Recognizing potential complicated labor patterns / Placenta previa, abruption, cord prolapse, Pre-E, GHTN, UTI, pyelonephritis
During labor, the client at 4 cm suddenly becomes short of breath, cyanotic, and hypoxic. The nurse must prepare or arrange immediately for which of the following? Select all that apply. A) Intravenous access B) Cesarean delivery C) Immediate vaginal delivery D) McRoberts maneuver E) A crash cart
ANS: A, B, E Explanation: A) When an amniotic fluid embolism is suspected, intravenous access is obtained as quickly as possible. B) Shortness of breath, cyanosis, and hypoxia are symptoms of an amniotic fluid embolus, which necessitates immediate cesarean delivery. C) The client is only 4 cm, so vaginal delivery will not take place immediately. D) McRoberts maneuver is used with shoulder dystocia. E) The chances of a code are high, so the crash cart needs to be available.
A pregnant patient is concerned about the development of several urinary tract infections (UTIs) over the last few months of her pregnancy. What should the nurse explain as reasons for the development of these infections in this patient? Select all that apply. (4) 1. Decrease in bladder tone 2. Hyperemic bladder mucosa 3. Urethral stricture and loss of micturition reflex 4. Ureters elongate and are displaced by the uterus 5. Distal ureters hypertrophy leading to ureteral stenosis
Answer: 1, 2, 4, 5 Explanation: A number of structural and functional changes occur during pregnancy that predispose pregnant women to urinary tract infections. Ureters elongate and are laterally displaced by the gravid uterus. Progesterone, which relaxes smooth muscles, can facilitate hypertrophy of the distal ureters with resulting ureteral stenosis and dilation, especially in the second half of pregnancy. Though the bladder has an increased capacity in pregnancy, it also has a decreased tone because progesterone relaxes the smooth muscle. Estrogen causes the bladder mucosa to become hyperemic and more susceptible to trauma and infection. Pregnancy does not cause urethral strictures and loss of the micturition reflex.
The nurse is caring for a client diagnosed with cystitis. When teaching the client about self-care techniques, which foods or beverages will the nurse advise the client to avoid? Select all that apply. 1. Caffeine 2. Dairy products 3. Alcohol 4. Carbonated beverages 5. Acidic fruit juices
Answer: 1, 3, 4 Explanation: The nurse should advise the client to avoid foods or beverages that are bladder irritants, such as caffeine, alcohol, or carbonated beverages. Dairy products and acidic fruit juices are not considered bladder irritants and would not be included when advising the client to avoid bladder irritants.
The home health nurse is visiting a client at 18 weeks who is pregnant with twins. Which nursing action is most important? A) Teach the client about foods that are good sources of protein. B) Assess the client's blood pressure in her upper right arm. C) Determine whether the pregnancy is the result of infertility treatment. D) Collect a cervicovaginal fetal fibronectin (fFN) specimen
Answer: A Explanation: A) A daily intake of 4000 kcal (minimum) and 135 g protein is recommended for a woman with normal-weight twins. B) Blood pressure can be assessed in either arm. C) The cause of the multifetal pregnancy does not impact nursing care. D) Preterm labor is not diagnosed until 20 weeks. This client is only at 18 weeks. Fetal fibronectin (fFN) testing is not indicated at this time.
The home health nurse is visiting a client at 18 weeks who is pregnant with twins. Which nursing action is most important? A) Teach the client about foods that are good sources of protein. B) Assess the client's blood pressure in her upper right arm. C) Determine whether the pregnancy is the result of infertility treatment. D) Collect a cervicovaginal fetal fibronectin (fFN) specimen.
Answer: A Explanation: A) A daily intake of 4000 kcal (minimum) and 135 g protein is recommended for a woman with normal-weight twins. B) Blood pressure can be assessed in either arm. C) The cause of the multifetal pregnancy does not impact nursing care. D) Preterm labor is not diagnosed until 20 weeks. This client is only at 18 weeks. Fetal fibronectin (fFN) testing is not indicated at this time.
While caring for a client admitted to the birthing unit, the nurse suspects that the client may be experiencing a uterine rupture. Which assessment finding should the nurse expect to appear first? A) Nonreassuring fetal heart rate B) Constant abdominal pain C) Loss of fetal station D) Cessation of contractions
Answer: A Explanation: A) A nonreassuring fetal heart rate is commonly the earliest warning sign of a possible uterine rupture. B) Constant abdominal pain is a finding that may be present, but is not commonly the earliest sign of uterine rupture. C) Loss of fetal station is a finding that may be present, but is not commonly the earliest sign of uterine rupture. D) Cessation of contractions is a finding that may be present, but is not commonly the earliest sign of uterine rupture.
The nurse on the birthing unit is caring for a client who has an amputated cervix and is about to undergo a cerclage procedure. Which type of cerclage procedure should the nurse anticipate? A) Abdominal cerclage B) Rescue cerclage C) Emergency cerclage D) Elective cerclage
Answer: A Explanation: A) An abdominal cerclage approach may be required for women with an amputated cervix. B) A rescue cerclage is one that is placed for emergent reasons, when dilatation and effacement have already occurred. C) An emergency cerclage is one that is placed for emergent reasons, when dilatation and effacement have already occurred. D) An elective, or cervical, cerclage will not be performed for a client who has an amputated cervix.
The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the client's chart requires immediate intervention? A) Previous birth by cesarean B) Frank breech ballotable C) 37 weeks, complete breech D) Failed ECV last week
Answer: A Explanation: A) Any previous uterine scar is a contraindication to ECV. Prior scarring of the uterus may increase the risk of uterine tearing or uterine rupture. B) There is no contraindication to ECV for this client. C) ECV is not attempted until 36 or 37 weeks. There is no contraindication for ECV for this client. D) Although this client is less likely to have a successful ECV this week if it was unsuccessful last week, there is no contraindication to attempting the procedure.
The nurse has received end-of-shift reports in the high-risk maternity unit. Which client should the nurse see first? A) The client at 26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement B) The client at 30 weeks' gestation with placenta previa whose fetal monitor strip shows late decelerations C) The client at 35 weeks' gestation with grade I abruptio placentae in labor who has a strong urge to push D) The client at 37 weeks' gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously
Answer: A Explanation: A) Assessment of the woman with placenta previa must be ongoing to prevent or treat complications that are potentially lethal to the mother and fetus. Painless, bright red vaginal bleeding is the best diagnostic sign of placenta previa. This client is the highest priority. B) Late decelerations are an abnormal finding, but put only the fetus at risk. This client is not the highest priority. C) Grade I abruptio placentae creates slight vaginal bleeding. The urge to push indicates that delivery is near. This client is not the highest priority. D) Although pregnancy-induced hypertension puts a woman at risk for developing abruptio placentae, there is no indication that this client is experiencing this complication. This client is not the highest priority.
The nurse knows that a baby born to a mother who had oligohydramnios could show signs of which of the following? A) Respiratory difficulty B) Hypertension C) Heart murmur D) Decreased temperature
Answer: A Explanation: A) Because there is less fluid available for the fetus to use during fetal breathing movements, pulmonary hypoplasia may develop. B) Hypertension has no relation to oligohydramnios. C) Heart murmur has no relation to oligohydramnios. D) Decreased temperature has no relation to oligohydramnios.
On assessment, a laboring client is noted to have cardiovascular and respiratory collapse and is unresponsive. What should the nurse suspect? A) An amniotic fluid embolus B) Placental abruption C) Placenta accreta D) Retained placenta
Answer: A Explanation: A) Cardiovascular and respiratory collapse are symptoms of an amniotic fluid embolus and cor pulmonale. B) Placental abruption does not have any of these symptoms. C) Placenta accreta does not have any of these symptoms. D) Retention of the placenta beyond 30 minutes after birth is termed retained placenta and does not have any of these symptoms.
A laboring client's obstetrician has suggested amniotomy as a method for creating stronger contractions and facilitating birth. The client asks, "What are the advantages of doing this?" What should the nurse cite in response? A) Contractions elicited are similar to those of spontaneous labor. B) Amniotomy decreases the chances of a prolapsed cord. C) Amniotomy reduces the pain of labor and makes it easier to manage. D) The client will not need an episiotomy.
Answer: A Explanation: A) Contractions after amniotomy are similar to those of spontaneous labor. B) A disadvantage of amniotomy is the increased chance of prolapsed cord, especially if the fetal presenting part is not well applied against the cervix. C) A disadvantage of amniotomy is that it can increase pain and make labor more difficult to manage. D) There is no correlation between amniotomy and episiotomy.
The client gave birth to a 7 pound, 14 ounce female 30 minutes ago. The placenta has not yet delivered. Manual removal of the placenta is planned. What should the nurse prepare to do? A) Start an IV of lactated Ringer's. B) Apply anti-embolism stockings. C) Bottle-feed the infant. D) Send the placenta to pathology
Answer: A Explanation: A) In women who do not have an epidural in place, intravenous sedation may be required because of the discomfort caused by the procedure. An IV is necessary. B) Anti-embolism stockings are used after major surgery that leads to immobility, thus increasing the risk of embolism. However, anti-embolism stockings are not needed for this client. C) The client's partner or family member, or a nursery nurse, can feed the infant. Preparation for manual removal of the placenta is a higher priority at this time. D) The placenta might be sent to pathology after it is removed, but preparing the client for manual removal of the placenta now is a higher priority.
A woman has been having contractions since 4 a.m. At 8 a.m., her cervix is dilated to 5 cm. Contractions are frequent, and mild to moderate in intensity. Cephalopelvic disproportion (CPD) has been ruled out. After giving the mother some sedation so she can rest, what would the nurse anticipate preparing for? A) Oxytocin induction of labor B) Amnioinfusion C) Increased intravenous infusion D) Cesarean section
Answer: A Explanation: A) Oxytocin is the drug of choice for labor augmentation or labor induction and may be administered as needed for hypotonic labor patterns. B) Amnioinfusion would not change the ineffective labor pattern. C) Increasing the IV infusion would not change the ineffective labor pattern. D) Because CPD has been ruled out, a cesarean section is not anticipated.
The nurse knows that a contraindication to the induction of labor is which of the following? A) Placenta previa B) Isoimmunization C) Diabetes mellitus D) Premature rupture of membranes
Answer: A Explanation: A) Placenta previa is a contraindication to the induction of labor. B) Isoimmunization is an indication for induction. C) Diabetes mellitus is an indication for induction. D) Premature rupture of membranes is an indication for induction.
A client is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes, and FHR of 150 bpm. Her membranes rupture spontaneously, and the FHR drops to 90 bpm with variable decelerations. What would the nurse's initial response be? A) Perform a vaginal exam B) Notify the physician C) Place the client in a left lateral position D) Administer oxygen at 2 L per nasal cannula
Answer: A Explanation: A) Prolapsed umbilical cord can occur when the membranes rupture. The fetus is more likely to experience variable decelerations because the amniotic fluid is insufficient to keep pressure off the umbilical cord. A vaginal exam is the best way to confirm. B) A vaginal exam should be performed before the physician is notified. C) Positioning will not relieve the decreased heart rate if the cord is compromised. D) Oxygen will not relieve the decreased heart rate if the cord is compromised
The nurse is performing a vaginal exam on a client who was admitted to the birthing unit after her membranes ruptured, and discovers a cord prolapse. Which intervention is priority at this time? A) Pushing the presenting fetal part upward B) Administering oxygen C) Initiating intravenous fluid D) Inserting an indwelling bladder catheter
Answer: A Explanation: A) Pushing the presenting fetal part upward is a life-saving measure that relieves pressure on the umbilical cord and supports fetal gas exchange. B) Administering oxygen is performed, but at a later time. C) Initiating intravenous fluid is performed, but at a later time. D) Inserting an indwelling bladder catheter may be later used to fill the woman's bladder and relieve pressure on the umbilical cord, but this should not be done in place of pushing the presenting fetal part upward.
After teaching a pregnant client about the effects of smoking on pregnancy, the nurse knows that the client needs further education when she makes which statement? A) "I am at increased risk for preeclampsia." B) "I am at increased risk for preterm birth." C) "I am at increased risk for placenta previa." D) "I am at increased risk for abruptio placentae."
Answer: A Explanation: A) Smoking is not associated with increased risk for preeclampsia. B) Smoking is associated with increased risk for preterm birth. C) Smoking is associated with increased risk for placenta previa. D) Smoking is associated with increased risk for abruptio placentae.
While performing a uterine assessment on a client in the birthing unit, the nurse notes a loss of fetal station and a change in uterine shape. The client reports constant abdominal pain, uterine tenderness, and is exhibiting signs of shock. Which condition should the nurse suspect? A) Uterine rupture B) Anaphylactoid syndrome of pregnancy C) Circumvallate placenta D) Breech presentation
Answer: A Explanation: A) The assessment findings are consistent with uterine rupture, which may also include a nonreassuring fetal heart rate, hematuria, and cessation of contractions. B) Anaphylactoid syndrome of pregnancy is characterized by shortness of breath, hypoxia, cyanosis, and cardiovascular and respiratory collapse. C) Circumvallate placenta may result in antepartum hemorrhage, prematurity, and abnormal bleeding during or following the third stage of labor. D) Assessment findings consistent with breech presentation include palpation of the fetal sacrum in the lower part of the maternal abdomen and fetal heart tones present above the umbilicus on auscultation.
A patient schedules an appointment to be seen in the community clinic for dysuria, urgency, frequency, blood in the urine, and low back pain. For which health problem should the nurse provide care for this patient? A) Cystitis B) Pyelonephritis C) Glomerulonephritis D) Asymptomatic bacteriuria
Answer: A Explanation: A) The classic initial symptoms of cystitis include dysuria, urgency, frequency, low back pain and hematuria. Manifestations of acute pyelonephritis include a sudden onset with chills, high temperature, costovertebral angle tenderness or flank pain, nausea, vomiting, and general malaise. Manifestations of glomerulonephritis include periorbital edema, elevated blood pressure, and urinary changes. Asymptomatic bacteriuria has no characteristic manifestations
The nurse is preparing teaching material for a pregnant patient with the following type of placenta previa. What information should the nurse provide the patient about this health problem? A) Internal os is partially covered by the placenta B) Internal os is covered completely by the placenta C) Edge of the placenta is at the margin of the internal os D) Placenta is implanted in the lower segment but does not reach the os
Answer: A Explanation: A) The diagram is of a partial placenta previa. The internal os is partially covered by the placenta. In total placenta previa the internal os is covered completely by the placenta. In marginal placenta previa the edge of the placenta is at the margin of the internal os. In low-lying placenta previa the placenta is implanted in the lower segment but does not reach the os, although it is in close proximity of it.
What is the most significant maternal risk factor for preterm birth? A) Previous preterm birth B) Smoking C) Stress D) Substance abuse
Answer: A Explanation: A) The most significant maternal risk factor for preterm birth is a previous preterm birth. B) Modifiable risk factors, such as smoking, substance abuse, stress, alcohol use, and other behavioral factors are not the most significant maternal risk factors for preterm birth. C) Modifiable risk factors, such as smoking, substance abuse, stress, alcohol use, and other behavioral factors are not the most significant maternal risk factors for preterm birth. D) Modifiable risk factors, such as smoking, substance abuse, stress, alcohol use, and other behavioral factors are not the most significant maternal risk factors for preterm birth.
A client admitted to the birthing unit with placenta previa asks the nurse, "What is the cause of my condition?" Which statement should be included in the nurse's response? A) "The placenta is improperly implanted in the lower uterus." B) "The placenta has separated prematurely." C) "The placenta has grown too large." D) "The placenta has prolapsed and is being compressed."
Answer: A Explanation: A) This statement correctly describes placenta previa, when the placenta implants low in the uterus or over the cervix. B) This statement describes abuptio placentae, another placental complication. C) Placenta previa is not when the placenta has grown too large; this statement should not be used by the nurse. D) Placenta previa is not when the placenta becomes prolapsed and is being compressed; this statement should not be used by the nurse.
A 26-year-old client is having her initial prenatal appointment. The client reports to the nurse that she suffered a pelvic fracture in a car accident 3 years ago. The client asks whether her pelvic fracture might affect her ability to have a vaginal delivery. What response by the nurse is best? A) "It depends on how your pelvis healed." B) "You will need to have a cesarean birth." C) "Please talk to your doctor about that." D) "You will be able to delivery vaginally."
Answer: A Explanation: A) Women with a history of pelvic fractures may also be at risk for cephalopelvic disproportion (CPD). B) Not all clients will be able to deliver vaginally, but not all will need cesarean birth. C) It is not therapeutic to tell a client to talk to someone else. D) Not all clients will be able to deliver vaginally, but not all will need cesarean birth.
What is one of the most common initial signs of nonreassuring fetal status? A) Meconium-stained amniotic fluid B) Cyanosis C) Dehydration D) Arrest of descent
Answer: A Explanation: A) The most common initial signs of nonreassuring fetal status are meconium-stained amniotic fluid and changes in the fetal heart rate (FHR). B) Cyanosis is not a common sign of nonreassuring fetal status. C) Dehydration is not a common sign of nonreassuring fetal status. D) Arrest of descent is not a common sign of nonreassuring fetal status
A client admitted to the birthing unit with placenta previa asks the nurse, "What is the cause of my condition?" Which statement should be included in the nurse's response? A) "The placenta is improperly implanted in the lower uterus." B) "The placenta has separated prematurely." C) "The placenta has grown too large." D)"The placenta has prolapsed and is being compressed
Answer: A Explanation: A) This statement correctly describes placenta previa, when the placenta implants low in the uterus or over the cervix. B) This statement describes abuptio placentae, another placental complication. C) Placenta previa is not when the placenta has grown too large; this statement should not be used by the nurse. D) Placenta previa is not when the placenta becomes prolapsed and is being compressed; this statement should not be used by the nurse.
A client is admitted to the labor and delivery unit in active labor. What nursing diagnoses might apply to the client with suspected abruptio placentae? Select all that apply. (3) A) Fluid Volume, Deficient, related to hypovolemia secondary to excessive blood loss B) Tissue Perfusion: Peripheral, Ineffective, related to blood loss secondary to uterine atony following birth C) Anxiety related to concern for own personal status and the baby's safety D) Knowledge, Deficient related to lack of information about inherited genetic defects E) Alteration in Respiratory Function related to blood loss
Answer: A, B, C Explanation: A) Maternal and perinatal fetal mortality are concerns due to hypoxia. B) Maternal and perinatal fetal mortality are concerns due to blood loss. C) This mother would be anxious for herself and her baby. D) Abruptio placentae is a premature separation of the placenta, not a genetic abnormality. E) Respiratory function is not related to the blood loss. Also, this is not a nursing diagnosis
The nurse is caring for a client who is about to receive an amnioinfusion. For which complication(s) should the nurse monitor the client? Select all that apply. A) Umbilical cord prolapse B) Amniotic fluid embolism C) Uterine rupture D) Amnionitis E) Abruptio placentae
Answer: A, B, C Explanation: A) Umbilical cord prolapse is a rare, but serious risk factor for the client receiving an amnioinfusion. B) Amniotic fluid embolism is a rare, but serious risk factor for the client receiving an amnioinfusion. C) Uterine rupture is a rare, but serious risk factor for the client receiving an amnioinfusion. D) The presence of amnionitis is a contraindication to amnioinfusion, but is not a condition that results from amnioinfusion. E) The presence of abruptio placentae is a contraindication to amnioinfusion, but is not a condition that results from amnioinfusion.
The nurse is performing an assessment on a client in the birthing unit who has acquired cervical insufficiency. Which other finding(s) may contribute to the client's condition? Select all that apply. (4) A) Inflammation B) Infection C) Cervical trauma D) Cone biopsy E) HPV positivity
Answer: A, B, C, D Explanation: A) Acquired cervical insufficiency may be related to inflammation. B) Acquired cervical insufficiency may be related to infection. C) Acquired cervical insufficiency may be related to cervical trauma. D) Acquired cervical insufficiency may be related to cone biopsy. E) Acquired cervical insufficiency is not related to HPV positivity
The nurse is performing a comprehensive assessment on a client admitted to the birthing unit with abruptio placentae. Which finding(s) contribute(s) to this condition? Select all that apply. (4) A) History of domestic violence B) Presence of uterine fibroids C) Alcohol consumption during pregnancy D) Hypertension E) Gestational diabetes mellitus
Answer: A, B, C, D Explanation: A) Domestic violence contributes to the development of abruptio placentae. B) The presence of fibroids contributes to the development of abruptio placentae. C) Alcohol consumption contributes to the development of abruptio placentae. D) Maternal hypertension is the most common cause of abruptio placentae. E) Gestational diabetes mellitus is not considered a finding that contributes to abruptio placentae.
The nurse on the birthing unit is collecting the obstetric history of a client at risk for cervical insufficiency. Which findings increase the client's risk for this condition? Select all that apply. (4) A) Multiple gestations B) Previous preterm births C) Progressively earlier births with each subsequent pregnancy D) Cervical manipulation E) Prolonged labors
Answer: A, B, C, D Explanation: A) Multiple gestations increase the risk for cervical insufficiency. B) Previous preterm births increase the risk for cervical insufficiency. C) Progressively earlier births with each subsequent pregnancy increase the risk for cervical insufficiency. D) Cervical manipulation increases the risk for cervical insufficiency. E) Short labors, not prolonged labors, increase the risk for cervical insufficiency.
Risk factors for tachysystole include which of the following? Select all that apply. (3) A) Cocaine use B) Placental abruption C) Low-dose oxytocin titration regimens D) Uterine rupture E) Smoking
Answer: A, B, D Explanation: A) Cocaine use is a risk factor for tachysystole. B) Placental abruption is a risk factor for tachysystole. C) High-dose oxytocin titration regimens are a risk factor for tachysystole. D) Uterine rupture is a risk factor for tachysystole. E) Smoking is not risk factor for tachysystole
When caring for a laboring client with oligohydramnios, what should the nurse be aware of? Select all that apply. (4) A) Increased risk of cord compression B) Decreased variability C) Labor progress is often more rapid than average D) Presence of periodic decelerations E) During gestation, fetal skin and skeletal abnormalities can occur
Answer: A, B, D, E Explanation: A) During the labor and birth, the lessened amounts of fluid reduce the cushioning effect for the umbilical cord, and cord compression is more likely to occur. B) The nurse should evaluate the EFM tracing for the presence of nonperiodic decelerations or other nonreassuring signs (such as increasing or decreasing baseline, decreased variability, or presence of periodic decelerations). C) Labor progress may be slower, not faster, than average due to the decreased amniotic fluid volume. Fetal movement can be impaired as a result of inadequate amniotic fluid volume. D) The nurse should evaluate the EFM tracing for the presence of nonperiodic decelerations or other nonreassuring signs (such as increasing or decreasing baseline, decreased variability, or presence of periodic decelerations). E) During the gestational period, fetal skin and skeletal abnormalities may occur because fetal movement is impaired as a result of inadequate amniotic fluid volume.
What are the primary complications of placenta accreta? Select all that apply. A) Maternal hemorrhage B) Insomnia C) Failure of the placenta to separate following birth of the infant D) Autonomic dysreflexia E) Shoulder dystocia
Answer: A, C Explanation: A) The primary complications of placenta accreta are maternal hemorrhage and failure of the placenta to separate following birth of the infant. B) Insomnia is not a complication of placenta accreta. C) The primary complications of placenta accreta are maternal hemorrhage and failure of the placenta to separate following birth of the infant. D) Autonomic dysreflexia is a rare complication that can occur in women with a spinal cord injury. E) The most significant complication in macrosomia is shoulder dystocia.
The nurse is admitting a client who was diagnosed with hydramnios. The client asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with which of the following? Select all that apply. A) Rh sensitization B) Postmaturity syndrome C) Renal malformation or dysfunction D) Maternal diabetes E) Large-for-gestational-age infants
Answer: A, D Explanation: A) Hydramnios is associated with Rh sensitization. B) Postmaturity is associated with oligohydramnios. C) Renal malformation or dysfunction is associated with oligohydramnios. D) Hydramnios is associated with maternal diabetes. E) Large-for-gestational-age infants are not associated with hydramnios.
The client delivered 30 minutes ago. Her blood pressure and pulse are stable. Vaginal bleeding is scant. The nurse should prepare for which procedure? A) Abdominal hysterectomy B) Manual removal of the placenta C) Repair of perineal lacerations D) Foley catheterization
Answer: B Explanation: A) Abdominal hysterectomy is not required. B) Retention of the placenta beyond 30 minutes after birth is termed retained placenta. Manual removal of the placenta is then performed. C) Repair of perineal lacerations would not ensue until after the placenta was delivered. D) There is no indication of urinary retention that requires a Foley catheter.
The nurse is preparing an education session for women on the prevention of urinary tract infections (UTIs). Which statement should be included? A) Lower urinary tract infections rarely occur in women. B) The most common causative organism of cystitis is E. coli. C) Wiping from back to front after a BM will help prevent a UTI. D) Back pain often develops with a lower urinary tract infection.
Answer: B Explanation: A) About 60% of women will experience an episode of cystitis during their lifetime. B) E. coli is present in 75% to 90% of women with UTIs. C) Wiping from back to front increases the risk of UTIs because the E. coli of the bowel is being drawn toward the urethra. Women should be instructed always to wipe from front to back. D) Low back or flank pain is a sign of pyelonephritis, which is an upper urinary tract infection.
The client at 38 weeks' gestation has been diagnosed with oligohydramnios. Which statement indicates that teaching about the condition has been effective? A) "My gestational diabetes might have caused this problem to develop." B) "When I go into labor, I should come to the hospital right away." C) "This problem was diagnosed with blood and urine tests." D) "Women with this condition usually do not have a cesarean birth
Answer: B Explanation: A) Hydramnios, not oligohydramnios, is associated with such maternal disorders as diabetes. B) The incidence of cord compression and resulting fetal distress is high when there is an inadequate amount of amniotic fluid. The client with oligohydramnios should come to the hospital in early labor. C) Oligohydramnios is diagnosed when the largest vertical pocket of amniotic fluid visible on ultrasound examination is 5 cm or less. D) The fetus is continually monitored during labor and birth. In the event that the fetal heart rate tracing is nonreassuring, late decelerations occur, and birth is not imminent, a cesarean birth may be performed.
If oligohydramnios occurs in the first part of pregnancy, the nurse knows that there is a danger of which of the following? A) Major congenital anomalies B) Fetal adhesions C) Maternal diabetes D) Rh sensitization
Answer: B Explanation: A) Major congenital anomalies are associated with hydramnios. B) If oligohydramnios occurs in the first part of pregnancy, there is a danger of fetal adhesions (one part of the fetus may adhere to another part). C) Maternal diabetes is associated with hydramnios. D) Rh sensitization is associated with hydramnios.
Dystocia encompasses many problems in labor. What is the most common? A) Meconium-stained amniotic fluid B) Dysfunctional uterine contractions C) Cessation of contractions D) Changes in the fetal heart rate
Answer: B Explanation: A) Meconium-stained amniotic fluid is a sign of nonreassuring fetal status. B) The most common problem is dysfunctional (or uncoordinated) uterine contractions that result in a prolongation of labor. C) Cessation of contractions is a symptom of possible uterine rupture. D) Changes in the fetal heart rate (FHR) are a sign of nonreassuring fetal status
Slowly removing some amniotic fluid is a treatment for hydramnios. What consequence can occur with the withdrawal of fluid? A) Preterm labor B) Prolapsed cord C) Preeclampsia D) Placenta previa
Answer: B Explanation: A) Preterm labor is not a known consequence of amniotic fluid reduction. B) A needle or a fetal scalp electrode is used to make a small puncture in the amniotic sac. There is a risk that the force of the fluid could make a larger hole in the amniotic sac, thus increasing the risk of a prolapsed cord. C) Preeclampsia is not a known consequence of amniotic fluid reduction. D) Placenta previa would not be a result of amniotic fluid reduction
A fetal weight is estimated at 4490 grams in a client at 38 weeks' gestation. Counseling should occur before labor regarding which of the following? A) Mother's undiagnosed diabetes B) Likelihood of a cesarean delivery C) Effectiveness of epidural anesthesia with a large fetus D) Need for early delivery
Answer: B Explanation: A) There is a possibility of undiagnosed diabetes, but that is not the current concern because the client is close to delivery. B) The likelihood of a cesarean delivery with a fetus over 4000 grams is high. This should be discussed with the client before labor. C) The weight of the fetus has no bearing on the effectiveness of epidural anesthesia. D) The client is already at term, so it is too late to discuss an early delivery
During labor, the fetus was in a brow presentation, but after a prolonged labor, the fetus converted to face presentation and was delivered vaginally with forceps assist. What should the nurse explain to the parents? A) The infant will need to be observed for meconium aspiration. B) Facial edema and head molding will subside in a few days. C) The infant will be given prophylactic antibiotics. D) Breastfeeding will need to be delayed for a day or two.
Answer: B Explanation: A) There is no mention of meconium-stained fluid that would cause the nurse to assess for meconium aspiration. B) Any facial edema and head molding that result from the use of forceps at birth will subside in a few days. C) There is no reason to place the infant on antibiotics. D) There is no reason to delay breastfeeding.
The nurse is admitting a client with possible hydramnios. When is hydramnios most likely suspected? A) Hydramnios is most likely suspected when there is less amniotic fluid than normal for gestation. B) Hydramnios is most likely suspected when the fundal height increases disproportionately to the gestation. C) Hydramnios is most likely suspected when the woman has a twin gestation. D) Hydramnios is most likely suspected when the quadruple screen comes back positive
Answer: B Explanation: A) Hydramnios occurs when there is more amniotic fluid than normal for gestation. B) Hydramnios should be suspected when the fundal height increases out of proportion to the gestational age. C) Hydramnios is not suspected simply because of a twin gestation. D) A positive quadruple screen is not indicative of hydramnios
The nurse is planning an in-service educational program to talk about disseminated intravascular coagulation (DIC). The nurse should identify which conditions as risk factors for developing DIC? . Select all that apply. (2) A) Diabetes mellitus B) Abruptio placentae C) Fetal demise D) Multiparity E) Preterm labor
Answer: B, C Explanation: A) Diabetes does not cause the release of thromboplastin that triggers DIC. B) As a result of the damage to the uterine wall and the retroplacental clotting with covert abruption, large amounts of thromboplastin are released into the maternal blood supply, which in turn triggers the development of disseminated intravascular coagulation (DIC) and the resultant hypofibrinogenemia. C) Perinatal mortality associated with abruptio placentae is approximately 25%. If fetal hypoxia progresses unchecked, irreversible brain damage or fetal demise may result. D) Multiparity does not cause the release of thromboplastin that triggers DIC. E) Preterm labor does not cause the release of thromboplastin that triggers DIC.
The nurse is planning an in-service educational program to talk about disseminated intravascular coagulation (DIC). The nurse should identify which conditions as risk factors for developing DIC? Select all that apply. A) Diabetes mellitus B) Abruptio placentae C) Fetal demise D) Multiparity E) Preterm labor
Answer: B, C Explanation: A) Diabetes does not cause the release of thromboplastin that triggers DIC. B) As a result of the damage to the uterine wall and the retroplacental clotting with covert abruption, large amounts of thromboplastin are released into the maternal blood supply, which in turn triggers the development of disseminated intravascular coagulation (DIC) and the resultant hypofibrinogenemia. C) Perinatal mortality associated with abruptio placentae is approximately 25%. If fetal hypoxia progresses unchecked, irreversible brain damage or fetal demise may result. D) Multiparity does not cause the release of thromboplastin that triggers DIC. E) Preterm labor does not cause the release of thromboplastin that triggers DIC.
The postpartum client is suspected of having acute cystitis. Which symptoms would the nurse expect to see in this client? Select all that apply. A) High fever B) Frequency C) Suprapubic pain D) Chills E) Nausea and vomiting
Answer: B, C Explanation: A) High fever is not usually present in acute cystitis, although it can appear if the cystitis progresses to pyelonephritis. B) Frequency is characteristic of acute cystitis. C) Suprapubic pain is characteristic of acute cystitis. D) Chills are not usually present in acute cystitis, although they can appear if the cystitis progresses to pyelonephritis. E) Nausea and vomiting are not usually present in acute cystitis, although they can appear if the cystitis progresses to pyelonephritis.
Absolute contraindications to exercise while pregnant include which of the following? Select all that apply. (3) A) Abruptio placentae B) Placenta previa after 26 weeks' gestation C) Preeclampsia-eclampsia D) Cervical insufficiency (cerclage) E) Intrauterine growth restriction (IUGR)
Answer: B, C, D Explanation: A) Abruptio placentae is not an absolute contraindication to exercise. B) Placenta previa after 26 weeks' gestation is an absolute contraindication to exercise. C) Preeclampsia-eclampsia is an absolute contraindication to exercise. D) Cervical insufficiency (cerclage) is an absolute contraindication to exercise. E) Intrauterine growth restriction (IUGR) is not an absolute contraindication to exercise
Nonreassuring fetal status often occurs with a tachysystole contraction pattern. Intrauterine resuscitation measures may become warranted and can include which of the following measures? Select all that apply. (3) A) Position the woman on her right side. B) Apply oxygen via face mask. C) Call the anesthesia provider for support. D) Increase intravenous fluids by at least 500 mL bolus. E) Call the physician/CNM to the bedside
Answer: B, C, D Explanation: A) The nurse would position the woman on her left side. B) The nurse would apply oxygen via face mask. C) The nurse would call the anesthesia provider for support. D) The nurse would increase intravenous fluids by at least 500 mL bolus. E) The nurse would not call the physician/CNM to the bedside
The nurse knows that the maternal risks associated with postterm pregnancy include which of the following? Select all that apply. (4) A) Polyhydramnios B) Maternal hemorrhage C) Maternal anxiety D) Forceps-assisted delivery E) Perineal damage
Answer: B, C, D, E Explanation: A) Polyhydramnios is not associated with postterm pregnancy. B) Maternal symptoms and complications in postterm pregnancy may include maternal hemorrhage. C) Maternal symptoms and complications in postterm pregnancy may include maternal anxiety. D) Maternal symptoms and complications in postterm pregnancy may include an operative vaginal birth with forceps or vacuum extractor. E) Maternal symptoms and complications in postterm pregnancy may include perineal trauma and damage.
Risk factors for labor dystocia include which of the following? Select all that apply. (3) A) Tall maternal height B) Labor induction C) Small-for-gestational-age (SGA) fetus D) Malpresentation E) Prolonged latent phase
Answer: B, D, E Explanation: A) Short maternal height, not tall, is a risk factor of dystocia. B) Labor induction is a risk factor of dystocia. C) Large-for-gestational-age (FGA) fetus, not small, is a risk factor of dystocia. D) Malpresentation is a risk factor of dystocia. E) Prolonged latent phase is a risk factor of dystocia.
Risk factors for labor dystocia include which of the following? choices are selected. Select all that apply. A) Tall maternal height B) Labor induction C) Small-for-gestational-age (SGA) fetus D) Malpresentation E) Prolonged latent phase
Answer: B, D, E Explanation: A) Short maternal height, not tall, is a risk factor of dystocia. B) Labor induction is a risk factor of dystocia. C) Large-for-gestational-age (FGA) fetus, not small, is a risk factor of dystocia. D) Malpresentation is a risk factor of dystocia. E) Prolonged latent phase is a risk factor of dystocia.
Amniotomy as a method of labor induction has which of the following advantages? Select all that apply. (3) A) The danger of a prolapsed cord is decreased. B) There is usually no risk of hypertonus or rupture of the uterus. C) The intervention can cause a decrease in pain. D) The color and composition of amniotic fluid can be evaluated. E) The contractions elicited are similar to those of spontaneous labor.
Answer: B, D, E Explanation: A) The danger of a prolapsed cord is increased once the membranes have ruptured, especially if the fetal presenting part is not firmly pressed down against the cervix. B) There is usually no risk of hypertonus or rupture of the uterus, and this is an advantage of amniotomy. C) The intervention can cause an increase in pain, making labor more difficult to manage. D) The color and composition of amniotic fluid can be evaluated, and this is an advantage of amniotomy. E) The contractions elicited are similar to those of spontaneous labor, and this is an advantage of amniotomy.
A woman has been in labor for 16 hours. Her cervix is dilated to 3 cm and is 80% effaced. The fetal presenting part is not engaged. The nurse would suspect which of the following? A) Breech malpresentation B) Fetal demise C) Cephalopelvic disproportion (CPD) D) Abruptio placentae
Answer: C Explanation: A) A breech presentation would not prevent the presenting part from becoming engaged. B) Fetal demise would not prevent the presenting part from becoming engaged. C) Cephalopelvic disproportion (CPD) prevents the presenting part from becoming engaged. D) Abruptio placentae has specific complications; however, it would not prevent engagement of the presenting part.
A client in her second trimester is complaining of spotting. Causes for spotting in the second trimester are diagnosed primarily through the use of which of the following? A) A non-stress test B) A vibroacoustic stimulation test C) An ultrasound D) A contraction stress test
Answer: C Explanation: A) A non-stress test is used to assess the well-being of the fetus. B) A vibroacoustic stimulation test is used to assess the well-being of the fetus. C) Indirect diagnosis is made by locating the placenta via tests that require no vaginal examination. The most commonly employed diagnostic test is the transabdominal ultrasound scan. D) A contraction stress test is used to assess the well-being of the fetus.
The nurse is admitting a client to the labor and delivery unit. Which aspect of the client's history requires notifying the physician? A) Blood pressure 120/88 B) Father a carrier of sickle-cell trait C) Dark red vaginal bleeding D) History of domestic abuse
Answer: C Explanation: A) Although the diastolic reading is slightly elevated, this blood pressure reading is not the top priority. B) The infant also might have sickle-cell trait, but it is not life-threatening at this time. C) Third-trimester bleeding is caused by either placenta previa or abruptio placentae. Dark red bleeding usually indicates abruptio placentae, which is life-threatening to both mother and fetus. D) This client is at risk for harm after delivery but is not in a life-threatening situation at this time. This is not the highest priority for the client.
What is the most significant cause of neonatal morbidity and mortality? A) Amenorrhea B) Posttraumatic stress disorder C) Prematurity D) Endometriosis
Answer: C Explanation: A) Amenorrhea the absence of menses in a woman and does not affect neonatal morbidity or mortality. B) Posttraumatic stress disorder does not affect neonatal morbidity or mortality. C) The most significant cause of neonatal morbidity and mortality is prematurity and its associated complications such as respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage. D) Endometriosis is a condition of a woman characterized by the presence of endometrial tissue outside the uterine cavity, and it does not affect neonatal morbidity or mortality.
The nurse is caring for a client experiencing a uterine rupture. Which outcome demonstrates that the plan of care has been effective for the client? A) The mother remains hemodynamically stable throughout emergency cesarean birth. B) The mother has additional knowledge regarding the problems, implications, and treatment plans. C) The FHR remains in normal range with supportive measures. D) The family is able to cope successfully with fetal or neonatal anomalies, if they exist.
Answer: C Explanation: A) An emergency cesarean birth is warranted in the case of a client experiencing a uterine rupture. Hemodynamic stability is a major goal of interventions performed for a client with a uterine rupture. B) Knowledge deficit is not a priority nursing diagnosis for a client experiencing a uterine rupture. C) In the case of a uterine rupture, fetal heart rate anomalies are often already present. D) Uterine rupture is not indicative of fetal or neonatal anomalies.
The nurse is supervising care in the emergency department. Which situation most requires an intervention? A) Moderate vaginal bleeding at 36 weeks' gestation; client has an IV of lactated Ringer's solution running at 125 mL/hour B) Spotting of pinkish-brown discharge at 6 weeks' gestation and abdominal cramping; ultrasound scheduled in 1 hour C) Bright red bleeding with clots at 32 weeks' gestation; pulse = 110, blood pressure 90/50, respirations = 20 D) Dark red bleeding at 30 weeks' gestation with normal vital signs; client reports an absence of fetal movement
Answer: C Explanation: A) Bleeding in the third trimester is usually due to placenta previa or placental abruption. The primary intervention for placenta previa or placental abruption is intravenous (IV) therapy, which the patient already has in place. B) Bleeding in the first trimester can be indicative of spontaneous abortion beginning, or of an ectopic pregnancy. Transvaginal ultrasound is used for diagnosis. C) Bleeding in the third trimester is usually due to placenta previa or placental abruption. Observe the woman for indications of shock, such as pallor, clammy skin, perspiration, dyspnea, or restlessness. Monitor vital signs, particularly blood pressure and pulse, for evidence of developing shock. D) Bleeding in the third trimester can indicate placental abruption. Normal vital signs indicate a normal vascular volume. Decrease in fetal movement or cessation of movement may indicate fetal compromise. The fetus is at greatest risk in this situation; the mother is stable
A client who is 11 weeks pregnant presents to the emergency department with complaints of dizziness, lower abdominal pain, and right shoulder pain. Laboratory tests reveal a beta-hCG at a lower-than-expected level for this gestational age. An adnexal mass is palpable. Ultrasound confirms no intrauterine gestation. The client is crying and asks what is happening. The nurse knows that the most likely diagnosis is an ectopic pregnancy. Which statement should the nurse include? A) "You're feeling dizzy because the pregnancy is compressing your vena cava." B) "The pain is due to the baby putting pressure on nerves internally." C) "The baby is in the fallopian tube; the tube has ruptured and is causing bleeding." D) "This is a minor problem. The doctor will be right back to explain it to you
Answer: C Explanation: A) Dizziness from vena cava compression occurs in the third trimester when women are supine. B) The fetus is too small to be putting pressure on the nerves. C) The woman who experiences one-sided lower abdominal pain or diffused lower abdominal pain, vasomotor disturbances such as fainting or dizziness, and referred right shoulder pain from blood irritating the subdiaphragmatic phrenic nerve is experiencing an ectopic pregnancy. D) Therapeutic communication requires giving the client an answer rather than referring the client to someone else.
Women with pyelonephritis during pregnancy are at significantly increased risk for which condition? A) Foul-smelling discharge B) Ectopic pregnancy C) Preterm labor D) A colicky large intestine
Answer: C Explanation: A) Foul-smelling discharge is not a symptom of pyelonephritis. B) Ectopic pregnancy is not a symptom of pyelonephritis. C) Women with pyelonephritis during pregnancy are at significantly increased risk of preterm labor, preterm birth, development of adult respiratory distress syndrome, and septicemia. D) A colicky large intestine is an incorrect response.
Which statement by a pregnant client to the nurse would indicate that the client understood the nurse's teaching? A) "Because of their birth relationship, fraternal twins are more similar to each other than if they had been born singly." B) "Identical twins can be the same or different sex." C) "Congenital abnormalities are more prevalent in identical twins." D) "Identical twins occur more frequently than fraternal twins."
Answer: C Explanation: A) Fraternal twins are not more similar to each other than if they had been born singly. B) Identical, or monozygotic twins, have identical chromosomal structures, and, therefore, are always the same sex. C) Monozygotic twinning is considered a random event and occurs in approximately 3 to 4 per 1000 live births. Congenital anomalies are more prevalent and both twins may have the same malformation. D) Dizygotic, or fraternal, twins occur more frequently than do monozygotic twins.
A client is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. What is this client at risk for? A) Gestational diabetes B) Placenta previa C) Abruptio placentae D) Placenta accreta
Answer: C Explanation: A) Gestational diabetes is not an issue with this client. B) Placenta previa is not an issue with this client. C) Abruptio placentae is more frequent in pregnancies complicated by smoking, premature rupture of membranes, multiple gestation, advanced maternal age, cocaine use, chorioamnionitis, and hypertension. D) Placenta accreta is not an issue with this client.
A laboring client's obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed? A) Maternal temperature, BP, and pulse B) Estimation of fetal birth weight C) Fetal presentation, position, station, and heart rate D) Biparietal diameter
Answer: C Explanation: A) Maternal vital signs do not affect the decision to perform an amniotomy. B) Fetal birth weight does not affect the decision to perform an amniotomy. C) Before an amniotomy is performed, the fetus is assessed for presentation, position, station, and FHR. D) Biparietal diameter does not affect the decision to perform an amniotomy.
If the physician indicates a shoulder dystocia during the delivery of a macrosomic fetus, how would the nurse assist? A) Call a second physician to assist. B) Prepare for an immediate cesarean delivery. C) Assist the woman into McRoberts maneuver. D) Utilize fundal pressure to push the fetus out
Answer: C Explanation: A) The vaginal delivery of a macrosomic fetus does not require a second physician. B) Although a cesarean might be necessary, it would not be an immediate need. C) The McRoberts maneuver is thought to change the maternal pelvic angle and therefore reduce the force needed to extract the shoulders, thereby decreasing the incidence of brachial plexus stretching and clavicular fracture. D) Fundal pressure should not be performed, because this can further wedge the shoulder against the suprapubic bone.
The client at 30 weeks' gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes which of the following? A) Limiting vaginal exams to only one per 24-hour period. B) Evaluating the fetal heart rate with an internal monitor. C) Monitoring for blood loss, pain, and uterine contractibility. D) Assessing blood pressure every 2 hours.
Answer: C Explanation: A) Vaginal exams are contraindicated because the exam can stimulate bleeding. B) Fetal heart rate monitoring will be done with an external, not internal, fetal monitor. C) Blood loss, pain, and uterine contractibility need to be assessed for client comfort and safety. D) Blood pressure measurements every 2 hours are unnecessary.
The client is at 6 weeks' gestation, and is spotting. The client had an ectopic pregnancy 1 year ago, so the nurse anticipates that the physician will order which intervention? A) A urine pregnancy test B) The client to be seen next week for a full examination C) An antiserum pregnancy test D) An ultrasound
Answer: C Explanation: A) Urine pregnancy tests are not quantifiable. B) It is not appropriate to wait until next week to see the client. C) A β-Subunit radioimmunoassay (RIA) uses an antiserum with specificity for the β-subunit of hCG in blood plasma. This test may not only detect pregnancy but also detect an ectopic pregnancy or trophoblastic disease. D) An ultrasound may be used to diagnose an ectopic pregnancy, but would not be needed now.
True postterm pregnancies are frequently associated with placental changes that cause a decrease in uterine-placental-fetal circulation. Complications related to alterations in placenta functioning include which of the following? Select all that apply. (3) A) Increased fetal oxygenation B) Increased placental blood supply C) Reduced nutritional supply D) Macrosomia E) Risk of shoulder dystocia
Answer: C, D, E Explanation: A) Decreased, not increased, fetal oxygenation is a complication related to alternations in placenta functioning. B) Reduced, not increased, placental blood supply is a complication related to alternations in placenta functioning. C) Reduced nutritional supply is a complication related to alternations in placenta functioning. D) Macrosomia is a complication related to alternations in placenta functioning. E) Risk of shoulder dystocia is a complication related to alternations in placenta functioning.
Lacerations of the cervix or vagina may be present when bright red vaginal bleeding persists in the presence of a well-contracted uterus. The incidence of lacerations is higher among which of the following childbearing women? Select all that apply. A) Over the age of 35 B) Have not had epidural block C) Have had an episiotomy D) Have had a forceps-assisted or vacuum-assisted birth E) Nulliparous
Answer: C, D, E Explanation: A) The incidence of lacerations is higher among childbearing women who are younger. B) The incidence of lacerations is higher among childbearing women who have had an epidural block. C) The incidence of lacerations is higher among childbearing women who undergo an episiotomy. D) The incidence of lacerations is higher among childbearing women who undergo forceps-assisted or vacuum-assisted birth. E) The incidence of lacerations is higher among childbearing women who are nulliparous.
The client is at 42 weeks' gestation. Which order should the nurse question? A) Obtain biophysical profile today. B) Begin nonstress test now. C) Schedule labor induction for tomorrow. D) Have the client return to the clinic in 1 week
Answer: D Explanation: A) A biophysical profile is a commonly used assessment for the postterm fetus. B) The nonstress test is a commonly used assessment for the postterm fetus. C) Most practitioners consider induction at 41 gestational weeks to reduce maternal and fetal-newborn risks associated with postterm pregnancy. D) Many practitioners use twice-weekly testing, providing the amniotic fluid level is normal. One week is too long a period between assessments.
The nurse is caring for a client in active labor. The membranes spontaneously rupture, with a large amount of clear amniotic fluid. Which nursing action is most important to undertake at this time? A) Assess the odor of the amniotic fluid. B) Perform Leopold maneuvers. C) Obtain an order for pain medication. D) Complete a sterile vaginal exam.
Answer: D Explanation: A) Although it is important to assess amniotic fluid for odors, checking the cervix to assess for cord prolapse is a higher priority. B) This assessment is not called for at this time. C) Pain medication is a low priority at this time. D) Checking the cervix will determine whether the cord prolapsed when the membranes ruptured. The nurse would assess for prolapsed cord via vaginal examination.
The multiparous client at term has arrived to the labor and delivery unit in active labor with intact membranes. Leopold maneuvers indicate the fetus is in a transverse lie with a shoulder presentation. Which physician order is most important? A) Artificially rupture membranes. B) Apply internal fetal scalp electrode. C) Monitor maternal blood pressure every 15 minutes. D) Alert surgical team of urgent cesarean.
Answer: D Explanation: A) Artificial rupture of the membranes is contraindicated with a transverse lie because of the high risk for prolapsed cord. B) An internal fetal scalp electrode cannot be applied until membranes have ruptured. C) The fetus is at risk for hypoxia secondary to prolapsed cord if the membranes rupture. The maternal blood pressure is less important than getting the cesarean under way. D) This is the highest priority because vaginal birth is impossible with a transverse lie. Labor should not be allowed to continue, and a cesarean birth should be done quickly.
Intercourse is contraindicated if the pregnancy is vulnerable because of which diagnosis? A) Gestational diabetes B) Cervical insufficiency (cerclage) C) Abruptio placentae D) Placenta previa
Answer: D Explanation: A) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of gestational diabetes. B) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of cervical insufficiency (cerclage). C) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of abruptio placentae. D) Intercourse is contraindicated if the pregnancy is vulnerable because of the diagnosis of threatened spontaneous abortion, placenta previa, or the risk of preterm labor.
The client is carrying monochorionic-monoamniotic twins. The nurse teaches the client what this is, and the implications of this finding. The nurse knows that teaching is successful when the client states which of the following? A) "My babies came from two eggs." B) "About two thirds of twins have this amniotic sac formation." C) "My use of a fertility drug led to this issue." D) "My babies have a lower chance of surviving to term than fraternal twins do."
Answer: D Explanation: A) Monochorionic-monoamniotic twins lie in the same amniotic sac. B) About 2% of twins are of this type. C) The majority of twins conceived through in vitro fertilization are fraternal (dizygotic) because multiple fertilized ova are inserted into the uterus, and are not monochorionic-monoamniotic twins. D) Monochorionic-monoamniotic twins are both in one amniotic sac. There is an increased risk of umbilical cords becoming tangled or knotted and a higher incidence of fetal demise.
Intervention to reduce preterm birth can be divided into primary prevention and secondary prevention. What does secondary prevention include? A) Diagnosis and treatment of infections B) Cervical cerclage C) Progesterone administration D) Antibiotic treatment and tocolysis
Answer: D Explanation: A) Primary prevention includes diagnosis and treatment of infections, cervical cerclage, and progesterone administration. B) Primary prevention includes diagnosis and treatment of infections, cervical cerclage, and progesterone administration. C) Primary prevention includes diagnosis and treatment of infections, cervical cerclage, and progesterone administration. D) Secondary prevention strategies are antibiotic treatment and tocolysis
The nurse is returning phone calls from clients. Which client does the nurse anticipate would not require a serum beta hCG? A) A client with a risk of ectopic pregnancy B) A client with spotting during pregnancy C) A client with previous pelvic inflammatory disease D) A client with a previous history of twins
Answer: D Explanation: A) Serial quantitative beta hCG testing can be used to distinguish a normally developing fetus from an ectopic pregnancy. B) Serologic evaluation in the first trimester is indicated for women with vaginal bleeding. C) Serial quantitative beta hCG testing can be used to distinguish a normally developing fetus from a risk of ectopic pregnancy (intrauterine device in place, previous pelvic inflammatory disease, or reversal of a tubal sterilization). D) A previous history of twins is not a risk factor for ectopic pregnancy. Beta hCG testing is not indicated for this client.
A patient treated for a urinary tract infection a month ago is experiencing symptoms of the same infection. What should the nurse suspect is the reason for the reoccurrence of the infection? A) Using oral contraceptives B) Wearing cotton underwear C) Cleansing from front to back D) Stopped antibiotics after 3 days
Answer: D Explanation: D) Not completing a full course of prescribed antibiotics could cause remaining bacteria to grow, leading to another infection. Use of oral contraceptives is not a risk factor for the development of a urinary tract infection. Wearing cotton underwear and cleansing from front to back are actions that reduce the risk of developing urinary tract infections.
The client at 24 weeks' gestation is experiencing painless vaginal bleeding after intercourse. The physician has ordered a transvaginal ultrasound examination. Which statements by the client indicate an understanding of why this exam has been requested? Select all that apply. A) "This ultrasound will show the baby's gender." B) "This ultrasound might cause the miscarriage of my baby." C) "This ultrasound carries a risk of creating a uterine infection." D) "This ultrasound can determine the location of my placenta." E) "This ultrasound might detect whether the placenta is detaching prematurely."
Answer: D, E Explanation: A) Although gender can sometimes be detected with second-trimester ultrasound, that is never the primary reason for the procedure. B) Ultrasound is non-invasive, and does not increase the risk for either fetal loss or uterine infection. C) Ultrasound is non-invasive, and does not increase the risk for either fetal loss or uterine infection. D) Painless bleeding in the second and third trimesters can be a symptom of placenta previa. Transvaginal ultrasound will determine the placental location. E) Painless bleeding in the second and third trimesters can be a symptom of placenta previa. Transvaginal ultrasound will determine the placental location.
The nurse would be alert for possible placental abruption during labor when assessment reveals which of the following? A) Macrosomia B) Gestational hypertension C) Gestational diabetes D) Low parity
B Feedback: Risk factors for placental abruption include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, domestic violence, and placental pathology. Macrosomia, gestational diabetes, and low parity are not considered risk factors.
The nurse would be alert for possible placental abruption during labor when assessment reveals which of the following? A) Macrosomia B) Gestational hypertension C) Gestational diabetes D) Low parity
B. Gestational hypertension Risk factors for placental abruption include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, domestic violence, and placental pathology. Macrosomia, gestational diabetes, and low parity are not considered risk factors.
The fetus of a woman in labor is determined to be in persistent occiput posterior position. Which of the following would the nurse identify as the priority intervention? A) Position changes B) Pain relief measures C) Immediate cesarean birth D) Oxytocin administration
D For hypotonic labor, a uterine stimulant such as oxytocin may be ordered once fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women experiencing preterm labor.
After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? A) Supine B) Side-lying C) Sitting D) Knee-chest
D. Knee-chest Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting would not provide relief of cord compression.
