OB 2

Mature milk is produced after ____ weeks and it appears _______ and slightly bluish in color, similar to skim milk

2 weeks; watery

A laboring patient's obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed? 1. Maternal temperature, BP, and pulse 2. Estimation of fetal birth weight 3. Fetal presentation, position, and station 4. Biparietal diameter

3. Fetal presentation, position, and station The most important assessment is for fetal presentation, position, and station. Fetal presentation and position must be known to determine whether vaginal delivery is possible. Station is important because if the fetal head is not engaged, a prolapsed cord is a risk.

The nurse assesses for Homans' sign by: 1. Extending the foot and inquiring about calf pain. 2. Extending the leg and inquiring about foot pain. 3. Flexing the knee and inquiring about thigh pain. 4. Dorsiflexing the foot and inquiring about calf pain.

4. Dorsiflexing the foot and inquiring about calf pain.

The nurse is explaining induction of labor to a client. The client asks what the indications for labor induction are. Which of the following should the nurse include when answering the client? 1. Suspected placenta previa 2. Breech presentation 3. Prolapsed umbilical cord 4. Hypertension

4. Hypertension Other options are indications for cesearan

S/S of ruptured uterus

Abnormal FHR tracing DECREASE B/P Loss of fetal station Abomindal HARD Abdominal pain Shock

Variability

Beat to beat variation Documented as : Absent: 0 Minimal: Less than 5 bpm Moderate: 6-25 bpm Marked: Above 25 bpm

In which clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion? Standard Text: Select all that apply. 1. Placental abruption 2. Meconium-stained fluid 3. Polyhydramnios 4. Late decelerations 5. Early decelerations

Correct Answer: 2,4

The nurse has just palpated contractions and compares the consistency to that of the forehead. The intensity of these contractions would be identified as: 1. Mild. 2. Moderate. 3. Strong. 4. Weak.

Correct Answer: 3 Rationale 1: The consistency of mild contractions is similar to that of the nose. Rationale 2: The consistency of moderate contractions is similar to that of the chin. Rationale 3: The consistency of strong contractions is similar to that of the forehead. Rationale 4: Weak contractions are not identified.

A woman is scheduled to have an external version for a breech presentation. The nurse carefully reviews the patient's chart for contraindications to this procedure, such as: Select all that apply. 1. Station -2. 2. 38 weeks' gestation. 3. Abnormal fetal heart rate and tracing. 4. Previous cesarean section. 5. Rupture of membranes.

Correct Answer: 3,4,5

A client delivered a 9 pound, 10 oz infant assisted by forceps. When the nurse performs the second 15 min assessment, the client reports increasing perineal pain and a lot of pressure. Which action should the nurse take? A. Apply ice to the client's perineum, reassuring the client this is normal. B. Call for assistance for another nurse. C. Assess the fundus for firmness. D. Check the perineum for a hematoma

D. Check the perineum for a hematoma

Reasons of late type PP hemorrhage

Infection Retained placenta Uterine Subinvolution

During _______ decelerations, the FHR drops below ____ bpm very quickly, and then rapidly returns to baseline. This deceleration concern with __________ compression

Variable decelerations, FHR drops below 90 bpm, then rapidly returns. Umbilicial Cord Compression

To assess the uterus postpartum look at ________

lochia

Don't give Methergine if a pt has __________

high blood pressure IM-- 0.2 MG = PP HEMORRHAGE

Early declerations

mirror contraction. benign. head compression. possible Cephalopelvic disproportion--> c section.

Contractions after amniotomy are similar to those of ________ labor

spontaneous labor.

The lower uterine segment incision most commonly used for cesarean section is the ____ incision.

transverse

The patient tells the nurse that she has come to the hospital so that her baby's position can be changed. The nurse would begin to organize the supplies needed to perform which procedure? 1. A version 2. An amniotomy 3. Leopold's maneuvers 4. A ballottement

1. Rationale 1: The nurse would prepare for a version. Rationale 2: Amniotomy is the artificial rupture of membranes. Rationale 3: Leopold's maneuvers are a series of palpations performed to determine fetal position. Rationale 4: Ballottement occurs when the fetus floats away and then returns to touch an examiner's hand during a vaginal exam.

Bishop Cervical Rippening Scale (5)

1. Cervical dilation 2. Fetal Station 3. Effacement 4. Consistency of cervix 5. Cervical position

An anesthesiologist informs the nurse that a patient scheduled for a caesarean section will be having general anesthesia with postoperative self-controlled analgesia. For which patients would a general anesthesia be recommended? Standard Text: Select all that apply. 1. The patient with a history of drug addiction 2. The patient who has had a lower back fusion 3. The patient who is 13 years old 4. The patient who is allergic to morphine sulfate 5. The patient who has had surgery for scoliosis

2 & 5

The nurse has presented a session on pain relief options to a prenatal class. Which statement indicates that additional teaching is needed? 1. "An epidural can be continuous or can be given in one dose." 2. "A spinal is usually used for a cesarean birth." 3. "Pudendal blocks are effective when a vacuum is needed." 4. "Local anesthetics provide good labor pain relief."

4. "Local anesthetics provide good labor pain relief."

The patient is having fetal heart rate decelerations. An amnioinfusion has been ordered for the patient to alleviate the decelerations. The nurse understands that the type of decelerations that will be alleviated by amnioinfusion is: 1. Early decelerations. 2. Moderate decelerations. 3. Late decelerations. 4. Variable decelerations.

4. Variable decelerations. Amnioinfusion can be used when cord compression is presenting as variable decelerations.

A cesarean section is ordered. Because the patient is to receive general anesthesia, the primary danger with which the nurse is concerned is: 1. Fetal depression. 2. Vomiting. 3. Maternal depression. 4. Uterine relaxation.

Correct Answer: 1

Factors that enhance involution

Uncomplicated birth Breastfeeding Early ambulation Complete expulsion of placenta and membranes

Reasons of early type PP hemorrhage

Uterine atony Genital tract trauma

With a sinosiudual there is NO _____

With a sinosiudol there is no beat to beat variability. Frequent = 3-5 min

Signs of hematoma

a. pain. b. pressure c. inability to void

To assess the healing of the uterus at the placental site, the nurse assesses: 1. Lab values. 2. Blood pressure. 3. Uterine size. 4. Type, amount, and consistency of lochia.

Correct Answer: 4

After inserting prostaglandin gel for cervical ripening, the nurse should: 1. Apply an internal fetal monitor. 2. Insert an indwelling catheter. 3. Withhold oral intake and start intravenous fluids. 4. Place the patient in a supine position with a right hip wedge.

4. Place the patient in a supine position with a right hip wedge.

Toward the end of the first stage of labor, a pudendal block is administered transvaginally. The nurse anticipates the patient's care will include: 1. Monitoring for hypotension every 15 minutes. 2. Monitoring FHR every 15 minutes. 3. Monitoring for bladder distention. 4. No additional assessments.

4. No additional assessments.

Before the physician performs an external version, the nurse should expect an order for a: a. Tocolytic drug. b.Contraction stress test. c.Local anesthetic. d.Foley catheter.

ANS: A A tocolytic drug will relax the uterus before and during version, making manipulation easier. CST is used to determine the fetal response to stress. A local anesthetic is not used with external version.

What is the first milk secreted and rich in protein and immunoglobulins

Colostrum

The nurse assesses the postpartum patient to have moderate lochia rubra with clots. Which nursing intervention would be appropriate? 1. Assess fundus and bladder status. 2. Catheterize the patient. 3. Administer Methergine IM per order. 4. Contact the physician immediately.

Correct Answer: 1

The postpartum patient delivered 4 hours ago. She has a mediolateral episiotomy and large hemorrhoids. She is rating her pain at 7 on a scale of 1-10. She has a history of anaphylactic reaction to Tylenol (acetaminophen). Which nursing action would be best? 1. Offer the patient 800 mg Advil (ibuprofen) orally with food. 2. Provide two Percocet (oxycodone with acetaminophen) by mouth. 3. Encourage the use of Dermoplast topical anesthetic spray. 4. Run very warm water into the tub and assist her into the bath.

Correct Answer: 1

To reduce possible side effects from a cesarean section under general anesthesia, patients are routinely given which type of medication? 1. Antacids 2. Tranquilizers 3. Antihypertensives 4. Anticonvulsants

Correct Answer: 1

A primigravida dilated to 5 cm has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was 120/80 before the procedure and is now 80/52. In addition to the bolus of fluids she has been given, which medication is preferred to increase her BP? 1. Epinephrine 2. Terbutaline 3. Ephedrine 4. Epifoam

Correct Answer: 3

During the initial intrapartal assessment of a patient in early labor, the nurse performs a vaginal examination. The patient's partner asks why this pelvic exam needs to be done. The nurse should explain that the purpose of the vaginal exam is to obtain information about the: Standard Text: Select all that apply. 1. Uterine contraction pattern. 2. Fetal position. 3. Presence of the mucous plug. 4. Cervical dilation and effacement. 5. Presenting part. Correct Answer: 4,5

Correct Answer: 4,5

Acceleration

Documented : Present or Absent Present: - Full term= 15/15. Above 15 bpm & 15 sec duration -Preterm= 10/10. Less than 32 weeks

Rule 5

Good for 5 hOURS @ room temperature Good for 5 DAYS in Fridge Good for 5 months in freezer

Advantages of epidural

Good pain relief. Redosing possible. No neonatal resp depression

What does terbutaline do?

Relax the uterus

Late decelerations

Starts after contractions. uteroplacental insufficiency, hypoxia

The labor and delivery nurse is preparing a prenatal class about facilitating the progress of labor. Which of the following frequent responses to pain should the nurse indicate is most likely to impede progress in labor? 1. Increased pulse 2. Elevated blood pressure 3. Muscle tension 4. Increased respirations

Correct Answer: 3

To improve placental blood flow immediately after the injection of an epidural anesthetic, the nurse should: a. Turn the woman to the right side. b. Place a wedge under the woman's right hip. c. Give the woman oxygen. d. Decrease the intravenous infusion rate.

ANS: B Tilting the woman's pelvis to the left side relieves compression of the vena cava and compensates for a lower blood pressure without interfering with dispersal of the epidural medication.

The priority nursing intervention following an amniotomy is to: a. Assess the color of the amniotic fluid. b. Change the client's gown. c. Estimate the amount of amniotic fluid. d. Assess the fetal heart rate.

ANS: D The fetal heart rate must be assessed immediately after the rupture of the membranes to determine whether cord prolapse or compression has occurred. This is important, but not the top priority. This is important for client comfort, but it is not the top priority. This is not a top priority for this client.

McRoberts maneuver

Macrosomia Shoulder dystonia sharp flexion of the maternal hips that decreases the inclination of the pelvis increasing the AP diameter of the free anterior shoulder

High FHR may indicate

Maternal Fever Early hypoxia Fetal distress

Factors that slow involution

Preciptous or prolonged birth Anesthisa Grand multiparity Anesthesia Retained placenta Over distension Bladder full Infection

Placenta previa =

When the placenta covers the opening in the mother's cervix. C- section.

The nurse is scheduling a patient for an external cephalic version (ECV). Which finding in the patient's chart requires immediate intervention? 1. Multip, previous birth by cesarean 2. Primip, frank breech ballotable 3. Multip, 37 weeks, complete breech 4. Primip, failed ECV last week

Correct Answer: 1 Rationale 1: Any previous uterine scar is a contraindication to ECV. The scar could rupture, leading to both fetal and maternal morbidity and to mortality. Rationale 2: There is no contraindication to ECV for this patient. Rationale 3: ECV is not attempted until 36 or 37 weeks. There is no contraindication for ECV for this patient. Rationale 4: Although this patient is less likely to have a successful ECV this week if it was unsuccessful last week, there is no contraindication to attempting the procedure.

The laboring patient has rated her pain at 9 on a scale of 1-10, and requests IV pain medication. Which statement is most important for the nurse to make? "Narcotic medications: 1. "Can make you unsteady. You need to ask for help when you get up." 2. "Have a very rapid onset and begin to work in 2-3 minutes." 3. "Are metabolized by your body, so they don't last as long as an epidural." 4. "Can cause sleepiness in the baby that can be reversed with Narcan."

Correct Answer: 1 Rationale 1: Being unsteady when getting up is a common side effect of narcotic medications, and a safety issue. To prevent falls, it is important that patients receiving IV narcotics ask for assistance when they are getting up. Rationale 2: This is true, but is not the most important consideration. Rationale 3: This is true, but is not the most important consideration.

The charge nurse is looking at the charts of laboring patients. Which patient is in greatest need of further intervention? 1. Multip at 7 cm, fetal heart tones auscultated every 90 minutes 2. Primip at 10 cm and pushing, external fetal monitor applied 3. Multip with meconium-stained fluid, internal fetal scalp electrode in use 4. Primip in preterm labor, external monitor in place

Correct Answer: 1 Rationale 1: During active labor, the fetal heart tones should be auscultated every 30 minutes; every 90 minutes is not frequent enough.

The nurse auscultates the FHR and determines a rate of 112 beats/min. Which action is appropriate? 1. Inform the maternal patient that the rate is normal. 2. Reassess the FHR in 5 minutes because the rate is low. 3. Report the FHR to the doctor immediately. 4. Turn the maternal patient on her side and administer oxygen.

Correct Answer: 1 Rationale 1: A fetal heart rate of 112 beats/min. falls within the normal range of 110-160 beats/min., so there is no need to inform the doctor, reposition the patient, or reassess later.

The nurse is preparing to assess the fetus of a laboring patient. Which assessment should the nurse perform first? 1. Perform Leopold's maneuvers to determine fetal position. 2. Count the fetal heart rate for 30 seconds and multiply by 2. 3. Dry the maternal abdomen before using the Doppler. 4. Place the patient in a left lateral position.

Correct Answer: 1 Rationale 1: Performing Leopold's maneuvers is the first step, so that the Doppler device can be placed directly over the heart and multiple attempts to hear the heart rate are avoided.

The laboring patient's fetal heart rate baseline is 120 beats per minute. Accelerations are present to 135 beats/min. During contractions, the fetal heart rate gradually slows to 110, and is at 120 by the end of the contraction. What nursing action is best? 1. Document the fetal heart rate. 2. Apply oxygen via mask at 10 liters. 3. Prepare for imminent delivery. 4. Assist the patient into Fowler's position.

Correct Answer: 1 Rationale 1: The described fetal heart rate has a normal baseline, the presence of accelerations indicates adequate fetal oxygenation, and early decelerations are normal. No intervention is necessary.

A cesarean section is ordered for the laboring patient with whom the nurse has worked all shift. The patient will receive general anesthesia. The nurse knows that potential complications of general anesthesia include: Standard Text: Select all that apply. 1. Fetal depression that is directly proportional to the depth and duration of the anesthesia. 2. Poor fetal metabolism of anesthesia, which inhibits use with preterm infants. 3. Uterine relaxation that causes increased blood loss. 4. Increased gastric motility that causes increased appetite. 5. Itching of the face and neck.

Correct Answer: 1,2,3

A prenatal patient asks the nurse about conditions that would necessitate a cesarean delivery. The nurse explains that cesarean delivery generally is performed in the presence of: Standard Text: Select all that apply. 1. Complete placenta previa. 2. Placental abruption. 3. Umbilical cord prolapse. 4. Precipitous labor. 5. Failure to progress.

Correct Answer: 1,2,3,5

During a visit to the obstetrician, a pregnant patient questions the nurse about the potential need for an amniotomy. The nurse explains that an amniotomy is performed to: . Standard Text: Select all that apply. 1. Stimulate the beginning of labor. 2. Augment labor progression. 3. Allow application of an internal fetal electrode. 4. Allow application of an external fetal monitor. 5. Allow insertion of an intrauterine pressure catheter.

Correct Answer: 1,2,3,5

During the latent phase of labor, when should the nurse assess the fetal heart pattern of a low-risk woman? Standard Text: Select all that apply. 1. After a vaginal exam 2. Before administration of analgesics 3. Periodically at the end of a contraction 4. Every 10 minutes 5. Before ambulating

Correct Answer: 1,2,3,5

The nurse is teaching a class on reading a fetal monitor to nursing students. The nurse explains that bradycardia is a fetal heart rate baseline below 110 and can be caused by: Standard Text: Select all that apply. 1. Maternal hypotension. 2. Prolonged umbilical cord compression. 3. Fetal dysrhythmia. 4. Central nervous system malformation. 5. Late fetal asphyxia.

Correct Answer: 1,2,3,5 Rationale 1: Maternal hypotension results in decreased blood flow to the fetus. Rationale 2: Cord compression can cause fetal bradycardia. Rationale 3: This will cause fetal bradycardia if there is a fetal heart block. Rationale 4: This does not cause bradycardia. Rationale 5: This is a depression of cardiac muscle activity.

The nurse is caring for a patient who had a cesarean birth 4 hours ago. Which interventions would the nurse implement at this time? Standard Text: Select all that apply. 1. Administer analgesics as needed. 2. Encourage the patient to ambulate to the bathroom to void. 3. Encourage leg exercises every 2 hours. 4. Encourage the patient to cough and deep-breathe every 2-4 hours. 5. Encourage the use of breathing, relaxation, and distraction.

Correct Answer: 1,3,4,5 Rationale 1: Administering analgesics as needed addresses the patient's nursing care needs, which are similar to those of other surgical patients. Rationale 2: Encouraging her to ambulate to the bathroom to void might be an intervention done on the 1st or 2nd day postpartum, but not in the first 4 hours. Rationale 3: Encouraging leg exercises every 2 hours addresses the patient's nursing care needs, which are similar to those of other surgical patients. Rationale 4: Encouraging the patient to cough and deep-breathe every 2-4 hours addresses the patient's nursing care needs, which are similar to those of other surgical patients. Rationale 5: Encouraging the use of breathing, relaxation, and distraction addresses the patient's nursing care needs, which are similar to those of other surgical patients.

The nurse is caring for a postpartum patient who is experiencing afterpains following the birth of her third child. Which comfort measure should the nurse implement to decrease her pain? Standard Text: Select all that apply. 1. Offer a warm water bottle for her abdomen. 2. Call the physician to report this finding. 3. Inform her that this is not normal, and she will need an oxytocic agent. 4. Administer a mild analgesic to help with breastfeeding. 5. Administer a mild analgesic at bedtime to ensure rest.

Correct Answer: 1,4,5

The nurse knows that the Bishop scoring system for cervical readiness includes cervical dilatation, consistency, position, and: Standard Text: Select all that apply. 1. Fetal station. 2. Fetal lie. 3. Fetal presenting part. 4. Cervical effacement. 5. Cervical softness.

Correct Answer: 1,4,5

The nurse is caring for a patient in the transition phase of labor, and notes that the fetal monitor tracing shows average short-term and long-term variability with a baseline of 142 beats per minute. What actions should the nurse take in this situation? Standard Text: Select all that apply. 1. Provide caring labor support. 2. Administer oxygen via face mask. 3. Change the patient's position. 4. Speed up the patient's intravenous. 5. Reassure the patient and her partner that she is doing fine.

Correct Answer: 1,5 Rationale 1: The tracing is normal, so the nurse can continue support of the labor. Rationale 2: No oxygen face mask is needed at this time. Rationale 3: There is no need to change the patient's position. Rationale 4: There is no need to speed up the intravenous. Rationale 5: The nurse can reassure the patient at this time, as the tracing is normal.

Four minutes after the birth of a baby, there is a sudden gush of blood from the mother's vagina and about 8 inches of umbilical cord slides out. What action should the nurse take first? 1. Place the bed in Trendelenburg position. 2. Watch for the emergence of the placenta. 3. Prepare for the delivery of an undiagnosed twin. 4. Roll her onto her left side.

Correct Answer: 2

A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, terbutaline will be administered to: 1. Provide analgesia. 2. Relax the uterus. 3. Induce labor. 4. Prevent hemorrhage.

Correct Answer: 2 Rationale 1: Terbutaline has no analgesic effect. Rationale 2: Terbutaline is a tocolytic administered with the purpose of relaxing the uterus. Rationale 3: Terbutaline does not induce labor. Rationale 4: Terbutaline does not prevent hemorrhage.

The nurse has received the end-of-shift report on the postpartum unit. Which patient should the nurse see first? 1. Multip, 2nd day post-cesarean, moderate lochia serosa 2. Primip, day of delivery, fundus firm 2 cm above umbilicus 3. Multip, 1st postpartum day, 4 cm diastasis recti abdominis 4. Primip, 1st postpartum day, hypoactive bowel sounds all quadrants

Correct Answer: 2 Rationale 1: This patient is not experiencing any unexpected findings. Rationale 2: This patient is the top priority. The fundus should not be positioned above the umbilicus after delivery. This high location could indicate an overdistended bladder or uterine atony and excessive bleeding. Rationale 3: This finding is normal, especially in a multiparous patient. Rationale 4: Bowel sounds are often decreased after delivery.

A patient received epidural anesthesia during the first stage of labor. The epidural is discontinued immediately after delivery. This patient is at increased risk for which problem during the fourth stage of labor? 1. Nausea 2. Bladder distention 3. Uterine atony 4. Hypertension

Correct Answer: 2 Rationale 2: Bladder distention can be a result of decreased bladder sensation in the fourth stage.

The client presents for cervical ripening in anticipation of labor induction tomorrow. What should the nurse include in her plan of care for this client? 1. Apply an internal fetal monitor. 2. Allow the client to void prior to insertion of dinoprostone (Cervidil) gel. 3. Withhold oral intake and start intravenous fluids. 4. Place the client in a semi-Fowler's position.

Correct Answer: 2 Rationale 1: . An internal fetal monitor cannot be applied until adequate cervical dilatation has occurred and the membranes are ruptured. Rationale 2: The client should void before insertion of the dinoprostone (Cervidil). Rationale 3: Until labor begins, there is no rationale for withholding oral intake. Rationale 4: The client will be positioned supine with a wedge under the right hip to maintain maximal gel contact with the cervix.

Which patient requires immediate intervention by the labor and delivery nurse? 1. Multip at 8 cm, systolic blood pressure has increased 35 mm Hg. 2. Primip who delivered 1 hour ago with WBC of 50,000 3. Multip at 5 cm with a respiratory rate of 22 between contractions 4. Primip in active labor with urine output of 100 ml/hour

Correct Answer: 2 Rationale 2: A WBC count of 25,000-30,000 is normal at the end of labor and during the early postpartum period. This count is abnormally high, and requires further assessment and provider notification.

Which physical assessment findings would the nurse consider normal for the postpartum patient following a vaginal delivery? Standard Text: Select all that apply. 1. Elevated blood pressure 2. Fundus firm and midline 3. Moderate amount of lochia serosa 4. Edema and bruising of perineum 5. Inflamed hemorrhoids

Correct Answer: 2,4

The nurse determines that a patient is carrying her fetus in the vertical lie. The nurse's judgment should be questioned if the fetal presenting part is the: Standard Text: Select all that apply. 1. Sacrum. 2. Left arm. 3. Mentum. 4. Left scapula. 5. Right scapula.

Correct Answer: 2,4,5 Rationale 1: A fetus in a sacral presentation is in a vertical lie. Rationale 2: A fetus with an arm presenting is likely in a horizontal lie. Rationale 3: A fetus in a mentum (chin) presentation is in a vertical lie. Rationale 4: A fetus with a left scapula presenting is in a horizontal lie. Rationale 5: A fetus with a right scapula presenting is in a horizontal lie.

On the 3rd day postpartum, a patient who is not breastfeeding experiences engorgement. To relieve her discomfort, the nurse should encourage the patient to: 1. Remove her bra. 2. Apply heat to the breasts. 3. Apply cold packs to the breasts. 4. Use a breast pump to release the milk.

Correct Answer: 3

The laboring primiparous patient with meconium-stained amniotic fluid asks the nurse why the fetal monitor is necessary, as she finds the belt uncomfortable. Which response by the nurse is most important? "The monitor: 1. "Is necessary so we can see how your labor is progressing." 2. "Will prevent complications from the meconium in your fluid." 3. "Helps us to see how the baby is tolerating labor." 4. "Can be removed, and oxygen given instead."

Correct Answer: 3

The nurse is preparing a patient education handout on the differences between false labor and true labor. What information is most important for the nurse to include? 1. True labor contractions begin in the back and sweep toward the front. 2. False labor often feels like abdominal tightening, or "balling up." 3. True labor can be diagnosed only if cervical change occurs. 4. False labor contractions do not increase in intensity or duration.

Correct Answer: 3

The nurse is providing discharge teaching to a woman who delivered her first child 2 days ago. The nurse understands that additional information is needed if the patient makes which statement? 1. "I should expect a lighter flow next week." 2. "The flow will increase if I am too active." 3. "My bleeding will remain red for about a month." 4. "I will be able to use a pantiliner in a day or two."

Correct Answer: 3

The nurse is providing education to the new family. Which question is best? 1. "Do you know how to give the baby a bath?" 2. "You have diapers and supplies at home, right?" 3. "How have your breastfeedings been going?" 4. "How much formal education do you have?"

Correct Answer: 3

The postpartum nurse is caring for a patient who gave birth to full-term twins earlier today. The nurse will know to assess for symptoms of: 1. Increased blood pressure. 2. Hypoglycemia. 3. Postpartum hemorrhage. 4. Postpartum infection.

Correct Answer: 3

Induction of labor is planned for a 31-year-old primip at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important? 1. Administer 100 mcg of misoprostol (Cytotec) vaginally every 2 hours. 2. Place dinoprostone (Prepidil) vaginal gel and ambulate patient for 1 hour. 3. Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec). 4. Prepare to induce labor after administering a tap water enema.

Correct Answer: 3 Rationale 1: One hundred mcg every 2 hours is too much medication administered too frequently. Rationale 2: The patient must remain recumbent for 2 hours after administration of dinoprostone (Prepidil) vaginal gel, during which time she is continuously monitored. Rationale 3: A minimum of 4 hours must elapse between the last dose of misoprostol (Cytotec) and the administration of Pitocin. Rationale 4: Enemas are not routinely used in labor. This order is not expected.

In the operating room, a patient is being prepped for a cesarean delivery. The doctor is present. What is the last assessment the nurse should make just before the patient is draped for surgery? 1. Maternal temperature 2. Maternal urine output 3. Vaginal exam 4. Fetal heart tones

Correct Answer: 4

The nurse is performing a postpartum assessment on a newly delivered patient. When checking the fundus, there is a gush of blood. The patient asks why that is happening. The best response is: 1. "We see this from time to time. It's not a big deal." 2. "The gush is an indication that your fundus isn't contracting." 3. "Don't worry. I'll make sure everything is fine." 4. "Blood pooled in the vagina while you were in bed."

Correct Answer: 4

The patient delivered her first child vaginally 7 hours ago. She has not voided since delivery. She has an IV of lactated Ringer's solution running at 100 ml/hr. Her fundus is firm, 1 FB U, to the right of midline. The best nursing action is to: 1. Massage the fundus vigorously. 2. Assess the patient's pain level. 3. Increase the rate of the IV. 4. Assist the patient to the bathroom.

Correct Answer: 4

While caring for a patient in labor, the nurse notices during a vaginal exam that the baby's head has rotated internally. What would the nurse expect the next set of cardinal movements for a baby in a vertex presentation to be? 1. Flexion, extension, restitution, external rotation, and expulsion 2. Expulsion, external rotation, and restitution 3. Restitution, flexion, external rotation, and expulsion 4. Extension, restitution, external rotation, and expulsion

Correct Answer: 4

After several hours of labor, the electronic fetal monitor (EFM) shows repetitive variable decelerations in the fetal heart rate. The nurse would interpret the decelerations to be consistent with: 1. Breech presentation. 2. Uteroplacental insufficiency. 3. Compression of the fetal head. 4. Umbilical cord compression.

Correct Answer: 4 Rationale 1: Breech presentations by themselves do not cause decelerations. Rationale 2: Uteroplacental insufficiency causes late decelerations. Rationale 3: Early decelerations occur with fetal head compression. Rationale 4: Variable decelerations occur when there is umbilical cord compression.

A patient is having contractions that last 20-30 seconds and occur every 8-20 minutes. The patient is requesting something to help relieve the discomfort of contractions. The nurse should suggest: 1. That a mild analgesic be administered. 2. An epidural. 3. A local anesthetic block. 4. Nonpharmacologic methods of pain relief.

Correct Answer: 4 Rationale 1: The patient does not have an established labor pattern, and analgesics given for pain relief could prolong labor or stop the process. Rationale 2: The patient does not have an established labor pattern, and an epidural given for pain relief could prolong labor or stop the process. Rationale 3: A local anesthetic block is given during the delivery of the baby to numb the perineal area. Rationale 4: For this pattern of labor, nonpharmacologic methods of pain relief should be suggested. These can include back rubs, showers, whirlpools, and the application of cool cloths.

A woman who is 40 weeks pregnant calls the labor suite to ask whether she should be evaluated. Which statements by the patient indicate she is likely in labor? Standard Text: Select all that apply. 1. "The contractions are 5-20 minutes apart." 2. "I had pink discharge on the toilet paper." 3. "I have had cramping for the past 3-4 hours." 4. "The contractions are about a minute long and I am unable to talk through them." 5. "The contractions hurt more when I walk."

Correct Answer: 4,5

Treatment for categorie III

O2 Increase B/P D/c Pitocin to allow perfusion Stop contractions: Terb Aminoinfusion Scalp stimulation C SECTION

Risk factors for ruptured uterus

Pitocin Aminoinfusion Past c-section and trying to deliver vaginially?