OB exam 2

A client is admitted to the labor and birthing suite in early labor. On review of her prenatal history, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal birth. Which pelvic shape would the nurse have noted?

gynecoid

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

A woman who has had a cesarean birth asks you if she will always need to have cesarean births in the future. Which of the following would be your best response?

"Although there are some exceptions, surgical techniques allow for vaginal birth after cesarean birth."

android pelvis

male pelvis

A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give?

"It distracts your brain from the sensations of pain."

A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse?

"The injection is given in the space outside the spinal cord."

During which time is the nurse correct to document the end of the third stage of labor?

At the time of placental delivery

A patient who has been in labor for 20 hours is being prepared for an emergent cesarean birth. Which action will help ensure the patient's fluid status during the procedure?

IV fluid therapy

Which of the following would be a danger signal of labor for a woman in labor?

Meconium-stained amniotic fluid

A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse prepares the client for this monitoring based on the understanding that which criterion must be present?

cervical dilation of at least 2 cm

Which action is a priority when caring for a woman during the fourth stage of labor?

checking the fundus

The nurse is providing preoperative care for a client who will undergo a cesarean section. The nurse should:

confirm the consent has been provided

Patterned breathing techniques used in labor provide which benefits? Select all that apply.

conscious relaxation -pain relief without special tools -distraction

Which consideration is a priority when caring for a mother with strong contractions 1 minute apart?

fetal heart rate in relation to contractions

What term is used to describe the position of the fetal long axis in relation to the long axis of the mother?

fetal lie

A nursing student correctly identifies which of the following as the most important predictor of fetal maturity:

fetal lung maturity

false pelvis

flatter upper portion of the bony pelvis -part of the bony passageway

During a spontaneous vaginal birth several things need to occur to the fetus in sequence. As the fetus encounters resistance, what is its usual reaction?

flexion

effleurage may help her manage the pain. This indicates that the nurse will

instruct the client or her partner to perform light fingertip repetitive abdominal massage.

A woman is told she has an anthropoid pelvis. This means her pelvis:

is narrow transversely.

After pelvic measurements, a patient who is 20 weeks' pregnant is informed that the diagonal conjugate diameter is narrow. For which component of labor should the nurse plan care to address this?

passageway

A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time?

push with contractions and rest between them

The nurse notes that the client has a moderate amount of bleeding after birth. Which instruction is anticipated to control bleeding?

put the newborn on the breast to suck

To prevent tearing of the perineum of a client during birth, a physician performs a mediolateral episiotomy. The nurse recognizes that an advantage of a mediolateral episiotomy over a midline episiotomy is which of the following?

reduce the risk of rectal mucosal tear

Which assessment finding in a client reporting uterine contractions would be most consistent as an indicator of approaching labor?

rupture of membranes

Which finding would the nurse expect in a neonate who is born with the assistance of a vacuum extractor?

scalp edema

A pregnant patient in labor is being encouraged to push with contractions. In which position should the nurse assist to help the patient at this time?

semi fowlers with legs bent against the abdomen

When developing a labor plan with the client, which outcome is the priority?

the patient is able to direct their pain control methods

A client has just given birth to a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent?

third stage of labor

A nursing student is studying labor and delivery and has learned that the first stage of labor consists of which of the following phases? Select all that apply.

transition active latent

It was once thought that an episiotomy made the birth less painful and heal faster than a spontaneous laceration of the perineum. Research has not shown these assumptions to be true. What is another finding in the research on episiotomies?

increases the risk of blood loss after delivery

A woman is about to go for her first cesarean delivery and asks the nurse what complications can come from this type of delivery. The nurse correctly identifies which of the following as the number one complication of cesarean delivery?

infection

The nurse is instructing a primipara who has concerns about the need for a cesearan section due to her sister's obstetrical history. Which statement by the client needs further instruction?

"My sister had a cesarean section with the first and then needs it for all subsequent pregnancies."

A nurse is monitoring a client during the second stage of labor. Which finding in the mother should cause concern for the nurse?

A rise in systolic blood pressure of 30 mm Hg with each contraction

The labor nurse reports to the nurse on the oncoming shift, "The woman in labor room 2 is handling her pain very well. She smiles whenever I go in to talk to her, and she doesn't complain at all!" What assessment by the oncoming labor nurse would best reveal if the off-going labor nurse's observations were correct?

Asking the woman to describe her pain and rate it on a scale of 0 to 10

When discussing the advantages and disadvantages of spinal anesthesia with a client in labor, which of the following would the nurse include as a disadvantage?

Lack of sensation of urge to push

qA 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 client may spend the latent phase of the first stage of labor at home unless which occurs?

The client experiences a rupture of membrane

A woman having a cesarean birth will have a low cervical incision. Which of the following would you cite as an advantage?

The skin incision will be just above her pubic hair.

Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia?

difficulty breathing

anthropoid pelvis

elongated in dimensions more narrow compared to gynecoid pelvis

he nurse is assisting a client in labor and delivery and notes the placenta is now delivered. Which documentation should the nurse prioritize?

end of the 3rd stage of labor

A new mother calls the clinic on her fourth day after delivery and reports difficulty urinating and defecating because of the perineal pain. What does the nurse suspect is causing these problems

episiotomy

A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?

every 15 minutes

If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor?

fetal heart rate declining late with contractions and remaining depressed

A patient who had a previous cesarean birth asks the nurse if all future births must occur the same way. Which response should the nurse make to support the 2020 National Health Goals regarding cesarean births?

not if you qualify for a vaginal birth

The practical nursing is evaluating the tracings on the fetal heart monitor. The nurse is concerned that there is a change in the tracings. What should the practical nurse do first?

reposition the woman

When an infant is born by cesarean delivery there is always a risk of complications. What is one of the most common complications to the fetus because of a cesarean delivery?

respiratory distress

During active labor, the nurse observes the patient crying during contractions and not using breathing techniques learned during prenatal classes. Which nursing diagnosis would be appropriate for the patient at this time?

risk for ineffective breathing pattern related to breathing exercises

In providing culturally competent care to a laboring woman, which is a priority?

Identify how the client expresses labor pain

A cesarean delivery is a major surgery and carries with it many risks for complications. The most common complication is infection. At what site is the infection likely to occur?

uterus

A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice?

"I respect your preference whether it is to have medication or not."

The nurse is monitoring a client who is recovering from general anesthesia after an emergent cesarean delivery. Which assessment findings will lead the nurse to predict the client is now developing malignant hyperthermia? Select all that apply.

-Muscle rigidity -Tachycardia and irregular heart rhythms -Decreased oxygen saturation and cyanosis

Which statement is true regarding analgesia versus anesthesia?

Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area

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 nurse notes the digital readings of the electronic fetal monitor shows decreased beat-to-beat variability in a client who was just admitted to the unit. The nurse interprets this as indicating which system is mainly being affected in the fetus?

Central nervous system

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

The obstetrician is examining a woman who is in early labor to determine the positioning of the fetus. The nurse knows that which of the following fetal attitudes would be the most advantageous for birth?

Head flexed forward so much that the chin touches the sternum

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

When teaching the pregnant patient about self-medicating for pain during labor, why did the nurse instruct the patient to avoid taking acetylsalicylic acid (aspirin)?

Interference with blood coagulation with increased risk of bleeding in mother or infant

The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor?

Pain originates from the cervix and lower uterine segment.

When going through the transition phase of labor, women often feel out of control. What do women in the transition phase of labor need the most?

Positive reinforcement

A 24-year-old primigravida has been laboring longer than 24 hours. She has entered the second stage of labor, and the baby is at +2 station. The fetal heart rate has been 90 bpm for the last 2 minutes. The physician applies a Kiwi vacuum; after 3 attempts (pop-offs), the baby is not delivered, and the fetal heart rate is still 90 bpm. What should the nurse do next? Choose the best answer.

Prepare for an emergency cesarean delivery

While monitoring the EFM tracing the nurse notes decelerations with each contraction. The nurse knows that for a deceleration to be classified as early it has to meet three criteria. What is one of these criteria?

The nadir of the deceleration coincides with the acme of the contraction.

On the second day postpartum following a cesarean birth, at which of the following locations would you expect to palpate the woman's fundus?

Two fingers below the umbilicus

Which changes in the female body occur to allow the passage of the fetus down the birth canal? Select all that apply.

Vaginal rugae stretch and smooth out The cervix dilates to 10 cm The cervix softens

A pregnant woman comes to the labor and birth unit in labor. The woman tells the nurse, "Yesterday, I had this burst of energy and cleaned everything in sight, but I don't know why." Which response by the nurse would be most appropriate?

You had a burst of adrenaline, which is common before labor."

The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy?

acupressure

A nursing instructor is teaching students about the labor and delivery process and recognizes a need for further teaching when overhearing a student make which statement?

anxiety can speed up the labor process

A student observing in labor and delivery watches a physician introduce a hard plastic instrument with a hook on the end into the vagina during a digital examination. The physician proceeds to guide the hook to snag a hole into the membranes. This process causes the body to release prostaglandins, which induces labor and is known as which of the following?

artificial rupture of membranes

most favorable shape for vaginal birth

gynecoid pelvis

In the labor and delivery unit, which is the best way to prevent the spread of infection?

hand hygiene

The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best?

the analgesia will limit your pain for a limited period of time

Immediately following an epidural block, a woman's blood pressure suddenly falls to 90/50. The nurse's first action would be to:

turn her on her left side or raise her legs

During the second stage of labor, a woman is generally:

turning inward to focus on body sensations

A patient having a cesarean birth will have a low segment incision. What should the nurse explain to the patient as an advantage for this type of incision?

vaginal deliveries can occur with future births

platypelloid pelvis

very narrow and wide -most unfavorable -difficult vaginal delivery

The nurse has been monitoring the progression of labor for a primipara. At which time is the nurse most correct to prepare for delivery?

when the fetus begins to crown

The nurse is caring for a woman who has had a baby by cesarean birth. Which of the following would be the most important assessment to make?

whether her abdomen is soft or not

A client has opted to receive epidural anesthesia during labor. Which of the following interventions should the nurse implement to reduce the risk of a significant complication associated with this type of pain management

Administration of 500 mL of IV Ringer's lactate

A client in labor has requested the administration of narcotics to reduce pain. At 2 cm cervical dilatation, she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do?

Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor.

A client states that "she thinks" her water has broken. Which best provides confirmation of the rupture of membranes?

a positive Nitrazine test