about the labor and delivery experience. - Immediately after birth, remove amniotic fluid and vernix from the baby before placing it skin-to-skin with the mother. - Provide all infants with pacifiers to promote infant and family rest.
Encourage the family to talk about the labor and delivery experience.
A woman with an epidural is 10 cm dilated and the baby is at 0 station. There is a reassuring fetal heart pattern, although the woman does not feel the urge to push. Which are appropriate actions by the nurse? - Encourage the patient to wait to push until she feels the urge. - Perform another vaginal examination to check for dilation. - Encourage the patient to push so that the baby can be born. - Encourage frequent position changes while remaining in the bed. - Turn off the epidural so the patient can feel the urge to push.
Encourage the patient to wait to push until she feels the urge. Encourage frequent position changes while remaining in the bed.
Which is the correct sequence for the cardinal movements of labor for a vertex presentation delivery? - Engagement, descent, flexion, internal rotation, extension, external rotation and expulsion - Engagement, external rotation, expulsion, flexion, internal rotation, extension, and external rotation - Internal rotation, descent, extension, flexion, expulsion, external rotation, and engagement - Internal rotation, flexion, extension, descent, external rotation, expulsion, and engagement
Engagement, descent, flexion, internal rotation, extension, external rotation and expulsion
A woman is experiencing strong contractions every 1.5 to 2 minutes, feels rectal pressure, and has a large amount of bloody show. At which frequency would the nurse anticipate assessing the fetal heart rate and pattern? - Every 30 to 45 minutes - Every 5 to 10 minutes - Every 15 to 30 minutes - Every 45 to 60 minutes
Every 15 to 30 minutes
Which fetal heart rate finding may result from maternal fever? - No expected changes - Prolonged decelerations - Fetal heart rate of 90 beats/min for 15 minutes - Fetal heart rate of 180 beats/min for 12 minutes
Fetal heart rate of 180 beats/min for 12 minutes
A woman is visibly anxious, refuses position changes in labor, and verbalizes, "I'm afraid I'm going to die." The nurse knows it is important to help the woman relax through effective coaching because of which responses to stress experienced in labor? - Fetal intolerance to labor - Bradycardia related to a vagal response - Release of catecholamines in the mother's body - Inhibited uterine contractions because of decreased blood flow to the placenta - Umbilical cord prolapse
Fetal intolerance to labor Release of catecholamines in the mother's body Inhibited uterine contractions because of decreased blood flow to the placenta
Stage 1 of labor is from ________________ to ________________________. - From the onset of regular contractions to delivery of the baby. - From the first contraction to the delivery of the placenta. - From the first contraction to the delivery of the baby. - From the onset of regular contractions to full dilation of the cervix.
From the onset of regular contractions to full dilation of the cervix.
A patient is experiencing intense back pain and discomfort during active labor. Which position would the nurse encourage the patient to assume? - Standing straight - Side-lying - Semi-sitting - Hands and knees
Hands and knees
The nurse midwife writes in the progress note that the baby is in the occiput posterior presentation. The nurse knows that which maternal position will help facilitate rotation of the fetal head? - Side-lying - Hands and knees - Semi-recumbent - Lithotomy
Hands and knees
Which uterine contraction strength classification is used when labor is measured at >500 Montevideo units (MVUs)? - Normal - Moderate - Hypotonic - Hypertonic
Hypertonic
The nurse notes fetal tachycardia and suspects that the patient may be dehydrated. Which nursing action is appropriate to address this nonreassuring finding? - Consult with the dietician. - Administer parenteral feeding. - Increase the rate of intravenous (IV) saline administration. Provide the patient an oral (PO) electrolyte replacement
Increase the rate of intravenous (IV) saline administration.
A patient arrives at a birthing center in active labor. Her membranes are still intact, and the health care provider prepares to perform an artificial rupture of membranes (AROM). What will the nurse relay to the patient as the most likely outcome of the procedure? - Less pressure on the cervix - Decreased number of contractions - Increased pressure on the cervix - The need for more cervical exams
Increased pressure on the cervix
Which uterine activity indicators does the intrauterine pressure catheter (IUPC) measure in mm HG? - Frequency - Duration - Intensity - Resting tone - Variability
Intensity Resting tone
What is the fetal position identified in this picture? - LOP - ROP - LOA - ROA
LOP
A woman in labor has been having regular contractions but has remained 5 cm dilated for 5 hours, with a reassuring fetal heart rate. Which intervention may be necessary for this patient? - Labor augmentation - Cesarean delivery - Vacuum-assisted delivery - Intrauterine resuscitation
Labor augmentation
A nurse is caring for a client with mitral stenosis who is in the active stage of labor. Which action would the nurse take to promote cardiac function? - Encourage the client to avoid the use of narcotics or epidural regional analgesia because this alters cardiac function. - Prepare the client for cesarean delivery because this is the recommended method to sustain hemodynamics. - Maintain the client in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. - Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.
Maintain the client in a side-lying position with the head and shoulders elevated to facilitate hemodynamics.
During the fourth stage of labor, the nurse notes an increased amount of bleeding. The uterine fundus consistency is boggy. Which is the most appropriate initial nursing action? - Alert the health care provider that the patient is experiencing postpartum hemorrhage. - Massage the uterine fundus and observe for change in consistency. - Administer uterotonic medications to increase uterine tone. - Do nothing, as this is a normal finding in the fourth stage of labor and the tone is transient.
Massage the uterine fundus and observe for change in consistency.
The nurse is providing care for a patient in labor, and the health care provider has just stated the patient's need for a forceps-assisted delivery. Which actions would the nurse's preparation include? - Obtaining a urinary catheter - Establishing intravenous (IV) access - Performing a head-to-toe assessment - Educating the patient about the risk for lacerations - Preparing the forceps using aseptic technique - Monitoring the fetal heart rate for signs of distress
Obtaining a urinary catheter Establishing intravenous (IV) access Preparing the forceps using aseptic technique Monitoring the fetal heart rate for signs of distress
In the fourth stage of labor, the nurse monitors the hemodynamic stability of the postpartum patient through which assessment? - Obtaining maternal vital signs every 15 minutes in the first postpartum hour - Assessing the couplet for bonding - Obtaining maternal vital signs every 30 minutes in the first postpartum hour - Assessing the color, amount, and odor of urine after the first void
Obtaining maternal vital signs every 15 minutes in the first postpartum hour
Occiput posterior refers to which component of the birth process? - Powers - Passenger - Passage - Psyche
Passenger
The nurse is assessing this external fetal monitoring strip of a laboring client. What should the nurse do first? - Notify the health care provider. - Increase the rate of the client's IV fluids - Place the client in lateral position. - Document the findings in the chart.
Place the client in lateral position.
While awaiting the delivery of the placenta in the third stage of labor, the nurse observes a large gush of blood and an increase in the length of the umbilical cord. Which event would the nurse recognize has probably occurred? - Placental separation from the uterine wall - Placental abruption - Umbilical cord detachment from the placenta - Postpartum hemorrhage as a result of retained placenta
Placental separation from the uterine wall
Why would the nurse administer a preanesthetic fluid bolus to a client who is prescribed spinal anesthesia in preparation for a cesarean delivery? - Prevent neonatal hypoglycemia - Maintain fluid balance - Potentiate effect of anesthesia - Prevent maternal hypotension
Prevent maternal hypotension
Which nonreassuring fetal heart rate (FHR) pattern includes a reduction in FHR of ≥15 beats/min for more than 2 minutes? - Accelerations - Tachycardia - Early decelerations - Prolonged decelerations
Prolonged decelerations
The nurse is caring for a patient who had a forceps delivery that caused a perineal hematoma. Which nursing intervention is most - Administer topical analgesic ointment as prescribed. - Provide the patient with an ice pack and educate her about its use. - Encourage the patient to lie on her side as much as possible until the injury heals. - Educate the patient about the fact that the hematoma was caused by the introduction of forceps.?
Provide the patient with an ice pack and educate her about its use.
After assessment of an actively laboring woman, the nurse finds a fetal heart rate (FHR) of 180 beats/min with contractions occurring less than 2 minutes apart and lasting more than 90 seconds. Which action would the nurse take next? - Reposition the patient to her side and alert the health care provider. - Nothing, these are normal findings. - Prepare for emergent cesarean delivery. - Reposition the patient only.
Reposition the patient to her side and alert the health care provider.
Which observations suggest that a woman is the latent phase of the second stage of labor? - The fetus is at 0 station. - There is an irregular and inconsistent urge to bear down with contractions. - The woman exhibits loud, songlike vocalizations with every contraction. - The fetus is at +3 station. - The woman sleeps between contractions. - The woman is pushing involuntarily.
The fetus is at 0 station. There is an irregular and inconsistent urge to bear down with contractions. The woman sleeps between contractions.
A pregnant woman arrives at the emergency department, and after completing a vaginal examination the nurse midwife states that the patient is 5 cm dilated and 75% effaced and the fetus is at −3 station. Which statement is accurate regarding this assessment? - The patient may initiate pushing efforts. - The cervix is fully dilated. - The cervix is fully effaced. - The fetus is not engaged within the maternal pelvis.
The fetus is not engaged within the maternal pelvis.
Which factors affect the process of labor and birth? Select all that apply - birth canal - endogenous endorphins - contractions - blood glucose levels - fetus and placenta
birth canal contractions fetus and placenta
Which condition is occurring in a multiparous client who has just given birth, her fundus is firm and globular, and she has a gush of dark red blood from her vagina? - Clots have formed in the upper uterine segment. - A cervical tear occurred during the birth. - The client is beginning to hemorrhage. - The placenta has separated.
The placenta has separated.
The nurse receives reports on two women in early labor, a nulliparous woman and a multiparous woman. Both are 3 cm dilated. Which statement is true regarding who will enter active labor first? - The multiparous woman will enter active labor first. - The nulliparous woman will enter active labor first. - They will both progress at similar rates. - The patient whose contractions palpate stronger will enter active labor first.
They will both progress at similar rates.
How is effacement measured? - Through digital palpation by a trained professional - Using transvaginal ultrasound - By estimating the stage of labor - Though palpation of cervical dilation - Through Leopold maneuvers
Through digital palpation by a trained professional Using transvaginal ultrasound
Which passenger position would interfere with a safe vaginal birth? - Transverse fetal lie - Flexed fetal head - Cephalic presentation - Longitudinal fetal lie
Transverse fetal lie
which is characteristic of true labor contractions? - subsides when walking around - causes discomfort over the top of the uterus - continues and gets stronger, even if the client relaxes and takes a shower - remains irregular but becomes stronger
continues and gets stronger, even if the client relaxes and takes a shower
Which characteristic is associated with false labor contractions? - painless - decrease in intensity with ambulation - regular pattern of frequency established - progressive in terms of intensity and duration
decrease in intensity with ambulation
Which fetal heart race tracing characteristics are considered reassuring or normal (category I)? - bradycardia not accompanied by baseline variability - early decelerations, either present or absent - sinusoidal pattern, either present or absent - tachycardia not accompanied by baseline variability
early decelerations, either present or absent
Which assessment would the nurse make after assessing an electronic fetal heart tracing that indicates umbilical cord compression? - variable decelerations - increase in fetal heart rate (FHR) - decrease in FHR - early decelerations
variable decelerations
The nurse is assessing the FHR tracing for a client and determines an FHR baseline of 175 beats/min. The nurse knows that this can be caused by which factor? - fetal ischemia - fetal tachycardia - fetal bradycardia - fetal hypotension
fetal tachycardia
A client who requires an emergency Cesarean Section would be MOST likely to experience what type of anesthesia? - epidural - epidural/spinal combo - spinal - general
general
Which condition is occurring in a multiparous client who has just given birth, her fundus is firm and globular, and she has a gush of dark red blood from her vagina? - placenta has separated - a cervical tear occurred during birth - the client is beginning to hemorrhage - clots have formed in the upper uterine segment
placenta has separated
While reviewing laboratory results for a woman being admitted for a Cesarean Section at 40 weeks gestation due to breech position, which of the laboratory results would the alert the nurse to a potential complication? - Hematocrit 34% - platelets 90,000 - urine positive for trace protein - WBC 14,000
platelets 90,000
The nurse is monitoring the fetal heart rate (FHR) of a full-term client in labor. Which measure would the nurse take to obtain the most accurate baseline FHR? - record or monitor a 10-minute segment of tracing - include periods of marked variability in the segment - include episodic changes in the segment of tracing - obtain at least 5 min of interpretable data in the segment
record or monitor a 10-minute segment of tracing
When assessing uterine activity, the nurse is aware of which consideration? - the examiner's hand should be placed on the fundus before, during, and after contractions - the frequency and duration of contractions are measured in seconds for consistency - contraction intensity is given a judgement number of 1 to 7 by the nurse and client together - the resting tone between contractions is described as either placid or turbulent
the examiner's hand should be placed on the fundus before, during, and after contractions
When caring for a nulliparous client in labor, the nurse knows that the experience for a nulliparous client is different from that of a multiparous client in which way? - the nulliparous client experiences less sensory pain during early labor - the nulliparous client experiences greater sensory pain in the second stage of labor - the nulliparous client experiences greater fatigue as a result of longer duration of labor - the nulliparous client experiences greater affective pain in the second stage of labor
the nulliparous client experiences greater fatigue as a result of longer duration of labor
Which are characteristics of the second stage of labor? select all that apply - the second stage is the stage in which the infant is born - in this stage, the birthing table is usually set up for the nulliparous client - the progress of labor is enhanced when the client changes position frequently during this stage of labor - this stage begins with full cervical dilation (10cm) and complete effacement (100%) and ends with the baby's birth - the force exerted by uterine contractions, gravity, and maternal bearing-down efforts facilitates achievement of the expected outcome of a spontaneous, uncomplicated vaginal birth - the median duration of this stage of labor is 50 to 60 min in nulliparous clients and 20 to 30 min in multiparous clients
the second stage is the stage in which the infant is born this stage begins with full cervical dilation (10cm) and complete effacement (100%) and ends with the baby's birth the force exerted by uterine contractions, gravity, and maternal bearing-down efforts facilitates achievement of the expected outcome of a spontaneous, uncomplicated vaginal birth the median duration of this stage of labor is 50 to 60 min in nulliparous clients and 20 to 30 min in multiparous clients
What is the primary difference between the labor of a nullipara and that of a multipara? - total duration of labor - amount of cervical dilatation - level of pain experienced - sequence of labor mechanisms
total duration of labor
Which stage of labor is indicated for a client who has been laboring for several hours, whose cervix is dilated 9 cm, and who is having strong uterine contractions, each lasting 45 to 90 seconds? - latent phase of the first stage of labor - active phase of the first stage of labor - active stage of the second phase of labor - transition phase of the first stage of labor
transition phase of the first stage of labor
The nurse is monitoring the fetal status of a client in labor. Which are causes that can lead to a decrease in fetal oxygen supply? select all that apply. - maternal obesity - umbilical cord prolapse - supine maternal position - increase in blood volume - excessive exogenous oxytocin
umbilical cord prolapse supine maternal position excessive exogenous oxytocin
The nurse is monitoring the client's FHR and notices late decelerations associated with uterine contractions, including a gradual decrease in and return to baseline. To which condition would the nurse attribute this pattern? - fundal pressure - uteroplacental insufficiency - vaginal examination - fetal scalp simulation
uteroplacental insufficiency