[OB-2]-Chapter 22-Birth-Related Procedures

The nurse is reviewing charts of clients who underwent cesarean births by request in the last two years. The hospital is attempting to decrease costs of maternity care. What findings contribute to increased health care costs in clients undergoing cesarean birth by request? 1. Increased abnormal placenta implantation in subsequent pregnancies 2. Decreased use of general anesthesia with greater use of epidural anesthesia 3. Prolonged anemia, requiring blood transfusions every few months 4. Coordination of career projects of both partners leading to increased income

Correct Answer: 1 Rationale 1: Placenta implantation problems are more common after cesarean birth, and increase health care costs because of the high risk care and testing required. Rationale 2: Which anesthesia method is used is not a significant factor in health care costs of cesarean birth by request. The need for anesthesia, use of the operating suite, equipment use, personnel, and other factors are more responsible for greater costs of cesarean birth compared with vaginal birth. Rationale 3: This is not a complication of cesarean birth by request. Rationale 4: The income of the couple does not affect health care costs directly.

The nurse knows that contraindications to the induction of labor include: 1. Placenta previa. 2. Isoimmunization. 3. Diabetes mellitus. 4. Premature rupture of membranes.

Correct Answer: 1 Rationale 1: Placenta previa is a contraindication to the induction of labor. Cesarean section is usually the preferred method of delivery for placenta previa. Rationale 2: Isoimmunization is an indication for induction. Rationale 3: Diabetes mellitus is an indication for induction. Rationale 4: Premature rupture of membranes is an indication for induction.

The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed? 1. "Since the scar on my belly goes down from my navel, I am not a candidate for a VBAC." 2. "My first baby was in a breech position, so for this pregnancy, I can try a VBAC if the baby is head-down." 3. "Because my hospital is so small and in a rural area, they won't let me attempt a VBAC." 4. "The rate of complications from VBAC is lower than the rate of complications from a cesarean

Correct Answer: 1 Rationale 1: Skin incision is not indicative of uterine incision. Only the uterine incision is a factor in deciding whether VBAC is advisable. Classical vertical incisions on the uterus have a higher rate of rupture, and VBAC should not be attempted. Rationale 2: Nonrecurring conditions such as any non-vertex presentation might make VBAC a viable option as long as this pregnancy is vertex. Rationale 3: For a VBAC to be safely attempted, a physician who can perform a cesarean must be available throughout active labor. Many small and rural hospitals do not have surgical and anesthesia staff available at night or on weekends and holidays, and therefore do not allow patients to have VBACs. Rationale 4: The incidence of uterine rupture is 0.9%. Women who have a successful VBAC have lower incidences of infection, less blood loss, fewer blood transfusions, and shorter hospital stays.

After being in labor for several hours with no progress, a patient is diagnosed with CPD (cephalopelvic disproportion), and must have a cesarean section. The patient is worried that she will not be able to have any future children vaginally. After sharing this information with her care provider, the nurse would anticipate that the patient would receive what type of incision? 1. Transverse 2. Suprapubic 3. Classic 4. Vertical

Correct Answer: 1 Rationale 1: The lower uterine segment incision most commonly used for cesarean section is the transverse incision. Rationale 2: The suprapubic incision is a type of vertical incision, which is associated with an increased risk of uterine rupture in subsequent pregnancies. Rationale 3: The classic incision is a type of vertical incision, which is associated with an increased risk of uterine rupture in subsequent pregnancies. Rationale 4: The vertical incision is associated with increased risk of uterine rupture in subsequent pregnancies, and so is not commonly used.

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

Correct Answer: 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.

A patient attending a prenatal class asks why episiotomies are performed. The nurse explains that risk factors that predispose women to episiotomies include: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Large or macrosomic fetus. 2. Use of forceps. 3. Shoulder dystocia. 4. Maternal health. 5. Shorter second stage.

Correct Answer: 1,2,3 Rationale 1: A large fetus places a woman at risk for an episiotomy to prevent lacerations. Rationale 2: Forceps delivery can damage the perineum, and an episiotomy may be performed to enlarge the opening for the fetus. Rationale 3: To enlarge the opening of the perineum to afford the traction placed on the fetus, an episiotomy may be performed. Rationale 4: Current research indicates that there are no maternal advantages in performing routine episiotomy. Rationale 5: There are no scientific data that episiotomies yield a shorter second stage.

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: Note: Credit will be given only if all correct choices and no incorrect choices are selected. 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 Rationale 1: Amniotomy is the artificial rupture of the amniotic membranes and can be used to induce labor. Rationale 2: Amniotomy can be done to augment labor. Rationale 3: Amniotomy allows access to the fetus in order to apply an internal fetal electrode to the fetal scalp. Rationale 4: Applying an external fetal monitor does not require an amniotomy. Rationale 5: Amniotomy may be performed during labor to allow an intrauterine pressure catheter to be inserted.

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: Note: Credit will be given only if all correct choices and no incorrect choices are selected. 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 Rationale 1: When the placenta completely covers the uterine opening, a cesarean is performed. Rationale 2: Premature separation of the placenta from the uterine wall requires an immediate cesarean. Rationale 3: A prolapsed cord is an emergency requiring an immediate cesarean. Rationale 4: Precipitous labor does not require a cesarean section. Rationale 5: Failure to progress can necessitate a cesarean birth.

The patient is undergoing an emergency cesarean birth for fetal bradycardia. The patient's partner has not been allowed into the operating room. What can the nurse do to alleviate the partner's emotional distress? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Allow the partner to wheel the baby's crib to the newborn nursery. 2. Take digital pictures of the newborn and show them to the partner. 3. Have the partner wait in the patient's postpartum room. 4. Encourage the partner to be in the nursery for the initial assessment. 5. Teach the partner how to take the patient's blood pressure.

Correct Answer: 1,2,4 Rationale 1: Effective measures include allowing the partner to take the baby to the nursery. Rationale 2: Effective measures include taking digital pictures for the partner to view until the baby is stable. Rationale 3: When the partner cannot be present at the birth, he often feels left out, disappointed, or fearful. Rationale 4: Effective measures include encouraging the partner to be present for the initial assessment. Rationale 5: The nurse must take the blood pressure as part of assessing the patient.

The nurse knows that the Bishop scoring system for cervical readiness includes cervical dilatation, consistency, position, and: Note: Credit will be given only if all correct choices and no incorrect choices are selected. 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 Rationale 1: Fetal station is one of the components evaluated by the Bishop scoring system. Rationale 2: Fetal lie is not one of the components evaluated by the Bishop scoring system. Rationale 3: The presenting part is not one of the components evaluated by the Bishop scoring system. Rationale 4: Cervical effacement is one of the components evaluated by the Bishop scoring system. Rationale 5: Cervical consistency is one of the components evaluated by the Bishop scoring system

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.

The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The provider requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth? 1. Elation, euphoria, and talkativeness 2. A sense of failure and self-disappointment 3. Questions about whether or not to circumcise 4. Uncertainty surrounding the baby's name

Correct Answer: 2 Rationale 1: Elation euphoria, and talkativeness are expected after birth. Rationale 2: Clients who participate in childbirth classes that stress the normalcy of birth often feel as though they have failed the class if an intervention is used during their labor or birth. Rationale 3: Decisions on circumcision and naming are often encountered after birth, and are not correlated with the use of intervention. Rationale 4: Decisions on circumcision and naming are often encountered after birth, and are not correlated with the use of intervention.

The physician has determined the need for forceps. The nurse should explain to the patient that the use of forceps is indicated: 1. Because her support person is exhausted. 2. Due to premature placental separation. 3. To shorten the first stage of labor. 4. To prevent fetal distress.

Correct Answer: 2 Rationale 1: Exhaustion of the support person is not an indication for use of forceps. Rationale 2: Forceps are applied during the second stage of labor. Indications for the use of forceps include premature placental separation, nonreassuring fetal heart rate, and the need to shorten the second stage of labor in cases of maternal exhaustion or regional anesthesia. Rationale 3: Indications for the use of forceps include the need to shorten the second (not the first) stage of labor in cases of maternal exhaustion or regional anesthesia. Rationale 4: Indications for the use of forceps include premature placental separation and a nonreassuring fetal heart rate. Using forceps does not prevent fetal distress.

The need for forceps has been determined. The patient's cervix is dilated to 10 cm, and the fetus is at +2 station. What category of forceps application would the nurse anticipate? 1. Input 2. Low 3. Mid 4. Outlet

Correct Answer: 2 Rationale 1: Input is not a term associated with the use of forceps. Rationale 2: Low forceps are applied when the leading edge of the fetal head is at +2 station. Rationale 3: Midforceps are applied when the fetal head is engaged. Rationale 4: Outlet forceps are applied when the fetal skull has reached the perineum.

The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring patient who will have a forceps delivery. Which action or assessment finding requires intervention? 1. Regional anesthesia is administered via pudendal block. 2. The patient is instructed to push between contractions. 3. Fetal heart tones are consistently between 110 and 115. 4. The patient's bladder is emptied using a straight catheter.

Correct Answer: 2 Rationale 1: Regional anesthesia is important to facilitate application of the forceps and cooperation with pushing efforts. Rationale 2: The patient should push only during contractions, not between contractions. Rationale 3: These are normal fetal heart tones. No intervention is needed. Rationale 4: The urinary bladder is emptied to prevent the full bladder from impeding descent of the fetal head.

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 obstetrician opts to use a vacuum extractor for a delivery. The nurse understands that: 1. There is little risk with vacuum extraction devices. 2. There should be further fetal descent with the first two pulls. 3. Traction is applied between contractions. 4. The woman often feels increased discomfort during the procedure.

Correct Answer: 2 Rationale 1: The risk of complications rises with the use of a vacuum extraction device. Rationale 2: There should be further descent with the first two pulls on the vacuum extractor, which will indicate there is nothing holding the fetus back. Rationale 3: Traction should be applied with contractions to maximize the effort. Rationale 4: The woman often feels only slight pressure during a vacuum extraction if she has adequate regional anesthesia.

The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance? 1. "A small cup will be put onto the baby's head, and a gentle suction will be applied." 2. "I can stop pushing and just rest if the vacuum extractor is used." 3. "The baby's head might have a bruise from the vacuum cup." 4. "The vacuum will be applied for a total of ten minutes or less."

Correct Answer: 2 Rationale 1: The vacuum extractor is a small cup-shaped device that is applied to the scalp. Rationale 2: Vacuum extraction is an assistive delivery, and the client must continue with pushing efforts to accomplish the birth. Rationale 3: The vacuum extractor might leave a bruise on the scalp where the device is placed. Rationale 4: The vacuum extractor is applied to the scalp for up to ten minutes total.

The nurse is developing a care plan for a newly delivered mother who had a forceps delivery. Which nursing diagnosis is appropriate for a postpartal mother with lacerations from a forceps delivery? 1. Alteration in Body Image related to scar formation 2. High Risk for Infection related to lochia and decreased perineal and birth canal integrity 3. Alteration in Nutrition: more than body requirements related to increased appetite 4. Self-care Deficit related to poor opportunity for independence

Correct Answer: 2 Rationale 1: While the mother might have concerns about eventual scar formation, this is not a priority. Rationale 2: This nursing diagnosis is appropriate for this patient. Rationale 3: Alteration in Nutrition is not related to the problem of lacerations in the postpartal period. Rationale 4: Self-care Deficit is not related to the problem of lacerations in the postpartal period.

Under which circumstances would the nurse remove prostaglandin from the patient's cervix? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Contractions every 5 minutes 2. Nausea and vomiting 3. Late decelerations 4. Contractions every 90 seconds 5. Baseline fetal heart rate of 140-148

Correct Answer: 2,3,4 Rationale 1: Contractions every 5 minutes are consistent with the plan of induction. Rationale 2: A main reason to remove prostaglandin from a patient's cervix is the presence of nausea and vomiting. Rationale 3: A main reason to remove prostaglandin from a patient's cervix is the presence of late decelerations. Rationale 4: A main reason to remove prostaglandin from a patient's cervix is hyperstimulation of contractions. Rationale 5: This is a good heart rate and would not warrant removing the prostaglandin.

In which clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. 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 Rationale 1: It is not appropriate to perform amnioinfusion if there has been an abruption. Rationale 2: The healthcare practitioner may order amnioinfusion for meconium-stained fluid. Rationale 3: The patient already has too much fluid and does not need more. Rationale 4: Amnioinfusion is sometimes done for late decelerations to prevent cord compression. Rationale 5: Amnioinfusion is not done for early decelerations.

A patient at 40 weeks' gestation is to undergo stripping of the membranes. The nurse provides the patient with information about the procedure. Which information is accurate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Intravenous administration of oxytocin will be used to initiate contractions. 2. The healthcare provider will insert a gloved finger into the cervical os and rotate the finger 360 degrees. 3. The procedure will not cause discomfort, and is usually effective. 4. Labor should begin within 24-48 hours after the procedure. 5. Uterine contractions, cramping, and a bloody discharge can occur after the procedure.

Correct Answer: 2,4,5 Rationale 1: Oxytocin is not used at this time. It may be used later if stripping of membranes is not effective. Rationale 2: This motion separates the amniotic membranes that are lying against the lower uterine segment and internal os from the distal part of the lower uterine segment. Rationale 3: The procedure does produce discomfort, and is not 100% effective. Rationale 4: If labor is initiated, it typically begins within 24-48 hours. Rationale 5: Uterine contractions, cramping, and bloody discharge can occur after the procedure.

The nurse is monitoring a patient who is receiving an amnioinfusion. Which assessments must the nurse perform to prevent a serious complication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Color of amniotic fluid 2. Maternal blood pressure 3. Cervical effacement 4. Uterine resting tone 5. Fluid leaking from the vagina

Correct Answer: 2,4,5 Rationale 1: The color of the amniotic fluid is not a critical assessment. Rationale 2: Blood pressure should be monitored along with other vital signs. Rationale 3: Cervical effacement is not directly related to the amnioinfusion. Rationale 4: The uterine resting tone should be carefully monitored with an internal pressure electrode. Rationale 5: The nurse should continually check to make sure the infused fluid is being expelled from the vagina so it does not build up in the uterus and cause rupture.

The patient requires vacuum extraction assistance. To provide easier access to the fetal head, the physician cuts a mediolateral episiotomy. After delivery, the patient asks the nurse to describe the episiotomy. The nurse responds, "The episiotomy: 1. "Goes straight back toward your rectum." 2. "Is from your vagina toward the urethra." 3. "Is cut diagonally away from your vagina." 4. "Extends from your vagina into your rectum."

Correct Answer: 3 Rationale 1: A midline episiotomy is straight back from the vagina toward the rectum. Rationale 2: Episiotomies are not cut anteriorly toward the urethra unless the patient has had a female circumcision. Rationale 3: A mediolateral episiotomy is angled from the vaginal opening toward the buttock. Rationale 4: Extension into the rectum is a fourth-degree laceration.

The nurse has received an order to rupture a patient's membranes artificially. Which finding in the patient's history would lead the nurse to question the order? 1. Group B strep negative yesterday 2. HbsAg negative at 28 weeks 3. HIV-positive X 3 years 4. History of genital herpes

Correct Answer: 3 Rationale 1: Artificial rupture of the membranes increases the incidence of chorioamnionitis. Group B strep negative findings yesterday decrease the risk of infection. Artificial rupture of the membranes is appropriate for this patient. Rationale 2: Artificial rupture of the membranes increases the incidence of perinatal transmission of hepatitis B. This patient is negative for hepatitis B; therefore, artificial rupture of the membranes is appropriate for this patient. Rationale 3: Artificial rupture of the membranes increases the incidence of perinatal transmission of HIV, and should not be undertaken in HIV/AIDS-positive women. Rationale 4: A history of genital herpes does not indicate that the patient is currently experiencing an outbreak. Artificial rupture of the membranes is appropriate for this patient.

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

Correct Answer: 3 Rationale 1: Maternal vital signs do not affect the decision to perform an amniotomy. Rationale 2: Fetal birth weight does not affect the decision to perform an amniotomy. Rationale 3: 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. Rationale 4: Biparietal diameter does not affect the decision to perform an amniotomy.

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.

A patient is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (VBAC) with this pregnancy. Which statement indicates that the patient requires more information about VBAC? 1. "I can try a vaginal birth because my uterine incision is a low segment transverse incision." 2. "The vertical scar on my skin doesn't mean that the scar on my uterus goes in the same direction." 3. "There is about a 90% chance of giving birth vaginally after a cesarean." 4. "Because my hospital has a surgery staff on call 24 hours a day, I can try a VBAC there."

Correct Answer: 3 Rationale 1: Only low segment transverse uterine incisions are recommended for attempting a VBAC. Rationale 2: Abdominal skin incisions and uterine incisions are not always the same. Rationale 3: The highest success rates for VBAC are 60% to 80%, and occur among women whose previous cesarean was performed because of nonrecurring indications. Rationale 4: VBAC should be attempted only in facilities that have 24-hour coverage of operating room staff and anesthesia.

The patient is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the patient asks for another. The best response from the nurse is: 1. "I'll get you one right away." 2. "You only need to use one ice pack." 3. "You need to leave it off for at least 20 minutes and then reapply." 4. "I'll bring you an extra so that you can change it when you are ready."

Correct Answer: 3 Rationale 1: Providing an additional ice pack before 20 minutes have passed would increase the perineal edema. Rationale 2: More than one ice pack must be used in order to apply ice for 20 minutes on followed by 20 minutes off. Rationale 3: Optimal effects from the use of an ice pack occur when it is applied for 20-30 minutes and then removed for at least 20 minutes before being reapplied. Rationale 4: An ice pack that is provided now for use in 20 minutes would melt before being used.

The nurse is teaching childbirth education classes. Teaching has been successful if the primiparous patient states: "I can reduce the likelihood that I'll tear or need an episiotomy if I: 1. "Push in a semi-sitting position." 2. "Make sure I push long and hard." 3. "Begin regular perineal massage." 4. "Pull back on my legs when pushing."

Correct Answer: 3 Rationale 1: The semi-sitting or lithotomy position increases the likelihood of perineal lacerations. Rationale 2: Short pushes during the expulsion of the head decrease the likelihood of perineal lacerations. Rationale 3: Perineal massage has been shown to decrease the need for episiotomy in primiparous patients. Rationale 4: Pulling back on the legs while pushing tightens the perineal tissue, which in turn increases the likelihood of perineal lacerations.

The patient demonstrates understanding of the implications for future pregnancies secondary to her classic uterine incision when she states: 1. "The next time I have a baby, I can try to deliver vaginally." 2. "The risk of rupturing my uterus is too high for me to have any more babies." 3. "Every time I have a baby, I will have to have a cesarean delivery." 4. "I can only have one more baby."

Correct Answer: 3 Rationale 1: This patient will not be able to deliver vaginally in future pregnancies. Rationale 2: There could be a risk if the patient were allowed to labor with the next pregnancy. Rationale 3: A classic uterine incision is made in the upper uterine segment and is associated with an increased risk of rupture in subsequent pregnancy, labor, and birth. Therefore, subsequent deliveries will be done by cesarean. Rationale 4: The number of subsequent pregnancies is not limited to one.

The patient has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal? 1. The head is delivered after eight pulls during contractions. 2. A bruise is present on the occiput that does not cross the suture line. 3. The location of the vacuum is apparent on the fetal scalp after birth. 4. Positive pressure is applied by the vacuum extraction during contractions.

Correct Answer: 3 Rationale 1: Use of the vacuum extraction for eight contractions is too many, and can damage the fetal head. Rationale 2: This is a cephalhematoma, a complication of vacuum extraction birth. Rationale 3: Caput in the shape of the vacuum cup is usually present immediately after birth, and resolves in 2-3 days. Rationale 4: Negative pressure is suction, which is needed to facilitate the birth.

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: Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: 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 Rationale 1: This is not a contraindication for version. Rationale 2: Preterm gestation is not a contraindication to version. Rationale 3: An abnormal fetal heart rate or tracing would be a contraindication to performing a version. Rationale 4: A previous cesarean is a contraindication for version. Rationale 5: Rupture of membranes is a contraindication for version because of insufficient amniotic fluid.

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.

Correct Answer: 4 Rationale 1: An internal fetal monitor cannot be applied until adequate cervical dilatation has occurred. Rationale 2: The patient should void before insertion of the prostaglandin gel. The patient should void on her own and not need a catheter. Rationale 3: Until labor begins, there is no rationale for withholding all intake. Rationale 4: It is recommended the patient stay in bed for only 1 hour.

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.

Correct Answer: 4 Rationale 1: Early decelerations require no intervention. Rationale 2: Moderate is not a descriptor used to identify decelerations. Rationale 3: Late decelerations are consistent with head compression. Amnioinfusion does not relieve head compression. Rationale 4: Amnioinfusion can be used when cord compression is presenting as variable decelerations.

The nurse is completing discharge teaching for a patient who delivered 2 days ago. Which statement by the patient indicates that further information is required? 1. "Because I have a midline episiotomy, I should keep my perineum clean." 2. "Soaking in the tub will help my mediolateral episiotomy to heal." 3. "I can take ibuprofen (Motrin) when my perineum starts to hurt." 4. "The tear I have through my rectum is unrelated to my episiotomy."

Correct Answer: 4 Rationale 1: Perineal hygiene is important when a patient has an episiotomy, to prevent infection and facilitate healing. Rationale 2: Warm tub baths are helpful to facilitate both comfort and healing of an episiotomy. Rationale 3: Healing episiotomies can be very painful, and pain medication should be provided for patients experiencing pain. Rationale 4: This statement is incorrect. Midline episiotomies tend to tear posteriorly toward the rectum.

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

Correct Answer: 4 Rationale 1: Suspected placenta previa is a contraindication to labor induction. Rationale 2: Suspected breech presentation is a contraindications to labor induction. Rationale 3: Prolapsed umbilical cord is a contraindications to labor induction. Rationale 4: A client with hypertension is appropriate for labor induction.

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 Rationale 1: The supine position would not cause an abnormality in maternal temperature. Rationale 2: The supine position would not cause an abnormality in maternal urine output. Rationale 3: There is no indication that a vaginal exam should be performed. Rationale 4: Fetal heart tones are assessed just before the start of surgery because the supine position can lead to fetal hypoxia.

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.

A laboring patient's obstetrician has suggested amniotomy as a method for creating stronger contractions and facilitating birth. The patient asks, "What are the advantages of doing this?" What should the nurse cite in response? 1. Contractions elicited are similar to those of spontaneous labor. 2. Amniotomy decreases the chances of a prolapsed cord. 3. Amniotomy reduces the pain of labor and makes it easier to manage. 4. The patient will not need an episiotomy.

Correct Answer: 1 Rationale 1: Contractions after amniotomy are similar to those of spontaneous labor. Rationale 2: A disadvantage of amniotomy is the increased chance of prolapsed cord, especially if the fetal presenting part is not well applied against the cervix. Rationale 3: A disadvantage of amniotomy is that it can increase pain and make labor more difficult to manage. Rationale 4: There is no correlation between amniotomy and episiotomy.