OB Chapter 18
A woman at 32 weeks' gestation is admitted in preterm labor. On your admission assessment, which of following findings should cause the nurse to question the administration of a tocolytic agent? a) A spontaneous abortion in an earlier pregnancy. b) Cervical dilation of 5 cm. c) Fetus in a breech presentation. d) Strong, regular contractions.
Cervical dilation of 5 cm.
A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. For what should the nurse immediately check the patient? a) Umbilical cord prolapse b) Amniotic fluid infection c) Placental abruption d) Amniotic fluid embolus
Umbilical cord prolapse
A woman experiences an amniotic fluid embolism as the placenta is delivered. Your first action would be to a) put firm pressure on the fundus of her uterus. b) tell the woman to take short, catchy breaths. c) increase her intravenous fluid infusion rate. d) administer oxygen by mask.
administer oxygen by mask.
The nurse is requested to assist the physician with an external version. What intervention should the nurse perform prior to and immediately after the external version? a) An electrocardiogram. b) A non-stress test. c) Administer tocolytics. d) Administer a narcotic analgesic
A non-stress test.
A woman presents to the delivery suite at 36 weeks' gestation reporting continuous, heavy vaginal discharge and pelvic pressure. A Nitrazine test confirms PROM. There is no sign of infection. She is admitted to the hospital for watchful waiting. You will be caring for her; which of the following interventions will you be most likely to perform? a) Administer 48 hours of antibiotics IV followed by 5 days PO. b) Administer IM corticosteroids to promote fetal lung maturation. c) Administer oxytocin to induce labor. d) Perform daily pelvic exams to monitor her progress.
Administer 48 hours of antibiotics IV followed by 5 days PO.
Immediately after delivering a full-term infant, a patient develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this patient? a) Aspiration b) Amniotic fluid embolism c) Placental separation d) Congestive heart failure
Amniotic fluid embolism
A client's membranes have just ruptured. Her fetus is presenting breech. Which of the following should the nurse do immediately to rule out prolapse of the umbilical cord in this client? a) Place the woman in Trendelenburg position b) Assess fetal heart sounds c) Administer amnioinfusion d) Administer oxygen at 10 L/min by face mask
Assess fetal heart sounds
A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: a) Delivery is unlikely within the 2 next weeks. b) Infection is present. c) No infection is present. d) Delivery is likely within the next 2 weeks.
Delivery is unlikely within the 2 next weeks.
A physician orders oral tocolytic therapy for a woman with preterm labor. Which agent would the nurse be least likely to administer? a) Magnesium sulfate b) Indomethacin c) Terbutaline d) Nifedipine
Magnesium sulfate
You are assisting with delivery of the second child of a healthy young woman. Her pregnancy has been uneventful, and labor has been progressing well. The fetal head begins to deliver but instead of continuing to emerge, it retracts into the vagina. What should you try first? a) Attempt to push one of the fetus' shoulders in a clockwise or counterclockwise motion. b) McRobert's maneuver c) Apply pressure to the fundus. d) Zavanelli's maneuver
McRobert's maneuver
A woman whose membranes have prematurely ruptured is discharged to home care. Which of the following therapies would you anticipate including in her teaching plan? a) Induction of labor by oxytocin. b) Bed rest in a semi-Fowler's position. c) Hourly assessment of Homan's sign. d) Monitoring temperature twice a day
Monitoring temperature twice a day
When a woman in labor has reached 8 cm dilation, you notice the fetal heat rate suddenly slows. On perineal inspection, you observe the fetal cord has prolapsed. Your first action would be to a) Place her in a knee-chest position. b) Cover the exposed cord with a dry, sterile wrap. c) Replace the cord with gentle pressure. d) Turn her to her left side.
Place her in a knee-chest position.
A multipara presents to the hospital after 2 hours of labor. The fetus is presenting in transverse lie. You notify the physician and take what action? a) Prepare to assist with external version or prep for a cesarean section delivery. b) Include a set of piper forceps when you prep the table. c) Apply pressure to the woman's lower back with a fisted hand. d) Assist with Nitrazine and fern tests.
Prepare to assist with external version or prep for a cesarean section delivery.
A nurse is caring for a client in labor, who has been diagnosed with placental problems. Which of the following is indicative of placenta succenturiata? a) Umbilical blood vessels are unprotected for long distances through the membranes b) Umbilical cord inserts at the placental margin rather than in the center c) Small accessory lobes develop in the membranes at a distance from the main placenta d) The membranes are folded back on the fetal surface, exposing part of the umbilical cord
Small accessory lobes develop in the membranes at a distance from the main placenta
A patient who experiences premature rupture of membranes can expect to be put on pelvic rest. The nurse should explain to the patient that pelvic rest involves which of the following? a) placing nothing in the vagina b) staying in bed at all times c) staying off of the feet the majority of the day d) staying in bed with bathroom privileges
placing nothing in the vagina
A patient who is at 7 months' pregnancy presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This patient is showing clinical signs of which of the following? a) precipitous labor b) premature rupture of membranes c) dystocia d) all of the above
premature rupture of membranes
When educating the post-term pregnant patient, what should the nurse be sure to include to prevent fetal complications? a) Be sure to monitor fetal movements daily. b) Increase fluid intake to prevent dehydration. c) Monitor bowel movements. d) Be sure to measure 24-hour urine output daily.
Be sure to monitor fetal movements daily.
Amniotic fluid embolism is a true medical emergency. If it occurs during labor, what sign of fetal distress is usually noted? a) Tachycardia b) Tachapnea c) Arrested fetal movement d) Bradycardia
Bradycardia
The nurse is assisting a physician to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the patient the procedure is called? a) Vaginal manipulation b) Internal rotation c) External version d) External rotation
External version
The nurse providing care for a woman with preterm labor on terbutaline (Brethine) would include which of the following assessments for safe administration of the drug? a) Breath sounds. b) Deep tendon reflexes. c) For elevated blood glucose d) For tachycardia
For tachycardia
At 31 weeks' gestation, a 37-year-old woman who has a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Her cervix is 2.1 cm long; she has fetal fibronectin in her cervical secretions, and her cervix is dilated 3 to 4 cm. For what do you prepare her? a) Hospitalization, tocolytic therapy, and IM corticosteroids b) Bed rest and hydration at home c) An emergency cesarean section d) Careful monitoring of fetal kick counts
Hospitalization, tocolytic therapy, and IM corticosteroids
Pre-term premature rupture of membranes (PROM) can be a serious complication of labor. What is the most common cause of pre-term PROM? a) Macrosomia b) Infection c) Cephalopelvic disproportion d) Incompetent cervix
Infection
A woman you care for has an Rh-negative blood type. Following the birth of her infant, you administer her Rho(D) (D immune globulin). The purpose of this is to a) Prevent fetal RH blood formation. b) Prevent maternal D antibody formation. c) Stimulate maternal D immune antigens. d) Promote maternal D antibody formation.
Prevent maternal D antibody formation.
A woman near term presents to the clinic highly agitated because her membranes have just ruptured and she felt something come out when they did. You are alone with her and notice that the umbilical cord is hanging out of the vagina. What should you do next? a) Put her in bed immediately, call for help, and hold the presenting part of the cord. b) With the woman in lithotomy position, hold her legs and sharply flex them toward her shoulders. c) Prep the woman for a vaginal delivery. d) Go find assistance to confirm that the cord is in the vagina.
Put her in bed immediately, call for help, and hold the presenting part of the cord.
The nurse would prepare a client for amnioinfusion when which of the following occurs? a) Severe variable decelerations are due to cord compression b) Maternal pushing is compromised due to anesthesia c) Fetal presenting part fails to rotate fully and descend in the pelvis d) The fetus shows non-reassuring fetal heart rate patterns
Severe variable decelerations are due to cord compression
The nurse is assisting with a vaginal birth. The patient is fully dilated, 100% effaced and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus? a) Breech position b) Nuchal cord c) Shoulder dystocia d) Umbilical cord prolapse.
Shoulder dystocia
A nurse is caring for a patient at 30 weeks' gestation who had preterm premature rupture of membranes (PROM) 25 hours ago. The patient has a temperature of 102 degrees F and a foul-smelling odor from the vagina. Which medication order should the nurse question? a) Erythromycin 500 mg IV b) Ampicillin 1 GM IV c) Terbutaline 0.25 mg subcutaneous d) Tylenol 650 mg by mouth
Terbutaline 0.25 mg subcutaneous
A 45-year-old pregnant woman with type O blood has had an amniocentesis to rule out Down syndrome. The fetus has type AB blood. What can the nurse warn the patient is a likely outcome if some fetal blood mixed with maternal blood during the procedure? a) Placental abruption b) The baby will develop hemolytic anemia. c) Preterm delivery d) The baby will have postdelivery jaundice.
The baby will have postdelivery jaundice.
