OB Exam 3 (Chapters 21, 22)

The nurse is caring for a client after experiencing a placental abruption (abruptio placentae). Which finding is the priority to report to the health care provider? Hematocrit of 36% 45 mL urine output in 2 hours Hemoglobin of 13 g/dL Platelet count of 150,000 mm3

45 mL urine output in 2 hours

A client has been admitted with placental abruption (abruptio placentae). She has lost 1,200 ml of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? Grade 2 Grade 1 Grade 3 Grade 4

Grade 2

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? Supine Side-lying Sitting Knee-chest

Knee-chest

A mother who had a cesarean delivery with her second child wishes to deliver her third baby vaginally. The nurse prepares the mother for an induction of labor. Because of the previous cesarean birth the nurse knows which classification of drugs will not be used in the induction process? Prostaglandins Oxytocin Ergot alkaloids Laminaria

Prostaglandins

The nursing student demonstrates an understanding of dystocia with which statement? "Dystocia is diagnosed at the start of labor." "Dystocia is not diagnosed until after the birth." "Dystocia is diagnosed after labor has progressed for a time." "Dystocia cannot be diagnosed until just before birth."

"Dystocia is diagnosed after labor has progressed for a time."

The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? Shorter dilation stage of labor Experience of additional back pain Need to have the baby manually rotated Necessity for vacuum extraction for birth

Experience of additional back pain

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? Fetal heart tones Signs of shock Infection Uterine stabilization

Fetal heart tones

A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: Longer length of labor Increased number of overall pregnancies Increasing birth weight Poor quality of prenatal care

Increasing birth weight

A client is experiencing dysfunctional labor that is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this client? Oxytocin therapy Fluid replacement Pain management Increasing activity

Oxytocin therapy

During a difficult labor of an infant in the face presentation, the nurse notes the infant has a large amount of facial edema with bruising and ecchymosis. Which assessment would be the priority for this infant? Ability to arch the eyebrows Patent airway Ability to swallow fluids Palpation of the anterior fontanels

Patent airway

A multigravida client at 31 weeks' gestation is admitted with confirmed preterm labor. As the nurse continues to monitor the client now receiving magnesium sulfate, which assessment findings will the nurse prioritize and report immediately to the RN or health care provider? Low potassium or elevated glucose, tachycardia, chest pain Respiratory depression, hypotension, absent tendon reflexes Severe lower back pain, leg cramps, sweating Pain in the abdomen, shoulder, or back

Respiratory depression, hypotension, absent tendon reflexes

The nurse is caring for a client who underwent a cesarean birth one day ago. After listening to the nurse's discussion about the plan of care, the client indicates that she is in a great deal of pain and does not wish to ambulate until the next day. What response by the nurse is most appropriate? "If you do not get up to walk you will not recover." "Walking is the best way to prevent complications such as blood clots." "As long as you walk more tomorrow to make up for the delay in walking today you should be fine." "Maybe you will feel better after you take pain medication."

"Walking is the best way to prevent complications such as blood clots."

The diabetic mother has been in active labor for 9 hours and has only reached 3 cm dilation (dilatation). It has been determined by ultrasound the fetus is very large. The decision has been made to deliver the fetus via cesarean. How much time does the nurse have to prepare the client before the surgery begins? 15 minutes 30 minutes 45 minutes 60 minutes

30 minutes

Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? Make sure the epidural medication is turned down Check for a full bladder Make sure the client is lying on her left side Assess vital signs every 30 minutes

Check for a full bladder

The nurse provides education to a postterm pregnant client. What information will the nurse include to assist in early identification of potential problems? Increase fluid intake to prevent dehydration Be sure to measure 24-hr urine output daily Continue to monitor fetal movements daily Monitor your bowel movements for constipation

Continue to monitor fetal movements daily

A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration? First degree Second degree Third degree Fourth degree

Fourth degree

Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor? Macrosomia Gestational hypertension Gestational diabetes Low parity

Gestational hypertension

The mother comes to her prenatal appointment. She tells the nurse that it feels like the baby is kicking on her bladder and it is harder to breathe. The nurse suspects the fetus is in breech position. Which procedure would the nurse implement to determine the position of the baby? Leopold maneuvers McRoberts maneuver Rubin maneuver Gaskin maneuver

Leopold maneuver

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? Hemorrhage Macrosomia Infection Dystocia

Macrosomia

Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. Which maneuver is first attempted to deliver an infant with shoulder dystocia? McDonald maneuver McGeorge maneuver McRoberts maneuver McRonald maneuver

McRoberts maneuver

A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? Preterm labor Normal labor Dystocia Precipitate labor

Preterm labor

The nurse is assisting with a vaginal birth. The client is fully dilated, 100% effaced, and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus? Shoulder dystocia Umbilical cord prolapse Nuchal cord Breech position

Shoulder dystocia

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? Bradypnea Sudden shortness of breath Bradycardia Unrelieved pain

Sudden shortness of breath

A laboring client is experiencing dysfunctional labor or dystocia due to the malfunction of one or more of the "four Ps" of labor. Which scenario best illustrates a power problem? The fetus is macrosomic The mother is fighting the contractions The mother has a small pelvic opening Uterine contractions are weak and ineffective

Uterine contraction are weak and ineffective

A G2P1 woman is in labor attempting a VBAC, when she suddenly complains of light-headedness and dizziness. An increase in pulse and decrease in blood pressure is noted as a change from the vital signs obtained 15 minutes prior. The nurse should investigate further for additional signs or symptoms of which complication? Uterine rupture Hypertonic uterus Placenta previa Umbilical cord compression

Uterine rupture

The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? 11 7 5 3

11

A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? 2-7 days 1-5 days 6-10 days 4-8 days

2-7 days

Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? "I will make handprints and footprints of the baby for you to keep." "I know you are hurting, but you can have another baby in the future." "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" "Have you named your baby yet? I would like to know your baby's name."

"I know you are hurting, but you can have another baby in the future."

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses "arrest of labor." The woman asks, "Why is this happening?" Which response is the best answer to this question? "Maybe your uterus is just tired and needs a rest." "It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby." "Maybe your baby has developed hydrocephaly and the head is too swollen." "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to: Administer oxygen by mask Increase her intravenous fluid infusion rate Put firm pressure on the fundus of her uterus Tell the woman to take short, catchy breaths

Administer oxygen by mask

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? Breast stimulation Amniotomy Laminaria Prostaglandin

Amniotomy

A nurse suspects that a client may be developing disseminated intravascular coagulation. The woman has a history of placental abruption (abruptio placentae) during birth. Which finding would help to support the nurse's suspicion? Severe uterine pain Board-like abdomen Appearance of petechiae Inversion of the uterus

Appearance of petechiae

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? Assess fetal heart sounds Place the woman in Trendelenburg position Administer oxygen at 10 L/min by face mask Administer amino infusion

Assess fetal heart sounds

The nurse instructs the pregnant mother that it will necessary to collect swabs for group B streptococcus at which prenatal visit? 32 weeks gestation 34 weeks gestation 36 weeks gestation 38 weeks gestation

36 weeks gestation

A laboring woman is receiving oxytocin IV to augment her labor and 2 hours later begins having contractions every 2 minutes lasting 60 to 90 seconds each with little, if any, rest time in between the contractions. At this time, which interventions would be the priority for the nurse caring for this client? Select all that apply. Administer betamethasone to mature the fetal lungs Ask the woman to drink 32 ounces (1 L) of water Discontinue the oxytocin infusion Administer an IV bolus of fluids Apply oxygen to the woman via mask at 8-10 L/min

Discontinue the oxytocin infusion Administer an IV bolus of fluids Apply oxygen to the woman via mask at 8-10 L/min

A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds that can prolong labor. The nurse is referring to which compounds? Prostaglandins Catecholamines Oxytocin Relaxin

Catecholamines

A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn? Asphyxia Clavicular fracture Cephalohematoma Central nervous system injury

Cephalohematoma

A nurse is providing care to a client at 32 weeks' gestation who is being evaluated for preterm labor. The client reports having mild uterine contractions every 6 to 8 minutes over the past 2 hours. A sterile speculum examination reveals the findings listed below. Which assessment finding is most indicative of preterm labor? Blood at cervical os Cervical dilation of 3 cm A positive fetal fibronectin test A shortened cervix

Cervical dilation of 3 cm

When planning the care of a client scheduled for induction of labor with exogenous oxytocin, the nurse should make which assessment? Fetal heart rate Cervical ripening Vaginal discharge Fundal height

Cervical ripening

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? Lack of cervical dilation past 2 cm Fetal buttocks as the presenting part Reports of severe back pain Contractions most forceful in the middle of uterus rather than the fundus

Contractions most forceful in the middle of uterus rather than the fundus

A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth? Fetal hydrocephalus Macrosomia Cord compression Should dystocia

Cord compression

A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position? Cord prolapse Uterine atony Placental abruption (abruptio placentae) Brachial plexus injury

Cord prolapse

A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the client is likely to increase the risk for shoulder dystocia? Diabetes Preterm birth Nullipara Pendulous abdomen

Diabetes

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? A low-lying placenta Fetopelvic disproportion Contraction ring Uterine bleeding

Fetopelvic disproportion

The fetus of a pregnant client is in a breech presentation. Where will the nurse auscultate fetal heart sounds? Low in the abdomen Left lateral abdomen High in the abdomen Right lateral abdomen

High in the abdomen

A pregnant client receiving intravenous oxytocin for 1 hour has contractions lasting 85 seconds. What should the nurse do first for this client? Discontinue the oxytocin infusion Slow the infusion to below 10 gtt/minute Increase the flow rate of the main line infusion Continue to monitor contraction duration every 2 hours

Discontinue the oxytocin infusion

A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? Hypotonic contractions Hypertonic contractions Uncoordinated contractions Braxton Hicks contractions

Hypotonic contractions

A nurse is describing the risks associated with post-term pregnancies as part of an in-service presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems concerning the fetus? Aging of the placenta Increased amniotic fluid volume Meconium aspiration Cord compression

Increased amniotic fluid volume

A woman in labor is having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. What is the highest priority fetal assessment the health care provider should focus on at this time? Monitor heart rate for tachycardia Monitor fetal movements to ensure they are neurologically intact Look for late decelerations on monitor, which is associated with fetal anoxia Monitor fetal blood pressure for signs of shock (low BP, high FHR)

Look for late decelerations on monitor, which is associated with fetal anoxia

A pregnant client tells the nurse that she hopes the baby is not in the breech position because she has heard that this causes difficult labor. What should the nurse include when explaining the reasons for this presentation to the client? Select all that apply. Multiple fetuses Maternal diabetes Fetal birth defects Lax abdominal muscles Fetal age less than 40 weeks

Multiple fetuses Fetal birth defects Lax abdominal muscles Fetal age less than 40 weeks

Four hours after giving birth a mother suddenly complains of not being able to breathe and is gasping for breath. The nurse administers oxygen and calls for help. Which type of oxygen delivery device would be most appropriate for the nurse to utilize? Nonrebreather mask Venturi mask Face mask Nasal cannula

Nonrebreather mask

A woman presents at Labor and Delivery very upset. She reports that she has not felt her baby moving for the last 6 hours. The nurse listens for a fetal heart rate and cannot find a heartbeat. An ultrasound confirms fetal death and labor induction is started. What intervention by the nurse would be appropriate for this mother at this time? Explain to her that there was probably something wrong with the infant and that is why it died Offer to take pictures and footprints of the infant once it is delivered Call the hospital chaplain to talk to the parents Recommend that she not hold the infant after it is delivered so as to not upset her more

Offer to take pictures and footprints of the infant once it is delivered

A woman in labor for over 12 hours has made very little progress. The health care provider thinks that her contractions lack the force needed to propel the infant downward through the birth canal. The provider asks a group of nursing students which hormone may need to be given to increase the force of the contraction. Which hormone would be the best answer? Antidiuretic hormone, a posterior pituitary hormone Oxytocin, a posterior pituitary hormone Luteinizing hormone, an anterior pituitary hormone Growth hormone, an anterior pituitary hormone

Oxytocin, a posterior pituitary hormone

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placenta previa causes painful, dark red vaginal bleeding during pregnancy Placenta previa is an abnormally implanted placenta that is too close to the cervix Placental abruption results in painless, bright red vaginal bleeding during labor Placental abruption requires "watchful waiting" during labor and birth

Placenta previa is an abnormally implanted placenta that is too close to the cervix

A nurse is reviewing a postpartum woman's history and labor and birth record. The nurse determines the need to closely monitor this client for infection based on which factor? Labor less than 3 hours Hemoglobin of 11. 5 mg/dL Placenta removed via manual extraction Multiparity

Placenta removed via manual extraction

The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss? Genetic abnormality Premature rupture of membranes Preeclampsia Placental abruption

Placental abruption

The nurse is caring for a laboring mother experiencing a precipitous delivery. The nurse would assess the mother for symptoms of which complication? Placental abruption (abruptio placentae) Prolapsed cord Fetal hypoglycemia Poor APGAR scores

Placental abruption (abruptio placentae)

A client has arrived at the labor and delivery suite for a scheduled induction of labor. Which nursing intervention will the nurse implement before starting the oxytocin infusion? Assessing the client's lung sounds Placing on a tocodynamometer Obtaining a urine specimen Completing an ultrasound

Placing on a tocodynamometer

A client at 7 months' gestation presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This client is showing clinical signs of which of the following? Precipitous labor Premature rupture of membranes Dystocia All of the above

Premature rupture of membranes

A 39-year-old multigravida with diabetes presents at 32 weeks' gestation reporting she has not felt movement of her fetus. Assessment reveals the fetus has died. The nurse shares with the mother that the institution takes pictures after the birth and asks if she would like one. What is the best response if the mother angrily says no and starts crying? Apologize and tell her that the photos will be destroyed immediately Console her with the fact that she has other children Tell her that the hospital will keep the photos for her in case she changes her mind Tell her that once she gets over her shock and grief, she will probably be happy to have the photos

Tell her that the hospital will keep the photos for her in case she changes her mind

A nurse is providing care to a postpartum client who had a placental abruption and has now become tachycardic with a thready pulse. The client also has moderate to heavy vaginal bleeding. Laboratory testing reveals anemia, thrombocytopenia, and altered liver function tests. The health care team suspects the client is developing disseminated intravascular coagulation (DIC). Which assessment finding is most indicative of DIC? Vaginal bleeding Tachycardia Altered liver function Thrombocytopenia

Thrombocytopenia

The nurse is assisting the mother to push. The nurse suspects shoulder dystocia is present when which symptom is present? Turtle sign Continuous "0 station" Battle sign Continuous back pain

Turtle sign

A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. The nurse should immediately check the client for: Amniotic fluid infection Amniotic fluid embolus Umbilical cord prolapse Placental abruption (abruptio placentae)

Umbilical cord prolapse

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? Fetal heart rate of 150 BPM Contractions every 2 minutes, lasting 45 seconds Uterine resting tone of 14 mm Hg Urine output of 20 mL/hr

Urine output of 20 mL/hr

A mother has delivered her baby vaginally in the occiput posterior position. When the mother holds her new baby she cries because she fears there is something seriously wrong. What reassurance can the nurse give the mother about her baby? "The bruising and swelling will resolve in about 48 hours." "His head shape is from the birth canal and it will resolve in about 2 weeks." "Most of the time there is no problem but we will have the pediatrician examine your baby." "Your baby is crying well so he is fine and you don't have to worry."

"The bruising and swelling will resolve in about 48 hours."

A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: 5 6 7 8

5

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor? If the woman has a full bladder, labor may be uncomfortable for her If the woman's bladder is distended, it may rupture A full bladder or rectum can impede fetal descent A full rectum can cause diarrhea.

A full bladder or rectum can impede fetal descent

A client at 22 weeks' gestation with painless vaginal bleeding is diagnosed with placenta previa. Which treatment(s) will the nurse reinforce with the client? Select all that apply. Avoid exercise Avoid sexual intercourse Take steroids as prescribed Have routine digital examinations Seek care if bleeding or contractions occur

Avoid exercise Avoid sexual intercourse Seek care if bleeding or contractions occur

The nurse in a busy L & D unit is caring for a woman beginning induction via oxytocin drip. Which prescription should the nurse question with regard to titrating the infusion upward for adequate contractions? Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate Start oxytocin drip, piggyback to main IV line to port closest to client Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each.

Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min

The nurse is caring for a laboring mother who is making little progress with cervical dilation (dilatation). The mother is very anxious and tense. How can the nurse best help this mother? Provide support Provide pain medication Reposition the mother Teach breathing techniques

Provide support

A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect? Amniotic fluid embolism Shoulder dystocia Uterine rupture Umbilical cord prolapse

Uterine rupture

The nurse is caring for a mother laboring with her third baby. Suddenly the nurse notes severe fetal bradycardia and the mother becomes hypotensive. For which emergent complication should the nurse direct care to the mother? Uterine rupture Placental abruption Fetal distress Amniotic embolism

Uterine rupture