M&P
A woman at 39 weeks gestation has been in labor for 8 hours and is asking how far she is dilated, she attended child birth classes and is aware of the stages and phases of labor. She had a vaginal exam 30 minutes prior to her asking again. How should the nurse respond to her question? A) "I will have the RN check your cervix, if you want." B) "The health care provider will have to check you, we can call them." C) "You labor signs have not changed; we are looking for changes in your labor pattern before we check you again." D) "Checking your cervix will not speed up labor, let's wait."
"You labor signs have not changed; we are looking for changes in your labor pattern before we check you again."
What is the normally accepted fetal heart rate range? A) 90-140 bpm B) 100-150 bpm C) 110-160 bpm D) 120-170 bpm
110-160 bpm
The expected fetal heart rate response in an active fetus is which of the following: A) Acceleration of at least 15 bpm for 15 seconds B) Increase in variability by 15 bpm C) Deceleration followed by acceleration of 15 bpm D) Decrease in variability for 15 seconds
Acceleration of at least 15 bpm for 15 seconds
Lana is in the first stage of labor, latent phase. Her membranes are intact and her contractions are mild. Considering Lana's condition and phase of labor, the nurse knows which of the following will facilitate labor. A) Complete bed rest C) Bathroom privileges B) Ambulation ad lib D) Up in chair TID
Ambulation ad lib
You are asked to start external electronic fetal monitoring (EFM) for a primigravida who has been hospitalized because she is showing indications of going into labor. The baseline FHR fluctuates between 135 and 150. You notice two instances in which the FHR reached 165 for 15 to 20 seconds before settling back to the baseline rate. What should you do? A) Immediately report to the RN that the FHR shows tachycardia B) Immediately report to the RN that the FHR shows no variability C) Before reporting to the RN, determine the short term variability (STV) D) Before reporting to the RN, determine the uterine contraction pattern
Before reporting to the RN, determine the uterine contraction pattern
The LPN is assisting in a vaginal exam of a woman with clear vaginal fluid leaking at 37 weeks gestation. The RN is using a speculum and performs a nitrazine paper test for rule out rupture of membranes. If the test is positive, what color will the nitrazine turn? A) Pink B) Yellow C) Blue D) White
Blue
The laboring patient is on continuous fetal monitoring when the nurse notes a decrease in the fetal heart rate with variable deceleration to 75 bpm. What is the initial nursing intervention? A) Administer oxygen C) Change the position of the patient B) Increase her IV fluids D) Notify the RN
Change the position of the patient
The nurse is assessing a women in active labor. She notes a small mass above the symphysis pubis, rounded and distended, non-tender. What intervention should the nurse take next? A) Check the chart for the last void B) Notify the RN of the mass C) Ask the patient if the mass has always been present D) Assume this is part of the uterus
Check the chart for the last void
A woman is experiencing considerable postpartum pain from an episiotomy. She reports that her pain is perhaps a 7 on a scale of 1 to 10 and she requests medication. What are you most likely to give her? A) Narcotic analgesia intravenously (IV) as needed B) One-time epidural anesthesia C) Codeine every 6 to 8 hours D) Ibuprofen on demand
Codeine every 6 to 8 hours
Which intervention has been demonstrated to reduce the release of catecholamines and anxiety, and has resulted in better birth outcomes for women? A) Massage therapy C) Pharmacologic pain management B) Continuous labor support D) Hypnosis
Continuous labor support
During the active phase of labor, the nurse should evaluate the labor pattern how often? A) Every 10 minutes C) Every 30 minutes B) Every 15 minutes D) Every hour
Every 30 minutes
When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be: A) Engagement of fetus C) Rupture of amniotic membranes B) Dilatation of cervix D) Bloody show
Dilatation of cervix
When completing a routine admission on the labor and delivery unit for induction of labor, after the admission information is collected, what is the next priority in planning care for the patient? A) Head to toe physical C) Fetal assessment B) Vital signs D) Placement of IV
Fetal assessment
Beverly is being admitted to labor and delivery. When admitting an obstetric patient in early labor, the first intervention by the nurse is: A) Perineal shave is done immediately to prepare for the examination B) The personal belongings are properly checked and secured C) Good rapport is established with the patient and significant other D) Vital signs and FHR are assessed by internal electronic monitoring
Good rapport is established with the patient and significant other
Which birthing position would you recommend to hasten delivery, enhance placental blood flow, decrease fetal stress, and reduce the possibility that an episiotomy will be required? A) Lithotomy C) Squatting B) Modified dorsal recumbent D) Hands and knees
Hands and knees
Mary Ellen presents in the early stage of labor with mild contractions 7 to 9 minutes apart and BP of 130/80 mm/Hg. You start maternal-fetal monitoring and engage her in conversation as a distraction technique. At first she seems happy, excited, and confident, but eventually she becomes introverted and restless. Her pulse is rapid, her blood pressure is now 137/85, and she is hyperventilating. The fetal monitor shows no variability for almost 20 minutes; variability then becomes evident but there are no late decelerations. What do you do? A) Notify the RN that Mary Ellen's blood pressure has increased. B) Notify the RN about the lack of FHR variability. C) Help Mary Ellen regain control of her breathing technique. D) Assist Mary Ellen into a squatting position.
Help Mary Ellen regain control of her breathing technique.
During contractions, the electronic fetal monitor (EFM) shows variable V-shaped decelerations in the FHR lasting about 30 seconds with accelerations of about 5 bpm before and after each deceleration. Overshoot is absent and the baseline FHR is within normal limits. What should you do first? A) Help the woman change positions B) Discontinue supplemental oxygen C) Position the woman on her side with a pillow under her left hip D) Start an oxytocic infusion and decrease the rate of IV fluids
Help the woman change positions
A multigravida is admitted to the hospital in active labor. The client's and the fetus' condition have been good since admission. The client calls out to the nurse, "the baby is coming!" What is the first action of the nurse? A) Time the contractions C) Contact the physician B) Auscultate the fetal heart tones D) Inspect the perineum
Inspect the perineum
The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's: A) Right upper quadrant C) Left upper quadrant B) Right lower quadrant D) Left lower quadrant
Left lower quadrant
Which occurrence after birth should be reported immediately to the RN? A) A uterine contraction followed by a steady trickle of blood from the vagina and the lengthening of the umbilical cord B) Maternal tachycardia and falling blood pressure C) Placental separation 15 minutes after delivery D) Dark red lochia
Maternal tachycardia and falling blood pressure
If the amniotic fluid is green when the membranes rupture, what do you report to the RN? A) Infection C) Meconium in the amniotic sac B) Umbilical cord prolapse D) Amniotic fluid embolism
Meconium in the amniotic sac
Jane S. is a gravida 1, in the active phase of stage l labor. The fetal position is LOA. When Jane's membranes rupture, the nurse should expect to see: A) Very large amount of blood B) Moderate amount of clear to straw-colored fluid C) Small amount of greenish fluid D) Small segment of the umbilical cord
Moderate amount of clear to straw-colored fluid
Joanne has been in labor for 5 hours. Earlier there was a gradual increase in FHR baseline with variables, but Joanne has changed position several times and now the fetus shows no signs of hypoxia. Joanne's cervix is almost completely effaced and is dilated to 8 cm. However, the labor graph indicates that the fetus has stopped descending. What should you do first? A) Inform the RN that internal fetal monitoring may be needed B) Palpate the area just above the symphysis pubis C) Institute effleurage and apply pressure to Joanne's lower back during contractions D) Encourage Joanne to push
Palpate the area just above the symphysis pubis
The role of the LPN nurse in labor and delivery is which of the following? A) Provide direct independent care to the patient B) Assist the providers in the delivery room C) Provide care to the patient under the supervision of an RN D) Observatory to assist the RN
Provide care to the patient under the supervision of an RN
A woman arrives in labor and delivery, is panting and screaming "the baby is coming". What is the priority intervention by the nurse? A) Assess vital signs B) Ask medical and obstetrical history C) Admit her to the unit and escort to a room D) Quickly move the woman to a labor bed, check the perineum
Quickly move the woman to a labor bed, check the perineum
Which of the following signs signify that the second stage of labor has begun? A) Emotions are calm and happy B) Frequency of contractions are 5-6 minutes C) Fetus is a -1 station D) The urge to push occurs
The urge to push occurs
A woman presents in advanced labor, and birth appears imminent. What is the most important and appropriate aspect of admission for this woman? A) Obtaining a comprehensive obstetric and medical-surgical history B) Determining her plans for the newborn C) Taking her blood pressure and determining whether clonus or edema is present D) Assessing her use of drugs, alcohol, and tobacco during pregnancy
Taking her blood pressure and determining whether clonus or edema is present
What is the most important thing that you can do during labor and delivery to prevent maternal and fetal infection? A) Clean the woman's perineum with a Betadine scrub B) Strictly follow universal precautions C) Remove soiled drapes and linen; place an absorbent pad under the buttocks and two sterile perineal pads against the perineum D) Thoroughly wash your hands before and after patient contact
Thoroughly wash your hands before and after patient contact
While caring for woman in labor the fetal heart monitor demonstrates late decelerations. The most common cause for their occurrence is: A) Cord compression C) Maternal fatigue B) Maternal hypotension D) Uteroplacental insufficiency
Uteroplacental insufficiency
