Maternity final practice questions

A nurse is caring for a client who is in labor and received meperidine for pain 1 hr prior to entering the second stage of labor. Which of the following actions should the nurse take? A. Assess the client's reflexes B. Assess the newborn for respiratory depression C. Assess the client for bradycardia D Assess the newborn for signs of opiate withdrawal

B. Assess the newborn for respiratory depression

A nurse is planning care for a client in active labor whose fetus is in an occipital brow presentation. Which of the following complications should the nurse anticipate as a result of this fetal presentation? A. Precipitous labor B. Prolonged labor C. Hypertonic uterine dysfunction D. Umbilical cord prolapse

B. Prolonged labor

A nurse is teaching a client during the client's first prenatal visit. Which of the following instructions should the nurse include? A. "A fetal stethoscope can first detect your baby's heart rate at 22 weeks." B. "After week 16, we can see if your baby is a boy or a girl." C "A Doppler device can detect vour baby's heart rate at 12 weeks." D "You will first feel the baby move at about 8 weeks."

C "A Doppler device can detect vour baby's heart rate at 12 weeks." The nurse should be able to detect the fetal heartbeat with a Doppler device toward the end of the first trimester, often as early as 10 weeks of gestation.

The perinatal nurse knows that the total blood volume in pregnancy increases on average by __________ %? A 5% to 10%. B 55% to 65% C 30% to 50%. D 15% to 25%

C 30% to 50%.

Why is it essential for women of childbearing age to receive preconception counseling? A Many Insurance companies have to pre-approve prenatal care B To receive instructions on how to limit their number of pregnancies C Much of fetal organ development occurs before the first or second missed menses. D A woman's cardiovascular system is stressed when pregnancies are less than two years apart

C Much of fetal organ development occurs before the first or second missed menses.

A nurse is providing teaching to a client who has come to the family-planning clinic requesting an intrauterine device (IUD). Which of the following pieces of information should the nurse provide the client? A. "If you lose weight, you will need to have your IUD refitted." B. "An IUD provides protection from certain sexually transmitted infections. C. "Your risk for ectopic pregnancy increases with an IUD." D. "You shouldn't use an IUD if you want to have children later.

C. "Your risk for ectopic pregnancy increases with an IUD." An IUD is a contraceptive device the provider inserts through the cervix into the uterus. The IUD works by changing the lining of the uterus and fallopian tubes, making fertilization in the uterus more difficult. Consequently, an IUD increases the risk of ectopic pregnancy.

A nurse is assisting with an amniocentesis for a client who is Rh-negative. Which of the following actions should the nurse take following the procedure? A. Send a sample of amniotic fluid to the laboratory to screen the client for chlamydia B. Send a sample of amniotic fluid to the laboratory to test for an elevated Rh-negative titer C. Administer immune globulin to the client to prevent fetal isoimmunization D. Administer intravenous antibiotics to prevent an infection

C. Administer immune globulin to the client to prevent fetal isoimmunization

A nurse is assessing a newborn. Which of the following findings should the nurse identify as an indication of recent maternal heroin use? A. Large for gestational age B. Hypotonicity C. Incessant crying D. Craniofacial anomalies

C. Incessant crying Manifestations of neonatal abstinence syndrome due to maternal heroin use include incessant crying, jitteriness, hyperactivity, poor feeding, tachycardia, and frequent yawning and sneezing.

A nurse at a prenatal clinic is assessing an adult client who had genital cutting performed as a child as part of her cultural practices. The nurse notes the client's clitoris and labia minor were removed, and she has scarring in the vaginal area. Which of the following actions should the nurse take? A. Report the findings to the local authorities B. Ask the client who performed the cutting C. Inform the client that giving birth vaginally might not be possible D. Prepare the client for the increased risk of spontaneous abortion

C. Inform the client that giving birth vaginally might not be possible

A nurse is planning care for a client who is scheduled to have prostaglandin E2 gel inserted for cervical ripening. Which of the following actions should the nurse take? A. Assess fetal heart rate and contraction pattern every 15 min after insertion B. Thaw the frozen gel in a warm water bath prior to insertion C. Maintain the client in a side-lying position for 30 min after insertion D. Initiate an oxytocin infusion for induction 1 hr after gel insertion

C. Maintain the client in a side-lying position for 30 min after insertion The client should maintain a side-lying or supine position with a lateral tilt for 30 to 40 minutes after the insertion of the medication to allow the gel to stay in contact with the cervix.

A nurse is discussing contraceptive methods with a new patient. The patient is interested in oral contraceptives. Which factor in the health history would make this method not a good choice for this patient? (Select all that apply) A The patient runs five miles four times a week B The patient is a vegetarian C The patient has a history of deep venous thrombosis D The patient has history of anemia E The patient is 37 years old and smokes

CE

Upon vaginal exam, it is found that the patient has entered the second stage of labor with a well-functioning epidural, and feels no urge to push. The fetus is at 0 station and the FHR is 130bpm, with no decelerations noted. Which of the following nursing actions is appropriate at this time? A Administer oxygen via a face mask at 10 liters a minute B Place the women on her side and assess her oxygen saturation C Coach the women on pushing during contractions D Allow the mother to labor down, in a lateral position

D Allow the mother to labor down, in a lateral position

A nurse is caring for a newborn who is experiencing opioid withdrawal. Which of the following manifestations should the nurse expect and report to the provider? A. Weak cry B. Absent Moro reflex C. Constipation D. Tremors

D. Tremors Newborns who have neonatal abstinence syndrome can have tremors, tachypnea, nasal flaring, apnea, retractions, incessant crying, frequent yawning and sneezing, mottling of the skin, excessive sucking, vomiting, and fevers.

A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of a miscarriage within the first trimester. The nurse is correct to document the history as which? a. G=4, T=2, P=0, A=0, L=1 b. G=1, T=1, P=1, A=0, L=1 c. G=3, T=1, P=0, A=1, L=1 d. G=2, T=0, P=0, A=0, L=

c. G=3, T=1, P=0, A=1, L=1

The nurse is admitting four full-term primigravida clients to the labor and delivery unit.The nurse requests pre-cesarean section orders from the health care practitioner for which of the clients? The client who has: Select all that apply. 1. Cervical cerclage. 2. FH 156 with beat-to-beat variability. 3. Maternal blood pressure of 90/60. 4. Full effacement. 5. Active herpes simplex 2

1 and 5 are correct. 1. Cervical cerclage, a stitch encircling the cervix, is incompatible with vaginal delivery. 5. Active herpes simplex 2 is an absolute indicator for a cesarean delivery.

The nurse administers RhoGAM to a postpartum client. Which of the following isthe goal of the medication? 1. Inhibit the mother's active immune response. 2. Aggressively destroy the Rh antibodies produced by the mother. 3. Prevent fetal cells from migrating throughout the mother's circulation. 4. Change the maternal blood type to Rh positive.

1. The goal of the injection of RhoGAM is to inhibit the mother's immune response.

The nurse is caring for a 32-week G8 P7007 with placenta previa. Which of the following interventions would the nurse expect to perform? Select all that apply. 1. Daily contraction stress tests. 2. Blood type and cross match. 3. Bed rest with passive range-of-motion exercises. 4. Daily serum electrolyte assessments.5. Weekly biophysical profiles.

2, 3, and 5 are correct.2. There should be blood available in the blood bank in case the woman begins to bleed.3. The nurse would expect to keep the woman on bed rest with bathroom privileges only.5. The nurse would expect that weekly biophysical profiles would be done to assess fetal well-being.

1. An obstetrician declares at the conclusion of the third stage of labor that a womanis diagnosed with placenta accreta. The nurse would expect to see which of thefollowing signs/symptoms? 1. Hypertension. 2. Hemorrhage. 3. Bradycardia. 4. Hyperthermia.

2. Hemorrhage.

A physician has notified the labor and delivery suite that four clients will be admittedto the unit. The client with which of the following clinical findings would be acandidate for an external version? 1. +3 station. 2. Left sacral posterior position. 3. Flexed attitude. 4. Rupture of membranes for 24 hours.

2. LSP position is a breech presentation. It may be appropriate for a physician to perform an external version prior to this delivery.

The nurse is monitoring a woman, G2 P1001, 41 weeks' gestation, in labor. A 12 p.m.assessment revealed: cervix, 4 cm; 80% effaced; -3 station; and FH 124 with moderate variability. A 5 p.m. assessment: cervix, 6 cm; 90% effaced; -3 station; and FH 120 with moderate variability. A 10 p.m. assessment: cervix, 8 cm; 100% effaced; -3 station; and FH 124 with moderate variability. Based on the assessments, which of the following should the nurse conclude? 1. Labor is progressing well. 2. The woman is likely carrying a macrosomic fetus. 3. The baby is in fetal distress. 4. The woman will be in second stage in about five hours.

2. The woman is likely carrying a macrosomic fetus.

The nurse is assessing the Bishop score on a postdates client. Which of the followingmeasurements will the nurse assess? Select all that apply. 1. Gestational age. 2. Rupture of membranes. 3. Cervical dilation. 4. Fetal station. 5. Cervical position.

3, 4, and 5 are correct. 3. Cervical dilation is part of the Bishop score. 4. Fetal station is part of the Bishop score. 5. Cervical position is part of the Bishop score. The Bishop score is calculated to determine the inducibility of the cervix. Although gestational age and ROM may be indications for calculating the score, neither has a direct implact on the inducibility of the cervix.

The nurse has assessed four primigravid clients in the prenatal clinic. Which of thewomen would the nurse refer to the nurse midwife for further assessment? 1. 10 weeks' gestation, complains of fatigue with nausea and vomiting. 2. 26 weeks' gestation, complains of ankle edema and chloasma. 3. 32 weeks' gestation, complains of epigastric pain and facial edema. 4. 37 weeks' gestation, complains of bleeding gums and urinary frequency.

3. Epigastric pain and facial edema are not normal. This client should be referredto the nurse midwife.

A nurse is caring for a client who is at 33 weeks of gestation and reports dark red vaginal bleeding and contractions that do not stop. Which of the following actions should the nurse take first? A. Check the fetal heart tones B. Assess the uterine contraction pattern C. Measure maternal vital signs D. Obtain a biophysical profile

A. Check the fetal heart tones

A multipara is admitted to the labor unit after her initial exam reveals the her cervix to be at 6 cms, 90% effaced and at -1 station. Based on these findings, the nurse should recognize that the client is in which phase of labor? A Expulsive phase B Latent phase C Active phase D Transitional Phase

C Active phase

A woman has just had a low forceps delivery. For which of the following should the nurse assess the woman during the immediate postpartum period?1. Infection. 2. Bloody urine. 3. Heavy lochia. 4. Rectal abrasions.

***3. The client should be monitored carefully for heavy lochia

A client is 3-days post-cesarean delivery for eclampsia. The client is receiving hydralazine (Apresoline) 10 mg 4 times a day by mouth. Which of the following findings would indicate that the medication is effective? 1. The client has had no seizures since delivery .2. The client's blood pressure has dropped from 160/120 to 130/90 .3. The client's postoperative weight has dropped from 154 to 144 lb. 4. The client states that her headache is gone.

.2. The client's blood pressure has dropped from 160/120 to 130/90

The nurse is caring for four women who are in labor. The nurse is aware that heor she will likely prepare which of the women for cesarean delivery? Select all thatapply. 1. Fetus is in the left sacral posterior position. 2. Placenta is attached to the posterior portion of the uterine wall. 3. Fetus has been diagnosed with meningomyelocele. 4. Client is hepatitis B surface antigen positive. 5. The lecithin/sphingomyelin ratio in the amniotic fluid is 1.5:1.

1 and 3 are correct. 1. The baby in the LSP position is in a breech presentation. Most breech babies are delivered by cesarean section. 3. The meningomyelocele sac could easily rupture during a vaginal delivery. Whena fetus has been diagnosed with the defect, a cesarean is usually performed.

A client enters the labor and delivery suite. It is essential that the nurse note thewoman's status in relation to which of the following infectious diseases? Select allthat apply. 1. Hepatitis B. 2. Rubeola. 3. Varicella. 4. Group B streptococcus.5 . HIV/AIDS.

1, 4, and 5 are correct. 1. The client's hepatitis B status should be assessed. 4. The client's group B streptococcus status should be assessed. 5. The client's HIV/AIDS status should be assessed.

A labor nurse is caring for a client, 38 weeks' gestation, who has been diagnosed with symptomatic placenta previa. Which of the following physician orders should the nurse question? 1. Begin oxytocin drip rate at 0.5 milliunits/min. 2. Assess fetal heart rate every 10 minutes. 3. Weigh all vaginal pads. 4. Assess hematocrit and hemoglobin.

1. Begin oxytocin drip rate at 0.5 milliunits/min.

The nurse is circulating on a cesarean delivery of a G5P4004. All of the client's previous children were delivered via cesarean section. The physician declares after delivering the placenta that it appears that the client has a placenta accreta. Which of the following maternal complications would be consistent with this diagnosis? 1. Blood loss of 2000 mL. 2. Blood pressure of 160/110. 3. Jaundice skin color .4. Shortened prothrombin time.

1. Blood loss of 2000 mL.

A client has just entered the labor and delivery suite with ruptured membranes for 2 hours, fetal heart rate of 146, contractions every 5 minutes × 60 seconds, and a history of herpes simplex type 2. She has no observable lesions. After notifying the doctor of the admission, which of the following is the appropriate action for the nurse to take? 1. Check dilation and effacement. 2. Prepare the client for surgery. 3. Place the bed in Trendelenburg position. 4. Check the biophysical profile results.

1. Check dilation and effacement.

A client has just entered the labor and delivery suite with ruptured membranes for2 hours, fetal heart rate of 146, contractions every 5 minutes × 60 seconds, and a history of herpes simplex type 2. She has no observable lesions. After notifying the doctor of the admission, which of the following is the appropriate action for the nurse to take? 1. Check dilation and effacement. 2. Prepare the client for surgery. 3. Place the bed in Trendelenburg position. 4. Check the biophysical profile results.

1. Check dilation and effacement.

Immediately after a woman spontaneously ruptures her membranes, the nurse notes a loop of the umbilical cord protruding from the woman's vagina. Which of the following actions should the nurse perform first? 1. Put the client in the knee-chest position. 2. Assess the fetal heart rate. 3. Administer oxygen by tight face mask. 4. Telephone the obstetrician with the findings.

1. Put the client in the knee-chest position.

A client, 42 weeks' gestation, is admitted to the labor and delivery suite with adiagnosis of acute oligohydramnios. The nurse must carefully observe this clientfor signs of which of the following? 1. Fetal distress. 2. Dehydration. 3. Oliguria. 4. Jaundice.

1. The nurse should carefully monitor the client for fetal distress. When the placenta begins to deteriorate, the hydration of the baby drops. Because the predominant component of amniotic fluid is fetal urine, when the baby is dehydrated, the quantity of amniotic fluid drops.

A woman, 32 weeks' gestation, contracting every 3 min × 60 sec, is receivingmagnesium sulfate. For which of the following maternal assessments is it criticalfor the nurse to monitor the client? 1. Low urinary output. 2. Temperature elevation. 3. Absent pedal pulses. 4. Retinal edema.

1. The urinary output should be carefully monitored.Magnesium sulfate is excreted through the kidneys. If the urinary output drops, the concentration of magnesium sulfate can rise in the bloodstream. It is very important for the nurse to monitor the urine output.

A woman has just had a macrosomic baby after a 12-hour labor. For which of the following complications should the woman be carefully monitored? 1. Uterine atony. 2. Hypoprolactinemia. 3. Infection. 4. Mastitis.

1. This client is high risk for uterine atony.The uterus of a woman who delivers a macrosomic baby has been stretched beyond the usual pregnancy size. The muscle fibers of the myometrium, therefore, are stretched. After delivery the muscles are often unable to contract effectively to stop the bleeding at the placental separation site.

Which of the following clients is at highest risk for developing a hypertensive illnessof pregnancy? 1. G1 P0000, age 44 with history of diabetes mellitus. 2. G2 P0101, age 27 with history of rheumatic fever. 3. G3 P1102, age 25 with history of scoliosis. 4. G3 P1011, age 20 with history of celiac disease.

1. This primigravid client—age 44 and with a history of diabetes—is very high risk for preeclampsia.

A client, 38 weeks' gestation, is being induced with IV oxytocin (Pitocin) for hypertension and oligohydramnios. She is contracting q 3 min × 60 to 90 seconds. She suddenly complains of abdominal pain accompanied by significant fetal heart bradycardia. Which of the following interventions should the nurse perform first? 1. Turn off the oxytocin infusion. 2. Administer oxygen via face mask. 3. Reposition the patient. 4. Call the obstetrician.

1. Turn off the oxytocin infusion.

The nurse is evaluating the EFFECTIVENESS of bed rest for a client with mild preeclampsia. Which of the following signs/symptoms would the nurse determine is a positive finding? 1. Weight loss. 2. 2+ proteinuria. 3. Decrease in plasma protein .4. 3+ patellar reflexes.

1. Weight loss is a positive sign.

A client just spontaneously ruptured membranes. Which of the following factorsmakes her especially at high risk for having a prolapsed cord? Select all that apply. 1. Breech presentation. 2. Station -3. 3. Oligohydramnios. 4. Dilation 2 cm. 5. Transverse lie.

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Which of the following physical findings would lead the nurse to suspect that a client with severe preeclampsia has developed HELLP syndrome? Select all that apply. 1. +3 pitting edema. 2. Petechiae. 3. Jaundice. 4. +4 deep tendon reflexes. 5. Elevated specific gravity.

2 and 3 are correct. 2. Petechiae may develop when a client is thrombocytopenic, one of the signs of HELLP syndrome. 3. Hyperbilirubinemia develops when red blood cells hemolyze, one of the changes that may develop as a result of liver necrosis. Jaundice is a manifestation of hyperbilirubinemia.

An obese gravid woman is being seen in the prenatal clinic. The nurse will monitor this client carefully throughout her pregnancy because she is high risk for which of the following complications of pregnancy? Select all that apply. 1 Placenta previa. 2. Gestational diabetes. 3. Abruptio placentae. 4. Preeclampsia. 5. Chromosomal defects.

2 and 4 are correct. 2. Obese clients are at high risk for gestational diabetes .4. Obese clients are at high risk for preeclampsia.

1. During a vaginal delivery, the obstetrician declares that a shoulder dystocia has occurred. Which of the following actions by the nurse is appropriate at this time? 1. Administer oxytocin intravenously per doctor's orders. 2. Flex the woman's thighs sharply toward her abdomen. 3. Apply oxygen using a tight-fitting face mask. 4. Apply downward pressure on the woman's fundus.

2. Flex the woman's thighs sharply toward her abdomen.

During a vaginal delivery, the obstetrician declares that a shoulder dystocia hasoccurred. Which of the following actions by the nurse is appropriate at this time? 1. Administer oxytocin intravenously per doctor's orders. 2. Flex the woman's thighs sharply toward her abdomen. 3. Apply oxygen using a tight-fitting face mask. 4. Apply downward pressure on the woman's fundus.

2. Flex the woman's thighs sharply toward her abdomen.

A nurse is caring for the following four laboring patients. Which client should thenurse be prepared to monitor closely for signs of postpartum hemorrhage (PPH)? 1. G1P0000, delivery at 29 weeks' gestation. 2. G2P1001, prolonged first stage of labor. 3. G2P0010, delivery by cesarean section. 4. G3P0200, delivery of 2200-gram neonate.

2. G2P1001, prolonged first stage of labor.

In which of the following clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion? 1. Placental abruption. 2. Meconium-stained fluid. 3. Polyhydramnios. 4. Late decelerations.

2. It would be appropriate for a health care practitioner to order an amnioinfusion when a client's amniotic fluid is meconium stained. The infusion will dilute the concentration of the meconium to decrease the potential of the baby aspirating large quantities of meconium at birth.

A nurse is caring for a client, PP2, who is preparing to go home with her infant.The nurse notes that the client's blood type is O (negative), the baby's type is A(positive), and the direct Coombs' test is negative. Which of the following actions by the nurse is appropriate? 1. Advise the client to keep her physician appointment at the end of the week in order to receive her RhoGAM injection. 2. Make sure that the client receives a RhoGAM injection before she is discharged from the hospital. 3. Notify the client that because her baby's Coombs' test was negative she will not receive an injection of RhoGAM. 4. Inform the client's physician that because the woman is being discharged on the second day, the RhoGAM could not be given.

2. Make sure that the client receives a RhoGAM injection before she is discharged from the hospital.

A client is admitted in labor with spontaneous rupture of membranes 24 hours earlier. The fluid is clear and the fetal heart rate is 124 with moderate variability. Which assessment is most important for the nurse to make at this time? 1. Contraction frequency and duration. 2. Maternal temperature. 3. Cervical dilation and effacement. 4. Maternal pulse rate.

2. Maternal temperature.

The fetal monitor tracing of a laboring woman who is 9 cm dilated shows recurringlate decelerations to 100 bpm. The nurse notes a moderate amount of greenish-colored amniotic fluid gush from the vagina after a practitioner performs an amniotomy. Which of the following nursing diagnoses is appropriate at this time? 1. Risk for infection related to rupture of membranes. 2. Risk for fetal injury related to possible intrauterine hypoxia. 3. Risk for impaired tissue integrity related to vaginal irritation. 4. Risk for maternal injury related to possible uterine rupture.

2. Risk for fetal injury related to possible intrauterine hypoxia.

A 29-week-gestation woman diagnosed with severe preeclampsia is noted to haveblood pressure of 170/112, 4+ proteinuria, and a weight gain of 10 pounds over thepast 2 days. Which of the following signs/symptoms would the nurse also expectto see? 1. Fundal height of 32 cm. 2. Papilledema. 3. Patellar reflexes of +2. 4. Nystagmus.

2. The nurse would expect to see papilledema.Increased ICP is present in a client with severe pre-eclampsia because she is third spacing large quantities of fluid. As a result of the elevated ICP, the optic disk sweels and papilledema is seen when the disk is viewed through an ophthalmoscope.

A client's 32-week clinic assessment was: BP 90/60; TPR 98.6°F, P 92, R 20; weight145 lb; and urine negative for protein. Which of the following findings at the34-week appointment should the nurse highlight for the certified nurse midwife? 1. BP 110/70; TPR 99.2°F, 88, 20. 2. Weight 155 lb; urine protein +2. 3. Urine protein trace; BP 88/56. 4. Weight 147 lb; TPR 99.0°F, 76, 18.

2. There has been a 10-lb weight gain in 2 weeks and a significant amount of protein is being spilled in the urine. This client should be brought to the attention of the primary caregiver.

A client is being taught fetal kick counting. Which of the following should be included in the patient teaching? 1. The woman should choose a time when her baby is least active. 2. The woman should lie on her side with her head elevated about 30°. 3. The woman should report fetal kick counts of greater than 10 in an hour. 4. The woman should refrain from eating immediately before counting.

2. This is the best position for perfusing the placenta.

Which of the following situations in a fully dilated client is incompatible with aforceps delivery? Select all that apply. 1. Maternal history of asthma. 2. Right occiput posterior position at +4 station. 3. Transverse fetal lie .4. Fetal heart rate of 60 beats per minute at -1 station. 5. Maternal history of cerebral palsy.

3 and 4 3. A baby in transverse lie is physically incapable of delivering vaginally. 4. It is not appropriate to deliver a baby vaginally who is at -1 station. The baby has yet to engage. This baby would likely be delivered by cesarean section for prolonged fetal distress.

A delirious patient is admitted to the hospital in labor. She has had no prenatal careand vials of crack cocaine are found in her pockets. The nurse monitors this client carefully for which of the following intrapartal complications? 1. Prolonged labor. 2. Prolapsed cord. 3. Abruptio placentae. 4. Retained placenta.

3. Abruptio placentae.

A woman being induced with oxytocin (Pitocin) is contracting every 3 min × 30 seconds. Suddenly the woman becomes dypsneic and cyanotic, and begins to cough up bloody sputum. Which of the following nursing interventions is of highest priority? 1. Check blood pressure. 2. Assess fetal heart rate. 3. Administer oxygen. 4. Stop oxytocin infusion.

3. Administer oxygen.

There are four clients in active labor in the labor suite. Which of the women should the nurse monitor carefully for the potential of uterine rupture? 1. Age 15, G3 P0020, in active labor. 2. Age 22, G1 P0000, eclampsia. 3. Age 25, G4 P3003, last delivery by cesarean section. 4. Age 32, G2 P0100, first baby died during labor.

3. Age 25, G4 P3003, last delivery by cesarean section.

There are four clients in active labor in the labor suite. Which of the women shouldthe nurse monitor carefully for the potential of uterine rupture? 1. Age 15, G3 P0020, in active labor. 2. Age 22, G1 P0000, eclampsia. 3. Age 25, G4 P3003, last delivery by cesarean section. 4. Age 32, G2 P0100, first baby died during labor.

3. Age 25, G4 P3003, last delivery by cesarean section.

A woman has been in the second stage of labor for 21/2 hours. The fetal head is at +4 station and the fetal heart is showing mild late decelerations. The obstetrician advises the woman that the baby will be delivered with forceps. Which of the following actions should the nurse take at this time? 1. Obtain a consent for the use of forceps. 2. Encourage the woman to push between contractions. 3. Assess the fetal heart rate after each contraction. 4. Advise the woman to refuse the use of forceps.

3. Assess the fetal heart rate after each contraction.

A client with mild preeclampsia who has been advised to be on bed rest at home asks why doing so is necessary. Which of the following is the best response for the nurse to give the client? 1. "Bed rest will help you to conserve energy for your labor." 2. "Bed rest will help to relieve your nausea and anorexia." 3. "Reclining will increase the amount of oxygen that your baby gets." 4. "The position change will prevent the placenta from separating."

3. Bed rest, especially side-lying, helps to improve perfusion to the placenta.The vital organs of pre-eclamptic patients are being poorly perfused as a result of the abnormally high blood pressure.

The nurse is caring for two post-cesarean section clients in the postanesthesia suite.One of the clients had her surgery under spinal anesthesia, while the other clienthad her surgery under epidural anesthesia. Which of the following is an importantdifference between the two types of anesthesia that the nurse should be aware of? 1. The level of the pain relief is lower in spinals. 2. Placement of the needle is higher in epidurals. 3. Epidurals do not fully sedate motor nerves. 4. Spinal clients complain of nausea and vomiting.

3. Epidurals do not fully sedate the motor nerves of the client. Epidural clients are capable of moving their lower extremities even when fully pain free. Epidural anesthesia is administered into the epidural space. This is outside of the spinal canal. The anesthesia, therefore, is not in direct contact w/ spinal nerves. In contrast, spinal anesthesia, instilled into the spinal canal, is in direct contact with the spinal nerves. All of the spinal nerves of the spinal anesthesia clients are anesthetized, including morot nerves. Spinal anesthesia clients are paralyzed until the anesthesia is metabolized by the body.

The labor nurse has just received a shift report on four gravid patients. Which of thepatients should the nurse assess first? 1. G5 P2202, 32 weeks, placenta previa, today's hemoglobin 11.6 g/dL. 2. G2 P0101, 39 weeks, type 2 diabetic, blood glucose (15 minutes ago) 85 mg/dL. 3. G1 P0000, 32 weeks, placental abruption, fetal heart (15 minutes ago) 120 bpm. 4. G2 P1001, 39 weeks, Rh-negative, today's hematocrit 31%.

3. G1 P0000, 32 weeks, placental abruption, fetal heart (15 minutes ago) 120 bpm.

A 28-week-gestation client with intact membranes is admitted with the followingfindings: Contractions every 5 min × 60 sec, 3 cm dilated, 80% effaced. Which of the following medications will the obstetrician likely order?1. Oxytocin (Pitocin). 2. Ergonovine (Methergine). 3. Magnesium sulfate. 4. Morphine sulfate.

3. Magnesium sulfate is a tocolytic agent. It would be appropriate for this medicationto be administered at this time.

A woman who is hepatitis B-surface antigen positive is in active labor. Which actionby the nurse is appropriate at this time? 1. Obtain an order from the obstetrician to prepare the client for cesarean delivery. 2. Obtain an order from the obstetrician to administer intravenous ampicillin duringlabor and the immediate postpartum. 3. Obtain an order from the pediatrician to administer hepatitis B immune globulinand hepatitis B vaccine to the baby after birth. 4. Obtain an order from the pediatrician to place the baby in isolation after delivery.

3. Obtain an order from the pediatrician to administer hepatitis B immune globulinand hepatitis B vaccine to the baby after birth.

In which of the following situations should a nurse report a possible deep veinthrombosis (DVT) even when the woman has a negative Homan's sign? 1. The woman complains of numbness in the toes and heel of one foot. 2. The woman has cramping pain in a calf that is relieved when the foot isdorsiflexed. 3. One of the woman's calves is swollen, red, and warm to the touch. 4. The veins in the ankle of one of the woman's legs are spider-like and purple.

3. One of the woman's calves is swollen, red, and warm to the touch. Even with a negative Homan's sign, these findings—swelling, redness, and warmth—indicate presence of a DVT.

A nurse is caring for a gravid client who is G1 P0000, 35 weeks' gestation. Which of the following would warrant the nurse to notify the woman's health care practitioner that the client is in preterm labor? Select all that apply. 1. Contraction frequency every 15 minutes. 2. Effacement 10%. 3. Dilation 3 cm. 4. Cervical length of 2 cm. 5. Contraction duration of 30 seconds.

3. The dilation of 3 cm is indicative of preterm labor.4. A cervical length of 2 cm is indicative of preterm labor.Preterm labor is defined as labor before 37 weeks' gestation with 3 or more contractions occurring within a 30 min period PLUS cervical change of one of the following: Cervical effacement greater than 80%, cervical dilation >1 cm, or cervical length of < 2.5cm. The change is cervical length is diagnosed by transvaginal ultrasound.

16. The nurse is caring for a postoperative cesarean client. The woman is obese and is an insulin-dependent diabetic. For which of the following complications should the nurse carefully monitor this client? 1. Ineffective lactogenesis. 2. Dysfunctional parenting. 3. Wound dehiscence. 4. Projectile vomiting.

3. Wound dehiscence.

A client is receiving terbutaline (Brethine) for preterm labor. Which of the followingfindings would warrant stopping the infusion? Select all that apply. 1. Change in contraction pattern from q 3 min × 90 sec to q 2 min × 60 sec. 2. Change in fetal heart pattern from no decelerations to early decelerations. 3. Change in beat-to-beat variability from minimal to moderate. 4. Change in fetal heart rate from 160 bpm to 210 bpm. 5. Change in the amniotic sac from intact to ruptured.

4 and 5 4. When the fetal heart rate pattern is greater than 200 bpm, the medication should be stopped. 5. Terbutaline is contraindicated when the membranes have ruptured prematurely.Terbutaline, a beta agonist, stimulates the "fight-or flight" response in the mother and in the fetus. The FHR therefore increases in response to the medication. When the rate is too high however there is insufficient time for the blood to enter the heart, which leads to a drop in cardiac output.

A nurse is caring for four clients on the labor and delivery unit. Which of the following actions should the nurse take first? 1. Check the blood sugar of a gestational diabetic. 2. Assess the vaginal blood loss of a client who is post-spontaneous abortion. 3. Assess the patellar reflexes of a client with mild preeclampsia. 4. Check the fetal heart rate of a client who just ruptured membranes.

4. Check the fetal heart rate of a client who just ruptured membranes.

A nurse administers magnesium sulfate via infusion pump to an eclamptic woman inlabor. Which of the following outcomes indicates that the medication is effective? 1. Client has no patellar reflex response. 2. Urinary output is 30 mL/hr. 3. Respiratory rate is 16 rpm. 4. Client has no grand mal seizures.

4. Client has no grand mal seizures.

A woman, G3 P1010, is receiving oxytocin (Pitocin) via IV pump at 3 milliunits/min. Her current contraction pattern is every 3 minutes × 45 seconds with moderate intensity. The fetal heart rate is 150 to 160 bpm with moderate variability. Which of the following interventions should the nurse take at this time? 1. Stop her infusion. 2. Give her oxygen. 3. Change her position. 4. Monitor her labor.

4. Monitor her labor.

1. A woman is scheduled to have an external version for a breech presentation. Thenurse carefully assesses the client's chart knowing that which of the following is acontraindication to this procedure? 1. Station -2. 2. 38 weeks' gestation. 3. Reactive NST. 4. Previous cesarean section.

4. Previous cesarean section.

1. A woman, G3 P2002, is 6 cm dilated. The fetal monitor tracing shows recurring deep late decelerations. The woman's doctor informs her that the baby must be delivered by cesarean section. The woman refuses to sign the informed consent. Which of the following actions by the nurse is appropriate? 1. Strongly encourage the woman to sign the informed consent. 2. Prepare the woman for the cesarean section. 3. Inform the woman that the baby will likely die without the surgery. 4. Provide the woman with ongoing labor support.

4. Provide the woman with ongoing labor support.

1. A client is scheduled for an external version. The nurse would expect to preparewhich of the following medications to be administered prior to the procedure? 1. Oxytocin (Pitocin). 2. Ergonovine (Methergine). 3. Betamethasone (Celestone). 4. Terbutaline (Brethine).

4. Terbutaline (Brethine).

A pregnant woman, G3 P2002, had her two other children by cesarean section. Which of the following situations would mandate that this delivery also be by cesarean? 1. The woman refuses to have a regional anesthesia. 2. The woman is postdates with intact membranes. 3. The baby is in the occiput posterior position. 4. The previous uterine incisions were vertical.

4. The previous uterine incisions were vertical.

A nurse is talking with a client during her initial prenatal visit. The client reports a history of trisomy 13 syndrome in her family and is concerned her fetus might be at risk. Which of the following statements should the nurse provide? A. "If you sign an informed consent form, we can perform genetic screening to see if your baby has this disorder." B. "If the genetic screening shows that your baby has this disorder, I can provide you with information about an abortion clinic." C. "Screening for trisomy 13 syndrome and other chromosomal disorders is done automatically for clients at increased risk." D. "I can provide you with information about sterilization so that the disorder is not passed to your future children."

A. "If you sign an informed consent form, we can perform genetic screening to see if your baby has this disorder"

A 40 year old client is 8 weeks pregnant and has a 3 year old child with Down syndrome. The nurse is discussing amniocentesis and chorionic villus sampling as genetic screening. Which of the following information should the nurse tell the client? A. Chorionic villus sampling can be performed earlier in pregnancy at 10 weeks B Amniocentesis is a more dangerous procedure for the mother C The test results for chorionic villus sampling take much longer D Amniocentesis and chorionic villus sampling both test for neural tube defects

A. Chorionic villus sampling can be performed earlier in pregnancy at 10 weeks

A nurse is reviewing the laboratory findings of a 24-hour-old newborn. Which of the following findings should the nurse report to the provider? A. Hemoglobin 12 g/dL B. Platelet count 200,000/mm^3 C. Total bilirubin 4 mg/dL D. Glucose 50 mg/dL

A. Hemoglobin 12 g/dL The nurse should report a hemoglobin level of 12 g/dL to the provider because it is below the expected reference range of 14 to 24 g/dL.

A nurse while monitoring a laboring patient notes V-shaped decelerations. The nurse interrupts this finding as resulting from which of the following? A. cord compression B. Head compression C. insufficient uteroplacental blood flow D. metabolic acidosis

A. cord compression