OB 2
A woman is admitted to a labor unit in active labor. Which assessment would alert you to the possibility that she may have difficulty accepting this child?
"I want this baby to be a boy."
A woman's primary care provider has told her he wants to use an episiotomy for birth. She asks the nurse what the purpose of this is. Which answer would be best?
"It relieves pressure on the fetal head."
A woman refuses to have an epidural block because she does not want to have a spinal headache after birth. What would be the nurse's best response?
"Spinal headache is not a usual complication of epidural blocks."
The nurse realizes the educational session conducted on due dates was successful when a participant is overheard making which statement? "The ability of my amniotic fluid to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." "The ability of my umbilical cord to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." "The ability of my body to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be increased." "The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised."
"The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised."
An experienced nurse is mentoring a graduate nurse and critiquing the graduate's shift handoff. Which statement requires clarification?
"The client reports a pain level of 8. She has a low pain tolerance."
The spouse of a pregnant patient is concerned about the risk of paralysis from an epidural block being used during labor. How should the nurse respond to the spouse's concern?
"The injection is given in the space outside the spinal cord."
During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used.
(-4); (-2); (0); (2); (4)
A low-risk client is in the active phase of labor. The nurse evaluates the fetal monitor strip at 10:00 a.m. and notes the following: moderate variability, FHR in the 130s, occasional accelerations, and no decelerations. At what time should the nurse reevaluate the FHR?
10:30 a.m.
The nurse is assessing a new client who presents in early labor. The nurse determines the fetus has an acceptable heart rate if found within which range?
110 to 160 bpm
The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh: 4,000 g or more. 3,500 g or more. 4,500 g or more. 3,000 g or more. 4,000 g or more.
4,000 g or more
A woman is in labor with her second child. She knows that she will want epidural anesthesia, and she has already signed her consent form. What must the nurse do before the woman receives the epidural?
Administer a fluid bolus through the IV line to reduce the risk of hypotension
The nurse is monitoring a client who just received IV sedation. Which instruction should the nurse prioritize with the client and her partner?
Ambulate only with assistance from the nurse or caregiver
A primigravida client has just arrived in early labor and is showing signs of extreme anxiety over the birthing process. Why should the nurse prioritize helping the client relax?
Anxiety can slow down labor and decrease oxygen to the fetus
A pregnant patient planning for labor is asking questions about pain control options. What should the nurse explain about pain control during labor?
Any medication should have maximum effect for the patient and minimal effect on the fetus
A primigravida client in the second stage of labor has been moaning, screaming, and generally vocal throughout her labor. Her husband is distraught seeing his wife this way and asks the nurse for more pain medication for her. What is the nurse's best response?
Ask the client to describe the intensity of her pain on a scale of 0 to 10
During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor?
Assess amount of cervical dilation
As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next?
Assess fetal heart rate for fetal safety
A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first?
Assess for labor progression
A client has just received combined spinal epidural. Which nursing assessment should be performed first?
Assess vital signs
A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels lightheaded and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform?
Assist the client to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask.
A primigravida client admitted with signs of labor is evaluated with external electronic fetal monitoring that shows baseline FHR of 136 to 150 and two instances of FHR at 165 for 15 to 20 seconds. Which response should the nurse prioritize?
Before reporting to the RN, determine the uterine contraction pattern
The nurse is monitoring a laboring client with continuous fetal monitoring and notes a decrease in FHR with variable deceleration to 75 bpm. Which intervention should the nurse prioritize?
Change the position of the client
A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture?
Clear to straw-colored fluid
The nurse is caring for a laboring client. The nurse observes that there are early decelerations. The fetal heart rate remains within normal limits with adequate variability. What is the nurse's best action?
Continue to monitor the client and the FHR
The nurse is preparing a young couple for the upcoming birth of their child, and the mother expresses concern for needing pain medications and the effects on the fetus. When counseling the couple about pain relief, the nurse would incorporate which information in the teaching about measures to help to decrease the requests for pain medication?
Continuous support through the labor process helps decrease the need for pain medication
A patient in labor is prescribed transcutaneous electrical nerve stimulation (TENS) to help with pain relief during labor. How should the nurse explain the process of pain relief with this method?
Counterirritation stimulation blocks pain from traveling to the spinal cord
When entering the second phase of labor, a patient tells the nurse that the pain is severe and is unsure if pain medication should be used. Which nursing diagnosis should the nurse use to guide the care of the patient at this time?
Decision conflict related to the use of analgesia during labor
A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using?
Effleurage
Transcutaneous electrical nerve stimulation (TENS) reduces pain by which of the following mechanisms?
Electrical impulses are created that interfere with nerve transmission
A client presents to the birthing center in labor. The client's membranes have just ruptured. Which assessment is the nurse's priority?
FHR
While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents?
FHR fluctuates from 6 to 25 beats per minute
The nurse is performing Leopold's maneuvers as part of the initial assessment. Which action would the nurse do first?
Feel for the fetal buttocks or head while palpating the abdomen
How does a woman who feels in control of the situation during labor influence her pain?
Feelings of control are inversely related to the client's report of pain
The nurse is admitting a client who is in early labor. After determining that the birth is not imminent, which assessment should the nurse perform next?
Fetal status
The nurse is teaching gavage feedings to the mother of a preterm infant. Which instruction is most important? Amount of feeding Expelling of gas Gastric residual present Quantity of bowel movement
Gastric residual present
The health care provider is reluctant to provide pain medication to a patient delivering a preterm fetus. What should the nurse explain to the patient as the reason for the preterm fetus being more affected by medication?
Inability of the immature liver to metabolize or inactivate drugs
The nurse is assisting a client through labor, monitoring her closely now that she has received an epidural. Which finding should the nurse prioritize to the anesthesiologist?
Inability to push
Immediately after birth, a preterm infant is placed in a radiant heat warmer. For which nursing diagnosis is this intervention addressing? Ineffective thermoregulation related to immaturity Risk for imbalanced nutrition, less than body requirements Risk for deficient fluid volume related to insensible water loss Impaired gas exchange related to immature pulmonary functioning
Ineffective thermoregulation related to immaturity
A G2 P1 client, at 37 weeks' gestation, arrives to the unit and announces, "I am pretty sure my water broke about half an hour ago." What action should the LPN prioritize for this client while checking her in?
Inform the RN that your client may have ruptured membranes
A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing?
Inhale slowly through nose and exhale through pursed lips
A pregnant client has opted for hydrotherapy for pain management during labor. Which measure should the nurse consider when assisting the client during the birthing process?
Initiate the technique only when the client is in active labor
A multigravida client admitted in active labor has progressed well and the client ane fetus have remained in good condition. Which action should the nurse prioritize if the client suddenly shouts out, "The baby is coming!"?
Inspect the perineum
Why should a woman be cautioned against taking acetylsalicylic acid (aspirin) to relieve pain in labor?
Interference with blood coagulation with increased risk of bleeding in mother or infant
The nurse is monitoring a client who has given birth and is now bonding with her infant. Which finding should the nurse prioritize and report immediately for intervention?
Maternal tachycardia and falling blood pressure
The nurse is admitting a client in early labor and notes: FHR 120 bpm, blood pressure 126/84 mm Hg, temperature 98.8oF, contractions every 4 to 5 minutes lasting 30 seconds, and greenish-color fluid in the vaginal vault. Which finding should the nurse prioritize?
Meconium in the fluid
A 29-week-gestation client is admitted with moderate vaginal discharge. The nurse performs a nitrazine test to determine if the membranes have ruptured. The nitrazine tape remains yellow to olive green, with pH between 5 and 6. What should the nurse do next?
Notify the health care provider
A client has been showing a gradual increase in FHR baseline with variables; however, after 5 hours of labor and several position changes by the client, the fetus no longer shows signs of hypoxia. The client's cervix is almost completely effaced and dilated to 8 cm. Which action should the nurse prioritize if it appears the fetus has stopped descending?
Palpate the area just above the symphysis pubis
A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage?
Practicing effleurage on the abdomen
The nursing instructor is teaching a group of nursing students about the various responsibilities of the labor and delivery medical team. The instructor determines the session is successful when the students correctly choose which function as the primary role of the LPN/LVN members of the team?
Provide care under the supervision of an RN
The nurse is preparing materials to instruct a pregnant patient about the use of a local anesthetic to block specific nerve pathways. About which type of pain reduction technique will the nurse instruct the patient?
Regional anesthesia
A nurse is caring for a preterm newborn who has developed rapid, irregular respirations with periods of apnea. Which additional assessment finding should the nurse identify as an indication of respiratory distress syndrome (RDS)?" Deep inspiration Expiratory lag Sternal retraction Inspiratory grunt
Sternal retraction
A client and her husband have prepared for a natural birth; however, as the client progresses to 8 cm dilation, she can no longer endure the pain and begs the nurse for an epidural. What is the nurse's best response?
Support the client's decision and call the obstetrician
Which sign appears early in a neonate with respiratory distress syndrome? Bilateral crackles Pale gray skin color Tachypnea more than 60 breaths/minute Poor capillary filling time (3 to 4 seconds)
Tachypnea more than 60 breaths/minute
When planning a labor experience for a primigravid, understanding which characteristic of labor pain is most helpful?
The characteristics of labor pain follow a pattern
When developing a labor plan with the client, which outcome is the priority?
The client will direct her pain management techniques
Which possible outcome would be a major disadvantage of any pain relief method that also affects awareness of the mother?
The mother may have difficulty working effectively with contractions
A one-day-old neonate born at 32 weeks' gestation is in the neonatal intensive care unit under a radiant overhead warmer. The nurse assesses the morning axilla temperature as 95 degrees F (35 degrees C). What could explain the assessment finding? Conduction heat loss is a problem in the baby. The supply of brown adipose tissue is not developed. Axillary temperatures are not accurate. This is a normal temperature.
The supply of brown adipose tissue is not developed
The nurse instructs the client about skin massage and the gate-control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?
This is a technique to prevent the painful stimuli from entering the brain
The client in labor at 3 cm dilation and 25% effaced is asking the nurse for analgesia. Which explanation should the nurse provide when explaining why it is too early to administer an analgesic?
This may prolong labor and increase complications
Immediately following an epidural block, a pregnant patient's blood pressure suddenly falls to 90/50 mmHg. What action should the nurse take first?
Turn onto the left side or raise the legs
There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain?
Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience.
The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction?
acme
A preterm infant is experiencing cold stress after birth. For which symptom should the nurse assess to best validate the problem? shivering hyperglycemia apnea metabolic alkalosis
apnea
The nurse examines a 26-week-old premature infant. The skin temperature is lowered. What could be a consequence of the infant being cold?apnea tachycardia sleepiness crying apnea
apnea
The nurse is providing preoperative care for a client who will undergo a cesarean section. The nurse should:
confirm that consent has been provided by the client
A woman received morphine during labor to help with pain control. Which finding would the nurse need to monitor the newborn for after birth?
decreased alertness
A nurse notes a pregnant woman has just entered the second stage of labor. Which interaction should the nurse prioritize at this time to assist the client?
encouraging the woman to push when she has a strong desire to do so
The nurse is caring for a client who is considered low-risk and in active labor. During the second stage, the nurse would evaluate the client's FHR at which frequency?
every 15 minutes
A pregnant client at 32-week gestation has been admitted to a health care center reporting decreased fetal movement. Which fetal structure should the nurse determine first before auscultating the fetal heart sounds?
fetal back
The nurse is monitoring a client's uterine contractions. Which factors should the nurse assess to monitor uterine contraction? Select all that apply.
frequency, intensity, and uterine resting tone
The nurse is teaching a group of parents who have preterm newborns about the differences between a full-term newborn and a preterm newborn. Which characteristic would the nurse describe as associated with a preterm newborn but not a term newborn? fewer visible blood vessels through the skin more subcutaneous fat in the neck and abdomen well-developed flexor muscles in the extremities greater surface area in proportion to weight
greater surface area in proportion to weight
A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia?
headache following anesthesia
During the assessment of a woman in labor, the nurse explains that certain landmarks are used to determine the progress of the birth. The nurse identifies which area as one of these landmarks?
ischial spine
A nurse is assessing a preterm newborn. The nurse determines that the newborn is comfortable and without pain based on which finding? lack of body posturing sudden high-pitched cry increased muscle tone fussiness
lack of body posturing
Early in labor, a pregnant client asks why contractions hurt so much. Which answer should the nurse provide?
lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels
A client in labor has administered an epidural anesthesia. Which assessment findings should the nurse prioritize?
maternal hypotension and fetal bradycardia
A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication?
naloxone
The newborn nursery nurse is admitting a small-for-gestational-age (SGA) infant and is reviewing the maternal history. What factor in maternal history would the nurse correlate as a risk factor for an SGA infant? placental factors blood group incompatibility grand multiparity age of 30 years
placental factors
The injection of a local anesthetic to block specific nerve pathways is referred to as
regional block
A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client?
respiratory depression
A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next?
respiratory rate
The health care provider is evaluating a high-risk woman for a continuous internal monitoring. It would be most appropriate to meet which criterion?
rupture of membranes
What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client?
starting an IV and hanging IV fluids
A nurse is assessing a postterm newborn. Which finding would the nurse correlate with this gestational age variation? moist, supple, plum skin appearance abundant lanugo and vernix thin umbilical cord absence of sole creases
thin umbilical cord
A nurse is caring for a client who has had a cesarean birth with general anesthesia. The nurse would assess the woman closely for which possible complication?
uterine atony