Intrapartum OB

A nurse in the labor and delivery suite is planning care for a group of 4 clients. Which of the following clients should the nurse see first? A. A client who is in active labor and has late decelerations on the fetal heart monitor strip B. A client who is in transition and screaming and disturbing other clients C. A client who has epidural analgesia and is reporting breakthrough pain D. A client who has received oxytocin infusion and is experiencing contractions every 2 min lasting 60 sec

A. A client who is in active labor and has late decelerations on the fetal heart monitor strip

A nurse is caring for a client in labor and observes a pattern of early decelerations on the fetal monitor. Which of the following actions should the nurse take? A. Notify the provider B. Document the findings and continue to monitor C. Administer oxygen via face mask D. Assist with a sterile speculum examination

B. Document the findings and continue to monitor

A nurse is caring for a client who is at 38 weeks gestation and in the active phase of the first stage of labor. The nurse notes 2 late decelerations of the fetal heart rate during the last 5 contractions. Which of the following actions should the nurse take? A. Slow the IV infusion rate B. Assist the client to a lateral position C. Assess the bladder for urinary retention D. Initiate an oxytocin infusion

B. Assist the client to a lateral position A late deceleration is a variation in the fetal heart rate that results from uteroplacental insufficiency. Side-lying position helps improve uteroplacental blood flow.

What does an external fetal monitor measure?

Amount of oxygen baby is receiving

What drug enhances fetal lung maturation?

Betamethasone

A nurse is caring for a client at 39 weeks gestation who is in the active phase of labor. The nurse observes late decelerations in the fetal heart rate (FHR). Which of the following findings should the nurse identify as the cause of late decelerations? A. Uteroplacental insufficiency B. Fetal head compression C. Fetal ventricular septal defect D. Umbilical cord compression

A. Uteroplacental insufficiency A late deceleration in the FHR is a non-reassuring FHR pattern resulting from fetal hypoxemia due to insufficient placental perfusion. The nurse should reposition the client, initiate oxygen, and increase the rate of IV fluid to enhance placental perfusion.

When assessing a client who is in the fourth stage of labor, the nurse suspects bladder distention. Which of the following findings should the nurse anticipate with bladder distention? A. The fundus is at midline B. The fundus is below the umbilicus C. The bladder is resonant with percussion D. The bladder fluctuates with palpation

D. The bladder fluctuates with palpation

A nurse if caring for a client in labor whose cervix is dilated to 9 cm. She is experiencing strong contractions every 2 min lasting 75 sec. The nurse should recognize that the client is in which of the following phases or stages of labor? A. latent phase of first stage B. Active phase of first stage C. second stage D. transition phase of first stage

D. transition phase of first stage

True/False: hypotension is a complication of an epidural block

True: Maternal hypotension is an adverse effect of epidural anesthesia. The nurse should administer an IV fluid bolus prior to the placement of epidural anesthesia in order to decrease the likelihood of this complication.

What is a side effect of meperidine hydrochloride when a client is in labor?

sleepiness

A nurse is caring for a client who is in labor and is receiving an infusion of oxytocin. The nurse should monitor the client for which of the following potential adverse effects? A. Diarrhea B. Thromboembolism C. Fetal asphyxia D. Oliguria

C. Fetal asphyxia Oxytocin can cause tachsystole, which can lead to uteroplacental insufficiency. Inadequate oxygen transfer to the placenta will result in fetal asphyxia.

How should a client be positioned after receiving prostaglandin E2 for cervical ripening?

Side-lying for 30 min after insertion

A nurse is planning care for a client who is positive for HIV. Which of the following actions should the nurse take after the baby is born? A. Encourage the mother to breastfeed B. Administer the hepatitis B vaccine prior to discharge C. Implement contact and droplet precautions when providing care for the infant D. Collect a cord blood specimen to test for the presence of HIV

B. Administer the hepatitis B vaccine prior to discharge Infants who are exposed to HIV should receive all routine vaccinations. Infants who are infected with HIV can receive all inactivated vaccinations.

A nurse is caring for a client who is scheduled to receive a spinal anesthetic. Which of the following actions should the nurse plan to perform? A. Infuse a 500 mL bolus of 0.9% sodium chloride immediately prior to the procedure B. Assess the fetal heart rate pattern for 10 min prior to the procedure C. Position the client upright and erect on the edge of the bed prior to the procedure D. Monitor vital signs every 15 min after the anesthetic is placed

A. Infuse a 500 mL bolus of 0.9% sodium chloride immediately prior to the procedure The nurse should infuse a fluid bolus of 500-1,000 mL of 0.9% sodium chloride or lactated Ringer's 15-30 minutes before the procedure to offset the potential complication of hypotension

A nurse is planning care for a client who is pregnant and is Rh-negative. In which of the following situations should the nurse administer Rh(D) immune globulin? A. While the client is in labor B. Following an episode of influenza during pregnancy C. Prior to a blood transfusion D. At 28 weeks gestation

D. At 28 weeks gestation The nurse should administer Rh(D) immune globulin to a client who is pregnant and has Rh-negative blood at 28 weeks gestation. Rh(D) immune globulin consists of passive antibodies against the Rh factor, which will destroy any fetal RBCs in the maternal circulation and block maternal antibody production.

A nurse is caring for a client who is in active labor and receiving an oxytocin infusion. The nurse notes tachysystole with a Category 1 fetal heart tracing. Which of the following actions should the nurse take? A. Discontinue oxytocin infusion and apply oxygen B. Increase oxytocin infusion rate by 2 mu/min C. Administer terbutaline 0.25 mg subcutaneously D. Reposition the client in a side-lying position and continue to monitor.

D. Reposition the client in a side-lying position and continue to monitor. A Category 1 fetal heart rate tracing is an expected finding and does not represent fetal distress. The nurse should reposition the client in a side-lying position to optimize uteroplacental perfusion and continue to monitor the tracing for another 10 minutes to determine if tachsystole resolves.

A nurse administers betamethasone to a client who is at 33 weeks gestation to stimulate fetal lung maturity. When planning care for the newborn, which of the following conditions should the nurse identify as an adverse effect of this medication? A. Hyperthermia B. Decreased blood glucose C. Rapid pulse rate D. Irritability

B. Decreased blood glucose Betamethasone causes hyperglycemia in the client, which predisposes the newborn to hypoglycemia in the first hours after delivery. The nurse must assess the newborn's blood glucose level within the first hour following birth and frequently thereafter until blood glucose levels are stable.

A nurse is caring for a client who has oligohydramnios. Which of the following fetal anomalies should the nurse expect? A. Atrial septal defect B. Renal agenesis C. Spina bifida D. Hydrocephalus

B. Renal agenesis Oligohydramnios is a volume of amniotic fluid that is <300 mL during the third trimester of pregnancy. This occurs when there is a renal system dysfunction or obstructive uropathy. The absence of fetal kidneys will cause oligohydramnios.

A nurse is caring for a client who had a precipitous delivery. Which of the following assessments is the priority during the fourth stage of labor? A. Obtaining the client's temperature B. Inspecting the client's perineum C. Palpating the client's fundus D. Checking the client for hemorrhoids

C. Palpating the client's fundus A precipitous delivery follows a labor <3 hours. Regardless of the cause of the rapid delivery, uterine atony can result, causing postpartum hemorrhage. The nurse should palpate the fundus and massage as needed to monitor for an reduce the risk of hemorrhage.

A nurse is caring for a client in active labor who has meconium staining of the amniotic fluid. The nurse notes a reassuring fetal heart rate (FHR) tracing from the external fetal monitor. Which of the following actions should the nurse perform? A. Prepare the client for an ultrasound examination B. Prepare the client for an emergency cesarean birth C. Prepare equipment needed for newborn resuscitation D. Perform endotracheal suctioning as soon as the fetal head is delivered

C. Prepare equipment needed for newborn resuscitation The nurse should ensure that all supplies and equipment needed for resuscitation of the newborn are readily available for every delivery. Endotracheal suctioning is recommended in cases of meconium staining only if the newborn has poor respiratory effort, decreased muscle tone, and bradycardia after delivery.

A nurse is caring for a client who is in labor. A vaginal examination reveals the following findings: 2 cm, 50%, +1, right occiput anterior (ROA). Based on this information, which of the following fetal positions should the nurse document in the medical record? A. Transverse B. Breech C. Vertex D. Mentum

C. Vertex

A nurse is admitting a client who is in labor and experiencing moderate bright red vaginal bleeding. Which of the following actions should the nurse take? A. Perform a vaginal examination to determine cervical dilation B. Obtain blood samples for baseline laboratory values C. Place a spiral electrode on the fetal presenting part D. Prepare the client for a transvaginal ultrasound

B. Obtain blood samples for baseline laboratory values The nurse should obtain samples of the client's blood for baseline testing of hemoglobin and hematocrit levels

A nurse is performing a nonstress NST) on a client who is at 41 weeks of gestation. The client asks what the purpose of the test is. Which of the following responses should the nurse provide? A. This test will determine if you are likely to deliver within the next week B. This test will help determine if your baby is healthy C. This test can see how your baby responds when you have contractions D. This test will determine if your baby's lungs are mature

B. This test will determine if your baby is healthy.

A nurse is assessing a client who is receiving magnesium sulfate as a treatment for pre-eclampsia. Which of the following clinical findings is the nurse's priority? A. Respirations 16/min B. Urinary output 40 mL in 2 hours C. Reflexes +2 D. Fetal heart rate 158/min

B. Urinary output 40 mL in 2 hours Urinary output is critical to the excretion of magnesium from the body. The nurse should discontinue the magnesium sulfate if the hourly output is <30 mL/hr.

Which medication should a nurse have available at the client's bedside when receiving an IV infusion of magnesium sulfate?

Calcium gluconate The nurse should monitor the client for a respiratory rate of less than or equal to 12/min, muscle weakness, and depressed deep-tendon reflexes which could indicate magnesium-sulfate toxicity.