Exam 2 OB

Immediately following an amniotomy to observe for complications, the nurse must assess the: A. Fetal heart rate. B. Maternal blood pressure. C. Maternal pulse. D. Fetal variability.

A. Fetal heart rate.

Which of the following measures will help prevent complications from an episiotomy? A. Pain medication every 3 to 4 hours as needed B. Cold applications after birth C. Warm applications after birth D. Early ambulation

B. Cold applications after birth

A woman developed shoulder dystocia during the birth. After the birth and the newborn has been stabilized, it is important for the nurse to assess the newborn for: A. Hip dysplasia. B. Lung excursion. C. Fractured clavicles. D. Clubfoot.

C. Fractured clavicles. -During shoulder dystocia, the shoulders are pushed hard against the symphysis and fractures of the clavicle may occur during the birth. The infant's clavicles should be checked for crepitus, deformity, and bruising, which suggest fractures.

A vaginal birth after cesarean is often abbreviated __________.

VBAC

A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with moderate variability and no decelerations, TPR 98.6°F, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)? Select one: a. Bishop score of 5 b. Fetal heart of 152 bpm c. Respiratory rate of 24 rpm d. More than 5 contractions in 10 minutes

d. More than 5 contractions in 10 minutes Cervidil should be removed in the presence of tachysystole or Category II/III FHR patterns.

When intrathecal morphine is used for post-operative pain, the anesthesiologist manages the woman's pain for the first 24 hours. The perinatal RN is aware that the most serious complication of intrathecal morphine in the first 24 hours following surgery is: Select one or more: a. Urinary retention b. Nausea and itching c. Decreased sensation in the legs d. Respiratory depression

d. Respiratory depression Severe respiratory depression is a life-threatening adverse reaction to intrathecal morphine. Naloxone and resuscitative equipment need to be available whenever intrathecal morphine is administered and during the 24 hours post-procedure.

Which of the following would be an indication for a cesarean birth? (Select all that apply). A. Maternal coagulation defects B. Fetal death C. Cephalopelvic disproportion D. Active genital herpes E. Persistent nonreassuring FHR patters

C. Cephalopelvic disproportion D. Active genital herpes E. Persistent nonreassuring FHR patters

During a cesarean section, which action by the nurse is done to prevent compression of the descending aorta and vena cava? Select one: a. Right lateral tilt b. Left lateral tilt c. Elevate head of gurney at 30 degrees d. Administration of IV fluid preload of 500 to 1000 mL

b. Left lateral tilt Positioning of the patient with a left tilt maintains a left uterine displacement to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava due to weight of the gravid uterus.

A woman with an epidural has been pushing for the past 2 hours with very little progression. An appropriate nursing action at this point is to: A. Assess for a full bladder. B. Assess for a full colon. C. Allow the woman to rest for two or three contractions before starting to push again. D. Change positions of the woman and attempt to push again.

A. Assess for a full bladder. -During labor, a full bladder is a common soft tissue obstruction. Bladder distention reduces available space in the pelvis and intensifies maternal discomfort. An epidural decreases the woman's sensation of the need to void, and the extra fluids administered in preparation for the epidural increase her urinary output.

A woman delivered a baby boy 30 minutes ago. The labor and birth were uneventful. The nurse is assessing the woman's vital signs when the woman suddenly complains of chest pain and difficulty breathing. The vital signs show a decreased blood pressure and a slightly increased pulse. The nurse's next action should be to: A. Call for assistance. B. Have the woman sit up and assist her to take deep breaths to help her relax. C. Administer pain medication. D. Increase the routine assessments to every 15 minutes until the vital signs stabilize

A. Call for assistance. -These are symptoms of an anaphylactoid syndrome or an embolism. The nurse should remain with the woman, but needs assistance to notify the health care provider and start oxygen. The woman may be in need of cardiopulmonary resuscitation and support, so it is important not to leave her at this time.

A nurse is reviewing the charts of antepartal clients. A 28-week-gestation woman's fetal fibronectin report has returned, with negative results. The nurse should: A. Document this report. B. Notify the health care provider. C. Document the need to do patient teaching on the signs of preterm labor. during the woman's next visit. D. Alter this woman's plan of care to include teaching about increasing protein intake in her diet

A. Document this report. -Fetal fibronectin is normally found in the vaginal secretions until about 20 weeks' gestation and again at term. If it is found between those dates, it suggests early labor. A negative report indicates that the woman is at low risk for labor at this time.

A woman who is 27 weeks pregnant calls the clinic and complains of constant low backache. The nurse should: A. Have the woman come in to be evaluated. B. Have the woman call back in 1 day if the backache does not improve. C. Have the woman call back if the pain increases. D. Tell the woman to drink plenty of fluids and maintain bed rest.

A. Have the woman come in to be evaluated. -A constant low backache is a common symptom of preterm labor. She needs to be evaluated as soon as possible. Drinking fluids has not been proven to stop preterm labor but decreases uterine irritability.

A woman is receiving magnesium sulfate intravenously to control preterm labor. She is at the maximum dose and the contractions have slowed to eight/ hr. The nurse is assessing the woman's vital signs every hour. In addition to blood pressure, pulse, and respirations, what other assessments should be carried out hourly? A. Lung sounds B. Edema in lower extremities C. Bowel sounds D. Range of motion to the lower extremities

A. Lung sounds -Magnesium sulfate can lead to fluid overload, which can cause pulmonary edema. Assessing lung sounds every hour will alert the nurse to changes. Bowel sounds should be checked every 4 to 8 hours. Magnesium sulfate should not affect the lower extremities.

A fetus in is the posterior position. The woman is complaining of back labor and the labor is prolonged. The nurse can best assist the mother with this problem by: A. Placing her in a hands and knees position. B. Placing her in a prone position C. Massaging her back. D. Encouraging her to use the whirlpool bath.

A. Placing her in a hands and knees position. -The hands and knees position encourages the fetus to rotate into an anterior position. This will decrease the back pain and increase the descent of the fetal head. A prone position is contraindicated with a pregnant woman. Massaging her back and the whirlpool are comfort measures, but will not help correct the problem.

Which of the following women will have the most successful induction of labor? A. Primigravida, Bishop score of 9, fFN is positive B. Gravida 2, Bishop score of 6, fFN is positive C. Gravida 2, Bishop score of 8, fFN is negative D. Primigravida, Bishop score of 5, fFN is negative

A. Primigravida, Bishop score of 9, fFN is positive

Which of the following are used to assist with the cervical ripening process prior to induction of labor? (Select all that apply). A. Prostaglandin B. Oxytocin C. Misoprostol (Cytotec) D. Laminaria tents E. Terbutaline

A. Prostaglandin C. Misoprostol (Cytotec) D. Laminaria tents

After a cesarean birth, the woman needs to be assessed routinely. Select all the assessments necessary for this woman. A. Vital signs B. Return of motion and sensation (if regional block was given) C. Abdominal dressing D. Pupil dilation E. Uterine firmness and position F. Urine output G. Deep tendon reflexes H. IV infusion

A. Vital signs B. Return of motion and sensation (if regional block was given) C. Abdominal dressing E. Uterine firmness and position F. Urine output H. IV infusion

The most appropriate time to give prophylactic antibiotics to the women undergoing cesarean section is: Select one: a. One hour before the surgery b. Two hours before the surgery c. Not indicated unless she has an active infection d. At the time the cord is clamped

Answer: A Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes prior to the skin incision.

A primigravida woman at 42 weeks' gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate? Select one: a. Perform Nitrazine analysis of the amniotic fluid. b. Report the lack of progress to the obstetrician. c. Place the woman on her left side. d. Ask the provider for an order for oxytocin.

Answer: B Prepidil is indicated for cervical ripening, the process of physical softening and opening of the cervix. Cervical status is the most important predictor of successful induction of labor. Cervical status is assessed before induction of labor using the Bishop score. A score of 6 or more is considered favorable for successful induction of labor.

Your patient is a 28-year-old gravida 2 para 1 in active labor. She has been in labor for 12 hours. Upon further assessment, the nurse determines that she is experiencing a hypotonic labor pattern. Possible maternal and fetal implications from hypotonic uterine dysfunction are: a. Intrauterine infection and maternal exhaustion with fetal distress usually occurring in the latent phase of labor. b. Intrauterine infection and maternal exhaustion with fetal distress usually occurring in the active phase of labor. c. Intrauterine infection and postpartum hemorrhage with fetal distress early in labor. d. Intrauterine infection, ruptured uterus and fetal death.

Answer: B With hypotonic uterine dysfunction, normal progress is seen in the latent phase of labor but during the active phase, the UCs become weaker and less effective. The woman is at risk for exhaustion and infection related to the prolonged labor. The fetus is at risk for fetal intolerance of labor and asphyxia.

During an emergency cesarean birth the "time-out" procedure may be omitted based on the obstetrical emergency. Select one: True False

Answer: False

While caring for a woman who is 10 cm dilated and is pushing, the nurse notices that the fetal heart rate has dropped to 85 bpm. The station is +3. The nurse can anticipate: A. A cesarean section. B. A low operative vaginal birth. C. A midpelvis operative vaginal birth. D. No change in the birth plan.

B. A low operative vaginal birth.

A 39-week-gestation gravida 1 is 6 cm dilated. Membranes are intact. The labor contractions have decreased in intensity, and she has not dilated in the past 2 hours. A diagnosis of hypotonic dysfunctional labor has been made. The nurse can anticipate which of the following actions? A. Immediate cesarean section B. Amniotomy C. Narcotic administration D. Having her walk around

B. Amniotomy -Amniotomy may be used to stimulate labor that slows after it is established.

A woman has reached 10 cm and is attempting to push. She had an epidural and is unable to feel the urge to push. The nurse can best assist her by: A. Allowing the epidural to wear off and then have her push. B. Coaching her with each push and giving her positive feedback. C. Changing her position to a side-lying. D. Preparing her for a forceps birth.

B. Coaching her with each push and giving her positive feedback. -Epidural analgesia may cause a loss of sensation, so the woman cannot feel the urge to push. She can be coached to push with each contraction and feedback given on the effectiveness of the pushing.

A woman who has been admitted for preterm labor is started on terbutaline (Brethine) to decrease uterine irritability. Within 24 hours, the contractions have stopped and the woman is resting comfortably. During vital sign assessment the nurse records a blood pressure reading of 125/74 mm Hg, pulse, 95 bpm, and respirations, 12 breaths/min. The blood pressure and respirations are within limits of previous readings, but the pulse has increased from a previous reading of 76 to 80 bpm. The nurse's next action should be to: A. Assess for internal bleeding. B. Continue to monitor the pulse rate at regular intervals. C. Assess the fetal heart rate. D. Reassess the vital signs in 1 hour.

B. Continue to monitor the pulse rate at regular intervals. -The most common side effect of terbutaline is maternal and fetal tachycardia.

Which of the following laboring women is at highest risk for a prolapsed cord? All the women have intact membranes and are cephalic presentations. A. Gravida 3, station +2, cervix 7 cm, and 100% effaced B. Gravida 1, station -2, cervix 3 cm, and 50% effaced C. Gravida 2, station 0, cervix 2 cm, and 60% effaced D. Gravida 6, station 0, cervix 9 cm, and 100% effaced

B. Gravida 1, station -2, cervix 3 cm, and 50% effaced -A fetus that is in a high station is at high risk for a prolapsed cord when the membranes rupture.

A woman came in for a prenatal check up on March 15. She tells the nurse that her last normal menstrual period was June 2. The nurse is aware that she will be scheduled for: A. Immediate birth. B. Testing to determine fetal well-being. C. Follow-up appointments every week until birth. D. Ultrasound to determine fetal age.

B. Testing to determine fetal well-being. -By dates, her EDD was March 9. To determine proper management of her pregnancy, it will be necessary to determine whether the fetus is thriving in the uterus. Ultrasounds at this stage are not accurate for fetal age.

A gravida 1 woman who is 39 weeks of gestation and has had no prenatal care is admitted into the labor unit in early labor. During the assessment, the nurse finds the fetal heart tones in the right upper quadrant. The nurse should anticipate: A. A precipitous labor. B. A prolonged first stage of labor. C. A cesarean birth. D. Rupture of membranes.

C. A cesarean birth. -Fetal heart tones are located in the upper quadrants when the fetus is in a breech presentation. A cesarean birth is usually performed for breech presentations to avoid complications, such as a prolapsed cord.

Which type of uterine rupture may go undiagnosed during labor and the postpartum period? A. Complete rupture B. Incomplete rupture C. Dehiscence D. All the ruptures are detectable by electronic uterine monitoring.

C. Dehiscence -During a dehiscence of an old uterine scar, little or no bleeding may occur. No signs or symptoms may exist, and the rupture may be found incidentally during a subsequent cesarean birth or other abdominal surgery.

A woman had premature rupture of the membranes at 37 weeks of gestation. She went into labor within 10 hours and delivered a 7 lb, 12 oz boy after a 12-hour labor. In planning care for the newborn, it is important to monitor him for: A. Respiratory distress syndrome. B. Transient tachypnea of the newborn. C. Infections. D. Cardiac anomalies.

C. Infections. -Both mother and newborn are at risk for infection during the postpartum period after premature rupture of the membranes.

The postpartum woman who had a long labor induced by oxytocin is at higher risk for which complication? A. Thrombophlebitis B. Hemorrhage C. Lacerations of the vaginal area D. Altered urinary elimination

C. Lacerations of the vaginal area

A nulliparous woman in labor has been diagnosed with a prolonged latent phase of the first stage of labor. Which of the following is true regarding this dysfunctional labor pattern? A. Diagnosis for this woman would have been made once the duration of the latent phase exceeded 14 hours. B. Hypotonic contractions are typically associated with this labor pattern. C. Management often involves therapeutic rest. D. Cephalopelvic disproportion (CPD). with failure of the fetal head to stimulate the cervix. is often the underlying cause of this pattern

C. Management often involves therapeutic rest. -For a nulliparous woman, the latent phase must exceed 20 hours for a diagnosis of a prolonged latent phase to be made. CPD is associated with a protracted or arrested active phase and contractions that become hypotonic. Hypertonic contractions that are painful and ineffective are usually associated with prolonged latent phase. The higher level of anxiety and fear experienced by a laboring nulliparous woman may be a contributing factor in causing this dysfunctional labor pattern. Therapeutic rest involves reducing pain and discomfort to facilitate maternal relaxation. Active labor often begins after the rest period.

A laboring woman just had an amniotomy performed to augment labor. The nurse is aware that the assessment times for which vital signs will be altered? A. Maternal blood pressure B. Maternal pulse C. Maternal temperature D. Maternal respiration

C. Maternal temperature

When admitting a client for induction of labor, the nurse will question the procedure if which of the following is on the client's prenatal record? A. Spontaneous rupture of membranes 24 hours ago, with no labor B. 42-week gestation C. Placenta previa D. Maternal heart disease that is worsening

C. Placenta previa

Misoprostol (Cytotec), 50 mcg, has been ordered for a woman to assist with the ripening of the cervix. The nurse's action should be to: A. Administer the medication vaginally. B. Administer the medication orally. C. Question the dosage amount. D. Monitor for contractions before administering the medication

C. Question the dosage amount.

A woman admitted with preterm labor is started on nifedipine (Procardia) to reduce uterine muscle contractions. The nurse should include in this woman's care plan a nursing diagnosis of: A. Risk for deficient fluid volume. B. Risk for infection. C. Risk for injury. D. Activity intolerance.

C. Risk for injury -Nifedipine is a vasodilator, so the woman may be prone to postural hypotension. She needs to be assisted when sitting or standing and taught about the effects of postural hypotension.

A woman is receiving oxytocin for labor induction. The nurse notices the woman is having contractions every 2 minutes lasting for 100 seconds. The fetal heart rate is 120 to 130 bpm, with moderate variability. The nurse's next action should be to: A. Continue to monitor. B. Notify the physician. C. Turn off the oxytocin. D. Turn the oxytocin up to a stronger level.

C. Turn off the oxytocin

Research has found that bed rest as an intervention for preventing preterm labor can result in: A. Maternal weight gain. B. Diarrhea. C. Increased maternal plasma volume and cardiac output. D. Bone demineralization, with calcium loss.

D. Bone demineralization, with calcium loss. -Calcium loss from bones can begin as early as 3 days after the onset of bed rest. Weight loss, constipation, and a decrease in plasma volume and cardiac output are associated with bed rest.

The perinatal nurse explains to the student nurse that the most frequent fetal risk associated with the use of forceps is cord compression. Select one: True False

False

Contraindications for induction of labor include: Select one or more: a. Abnormal fetal position b. Post-term pregnancy c. Pregnancy-induced hypertension d. Placental abnormalities

a. Abnormal fetal position d. Placental abnormalities Contraindications for induction of labor include abnormal fetal position because of the risk of fetal injury and placental abnormalities because of the risk of hemorrhage. Pregnancy-induced hypertension and post-term pregnancy are two of the common indications for induction of labor.

The perinatal nurse is caring for a woman in the recovery room immediately following cesarean birth. Which of the following assessment findings would indicate the need for immediate notification of the obstetrical provider? Select one or more: a. Catheter is draining blood-tinged urine. b. Woman complains of itching c. Woman complains of nausea d. Lochia is moderate

a. Catheter is draining blood-tinged urine. Blood in the urine occurs when there has been trauma to the bladder. Bladder, ureter, and bowel trauma are surgical complications requiring prompt attention. Itching and nausea are common reactions to anesthesia and are treated with ordered medications. Moderate lochia is an expected finding.

A nurse is preparing a woman in early labor for an urgent cesarean birth related to breech presentation. Select the best nursing action for reducing the couple's anxiety levels. Select one: a. Explain the reason for the need for a cesarean section. b. Inform parents that their baby is in distress. c. Ask the couple to share their concerns. d. Reassure the couple that both the woman and baby are in no danger.

a. Explain the reason for the need for a cesarean section. Urgent cesarean births, rather than emergent, should allow the RN time to discuss with the family their feelings and concerns. The RN should provide emotional support during the preparation for surgery in an attempt to facilitate communication and decrease fear, anxiety, and distress. Medical management includes the determination of the need for cesarean birth and the explanation of the procedure in order to obtain consent.

Documentation related to vacuum delivery includes which of the following: Select one or more: a. Fetal heart rate b. Timing and number of applications c. Position and station of fetal head d. Maternal position

a. Fetal heart rate b. Timing and number of applications c. Position and station of fetal head Assessment of fetal heart rate is part of second-stage management, timing and number of applications are part of standard of care related to safe vacuum deliveries, and position and station of fetal head are noted for safe vacuum extraction. Maternal position is not critical to the documentation related to vacuum deliveries.

Which of the following are indications for cesarean birth? (Select all that apply.) Select one or more: a. Previous cesarean birth b. Placental abnormalities c. Previous uterine surgery d. Failure to progress

a. Previous cesarean birth Correct b. Placental abnormalities Correct c. Previous uterine surgery Correct d. Failure to progress Correct

During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action? Select one: a. Increase oxytocin infusion rate per provider's protocol. b. Stop oxytocin infusion immediately. c. Maintain present oxytocin infusion rate and continue to assess. d. Decrease oxytocin infusion rate by 2 mU/min and report to provider.

c. Maintain present oxytocin infusion rate and continue to assess. The goal of oxytocin use in labor is to establish uterine contraction patterns that promote cervical dilation of about 1 cm/hr once in active labor. The lowest possible dose should be used to achieve labor progress. Generally, the labor pattern should be 3 UCs in 10 minutes, lasting 40-60 seconds with an intensity of 25-75 mm/HG with IUPC and resting tone <20 mm HG with 1 minute between each UC. The labor pattern described above is appropriate and no increase or decrease in oxytocin infusion rate is indicated.

The perinatal nurse is providing care to Carol, a 28-year-old multiparous woman in labor. Upon arrival to the birthing suite, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as "strong." Carol states she labored for 1 hour at home. As the nurse assists Carol from the assessment area to her labor and birth room, Carol states that she is feeling some rectal pressure. Carol is most likely experiencing: Select one: a. Hypertonic contractions b. Hypotonic contractions c. Precipitous labor d. Uterine hyperstimulation

c. Precipitous labor Precipitous labor that lasts fewer than 3 hours from onset to birth. Precipitous labor is more likely to be seen in woman who have previously given birth or have a previous history of rapid labors. As the fetal head descends, the woman may feel rectal pressure indicating delivery is imminent.

The perinatal nurse listens as Chantal describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist Chantal in: Select one: a. Her role development in the "letting go" stage b. Decreasing her ambivalence about her labor and birth c. Understanding her guilt involved in her labor and birth d. Developing more positive feelings about her labor and birth

d. Developing more positive feelings about her labor and birth Correct After a cesarean birth, especially when unplanned, nurses must be aware of the myriad of potential psychological issues that may arise. Research suggests that women may perceive cesarean birth to be a less positive experience than a vaginal birth. Unplanned or emergent cesarean deliveries and the experience of cesarean birth may be associated with more negative perceptions of the birthing experience. Allowing Chantal to talk about the experience can help her develop a more positive attitude about her own experience.

If the umbilical cord prolapses during labor, the nurse should immediately: Select one: a. Type and cross-match blood for an emergency transfusion. b. Await provider order for preparation for an emergency cesarean section. c. Attempt to reposition the cord above the presenting part. d. Performing vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord.

d. Performing vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord. Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus. The cord becomes trapped against the presenting part and circulation is occluded; FHR will usually show bradycardia or prolonged decel. An emergency cesarean birth is typically performed. Occlusion of the cord may be partially relieved by lifting the presenting part off the cord with a vaginal exam. The examiner's hand remains in the vagina, lifting the presenting part off the cord until delivery by cesarean. There is no attempt to push the cord above the presenting part. Type and screen of blood is generally done on admission for all laboring women; type and cross-match can readily be accomplished using the blood sample already in the lab.

A nurse is admitting a woman for a scheduled cesarean section. Which of the following assessment data should be immediately reported to the physician? Select one: a. White cell count of 11,000 b. Hemoglobin of 11 g/dL c. Hematocrit of 33% d. Platelet count of 75,000

d. Platelet count of 75,000 Correct Contraindications for epidural or spinal anesthesia include low platelet count, <100,000 due to increased possibility of hemorrhage.

A nurse is caring for a woman 10 hours post-cesarean birth. She received a dose of intrathecal morphine at the time of the birth. Which of the following assessment data would require immediate intervention? Select one: a. Itching of the palms and feet b. Nausea c. Urinary output of 300 mL in the past 4 hours d. Respiratory rate of 8 breaths/minute

d. Respiratory rate of 8 breaths/minute Severe respiratory depression is the most serious complication of intrathecal morphine administration.