NUR1025 Most Missed Questions Exam 2

What is the most common cause of spontaneous abortions?

Chromosomal abnormalities

A placenta previa in which the placental edge just reaches the internal os is called:

marginal

A client is scheduled for a cesarean section under spinal anesthesia. After instruction is given by the anesthesiologist, the nurse determines the client has understood the instructions when the client states:

"I may end up with a severe headache from the spinal anesthesia."

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states:

"I will need to increase my insulin dosage during the first 3 months of pregnancy."

When a diabetic patient asks about maintaining adequate blood glucose levels, which of the following statements by the nurse relates most directly to the necessity of maintaining blood glucose levels no lower than about 74 mg/dl?

"The central nervous system cannot store glucose and needs a continuous supply of glucose for fuel."

The nurse recognizes that a woman is in true labor when she states?

"The contractions in my uterus are getting stronger and closer together."

The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is

"The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult."

A nurse teaches a pregnant woman about the characteristics of true labor contractions. Which of the following statements indicated that the client correctly understands the nurse's instructions

"True labor contractions will continue and get stronger even if I relax and take a shower"

7 Cardinal Movements of the Mechanism of Labor

- Engagement - Descent - Flexion - Internal Rotation - Extension - External Rotation (Restitution) - Birth by Expulsion

Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations. (Select all that apply)

- Establish gestational age - Obesity - Fetal abnormalities - Ectopic pregnancy

Cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman in her second trimester?

- Increased pulse rate - Decreased blood pressure

The baseline FHR is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the client's most recent 10-minute segment on the monitor strip and notes a late deceleration. Which is likely to have caused this change? (Select all that apply.)

- Placental abruption - Maternal supine hypotension

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply):

- Rupture of membranes at or near term - Chorioamnionitis (inflammation of the amniotic sac) - Post-term pregnancy - Fetal death

With regard to the turns and other adjustments of the fetus during the birth process, known as the mechanism of labor, nurses should be aware that:

- The effects of the forces determining descent are modified by the shape of the woman's pelvis and the size of the fetal head - The size of the maternal pelvis and the ability of the fetal head to mold also affect the process

Which of the following would be included in the assessment of a patient with diabetes mellitus who is experiencing a hypoglycemic reaction? (Select all that apply)

- Tremors - Nervousness - Profuse perspiration

Signs of opioid/narcotic withdrawal in the mother would include (Select all that apply):

- Yawning, runny nose - Chills or hot flashes - Irritability, restlessness

Complications and risks associated with cesarean births include: (Select all that apply.)

- wound dehiscence - hemorrhage - urinary tract infections - fetal injuries

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?

Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours

While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy as early as _____ weeks.

10

Concerning the third stage of labor, nurses should be aware that:

An expectant or active approach to managing this stage of labor reduces the risk of complications

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve:

IV therapy to correct fluid and electrolyte imbalances

A 3-month-old infant is at increased risk for developing anemia. The nurse would identify which principle contributing to this risk?

A depletion of fetal hemoglobin occurs

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is:

A gravida 4 who has had all cesarean births.

A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her "fertile" time. She asks the nurse about emergency contraception. The nurse tells her that:

An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting

A laboring woman is lying in the supine position. The most appropriate nursing action at this time is to:

Ask her to turn to one side

To reassure and educate pregnant clients about changes in their cardiovascular system, maternity nurses should be aware that:

Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR):

Before and after ambulation and rupture of membranes

Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?

Breathing and relaxation techniques

The nurse is explaining to a student nurse about impaired central perfusion. The nurse knows the student understands this problem when the student makes which statement?

Central perfusion involves the entire body

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:

Change in position

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that:

Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy

Some pregnant clients may complain of changes in their voice and impaired hearing. The nurse can tell these clients that these are common reactions to:

Congestion and swelling, which occur because the upper respiratory tract has become more vascular

In evaluating the effectiveness of oxytocin induction, the nurse would expect:

Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart.

A woman arrives for evaluation of signs and symptoms that include a missed period, abdominal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the woman's umbilicus. What does this finding indicate?

Cullen sign associated with a ruptured ectopic pregnancy

The nurse is explaining the physiology of uterine contractions to a group of nursing students. Which statement best explains the maternal-fetal exchange of oxygen and waste products during a contraction?

Diminishes as the spiral arteries are compressed

Remaining fairly stable throughout the first and second stages

Duration

A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurses's plan of care?

During the 2nd and 3rd trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus

With regard to follow-up visits and the physical examination for women receiving prenatal care, nurses should be aware that:

During the abdominal examination, the nurse should be alert for supine hypotension

Long, difficult, or abnormal labor Can be caused by: - Ineffective uterine contractions or maternal bearing-down efforts (the powers) - Fetal causes (the passenger) including abnormalities of presentation, position, or development - Alteration in the pelvic structure (the passage) including abnormalities of the maternal bony pelvis or soft-tissue abnormalities of the reproductive tract Suspected when there is: - an alteration in characteristics of uterine contractions - a lack of progress in the rate of cervical dilation - a lack of progress in fetal descent & expulsion

Dysfunctional Labor

Which deceleration of the FHR would NOT require the nurse to change the maternal position?

Early decelerations

Maternity nurses often have to answer questions about the many, sometimes unusual ways people have tried to make the birthing experience more comfortable. For instance, nurses should be aware that:

Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins

A nulliparous woman who has just begun the second stage of her labor would most likely:

Feel tired yet relieved that the worst is over

The nurse who encourages the gate control theory of pain control would advise a woman in labor and her partner to use which nonpharmacological method of pain management?

massage

Which description of the four stages of labor is correct for both definition and duration?

First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours

For the labor nurse, care of the expectant mother begins with any or all of these situations, with the exception of:

Formulation of the woman's plan of care for labor

Which finding in the urine analysis of a pregnant woman is considered a variation of normal?

Glucosuria

Which patient finding would the nurse identify as being a risk factor for altered transport of oxygen?

Hemoglobin level of 8.0

Nurses should be aware that the biophysical profile (BPP):

Is an accurate indicator of impending fetal death

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects the application of the gate-control theory?

Massaging the woman's back

What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus?

Missed abortion

The priority nursing care associated with an oxytocin infusion is:

Monitoring uterine response; if infusing too rapidly, uterine could rupture

With regard to nerve block analgesia and anesthesia, nurses should be aware that:

Most local agents are related chemically to cocaine and end in the suffix -caine

NST: FHR did not accelerate during fetal movement

Non-Reactive NST

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority?

Placing the woman in the knee-chest position

Labor that lasts less than 3 hours from the onset of contraction to the time of birth May result from hypertonic uterine contractions that are tetanic in intensity Conditions often associated with this type of uterine contractions include: - Placental abruption - Uterine tachysystole - Recent cocaine Maternal complications can include: - Uterine rupture - Lacerations of the birth canal - Amniotic fluid embolus (anaphylactoid syndrome of pregnancy) - Postpartum hemorrhage Fetal complications include: - Hypoxia caused by decreased periods of uterine relaxation between contractions - (in rare instances) intracranial trauma related to rapid birth Women who have experienced precipitous labor often describe feelings of: - disbelief that their labor began so quickly, alarm that their labor progressed so rapidly - Panic about the possibility they would not make it to the hospital in time to give birth - Relief when they arrive at the hospital - In addition, women have expressed frustration when nurses did not believe them when they reported their readiness to push

Precipitous Labor

Which clinical management prevention concept would the nurse identify as representative of secondary prevention?

Prevention of pneumonia in patients with chronic lung disease

In planning for home care of a woman with preterm labor, which concern should the nurse need to address?

Prolonged bed rest may cause negative physiologic effects

When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the likely position of the fetus?

RSA (right sacral anterior)

NST: When two or more HR accelerations of at least 15 bmp with a duration of 15 seconds in a 20-minute period

Reactive NST

An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The client states, "My contractions are so strong, I don't know what to do." Before making a plan of care, what should the nurse's first action be?

Recognize that pain is personalized for each individual

A man's wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as:

Recurrence risk

Commonly 45 seconds or more in the second stage of labor

Relaxation time

Average of 10 mm Hg

Resting tone

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor?

She is exhibiting hypertonic uterine dysfunction

Peaking at 40 to 70 mm Hg in the first stage of labor

Strength

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates the preterm labor is occurring?

The cervix is effacing and dilated to 2 cm

Which description of the phases of the second stage of labor is accurate?

The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on a number of factors

What is an advantage of external electronic fetal monitoring?

The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor, particularly when the membranes are intact.

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?

The vulva bulges and encircles the fetal head

Which maternal condition always necessitates delivery by cesarean birth?

Total placenta previa

Which statement about multifetal pregnancy is inaccurate?

Twin pregnancies come to term with the same frequency as single pregnancies

V.E.A.L. C.H.O.P.

Variable -- Cord Compression Early Deceleration -- Head Compression Acceleration -- Okay! Late Deceleration -- Placental Insufficiency

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:

Variable decelerations

With regard to spinal and epidural (block) anesthesia, nurses should know that?

a high incidence of after-birth headache is seen with spinal blocks

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be:

alteration in the pattern of fetal movement

When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal:

attitude

With regard to breathing techniques during labor, maternity nurses should understand that?

breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:

congenital anomalies in the fetus

In the first trimester, ultrasonography can be used to gain information on:

location of gestational sacs

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for:

hydralazine

What are nonreassuring fetal monitoring strips associated with?

hypoxemia which can deteriorate to severe fetal hypoxia

A nurses is assessing a differential WBC, this can imply:

inflammation or infection

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):

is considered negative if no late decelerations are observed with the contractions

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:

its most important function is to afford the opportunity to administer antenatal glucocorticoids

To provide adequate after-birth care, the nurse should be aware that postpartum depression (PPD) with psychotic features?

may include bipolar disorder (formerly called "manic depression")

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be:

negative

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring client with diabetes mellitus, the nurse is aware that she is at a greater risk for:

polyhydramnios

Which assessment finding in a diabetic patient would show a decrease in renal function?

protein in urine

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is:

referred pain

Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing?

respiratory distress syndrome

In order to help patients manage discomfort and pain during labor, nurses should be aware that:

the predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen

The nurse knows that the second stage of labor, the descent phase, has begun when:

the woman experiences a strong urge to bear down

The nurse caring for the woman in labor should understand that maternal hypotension can result in?

uteroplacental insufficiency

Generally ranging from two to five contractions per 10 minutes of labor

​​Frequency