OB Exam 3 Practice Questions

The nurse in labor and delivery is preparing to initiate labor induction with the administration of oxytocin. After research about oxytocin, the nurse is aware of which fact about the drug? 1. Synthetic oxytocin is identical to endogenous oxytocin. 2. Hypothalamus stimulation increases circulating oxytocin. 3. The half-life of oxytocin is 1 hour, supporting close monitoring. 4. Action from IV oxytocin administration is less than 1 minute.

1 This is correct. The nurse is aware from drug research that synthetic oxytocin is identical to endogenous oxytocin. 2 This is incorrect. Labor induction is not a result of endogenous oxytocin, which is a peptide synthesized by the hypothalamus that is transported to the posterior lobe of the pituitary gland. Oxytocin is naturally released in response to vaginal and cervical stretching. 3 This is incorrect. The administration of oxytocin does require close monitoring, but the half-life of the drug is 10 minutes, not 1 hour. 4 This is incorrect. Uterine response to oxytocin usually occurs within 3 to 5 minutes after IV administration begins.

The nurse understands that logically ______________________cesarean births are an influential factor related to the overall incidence of cesarean births

Previous Feedback: The incidence of cesarean births in 2016 reflects a 54% increase over a 19-year period between 1996 and 2016. Logically, the nurse understands that previous cesarean births is an influential factor related to the overall incidence of cesarean births. As nonmedical and elective cesareans decrease, the overall incidence should also decrease

A high probability of successful induction of labor is associated with a Bishop score of: 1. Greater than 2 2. Greater than 4 3. Greater than 6 4. Greater than 8

4: Feedback 1 This is incorrect. A Bishop's score greater than 8 generally confers the same likelihood of vaginal delivery with induction of labor as that following spontaneous labor, and thus has been considered to indicate a favorable cervix. Conversely, a Bishop's score of 6 or less has been used to denote an unfavorable cervix in many studies and has been associated with a higher risk of cesarean delivery when labor is induced compared with spontaneous labor. 2 This is incorrect. A Bishop's score greater than 8 has been considered to indicate a favorable cervix. Conversely, a Bishop's score of 6 or less has been used to denote an unfavorable cervix. 3 This is incorrect. A Bishop's score of 6 or less has been used to denote an unfavorable cervix in many studies and has been associated with a higher risk of cesarean delivery when labor is induced compared with spontaneous labor. 4 This is correct. A Bishop's score greater than 8 generally confers the same likelihood of vaginal delivery with induction of labor as that following spontaneous labor, and thus has been considered to indicate a favorable cervix.

During a vaginal delivery, the primary care provider (PCP) notices greenish yellow coloration on the fetal head during crowning. Intrapartum suctioning is performed as soon as the fetus's head is delivered. The nurse understands the aspiration of meconium will have which effects on the neonate's respiratory function? Select all that apply. 1. Result in airway obstruction 2. Contribute to pulmonary hypertension 3. Result in chemical pneumonitis 4. Create strain on cardiac function 5. Cause surfactant dysfunction

1, 2, 3, 5: This is correct. Meconium aspiration syndrome (MAS) will result in airway obstruction, which is relative to the amount and consistency of the aspirated meconium. 2 This is correct. Due to airway obstruction related to MAS, there is a high risk for the development of pulmonary hypertension. 3 This is correct. Chemical pneumonitis is inflammation of the bronchial structures of the lungs caused by chemicals and/or substances that are foreign to the lungs. The presence of meconium or the medications used to treat MAS could be sources for the condition. 4 This is incorrect. The question specifically asks for identification of MAS on the fetus/neonate's respiratory function. 5 This is correct. If the meconium is aspirated deeply enough, the air sacs may be coated with the aspirate, which will interfere with the functioning of surfactant

The nurse is aware that there are multiple classifications for cesarean deliveries. Which situations does the nurse classify as an unscheduled cesarean birth? Select all that apply. 1. The cervix fails to fully dilate after prolonged labor. 2. There is evidence of a prolapsed cord with membrane rupture. 3. Patient had a previous cesarean delivery. 4. Patient has a preexisting cardiac health condition. 5. There is recognition of placenta previa with mild bleeding.

1,2, 4, 5 This is correct. When the cervix fails to fully dilate after prolonged labor, an unplanned nonurgent cesarean birth is performed. 2 This is correct. Evidence of a prolapsed cord with membrane rupture is a complication requiring an emergent cesarean delivery. 3 This is incorrect. When a patient has a cesarean, a repeat cesarean is commonly scheduled for any additional pregnancies. 4 This is correct. The patient with a preexisting cardiac health condition is usually scheduled for a planned cesarean delivery. The patient is at risk during labor and/or vaginal birth. 5 This is correct. Recognition of placenta previa with mild bleeding is a reason for an urgent cesarean birth because of the need for rapid delivery of the fetus

The nurse is providing care for a patient who delivered via cesarean 24 hours ago. Which teaching does the nurse provide for the patient and family? Select all that apply. 1. Signs and symptoms to report to the health-care provider (HCP) 2. Comfortable positions for feeding the newborn 3. Encouragement for early dietary intake of solid foods 4. Encouragement for family to help with infant care and housework 5. Information on nutrition to promote tissue healing

1,2,3,4,5 This is correct. The nurse teaches the patient and family about the signs and symptoms that need to be reported to the HCP. Patients with cesarean deliveries are more prone to infection. 2 This is correct. Due to abdominal tenderness related to cesarean birth, the nurse will need to teach the mother and family about comfortable positions for feeding the newborn. Breastfeeding mothers may be more comfortable in a side-lying position. 3 This is correct. Following a cesarean, patients who eat solid foods early rather than waiting for the presence of bowel sounds have shown an earlier return of bowel function. 4 This is correct. Because the recovery for a cesarean will be 6 weeks or longer, the nurse will encourage the family to help with infant care and housework. 5 This is correct. Because the patient has an abdominal incision, the nurse needs to provide teaching for a diet that will promote healing

A patient in labor receives high-level regional anesthesia, which inhibits her ability to push during the second state of labor. The primary care provider (PCP) will use forceps to aid in the delivery of the fetus. Which fetal complications is the nurse aware of being related to a forceps birth? Select all that apply. 1. Intracranial hemorrhage 2. Skin lacerations 3. Nerve injuries 4. Cephalohematoma 5. Skull fracture

1,2,3,4,5: This is correct. Intracranial hemorrhage is a possible complication of a forceps delivery and results from pressure on the fetal head by the forceps during birth. 2 This is correct. Skin lacerations are a possible complication of forceps delivery and result primarily during the insertion of the forceps. 3 This is correct. Nerve injuries are a possible complication of a forceps delivery and result from the pulling action of moving the fetus down the birth canal. 4 This is correct. Cephalohematoma is a possible complication of a forceps delivery and results from pressure on the head, which causes the rupture of small blood vessels and the collection of blood beneath the scalp. 5 This is correct. Skull fracture is a possible complication of a forceps delivery and results from pressure on the fetal skull during insertion of the forceps and/or when exerting pressure during extraction of the fetus.

. The nursing preceptor is teaching the nursing student about fetal tachycardia. Which is true of the maternal reasons for fetal tachycardia? Select all that apply. 1. A urine toxicology screen may reveal recent cocaine use; the nurse should also monitor for placental abruption. 2. Administer terbutaline to the mother for uterine tachysystole; this is self-limiting to when the drug is affecting the mother. 3. Maternal fever is a common sign. 4. Check the chart for a history of maternal mental illness, particularly maternal anxiety; speak with the patient regarding her anxiety and take steps to ease her anxieties. 5. Check the maternal blood pressure, as hypotension is linked to fetal tachycardia; identify the on-call provider.

1,2,3,4: This is correct. Illicit drugs such as cocaine can cause fetal tachycardia and additionally can cause placental abruption. 2 This is correct. Terbutaline is given to mothers for uterine tachysystole in labor, and its effect is limited to how quickly the drug is cleared from the maternal system. 3 This is correct. Maternal fever can result in fetal tachycardia. 4 This is correct. Fetal tachycardia can be linked to maternal anxiety, and taking steps to reduce it can correct the fetal heart rate (FHR). 5 This is incorrect. There is no link between hypotension and fetal tachycardia.

The nurse-educator is preparing a presentation on fetal heart monitoring. Which of the following should be included? Select all that apply. 1. Intermittent auscultation should be performed every hour in the latent phase. 2. For Category I situations, intermittent electronic fetal monitoring (EFM) should be performed for 10 to 30 minutes every 1 to 2.5 hours. 3. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 4. A patient with a previous cesarean section should have EFM for 10 to 30 minutes every 1 to 2.5 hours. 5. A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.

1,2,3,5: Feedback 1 This is correct. Intermittent auscultation should be done every hour in the latent phase. 2 This is correct. For Category I situations, intermittent EFM should be done for 10 to 30 minutes every 1 to 2.5 hours. 3 This is correct. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 4 This is incorrect. A patient with a previous cesarean section should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 5 This is correct. A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage

The obstetric nurse is assessing the laboring patient for pain. Which of the following should the nurse identify in a pain assessment? Select all that apply. 1. Intensity of contractions 2. Presence of pain in the neck or back 3. Presence of fetal heart rate (FHR) with intermittent auscultation 4. Signs of anxiety 5. Frequency and duration of contractions

1,2,4,5: Feedback 1 This is correct. In a pain assessment, the nurse should assess for intensity 2 This is correct. In a pain assessment, the nurse should assess for location. 3 This is incorrect. Fetal heart tones are not part of a pain assessment. 4 This is correct. In a pain assessment, the nurse should assess for degree of distress. 5 This is correct. In a pain assessment, the nurse should assess for pattern

When assisting with a vacuum-assisted vaginal delivery, the nurse is aware that adherence to which guidelines for the vacuum device will minimize the nurse's liability in vacuum-assisted vaginal births? Select all that apply. 1. Pump up the vacuum manually to the pressure indicated on the pump. 2. Recognize that cup detachment (pop off) is a warning sign. 3. The cup should not be on the fetal head for longer than 5 to 10 minutes. 4. The procedure is timed from insertion of the cup into the vagina until the birth. 5. Understand that pressure should be released between contractions

1,2,4,5: This is correct. Pump up the vacuum manually to the pressure indicated on the pump, not to exceed 500 to 600 mm Hg. 2 This is correct. The nurse needs to be aware that cup detachment (pop off) is a warning that too much ineffective force is being exerted on the fetal head. 3 This is incorrect. The cup should not be on the fetal head for longer than 15 to 20 minutes. The nurse needs to be the reminder of the "three-pull rule" that specifies that vacuum-assisted efforts need to be stopped after three attempts in 15 minutes. 4 This is correct. The procedure is timed from point of insertion of the cup into the vagina until the birth. If the vacuum-assisted delivery does not occur after three attempts within 15 to 20 minutes, cesarean is indicated. 5 This is correct. It is important to understand that pressure should be released between contractions; retention of unnecessary pressure increases the risk for fetal injury.

The nurse in labor and delivery notices an increase in the number of women requesting cesarean births. Which are the parameters and criteria used when making the decision to perform a cesarean delivery on maternal request (CDMR)? Select all that apply. 1. Procedure is performed after 39 weeks' gestation. 2. Patient is willing to defer from legal litigation. 3. Patient is aware of possible neonatal complications. 4. Mother is planning to only have one child. 5. Patient is able to self-pay for the procedure

1,3 This is correct. Because of the increased risk for neonatal complications, the patient needs to understand that CDMR does not occur before 39 weeks' gestation. 2 This is incorrect. The willingness of a patient and partner to defer from legal litigation is not part of the parameters and criteria relative to a CDMR. 3 This is correct. Part of the parameters and criteria relative to a CDMR is that the patient recognizes that the fetus is at risk for respiratory distress, hypothermia, hypoglycemia, and/or neonatal intensive care unit (NICU) admission. 4 This is incorrect. The risk for complications increases with each cesarean birth. However, the intention of the mother to have only one child is not part of the parameters and criteria relative to a CDMR. 5 This is incorrect. The ability to self-pay for a cesarean delivery is not part of the parameters and criteria relative to a CDMR

The nurse is making a plan of care for a patient who is in the first 24-hour period past a cesarean delivery. Which interventions will the nurse include in regards to medications? Select all that apply. 1. Continue a daily stool softener. 2. Provide prophylaxis antibiotics. 3. Ensure the availability of naloxone. 4. Manage pain with morphine. 5. Administer RhoGAM if needed

1,3,4,5 This is correct. Within the first 24 hours and beyond, the nurse will continue administration of a daily stool softener. Constipation related to opiate pain control is common. 2 This is incorrect. Prophylaxis antibiotics are administered before the cesarean delivery to prevent infection. 3 This is correct. Naloxone is administered for any signs of morphine overdose. 4 This is correct. Following a cesarean, morphine is administered for management of post-surgery pain. 5 This is correct. If the mother is Rh-negative, RhoGAM is given within the first 24 hours

The nurse is speaking with a pregnant patient who is asking what processes start labor. Which responses by the nurse are appropriate? Select all that apply. 1. There is more pressure on the cervix, which causes the start of contractions by releasing oxytocin. 2. The uterus begins to contract due to a decrease in estrogen. 3. Oxytocin stimulates uterine muscles to contract. 4. The fetus releases a stress hormone, cortisol, and this starts contractions. 5. The placenta begins to age and deteriorate and this triggers the start of contractions.

1,3,4,5: Feedback 1 This is correct. Increased pressure on the cervix stimulates the nerve plexus, causing release of oxytocin by the maternal pituitary gland, which then stimulates contractions. 2 This is incorrect. It is an increase in estrogen that stimulates a uterine response 3 This is correct. Oxytocin stimulates uterine muscles to contract. 4 This is correct. Fetal cortisol rises and stimulates the uterus to contract. 5 This is correct. As the placenta ages, it begins to deteriorate, triggering initiation of contractions

The nurse is teaching the patient about the trends and risks of epidural anesthesia. Which of the following should the nurse relay about the risks of epidural anesthesia? Select all that apply. 1. There is a higher rate of instrumental vaginal delivery. 2. There is a higher rate of spontaneous vaginal delivery. 3. When using an epidural, women are less likely to sweat with a fever. 4. Labor may be longer with an epidural. 5. There is a higher rate of fever and sepsis.

1,3,4,5: Feedback 1 This is correct. Epidurals are associated with higher rates of forceps and vacuum suction rates. 2 This is incorrect. Epidurals are associated with lower rates of spontaneous vaginal delivery. 3 This is correct. An elevation in maternal temperature is associated with regional anesthesia, and it is also associated with reduced perspiration. 4 This is correct. Epidurals are associated with longer labor. 5 This is correct. Epidurals are associated with higher rates of fever and sepsis

The nurse educator is teaching about regional and local anesthesia in a childbirth education class. The nurse should teach that regional anesthesia is used for which of the following? Select all that apply. 1. Epidural with lidocaine for pain in labor 2. Lidocaine 1% for episiotomy 3. Spinal block with lidocaine for a cesarean delivery 4. Lidocaine 1% for episiotomy repair 5. Lidocaine without epinephrine for forceps use

1,3,5: Feedback 1 This is correct. Regional anesthesia can be used for labor pain in the form of a pudendal block, epidural block, or spinal block. 2 This is incorrect. A local anesthesia can be used for episiotomy. 3 This is correct. Regional anesthesia can be used for surgical pain in cesarean section. 4 This is incorrect. A local anesthesia is used for episiotomy repair. 5 This is correct. A pudendal block (which is regional anesthesia) is used for forceps use.

The nurse is providing care to a patient who is in labor. The patient's membranes rupture spontaneously, and the nurse notices meconium-stained amniotic fluid. Which actions does the nurse immediately perform? Select all that apply. 1. Alert the neonatal team of a possible meconium aspiration neonate. 2. Promote fetal well-being by placing the patient on her left side. 3. Notify the primary care provider (PCP) about the presence of meconium. 4. Administer oxygen to the mother to help prevent fetal hypoxia. 5. Test the stained fluid for percentage of meconium content.

1,3: This is correct. The nurse will immediately inform the neonatal resuscitation team that they may expect a meconium aspiration neonate. It is imperative that resuscitation occur immediately in order to avoid or decrease respiratory complications. 2 This is incorrect. The nurse will need to monitor for fetal well-being because the presence of meconium in the amniotic fluid can be indicative of fetal distress. However, placing the patient on her left side is not necessary. 3 This is correct. The nurse immediately notifies the PCP about the meconium-stained amniotic fluid, which may be an indicator of fetal distress. 4 This is incorrect. Administering oxygen to the patient may or may not be necessary. Fetal monitoring is performed to help identify any indications of fetal hypoxia. 5 This is incorrect. There is no reason for or means to test the amniotic fluid to determine the percentage of meconium. All infants with meconium in the amniotic fluid should have their nose, mouth, and pharynx suctioned as soon as the head is delivered (intrapartum suctioning) regardless of whether the meconium is thin or thick

The nurse educator is teaching the nursing student the basic principles of using analgesia by using a patient, Christa, as an example. Which of the following demonstrates the basic principles of analgesia during Christa's labor and delivery? Select all that apply. 1. Christa has been in labor for 4 hours. She has been having contractions every 3 minutes. Contractions last a minute and are intense. She has had cervical change from 3 to 5 cm over the past 4 hours. 2. Local anesthesia in the perineal area was used in conjunction with the epidural throughout labor and delivery. 3. Christa received butorphanol (Stadol) within 3 hours of delivery and the infant experienced neonatal depression. 4. The medication Christa wants is an epidural. After she receives the epidural, the fetal heart rate (FHR) tracing is within normal limits. 5. Christa has a history of opiate abuse and therefore it was understood that she might require higher doses of medications to experience relief.

1,4,5: Feedback 1 This is correct. Labor must be well established before administration of an analgesic is begun. 2 This is incorrect. Local anesthesia is used at the time of delivery for episiotomy and repair. 3 This is incorrect. Neonatal depression may occur if medication is given within an hour before delivery. 4 This is correct. Medication should provide relief to the mother with minimal risk to the baby. 5 This is correct. Women with a history of drug abuse may have a lessened effect from pain medication and require higher doses

The most common cause of postpartum hemorrhage is: 1. Uterine atony 2. Cervical laceration 3. Placenta accreta 4. Retained placenta

1: Feedback 1 This is correct. An atonic uterus is the most common cause of postpartum hemorrhage. 2 This is incorrect. Cervical lacerations are not the most common cause of postpartum hemorrhage and rarely occur. 3 This is incorrect. Placenta accreta is not the most common cause of postpartum hemorrhage and rarely occurs . 4 This is incorrect. Retained placenta is not the most common cause of postpartum hemorrhage and rarely occurs.

The nurse is providing care for a patient who is admitted for cervical ripening. The health-care provider (HCP) has prescribed the use of a hygroscopic dilator. Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening? 1. The method may be indicative of fetal demise. 2. The patient has a history of cesarean childbirth. 3. This method is quicker than hormonal ripening. 4. This patient is being treated for active herpes

1: Feedback 1 This is correct. Currently, hygroscopic dilators are used primarily during pregnancy termination rather than for cervical ripening in term pregnancies. Pregnancy termination may be necessary due to fetal demise. 2 This is incorrect. Hydroscopic dilators for cervical ripening are not used specifically for women who have a history of cesarean childbirth. Pharmacological ripening can be achieved through the use of Cervidil. Misoprostol is avoided with a patient with a history of cesarean due to the risk of uterine rupture. 3 This is incorrect. The process of cervical ripening using a hygroscopic dilator occurs over a period of 12 to 24 hours as the inserted material absorbs water. 4 This is incorrect. Being treated for active herpes is a contraindication for any method of cervical ripening. The patient with active herpes will require a cesarean delivery

The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor? 1. Dystocia is associated with extreme fear. 2. Mothers cannot enjoy the actual birth. 3. Fear promotes feelings of exhaustion. 4. Fear during labor causes postpartum depression.

1: Feedback 1 This is correct. Extreme maternal fear or exhaustion can result in catecholamine release interfering with uterine contractility, a condition that will cause dystocia. 2 This is incorrect. The nurse will focus on the physiological impact of fear during labor rather than on the extent to which a patient will enjoy the birthing process. 3 This is incorrect. Fear and exhaustion are often experienced together by the patient in labor. However, there is a more important reason to focus on fear. 4 This is incorrect. Postpartum depression is related to hormonal changes after birth

The nurse is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacological methods of pain relief. The nurse thinks that sterile water injections may help with her pain management. Which of the following explanations should the nurse explain to the patient? 1. "We will inject 0.5 mL of sterile water subcutaneously, and it will last for an hour to 90 minutes." 2. "We will inject 1 mL of sterile water intramuscularly, and it will last for about an hour." 3. "We will inject 1 mL of sterile water subcutaneously, and it will last for about a half hour." 4. "We will inject 0.5 mL of sterile water intramuscularly, and it will last for about 3 hours."

1: Feedback 1 This is correct. Sterile water injections are subcutaneous injections of 0.5 mL sterile water and provide 60 to 90 minutes of lower back pain relief. 2 This is incorrect. Sterile water injections are subcutaneous injections, not intramuscular, of 0.5 mL, not 1.0 mL, of sterile water that can provide up to 90 minutes of lower back pain relief. 3 This is incorrect. Sterile water injections are subcutaneous injections of 0.5 mL, not 1.0 mL, sterile water and provide up to 90 minutes, not 30 minutes, of lower back pain relief. 4 This is incorrect. Sterile water injections are subcutaneous, not intramuscular, injections of 0.5 mL sterile water and provide 60 to 90 minutes, not 3 hours, of lower back pain relief

The nurses in a labor and delivery unit are concerned about the high incidence of cesarean deliveries at their facility and initiate an internal study. Which is the most likely condition the nurses will recognize as a contributor to the rate of cesarean births? 1. Policies and parameters for cesarean need to be reviewed and refined. 2. The facility has a high rating for managing high-risk pregnancies. 3. Community education about the advantages of vaginal birth is deficient. 4. The incidence of maternal requests for cesarean delivery is increasing

1: This is correct. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress as a means to reduce the numbers of cesarean births. Clinical improvement strategies with careful examination of labor management practices are important. 2 This is incorrect. The high rating of the facility for management of high-risk pregnancies may or may not impact the number of cesareans performed; not every high-risk pregnancy ends with a cesarean birth. 3 This is incorrect. It is important that community education be provided explaining the advantages of vaginal births. However, this is not the lone action that will reduce the numbers of cesarean births. 4 This is incorrect. Cesarean delivery by maternal request (CDMR) accounts for only 3% of cesarean births in the United States.

The nurse is assisting with the preparation of a patient admitted for a planned cesarean birth. The patient has signed the consent form and discussed the elected regional anesthesia with the nurse anesthetist. Which is the most important action for the nurse related to anesthesia? 1. Verify the patient has been nothing by mouth (NPO) for 6 to 8 hours. 2. Obtain a baseline fetal heart rate (FHR) monitor strip. 3. Administer preoperative medications per orders. 4. Start an IV line and administer an IV fluid as ordered

2 This is incorrect. Verifying the patient has been NPO for 6 to 8 hours before surgery is important; however, there is another more important nursing action. 2 This is correct. Obtaining a baseline FHR monitor strip for at least 20 minutes before the administration of anesthesia is the most important nursing action. Another 20-minute strip will be obtained after the administration of the anesthesia. This comparison makes fetal monitoring more effective. 3 This is incorrect. Administering preoperative medications per orders is important; however, there is another more important nursing action. 4 This is incorrect. Starting an IV line and administering an IV fluid as ordered is important; however, there is another more important nursing action

The nurse is caring for a pregnant patient who expresses concern about the effects of electronic fetal monitoring (EFM) on her labor and delivery. Which responses by the nurse would be appropriate in this situation? Select all that apply. 1. "There is a decrease in the incidence of cerebral palsy if a patient has EFM during labor." 2. "There is a reduced rate of seizures if a patient has EFM during labor." 3. "There is an increase in operative vaginal births and the use of continuous EFM." 4. "There is a link between the rate of cesarean sections and continuous EFM." 5. "There is a link between decreased infant mortality and EFM during delivery."

2,3,4: Feedback 1 This is incorrect. EFM during labor has not been shown to reduce cerebral palsy. 2 This is correct. EFM during labor is associated with reduced rates of neonatal seizures. 3 This is correct. Continuous EFM increases the rate of operative vaginal births. 4 This is correct. Continuous EFM increases the rate of cesarean sections. 5 This is incorrect. EFM during labor has not been shown to reduce infant mortality.

A patient is interested in a pain relief option that she can control during labor. The nurse explains to the patient what pain relief options are available that would meet her needs, and they mutually decide on nitrous oxide. Which of the following does the nurse describe to the patient about the use of nitrous oxide in labor? Select all that apply. 1. "If started, it should be used throughout the entire labor." 2. "There is no effect on the labor progress from active labor to delivery, and therefore you do not need to worry about longer labors with the medication." 3. "The gas takes effect in about 50 seconds after the first breath, and the patient will feel calm." 4. "The nurses will administer it to you during every contraction so we will need to be with you during the entire labor." 5. "It has no trade name and is only available in generic forms."

2,3: Feedback 1 This is incorrect. It can be started and stopped at any point in labor This is correct. It has no adverse effects on the normal physiology and progress of labor. 3 This is correct. It takes effect in about 50 seconds after the first breath, and the effect is transient. 4 This is incorrect. It is self-administered by the patient. 5 This is incorrect. It is called by the trade name Nitronox

The nurse encourages the patient to bring loved ones to be with her during labor because the nurse knows that their presence does which of the following? Select all that apply. 1. Lowers the chance that the patient will breastfeed 2. Reduces the likelihood that a patient will require an epidural 3. Reduces the risk of infection after birth 4. Shortens the length of labor 5. Increases patients' happiness and satisfaction with the outcome of their birth

2,4,5: Feedback 1 This is incorrect. In 2011, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) found that having support persons increases the likelihood of breastfeeding. 2 This is correct. In 2011, the AWHONN found that having support persons decreases the use of analgesia. 3 This is incorrect. Having support persons has not been shown to have an effect on post-delivery infections. 4 This is correct. In 2011, the AWHONN found that having support persons shortens labor. 5 This is correct. In 2011, the AWHONN found increased satisfaction with the birth experience in those with support persons

The nurse is monitoring a patient when the electronic fetal monitor (EFM) strip conveys fetal bradycardia. Which action would be the most urgent for the nurse to take? 1. Check the patient's input and output. 2. Check the mother for vaginal bleeding and severe abdominal pain. 3. Change the mother's position from supine to left lateral. 4. Take a blood pressure to determine if the mother has hypotension.

2: Feedback 1 This is incorrect. Dehydration is a possible cause of fetal bradycardia but is not the most urgent action. 2 This is correct. Placental abruption is a possible cause of fetal bradycardia and is an emergency. 3 This is incorrect. Supine position is a possible cause of fetal bradycardia, so it may help to place the patient in a left lateral position, but it is not the most urgent action. 4 This is incorrect. Hypotension is a possible cause of fetal bradycardia but is not the most urgent action

The electronic fetal monitor (EFM) tracing shows the following: Fetal heart rate (FHR) baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the Category FHR interpretation system, how should the nurse interpret this tracing? 1. Category I 2. Category II 3. Category III 4. Normal FHR pattern

2: Feedback 1 This is incorrect. Fetal heart rate (FHR) baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm indicates a Category II FHR pattern. 2 This is correct. Fetal heart rate (FHR) baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm indicates a Category II FHR pattern 3 This is incorrect. Fetal heart rate (FHR) baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm indicates a Category II FHR pattern. 4 This is incorrect. This is not a reassuring FHR pattern Fetal heart rate (FHR) baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm indicates a Category II FHR pattern

The normal fetal heart rate (FHR) baseline rate: 1. Decreases during labor 2. Fluctuates during labor 3. Increases during labor 4. Accelerates during labor

2: Feedback 1 This is incorrect. The normal FHR baseline rate should fluctuate during labor, not decrease. Fetal bradycardia can be abnormal. 2 This is correct. The normal FHR baseline rate should fluctuate during labor, not increase or decrease. 3 This is incorrect. The normal FHR baseline rate should fluctuate during labor, not increase. 4 This is incorrect. The normal FHR baseline rate should fluctuate during labor, not accelerate. Fetal tachycardia can be abnormal.

The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with spontaneous rupture of membranes (SROM) and clear fluid 2 hours ago. What action should the nurse take? 1. Monitor the patient's blood pressure, temperature, and respirations every 2 hours. 2. Help the patient change her position from side to side every 30 minutes. 3. Have the patient rate her pain on a scale from 1 to 10 roughly every hour. 4. Monitor the fetal heart tones every hour

2: Feedback 1 This is incorrect. When the patient is in active labor, the nurse should monitor the patient's vital signs every hour. Once rupture of the membranes has occurred, the nurse should monitor the patient's temperature every hour. 2 This is correct. When the patient is in active labor, the nurse should help the woman change position every 30 minutes and as needed. 3 This is incorrect. When the patient is in active labor, the nurse should assess the patient's pain status every 30 minutes and as needed. 4 This is incorrect. When the patient is in active labor, the nurse should monitor fetal heart rate every 15 to 30 minutes

A patient who is at 39 weeks' gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure? 1. Prior amniotic fluid leakage must be validated before the procedure. 2. The fetal head is currently engaged in the maternal pelvis. 3. The nurse must have certification to perform the procedure. 4. Ultrasound indicates the umbilical cord is away from the cervix

2: This is incorrect. Amniotic fluid leakage does not need to be confirmed before an amniotomy. 2 This is correct. An important criterion for performing an amniotomy is for the fetal head to be engaged in the maternal pelvis. Lack of engagement will result in a prolonged labor and/or an increased risk for infection. 3 This is incorrect. The amniotomy is performed by the primary health-care provider (HCP), who needs to be available in the event that an emergency intervention is necessary. Nurses do not perform this procedure. This is incorrect. A possible complication with amniotomy is for prolapse of the umbilical cords, and careful monitoring is required. However, the placement of the cord is not identified by ultrasound before the procedure

Ephedrine is used to correct which side effect of epidural anesthesia/analgesia? 1. Nausea and vomiting 2. Pruritis 3. Anxiety 4. Hypotension

4: Feedback 1 This is incorrect. Ephedrine is used to correct hypotension, not nausea and vomiting. Nausea and vomiting are not a common side effect of epidural anesthesia/analgesia. 2 This is incorrect. Ephedrine is used to correct hypotension, not pruritis. 3 This is incorrect. Ephedrine is not used for anxiety. 4 This is correct. Ephedrine is used to correct hypotension, a side effect of epidural anesthesia/analgesia

A patient who is expecting her first baby tells the nurse, "I am afraid of the whole birth experience and plan to ask the doctor for a cesarean delivery." Which response by the nurse is most appropriate? 1. "Most women avoid cesarean births unless it is an emergency." 2. "I will get you some material about how labor pain is managed." 3. "Cesarean will cause you issues with additional pregnancies." 4. "I suggest you talk with the physician and get another opinion."

3 This is incorrect. It is true that most women attempt to avoid cesarean delivery unless it is an emergency. However, the patient may not be interested in decisions made by other women. 2 This is incorrect. It is appropriate for the nurse to supply the patient with material about pain management during labor and delivery; however, it is most important for the nurse to explain the risks associated with cesarean delivery on maternal request (CDMR). 3 This is correct. The nurse needs to inform the patient that if additional pregnancies are desired, cesarean delivery risks increase with each additional pregnancy. Risk for placenta previa, placenta accreta, and gravid hysterectomy rises with each cesarean delivery. 4 This is incorrect. It is within the scope of practice for the nurse to provide patient teaching, and the nurse can also suggest the patient explore the topic further with the health-care provider (HCP). However, it is most important for the nurse to explain risks related to CDMR

A patient at 34 weeks' gestation is in labor with twins. The primary care provider (PCP) decides the fetuses need to be delivered by cesarean. Which medical and nursing interventions will be in place for this delivery? Select all that apply. 1. The fetal heart rate (FHR) for the two fetuses is monitored alternately. 2. The usual personnel to attend delivery are arranged. 3. The placement of a large-bore IV access is ensured. 4. A hospital with a Level II or III nursery is selected. 5. Delivery is attended by two medical personnel.

3, 4, 5: This is incorrect. The nurse will continue to monitor both fetuses simultaneously and continuously. Once membranes are ruptured, internal monitoring for twin A is initiated. The well-being of one twin does not ensure the well-being of the other twin. 2 This is incorrect. For the delivery of multiple fetuses, the usual personnel for surgery will be required. Personnel will include an anesthesia provider, a scrub nurse, and a circulating nurse. 3 This is correct. The nurse will make sure that a large-bore IV access is in place for fluid replacement in case of hemorrhage or need for emergency fluid replacement and anesthesia administration. 4 This is correct. Due to the possibilities of fetal distress or need of special care related to immaturity, the cesarean needs to be performed in a hospital with either a Level II or III nursery. 5 This is correct. For multiple births, either two experienced obstetricians or one obstetrician and a board-certified midwife will attend the delivery

The nurse is providing care for a patient who is at 42 weeks' gestation. The patient's primary care provider (PCP) is suggesting induction, but the patient is resistant. Which facts can the nurse provide if the patient asks about allowing labor to start spontaneously? Select all that apply. 1. Maternal death rate is higher if the pregnancy is continued beyond 42 weeks. 2. Post-term fetuses are prone to developmental delays related to uterine hypoxia. 3. Stillbirth or newborn death increases in pregnancies beyond 42 weeks. 4. There is a greater chance of developing complications because of larger fetal size. 5. Postmature fetuses have decreased subcutaneous fat and lack vernix and lanugo

3, 4, 5: This is incorrect. There is no support for a higher maternal death rate related to post-term pregnancies. 2 This is incorrect. There is no definitive connection between post-term pregnancies and developmental delays in the child born post-term. 3 This is correct. One of the greatest concerns about post-term pregnancy is the increased risk of stillbirth or infant death. 4 This is correct. The fetus who is post-term is most likely to exhibit macrosomia, a condition that contributes to a higher risk for complications associated with both the mother and fetus. 5 This is correct. Postmature fetuses have decreased subcutaneous fat and lack vernix and lanugo. However, although the nurse can present this as factual information, it is likely

In preparation for a cesarean birth, the nurse expects which medical-based preoperative interventions? Select all that apply. 1. Assessment of the woman's knowledge and educational needs 2. Verification that the woman has been nothing by mouth (NPO) for 6 to 8 hours before surgery 3. Administration of narrow-spectrum prophylactic antibiotics 4. Assessment for risk of venous thromboembolism (VTE) 5. Prescription for sequential compression devices before surgery

3,4, 5 This is incorrect. Assessment of the woman's knowledge and educational needs is performed primarily for the planned or non-urgent cesarean. The assessment is primarily a nursing-based intervention. 2 This is incorrect. Verification that the woman has been NPO for 6 to 8 hours before cesarean surgery is obtained only if the cesarean is a planned procedure. The verification is a nursing-based intervention. 3 This is correct. Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes before the skin incision for any cesarean. If the cesarean is emergent, the antibiotics can be administered during or immediately after the procedure. Prescription of medications is a medical-based intervention. 4 This is correct. Performing an assessment for risk of VTE and classifying the woman based on VTE classification guidelines is a medical-based intervention. Preoperative anticoagulant therapy may be necessary for women classified as moderate or high risk or with a history of recurrent thrombosis. 5 This is correct. Application of sequential compression devices before surgery is to promote lower extremity circulation and aid in the prevention of blood clots. The nurse performs the action based on a medical prescription.

The nurse educator is in a childbirth education class discussing nonpharmacological ways nurses can assist to enhance labor and spontaneous vaginal delivery. Which of the following facts regarding nonpharmacological approaches will the nurse use to help illustrate its benefits? 1. Using peppermint aromatherapy oils will help promote relaxation. 2. The client can achieve self-hypnosis with the Bradley method. 3. Effleurage is performed in rhythm with breathing during a contraction. 4. Sterile water injections can be very useful for pelvic pain

3: Feedback 1 This is incorrect. Although aromatherapy is a nonpharmacological method of promoting relaxation and decreasing pain perception, peppermint is used to help with nausea, not to enhance labor and spontaneous vaginal delivery. 2 This is incorrect. Although the Bradley method is a nonpharmacological way to help manage labor pain, it is husband-coached. 3 This is correct. Effleurage is cutaneous stimulation by lightly stroking the maternal abdomen in rhythm with breathing during contractions. 4 This is incorrect. Sterile water injections are used for lower back pain relief

The nurse is looking at an electronic fetal monitor (EFM) strip and sees that the patient is having contractions that are measuring 150 MVU every 10 minutes for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps? 1. The patient's contractions are adequate, so the main focus should be on resuscitating the fetus with maternal oxygen and maternal position change. 2. The patient's contractions are adequate, so the main focus should be on determining her progress through cervical change. 3. The patient's contractions are inadequate; the provider could consider an amnioinfusion through the intrauterine pressure catheter (IUPC), and once the fetus has improved, contractions need to be augmented to be more effective. 4. The patient's contractions are inadequate; the provider could consider augmenting with Pitocin to be more effective

3: Feedback 1 This is incorrect. Although the fetus should be resuscitated, the patient's contractions are inadequate. 2 This is incorrect. The patient's contractions are inadequate, and determining her progress through cervical change would not improve the mother's or fetus's condition. 3 This is correct. The patient's contractions are inadequate, so the provider could consider an amnioinfusion through the IUPC. Then, once the fetus has improved,

The nurse is caring for a baby who is experiencing fetal tachycardia. Which action should the nurse take next? 1. Perform fetal scalp stimulation for 5 seconds. 2. Apply heat packs to the maternal chest and head 3. Check maternal allergies in the patient chart. 4. Stimulate the fetus with a vibroacoustic device

3: Feedback 1 This is incorrect. Fetal scalp stimulation should be used for fetal bradycardia. 2 This is incorrect. Fetal tachycardia can be caused by maternal fever. Heat application would increase maternal temperature. 3 This is correct. Fetal tachycardia can be caused by maternal or fetal infection and antibiotics may be administered; typically, penicillin is administered and a penicillin allergy would require a different medication. 4 This is incorrect. Fetal movement can cause fetal tachycardia; a vibroacoustic device would cause fetal movement and is therefore unnecessary

The nurse preceptor is teaching a nursing student about the physiology of the fetal heart rate (FHR) pattern. Which statement by the student indicates successful teaching about this concept? 1. "Vagus nerve stimulation increases FHR and helps maintain variability." 2. "Action of the FHR occurs through the absence of norepinephrine." 3. "The sympathetic nervous system is responsible for heart rate variability." 4. "Baroreceptors are responsible for increasing FHR and fetal blood pressure.

3: This is incorrect. Vagus nerve stimulation slows FHR and helps maintain variability. 2 This is incorrect. Action occurs through the release of norepinephrine. 3 This is correct. The sympathetic nervous system is responsible for heart rate variability. 4 This is incorrect. Baroreceptors are stretch receptors that protect homeostasis and regulate heart rate by stimulating a vagal response and decreasing FHR, fetal blood pressure, and cardiac output.

The nurse is obtaining a baseline fetal heart rate (FHR). At 1:00 p.m. the baseline FHR was 130, at 1:20 p.m. FHR baseline was 166, and at 1:40 p.m. the baseline FHR was 204. What should the nurse assess from this trend of fetal baselines? Select all that apply. 1. The 1:20 p.m. FHR baseline should be corrected immediately with delivery. 2. The 1:20 p.m. FHR baseline warranted immediate fetal resuscitation. 3. The 1:00 p.m. FHR baseline warranted immediate maternal resuscitation. 4. The 1:00 p.m. FHR baseline warranted no further action. 5. The 1:40 p.m. FHR baseline should be corrected immediately.

4,5: Feedback 1 This is incorrect. An FHR that is tachycardic should be corrected but other measures should be performed before delivery. 2 This is incorrect. FHR baseline above 160 bpm for at least 10 minutes is tachycardic; however, maternal position change may correct the problem before fetal resuscitation. 3 This is incorrect. The normal range is 110 to 160 bpm and therefore no maternal resuscitation was needed at that time. 4 This is correct. The normal range is 110 to 160 bpm. 5 This is correct. If tachycardia persists above 200 to 220 bpm, fetal demise may occur.

The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient? 1. Narrower pubic arch 2. Shorter diameter between her coccyx and ischium 3. Smaller inlet 4. Wider outlet

4: Feedback 1 This is incorrect. A gynecoid pelvis has a wider pubic arch than an android pelvis. 2 This is incorrect. A gynecoid pelvis has a longer diameter between the coccyx and the ischium than an android pelvis. 3 This is incorrect. A gynecoid pelvis has a larger inlet than an android pelvis. 4 This is correct. A gynecoid pelvis has a wider outlet than an android pelvis