Antepartum/Intrapartum Period OB Scc 4th Quarter

Umbilical cord prolapse occurs after spontaneous rupture of the membranes. What should the nurse do immediately?

Place the client in a Trendelenburg position.

During labor, a primigravid client receives an epidural anesthetic, and the nurse assists in monitoring maternal and fetal status. Which finding suggests an adverse reaction to the anesthesia?

Maternal hypotension

A client who is 15 weeks pregnant comes to the clinic for amniocentesis. The nurse knows that this test can be used to identify which characteristics or problems?

• Chromosomal defects. • Neural tube defects. • Sex of the fetus.

A multigravida in active labor is 7 cm dilated. The fetal heart rate baseline is 130 bpm with moderate variability. The client begins to have variable decelerations to 100 to 110 bpm. What should the nurse do next?

Reposition the client and continue to evaluate the tracing.

A nurse assesses a client for signs and symptoms of ectopic pregnancy. Which assessment finding should the nurse expect?

Abdominal pain

A client at 42 weeks of gestation is 3 cm dilated and 30% effaced, with membranes intact and the fetus at 12 station. Fetal heart rate (FHR) is 140 beats/minute. After 2 hours, the nurse notes that, for the past 10 minutes, the external fetal monitor has been displaying an FHR of 190 beats/minute. The client states that her baby has been extremely active. Uterine contractions are strong, occurring every 3 to 4 minutes and lasting 40 to 60 seconds. Which finding would indicate fetal hypoxia?

Excessive fetal activity and fetal tachycardia

In the first stage of labor, a client with a full-term pregnancy has external electronic fetal monitoring (EFM) in place. Which EFM pattern suggests adequate uteroplacental-fetal perfusion?

Fetal heart rate accelerations

A nurse is performing a physical examination of a primigravid client who's 8 weeks pregnant. At this time, the nurse expects to assess:

Hegar's sign.

client who is 34 weeks pregnant is experiencing bleeding caused by placenta previa. The fetal heart sounds are normal and the client is not in labor. Which nursing intervention should the nurse perform?

Monitor the amount of vaginal blood loss.

A nursing assistant escorts a client in the early stages of labor to the bathroom. When the nurse enters the client's room, she detects a strange odor coming from the bathroom and suspects the client has been smoking marijuana. What should the nurse do next?

Notify the physician and security immediately.

An obstetric ultrasound reveals that the client's fetus has spina bifida. The mother is concerned about raising a child with a congenital abnormality and she starts to cry. Which response by the nurse is best?

Sit at her bedside and allow the client to express her feelings.

A client who's 7 months pregnant reports severe leg cramps at night. Which nursing action would be most effective in helping the client cope with these cramps?

Teaching her to dorsiflex her foot during the cramp

A 27-year-old primigravid client with insulin-dependent diabetes at 34 weeks' gestation undergoes a nonstress test, the results of which are documented as reactive. What should the nurse tell the client that the test results indicate?

There is evidence of fetal well-being.

A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The nurse should assess the client for:

abruptio placentae

Which outcome would the nurse identify as the priority to achieve when developing the plan of care for a primigravid client at 38 weeks' gestation who is hospitalized with severe preeclampsia and receiving intravenous magnesium sulfate?

absence of any seizure activity during the first 48 hours

The health care provider (HCP) who elects to perform a cesarean birth on a primigravid client for fetal distress has informed the client of possible risks during the procedure. When the nurse asks the client to sign the consent form, the client's husband says, "I will sign it for her. She's too upset by what is happening to make this decision." The nurse should:

ask the client to sign the consent form.

A multigravid client diagnosed with chronic hypertension is now in preterm labor at 34 weeks' gestation. The health care provider (HCP) has prescribed magnesium sulfate at 3 g/h. Which assessment finding indicates that the intended therapeutic effect has occurred?

decrease in the frequency and number of contractions

For the client who is receiving intravenous magnesium sulfate for severe preeclampsia, which assessment findings would alert the nurse to suspect hypermagnesemia?

decreased deep tendon reflexes

A multigravid client at term is admitted to the hospital for a trial labor and possible vaginal birth. She has a history of previous cesarean birth because of fetal distress. When the client is 4 cm dilated, she receives nalbuphine intravenously. While monitoring the fetal heart rate, the nurse observes minimal variability and a rate of 120 bpm. The nurse should explain to the client that the decreased variability is most likely caused by which factor?

effects of the analgesic medication

The nurse is working on a birthing unit that has several unlicensed assistive personnel (UAP). The nurse should instruct the UAP assigned to several clients in labor to notify the nurse if the UAP notes any of the clients have which finding?

evidence of spontaneous rupture of the membranes

A multigravid client at 32 weeks' gestation has experienced hemolytic disease of the newborn in a previous pregnancy. The nurse should prepare the client for frequent antibody titer evaluations obtained from which source?

maternal blood

A client undergoes an amniotomy. Shortly afterward, the nurse detects large variable decelerations in the fetal heart rate (FHR) on the external electronic fetal monitor (EFM). These findings signify

umbilical cord prolapse.

A client is being admitted to the labor and childbirth unit. Her GTPAL classification is 5-2-1-1-2. When providing shift report, which information would the nurse include? Select all that apply.

• The client has had two full-term children, one premature child, and one abortion. • The client has two living children and is pregnant again. • The client has had four previous pregnancies.

The nurse is caring for a client in labor. Which assessment findings would prompt the nurse to notify the health care provider? Select all that apply.

• The client's membranes rupture and the amniotic fluid is green. • Late decelerations are noted on the external fetal monitor strip.

A primigravid client in active labor has just received an epidural block for pain. After administration of the epidural block, the nurse should assess the client for:

hypotension.

After instructing a primigravid client at 38 weeks' gestation about how preeclampsia can affect the client and the growing fetus, the nurse realizes that the client needs additional instruction when she says that preeclampsia can lead to which problem?

hydrocephalic infant

A 34-year-old multiparous client at 16 weeks' gestation who received regular prenatal care for all of her previous pregnancies tells the nurse that she has already felt the baby move. How does the nurse interpret this finding?

normal because multiparous clients can experience quickening between 14 and 20 weeks' gestation

When explaining to a pregnant client about the need to take supplemental vitamins with iron during her pregnancy, the nurse should instruct the client to take the iron with which liquid to promote maximum absorption?

orange juice

A full-term client is admitted for an induction of labor. The health care provider (HCP) has assigned a Bishop score of 10. Which drug would the nurse anticipate administering to this client

oxytocin 30 units in 500 ml D5W

During a childbirth preparation class, a primigravid client at 36 weeks' gestation tells the nurse, "My lower back has really been bothering me lately." Which exercise suggested would be most helpful?

pelvic rocking

A client at 28 weeks' gestation is complaining of contractions. Following admission and hydration, the physician writes an order for the nurse to give 12 mg of betamethasone I.M. This medication is given to:

promote fetal lung maturity.

During a scheduled cesarean birth for a primigravid client with a fetus at 39 weeks' gestation in a breech presentation, a neonatologist is present in the operating room. The nurse explains to the client that the neonatologist is present because neonates born by cesarean birth tend to have an increased incidence of which problem?

respiratory distress syndrome

A client at 15 weeks' gestation presents at the obstetrical triage unit with dark brown vaginal bleeding and continuous nausea and vomiting. Her blood pressure is 142/98 mm Hg and fundal height is 19 cm. Which prescription is most important for the nurse to request from the primary care provider?

stat ultrasound

During labor, a low-risk multigravid client in active labor has begun pushing, and the fetal head is beginning to crown. To prevent perineal lacerations during the birth, the nurse should:

stretch the perineal tissues with sterile gloved fingers.

A newly pregnant woman tells the nurse that she hasn't been taking her prenatal vitamins because they make her nauseated. In addition to telling the client how important taking the vitamins are, the nurse should advise her to:

take the vitamin on a full stomach.

A primigravid client at 30 weeks' gestation has been admitted to the hospital with premature rupture of the membranes without contractions. Her cervix is 2 cm dilated and 50% effaced. The nurse should next assess the client's:

temperature

A client is scheduled for amniocentesis. When preparing her for the procedure, the nurse should:

ask the client to void.

During her fourth clinic visit, a client who's 5 months pregnant tells the nurse she was exposed to rubella during the past week and asks whether she can be immunized now. How should the nurse respond?

"No because the live viral vaccine is contraindicated during pregnancy."

A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. How should the nurse respond?

"I can see that you're upset; however, you must wait at least 1 year before becoming pregnant again."

A client who's 12 weeks pregnant attends a class on fetal development as part of a childbirth education program. The nurse anticipates that at 16 weeks' gestation, the client's fetus will:

have audible heart sounds.

A client in the 13th week of pregnancy develops hyperemesis gravidarum. Which laboratory finding indicates the need for intervention?

Ketones in urine.

After instruction of a primigravid client at 8 weeks' gestation about measures to overcome early morning nausea and vomiting, which client statement indicates the need for additional teaching?

"I will eat two large meals daily with frequent protein snacks."

After teaching a primigravid client at 24 weeks' gestation, who has received permission from the primary care provider to make a 6-hour automobile trip to visit her parents, about precautions to take during the trip, which client statement indicates the need for further teaching?

"I will sleep for 1 hour at the halfway point of the trip."

A multigravida with a history of cesarean birth due to fetal distress is admitted for a trial labor and possible vaginal birth. After several hours of active labor, the primary care provider prescribes nalbuphine. The nurse evaluates the drug as effective when the client makes which statement?

"The contractions do not seem as painful as before."

During a preparation for parenting class, one of the participants asks the nurse, "How will I know if I am really in labor?" What should the nurse tell the participant about true labor contractions?

"True labor contractions are felt first in the lower back, then the abdomen."

Accompanied by her partner, a client seeks admission to the labor and delivery area. She states that she's in labor and says she attended the facility clinic for prenatal care. Which question should the nurse ask her first?

"What is your expected due date?"

A client in the first trimester of pregnancy comes to the facility for a routine prenatal visit. She tells the nurse she doesn't know whether she's ready to have a baby, even though this was a planned pregnancy. Which response should the nurse offer?

"You're feeling ambivalent, which is normal during the first trimester."

During a prenatal visit, a nurse measures a client's fundal height at 19 cm. This measurement indicates that the fetus has reached approximately which gestational age?

19 weeks

A 16-year-old primigravida at 36 weeks' gestation who has had no prenatal care experienced a seizure at work and is being transported to the hospital by ambulance. What should the nurse do upon the client's arrival?

Admit the client to a quiet, darkened room.

An adolescent client in labor is dilated 4 cm and asks for an epidural. For cultural reasons, the client's mother states that her daughter "has to bite the bullet, just like I did." What should the nurse do to make sure her client's request is honored?

Ask the client in a nonthreatening way if she wishes to have an epidural, and then speak with the physician.

A multigravid client is receiving oxytocin augmentation. When the client's cervix is dilated to 6 cm, her membranes rupture spontaneously with meconium-stained amniotic fluid. Which action should the nurse perform first?

Assess the fetal heart rate.

A 26-year-old primigravida visiting the prenatal clinic for her regular visit at 34 weeks' gestation tells the nurse that she takes mineral oil for occasional constipation. What should the nurse should instruct the client to do?

Avoid mineral oil because it interferes with the absorption of fat-soluble vitamins

A nurse is developing a teaching plan for a primigravid client who's 2 months pregnant. The nurse should tell the client that she can expect to feel the fetus move at which time?

Between 18 and 20 weeks' gestation

A nurse is caring for a client with bruises on her face and arms. Her husband refuses to leave the client's bedside and answers all of the questions for the client. Which intervention by the nurse would be most appropriate?

Collaborate with the physician to make a referral to social services.

While assessing a multigravid client at 10 weeks' gestation, the nurse notes a purplish color to the vagina and cervix. The nurse documents this as what finding?

Chadwick's sign

The nurse is assisting in the birthing room. The physician performs an episiotomy, an incision in the client's perineum to enlarge the vaginal opening and facilitate childbirth. Which interventions should the nurse perform when caring for the client after this procedure? Select all that apply.

Check the episiotomy repair site. • Apply ice to the perineum. • Administer pain medication, as prescribed. • Explain perineal care to the client when she can focus on the instructions

During a visit to the clinic, a pregnant 25-year-old woman who began prenatal care at 10 weeks' gestation and is now in her third trimester reports frequent constipation. Which suggestion by the nurse would be most helpful?

Eat at least four pieces of fruit daily.

A pregnant client comes to the facility for her first prenatal visit. When providing teaching, the nurse should be sure to cover which topic?

Danger signs during pregnancy

A client in labor is receiving oxytocin. The electronic fetal monitoring strip shows contractions occurring every 30 seconds to 2 minutes, with an intensity of 90 mm Hg and increasing resting tone. How should the nurse respond to these findings?

Discontinue the oxytocin infusion.

A client is induced with oxytocin. The fetal heart rate is showing accelerations lasting 15 seconds and exceeding the baseline with fetal movement. What action associated with this finding should the nurse take

Document fetal well-being.

Initial client assessment information includes: blood pressure 160/110 mm Hg, pulse 88 beats/minute, respiratory rate 22 breaths/minute, reflexes +3/+4 with 2 beat clonus. Urine specimen reveals +3 protein, negative sugar and ketones. Based on these findings, a nurse should expect the client to have which complaints?

Headache, blurred vision, and facial and extremity swelling

A client asks about complementary therapies for relief of discomfort related to pregnancy. Which comfort measure mentioned by the client indicates a need for further teaching?

Herbal remedies

A nurse notices that a large number of clients who receive oxytocin to induce labor vomit as the infusion is started. The nurse assesses the situation further and discovers that these clients received no instruction before arriving on the unit and haven't fasted for 8 hours before induction. How should the nurse intervene?

Initiate a unit policy involving staff nurses, certified nurse-midwives, and physicians in teaching clients before labor induction.

While a 31-year-old multigravida at 39 weeks' gestation in active labor is being admitted, her amniotic membranes rupture spontaneously. The client's cervix is 5 cm dilated, the presenting part is at 0 station, and the electronic fetal heart rate pattern is reassuring. What should the nurse do first?

Note the color, amount, and odor of the amniotic fluid.

The nurse is caring for a full-term, nonmedicated, primiparous client who is in the transition stage of labor. The client is writhing in pain and saying, "Help me, help me!" Her last vaginal exam 1 hour ago showed that she was 8 cm dilated, +1 station, and in what appeared to be a comfortable position. What does the nurse anticipate as the highest priority intervention in caring for this client?

Perform a vaginal examination to determine if the client is fully dilated.

A nurse is developing a care plan for a client in her 34th week of gestation who's experiencing premature labor. What nonpharmacologic intervention should the plan include to halt premature labor?

Promoting adequate hydration

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate?

The fetus isn't in distress at this time.

A 25-year-old woman who is in the first stage of labor receives a continuous lumbar epidural block when the cervix is 6 cm dilated. After administration of this anesthesia, which assessment would be most important?

fetal heart rate

Two hours ago, a multigravid client was admitted in active labor with her cervix dilated at 5 cm and completely effaced and the fetus at 0 station. Currently, the client is experiencing nausea and vomiting, a slight chill with perspiration beads on her lip, and extreme irritability. The nurse should first:

assess the client's cervical dilation and station

A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should:

assess the fetal heart rate.

When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which point?

at about the level of the client's umbilicus

Which client is the best candidate for a vaginal birth after a caesarean (VBAC)? a) client who dilated 6 cm in her last delivery and failed to progress beyond this point despite 5 more hours of labor b) diabetic client whose last infant was over 10 lbs (4.5 kg). This infant is larger, as seen on ultrasound. c) client who had a breech presentation in her last pregnancy, and this pregnancy is a vertex pregnancy d) client who had an emergency caesarean section because of fetal distress during her last delivery and has a classic incision

client who had a breech presentation in her last pregnancy, and this pregnancy is a vertex pregnancy

The nurse is caring for a multigravida in active labor with continuous electronic fetal heart rate monitoring. As the client begins to push, the nurse observes that the fetal heart rate shows a deceleration pattern that mirrors the contractions. The nurse should:

continue to monitor the client and fetus.

A multipara at 16 weeks' gestation is diagnosed as having a fetus with probable anencephaly. The client is a devout Baptist and has decided to continue the pregnancy and donate the neonatal organs after the death of the neonate. The nurse should:

explore the nurse's own feelings about the issues of anencephaly and organ donation.

A primigravid client has just completed a difficult, forceps-assisted birth of a 9-lb (4.08-Kg) neonate. Her labor was unusually long and required oxytocin augmentation. The nurse who's caring for her should stay alert for:

uterine atony.

After teaching a pregnant client about potential complications of amniocentesis that must be reported immediately, the nurse determines that the client understands the instruction when she says that she will report:

vaginal bleeding.

Two hours ago, examination of a multigravid client in labor without anesthesia revealed the following: cervical dilation at 5 cm with complete effacement, presenting part at 0 station, and membranes intact. The nurse caring for the client now observes that the client is irritable and has had some nausea with one episode of vomiting. The client is most likely experiencing:

transition phase of labor.

After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which hormone is produced by the placenta?

testosterone

client who is in her third trimester presents at the labor and delivery triage area with a history of a fall. She has bruising on her back and arms. There is no vaginal bleeding and the fetal heart rate (FHR) shows accelerations. A completed Abuse Assessment Screen indicates the possibility of abuse. The nurse should refer this client to

the social worker on call.

A laboring client at -2 station has a spontaneous rupture of the membranes, and a cord immediately protrudes from the vagina. The nurse should first:

place gentle pressure upward on the fetal head.

Assessment of a primigravid client reveals cervical dilation at 8 cm and complete effacement. The client has severe back pain during this phase of labor. The nurse explains that the client's severe back pain is most likely caused by the fetal occiput being in which position?

posterior