OB FINAL STACK 3

9. The nurse is providing care in PACU for a patient who just delivered a neonate via cesarean section. The patient reports tightness in her chest. Assessment findings include tachypnea, hypotension, and decreasing oxygen saturation levels. Which complication does the nurse report to the health care provider? 1. Pulmonary embolism 2. Postpartum hemorrhage 3. Surgical-site infection 4. Developing endometritis

ans 1 This is correct. The patient's manifestations are classic for pulmonary embolus. Other assessment findings will include dyspnea, shortness of breath, and hypotension.

_ 10. The nurse in the post-delivery unit is encouraging skin-to-skin contact for a mother and neonate after cesarean delivery. Which action, if noticed by the nurse, requires immediate intervention by the nurse? 1. Mother is sitting up with the neonate prone on her chest. 2. Mother is supine with the neonate prone on her chest. 3. The neonate is prone on mother's chest and facing to the side. 4. Neonate is prone with mother resting in semi-Fowler's position.

ans 2 This is correct. Neonates are susceptible to sudden respiratory and cardiac arrest during the first few hours of life. Newborns in prone position on the mother's chest, especially if the mother is on her back, are especially susceptible to sudden unexpected newborn collapse (SUNC). The nurse will intervene

10. The nursing is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacologic 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 1 mL of sterile water intramuscularly, and it will last for about an hour." 2. "We will inject 0.5 mL of sterile water subcutaneously, and it will last for an hour to 90 minutes." 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."

ans 2 This is correct. Sterile water injections are subcutaneous injections of 0.5 ml

3. 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. The facility has a high rating for managing high-risk pregnancies. 2. Policies and parameters for cesarean need to be reviewed and refined. 3. Community education about the advantages of vaginal birth is deficient. 4. The incidence of maternal requests for cesarean delivery is increasing.

ans 2 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 is important.

6. An emergency cesarean is being implemented. The patient describes tingling in her ears and a metallic taste with the administration of regional anesthesia. The nurse is aware that which incidence has occurred? 1. Manifestation of maternal respiratory depression related to anesthesia 2. Inadvertent injection of the anesthetic agent into the maternal bloodstream 3. Maternal hypotension is occurring related to administration of anesthesia 4. Expected manifestations related to anesthetic medications are present

ans 2 This is correct. The patient is exhibiting cardinal signs related to inadvertent injection of the anesthetic agent into the maternal bloodstream. The patient may also exhibit hypotension that can lead to loss of consciousness and cardiac arrest.

2. The nurse is providing care for a prenatal patient who is told she will require a cesarean delivery because of cephalopelvic disproportion. Which explanation of the condition will the nurse provide to the patient? 1. The patient has a preexisting medical condition that supports cesarean birth. 2. The size and/or shape of either the fetal head or patient pelvis is an issue. 3. The placenta is implanted in an unfavorable position in the uterus. 4. The patient had a surgery with an incision through the myometrium of the uterus.

ans 2 This is correct. The patient requires a definition of cephalopelvic disproportion, which prior to labor includes the determination that the size and/or shape of either the fetal head or patient pelvis is an issue.

5. The nurse is monitoring a patient who has been in prolonged labor. Which assessment finding will result in the nurse notifying the health care provider about the development of an emergent situation requiring a cesarean delivery? 1. Maternal blood pressure indicative of hypotension 2. Maternal exhaustion from prolonged uterine activity 3. Recognition of a Category II fetal heart rate pattern 4. Increased maternal temperature related to infection

ans 3 This is correct. The nurse will notify the health care provider about recognition of a Category II fetal heart rate pattern, which is an indication of fetal intolerance of labor

4. 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. Wider outlet 4. Smaller inlet

ans 3 This is correct. A gynecoid pelvis has a wider outlet than an android pelvis.

8. The patient is a 26-year-old G1P0 at 38 weeks, 2 days of gestation. She is at her provider's office for a visit and complains to the nurse of wrist pain, fatigue, increased discharge, and "feeling heavy." Which complaint could be a sign of impending labor? 1. Wrist pain 2. Fatigue 3. Increased discharge 4. Heavy feeling

ans 3 This is correct. When labor is impending, the patient may lose her mucous plug or have a change in discharge.

7. The nursing is caring for a 31-year-old female patient who is pregnant at 37 weeks and 5 days gestation. The patient is having contractions every 3 minutes and was found to have a platypelloid pelvis upon examination. The fetus has an estimated fetal weight of 7 lbs and is in the LOA position. This patient is laboring on the birth ball, and her mother-in-law is helping her labor. The nurse is concerned about the five Ps and their effect on the patient's labor. Which P is the nurse most likely concerned about based on the patient's history? 1. Passenger 2. Position 3. Passage 4. Psyche

ans 3 This is correct. A platypelloid pelvis is found in only 3% of women and is not an optimal pelvis for the passage of a vaginal delivery.

3. The patient is having an unmedicated childbirth and has begun to bear down. She vocalizes, "The baby is coming!" Which action should the nurse take? 1. Help the patient in a lithotomy position. 2. Help the patient onto all fours. 3. Have the patient assume a comfortable and upright position. 4. Help the patient into a knee-chest position.

ans 3 This is correct. An upright position allows gravity to assist with the descent of the baby.

17. 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 health care provider 2. Comfortable positions for feeding the newborn 3. Encouragement for early dietary intake of solid foods 4. Encourage family to help with infant care and housework 5. Provide information on nutrition to promote tissue healing

17. ANS: 1, 2

18. 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. Manage pain with morphine. 3. Ensure the availability of naloxone. 4. Provide prophylaxis antibiotics. 5. Administer Rhogam if needed.

18. ANS: 1, 2, 3, 5

15. 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. Frequency and duration of contractions 4. Signs of anxiety 5. Presence of FHR with intermittent auscultation

ANS: 1, 2, 3, 4

13. 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. Oxytocin stimulates uterine muscles to contract. 3. The uterus begins to contract due to a decrease in estrogen. 4. The placenta begins to age and deteriorate and this triggers the start of contractions. 5. The fetus releases a stress hormone, cortisol, and this starts contractions.

ANS: 1, 2, 4, 5

20. The nurse is helping the patient assume a position for placement of an epidural. Which of the following positions are appropriate for placing an epidural? Select all that apply. 1. Lateral position with head flexed toward chest 2. Trendelenburg position 3. Lithotomy position 4. Sitting position with elbows on knees 5. Prone position

ANS: 1, 4

18. 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. Lidocaine 1% for episiotomy 2. Epidural with lidocaine for pain in labor 3. Spinal block with lidocaine for a cesarean delivery 4. Lidocaine 1% for episiotomy repair 5. Lidocaine without epinephrine for forceps use

ANS: 2, 3, 5

19. 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. When using an epidural, women are less likely to sweat with a fever. 3. There is a higher rate of spontaneous vaginal delivery. 4. Labor may be longer with an epidural. 5. There is a higher rate of fever and sepsis.

ANS: 2, 4, 5

11. The nurse is caring for a 24-year-old woman who is G1P0 at 40 weeks, 1 day gestation and in active labor. She has just received an epidural and now complains of "an itchy feeling all over." Her vitals are as follows: HR 120, RR 12, BP 130/74, T 98.8, and O2 sat 98%. Which action should the nurse take first? 1. Call the health care provider regarding the patient's pruritus to order an antipruritic medication. 2. Activate emergency response due to the patient's pruritus and tachycardia postepidural placement. 3. Call the anesthesiologist regarding the patient's oxygen saturation level. 4. Take no further action regarding the patient's complaints, as they are normal after epidural placement

ans 1 This is correct. Ninety percent of women who receive opioids in epidural have itching, and the health care provider should be notified so the correct medications can be ordered and administered to treat the pruritus.

1. The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring strip. How would the nurse assess this? 1. Time the amount of time in between the ending of one contraction and the beginning of another. 2. Palpate the maternal abdomen right after a contraction ceases. 3. Palpate the maternal abdomen during a contraction. 4. Monitor the patients' vocalizations and facial expressions

ans 3 This is correct. Intensity is evaluated by palpating the fingertips on the maternal abdomen.

2. A 40-year-old G5P1031 is attending a childbirth education class. During the class, the woman says, "The worst part of contractions with my last labor was when they were at the peak of intensity." The nurse educator correctly explains that the woman is identifying which part of a contraction? 1. When the uterine wall is resistant to indentation 2. The longest part of the contraction 3. The shortest part of the contraction 4. Descending of contraction

ans 3 This is correct. The acme is the peak of the contraction's intensity but also is the shortest part of the contraction.

12. 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 SROM 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. Have the patient rate her pain on a scale from 1-10 roughly every hour. 3. Help the patient change her position from side to side every 30 minutes. 4. Monitor the fetal heart tones every hour

ans 3 This is correct. When the patient is in active labor, the nurse should help the woman change position every 30 minutes and as needed.

9. 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 nonpharmacologic 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. Sterile water injections can be very useful for pelvic pain. 4. Effleurage is performed in rhythm with breathing during a contraction.

ans 4 This is correct. Effleurage is cutaneous stimulation by lightly stroking the maternal abdomen in rhythm with breathing during contractions.

14. 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. Shortens the length of labor 2. Reduces the likelihood that a patient will require an epidural 3. Reduces the risk of infection after birth 4. Lowers the chance that the patient will breastfeed 5. Increases patients' happiness and satisfaction with the outcome of their birth

. ANS: 1, 2, 5

12. 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. Patient is able to self-pay for the procedure. 2. Patient is willing to defer from legal litigation. 3. Mother is planning to only have one child. 4. Patient is aware of possible neonatal complications. 5. Procedure is performed after 39 weeks gestation.

12. ANS: 4, 5

7. A patient is being prepared for an unplanned cesarean section. Which pre-procedure information is most important for the nurse to report before the administration of regional anesthesia? 1. Hypovolemia corrected with IV fluid administration 2. Inability of the patient to sit on the bedside and flex forward 3. Laboratory value indicating a low platelet count 4. History of patient experiencing headaches after a spinal

ans 3 This is correct. The most important information to be reported by the nurse is the laboratory value that indicates a low platelet count. It is the most common contraindication, especially with women who have preeclampsia and/or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

6. The nurse is counseling a 15-year-old pregnant patient at her first prenatal appointment. Which patient teaching by the nurse is appropriate? 1. "Adolescents usually have very effective coping mechanisms." 2. "Teenagers always have larger babies than older patients." 3. "Adolescents' ego integrity is less easily threatened by stress and pain." 4. "Your response to pregnancy, labor, and delivery will differ from that of an adult because your cognitive development is not yet complete."

ans 4 This is correct. According to AWHONN, teenagers have incomplete cognitive development.

4. 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 NPO for 6 to 8 hours. 2. Start an IV line and administer an IV fluid as ordered. 3. Administer preoperative medications per orders. 4. Obtain a baseline fetal heart rate monitor strip.

ans 4 This is correct. Obtaining a baseline fetal heart rate 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.

1. 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. "I will get you some material about how labor pain is managed." 2. "Most women avoid cesarean births unless it is an emergency." 3. "I suggest you talk with the physician and get another opinion." 4. "Cesarean will cause you issues with additional pregnancies."

ans 4 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.

_ 11. The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the facility. Which reasons contribute to the high rates of cesarean births? Select all that apply. 1. Fetuses in breech position unable to deliver vaginally 2. Increased number of elective or maternal request cesareans 3. Incidences of women of older maternal age getting pregnant 4. Decreasing rate of malpractice litigation with cesarean birth 5. Presence of nonreassuring fetal tracings during labor

11. ANS: 1, 2, 3, 5

13. 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. Patient had a previous cesarean delivery. 2. There is evidence of a prolapsed cord with membrane rupture. 3. The cervix fails to fully dilate after prolonged labor. 4. Patient has a preexisting cardiac health condition. 5. There is recognition of placenta previa with mild bleeding.

13. ANS: 2, 3, 4, 5

14. In preparation for a cesarean birth, the nurse expects which medical-based preoperative interventions? Select all that apply. 1. Administration of narrow-spectrum prophylactic antibiotics 2. Verification that the woman has been NPO for 6 to 8 hours before surgery 3. Assessment of the woman's knowledge and educational needs 4. Assessment for risk of venous thromboembolism (VTE) 5. Prescription for sequential compression devices prior to surgery

14. ANS: 1, 4, 5

15. A nurse has recently transferred to a labor and delivery unit. During a scheduled cesarean, the nurse notices a prescription for the administration of 1,000 mL of prewarmed IV fluid. For which reason does the health care provider prescribe the fluid in this manner? Select all that apply. 1. Results in an increased maternal core temperature 2. Results in improved neonatal umbilical arterial pH 3. Results in improved Apgar scores 4. Results in decreased risk for maternal shock 5. Results in lower incidence of post-partum hypothermia

15. ANS: 1, 2, 3

16. Following a cesarean birth, intrathecal morphine is administered to the patient for postoperative pain management. Of which fact about intrathecal morphine therapy is the nurse aware? Select all that apply. 1. An anesthesiologist or CRNA administers it intrathecally. 2. The nurse needs to closely monitor for common side effects. 3. The drug produces generalized CNS depression. 4. The recommended dose is 10 to 15 mg. 5. The drug alters perception of and response to painful stimuli

16. ANS: 1, 2, 3, 5