Labor and delivery
What is the success rate of an ECV? a. 60% b. 90% c. 50% d. 75%
A
A client is admitted to the obstetrical unit with preterm labor. The nurse anticipates that the client will have which of the following needs? 1. Financial difficulties 2. Anxiety medication order 3. Work release note 4. Emotional support
4.
Which factor may increase the risks of having preterm labor? 1. Working while pregnant 2. Primagravida 3. Hispanic race 4. Bacterial vaginosis infection
4.
Which of the following are required in order for a health care provider to perform an external cephalic version (ECV)? Select all that apply. a. Adequate amniotic fluid b. Singleton gestation c. Gestational age of 36—37 weeks d. Multiple gestation e. Presenting part engaged in the maternal pelvis
a, b, c
The nurse is caring for a woman following a cesarean delivery with a low transverse incision. What are the advantages of a low transverse uterine incision versus a classical incision for a cesarean birth? Select all that apply. a. Involves less blood loss b. More appropriate for preterm births or multiple gestations c. Easier to repair surgically d. Less likely to cause bowel adhesions e. Less likely to rupture with subsequent pregnancies
a, c, d, e
The nurse is caring for a client who had a classical uterine incision for her cesarean birth. The nurse knows that the client understands implications for future pregnancies that are secondary to her classical uterine incision when the client makes which of the following statements? a. "Every time I have a baby, I will have to have a cesarean delivery." b. "The risk of rupturing my uterus is too high for me to have any more babies." c. "The next time I have a baby, I can try to deliver vaginally." d. "I can only have one more baby."
a.
Nursing care of the woman experiencing preterm labor includes which of the following? Select all that apply. 1. Assessing maternal vital signs 2. Providing patient education about preterm labor 3. Assessing fetal well-being 4. Monitoring uterine activity 5. Monitoring response to oxytocic therapy
1, 2, 3, 4
The nurse is caring for a client who is scheduled for induction of labor. Which of the following conditions are indications for induction? Select all that apply. 1. Diabetes mellitus 2. Preeclampsia 3. Post term gestation 4. Fetal demise 5. Multiple gestation
1, 2, 3, 4
A pregnant client's preterm labor will be managed at home. The nurse anticipates which of the following in the plan of care? Select all that apply. 1. Home uterine monitoring 2. Bed rest and pelvic rest 3. Biophysical profiles and fetal kick counts 4. Administration of IV tocolytics 5. Regular prenatal visits to assess cervical dilation
1, 2, 3, 5
The health care provider has performed an amniotomy on a client in labor. Which interventions by the nurse are indicated when caring for this client during and immediately following the procedure? Select all that apply. 1. Assessment for prolapse of umbilical cord 2. Assessment of fetal heart rate 3. Assessment for cervical dilation 4. Assessment of the amount of amniotic fluid 5. Assessment of the amniotic fluid color
1, 2, 4, 5
The nurse is educating a client who is 28 weeks pregnant with preterm labor. Which statements should the nurse include? Select all that apply. 1. "Pelvic rest means no sexual activity during this period." 2. "Let's discuss the signs and symptoms of preterm labor." 3. "You will not be able to see the provider while you are on bed rest." 4. "Staying on bed rest may help prevent a preterm delivery." 5. "It is important to stay well hydrated during the day."
1, 2, 4, 5
A client at 37 weeks gestation is discharged after a successful external cephalic version. What aftercare instructions would be important to discuss with the client? Select all that apply. 1. Recognizing signs of infection 2. Monitoring for uterine contractions 3. Observing for excessive fetal movement 4. Maintaining clear liquids for 12 hours 5. Performing fundal massage
2, 3
A laboring client at 39 weeks gestation has been pushing for 2 hours. The nurse anticipates that the health care provider may choose to use forceps to assist in the delivery. What criteria must be met to consider forceps? Select all that apply. 1. Cephalopelvic disproportion should be present. 2. Adequate maternal anesthesia should be provided. 3. Membranes must be ruptured. 4. The cervix must be fully dilated. 5. The maternal bladder should be full.
2, 3, 4
Which of the following conditions would indicate that induction of labor is needed? Select all that apply. 1. Unfavorable cervix 2. Infection 3. Fetal compromise 4. Preeclampsia 5. Transverse fetal lie
2, 3, 4
A G3P2 client presents at 38 weeks gestation with a transverse lie. The nurse is preparing the client for an external version. Which client statement indicates that the client understands the procedure? Select all that apply. 1. "I will be starting labor after the procedure." 2. "I will have an ultrasound done after the procedure." 3. "The procedure is uncomfortable." 4. "I will need a nonstress test before the procedure." 5. "I will need to get an IV started for the procedure."
2, 3, 4, 5
Which of the following are clinical manifestations of preterm labor? Select all that apply. 1. Decreased vaginal discharge 2. Abdominal pain 3. Cervical dilation 4. Diarrhea 5. Lower back pain
2, 3, 4, 5
A client is going to have a cephalic version at 38 weeks gestation for a breech presentation. The nurse determines that the client has understanding of the procedure when the client makes which of the following statements? 1. "My baby's head will be turned slightly to make the delivery easier." 2. "My baby will be turned to a head-down position." 3. "The procedure cannot be stopped even if my baby shows signs of distress." 4. "After the baby is turned, I must remain in bed."
2.
A laboring client suddenly sits up in bed, is dyspneic, becomes cyanotic, and has frothy sputum from her mouth. The nurse is unable to palpate a pulse. What is the initial action by the nurse? 1. Obtain the client's blood pressure. 2. Call for assistance and start CPR. 3. Position the client on her side with her feet elevated. 4. Assess the fetal heart rate.
2.
An external cephalic version (ECV) to change the position of the fetus is generally performed when? 1. Immediately preceding labor 2. After 36—37 weeks gestation 3. After the 20-week anatomy scan 4. As soon as malpresentation is detected
2.
Once the external cephalic version is completed, what is your responsibility? 1. Removing the Foley catheter 2. Monitoring maternal uterine activity and fetus status 3. Ensuring the woman doesn't have questions regarding the procedure 4. Providing emotional support
2.
The client about to have a forceps-assisted delivery asks what complications can occur. The nurse understands that which of the following is a potential maternal complication of a forceps delivery? 1. Erb's palsy 2. Postpartum infection 3. Uterine rupture 4. Maternal hypertension
2.
The nurse is caring for a client who will be having a cesarean delivery. Which of the following statements by the client would cause the nurse to determine that the client does not understand what to expect during a cesarean delivery? 1. "An indwelling (Foley) catheter will be inserted before surgery." 2. "I will receive a blood transfusion during surgery." 3. "I may be given an antacid before surgery." 4. "My husband can be present during birth."
2.
What is the most common fetal malposition? 1. Occiput anterior 2. Occiput posterior 3. Vertex 4. Breech
2.
Why would you add a urinary catheter to the delivery room table before a vaginal birth? 1. If the operative vaginal birth fails, you should be prepared for a cesarean birth. 2. An empty bladder provides more room on the pelvic floor. 3. As a comfort to the laboring woman 4. To increase the safety of the fetus
2.
A client is in the recovery room following a cesarean birth. She is stable and alert. Which of the following should be the nurse's focus for teaching during this time? 1. How to bathe the newborn 2. When to follow up with her health care provider 3. What to expect during the postpartum period 4. Future birth control options
3.
A laboring client at term is experiencing a prolonged second stage of labor. She has made no progress for more than 2 hours. The fetal scalp is visible between contractions. The client says, "I just can't push any longer, please help me!" The nurse notifies the health care provider and anticipates the need to do which of the following? 1. Encourage the client to empty her bladder. 2. Provide perineal hygiene. 3. Expect an instrument-assisted delivery. 4. Provide emotional support.
3.
A pregnant client is admitted to the hospital in premature labor. The nurse anticipates which of the following assessment findings? 1. Elevated blood pressure 2. Decreased fetal movement 3. Cervical dilation 4. Headache
3.
Mrs. Smithson is at 37 weeks gestation and her fetus is in a breech presentation. She is undergoing an external cephalic version (ECV) and is in extreme pain. Which of these statements best demonstrates her understanding of her options? 1. I want a cesarean birth. 2. I'd like a different doctor. 3. Stop the procedure. 4. I need morphine.
3.
The nurse in a prenatal care setting is caring for a woman at 39 weeks gestation. The health care provider is going to strip the client's amniotic membrane. The client asks the nurse what this will do. What would be the best response by the nurse? 1. Stripping the membranes will help stimulate the fetus. 2. Stripping the membranes releases progesterone that will prevent preterm labor. 3. Stripping the membranes releases prostaglandins that may help labor begin. 4. Stripping the membranes will cause the fetus to drop lower in the pelvis.
3.
Which of the following is a nursing intervention for a client experiencing preterm labor? 1. Administering anti-anxiety medications 2. Contacting employers for work release 3. Providing emotional support 4. Restricting family visitors
3.
You are assisting at Mrs. Sze's birth. She is a 36-year-old woman who has opted for an epidural. She has been pushing for over 4 hours. She is exhausted, and her baby's head remains at the +3 station. The doctor has attempted a vacuum extraction twice, but the suction cup has popped off both times. What is the most likely next step? 1. A low forceps-assisted birth 2. A cesarean birth 3. A third attempt at vacuum extraction 4. A mid-forceps-assisted birth
3.
A client asks the nurse about the medications she is receiving for preterm labor. What is an appropriate nursing diagnosis? 1. Ineffective coping related to imposed activity restrictions 2. Fear related to potential preterm birth 3. Risk for injury related to premature cervical dilation 4. Knowledge deficit related to treatment for preterm labor
4.
A client is experiencing a hypertonic pattern of uterine contractions. How often are her contractions occurring? 1. Every 3-5 minutes 2. Less than 6-8 minutes between contractions 3. Less than 5 minutes apart 4. Every 2 minutes or less
4.
Mrs. Johnson, who was admitted for induction of labor, is exhibiting a hypertonic contraction pattern. What is the appropriate nursing intervention? 1. Have the client ambulate in the hall. 2. Ask the client to begin pushing and bear down. 3. Assist the client to the restroom to void. 4. Decrease oxytocin and notify the health care provider.
4.
Shana Thompson is experiencing preterm labor. She shares with you that she is worried her baby will be injured or unhealthy. What is an appropriate outcome for this client? 1. The client demonstrates self-care measures. 2. The client verbalizes understanding of preterm labor. 3. The client demonstrates adequate coping. 4. The client gives birth to a healthy newborn safely.
4.
The nurse formulates a diagnosis of fear related to fetal outcomes for a laboring client with fetal malpresentation. What is an appropriate client outcome to include in the care plan? 1. The mother identifies two support people for the birth. 2. The mother safely delivers a viable newborn. 3. The mother is able to verbalize understanding of the labor process. 4. The mother reports a decrease in fear and anxiety related to the birth.
4.
Which of the following is a common side effect associated with the use of vacuum extraction? 1. Fetal hair loss 2. Memory loss 3. Fetal distress 4. Swelling of the scalp
4.
Which of the following must be ruled out before labor may be augmented with an amniotomy or oxytocin? 1. Vertex positioning of the fetus 2. Twin gestation 3. Full-term pregnancy status 4. Cephalopelvic disproportion
4.
Which of the following pieces of information would you use to determine how favorable the cervix is for induction? 1. Apgar score 2. Premature rupture of the membranes (PROM) 3. Fetal heart rate 4. Bishop Score
4.
Match the proper type of forceps to be used with each location of the fetal head. Fetal Head A. Between 0 and +2 station B. At +2 station or lower C. At or on the perineum and visible at the vaginal opening
A. Mid forceps B. Low forceps C. Outlet forceps
A client is going to have an external version for a transverse fetus and is concerned about the terbutaline she is about to receive. The nurse explains that terbutaline (a tocolytic) is used to do which of the following? a. Prevent abruptio placentae b. Lower the maternal blood pressure c. Prevent preterm labor d. Relax the uterus
d.
Mrs. Hernandez was admitted to the hospital in active labor. She is 3 cm dilated and her doctor performs an amniotomy to release her amniotic fluid. What should you do? a. Decrease her epidural dose. b. Clean her up. c. Test her Bishop Score. d. Document the amniotic fluid's characteristics.
d.
What is the maximum length of time a vacuum extractor can be used without increasing the risk of injury to the fetal scalp? a. 15 minutes b. 45 minutes c. 1 hour d. 10 minutes
d.
If you administered the ripening agents Cervidil and Prepidil, which of the following could you expect to be associated with the drug? Select all that apply. 1. Uterine hyperstimulation 2. Nonreassuring fetal status 3. The need for more oxytocin during labor 4. Difficulty in administration 5. Postpartum hemorrhage
1, 2, 5
A client is told that her pelvic diameters are slightly contracted. The client asks the nurse what this means for her vaginal birth plan. What is the correct response by the nurse? 1. "You will have a trial of labor first; a cesarean section will occur if the trial is not successful." 2. "It might be possible, but I would count on a cesarean delivery." 3. "Yes, you can deliver vaginally." 4. "You will have to have a cesarean delivery."
1.
The midwife asks the nurse to assist the laboring client with McRoberts maneuver to help with shoulder dystocia. What is the appropriate nursing action? 1. Ask the client to flex her knees to her chest. 2. Rotate the fetal shoulder 180 degrees. 3. Apply firm pressure to the fundus until the shoulder releases. 4. Apply suprapubic pressure for 5 minutes.
1.
Which is an appropriate goal for a client who is afraid of having preterm labor? 1. The client will verbalize fears regarding her condition. 2. The client will demonstrate adequate coping. 3. The client will verbalize understanding of preterm labor. 4. The client will utilize options to alleviate boredom.
1.
You receive a report from the emergency room nurse that a client is being transferred to your unit in preterm labor. You anticipate which of the following health care provider orders? 1. Apply continuous external electronic fetal monitoring. 2. Administer oxytocin IV per protocol. 3. Apply 2 liters of oxygen via nasal cannula. 4. Nutritional consultation request.
1.
A client who has undergone a vacuum-assisted birth asks the nurse how long the swelling on the infant's head will remain. Which would be the best response by the nurse? a. 5-7 days b. 48-72 hours c. 12-24 hours d. 8-12 hours
b.
The health care provider of a client at 40 weeks gestation has ordered Cytotec for labor induction. The nurse should be aware that Cytotec will produce what change for this client? a. Rupture membranes b. Decrease anxiety c. Cervical ripening d. Decrease pain
c.