Combo OB review questions

A positive Babinski's signs is present in infants until approx. what age?

1 year of age this is normal in neonates but abnormal in adults

After pitocin is administed, how often is it increased determining on dilation and effacement?

1-2mu per 15 min 20 mu max. 30 mu max with physician orders

A clients labor doesnt progress. After ruling out CPD, the doctor orders IV admin of 1,000 ml normal saline w/ Pitocin 10 units to run at 2 miliunits / min. 2 miliunits/min is equivalent to how many ml/unit 1. 0.002 2. 0.02 3. 0.2 4. 2.0

3 = 0.2 each unit of oxytocin contains 1,000 miliunits. Therefore, 1,000 ml of IV fluid contains 10,000 miliunits (10 units) of Pitocin

A client, 34 weeks pregnant, arrives at the ER with SEVERE abdominal pain, uterine tenderness and an increased uterine tone. The client denies vaginal bleeding. The external fetal monitor shows fetal distress with severe, variable decels. The client most likely has which of the following?

1. Abruptio placentae a client w/ severe abruptio placentae will often have SEVERE abdominal pain. The uterus will have increased tone w/ little to no return to resting tone btw/ contractions. The fetus will start to show signs of distress, with decels in the HR or even fetal death w/ large placental separation. Placenta previa usually involves PAINLESS vaginal bleeding w/out UCs. A molar preg. generally would be detected before 34 weeks gestation. An ecoptic preg. which usually occurs in the FALLOPIAN TUBES, would rupture well before 34 weeks gestation

Two days after circumcision, the nurse notes a yellow - white exudate around the head of the neonates penis. What would be the most appropriate nursing intervention? 1. Leave the area alone as this is a normal finding 2. report findings to physician and document it 3. Take the neonate's temperature bc an infection is suspected 4. Try to remove the exudate with a warm washcloth

1. the yellow white exudate is part of the granulation process and a normal finding for a healing penis after circumcision therefore, notifying the doctor isnt necessary theres no indication of an infection that would necessitate taking the neonates temp the exudate shouldnt be removed

When teaching an antepartal client about the passage of the fetus through the birth canal during labor, the nurse describes the cardinal mechanisms of labor. Place these events in the proper sequence in which they occur: 1. Flexion 2. External rotation 3. Descent 4. Expulsion 5. Internal Rotation 6. Extension

1. Descent 2. Flexion 3. Internal rotation 4. Extension 5. External rotation 6. Expulsion DFI EEE

A client who is 32 weeks pregnant is being monitored in the antepartum unit for PIH. She suddenly complains of continuous abdominal pain and vaginal bleeding. Which of the following nursing internventions should be included in the care of this client? Check all that apply 1. Evaluate VS 2. Prepare for vaginal delivery 3. Reassure client that she'll be able to continue pregnancy 4. Evaluate FHT 5. Monitor amt of vaginal bleed 6. Monitor I&O

1. Evaluate VS 4. Evaluate FHT 5. Monitor amt of vaginal bleed 6. Monitor I&O The clients Sx indicate that she's experiencing abruptio placenta. The nurse must immed eval the moms well being by eval VS, FWB, by auscultation of heart tones, monitoring amt of blood loss and eval the vol status by measuring I&O. After the severity of the abruption has been determined and blood and fluid have been replaced, prompt C-SECTION delivery of the fetus (not vaginal) is indicated if the fetus is in distress

Which of the following nursing actions is required before a client in labor receives an epidural? 1. Give a fluid bolus of 500 ml 2. check for maternal pupil dilation 3. assess maternal reflexes 4. assess maternal gait

1. Give a fluid bolus of 500 ml one of the major adverse effects of epidural admin is hypotension therefore, a 500ml fluid bolus is usually admin to help prevent hypotension in the client who wishes to receive an epidural for pain relief. assessments of meternal reflexes, pupil response and gait arent necessary

What are the 3 types of cesarean section cuts that can be made. What are their advantages?

1. Kerr (Transverse) : Allows VBAC for 2nd birth 2. Selheim : Low incision 3. Classical : Fastest(Risk or Trauma), Dihisance Risk, No vaginal supsequent births.

What are the 2 types of Episiotomies? What are there benefits?

1. Midline (Faster Healing, Less Muscle Damage, Risk of tearing anus) 2. Medial Lateral (Slow healing, More muscle repair, No risk of tearing Anus)

What three test are done to confirm a rupture of the amniotic membranes?

1. Nitrazine Paper (Turn blue to change in pH) 2. Ferning Test (Fluid dried shows fern like design) 3. Free Flow (Cervical exam, pt asked to bear down, fluid seen on cervix)

a client is being admitted to the antepartum unit for hypovolemia secondary to hyperemesis gravidarum. WHich of the following factors predisposes a client to the development of this? 1. trophoblastic disease 2. maternal age > 35 y.o. 3. malnourished or underweight clients 4. low levels of HCG

1. Trophoblastic disease is associated w/ hyperemesis grav obesity and maternal age younger than 20 y.o. are risk factors too. High levels of estrogen HCG have also been associated with the development.

Which of the following fetal positions is most favorable for birth? 1. Vertex 2. Transverse lie 3. Frank breech presentation 4. Posterior position of the head

1. Vertex presentation flexion of the fetal head is the optimal presentation for passage thru the birth canal. Transverse lie is an unacceptable fetal position for vaginal birth and requires c-section frank breech presentation, in which the buttocks presents first, can be difficult vaginal delivery. posterior positioning of the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis.

When performing an assessment on a neonate, which assessment finding is MOST SUGGESTIVE of hypothermia? 1. bradycardia 2. hyperglycemia 3. metabolic alkalosis 4. shivering

1. bradycardia hypothermic neonates become bradycardic proportional to the degree of core temp HYPOGLYCEMIA is seen in HYPOTHERMIC NEONATES Shivering is rarely observed in neonates metabolic ACIDOSIS, not alkalosis is seen due to slowed resp

Clients with gestational diabetes are usually managed by which of the following therapies? 1. diet 2. long acting insulin 3. oral hypoglycemic drugs 4. oral hypoglycemic drugs/insulin

1. diet oral hypoglycemics are contraindicated in preg. long acting insulin usually inst needed for blood glucose control in the client with GDM

Which of the following changes in resp functioning during pregnancy is considered normal? 1. increased tidal volume 2. increases expiratory volume 3. decreased inspiratory capacity 4. decreased oxygen consumption.

1. increased tidal volume a pregnant client breathes deeper, which increases the tidal volume of gas moved in and out of the respiratory tract w/ each breath. The expiratory volume and residual volume DECREASE as the preg. progresses. The inspiratory capacity INCREASES during preg. The increases oxygen consumption in the preg client is 15-20% greater than in the nonpreg state

Which statement best describes lochia rubra? 1. it contains a mixture of mucus, tissue debris and blood 2. it contains placental fragments, and blood 3. it contains mucus, placental fragments and blood. 4. it contains tissue debris and blood

1. lochia rubra contains a mixture of mucus tissue debris blood normal lochia rubra contains NO PLACENTAL FRAGMENTS

Which of the following conditions isnt dx by abdominal US during the prenatal period? 1. fetal presentation 2. fetal heart activity 3. maternal diabetes 4. amniotic fluid volume

3. maternal diabetes abdominal US evals fetal presentation, fetal heart activity, amniotic fluid volume although it may show increased amnitoic flud, thus helping to diagnose maternal diabetes, it isnt used for that purpose.

A client is 33 weeks pregnant and has had diabetes since she was 21. When checking her fasting blood sugar level, which values indicate the clients disease was controlled. 1. 45 mg/dl 2. 85 mg/dl 3. 120 mg/dl 4. 136 mg/dl

2. 85 mg/dl recommended fasting blood sugar levels in pregnant clients w/ dm are 60-90 mg/dl a fasting blood sugar level of 45mg/dl is low and may result in hypoglyecemia a bs level below 120mg/dl is recommeded for 1hour postprandial values a bs level above 136 mg/dl in a pregnant client indicates hyperglycemia

a 21 y.o. client, 6 weeks pregnant, is diagnosed with hyperemesis gravidum. This excessive vomiting during pregnancy will often result in which of the following? 1. bowel perforation 2. electrolyte imbalance 3. miscarriage 4. PIH

2. ELECTROLYTE IMBALANCE Excessive vomiting in clients with hyperemesis grav often causes weight loss / fluid and electrolyte, acid base imbalance. PIH and bowel perforation arent r/t hyper grav the effects of hyper grav on the fetus depend on the severity of the disorder. clients w/ severe hyper grav may have low birth weight infant, but the disorder isnt life threatening to the fetus.

A 21 y.o. has arrives to the ER with c/o cramping abdominal pain and mild vaginal bleeding. Pelvic exam shows a left adnexal mass that's tender when palpated. Culdocentesis shows blood in the culdesac. This client probably has which of the following conditions? 1. Abruptio placentae 2. Ecoptic pregnancy 3. Hydatidiform mole 4. Pelvic Inflammatory Disease

2. Ecoptic pregnancy most ecoptic pregnancies dont appear as obvious life threatening med emergencies. THey must be considered in any sexually active woman of childbearing age who c/o menstrual irregularity, cramping abdominal pain, and mild vaginal bleeding. PID, abruptio placentae and hydatidiform moles wont show blood in the cul de sac

Which of the following is best to monitor a fetus of a client with diabetes in her 3rd trimester 1. US exam weekly 2. NST 2x/week 3. Daily contraction stress test at 32 weeks 4. monitoring fetal activity by client weekly

2. NST 2X/week NST is the preferred antepartum HR screening test for pregnant clients with diabetes. NSTs should be done at least 2x per week staring at 32 weeks gestation, as fetal deaths in clients w/ diabetes have been noted within 1 week of a reactive NST. US should be done ever 4-6 weeks to monitor fetal growth. CST wouldnt be initiated at 32 weeks Maternal fetal activity monitoring should be done daily

A woman with a term, uncomplicated pregnancy comes into L&D in early labor saying that she thinks her water broke. Which action should the nurse take? 1. prep the woman for delivery 2. note color, amt and odor of fluid 3. immed contact doctor 4. collect sample of fluid for microbial analysis

2. Noting color, amount and odor of the fluid as well as the time of the rupture, will help guide the nurse in her next action. There's no need to call the doctor immed or prep the client for delivery if the fluid is clear and delivery isnt imminent. ROM isnt unusual in early stages of labor. Fluid collection for microbe analysis isnt routine and theres no concern for infection/maternal fever.

Rh isoimmunization in a pregnant client develops during which conditions? 1. Rh positive maternal blood crosses into fetal blood, stimulating fetal antibodies. 2. Rh positive fetal blood crosses into maternal blood, stimulating maternal antibodies. 3. Rh Negative fetal blood crosses into maternal blood, stimulating maternal antibodies. 4. Rh negative maternal blood crosses into fetal blood, stimulating fetal antibodies.

2. Rh positive fetal blood crosses into maternal blood, stimulating maternal antibodies. Rh isoimmunization occurs when Rh positive fetal blood cells cross into the maternal circulation and stimulate maternal antibody production. In subsequent pregnancies w/ Rh positive fetuses, maternal antibodies may cross back into the fetal circulation and destroy fetal blood cells.

A 17 y.o. primpigravida with severe PIH has been receiving mag sulfate IV for 3 hours. The latest assessment reveals DTR of +1, BP 150/100 mmgHg, pulse 92 bpm, respiratory rate 10bpm and urine output 20ml/hr. Which of the following actions would be most approp? 1. Continue monitoring per standards of care 2. Stop the mag sulfate infusion 3. Increase infusion by 5gtt/min 4. Decrease infusion by 5gtt/min

2. Stop the mag sulfate infusion Mag sulfate should be withheld if the clients resp rate or urine output falls or if reflexes are diminished / absent. The client also shows other signs of impending toxicity such as flushing / feeling warm. Inaction wont resolve the clients suppressed DTRs and low RR / urine output. The client is already showing CNS depression bc of excessive magsulfte so increasing the infusion is wrong. Impending toxicity indicates that the infusion should be stopped rather than just slowed down.

A woman who's 36 week preg comes into L&D with mild contractions. Which of the following complications should the nurse watch for when the client informs her that she has placenta previa? 1. sudden ROM 2. Vaginal bleeding 3. emesis 4. fever

2. Vaginal bleeding contractions may disrupt the microvascular network in the placenta of the client with placenta previa and result in bleeding. if the separation of the placenta occurs at the margin of the placenta, the blood will escape vaginally. sudden ROM isnt r/t placenta previa fever would indicate an infections process, and emesis isnt r/t placenta previa

A client at 33 weeks gestation and leaking amniotic fluid is place on an EFM. The monitor indicates uterine irritability and contractions occuring every 4-6 min. The doctor orders terbutaline. Which of the following teaching statements is approp for this client? 1. This medicine will make you breathe better 2. You may feel fluttering or tight sensation in your chest 3. This will dry your moth and make you thirsty 4. You'll need to replace potassium lost by this drug

2. You may feel fluttering or tight sensation in your chest A fluttering or tight sensation in the chest is a common adverse reaction to terbutaline It relives bronchospasm but the client is getting it to reduce uterine motility. Mouth dryness and thirst occur w/ the inhaled form but are unlikely with subcut form Hypokalemia is a potential adverse reaction following large doses of terbutaline but not at doses of 0.25 mg

The phrase gravida 4, para 2 indicated which of the following prenatal histories? 1. a client has been pregnant 4 times and had 2 miscarriages. 2. a client has been pregnant 4 times and had 2 live born children 3. a client has been pregnant 4 times and had 2 c-sections 4. a client has been pregnant 4 times and 2 spontaneous abortions.

2. a client has been pregnant 4 times and had 2 live born children Gravida refers to the number of times a client has been pregnant. Para refers to the # of viable children born. Therefore, the client who's gravida 4, para2 has been pregnant 4x and had 2 live born children.

Lochia alba follows lochia serosa and usually lasts from the 1st to 3rd week PP. Which of the following statements best describes lochia alba? 1. creamy white-brown, stale odor 2. creamy white to brown, contains decidual cells, may have stale odor 3. brown to red, tissue fragments, odor 4. brown to red contains decidual cells and leukocytes

2. creamy white to brown, contains decidual cells, may have stale odor also contais leukocytes but it shouldnt contain tissue fragments or have a foul odor

Before the placenta functions, the corpus luteum is the primary source for synthesis of which of the following hormones? 1. cortisol and thyroxine 2. estrogen and progesterone 3. LH and FSH 4. T4 and T3

2. estrogen and progesterone The CL produces progesterone and estrogen for the 1st 8-10 weeks of pregnancy until the placenta takes over this function. The high levels of estrogen and progesterone cause suppression of LH and FSH. T4 and T3 are produced in the adrenal gland

A client diagnosed with preterm labor at 28 weeks gestation. Later, she comes to the emergency dept saying "I think im in labor" The nurse would expect her physical exam to show which condition? 1. painful contractions with no cervical dilation 2. regular uterine contractions with cervical dilation 3. irregular uterine contractions with no cervical dilation 4. irregular uterine contractions with cervical effacement

2. regular uterine contractions (every 10 min or more) along with cervical dilation change before 36 weeks = PTL no cervical change with UC isnt' PTL

Which drug would the nurse choose to utilize as an antagonist for magnesium sulfate? 1. Oxytocin 2. Terbutaline 3. Calcium gluconate 4. Narcan

3. Calcium gluconate should be kept at the bedside while a client is recieivng mag sulfate infusion. If magnesium toxicity occurs, calcium gluconate is admined as an antidote oxytocin is the synthetic form of the naturally occurring pituitary hormone used to initiate or augment UCs Terbutaline is a beta2 adrenergic agonist that may be used to relax smooth muscle of the uterus, esp for PTL and uterine hyperstimulation Naloxone is an opiate antagonist admin to reverse resp distress

At what gestational age is a conceptus considered viable (able to live outside the womb)? 1. 9 weeks 2. 14 weeks 3. 24 weeks 4. 30 weeks

3. 23 / 24 weeks the lungs are developed enough to sometimes maintain extrauterine life. the lungs are the most immature system during the gestational period. medical care for premature labor begins much earlier (aggressively at 21 weeks0

Which of the following terms is used to describe the thinning and shortening of the cervix that occurs just before and during labor? 1. Ballottement 2. Dilation 3. Effacement 4. Muliparous

3. Effacement effacement is cervical shortening and thinning while dilation is widening of the cervix both facilitate opening the cervix in prep for delivery. Ballottement is the ability of another individual to move the fetus by externally manipulating the maternal abdomen. A ballotable fetus hasn't yet engaged in the maternal pelvis. Multiparous refers to a woman who has had previous live births.

A client hospitalized for premature labor tells the nurse she's having occasional contractions. Which of the following nursing interventions would be the most appropriate? 1. Teach the client the possible complications of premature birth. 2. Tell the clients to walk to see if she can get rid of the contractions. 3. Encourage her to empty her bladder and drink plenty of fluids, IV fluids 4. Notify anesthesia for immediate epidural placement to relieve the pain associated with contractions.

3. Encourage her to empty her bladder and drink plenty of fluids, IV fluids An empty bladder and adequate hydration may help decrease or stop labor contractions. Walking may encourage contractions to become stronger. Teaching the potential complications is likely to increase the clients anxiety rather than relax her It would be inappropriate to call anesthesia

During the last 6 weeks of gestation, which of the following tests isnt used to determine FWB? 1. BPP 2. NST 3. Maternal blood count 4. FM count

3. Maternal Blood count - evaluates maternal, not fetal well being BPP - uses US to eval fetal body movements, breathing movements, muscle tone, reactive fetal cardiac rate, amniotic fluid volume NST - evals the FHR for accels during FM FM - counts are used during the last trimester to obtain a rough index of fetal health - the number of FM are counted at diff times throughout the day and then charted to detect any change in overall activity over a number of days

During a vaginal exam of a client in labor, the nurse palpates the fetus' larger, diamond shaped fontanelle toward the anterior portion of the clients pelvis. Which of the following statements best describes this situation? 1. The client can expect a brief and intense labor, which potential for lacerations. 2. The client is at risk for uterine rupture and needs constant monitoring 3. The client may need interventions to ease back pain and change fetal position 4. The fetus will be delivered using forceps or vacuum extractor

3. The client may need interventions to ease back pain and change fetal position The fetal position is occiput posterior, a position that commonly produces intense back pain during labor. Most of the time, the fetus rotates during labor to occiput anterior position. Positioning the client on her side can facilitate this rotation. An occiput posterior position would most likely result in prolonged labor POSTERIOR - PROLONGED. occiput posterior alone doesnt create a risk of uterine rupture. The fetus wont be delivered with forceps / vacuum only if its presenting part DOESNT rotate and descend spontaneously

The nurse receives an order to start an infusion for a client whos hemorrhaging due to a placenta previa. What supplies will be needed? 1. Y tubing, normal saline solution, and 20G cathether 2. Ytubing, lactated Ringers solution and 18G cath 3. Y tubing, normal saline, 18G cath 4. Y tubing, lactated RIngers, 20G cath

3. Y tubing, normal saline, 18G cath blood transfusions require Y tubing Normal Saline solution to mix with the blood product and an 18G cath to avoid lysing breaking the RBCs. A 20G cath lumen isnt large enough for a blood transfusion. Lactated RIngers solutions isnt the IV solution of choice for blood transfusions

WHich finding might be seem in a neonate suspected of having an infection? 1. flushed cheeks 2. increased temp 3. decreased temp 4. increased activity level

3. decreased temp temp instability esp when it resutls in low temp in the neonate, may be a sign of infection. the neonate's color often changes with an infection process but generally becomes ashen or mottled the neonate w/ an infection will usually show a decrease in activity level or lethargy

A client has just given birth at 42 weeks gestation. When assessing the neontate, which phsycial finding is expected? 1. a sleepy, lethargic baby 2. lanugo covering body 3. desquamation of the epidermis 4. vernix caseosa covering the body

3. desquamation of the epidermis postdate fetuses lose the vernix caseosa and the epidermis may become desquamated these neonates are usually VERY alert lanugo is missing in the postdate neonate

Which nursing ntervention helps prevent evaporative heat loss in the neonate immed after birth? 1. admin warm oxygen 2. controlling drafts in the room 3. immed drying the neonate 4. placing neonate on a warm, dry towel

3. immed drying the neonate decreases evaoporative heat loss from moist body from birth placing the neonate on a warm, dry towel decreases CONDUCTIVE losses. controlling draft in the room and admin warm oxygen helps reduce CONVECTIVE LOSS

3 day old neonate needs phototherapy for hyperbilirubinemia. nursery care of a neonate getting phototherapy would include which nursing intervention? 1. tube feedings 2. feeding the neonate under phototheraphy lights 3. mask over the eyes to prevent retinal damage 4. temp monitored every 6 hours during phototherapy

3. mask the neonate's eyes must be covered with eye patches to prevent damage the mouth of the neonate doesnt need to be covered the neonate can be removed from the lights and held for feeding the neonates temp should be monitored at least every 2-4 hours due to risk of hyperthermia w/ phototherpahy

Which of the following conditions is common in pregnant clients in the 2nd trimester of preg? 1. mastitis 2. metabolic alkalosis 3. physiologic anemia 4. respiratory acidosis

3. physiologic anemia Hgb and Hct values DECREASE during preg as the INCREASE in plasma volume exceeds the increase in RBC production. Alterations in acid-base balance during pregnancy result in a state of resp. alkalosis, compensated by mild metabolic acidosis. Mastitis is an infection in the breast characterized by a swollen tender breast and flu like Sx. this condition is most freq. seen in breast feeding clients.

Which of the following complications is possible with an episiotomy? 1. blood loss 2. uterine disfigurement 3. prolonged dyspareunia 4. hormonal flucuation postpartum

3. prolonged dyspareunia - painful intercourse may result when complications such as infection interefere with wound healing. minimal blood loss occurs when an episitomy is done the uterus isnt affected bc its the perineum that's cut to accomodate the fetus hormonal fluctuations that occur during the postpartum period arent the result of an episiotomy

Which of the following complications can be potentially life threatening and can occur in a client receiving a tocolytic agent? 1. diabetic ketoacidosis 2. hyperemesis gravidarum 3. pulmonary edema 4. sickle cell anemia

3. pulmonary edema Tocolytics are used to stop labor contractions. The most common adverse effect associated with the use of these drugs is pulmonary edema. Clients who dont have diabetes dont need to be observed for diabetic ketoacidosis. Hyperemesis gravidium doesnt result from tocolytic use. Sickle cell anemia is an inherited genetic condition and doesnt develop spontaneously

After reviewing the client's maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate? 1. hypoglycemia 2. jitteriness 3. resp depression 4. tachycardia

3. resp depression mag sulfate crosses the placenta and adverse neonatal effects are: resp depression hypotonia bradycardia the serum blood sugar isnt affected by mag sulfate the neonate wold be floppy, not jittery

Which of the following rationales best explains why a pregnant client should lie on her left side when resting or sleeping in the later stages of pregnancy? 1. to facilitate digestion 2. to facilitate bladder emptying 3. to prevent compression of vena cava 4. to avoid fetal anomalies

3. to prevent compression of vena cava the weight of the preg uterus is sufficiently heavy to compress the vena cava, which could impair blood flow to the uterus, possibily decreasing oxygen to the fetus. The side lying position hasnt been shown to prevent fetal anolmaies nor bladder emptying and or digestion

What concentrations do Pitocin usually come in?

30u/500L 20u/1000L 10u/1000L

What is the definition of Labor?

Contractions with cervical change.

Which of the following factors would contribute to a high risk pregnancy? 1. Blood type O positive 2. first pregnancy at age 33y.o. 3. Hx of allergy to honey bee pollen 4. Hx of insulin dependent DM

4. a woman w/ a hx of diabetes has an increased risk for perinatal complications, including HTN, preeclampsia, and neonatal hypoglycemia. The age of 33 years w/out other risk factors doesn't increase risk, nor does type O positive blood or environmental allergens.

When caring for a client in the first stage of labor, the nurse documents cervical dilation of 9 cm and intense contractions lasting 45 to 60 seconds and occurring about every 2 minutes. Based on these findings, the nurse should recognize that the client is in which phase of labor? 1. Active phase 2. Latent phase 3. Descent phase 4. Transitional phase

4 RATIONALES: In the transitional phase, the cervix dilates from 8 to 10 cm, and intense contractions occur every 1½ to 2 minutes and last for 45 to 90 seconds. In the active phase, the cervix dilates from 5 to 7 cm, and moderate contractions progress to strong contractions that last 60 seconds. In the latent phase, the cervix dilates 3 to 4 cm, and contractions are short, irregular, and mild. No descent phase exists. (Fetal descent may begin several weeks before labor but usually doesn't occur until the second stage of labor.)

A male neonate has just been circumcised. Which nursing intervention is part of the initial care of a circumcised neonate? 1. apply alcohol to the site 2. Change the diaper as needed 3. keep the neonate in supine position 4. apply petroleum gauze to the site for 24 hours

4. Petroleum gauze is applied to the site for the 1st 24 hours to prevent the skin edges from sticking to the diaper neonates are initially kept in the prone position diapers are changed more freq to insepct the site alcohola is CONTRAINDICATED

A 21y.o. client has been diagnosed with hydatidiform mole. Which of the following factors is considered a risk factor for developing hydatidiform mole? 1. age in 20s or 30s 2. high in SES 3. Primigravida 4. prior molar gestation

4. previous molar gestation increases risk for developing subsequent molar gestation by 4-5 times. Adolescents and women ages 40+ are at increased risk for molar pregs. MULTIGRAVIDAS, esp women with prior preg loss, and women with LOWER SES are at increased risk for this problem.

Which of the following doses of Rh immune globulin RhoGAM is appropriate for a pregnant client at 28 weeks gestation? 1. 50 mcg in a sensitized client 2. 50 mcg in an unsensitized client 3. 300 mcg in a sensitized client 4. 300 mcg in a unsensitized client

4. 300 mcg in a unsensitized client An Rh negative unsensitized woman should be given 300 mcg of RhoGAM at 28 weeks after an indirect Coombs test is done to verify that sensitization hasn't occurred. For a 1st trimester abortion or ectopic pregnancy, 50 mcg of RhoGAM is given.

Which assessment finding would be the most unlikely risk factor for RDS 1. second born of twins 2. neonate born at 34 weeks 3. neonate of diabetic mom 4. chronic maternal HTN

4. CHRONIC MATERNAL HTN unlikely factor bc chronic fetal stress tends to INCREASE LUNG MATURITY premature neonates < 35 weeks are associated with RDS Even with a mature lecithin to sphingomyelin ration, neonates of moms with diabetes still develop RDS 2nd born of twins may be prone to greater risk of asphyxia

A client at 42 weeks gest is 3cm dilated, 30% effaced, with membranes intact and the fetus at +2 station. FHR is at 140-150 bpm. After 2 hours, the nurse notes on the EFM that, for the past 10 min, the FHR ranged from 160-190bpm. The client states that her baby has been extremely active. UCs are strong, occurring every 3-4 min. and lasting 40-60 sec. Which of the following findings would indicate fetal hypoxia? 1. Abnormally long UCs 2. Abnormally strong uterine intensity 3. Excessively frequent contractions with rapid fetal movement 4. Excessive fetal activity and fetal tachycardia

4. Excessive fetal activity and fetal tachycardia Fetal tachycardia and excessive fetal activity are the FIRST SIGNS OF FETAL HYPOXIA The duration of UCs is w/in normal limits. Uterine intensity can be mild-strong and still be w/in normal limit. The frequency of contractions is w/in normal limits for the active phase of labor.

Neonates born to women infected with hepatitis B should undergo which Tx regimen 1. Hep B vaccine at birth and 1 month 2. Hep B immune globulin at birth, no hepatitis B vaccine 3. Hepatits B immune globulin within 48 hours of birth and Hep B vaccine at 1 month 4. Hep B immune globulin within 12 hours of birth and Hep B vaccine at birth, 1 month, 6 months

4. Hep B immune globulin within 12 hours of birth and Hep B vaccine at birth, 1 month, 6 months Hep B immune globulin should be given as soon as possible after birth but within 12 hours neonates should also receive hep B vaccine at regularly scheduled intervals this sequence of care has been determined as superior to the others

A client in early labor states that she has a thick yellow discharge from both of her breasts. Which of the following actions by the nurse would be correct? 1. tell her that her milk is starting to come in bc she's in labor 2. complete a thorough breast exam and document the results in the chart. 3. perform a culture on the discharge and inform the client that she might have mastitis 4. inform the client that the discharge is colostrum, normally present after the 4th month of preg.

4. after the 4th month, colostrum may be expressed. the breasts normally produce colostrum for the first few days after delivery. milk production begins 1-3 days PP A clinical breast exam isnt indicated in intrapartum although a culture may be indicated, it requires advanced assessment as well as a medical order

A neonate has been diagnosed with caput succedaneum. which statement is true? 1. usually resolves in 3-6 weeks 2. collection of blood btw/ skill and periosteum 3. doesnt cross the cranial suture line 4. it involves swelling of the tissue over the presenting part of the head

4. it involves swelling of the tissue over the presenting part of the head due to sustained pressure this boggy edematous swelling is present at birth, CROSSES the suture line occurs in occipital area a cephalohematoma is a collection of blood btw/ the skill and periosteum that DOESNT cross the suture lines and resolves in 3-6 weeks caput seccedaneum resolves within 3-4 DAYS

Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are exchanged? 1. conception 2. 9 weeks gestation when the fetal heart is well developed 3. 32-34 weeks gestation 3rd Trimester 4. maternal and fetal blood are never exchanged

4. maternal and fetal blood are never exchanged only nutrients and waste products are transferred across the placenta. blood exchange never occurs complications and some medical procedures can cause an exchange to occur accidentally

The SGA neonate is at increased risk during the transitional period for which complication? 1. anemia probably due to chronic fetal hypoxia 2. hyperthermia due to decreased glycogen stores 3. hyperglycemia due to decreased glycogen stores 4. polycythemia probably due to chronic fetal hypoxia

4. polycythemia probably due to chronic fetal hypoxia the SGA baby is at risk for developing polycythemia during the transitional period in an attempt to decrease hypoxia the neonates are also at increased risk for developing hypoglycemia due to decreased glycogen stores

Which Sx would indicate the neonate was adapting approp to extrauterine life w/out difficulty? 1. nasal flare 2. light audible grunting 3. resp rate 40-60 breaths/min 4. resp rate 60-80 breaths/min

4. resp rate of 40-60 breaths/min is normal for a neonate during the transitional period nasal flaring, resp rate > 60 and audible grunting = SIGNS OF RESP DISTRESS!

According to Ballard assessment scale, what size determines and large for gestational age baby and a small for gestational age baby? What measurements are used to get to this score?

>90% growth = LGA <10% growth = SGA 1. Head Circumference 2. Crown to Rump Distance 3. Femur Length

Because uteroplacental circulation is compromised in clients with preeclampsia, a NST is performed to detect which conditions? 1. Anemia 2. Fetal well being 3. IUGR 4. oligohydarminos

An NST is based on the theory that a healthy fetus will have transient fetal heart rate accelerations with fetal movement. A fetus with compromised uteroplacental circulation usually wont have these accelerations, which indicate a nonreactive NST. Serial US wil detect IUGR and oligohydramnios in a fetus. An NST cant detect anemia in a fetus

Which of the following instructions should be included in the nurse's teaching regarding oral contraceptives? a. Weight gain should be reported to the physician. b. An alternate method of birth control is needed when taking antibiotics. c. If the client misses one or more pills, two pills should be taken per day for 1 week. d. Changes in the menstrual flow should be reported to the physician.

Answer B is correct. When the client is taking oral contraceptives and begins antibiotics, another method of birth control should be used. Antibiotics decrease the effectiveness of oral contraceptives. Approximately 5-10 pounds of weight gain is not unusual, so answer A is incorrect. If the client misses a birth control pill, she should be instructed to take the pill as soon as she remembers the pill. Answer C is incorrect. If she misses two, she should take two; if she misses more than two, she should take the missed pills but use another method of birth control for the remainder of the cycle. Answer D is incorrect because changes in menstrual flow are expected in clients using oral contraceptives. Often these clients have lighter menses.

A client telephones the emergency room stating that she thinks that she is in labor. The nurse should tell the client that labor has probably begun when: a. Her contractions are 2 minutes apart. b. She has back pain and a bloody discharge. c. She experiences abdominal pain and frequent urination. d. Her contractions are 5 minutes apart.

Answer D is correct. The client should be advised to come to the labor and delivery unit when the contractions are every 5 minutes and consistent. She should also be told to report to the hospital if she experiences rupture of membranes or extreme bleeding. She should not wait until the contractions are every 2 minutes or until she has bloody discharge, so answers A and B are incorrect. Answer C is a vague answer and can be related to a urinary tract infection

The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic pregnancy? a. Painless vaginal bleeding b. Abdominal cramping c. Throbbing pain in the upper quadrant d. Sudden, stabbing pain in the lower quadrant

Answer D is correct. The signs of an ectopic pregnancy are vague until the fallopian tube ruptures. The client will complain of sudden, stabbing pain in the lower quadrant that radiates down the leg or up into the chest. Painless vaginal bleeding is a sign of placenta previa, abdominal cramping is a sign of labor, and throbbing pain in the upper quadrant is not a sign of an ectopic pregnancy, making answers A, B, and C incorrect.

A client in labor for the past 10 hours shows no change in cervical dilation and has stayed at 5 to 6 cm for the past 2 hours. Her contractions remain regular at 2-minute intervals, lasting 40 to 45 seconds. Which of the following would be the nurse's initial action? 1. Assess for presence of a full bladder. 2. Suggest the placement of an internal uterine pressure catheter to determine adequacy of contractions. 3. Encourage the mother to relax by assisting her with appropriate breathing techniques. 4. Suggest to the physician that oxytocin augmentation be started to stimulate labor.

Answer: 1 RATIONALES: A full bladder will slow or stop cervical dilation and produce symptoms that could be misdiagnosed as arrest in labor. Other strategies, such as internal uterine monitoring, relaxation, and oxytocin augmentation, would be appropriate later, but assessing the bladder first is key.

The nurse observes a late deceleration. It's characterized by and indicates which of the following? 1. U-shaped deceleration occurring after the first half of the contraction, indicating uteroplacental insufficiency 2. U-shaped deceleration occurring with the contraction, indicating cord compression 3. V-shaped deceleration occurring after the contraction, indicating uteroplacental insufficiency 4. Deep U-shaped deceleration occurring before the contraction, indicating head compression

Answer: 1 RATIONALES: A late deceleration is U-shaped and occurs after the first half of the contraction, indicating uteroplacental insufficiency. It's an ominous pattern and requires immediate action — such as administering oxygen, repositioning the mother, and increasing the I.V. infusion rate — to correct the problem. U- and V-shaped decelerations are variable decelerations occurring at unpredictable times during contractions and are related to umbilical cord compression. Deep U-shaped deceleration occurring before the contraction is early deceleration.

For a client who's moving into the active phase of labor, the nurse should include which of the following as the priority of care? 1. Offer support by reviewing the short-pant form of breathing. 2. Administer narcotic analgesia. 3. Allow the mother to walk around the unit. 4. Watch for rupture of the membranes.

Answer: 1 RATIONALES: By helping the client use the pant form of breathing, the nurse can help the client manage her contractions and reduce the need for opioids and other forms of pain relief, which can have an effect on fetal outcome. In the active phase, the mother most likely is too uncomfortable to walk around the unit. The nurse will observe for rupture of membranes and may administer opioid analgesia but these don't take priority.

A primigravid client is admitted to the labor and delivery area. Assessment reveals that she's in the early part of the first stage of labor. Her pain is likely to be most intense: 1. around the pelvic girdle. 2. around the pelvic girdle and in the upper legs. 3. around the pelvic girdle and at the perineum. 4. at the perineum.

Answer: 1 RATIONALES: During most of the first stage of labor, pain centers around the pelvic girdle. During the late part of this stage and the early part of the second stage, pain spreads to the upper legs and perineum. During the late part of the second stage and during childbirth, intense pain occurs at the perineum.

Assessment of a client in active labor reveals meconium-stained amniotic fluid and fetal heart sounds in the upper right quadrant. Which of the following is the most likely cause of this situation? 1. Breech position 2. Late decelerations 3. Entrance into the second stage of labor 4. Multiple gestation

Answer: 1 RATIONALES: Fetal heart sounds in the upper right quadrant and meconium-stained amniotic fluid indicate a breech presentation. The staining is usually caused by the squeezing actions of the uterus on a fetus in the breech position, although late decelerations, entrance into the second stage of labor, and multiple gestation may contribute to meconium-stained amniotic fluid.

Which of the following describes the term fetal position? 1. Relationship of the fetus's presenting part to the mother's pelvis 2. Fetal posture 3. Fetal head or breech at cervical os 4. Relationship of the fetal long axis to the mother's long axis

Answer: 1 RATIONALES: Fetal position refers to the relationship of the fetus's presenting part to the mother's pelvis. Fetal posture refers to "attitude." Presentation refers to the part of the fetus at the cervical os. Lie refers to the relationship of the fetal long axis to that of the mother's long axis.

During labor, a client asks the nurse why her blood pressure must be measured so often. Which explanation should the nurse provide? 1. Blood pressure reflects changes in cardiovascular function, which may affect the fetus. 2. Increased blood pressure indicates that the client is experiencing pain. 3. Increased blood pressure signals the peak of the contraction. 4. Medications given during labor affect blood pressure.

Answer: 1 RATIONALES: Frequent blood pressure measurement helps determine whether maternal cardiovascular function is adequate. During contractions, blood flow to the intervillous spaces changes, compromising fetal blood supply. Increased blood pressure is expected during pain and contractions. Measuring blood pressure frequently helps determine whether blood pressure has returned to precontraction levels, ensuring adequate blood flow to the fetus. Although medications given during labor can affect blood pressure, the main purpose of measuring blood pressure is to verify adequate fetal status.

When assessing a client who has just delivered a neonate, the nurse finds that the fundus is boggy and deviated to the right. What should the nurse do? 1. Have the client void. 2. Assess the client's vital signs. 3. Evaluate lochia characteristic 4. Massage the fundus.

Answer: 1 RATIONALES: Having the client void can determine whether the boggy, deviated fundus results from a full bladder — the most common cause of these fundal findings. Vital sign assessment is unnecessary unless the nurse suspects hemorrhage from delayed involution. In a client who doesn't have a full bladder, the nurse should evaluate lochia characteristics to detect possible hemorrhage. If the client has a full bladder, massaging the fundus won't stimulate uterine contractions (which aid uterine involution) or prevent uterine atony — a possible cause of hemorrhage.

The nurse applies an external electronic fetal monitor (EFM) to assess a client's uterine contractions and evaluate the fetal heart rate (FHR). However, the client is uncomfortable and changes positions frequently, making FHR hard to assess. Consequently, the physician decides to switch to an internal EFM. Before internal monitoring can begin, which of the following must occur? 1. The membranes must rupture. 2. The client must receive anesthesia. 3. The cervix must be fully dilated. 4. The fetus must be at 0 station.

Answer: 1 RATIONALES: Internal EFM can be used only after the client's membranes rupture, when the cervix is dilated at least 2 cm and when the presenting part is at least at -1 station. Anesthesia isn't required for internal EFM.

A client, age 19, goes into labor at 40 weeks' gestation. When assessing the fetal monitor strip, the nurse sees that the fetal heart rate (FHR) has decreased to 60 beats/minute and that the waveforms sometimes resemble a V and begin and end abruptly. The nurse should interpret this pattern as: 1. variable decelerations. 2. decreased short-term variability. 3. increased long-term variability. 4. early decelerations.

Answer: 1 RATIONALES: On a fetal monitor strip, variable decelerations are characterized by an FHR that commonly decreases to 60 beats/minute; waveform shapes that vary and may resemble the letter U, V, or W; and deceleration waveforms with an abrupt onset and recovery. Decreased short-term variability manifests as fewer than 2 to 3 beats/amplitude of the baseline FHR. Increased long-term variability manifests as more than 5 to 20 beats/minute of the baseline FHR in rhythmic fluctuation. Early decelerations are seen as the descent, peak, and recovery of the deceleration waveform that mirrors the contraction waveform.

During labor, a client's cervix fails to dilate progressively, despite her uncomfortable uterine contractions. To augment labor, the physician orders oxytocin (Pitocin). When preparing the client for oxytocin administration, the nurse describes the contractions the client is likely to feel when she starts to receive the drug. Which description is accurate? 1. Contractions will be stronger and more uncomfortable and will peak more abruptly. 2. Contractions will be weaker, longer, and more effective. 3. Contractions will be stronger, shorter, and less uncomfortable. 4. Contractions will be stronger and shorter and will peak more slowly.

Answer: 1 RATIONALES: Oxytocin administration causes stronger, more uncomfortable contractions, which peak more abruptly than spontaneous contractions. Oxytocin doesn't affect the duration of contractions.

The nurse is administering oxytocin (Pitocin) to a client in labor. During oxytocin therapy, why must the nurse monitor the client's fluid intake and output closely? 1. Because oxytocin causes fluid retention 2. Because oxytocin causes excessive thirst 3. Because oxytocin has a diuretic effect

Answer: 1 RATIONALES: Oxytocin has an antidiuretic effect; prolonged I.V. infusion may lead to severe fluid retention, resulting in seizures, coma, and even death. Excessive thirst results from the work of labor and lack of oral fluids, not oxytocin administration. Oxytocin isn't toxic to the kidney.

At 28 weeks' gestation, a client is admitted to the labor and delivery area in preterm labor. An I.V. infusion of ritodrine (Yutopar) is started. Which client outcome reflects the nurse's awareness of an adverse effect of ritodrine? 1. "The client remains free from tachycardia." 2. "The client remains free from polyuria." 3. "The client remains free from hypertension." 4. "The client remains free from hyporeflexia."

Answer: 1 RATIONALES: Ritodrine and other beta-adrenergic agonists may cause tachycardia, hypotension, bronchial dilation, increased plasma volume, increased cardiac output, arrhythmias, myocardial ischemia, reduced urine output, restlessness, headache, nausea, and vomiting. These drugs aren't associated with polyuria, hypertension, or hyporeflexia.

A client is admitted to the labor and delivery department in preterm labor. To help manage preterm labor the nurse would expect to administer: 1. ritodrine (Yutopar). 2. bromocriptine (Parlodel). 3. magnesium sulfate. 4. betamethasone (Celestone).

Answer: 1 RATIONALES: Ritodrine reduces frequency and intensity of uterine contractions by stimulating B2 receptors in the uterine smooth muscle. It's the drug of choice when trying to inhibit labor. Bromocriptine, a dopamine receptor agonist and an ovulation stimulant, is used to inhibit lactation in the postpartum period. Magnesium sulfate, an anticonvulsant, is used to treat preeclampsia and eclampsia — a life-threatening form of pregnancy-induced hypertension. Betamethasone, a synthetic corticosteroid, is used to stimulate fetal pulmonary surfactant (administered to the mother).

A diabetic client in labor tells the nurse she has had trouble controlling her blood glucose level recently. She says she didn't take her insulin when the contractions began because she felt nauseated; about an hour later, when she felt better, she ate some soup and crackers but didn't take insulin. Now, she reports increased nausea and a flushed feeling. The nurse notes a fruity odor to her breath. What do these findings suggest? 1. Diabetic ketoacidosis 2. Hypoglycemia 3. Infection 4. Transition to the active phase of labor

Answer: 1 RATIONALES: Signs and symptoms of diabetic ketoacidosis include nausea and vomiting, a fruity or acetone breath odor, signs of dehydration (such as flushed, dry skin), hyperglycemia, ketonuria, hypotension, deep and rapid respirations, and a decreased level of consciousness. In contrast, hypoglycemia causes sweating, tremors, palpitations, and behavioral changes. Infection causes a fever. Transition to the active phase of labor is signaled by cervical dilation of up to 7 cm and contractions every 2 to 5 minutes.

Because cervical effacement and dilation aren't progressing in a client in labor, the physician orders I.V. administration of oxytocin (Pitocin). Why must the nurse monitor the client's fluid intake and output closely during oxytocin administration? 1. Oxytocin causes water intoxication. 2. Oxytocin causes excessive thirst. 3. Oxytocin is toxic to the kidneys. 4. Oxytocin has a diuretic effect.

Answer: 1 RATIONALES: The nurse should monitor fluid intake and output because prolonged oxytocin infusion may cause severe water intoxication, leading to seizures, coma, and death. Excessive thirst results from the work of labor and limited oral fluid intake — not oxytocin. Oxytocin has no nephrotoxic or diuretic effects. In fact, it produces an antidiuretic effect.

When assessing the fetal heart rate tracing, the nurse becomes concerned about the fetal heart rate pattern. In response to the loss of variability, the nurse repositions the client to her left side and administers oxygen. These actions are likely to improve which of the following? 1. Fetal hypoxia 2. The contraction pattern 3. The status of a trapped cord 4. Maternal comfort

Answer: 1 RATIONALES: These actions, which will improve fetal hypoxia, increase the amount of maternal circulating oxygen by taking pressure created by the uterus off the aorta and improving blood flow. These actions won't improve the contraction pattern, free a trapped cord, or improve maternal comfort.

The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first? 1. Change the client's position. 2. Prepare for emergency cesarean section. 3. Check for placenta previa. 4. Administer oxygen.

Answer: 1 RATIONALES: Variable decelerations in fetal heart rate are an ominous sign, indicating compression of the umbilical cord. Changing the client's position may immediately correct the problem. An emergency cesarean section is necessary only if other measures, such as changing position and amnioinfusion with sterile saline, prove unsuccessful. Administering oxygen may be helpful, but the priority is to change the woman's position and relieve cord compression.

The nurse is evaluating a client who is 34 weeks pregnant for premature rupture of the membranes (PROM). Which findings indicate that PROM has occurred? 1. Fernlike pattern when vaginal fluid is placed on a glass slide and allowed to dry 2. Acidic pH of fluid when tested with nitrazine paper 3. Presence of amniotic fluid in the vagina 4. Cervical dilation of 6 cm 5. Alkaline pH of fluid when tested with nitrazine paper

Answer: 1,3,5 RATIONALES: The fernlike pattern that occurs when vaginal fluid is placed on a glass slide and allowed to dry, presence of amniotic fluid in the vagina, and alkaline pH of fluid are all signs of ruptured membranes. The fernlike pattern seen when the fluid is allowed to dry on a slide is a result of the high sodium and protein content of the amniotic fluid. The presence of amniotic fluid in the vagina results from the expulsion of the fluid from the amniotic sac. Cervical dilation and regular contractions are signs of progressing labor but don't indicate PROM.

The nurse is monitoring a client who is receiving oxytocin (Pitocin) to induce labor. The nurse should be prepared for which maternal adverse reactions? 1. Hypertension 2. Jaundice 3. Dehydration 4. Fluid overload 5. Uterine tetany 6. Bradycardia

Answer: 1,4,5 RATIONALES: Adverse reactions to oxytocin in the mother include hypertension, fluid overload, and uterine tetany. The antidiuretic effect of oxytocin increases renal reabsorption of water, leading to fluid overload — not dehydration. Jaundice and bradycardia are adverse reactions that may occur in the neonate. Tachycardia, not bradycardia, is reported as a maternal adverse reaction.

Several minutes after a vaginal delivery, nursing assessment reveals blood gushing from the client's vagina, umbilical cord lengthening, and a globular-shaped uterus. The nurse should suspect which condition? 1. Cervical or vaginal laceration 2. Placental separation 3. Postpartum hemorrhage 4. Uterine involution

Answer: 2 RATIONALES: Placental separation is characterized by a sudden gush or trickle of blood from the vagina, further protrusion of the umbilical cord from the vagina, a globular-shaped uterus, and an increase in fundal height. With cervical or vaginal laceration, the nurse notes a consistent flow of bright red blood from the vagina. With postpartum hemorrhage, usually caused by uterine atony, the uterus isn't globular. Uterine involution can't begin until the placenta has been delivered.

The nurse notices that a client in the first stage of labor seems agitated. When the nurse asks why she's upset, she begins to cry and says, "I guess I'm a little worried. The last time I gave birth, I was in labor for 32 hours." Based on this information, the nurse should include which nursing diagnosis in the client's care plan? 1. Anxiety related to the facility environment 2. Fear related to a potentially difficult childbirth 3. Compromised family coping related to hospitalization 4. Acute pain related to labor contractions

Answer: 2 RATIONALES: A client's ability to cope during labor and delivery may be hampered by fear of a painful or difficult childbirth, fear of loss of control or self-esteem during childbirth, or fear of fetal death. A previous negative experience may increase these fears. Therefore, Fear related to a potentially difficult childbirth is the most appropriate nursing diagnosis. The client's anxiety stems from her past history of a long labor, not from being in the facility; therefore a diagnosis of Anxiety related to the facility environment isn't warranted. There is no evidence of compromised family coping related to hospitalization. Although acute pain related to labor contractions may be a problem, this isn't mentioned in the question.

When caring for a client who's having her second baby, the nurse can anticipate the client's labor will be which of the following? 1. Shorter than her first labor 2. About half as long as her first labor 3. About the same length of time as her first labor 4. A length of time that can't be determined based on her first labor

Answer: 2 RATIONALES: A woman having her second baby can anticipate a labor about half as long as her first labor. The other options are incorrect.

The physician decides to artificially rupture the membranes. Following this procedure, the nurse checks the fetal heart tones for which reason? 1. To determine fetal well-being 2. To assess for fetal bradycardia 3. To assess fetal position 4. To prepare for an imminent delivery

Answer: 2 RATIONALES: After a client has an amniotomy, the nurse should assure that the cord isn't prolapsed and that the baby tolerated the procedure well. The most effective way to do this is to check the fetal heart rate. Fetal well-being is assessed via a nonstress test. Fetal position is determined by vaginal examination. Artificial rupture of membranes doesn't indicate an imminent delivery.

During the active phase of the first stage of labor, a client undergoes an amniotomy. After this procedure, which nursing diagnosis takes the highest priority? 1. Deficient knowledge (testing procedure) related to amniotomy 2. Ineffective fetal cerebral tissue perfusion related to cord compression 3. Acute pain related to increasing strength of contractions 4. Risk for infection related to rupture of membranes

Answer: 2 RATIONALES: Amniotomy increases the risk of cord prolapse. If the prolapsed cord is compressed by the presenting fetal part, the fetal blood supply may be impaired, jeopardizing the fetal oxygen supply. Because lack of oxygen to the fetus may cause fetal death, the nursing diagnosis of Ineffective fetal cerebral tissue perfusion takes priority over diagnoses of Deficient knowledge, Acute pain, and Risk for infection.

A client with Rh isoimmunization delivers a neonate with an enlarged heart and severe, generalized edema. Which nursing diagnosis is most appropriate for this client? 1. Ineffective denial related to a socially unacceptable infection 2. Impaired parenting related to the neonate's transfer to the intensive care unit 3. Deficient fluid volume related to severe edema 4. Fear related to removal and loss of the neonate by statute

Answer: 2 RATIONALES: Because the neonate is severely ill and needs to be placed in the neonatal intensive care unit, the client may have a nursing diagnosis of Impaired parenting related to the neonate's transfer to the neonatal intensive care unit. (Another pertinent nursing diagnosis may be Compromised family coping related to lack of opportunity for bonding.) Rh isoimmunization isn't a socially unacceptable infection. This condition causes an excess fluid volume (not deficient) related to cardiac problems. Rh isoimmunization doesn't lead to loss of the neonate by statute.

After admission to the labor and delivery area, a client undergoes routine tests, including a complete blood count, urinalysis, Venereal Disease Research Laboratory test, and gonorrhea culture. The gonorrhea culture is positive, although the client lacks signs and symptoms of this disease. What is the significance of this finding? 1. Maternal gonorrhea may cause a neural tube defect in the fetus. 2. Maternal gonorrhea may cause an eye infection in the neonate. 3. Maternal gonorrhea may cause acute liver changes in the fetus. 4. Maternal gonorrhea may cause anemia in the neonate.

Answer: 2 RATIONALES: Gonorrhea in the cervix may cause neonatal eye infection during delivery as well as a serious puerperal infection in the client. Maternal gonorrhea isn't associated with neural tube defects, acute fetal liver changes, or neonatal anemia.

A primigravid client, age 20, has just completed a difficult, forceps-assisted delivery of twins. Her labor was unusually long and required oxytocin (Pitocin) augmentation. The nurse who's caring for her should stay alert for: 1. uterine inversion. 2. uterine atony. 3. uterine involution. 4. uterine discomfort.

Answer: 2 RATIONALES: Multiple fetuses, extended labor stimulation with oxytocin, and traumatic delivery commonly are associated with uterine atony, which may lead to postpartum hemorrhage. Uterine inversion may precede or follow delivery and commonly results from apparent excessive traction on the umbilical cord and attempts to deliver the placenta manually. Uterine involution and some uterine discomfort are normal after delivery.

At 40 weeks' gestation, a client is admitted to the labor and delivery area. She and her husband are worried about the fetus's health because she had problems during her previous childbirth. The nurse reassures them that the fetus will be monitored closely with an electronic fetal monitor (EFM). On the fetal monitor strip, what is the single most reliable indicator of fetal well-being? 1. Normal long-term variability 2. Normal short-term variability 3. Normal baseline fetal heart rate (FHR) 4. Normal contraction sequence

Answer: 2 RATIONALES: Normal short-term variability — 2 to 3 beats per amplitude — is the single most reliable indicator of fetal well-being on an EFM strip. It represents actual beat-to-beat fluctuations in the FHR. Normal long-term variability, although a helpful indicator, takes into account larger periodic and rhythmic deviations above and below the baseline FHR. Baseline FHR serves only as a reference for all subsequent FHR readings taken during labor. Contraction sequence provides no information about fetal well-being, although it does give some indication of maternal well-being and progress.

The nurse notices that a large number of clients who receive oxytocin (Pitocin) to induce labor, vomit as the infusion is started. The nurse assesses the situation further and discovers that these clients received no instruction before arriving on the unit and haven't fasted for 8 hours before induction. How should the nurse intervene? 1. Notify the physicians and explain that they need to teach their clients before inducing labor. 2. Initiate a unit policy involving staff nurses, certified nurse midwives, and physicians in teaching clients before labor induction. 3. Report the physicians for providing inferior care. 4. Initiate a protocol order that allows the nurse to administer promethazine (Phenergan) before administering oxytocin.

Answer: 2 RATIONALES: The best intervention by the nurse is to initiate a unit policy that involves the multidisciplinary team. This approach creates an atmosphere of collegiality and professionalism with the goal of providing the best care for clients in labor. Option 1 blames the physician and doesn't promote multidisciplinary teamwork. Reporting the physicians is unnecessary because nothing indicates that the physicians provided inferior care. The nurse can approach the medical staff about initiating a protocol order that allows the nursing staff to administer promethazine; however, this option doesn't address the problem — the lack of client education.

A pregnant client arrives at the health care facility, stating that her bed linens were wet when she woke up this morning. She says no fluid is leaking but complains of mild abdominal cramps and lower back discomfort. Vaginal examination reveals cervical dilation of 3 cm, 100% effacement, and positive ferning. Based on these findings, the nurse concludes that the client is in which phase of the first stage of labor? 1. Active phase 2. Latent phase 3. Expulsive phase 4. Transitional phase

Answer: 2 RATIONALES: The latent phase of the first stage of labor is associated with irregular, short, mild contractions; cervical dilation of 3 to 4 cm; and abdominal cramps or lower back discomfort. During the active phase, the cervix dilates to 7 cm and moderately intense contractions of 40 to 50 seconds' duration occur every 2 to 5 minutes. Fetal descent continues throughout the active phase and into the transitional phase, when the cervix dilates from 8 to 10 cm and intense contractions of 45 to 60 seconds' duration occur every 1½ to 2 minutes. The first stage of labor doesn't include an expulsive phase.

A client is admitted to the labor and delivery area. How can the nurse most effectively determine the duration of the client's contractions? 1. By timing the period between one contraction and the beginning of the next contraction 2. By timing the period from the onset of uterine tightening to uterine relaxation 3. By timing the period from the increment (building-up) phase to the acme (peak) phase 4. By timing the period from the acme (peak) phase to the decrement (letting-down) phase

Answer: 2 RATIONALES: To determine the duration of contractions, the nurse should time the period from the onset of uterine tightening to uterine relaxation. Timing the period between one contraction and the beginning of the next contraction helps determine the frequency of contractions. Timing the period from the increment to the acme or from the acme to the decrement supplies only partial information about contractions.

An adolescent in the early stages of labor is admitted to the labor and delivery unit. The nurse notes lymphadenopathy and a macular rash on the palmar surfaces of the hands and plantar surfaces of the feet. Admission laboratory testing reveals trace ketones in the urine, white blood cell count 10,000/μl, hemoglobin 14.5 g/dl, hematocrit 40%, and the nontreponemal antibody test is positive. The nurse notifies the physician of the laboratory results. Which action by the nurse takes priority? 1. Notifying the laboratory that a repeat hemoglobin and hematocrit have been ordered. 2. Recommending that the client drink plenty of fluids. 3. Consulting with the infection control nurse. 4. Asking the client if she has been exposed to varicella in the past 3 weeks.

Answer: 3 RATIONALES: A nontreponemal test screens the client for syphilis. The positive test result, along with the lymphadenopathy and rash, indicate that the client has secondary syphilis. Based on these findings, the neonate will most likely have signs and symptoms of congenital syphilis. The hemoglobin and hematocrit results are normal for a pregnant client. The laboratory results don't show signs of dehydration, so having the client drink plenty of fluids isn't necessary. The lesions associated with varicella are vesicular, and don't resemble the rash associated with syphilis.

A client with intrauterine growth retardation is admitted to the labor and delivery unit and started on an I.V. infusion of oxytocin (Pitocin). Which of the following is least likely to be included in her care plan? 1. Carefully titrating the oxytocin based on her pattern of labor 2. Monitoring vital signs, including assessment of fetal well-being, every 15 to 30 minutes 3. Allowing the client to ambulate as tolerated 4. Helping the client use breathing exercises to manage her contractions

Answer: 3 RATIONALES: Because the fetus is at risk for complications, frequent and close monitoring is necessary. Therefore, the client shouldn't be allowed to ambulate. Carefully titrating the oxytocin, monitoring vital signs, including fetal well-being, and assisting with breathing exercises are appropriate actions to include.

The nurse is assessing the fetal heart rate (FHR) of a client, who is at term, admitted to the labor and delivery area. Which of the following should the nurse identify as the normal range of the baseline FHR? 1. 60 to 80 beats/minute 2. 80 to 120 beats/minute 3. 120 to 160 beats/minute 4. 160 to 200 beats/minute

Answer: 3 RATIONALES: In a full-term fetus, the baseline FHR normally ranges from 120 to 160 beats/minute. FHR below 120 beats/minute reflects bradycardia; above 160 beats/minute, tachycardia.

Which of the following would be an inappropriate indication of placental detachment? 1. An abrupt lengthening of the cord 2. An increase in the number of contractions 3. Relaxation of the uterus 4. Increased vaginal bleeding

Answer: 3 RATIONALES: Relaxation isn't an indication for detachment of the placenta. An abrupt lengthening of the cord, an increase in the number of contractions, and an increase in vaginal bleeding are all indications that the placenta has detached from the wall of the uterus.

The third stage of labor ends with which of the following? 1. The birth of the baby 2. When the client is fully dilated 3. After the delivery of the placenta 4. When the client is transferred to her postpartum bed

Answer: 3 RATIONALES: The definition of the third stage of labor is the delivery of the placenta. The first stage of labor ends with complete cervical dilation and effacement. The second stage of labor ends with the birth of the baby. The fourth stage of labor includes the first 4 hours after birth.

During labor, a client tells the nurse that her last baby "came out really fast." The nurse can help control a precipitous delivery by: 1. applying counterpressure to the fetus's head. 2. encouraging the client to push. 3. massaging and supporting the perineum. 4. instructing the client to contract the perineal muscles.

Answer: 3 RATIONALES: The nurse can help control a precipitous delivery by stretching the labia, such as by massaging and bracing the perineum with gentle back pressure. This helps prevent perineal lacerations — the primary maternal complication of precipitous delivery. Applying counterpressure to the fetus's head reduces perineal stress temporarily; however, delivery proceeds when the client pushes with uterine contractions. Pushing puts further stress on the perineum, promoting delivery. When the fetus's head exerts pressure on the perineum, contracting the perineal muscles is virtually impossible.

A nursing assistant escorts a client in the early stages of labor to the bathroom. When the nurse enters the client's room, she detects a strange odor coming from the bathroom and suspects the client has been smoking marijuana. What should the nurse do next? 1. Tell the client that smoking is prohibited in the facility, and that if she smokes again, she'll be discharged. 2. Explain to the client that smoking poses a danger of explosion because oxygen tanks are stored close by. 3. Notify the physician and security immediately. 4. Ask the nursing assistant to dispose of the marijuana that the client can't smoke anymore.

Answer: 3 RATIONALES: The nurse should immediately notify the physician and security. The physician must be informed because illegal drugs can interfere with the labor process and affect the neonate after delivery. Moreover, the client might have consumed other illegal drugs. The nurse should also inform security who are specially trained to handle such situations. Most hospitals prohibit smoking. The nurse needs to alert others about the client's illegal drug use, not simply explain to the client that smoking is prohibited. Smoking is dangerous around oxygen and it's fine for the nurse to explain the hazard to the client; however, the nurse must first notify the physician and security. The nursing assistant shouldn't be asked to dispose of the marijuana.

A client in the fourth stage of labor asks to use the bathroom for the first time since delivery. The client has oxytocin (Pitocin) infusing. Which response by the nurse is best? 1. "You'll have to wait until the vaginal bleeding stops." 2. "You'll have to wait until the oxytocin is infused." 3. "You may use the bathroom with my assistance." 4. "You may get up to the bathroom whenever you need to."

Answer: 3 RATIONALES: The nurse should tell the client that she may use the bathroom with the nurse's assistance. The nurse should assist the client for the client's first trip to the bathroom after delivery. It isn't uncommon for a client to faint after delivery. Telling the client she must wait until her vaginal bleeding stops is inappropriate; vaginal bleeding continues for about 6 weeks after delivery. The nurse shouldn't tell the client she can get up whenever she needs to use the bathroom; doing so places the client at risk for injury.

When caring for a client with preeclampsia, which action is a priority? 1. Monitoring the client's labor carefully and preparing for a fast delivery 2. Continually assessing the fetal tracing for signs of fetal distress 3. Checking vital signs every 15 minutes to watch for increasing blood pressure 4. Reducing visual and auditory stimulation

Answer: 4 RATIONALES: A client with preeclampsia is at risk for seizure activity because her neurologic system is overstimulated. Therefore, in addition to administering pharmacologic interventions to reduce the possibility of seizures, the nurse should lessen auditory and visual stimulation. Although the other actions are important, they're of a lesser priority.

A nulliparous client has been in the latent phase of the first stage of labor for several hours. Despite continued uterine contractions, her cervix hasn't dilated further since the initial examination. Her latent phase may be considered prolonged after: 1. 6 hours. 2. 10 hours. 3. 14 hours. 4. 20 hours.

Answer: 4 RATIONALES: Based on research, the latent phase may be considered prolonged if it exceeds 20 hours in a nulliparous client or 14 hours in a multiparous client.

The nurse is caring for a woman receiving a lumbar epidural anesthetic block to control labor pain. What should the nurse do to prevent hypotension?

Answer: 4 RATIONALES: Because the woman is in a state of relative hypovolemia, administering fluids I.V. before the epidural anesthetic is given may prevent hypotension. Administration of an epidural anesthetic may lead to hypotension because blocking the sympathetic fibers in the epidural space reduces peripheral resistance. Ephedrine may be administered after an epidural block if a woman becomes hypotensive and shows evidence of cardiovascular decompensation. However, ephedrine isn't administered to prevent hypotension. Oxygen is administered to a woman who becomes hypotensive, but it won't prevent hypotension. Placing a pregnant woman in the supine position can contribute to hypotension because of uterine pressure on the great vessels.

During assessment for admission to the labor and delivery area, a client and her husband ask the nurse whether their sons, ages 8 and 10, can witness the childbirth. Before answering this question, the nurse should consider which guideline? 1. The children and client should share a support person during the childbirth. 2. Children should attend childbirth only if it takes place at home. 3. Children shouldn't attend childbirth because it will frighten them. 4. Each child attending the childbirth should have a separate support person.

Answer: 4 RATIONALES: Each child attending the childbirth should have a support person — one who isn't also serving as the client's support person. The support person explains what is happening, reassures the child, and removes the child from the area if an emergency occurs or if the child becomes frightened. Children can attend childbirth in any setting. The decision to have a child present hinges on the child's developmental level, ability to understand the experience, and amount of preparation.

A client with active genital herpes is admitted to the labor and delivery area during the first stage of labor. Which type of birth should the nurse anticipate for this client? 1. Mid forceps 2. Low forceps 3. Induction 4. Cesarean

Answer: 4 RATIONALES: For a client with active genital herpes, cesarean birth helps avoid infection transmission to the neonate, which would occur during a vaginal birth. Mid forceps and low forceps are types of vaginal births that could transmit the herpes infection to the neonate. Induction is used only during vaginal birth; therefore, it's inappropriate for this client.

For a client who's fully dilated, which of the following actions would be inappropriate during the second stage of labor? 1. Positioning the mother for effective pushing 2. Preparing for delivery of the baby 3. Assessing vital signs every 15 minutes 4. Assessing for rupture of membranes

Answer: 4 RATIONALES: In most cases, the membranes have ruptured (spontaneously or artificially) by this stage of labor. Positioning for effective pushing, preparing for delivery, and assessing vital signs every 15 minutes are appropriate actions at this time.

A client with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is admitted to the labor and delivery unit. The client's condition rapidly deteriorates and despite efforts by the staff, the client dies. After the client's death, the nursing staff displays many emotions. Who should the nurse manager consult to help the staff cope with this unexpected death? 1. The human resource director, so she can arrange vacation time for the staff 2. The physician, so he can provide education about HELLP syndrome 3. The social worker, so she can contact the family about funeral arrangements and pass along the information to the nursing staff 4. The chaplain, because his educational background includes strategies for handling grief

Answer: 4 RATIONALES: The chaplain should be consulted because his educational background provides strategies for helping others handle grief. Providing the staff with vacation isn't feasible from a staffing standpoint and doesn't help staff cope with their grief. The staff needs grief counseling, not education about HELLP syndrome. Asking the social worker to contact the family about the funeral arrangements isn't appropriate.

The nurse is caring for a client who's in the first stage of labor. What is the shortest but most difficult part of this stage? 1. Active phase 2. Complete phase 3. Latent phase 4. Transitional phase

Answer: 4 RATIONALES: The transitional phase, which lasts 1 to 3 hours, is the shortest but most difficult part of the first stage of labor. This phase is characterized by intense uterine contractions that occur every 1½ to 2 minutes and last 45 to 90 seconds. The active phase lasts 4½ to 6 hours; it's characterized by contractions that start out moderately intense, grow stronger, and last about 60 seconds. The complete phase occurs during the second, not first, stage of labor. The latent phase lasts 5 to 8 hours and is marked by mild, short, irregular contractions.

Using the acronym COAT or TOCA, what is the nurse assessing and what are important to ask the client?

Assessing the amniotic fluid after the bag of membranes has been broken. • C : Color (Clear, Blood Tinged, Green Meconium) • O : Odor (Possible Infection) • A : Amount (Trickle (scant), Copius, Moderate) • T : Time (When? To prevent infection labor within 24 hrs.)

A laboring client in transition phase is 8 cm dilated and feels the urge to push. What are the risks to the mom and what is the nursing intervention?

Risk of tearing perinium when <10cm dialted • Use open glottis, short breaths when feeling the urge to push.

Variable decellerations in fetal heart monitor indicates what?

Pressure on the cord causing circulation problems. • Prolapsed Cord • Fetus positioned on cord • Insufficient profusion to fetus

After pitocin has been administered, how often should the fetal monitoring be checked? How often should vitals be taken? How often should temperature be checked?

FHR/FT : Q15min. VS : Q30min Temp. :Q4hrs (if fever Q1hr.)

When a pregnant client arrives at the hospital and is taken to triage to determine what stage of labor she is in, the nurse gets a urine sample immediately, what is being tested for and what are the implications?

Protein : Hypertention Nitrates : Infection Ketones : Renal Problems and Glucose (Diabetic?)

Which of the following hormones would be administered for the stimulation of uterine contractions? 1. Estrogen 2. Fetal cortisol 3. Oxytocin 4. Progesterone

Oxytocin is the hormone responsible for stimulating UCs. Pitocin, the synthetic form, may be given to clients who are past their due date. Progesterone has a relaxation effect on the uterus Fetal cortisol is believed to slow the production of progesterone by the placenta although estrogen has a role in UC, it isnt given in a synthetic form to help UC

If there has been a SROM or AROM, how often should the nurse take vital signs?

Q 2hrs.

A client is having contractions every 6-8 minutes apart lasting for 30 seconds and are mild in intensity. Her cervix is 2cm dialated, what stage and phase of labor is she in?

Stage One, Latent(Early) Phase

A laboring mom is 9 cm dilated and experiencing contractions every 2 minutes for 90 seconds each. Which stage and phase of labor is she in?

Stage One, Transition Phase

The cervix of a 26 year old primigravida in labor is 5cm dilated and 75% effaced, and the fetus is at 0 station. The doctor prescribes an epidural regional block. Into which of the following positions should the nurse place the client when the epidural is admin? 1. Lithotomy 2. Supine 3. Prone 4. Lateral

THe client should be placed on her left side or sitting up right, with her shoulders parallel and legs slightly flexed. Her back shouldnt be flexed bc this position increases increases the possibility that the dura may be punctured and the anesthetic will accidentally be given as spinal, not epidural, anesthesia.

A nursing instructor is conducting lecture and is reviewing the functions of the female reproductive system. She asks Mark to describe the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). Mark accurately responds by stating that: a. FSH and LH are released from the anterior pituitary gland. b. FSH and LH are secreted by the corpus luteum of the ovary c. FSH and LH are secreted by the adrenal glands d. FSH and LH stimulate the formation of milk during pregnancy.

a. FSH and LH are released from the anterior pituitary gland. FSH and LH, when stimulated by gonadotropin-releasing hormone from the hypothalamus, are released from the anterior pituitary gland to stimulate follicular growth and development, growth of the graafian follicle, and production of progesterone.

A woman who's 36 weeks pregnant comes into the labor & delivery unit with mild contracts. Which of the following complications should the nurse watch out for when the client informs her that she has placenta prevue? a. sudden rupture of membranes b. vaginal bleeding c. emesis d. fever

b. vaginal bleeding contractions may disrupt the microvascular network in the placenta of a client with placenta prevue and result in bleeding. If the separation of the placenta occurs at the margin of the placenta, the blood will escape vaginally. Sudden rupture of the membranes isn't related to placenta prevue. Fever would indicate an infectious process, and emesis isn't related to placenta previa

MENCONIUM

collects in the GI tract during gestation and is initially STERILE greenish black bc of occult blood and is viscous stools of breast fed neonates - are loose golden yellow after the transition to extrauterine life stools of formula fed babies are - typically soft and pale yellow after feeding's well established

Main role of surfactant in the neonate

helps the lungs remain expanded after the initiation of breathing works by reducing surface tension in the lung allows the lung to remain slightly expanded decreases amount of work required for inspiration

Conduction heat loss

is the loss of heat from the BODY SURFACE to COOLER SURFACES in direct contact

RADIATION HEAT LOSS

is the loss of heat from the body surface to COOLER SOLID SURFACES NOT in direct contact but in relative proximity

how long should normal acrocyanosis last max.

max 24 hours post birth

On the 2nd PP day, a client complains that shes urinating more than when she was pregnant. Which is the primary cause of increased urinary output post delivery? 1. postpartum diuresis

occurs as the body starts to reduce the extracellular fluid volume that increased during preg renal plasma flow and GFR also increase slightly until approx 1 week PP Renal malfunctioning is more likely to decrease urinary output, not increase it increase PP fluid intake and breast feeding arent major causes of PP diuresis

Breastfeeding preterm neonates

studies have proven that breast milk provides preterm neonates w/ better protection from infection such as NEC bc of the antibodies contained in breast milk Commercial formula doesn't provide any better nutrition than breast milk breast milk feedings can be started as soon as the neonate is stable and the neonate is more likely to develop infections when fed formula rather than breast milk

Pulmonary embolus signs

sudden dyspnea diaphoresis confusion tachycardia stationary blood clot from a varicose vein becomes an embolus (moving clot) that lodges in the pulmonary circulation chills and fever = infection

Convection heat loss

the flow of heat from the body surface to COOLER AIR

Evaporation Heat Loss

the loss of heat that occurs when a liquid is converted to a vapor

Role of vitamin k in a neonate

vitamin K, deficient in the neonate, is needed to activate clotting factors II,IV,IX and X In the event of trauma, the neonate would be at risk for EXCESSIVE BLEEDING vitamin k doesnt assist the gut to mature but the gut PRODUCES vitamin K once maturity is achieved

What is pitocin drug half-life and where should it be administered and why?

• 6 min. 1/2 life • Closest port to IV site • To provide tight control of medication infusion