OB Quiz #9

A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman makes which statement? A. "I'll drink several glasses of water." B. "I'll sit down to rest for 30 minutes." C. "I'll try to move my bowels." D. "I'll lie down with my legs raised."

A. "I'll drink several glasses of water." If the woman experiences any signs and symptoms of preterm labor, she should stop what she is doing and rest for 1 hour, empty her bladder, lie down on her side, drink two to three glasses of water, feel her abdomen and note the hardness of the contraction, and call her health care provider and describe the contraction

A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies because the woman just experienced preterm labor with her most recent pregnancy. The nurse determines that the teaching was successful based on which statement by the woman? A. "I'll make sure to limit the amount of long distance traveling I do." B. "Stress isn't a problem that is related to preterm labor." C. "I'll need extra iron in my diet so I have a extra for the baby." D. "Separating pregnancies by about a year should be helpful."

A. "I'll make sure to limit the amount of long distance traveling I do."

A pregnant woman at 31-weeks' gestation calls the clinic and tells the nurse that she is having contractions sporadically. Which instructions would be most appropriate for the nurse to give the woman? Select all that apply. A. "Stop what you are doing and rest." B. "Drink 2 or 3 glasses of water." C. "Try emptying your bladder." D. "Lie down on your back." E. "Walk around the house for the next half hour."

A. "Stop what you are doing and rest." C. "Try emptying your bladder." B. "Drink 2 or 3 glasses of water."

A nurse is assessing a pregnant woman who has come to the clinic. The woman reports that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman may be experiencing preterm labor based on which additional assessment findings? Select all that apply. A. dysuria B. four to five contractions in 1 hour C. malodorous vaginal discharge D. dull low backache E. constipation

A. dysuria C. malodorous vaginal discharge D. dull low backache Symptoms of preterm labor are often subtle and may include change or increase in vaginal discharge with mucus, water, or blood in it; pelvic pressure; low, dull backache; nausea, vomiting or diarrhea, and intestinal cramping with or without diarrhea

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? A. fetopelvic disproportion B. contraction ring C. a low-lying placenta D. uterine bleeding

A. fetopelvic disproportion

The nurse would be alert for possible placental abruption during labor when assessment reveals which finding? A. gestational hypertension B. gestational diabetes C. low parity D. macrosomia

A. gestational hypertension

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? A. knee-chest B. side-lying C. sitting D. supine

A. knee-chest

A nurse is explaining to a group of nurses new to the labor and birth unit about about methods used for cervical ripening. The group demonstrates understanding of the information when they identify which method as a mechanical one? A. laminaria B. herbal agents C. amniotomy D. membrane stripping

A. laminaria

A pregnant client has received dinoprostone. Following administration of this medication, the nurse assesses the client and determines that the client is experiencing an adverse effect of the medication based on which client report? Select all that apply. A. nausea B. headache C. diarrhea D. tachycardia E. hypotension

A. nausea B. headache C. diarrhea

When assessing several women for possible VBAC, which woman would the nurse identify as being the best candidate? A. one who had a previous cesarean birth via a low transverse incision B. one who has a history of a contracted pelvis C. one who has a vertical incision from a previous cesarean birth D. one who has undergone a previous myomectomy

A. one who had a previous cesarean birth via a low transverse incision

The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? A. shortened B. firm C. posterior position D. closed

A. shortened

The nurse notifies the obstetrical team immediately because the nurse suspects that the pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. Which findings would the nurse most likely assess? Select all that apply. A. significant difficulty breathing B. pulmonary edema C. hypertension D. tachycardia E. bleeding with bruising

A. significant difficulty breathing B. pulmonary edema D. tachycardia E. bleeding with bruising The clinical appearance is varied, but most women report difficulty breathing. Other symptoms include hypotension, cyanosis, seizures, tachycardia, coagulation failure, disseminated intravascular coagulation, pulmonary edema, uterine atony with subsequent hemorrhage, adult respiratory distress syndrome, and cardiac arrest.

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? A. urine output of 20 mL/hour B. uterine resting tone of 14 mm Hg C. fetal heart rate of 150 beats/minute D. contractions every 2 minutes, lasting 45 seconds

A. urine output of 20 mL/hour Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is within the accepted range of 120 to 160 beats/minute. Contractions should occur every 2 to 3 minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require intervention.

A woman with a history of crack cocaine abuse is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect? A. amniotic fluid embolism B. uterine rupture C. umbilical cord prolapse D. shoulder dystocia

B. uterine rupture Uterine rupture is associated with crack cocaine use, and generally the first and most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part. Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress. Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered. Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of the presenting part of the fetus.

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer? A. tocolytics B. sedatives C. oxytocins D. corticosteroids

C. oxytocins For hypotonic labor, a uterine stimulant such as oxytocin may be ordered once fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women experiencing preterm labor.

The fetus of a woman in labor is determined to be in persistent occiput posterior position. Which intervention would the nurse identify as the priority? A. oxytocin administration B. position changes C. pain relief measures D. immediate cesarean birth

C. pain relief measures Intense back pain is associated with persistent occiput posterior position. Therefore, a priority is to provide pain relief measures. Position changes that can promote fetal head rotation are important after the nurse institutes pain relief measures. Additionally, the woman's ability to cooperate and participate in these position changes is enhanced when she is experiencing less pain. Immediate cesarean birth is not indicated unless there is evidence of fetal distress. Oxytocin would add to the woman's already high level of pain.

A nurse is preparing an inservice education program for a group of nurses about dystocia involving problems with the passenger. Which problem would the nurse most likely include as the most common? A. multifetal pregnancy B. macrosomia C. persistent occiput posterior position D. breech presentation

C. persistent occiput posterior position

A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse assesses the woman closely for which effect? a. hypotension b.blurred vision c.headache d.uterine hyperstimulation

d.uterine hyperstimulation

The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? A. 6 B. 11 C. 8 D. 3

B. 11 The Bishop score helps identify women who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score: a score over 8 indicates a successful vaginal birth. Therefore the woman with a Bishop score of 11 would have the greatest chance for success. Bishop scores of less than 6 usually indicate that a cervical ripening method should be used prior to induction.

A nurse is reviewing the medical record of a pregnant client. The nurse suspects that the client may be at risk for dystocia based on which factor? A. plan for pudendal block anesthetic use B. breech fetal presentation C. multiparity D. short maternal stature E. maternal age over 35

B. breech fetal presentation D. short maternal stature F. maternal age over 35

A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately? A. alert level of consciousness B. diminished deep tendon reflexes C. respiratory rate of 16 breaths per minute D. urine output of 45 mL/hour

B. diminished deep tendon reflexes

A nurse is describing the risks associated with prolonged pregnancies as part of an inservice presentation. Which factor would the nurse be least likely to incorporate in the discussion as an underlying reason for problems in the fetus? A. cord compression B. increased amniotic fluid volume C. aging of the placenta D. meconium aspiration

B. increased amniotic fluid volume

A nurse is reading a journal article about cesarean births and the indications for them. Which indication for cesarean birth occurs most frequently? A. multiple gestation B. labor dystocia C. fetal malpresentation D. abnormal fetal heart rate tracing

B. labor dystocia

A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. A. dinoprostone B. magnesium sulfate C. indomethacin D. misoprostol E. nifedipine

B. magnesium sulfate C. indomethacin E. nifedipine Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), terbutaline (Brethine, a beta-adrenergic), indomethacin (Indocin, a prostaglandin synthetase inhibitor), and nifedipine (Procardia, a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix.

A nurse is describing the risks associated with prolonged pregnancies as part of an inservice presentation. Which factor would the nurse be least likely to incorporate in the discussion as an underlying reason for problems in the fetus? A. cord compression B. meconium aspiration C. increased amniotic fluid volume D. aging of the placenta

C. increased amniotic fluid volume

After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching? A. "I guess the nurses will be getting me up and out of bed rather quickly." B. "I'll probably have a tube in my bladder for about 24 hours or so." C. "I'm going to have to wait a few days before I can start breast-feeding." D. "Holding a pillow against my incision will help me when I cough."

C. "I'm going to have to wait a few days before I can start breast-feeding."

A woman is to undergo an amnioinfusion. Which statement would be most appropriate to include when teaching the woman about this procedure? A. "After the infusion, you'll be scheduled for a cesarean birth." B. "A suction cup is placed on your baby's head to help bring it out." C. "You'll need to stay in bed while you're having this procedure." D. "We'll give you an analgesic to help reduce the pain."

C. "You'll need to stay in bed while you're having this procedure." An amnioinfusion involves the instillation of a volume of warmed, sterile normal saline or Ringer's lactate into the uterus via an intrauterine pressure catheter. The client must remain in bed during the procedure. The use of analgesia is unrelated to this procedure. A cesarean birth is necessary only if the FHR does not improve after the amnioinfusion. Application of a suction cup to the head of the fetus refers to a vacuum-assisted birth.

A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn? A. clavicular fracture B. asphyxia C. cephalhematoma D. central nervous system injury

C. cephalhematoma Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as ecchymoses, facial and scalp lacerations, facial nerve injury, cephalhematoma, and caput succedaneum. Asphyxia may be related to numerous causes but it is not associated with use of a vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous system injury is not associated with the use of a vacuum extractor.

Assessment of a woman in labor who is experiencing hypertonic uterine dysfunction would reveal contractions that are: A. poor in quality. B. brief. C. erratic. D. well coordinated.

C. erratic. Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction. Hypotonic uterine contractions are poor in quality and lack sufficient intensity to dilate and efface the cervix. Contractions of precipitous labor occur rapidly such that labor is completed in less than 3 hours.

A woman who is 42 weeks pregnant comes to the clinic. During the visit, which assessment would be most important for the nurse to perform? A. checking for spontaneous rupture of membranes B. asking her about the occurrence of contractions C. measuring the height of the fundus D. determining an accurate gestational age

D. determining an accurate gestational age

A pregnant woman is receiving misoprostol to ripen her cervix and induce labor. The nurse assesses the woman closely for which effect? A. hypotension B. blurred vision C. headache D. uterine hyperstimulation

D. uterine hyperstimulation A major adverse effect of the obstetric use of Cytotec is hyperstimulation of the uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Headache, blurred vision, and hypotension are associated with magnesium sulfate.

A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn? A.central nervous system injury B.clavicular fracture C.asphyxia D.cephalhematoma

D.cephalhematoma