OB Intrapartum
A nurse is reinforcing teaching with a client who is in labor about why epidural anesthesia is not initiated until a good labor pattern has been established. Which of the following explanations should the nurse include?
"Given too soon, epidural anesthesia can prolong labor."
A nurse in a provider's office is collecting data from a female client in her third trimester of pregnancy. The client describes actions she took to obtain relief from a headache which lasted all day. Which of the following client statements should the nurse identify as the priority?
"I took 400 mg of ibuprofen with a diet soda."
A nurse is caring for a client who wants to know if it is possible to have a vaginal birth after a cesarean birth (VBAC). Which of the following statements by the nurse is appropriate?
"The primary consideration is what type of incision you had."
A nurse is assisting with the care of a client who is 32 weeks of gestation and in labor. The client asks the nurse, "Will my baby be okay?" Which of the following responses should the nurse make?
"You must be feeling very scared."
A nurse is teaching about signs preceding the onset of labor with a client who is at 39 weeks of gestation. Which of the following statements should the nurse include?
"You will experience a surge of energy."
A nurse is caring for a group of clients on an Intrapartum unit. Which of the following findings should be reported to the RN immediately?
A client who has preeclampsia and reports epigastric pain and unresolved headache
A nurse is assisting with the care of a client who is using pattern-paced breathing during the first stage of labor. The client says he feels lightheaded and her fingers are tingling. Which of the following actions should the nurse take?
Assist the client to breathe into a paper bag.
A nurse is caring for a client who is 38 weeks of gestation and has a score of 10 on her biophysical profile. Which of the following actions should the nurse take?
Assure the client that the score is within expected range.
A nurse is preparing to palpate the uterine fundus of a client who is at 22 weeks of gestation to measure fundal height. At which of the following locations should the nurse expect to find the fundus?
At the umbilicus
A nurse is caring for a client in the prenatal clinic who is at 7 weeks of gestation. The client reports urinary frequency and asks the nurse if this will continue throughout her pregnancy. Which of the following responses by the nurse is appropriate?
· "No, it should only last until about your 12th week, but it will return near the end of the pregnancy."
A nurse is assisting with the care of a client who is in labor. Immediately after delivery of a newborn, which of the following actions should the nurse take first?
Dry the newborn.
A nurse is reinforcing teaching with a client about how to reduce the risk of giving birth to a newborn who has a neural tube defect. Which of the following instructions should the nurse include in the teaching?
Eat foods fortified with folic acid.
A nurse is assisting in the care of a client following an amniotomy who is now in the active phase of the first stage of labor. Which of the following actions should the nurse take?
Encourage the client to empty the bladder every 2 hours.
A nurse is assisting with the care of a client who is in labor. Which of the following findings should the nurse report to the provider?
Fetal heart rate 100/min for a 10-minute period
A nurse is assisting with a care of a client who is in active labor at 39 weeks of gestation. The nurse locates the fetal heart tones above the client's umbilicus at midline. The nurse should suspect that the fetus is in which of the following positions?
Frank breech
A nurse is caring for a client who is pregnant and reports constipation. Which of the following recommendations should the nurse make?
Increase cellulose and fluid in the diet.
A nurse is assisting with the care of a client who is in labor. Which of the following nursing actions reflects application of the gate control theory of pain?
Massage the client's back.
A nurse is caring for a client who is 32 weeks of gestation and is in labor. Which of the following medications is contraindicated for this client?
Misoprostol (can cause abortion, PTL, birth defects)
A nurse is reinforcing teaching with a client who is pregnant and has a new prescription for ferrous sulfate due to iron-deficiency anemia. The nurse should instruct the client to take this medication with which of the following?
Orange juice
A nurse is assisting with the care of a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from of the vagina. Which of the following actions should the nurse take first?
Place the client in a knee-chest or Trendelenburg position.
A nurse is assisting with the care of a client who has an epidural anesthesia block during early stage of labor. The client's blood pressure 80/40 mm Hg and the fetal heart recording is 140/min. Which of the following actions should the nurse take first?
Place the client in a lateral position.
A nurse is assisting with the care of client who is in labor and has an electronic fetal monitor. The nurse observes that the fetal heart rate begins to decelerate after the contraction has started, with the lowest point of the deceleration occurring after the peak of the contraction. Which of the following actions should the nurse take first?
Place the client in the lateral position.
A nurse is assisting in the care of a client who is in active labor. The nurse notes late decelerations on the fetal monitor tracing. Which of the following actions should the nurse do first?
Position the client on her side.
A nurse is preparing to auscultate fetal heart tones for the client who is pregnant. Using Leopold maneuvers, the nurse palpates a round, firm, moveable part in the fundal portion of the uterus and a long, smooth surface on the mother's right side. In which of the following maternal quadrants should the nurse auscultate fetal heart tones?
Right upper quadrant
A nurse is assisting with the care of a client who presents to a labor and delivery unit with rapidly progressing labor. Which of the following actions is the priority for the nurse to take?
Supporting the infant during the labor.
A nurse is reinforcing teaching with a client who is scheduled for a nonstress test. Which of the following information should the nurse include?
An external fetal monitor will be used to monitor the FHR.
A nurse is assisting in the care of a client who is to undergo an amniotomy. Which of the following is the priority nursing action following this procedure?
Check the fetal heart rate pattern.
A nurse in a prenatal clinic is reviewing the medical record of a client who is at 28 weeks of gestation. The client's history reveals one pregnancy terminated by elective abortion at 9 weeks; the birth of twins at 36 weeks; and a spontaneous abortion at 15 weeks of gestation. According to the GTPAL system, which of the following describes her present parity?
2-0-1-2-2
A nurse is assisting with the care of a client who is in early labor with intact membranes and temperature of 38.9C (102F). After notifying the provider, which of the following actions should the nurse take?
Administer acetaminophen orally.
A nurse is assisting a midwife in examining a client who is a primigravida at 42 weeks of gestation and states that she thinks she is in labor. Which of the following findings confirm that the client is in labor?
Cervical dilation
A nurse is assisting in the care of a client who is in labor. The doctor documents the vaginal examination as: 3 cm, 30% and -1. The nurse evaluates this documentation to mean which of the following?
Cervical dilation of 3 cm, it is effaced 30%, and the presenting part is 1 cm above the ischial spines.
A nurse is assisting with the care of a client who is in labor and has the urge to push. Which of the following instructions should the nurse give the client?
"Take a deep, cleansing breath before and after each contraction."
A nurse is reinforcing teaching with a client who is pregnant and has a body mass index (BMI) of 26.5. She asks the nurse how much weight she should gain over the course of her pregnancy. Which of the following statements is an appropriate response by the nurse?
"The recommendation for you is about 15-25 pounds."
A nurse is caring for a client who has consented to an amniocentesis for genetic cell analysis. The client asks why she can't have the test before 14 weeks of gestation. Which of the following responses should the nurse make?
"There is not enough amniotic fluid until this time."
A nurse is speaking on the phone to a client who is pregnant and taking iron supplements for iron-deficiency anemia. The client reports that her stools are black but she has no abnormal pain or cramping. Which of the following responses by the nurse is appropriate?
"This is expected because of the way iron is broken down during digestion."
A nurse is caring for a client who is pregnant and undergoing a nonstress test. The nurse records the FHR as 130 to 150/min with no fetal movement for 15 minutes. Which of the following actions should the nurse take?
Apply vibrocoustic stimulation to the woman's abdomen.
A nurse in a prenatal clinic is determining a client's estimated date of delivery using Naegele's rule. The first day of her last menstrual period was May 4. Which of the following dates should the nurse tell the client is her estimated date of delivery?
February 11
A nurse is assisting with the care of a client who is in labor. The client's labor is difficult and prolonged and she reports a severe backache. Which of the following is a contributing cause of difficult, prolonged labor?
Fetal position is persistent occipital posterior.
A nurse is assisting with the care of a client who is multigravida and in active labor with 7 cm of cervical dilation and 100% effacement. The fetus is at +1 station, and the client's amniotic membranes are intact. The client suddenly states she needs to push. Which of the following is appropriate nursing response?
Have client pant during the next few contractions.
A nurse is reinforcing teaching about nutritional needs with a client who is pregnant. Which of the following nutrients should the nurse instruct the client to increase during pregnancy?
Iron
A nurse is reinforcing teaching with a client who is at 6 weeks of gestation. The client tells the nurse that she smokes one pack of cigarettes per day. The nurse should instruct the client that her newborn is at increased risk for which of the following clinical manifestations?
Low birth weight.
A nurse is caring for a client who is at 38 weeks of gestation and has a positive contraction stress test. Which of the following actions should the nurse take?
Prepare the client for admission to the hospital.
A nurse is reinforcing teaching about quickening with a client who is at 6 weeks of gestation. Which of the following information should the nurse include?
Quickening occurs between the fourth and fifth months of pregnancy.
A nurse is reinforcing teaching with a newly licensed nurse about a biophysical profile. Which of the following information should the nurse include in the teaching?
The test predicts fetal well-being in the third trimester.
A nurse is reinforcing teaching with a client who is pregnant and has a prescription for Rho(D) immune globulin. Which of the following information should the nurse include?
This medication prevents the formation of Rh antibodies by a woman who is Rh-negative.
A nurse is reinforcing teaching with a client who is at 17 weeks of gestation and is scheduled to have a maternal serum alpha-fetoprotein (MSAFP) determination. Which of the following information should the nurse include?
This test will screen for neural tube defects.
A nurse is assisting in the care of a client who is in active labor. The nurse notes variable deceleration on the FHR. The nurse should identify which of the following as a cause of variable decelerations?
Umbilical cord compression.
A nurse is assisting with the monitoring of a client who is in the first stage of labor, with an external fetal monitor in place and IV fluids infusing. Which of the following factors will cause variable decelerations in the fetal heart rate?
Umbilical cord compression.
A nurse is reinforcing teaching about common discomforts of pregnancy during the first trimester with a client who is pregnant. Which of the following manifestations should the nurse include in the teaching?
Urinary urgency.
A nurse is assisting in the care of a client who is in the second stage of labor. Which of the following findings should the nurse report to the provider?
Uterine contractions lasting 2 minutes
