Test 2 General questions

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: A. 1 cm above the ischial spine B. 1 fingerbreadth below the symphysis pubis C. 1 inch below the coccyx D. 1 inch below the iliac crest

Correct Answer: A. 1 cm above the ischial spine Station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, is measured in centimeters, and is noted as a negative number above the line and a positive number below the line. At -1 station, the fetal presenting part is 1 cm above the ischial spines. Option B: The doctor will assign a number from -5 to +5 to describe where the baby is in relation to the ischial spines. The ischial spines are bony protrusions located in the narrowest part of the pelvis. During a vaginal exam, the doctor will feel for the baby's head. If the head is high and not yet engaged in the birth canal, it may float away from their fingers. Option C: When the baby's head is level with the ischial spines, the fetal station is zero. Once the baby's head fills the vaginal opening, just before birth, the fetal station is +5. Option D: Usually about two weeks before delivery, the baby will drop into the birth canal. This is called being "engaged." At this point, the baby is at station 0. This drop into the birth canal is called a lightening.

In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh-negative, the nurse must: A. Administer RhoGAM within 72 hours. B. Make certain she receives RhoGAM on her first clinic visit. C. Not give RhoGAM, since it is not used with the birth of a stillborn. D. Make certain the client does not receive RhoGAM since the gestation only lasted 12 weeks.

Correct Answer: A. Administer RhoGAM within 72 hours. RhoGAM is given within 72 hours postpartum if the client has not been sensitized already. When the blood of an Rh-positive fetus gets into the bloodstream of an Rh-negative woman, her body will recognize that the Rh-positive blood is not hers. Her body will try to destroy it by making anti-Rh antibodies. These antibodies can cross the placenta and attack the fetus's blood cells. This can lead to serious health problems, even death, for a fetus or a newborn. Option B: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. RhoGAM is administered by intramuscular (IM) injection. RhoGAM is purified from human plasma containing anti-Rh (anti-D). Option C: The doctor will administer at least one dose of RhoGAM between 26 and 28 weeks of pregnancy. If the baby is found to be Rh-positive at birth, the mother will receive an additional dose within 72 hours after delivery. Option D: 1 Rh-negative pregnant woman in 5 will become sensitive to the Rh-positive factor if she doesn't receive RhoGAM. That means that her baby can be born with one or more of the following things: anemia, a lack of healthy red blood cells. heart failure.

When monitoring the fetal heart rate of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be documented as: A. An acceleration B. An early elevation C. A sonographic motion D. A tachycardic heart rate

Correct Answer: A. An acceleration An acceleration is an abrupt elevation above the baseline of 15 beats per minute for 15 seconds; if the acceleration persists for more than 10 minutes it is considered a change in baseline rate. A tachycardic FHR is above 160 beats per minute. Option B: Increased variability in the baseline FHR is present when the oscillations exceed 25 bpm. This pattern is sometimes called a saltatory pattern and is usually caused by acute hypoxia or mechanical compression of the umbilical cord. This pattern is most often seen during the second stage of labor. The presence of a saltatory pattern, especially when paired with decelerations, should warn the physician to look for and try to correct possible causes of acute hypoxia and to be alert for signs that the hypoxia is progressing to acidosis. Although it is a nonreassuring pattern, the saltatory pattern is usually not an indication for immediate delivery. Option C: Auscultation of the fetal heart rate (FHR) is performed by external or internal means. External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the FHR during a uterine contraction and for 30 seconds thereafter to identify fetal response. The transducer uses Doppler ultrasound to detect fetal heart motion and is connected to an FHR monitor. The monitor calculates and records the FHR on a continuous strip of paper. Option D: Fetal tachycardia is defined as a baseline heart rate greater than 160 bpm and is considered a nonreassuring pattern. Tachycardia is considered mild when the heart rate is 160 to 180 bpm and severe when greater than 180 bpm. Tachycardia greater than 200 bpm is usually due to fetal tachyarrhythmia or congenital anomalies rather than hypoxia alone.

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? A. Calcium gluconate B. Hydralazine (Apresoline) C. Narcan D. RhoGAM

Correct Answer: A. Calcium gluconate. Calcium gluconate is the antidote for magnesium toxicity. Ten ml of 10% calcium gluconate is given IV push over 3-5 minutes. Hydralazine is given for sustained elevated blood pressures in preeclamptic clients. Option B: Hydralazine is used to treat high blood pressure. Hydralazine is in a class of medications called vasodilators. It works by relaxing the blood vessels so that blood can flow more easily through the body. Option C: Narcan (naloxone) is an opioid antagonist used for the complete or partial reversal of opioid overdose, including respiratory depression. Narcan is also used for diagnosis of suspected or known acute opioid overdose and also for blood pressure support in septic shock. Narcan is available in generic form. Option D: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood.

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? A. Document the findings and tell the mother that the monitor indicates fetal well-being. B. Take the mother's vital signs and tell the mother that bed rest is required to conserve oxygen. C. Notify the physician or nurse-midwife of the findings. D. Reposition the mother and check the monitor for changes in the fetal tracing.

Correct Answer: A. Document the findings and tell the mother that the monitor indicates fetal well-being. Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve. Option B: Inform the mother that they are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation. The presence of accelerations is considered a reassuring sign of fetal well-being. Option C: Accelerations are the basis for the nonstress test (NST). The presence of at least two accelerations, each lasting for 15 or more seconds above baseline and peaking at 15 or more bpm, in a 20-minute period is considered a reactive NST. Option D: The FHR is controlled by the autonomic nervous system. The inhibitory influence on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is conveyed by the sympathetic nervous system. Progressive vagal dominance occurs as the fetus approaches term and, after birth, results in a gradual decrease in the baseline FHR. Stimulation of the peripheral nerves of the fetus by its own activity (such as movement) or by uterine contractions causes acceleration of the FHR.

Which of the following observations indicates fetal distress? A. Fetal scalp pH of 7.14 B. Fetal heart rate of 144 beats/minute C. Acceleration of fetal heart rate with contractions D. Presence of long-term variability

Correct Answer: A. Fetal scalp pH of 7.14 A fetal scalp pH below 7.25 indicates acidosis and fetal hypoxia. Fetal response to oxygen deprivation is regulated by the autonomic nervous system, mediated by parasympathetic and sympathetic mechanisms. The fetus is equipped with compensatory mechanisms for transient hypoxia during labor, but prolonged, uninterrupted fetal hypoxia may lead progressively to acidosis with cell death, tissue damage, organ failure and potentially death. Option B: The fetal heart rate changes markedly in response to prolonged oxygen deprivation, making fetal heart rate monitoring a potentially valuable and commonly used tool for assessing fetal oxygenation status in real-time. Non-reassuring fetal heart rate patterns are observed in approximately 15% of labors Option C: While accelerations are associated with fetal well-being, decelerations, especially prolonged bradycardia, late decelerations, and severe variable decelerations are indicative of fetal stress and should prompt the clinician to evaluate and initiate intrauterine resuscitation with consideration for delivery of the fetus as indicated. Option D: Abnormal fetal heart rate patterns have high sensitivity, but low specificity and low predictive value to discriminate between neonates with or without metabolic acidosis. While a normal fetal heart rate pattern usually indicates reassuring fetal status, an abnormal fetal heart rate pattern does not necessarily equate with hypoxia or acidosis.

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: A. Not yet engaged B. Entering the pelvic inlet C. Below the ischial spines D. Visible at the vaginal opening

Correct Answer: C. Below the ischial spines A station of +1 indicates that the fetal head is 1 cm below the ischial spines. Positive numbers are used when a baby has descended beyond the ischial spines. During birth, a baby is at the +4 to +5 station. Option A: During a vaginal exam, the doctor will feel for the baby's head. If the head is high and not yet engaged in the birth canal, it may float away from their fingers. Option B: When the baby's head is level with the ischial spines, the fetal station is zero. Once the baby's head fills the vaginal opening, just before birth, the fetal station is +5. Option D: Usually about two weeks before delivery, the baby will drop into the birth canal. This is called being "engaged." At this point, the baby is at station 0. This drop into the birth canal is called a lightening.

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? A. Swelling of the calf in one leg B. Prolonged clotting times C. Decreased platelet count D. Petechiae, oozing from injection sites, and hematuria

Correct Answer: A. Swelling of the calf in one leg DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Swelling and pain in the calf of one leg are more likely to be associated with thrombophlebitis. Option B: Fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. Derangement of the fibrinolytic system further contributes to intravascular clot formation, but in some cases, accelerated fibrinolysis may cause severe bleeding. Hence, a patient with DIC can present with a simultaneously occurring thrombotic and bleeding problem, which obviously complicates the proper treatment. Option C: Platelets are decreased because they are consumed by the process; coagulation studies show no clot formation (and are thus normal to prolong). Exposure to tissue factor (TF) in the circulation occurs via endothelial disruption, tissue damage, or inflammatory or tumor cell expression of procoagulant molecules (including TF). TF activates coagulation via the extrinsic pathway involving factor VIIa. The TF-VIIa complex activates thrombin, which cleaves fibrinogen to fibrin while simultaneously causing platelet aggregation.. Option D: The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC. With acute DIC, the physical findings are usually those of the underlying or inciting condition; however, patients with the acute disease (ie, the hemorrhagic variety associated with excess plasmin formation) have petechiae on the soft palate, trunk, and extremities from thrombocytopenia and ecchymosis at venipuncture sites. These patients also manifest ecchymosis in traumatized areas.

Which of the following fetal positions is most favorable for birth? A. Vertex presentation B. Transverse lie C. Frank breech presentation D. Posterior position of the fetal head

Correct Answer: A. Vertex presentation Vertex presentation (flexion of the fetal head) is the optimal presentation for passage through the birth canal. Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the position of a fetus is facing rearward (toward the woman's back) with the face and body angled to one side and the neck flexed, and presentation is head first. Option B: Transverse lie is an unacceptable fetal position for vaginal birth and requires a C-section. In transverse lie, the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina. Option C: Frank breech presentation, in which the buttocks present first, can be a difficult vaginal delivery. When delivered vaginally, babies that present buttocks first are more likely to be injured than those that present head first. Such injuries may occur before, during, or after birth. The baby may even die. Complications are less likely when breech presentation is detected before labor or delivery. Option D: Posterior positioning of the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis. In occiput posterior presentation (also called sunny-side up), the fetus is head first but is facing up (toward the mother's abdomen). It is the most common abnormal position or presentation. When a fetus faces up, the neck is often straightened rather than bent, and the head requires more space to pass through the birth canal. Delivery by a vacuum extractor or forceps or cesarean delivery may be necessary.

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? A. Identifying the types of accelerations B. Assessing the baseline fetal heart rate C. Determining the frequency of the contractions D. Determining the intensity of the contractions

Correct Answer: B. Assessing the baseline fetal heart rate Assessing the baseline fetal heart rate is important so that abnormal variations of the baseline rate will be identified if they occur. Options 1 and 3 are important to assess, but not as the first priority. Option A: The FHR recordings may be interpreted as reassuring, nonreassuring or ominous, according to the pattern of the tracing. Reassuring patterns correlate well with a good fetal outcome, while nonreassuring patterns do not. Evaluation of fetal well-being using fetal scalp stimulation, pH measurement, or both, is recommended for use in patients with nonreassuring patterns. Option C: Frequency is based on the time between the start of one contraction and the start of the next contraction. Time the frequency of contractions by noting the time when one contraction starts and the time when the next contraction starts. Option D: The intensity of the contractions can be estimated by touching the uterus. The relaxed or mildly contracted uterus usually feels about as firm as a cheek, a moderately contracted uterus feels as firm as the end of the nose, and a strongly contracted uterus is as firm as the forehead.

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? A. Bowel perforation B. Electrolyte imbalance C. Miscarriage D. Pregnancy induced hypertension (PIH)

Correct Answer: B. Electrolyte imbalance. Excessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid, electrolyte, and acid-base imbalances. Severe hyperemesis requiring hospital admission occurs in 0.3-2% of pregnancies. Option A: Gastrointestinal perforation (GP) occurs when a hole forms all the way through the stomach, large bowel, or small intestine. It can be due to a number of different diseases, including appendicitis and diverticulitis. It can also be the result of trauma, such as a knife wound or gunshot wound. Option C: Most miscarriages occur because the fetus isn't developing normally. About 50 percent of miscarriages are associated with extra or missing chromosomes. Most often, chromosome problems result from errors that occur by chance as the embryo divides and grows — not problems inherited from the parents. Option D: Gestational hypertension refers to hypertension with onset in the latter part of pregnancy (>20 weeks' gestation) without any other features of preeclampsia, and followed by normalization of the blood pressure postpartum. Of women who initially present with apparent gestational hypertension, about one third develops the syndrome of preeclampsia.

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: A. Above the umbilicus at the midline B. Above the umbilicus on the left side C. Below the umbilicus on the right side D. Below the umbilicus near the left groin

Correct Answer: C. Below the umbilicus on the right side Fetal heart tones are best auscultated through the fetal back; because the position is ROP (right occiput presentation), the back would be below the umbilicus and on the right side. Option A: The baby's heartbeat is loudest in its upper chest or upper back, depending on which way the baby is facing. Option B: If you hear the heartbeat loudest above the mother's umbilicus, the baby may be in the breech position Option D: If you hear the heartbeat loudest below the mother's umbilicus, the baby is probably head down.

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? A. Hypotonic contractions B. Forceps delivery C. Schultz delivery D. Weak bearing down efforts

Correct Answer: B. Forceps delivery. Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and shoulder dystocia can place a woman at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing down efforts do not alone add to the risk of rupture because they do not add to the stress on the uterine wall. Option A: Phelan et al found that abnormal patterns of uterine activity, such as tetany and hyperstimulation, are often not associated with uterine rupture. In their study, in which monitoring of uterine activity was limited to external tocodynamometry, tetany was defined as a contraction lasting longer than 90 seconds, and hyperstimulation was defined as more than 5 contractions in 10 minutes. Option C: The separation of the placenta from the uterine wall during labor; it begins at the placental center and leads to an expulsion of the placenta after delivery of the baby. Option D: Rodriguez et al found that the usefulness of intrauterine pressure catheters (IUPCs) for diagnosing uterine rupture was not supported. In 76 cases of uterine rupture, the classic description of decreased uterine tone and diminished uterine activity was not observed in any patients, 39 of whom had IUPCs in place. In addition, rates of fetal and maternal morbidity and mortality associated with uterine rupture did not differ with the use of an IUPC compared with external tocodynamometry.

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: A. Less pressure on her cervix B. Increased efficiency of contractions C. Decreased number of contractions D. The need for increased maternal blood pressure monitoring

Correct Answer: B. Increased efficiency of contractions Amniotomy can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the process begins to slow. Rupturing of membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. Option A: Amniotomy is usually performed for the purpose of inducing or expediting labor or in anticipation of the placement of internal monitors (uterine pressure catheters or fetal scalp electrodes). It is typically done at the bedside in the labor and delivery suite. Option C: It is commonly felt that relieving the amniotic sac of amniotic fluid induces uterine contraction activity, increases the strength of contractions, and may augment labor by allowing direct pressure from the fetal scalp on the uterine cervix which may assist in dilating the cervix. Option D: The nurse has a very important rule in the assessment and continuous monitoring of pregnant women in labor. The nurse should be very vigilant and report any untoward change in the hemodynamic status of the pregnant woman to the clinician at all times.

A nurse explains the purpose of effleurage to a client in early labor. The nurse tells the client that effleurage is: A. A form of biofeedback to enhance bearing down efforts during delivery. B. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus. C. The application of pressure to the sacrum to relieve a backache. D. Performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest.

Correct Answer: B. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus. Effleurage is a specific type of cutaneous stimulation involving light stroking of the abdomen and is used before a transition to promote relaxation and relieve mild to moderate pain. Effleurage provides tactile stimulation to the fetus. Option A: Women using biofeedback during childbirth reported significantly lower pain: from admission to labor and delivery, at delivery, and 24-hr postpartum. Also, women in the biofeedback group labored an average of 2 hr less and used 30% fewer medications. The results of a study suggest that EMG biofeedback may be effective in reducing levels of acute pain experienced by childbearing women. Option C: Low back pain in pregnancy is generally ascribed to the many changes in load and body mechanics that occur during the carrying of a child. It is normal to gain between 20 and 40 pounds during pregnancy. This clearly shifts the body's center of gravity anteriorly and increases the moment arm of forces applied to the lumbar spine. Option D: The primary hormones involved include estrogen, progesterone, and oxytocin. Oxytocin is one of the most widely studied hormones involved in uterine contractions. It decreases Ca2+ efflux, by inhibiting the Ca2+/ATPase of the myometrial cell membrane which pumps calcium from the inside to the extracellular space, and increases Ca2+ influx, as well as causes the release of Ca2+ from the SR via IICR.

During the period of induction of labor, a client should be observed carefully for signs of: A. Severe pain B. Uterine tetany C. Hypoglycemia D. Umbilical cord prolapse

Correct Answer: B. Uterine tetany. Uterine tetany could result from the use of oxytocin to induce labor. Because oxytocin promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion must be stopped to prevent uterine rupture and fetal compromise. Option A: Women being offered induction of labor should be informed that induced labor is likely to be more painful than spontaneous labor. During the induction of labor, healthcare professionals should provide women with the pain relief appropriate for them and their pain. Option C: Since people with GDM and their babies are at increased risk of pregnancy complications, some care providers encourage women with GDM to plan an early birth (usually elective induction) at or near term instead of waiting for labor to start on its own. Option D: Umbilical cord prolapse is an uncommon but potentially fatal obstetric emergency. When this occurs during labor or delivery the prolapsed cord is compressed between the fetal presenting part and the cervix. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.

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? A. Early decelerations B. Variable decelerations C. Late decelerations D. Short-term variability

Correct Answer: B. Variable decelerations Variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus. Pressure on the cord initially occludes the umbilical vein, which results in an acceleration (the shoulder of the deceleration) and indicates a healthy response. This is followed by occlusion of the umbilical artery, which results in a sharp downslope. Finally, the recovery phase is due to the relief of the compression and the sharp return to the baseline, which may be followed by another healthy brief acceleration or shoulder Option A: Early decelerations result from pressure on the fetal head during a contraction. This type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction. Thus, it has the characteristic mirror image of the contraction Option C: Late decelerations are an ominous pattern in labor because it suggests uteroplacental insufficiency during a contraction. A late deceleration is a symmetric fall in the fetal heart rate, beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction has ended. The descent and return are gradual and smooth. Regardless of the depth of the deceleration, all late decelerations are considered potentially ominous. Option D: Short-term variability refers to the beat-to-beat range in the fetal heart rate. The FHR is under constant variation from the baseline. This variability reflects a healthy nervous system, chemoreceptors, baroreceptors, and cardiac responsiveness. Prematurity decreases variability; therefore, there is little rate fluctuation before 28 weeks. Variability should be normal after 32 weeks.

The nurse observes the client's amniotic fluid and decides that it appears normal, because it is: A. Clear and dark amber in color B. Milky, greenish yellow, containing shreds of mucus C. Clear, almost colorless, and containing little white specks D. Cloudy, greenish-yellow, and containing little white specks

Correct Answer: C. Clear, almost colorless, and containing little white specks. By 36 weeks gestation, normal amniotic fluid is colorless with small particles of vernix caseosa present. Amniotic fluid is usually clear to pale yellow in color. It should be odorless, or slightly sweet in odor—although some say it has a bleach-like smell. Option A: Dark fluid can also be seen with an intrauterine fetal demise (IUFD) when the fetus has died during pregnancy. Option B: In full-term or near-term pregnancies, green or brown fluid may indicate the baby has had a bowel movement (meconium), which contributes to the color change. This can be an indication of a baby in distress or simply that the pregnancy has extended enough for the baby to pass that first stool in utero. Option D: The amniotic fluid may also be blood-tinged, especially during labor, if the cervix has started dilating, or if there are placental problems.

A laboring client is to have a pudendal block. The nurse plans to tell the client that once the block is working, she: A. Will not feel the episiotomy B. May lose bladder sensation C. May lose the ability to push D. Will no longer feel contractions

Correct Answer: C. May lose the ability to push A pudendal block is a local anesthetic injection given as a treatment for pain in the second stage of labor (pushing) just before the delivery of the baby. It is administered through the vaginal wall and into the pudendal nerve in the pelvis, providing anesthesia to the perineum. The numbing effect of the pudendal block may cause the woman to lose the ability to push that is why it is not given when the baby's head is too far down in the vagina. Option A: A pudendal nerve block targets the pudendal nerve trunk as it enters the lesser sciatic foramen, about 1 cm inferior and medial to the attachment of the sacrospinous ligament to the ischial spine. Here, the nerve is medial to the internal pudendal vessels. This nerve is accessed by 2 approaches, transvaginal and transcutaneous (or perineal). Option B: Bladder sensation is not lost. The sensory and motor innervation of the perineum is derived from the pudendal nerve, which is composed of the anterior primary divisions of the second, third, and fourth sacral nerves. Option D: Pudendal block does not abolish the pain of uterine contractions and cervical dilatation; this sensation is transmitted by the sympathetic fibers derived from the spinal levels of T10-L2.

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? A. Keeping the significant other informed of the progress of the labor. B. Providing comfort measures. C. Monitoring fetal heart rate. D. Changing the client's position frequently.

Correct Answer: C. Monitoring fetal heart rate. The priority is to monitor the fetal heart rate. The continuous monitoring of the external fetal heart rate provides insight into fetal well-being. The assessment of the fetal heart rate could be performed utilizing external or internal fetal heart rate monitoring. An alternative is fetal heart rate auscultation every 15 minutes in the first stage of labor and after each contraction during the second stage of labor. In the interpretation of the fetal heart rate strip millimeters considered are baseline viability, basal heart rate, cardiac accelerations or decelerations, endocrine activity. Strip abnormalities are characterized based on consideration of the above parameters. Option A: At admission to labor and delivery, prenatal records and obstetric history should be reviewed because these optimally inform the provider to the best intrapartum obstetric care. This care includes the determination of the static gestational age. Option B: Most labor and delivery units will have an established protocol for administration of oxytocin that entails the administration of the proper medication and dosage, as well as criteria for an incremental increase as clinically warranted. The protocols also include monitoring maternal and fetal vital signs, as well as the atria, for discontinuation of the medication in the event of concern for tachycardia systole all fetal well-being. Option D: The uterine activity is assessed by external tocometry and targeted at 3 to 5 contractions in the 10-minute window. The contractions should last 30 to 40 seconds to be effective. Internal intrauterine pressure assessment using a catheter could be utilized, in which case marked medial units are used and targeted at more than 200 Montevideo units in a 10-minute window. The monitoring of uterine contractions should be continuous during labor.

A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of slowing labor. The nurse is reviewing the physician's orders and would expect to note which of the following prescribed treatments for this condition? A. Medication that will provide sedation B. Increased hydration C. Oxytocin (Pitocin) infusion D. Administration of a tocolytic medication

Correct Answer: C. Oxytocin (Pitocin) infusion Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows. Hypotonic labor is an abnormal labor pattern, notable especially during the active phase of labor, characterized by poor and inadequate uterine contractions that are ineffective to cause cervical dilation, effacement, and fetal descent, leading to a prolonged or protracted delivery. Option A: Provided there are no contraindications. Oxytocin is the medication of choice for augmenting contractions. The dosage regimen should be titrated to effect for achieving adequate uterine contractions. However, dosing generally does not exceed 30milliunit/ minute. The usual protocol is 5units of oxytocin in 500mls of 5% Dextrose intravenous infusion, starting with 10 drops/min and gradually titrating the rate to achieve a contraction rate of at least 3 per minute. Option B: Maintain adequate hydration. Encourage ambulation and avoid supine position. Although these are not proven to improve contractions or prolonged labor due to hypocontractility, they may improve the comfort of the parturient. Option D: A combination of amniotomy and oxytocin augmentation is more effective in the management of hypocontractile labor than amniotomy alone when instituted early in the active phase.

Labor is a series of events affected by the coordination of the five essential factors. One of these is the passenger (fetus). Which are the other four factors? A. Contractions, passageway, placental position and function, pattern of care. B. Contractions, maternal response, placental position, psychological response. C. Passageway, contractions, placental position, and function, psychological response. D. Passageway, placental position, and function, paternal response, psychological response.

Correct Answer: C. Passageway, contractions, placental position and function, psychological response. The five essential factors (5 P's) are passenger (fetus), passageway (pelvis), powers (contractions), placental position and function, and psyche (psychological response of the mother). Option A: The passage is defined as the bony boundaries of the pelvis. The shape of the pelvis determines how easily the baby can pass through. The most common pelvic shaped bone for a woman is called a gynecoid pelvis. This shaped pelvis is easiest for a baby to pass through. Option B: The power factor in labor refers to the ability of the uterine muscle to contract. The uterus is an involuntary muscle. It has to not only start contracting, but it must establish a pattern of contractions. Every time the uterus contracts it pushes the baby towards the cervix. This is really what labor is all about. The contractions cause the cervix to stretch open and allow the baby into the birth canal. Option D: Position refers to not only the position of the baby but also the position of the mother. The old adage that what is up must come down also refers to babies. When a mother is in an upright position this contributes to abdominal wall relaxation. This helps the fundus (the upper portion of the uterus) to go forward due to the force of gravity, which then leads to the straightening of the birth canal and widening of the pelvic outlet. All of which helps a baby to be born.

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? A. Urinary output of 20 ml since the previous assessment B. Deep tendon reflexes of 2+ C. Respiratory rate of 10 BPM D. Fetal heart rate of 120 BPM

Correct Answer: C. Respiratory rate of 10 BPM. Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. Option A: A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. The kidneys face remarkable demands during pregnancy, and it is critical that the practicing nephrologist understands the normal kidney adaptations to pregnancy. GFR rises early to a peak of 40% to 50% that of prepregnancy levels, resulting in lower levels of serum creatinine, urea, and uric acid. There is a net gain of sodium and potassium, but a greater retention of water, with gains of up to 1.6 L. Option B: Deep tendon reflexes of 2+ are normal. With preeclampsia, a woman's reflexes become unusually active. Increasing blood pressure will lead to increasing hyperreflexia until uncontrollable seizures eventually result. Testing for this change is difficult in the field setting; in a clinic setting an overactive patellar response is a good indicator. Option D: The fetal heart rate is WNL for a resting fetus. Current international guidelines recommend for the normal fetal heart rate (FHR) baseline different ranges of 110 to 150 beats per minute (bpm) or 110 to 160 bpm.

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: A. Over the fetus that is most anterior to the mother's abdomen. B. Over the fetus that is most posterior to the mother's abdomen. C. So that each fetal heart rate is monitored separately. D. So that one fetus is monitored for a 15-minute period followed by a 15 minute fetal monitoring period for the second fetus.

Correct Answer: C. So that each fetal heart rate is monitored separately. In a client with a multifetal pregnancy, each fetal heart rate is monitored separately. Simultaneous monitoring of twins is preferable to non simultaneous monitoring to discriminate between their separate FHRs (ACOG, 1989). Synchronizing the internal clocks of both monitors will help produce accurate documentation. Otherwise, time increments should be documented on both monitor tracings for later comparison, to ensure that each twin has been monitored. If the monitor strips are synchronous, portable real-time ultrasound can be used to verify that both twins are being monitored independently Option A: Among the advantages of simultaneous twin monitoring is the increased likelihood that both twins are being monitored with potentially less nursing time. Option B: The nonstress test (NST) is the most widely used method of evaluating twins for any of the aforementioned risk factors. Normative data for simultaneous twin NSTs show synchrony or similarity in the tracings with incidences of 57.14% and 58% in twins monitored from 27?weeks until term. Option D: Synchrony is thought by some to occur because the first twin's movement produces a vibration and stimulates movement and FHR accelerations in the second twin. Recently, this idea was supported in a limited investigation of twins in which vibratory acoustic stimulation evoked an immediate transition from asynchronous to synchronous FHR tracings in all 16 tests carried out in the study (Sherer, Abramowicz, D'Amico, Caverly, & Woods, 1991).

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? A. Blood pressure reading is at the prenatal baseline. B. Urinary output has increased. C. The client complains of a headache and blurred vision. D. Dependent edema has resolved.

Correct Answer: C. The client complains of a headache and blurred vision. If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening preeclampsia. Option A: In normal pregnancy, women's mean arterial pressure drops 10-15 mm Hg over the first half of pregnancy. Most women with mild chronic hypertension (ie, SBP 140-160 mm Hg, DBP 90-100 mm Hg) have a similar decrease in blood pressures and may not require any medication during this period. Option B: In addition to rising hormones, the body's fluid levels start to increase during pregnancy. This means the kidneys have to work extra hard to flush the extra fluid. The amount of urine released will increase as well. In the third trimester, the baby's growing size means they're pressing even more on the bladder. Option D: During normal pregnancy total body water increases by 6 to 8 liters, 4 to 6 liters of which are extracellular, of which at least 2 to 3 liters are interstitial. At some stage in pregnancy 8 out of 10 women have demonstrable clinical edema.

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? A. Hysteria compounded by the flu B. Placental abruption C. Uterine rupture D. Dysfunctional labor

Correct Answer: C. Uterine rupture. Uterine rupture is a medical emergency that may occur before or during labor. Signs and symptoms typically include abdominal pain that may ease after uterine rupture, vomiting, vaginal bleeding, hypovolemic shock, and fetal distress. With placental abruption, the client typically complains of vaginal bleeding and constant abdominal pain. Option A: The woman does not have hysteria. Uterine rupture in pregnancy is a rare and often catastrophic complication with a high incidence of fetal and maternal morbidity. Numerous factors are known to increase the risk of uterine rupture, but even in high-risk subgroups, the overall incidence of uterine rupture is low. Option B: Placental abruption occurs when the maternal vessels tear away from the placenta and bleeding occurs between the uterine lining and the maternal side of the placenta. As the blood accumulates, it pushes the uterine wall and placenta apart. The placenta is the fetus' source of oxygen and nutrients as well as the way the fetus excretes waste products. Diffusion to and from the maternal circulatory system is essential to maintaining these life-sustaining functions of the placenta. When accumulating blood causes separation of the placenta from the maternal vascular network, these vital functions of the placenta are interrupted. If the fetus does not receive enough oxygen and nutrients, it dies. Option D: Dysfunctional or prolonged labor refers to prolongation in the duration of labor, typically in the first stage of labor. Diagnosis of delay in labor is dependent on careful monitoring of uterine contraction intensity, duration and frequency, cervical dilation, and descent of the fetus through the pelvis.

At 38 weeks gestation, a client is having late decelerations. The fetal pulse oximeter shows 75% to 85%. The nurse should: A. Discontinue the catheter if the reading is not above 80%. B. Discontinue the catheter if the reading does not go below 30%. C. Advance the catheter until the reading is above 90% and continue monitoring. D. Reposition the catheter, recheck the reading, and if it is 55%, keep monitoring.

Correct Answer: D. Reposition the catheter, recheck the reading, and if it is 55%, keep monitoring. Adjusting the catheter would be indicated. Normal fetal pulse oximetry should be between 30% and 70%. 75% to 85% would indicate maternal readings. Fetal pulse oximetry measures how much oxygen the baby's blood is carrying. It uses a probe that sits on the baby's head whilst in the uterus and vagina during labor. The probe is said not to interfere with the woman's mobility during labor. Option A: This method has two potential advantages over conventional fetal heart rate monitoring: (i) it directly measures the proportion of hemoglobin that is carrying oxygen: thus, oxygenation, the primary variable underlying the tissue-damaging effects of hypoxia/ischemia is being monitored; and (ii) it relies on an established, safe, noninvasive, widely?used technology found in every modern intensive care unit and operating theatre. Option B: A variety of fetal pulse oximetry sensors has been studied. These are placed during a vaginal examination to attach to the top of the fetal head by suction (Arikan 2000) or clip (Knitza 2004), lie against the fetal temple or cheek (Mallinckrodt 2000; Nellcor 2004), or to lie along the fetal back (Prothia 2014). The sensor remains in situ and fetal pulse oximetry values are recorded for approximately 81% of the monitoring time (East 1997). Option C: A prospective observational study found a low pulse oximetry oxygen saturation < 30% for at least 10 minutes correlates highly with fetal acidosis in cases of nonreassuring fetal heart rate (Nonnenmacher 2010). A novel fetal phantom based on actual fetal parameters showed that the wireless oximeter was capable of identifying 4% and 2% changes in diameter between the diastolic and systolic point in arteries of over 0.2 and 0.4 mm inner diameter, respectively (Stubán 2009).

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? A. Absence of abdominal pain B. A soft abdomen C. Uterine tenderness/pain D. Painless, bright red vaginal bleeding

Correct Answer: C. Uterine tenderness/pain In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompany placental abruption, especially with a central abruption and trapped blood behind the placenta. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by failure of the uterus to relax in an attempt to constrict blood vessels and control bleeding. Option A: Placental abruption occurs when there is a compromise of the vascular structures supporting the placenta. In other words, the vascular networks connecting the uterine lining and the maternal side of the placenta are torn away. These vascular structures deliver oxygen and nutrients to the fetus. Option B: The abdomen will feel hard and board like on palpation as the blood penetrates the myometrium and causes uterine irritability. Disruption of the vascular network may occur when the vascular structures are compromised because of hypertension or substance use or by conditions that cause stretching the uterus. The uterus is a muscle and is elastic whereas the placenta is less elastic than the uterus. Therefore, when the uterine tissue stretches suddenly, the placenta remains stable and the vascular structure connecting the uterine wall to the placenta tears away. Option D: If bleeding is present, the quantity and characteristic of the blood, as well as the presence of clots, is evaluated. Remember, the absence of vaginal bleeding does not eliminate the diagnosis of placental abruption.

Which of the following symptoms occurs with a hydatidiform mole? A. Heavy, bright red bleeding every 21 days. B. Fetal cardiac motion after 6 weeks gestation. C. Benign tumors found in the smooth muscle of the uterus. D. "Snowstorm" pattern on ultrasound with no fetus or gestational sac.

Correct Answer: D. "Snowstorm" pattern on ultrasound with no fetus or gestational sac. The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months. Option A: The most common symptom of placenta previa is bright red, painless bleeding from the vagina. This is most common in the third trimester of pregnancy. Option B: The heart rate (HR) increases between the 5th week of gestation and 9th week of gestation and after the 13th week of gestation reduces. Cardiovascular development in a human embryo occurs between 3 and 6 weeks after ovulation. Cardiac function is the first sign of independent cardiac activity that can be explored with non-invasive techniques such as Doppler ultrasound Option C: Uterine smooth muscle tumors are neoplasms composed of smooth muscle; they range from benign leiomyomas to low-grade and high-grade leiomyosarcomas. Several histologic subtypes exist, including usual (spindled), epithelioid, and myxoid tumors.

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: A. Exhaustion B. Valsalva's maneuver C. Involuntary grunting D. Fear of losing control

Correct Answer: D. Fear of losing control Pains, helplessness, panicking, and fear of losing control are possible behaviors in the 2nd stage of labor. In women who have delivered vaginally previously, whose bodies have acclimated to delivering a fetus, the second stage may only require a brief trial, whereas a longer duration may be required for a nulliparous female. Option A: Labour as a life event is characterized by tremendous physiological and psychological changes that require major behavioral adjustments in a short period of time. Option B: Exercise involving the Valsalva maneuver (holding one's breath during exertion) because it can cause increased intra-abdominal pressure. Option C: Labour presents a physical and psychological challenge for women. The latter stages of pregnancy can be a difficult time emotionally. Fear and apprehension are experienced alongside excitement. There are emotions both positive and negative that will affect the woman's birth experience.

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? A. Disseminated intravascular coagulation B. Chronic hypertension C. Infection D. Hemorrhage

Correct Answer: D. Hemorrhage Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding. Vaginal bleeding secondary to placenta previa can lead to postpartum hemorrhage requiring a blood transfusion, hysterectomy, maternal intensive care admission, septicemia, and maternal death. Option A: Out of 4,334 obstetrical admissions, DIC was diagnosed in 40 (0.92%) patients. Risk factors noted were eclampsia 28 (70%), abruptio placentae 7 (17.5%), septicaemia 3 (7.5%), pancytopenia 1 (2.5%), and 1 (2.5%) patient had DIC secondary to hemorrhagic shock due to placenta previa. Option B: Women with chronic hypertension had a relative risk of 1.2 (95% confidence interval 0.4 to 3.7) for placenta previa compared with normotensive women. However, the risk of pregnancy-induced hypertension was reduced by half among those with placenta previa (relative risk 0.5, 95% confidence interval 0.3 to 0.7). Option C: Patients with placenta previa presenting with vaginal bleeding have intra-amniotic infection in 5.7% of the cases, and IAI in 17.9%. IAI in patients with placenta previa and vaginal bleeding is a risk factor for preterm delivery within 48 h.

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia would be: A. Severe postpartum headache B. Limited perception of bladder fullness C. Increase in respiratory rate D. Hypotension

Correct Answer: D. Hypotension. Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain adequate blood pressure. Option A: Headache is not a side effect since the spinal fluid is not disturbed by this anesthetic as it would be with a low spinal (saddle block) anesthesia; Option B: Limited perception of bladder fullness is an effect of epidural anesthesia but is not the most harmful. After having an epidural, the woman may not be able to feel when her bladder is full because the epidural affects the surrounding nerves. Option C: Respiratory depression is a potentially serious complication. Occasionally, some medicines used in an epidural can cause slow breathing or drowsiness.

Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged? A. Conception B. 9 weeks' gestation, when the fetal heart is well developed. C. 32-34 weeks gestation D. Maternal and fetal blood are never exchanged.

Correct Answer: D. Maternal and fetal blood are never exchanged. Only nutrients and waste products are transferred across the placenta. Blood exchange only occurs in complications and some medical procedures accidentally. The fetal circulation system is distinctly different from adult circulation. This intricate system allows the fetus to receive oxygenated blood and nutrients from the placenta. It comprises the blood vessels in the placenta and the umbilical cord, which contains two umbilical arteries and one umbilical vein. Option A: The placenta connects the fetus to the wall of the uterus. It provides oxygen and nutrients from the mother to the growing fetus and also removes metabolic wastes and carbon dioxide from the fetus via the blood vessels in the umbilical cord. The umbilical cord develops from the placenta and is attached to the fetus. Option B: Oxygenated blood from the mother in the placenta flows through the umbilical vein and into the inferior vena cava (IVC), bypassing the liver via the ductus venosus. From the IVC, oxygenated blood travels to the right atrium of the heart. There is greater pressure in the right atrium compared to the left atrium in fetal circulation; therefore most of the blood is shunted from the right atrium to the left atrium through an opening called the foramen ovale. Once in the left atrium, blood travels through the left ventricle into the aorta and the systemic circulation. Option C: The deoxygenated blood travels back to the placenta via the umbilical arteries to be oxygenated by the mother. Additionally, some oxygenated blood in the right atrium can also enter the right ventricle and then the pulmonary artery. Because there is high resistance to blood flow in the lungs, the blood is shunted from the pulmonary artery into the aorta via the ductus arteriosus, hence bypassing the lungs. Blood then enters the systemic circulation, and the deoxygenated blood is recycled back to the mother via the umbilical arteries.

A laboring client complains of low back pain. The nurse replies that this pain occurs most when the position of the fetus is: A. Breech B. Transverse C. Occiput anterior D. Occiput posterior

Correct Answer: D. Occiput posterior A persistent occiput posterior position causes intense back pain because of fetal compression of the sacral nerves. Occiput anterior is the most common fetal position and does not cause back pain. Option A: Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22-25% of births prior to 28 weeks' gestation to 7-15% of births at 32 weeks' gestation to 3-4% of births at term. Option B: The transverse lie position is where the baby's head is on one side of the mother's body and the feet on the other, rather than having the head close to the cervix or close to the heart. The baby can also be slightly at an angle, but still more sideways, than up or down. Option C: The left occiput anterior (LOA) position is the most common in labor. In this position, the baby's head is slightly off-center in the pelvis with the back of the head toward the mother's left thigh.

A laboring client has external electronic fetal monitoring in place. Which of the following assessment data can be determined by examining the fetal heart rate strip produced by the external electronic fetal monitor? A. Gender of the fetus B. Fetal position C. Labor progress D. Oxygenation

Correct Answer: D. Oxygenation Oxygenation of the fetus may be indirectly assessed through fetal monitoring by closely examining the fetal heart rate strip. Accelerations in the fetal heart rate strip indicate good oxygenation, while decelerations in the fetal heart rate sometimes indicate poor fetal oxygenation. Option A: In the second and third trimesters of pregnancy, ultrasound imaging scans the genital anatomy of the fetus to identify its gender. In the early studies conducted on the use of ultrasound results for identifying the fetal gender, a male fetus was demonstrated by the presence of a scrotum and a penis, and a female fetus by the absence of these organs. Option B: Ultrasonography is noninvasive and has been found to be more accurate for assessing position of the fetal head, during labor. Recent studies by Sherer et al., Chou et al., Dupuis et al., and Zahalka et al. have shown that ultrasound scanning is a quick and efficient way of increasing the accuracy of the assessment of fetal head position during the second stage of labor. Option C: Recently, intrapartum transperineal ultrasound for the assessment of fetal head descent has been introduced to assess labor progress in the first stage of labor in a more objective and non-invasive way.

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: A. Hematoma B. Placenta previa C. Uterine atony D. Placental separation

Correct Answer: D. Placental separation As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears. Delivery of the placenta usually happens within 5-10 minutes after delivery of the fetus, but it is considered normal up to 30 minutes after delivery of the fetus. Option A: A hematoma is a bad bruise. It happens when an injury causes blood to collect and pool under the skin. The pooling blood gives the skin a spongy, rubbery, lumpy feel. A hematoma usually is not a cause for concern. It is not the same thing as a blood clot in a vein, and it does not cause blood clots. Option B: Placenta previa occurs when a baby's placenta partially or totally covers the mother's cervix — the outlet for the uterus. Placenta previa can cause severe bleeding during pregnancy and delivery. If the woman has placenta previa, she might bleed throughout her pregnancy and during her delivery. Option C: Atony of the uterus, also called uterine atony, is a serious condition that can occur after childbirth. It occurs when the uterus fails to contract after the delivery of the baby, and it can lead to a potentially life-threatening condition known as postpartum hemorrhage.

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? A. A loud mouth B. Low self-esteem C. Hemorrhage D. Postpartum infections

Correct Answer: D. Postpartum infections Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Good nutrition is the best way to prevent anemia if the woman is pregnant or trying to become pregnant. Eating foods high in iron content (such as dark green leafy vegetables, red meat, fortified cereals, eggs, and peanuts) can help ensure that she maintains the supply of iron her body needs to function properly. The obstetrician will also prescribe vitamins to ensure that the woman has enough iron and folic acid. Make sure to get at least 27 mg of iron each day. If the woman does become anemic during pregnancy, it can usually be treated by taking iron supplements. Option A: The amount of blood in the body increases by about 20-30 percent, which increases the supply of iron and vitamins that the body needs to make hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen to other cells in the body. Option B: Mild anemia is normal during pregnancy due to an increase in blood volume. More severe anemia, however, can put the baby at higher risk for anemia later in infancy. In addition, if the mother is significantly anemic during the first two trimesters, she is at greater risk for having a preterm delivery or low-birth-weight baby. Being anemic also burdens the mother by increasing the risk of blood loss during labor and making it more difficult to fight infections. Option C: Anemia does not specifically present a risk for hemorrhage. Severe anemia may weaken uterine muscular strength or lower resistance to infectious diseases, contributing to postpartum hemorrhage and subsequent maternal mortality. However, the severity of anemia that places a woman at a greater risk of experiencing postpartum hemorrhage or a debilitating and clinically relevant blood loss has not been investigated. Indeed, the impact of anemia on the extent of blood loss at childbirth and postpartum is not well-understood.

An expected cardiopulmonary adaptation experienced by most pregnant women is: A. Tachycardia B. Dyspnea at rest C. Progression of dependent edema D. Shortness of breath on exertion

Correct Answer: D. Shortness of breath on exertion. This is an expected cardiopulmonary adaptation during pregnancy; it is caused by an increased ventricular rate and elevated diaphragm. Option A: In pregnancy, the cardiac output increases 30 to 60%, with the majority of the increase occurring during the first trimester. The maximum output is reached between 20 and 24 weeks and is maintained until delivery. Initially, the increase in cardiac output is due to an increase in stroke volume. As the stroke volume decreases towards the end of the third trimester, an increase in heart rate acts to maintain the increased cardiac output. Option B: During pregnancy, the diaphragm elevates, resulting in a 5% decrease in total lung capacity (TLC). However, the tidal volume (TV) increases by 30 to 40%, thereby decreasing the expiratory reserve volume by 20%. Minute ventilation is similarly increased by 30 to 40%, owing to the fact that TV becomes increased while a constant respiratory rate is maintained. Option C: During pregnancy, the extra fluid in the body and the pressure from the growing uterus can cause swelling (edema) in the ankles and feet. The swelling tends to get worse as a woman's due date nears, particularly near the end of the day and during hotter weather.

A client arrives at the hospital in the second stage of labor. The fetus' head is crowning, the client is bearing down, and the birth appears imminent. The nurse should: A. Transfer her immediately by stretcher to the birthing unit. B. Tell her to breathe through her mouth and not to bear down. C. Instruct the client to pant during contractions and to breathe through her mouth. D. Support the perineum with the hand to prevent tearing and tell the client to pant.

Correct Answer: D. Support the perineum with the hand to prevent tearing and tell the client to pant. Gentle pressure is applied to the baby's head as it emerges so it is not born too rapidly. The head is never held back, and it should be supported as it emerges so there will beno vaginal lacerations. It is impossible to push and pant at the same time. Option A: Imminent delivery is when the baby's head is visible at the vaginal opening during a contraction (crowning). C. A visual inspection of the perineal area should only be done when contractions are less than 5 minutes apart, there is bleeding/fluid discharge, and/or the patient feels the urge to push. Option B: A visual inspection of the perineal area should only be done when contractions are less than 5 minutes apart, there is bleeding/fluid discharge, and/or the patient feels the urge to push. Do not perform a digital examination to gauge cervical dilation. Option C: Begin each contraction with two deep breaths. Inhale deeply and exhale slowly through pursed lips. Relax the bottom and push down. Keep the abdominal muscles tight around the baby as she takes another breath. The woman may find herself making throaty sounds. Repeat these steps as long as the contraction lasts.

Which of the following findings meets the criteria of a reassuring FHR pattern? A. FHR does not change as a result of fetal activity. B. Average baseline rate ranges between 100 - 140 BPM. C. Mild late deceleration patterns occur with some contractions. D. Variability averages between 6 - 10 BPM.

Correct Answer: D. Variability averages between 6 - 10 BPM. Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system. The FHR is under constant variation from the baseline. This variability reflects a healthy nervous system, chemoreceptors, baroreceptors and cardiac responsiveness. Prematurity decreases variability; therefore, there is little rate fluctuation before 28 weeks. Variability should be normal after 32 weeks. Option A: FHR should accelerate with fetal movement. The FHR is controlled by the autonomic nervous system. The inhibitory influence on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is conveyed by the sympathetic nervous system. Progressive vagal dominance occurs as the fetus approaches term and, after birth, results in a gradual decrease in the baseline FHR. Stimulation of the peripheral nerves of the fetus by its own activity (such as movement) or by uterine contractions causes acceleration of the FHR. Option B: Baseline range for the FHR is 120 to 160 beats per minute. The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. Prematurity, maternal anxiety, and maternal fever may increase the baseline rate, while fetal maturity decreases the baseline rate. Option C: Late deceleration patterns are never reassuring, though early and mild variable decelerations are expected, reassuring findings. Late decelerations are associated with uteroplacental insufficiency and are provoked by uterine contractions. Any decrease in uterine blood flow or placental dysfunction can cause late decelerations. Maternal hypotension and uterine hyperstimulation may decrease uterine blood flow. Postdate gestation, preeclampsia, chronic hypertension, and diabetes mellitus are among the causes of placental dysfunction. Other maternal conditions such as acidosis and hypovolemia associated with diabetic ketoacidosis may lead to a decrease in uterine blood flow, late decelerations, and decreased baseline variability.