ob test2
A multiparous patient reports severe uterine cramps the first day after a vaginal delivery. The nurse is aware the patient is breastfeeding and associates the patient's pain primarily with which occurrence? 1. An increase in oxytocin release related to the newborn suckling 2. The presence of intense afterbirth pains related to multiparity 3. An expected response to the daily administration of oxytocin 4. The efforts of the uterus to return to a prepregnancy condition
1
A patient arrives at labor and delivery for the induction labor for her first child. The patient tells the nurse, "I can't believe how easy this is just to pick a day, sign a paper, and have a baby." Which action does the nurse take before the induction process? 1. Call the health care provider to validate patient understanding. 2. Check the patient's chart for an informed consent. 3. Explain the possible complications of induction to the patient. 4. Report an incidence of probable malpractice by the health care provider.
1
Loutzenhiser, McAuslan, and Sharpe (2015) performed a study regarding maternal and paternal fatigue and factors associated with fatigue across the transition to parenthood. Which evidence-based conclusion is made regarding fatigue and the transitioning parents? 1. Levels of prenatal and postnatal fatigue are associated. 2. Postnatal fatigue remains consistent for a period of 1 year. 3. Poor sleep quality in fathers is related to depressive symptoms. 4. The length of couple relationship strongly impacts parenteral fatigue.
1
The nurse is providing care for a patient in the second phase of labor. After more than 4 hours of pushing, the nurse suspects fetal dystocia. Which is the greatest risk related to the nurse's suspected complication? 1. Neonatal asphyxia related to prolonged labor 2. Fetal injury confirmed by the presence of bruising 3. Greater risk for maternal lacerations 4. Increased consideration for a cesarean delivery
1
The nurse is providing care in PACU for a patient who just delivered a neonate via cesarean section. The patient reports tightness in her chest. Assessment findings include tachypnea, hypotension, and decreasing oxygen saturation levels. Which complication does the nurse report to the health care provider? 1. Pulmonary embolism 2. Postpartum hemorrhage 3. Surgical-site infection 4. Developing endometritis
1
The nurse is providing care to a patient who is at 41 weeks gestation. Which factor about the patient does the nurse consider as an indication of late-term or post-term pregnancy? 1. Fetus is identified as a male 2. Patient's multiparity status 3. Delivered two babies at 38 weeks 4. History of regular menstruation
1
The nurse on a postpartum unit focuses on how to assist the father in identifying his role with the neonate. Which intervention by the nurse is most helpful? 1. Encourage the couple to identify mutual expectations of the fathering role. 2. Critique the father's methods of providing physical care for the neonate. 3. Provide written materials about the physical and emotional role of a father. 4. Observe for a competitive attitude between the parents about providing baby care.
1
The nurse on a postpartum unit is focused on providing care that will assist the mother and father in making the transition to parenthood. For which reason does the nurse review the prenatal and labor records? 1. Pregnancy and birth experiences, which can either enhance or impede the process of becoming a mother. 2. Awareness of prenatal classes that will help identify and focus on learning needs of both parents. 3. Identification of preexisting maternal conditions that may interfere with parenting transitions. 4. Knowledge regarding questions and concerns the mother and father may have about neonate issues.
1
The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing with a baseline of 120, moderate variability, with absence of decelerations and accelerations. According to the National Institute of Child Health and Human Development tier system, what category tracing does the patient's fall into? 1. A Category I tracing 2. A Category II tracing 3. A Category III tracing 4. A Category IV tracing
1, Category I tracing
The nurse is providing care for a patient who delivered via cesarean 24 hours ago. Which teaching does the nurse provide for the patient and family? Select all that apply. 1. Signs and symptoms to report to health care provider 2. Comfortable positions for feeding the newborn 3. Encouragement for early dietary intake of solid foods 4. Encourage family to help with infant care and housework 5. Provide information on nutrition to promote tissue healing
1,2
The nurse is researching for evidence-based practice related to a mother's response during the postpartum period. Based on research by Rubin and Mercer, which finding will the nurse be able to easily implement to change the culture of the unit? 1. Satisfaction questionnaires 2. Alterations in terminology 3. Decrease nurse/patient ratios 4. Soliciting paternal expectations
2
The nurse is providing teaching to a patient who is breastfeeding a newborn. The patient expresses interest in maintaining a healthy nutritional status for both her and her baby. Which information does the nurse present to meet the patient's need? Select all that apply. 1. Increase caloric intake by 500 to 1,000 per day. 2. Drink 2 to 3 liters of fluid each day. 3. Abstain from the intake of alcohol. 4. Eat fresh fruits and vegetables. 5. Avoid the intake of processed foods.
1,2
A nurse has recently transferred to a labor and delivery unit. During a scheduled cesarean, the nurse notices a prescription for the administration of 1,000 mL of prewarmed IV fluid. For which reason does the health care provider prescribe the fluid in this manner? Select all that apply. 1. Results in an increased maternal core temperature 2. Results in improved neonatal umbilical arterial pH 3. Results in improved Apgar scores 4. Results in decreased risk for maternal shock 5. Results in lower incidence of post-partum hypothermia
1,2,3
The nurse is caring for a 30-year-old woman who is G4P2012 at 38 weeks and 5 days gestation. The nurse is watching her EFM strip and notices that for the past 10 minutes the fetus has shown minimal variability. Which actions should the nurse perform? Select all that apply. 1. Check to see if the patients' membranes have been ruptured, as there could be potential cord compression. 2. Look to see what the patient's position is and is she supine; change her to left side lying. 3. Continue to watch the strip, but know that this could be due to fetal sleep. 4. Recognize that the fetus is 38 weeks and therefore this could be due to fetal maturity. 5. Check the FHR and connect the minimal variability to fetal bradyasystole.
1,2,3
During a vaginal delivery, the primary care provider notices greenish yellow coloration on the fetal head during crowning. Intrapartum suctioning is performed as soon as the fetus's head is delivered. The nurse understands the aspiration of meconium will have which effects on the neonate's respiratory function? Select all that apply. 1. Result in airway obstruction 2. Contribute to pulmonary hypertension 3. Result in chemical pneumonitis 4. Cause surfactant dysfunction 5. Create strain on cardiac function
1,2,3,4
When assisting with a vacuum-assisted vaginal delivery, the nurse is aware that adherence to which guidelines for the vacuum device will minimize the nurse's liability in vacuum-assisted vaginal births? Select all that apply. 1. Pump up the vacuum manually to the pressure indicated on the pump. 2. Recognize that cup detachment (pop off) is a warning sign. 3. Understand that pressure should be released between contractions. 4. The procedure is timed from insertion of the cup into the vagina until the birth. 5. The cup should not be on the fetal head for longer than 5 to 10 minutes.
1,2,3,4
A patient in labor receives high-level regional anesthesia, which inhibits her ability to push during the second state of labor. The primary care provider will use forceps to aid in the delivery of the fetus. Which fetal complications is the nurse aware of being related to a forceps birth? Select all that apply. 1. Intracranial hemorrhage 2. Cephalohematoma 3. Nerve injuries 4. Skin lacerations 5. Skull fracture
1,2,3,4,5
A postpartum patient states, "I am really in pain." For which sources of pain will the nurse specifically assess the patient? Select all that apply. 1. Uterine contractions 2. Perineal trauma 3. Breast engorgement 4. Hemorrhoids 5. General soreness
1,2,3,4,5
Following a cesarean birth, intrathecal morphine is administered to the patient for postoperative pain management. Of which fact about intrathecal morphine therapy is the nurse aware? Select all that apply. 1. An anesthesiologist or CRNA administers it intrathecally. 2. The nurse needs to closely monitor for common side effects. 3. The drug produces generalized CNS depression. 4. The recommended dose is 10 to 15 mg. 5. The drug alters perception of and response to painful stimuli.
1,2,3,5
The nurse is making a plan of care for a patient who is in the first 24-hour period past a cesarean delivery. Which interventions will the nurse include in regards to medications? Select all that apply. 1. Continue a daily stool softener. 2. Manage pain with morphine. 3. Ensure the availability of naloxone. 4. Provide prophylaxis antibiotics. 5. Administer Rhogam if needed.
1,2,3,5
The nurse is performing a uterus assessment on a patient who is 20 hours postpartum. The nurse finds the fundus of the uterus to be soft and boggy. In addition, the uterus is displaced to the left and moderate bleeding is noted. If the uterus does not respond to uterine massage, which actions does the nurse implement? Select all that apply. 1. Assist the patient to the bathroom to void. 2. Reassess to determine response to treatment. 3. Administer oxytocin as prescribed. 4. Place an emergency call to the HCP. 5. Make the patient NPO for surgery.
1,2,3,5
The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the REEDA acronym. Which specific assessments are covered by REEDA? Select all that apply. 1. Perineal coloration 2. Suture line appearance 3. Amount of swelling 4. Description of pain 5. Soft tissue trauma
1,2,3,5
The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the facility. Which reasons contribute to the high rates of cesarean births? Select all that apply. 1. Fetuses in breech position unable to deliver vaginally 2. Increased number of elective or maternal request cesareans 3. Incidences of women of older maternal age getting pregnant 4. Decreasing rate of malpractice litigation with cesarean birth 5. Presence of nonreassuring fetal tracings during labor
1,2,3,5
Which actions indicate the is assessing uterine activity? Select all that apply. 1. Feeling the maternal abdomen in between contractions 2. Checking the EFM strip to determine if contractions are either 2 or 3 minutes apart 3. Evaluating that the EFM strip shows 200 MVU every 10 minutes. 4. Checking the EFM strip to see if the fetus has an elevation of 15 bpm over baseline for 15 seconds twice in a 20-minute period 5. Evaluating that the EFM strip shows that each contraction lasts 1 minute
1,2,3,5
A patient at 34 weeks gestation is in labor with twins. The primary care provider decides the fetuses need to be delivered by cesarean. Which medical and nursing interventions will be in place for this delivery? Select all that apply. 1. Delivery is attended by two medical personnel. 2. The placement of a large-bore IV access is ensured. 3. The usual personnel to attend delivery is arranged. 4. A hospital with a Level II or III nursery is selected. 5. The FHR for the two fetuses is monitored alternately.
1,2,4
The nurse-educator is preparing a presentation on fetal heart monitoring. Which of the following should be included? Select all that apply. 1. Intermittent auscultation should be performed every hour in the latent phase. 2. For Category I situations, intermittent electronic fetal monitoring (EFM) should be performed for 10 to 30 minutes every 1 to 2.5 hours. 3. A patient with a previous cesarean section should have EFM for 10 to 30 minutes every 1 to 2.5 hours. 4. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 5. A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.
1,2,4,5
The nurse is assessing patients who are postpartum. Which patients does the nurse identify as being at increased risk for respiratory complications? Select all that apply. 1. The patient who was placed on bedrest for threatened abortion 2. The patient with preeclampsia treated with magnesium sulfate 3. The patient with a preexisting diagnosis of diabetes mellitus 4. The patient who delivered a neonate after regional anesthesia 5. The patient who received large amounts of IV fluid due to blood loss
1,2,5
The nurse is providing care for a patient who is at 42 weeks gestation. The patient's primary care provider is suggesting induction, but the patient is resistant. Which facts can the nurse provide if the patient asks about allowing labor to start spontaneously? Select all that apply. 1. Stillbirth or newborn death increases in pregnancies beyond 42 weeks. 2. There is a greater chance of developing complications because of larger fetal size. 3. Maternal death rate is higher if the pregnancy is continued beyond 42 weeks. 4. Post-term fetuses are prone to developmental delays related to uterine hypoxia. 5. Postmature fetuses have decreased subcutaneous fat and lack vernix and lanugo.
1,2,5
The nurse is reviewing the medical record for a patient who is postpartum. The nurse notices the patient is rubella-nonimmune. Which information does the nurse present to the patient? Select all that apply. 1. The risks to the fetuses of any future pregnancies. 2. The patient will need to be immunized before discharge. 3. Breastfeeding should be avoided for 24 hours after immunization. 4. Maternal immunization carries over to the neonate. 5. Pregnancy should be avoided for 4 weeks.
1,2,5
In preparation for a cesarean birth, the nurse expects which medical-based preoperative interventions? Select all that apply. 1. Administration of narrow-spectrum prophylactic antibiotics 2. Verification that the woman has been NPO for 6 to 8 hours before surgery 3. Assessment of the woman's knowledge and educational needs 4. Assessment for risk of venous thromboembolism (VTE) 5. Prescription for sequential compression devices prior to surgery
1,4,5
The nurse is caring for a pregnant patient who expresses concern about the effects of electronic fetal monitoring (EFM) on her labor and delivery. Which responses by the nurse would be appropriate in this situation? Select all that apply. 1. "There is a reduced rate of seizures if a patient has EFM during labor." 2. "There is a decrease in the incidence of cerebral palsy if a patient has EFM during labor." 3. "There is a link between decreased infant mortality and EFM during delivery." 4. "There is a link between the rate of cesarean sections and continuous EFM." 5. "There is an increase in operative vaginal births and the use of continuous EFM."
1,4,5
The nurse is obtaining a baseline fetal heart rate (FHR). At 1:00 pm the baseline FHR was 130, at 1:20 pm FHR baseline was 166, and at 1:40 pm the baseline FHR was 204. What should the nurse assess from this trend of fetal baselines? Select all that apply. 1. The 1:00 pm FHR baseline warranted no further action. 2. The 1:20 pm FHR baseline warranted immediate fetal resuscitation. 3. The 1:00 pm FHR baseline warranted immediate maternal resuscitation 4. The 1:20 pm FHR baseline should be corrected immediately with delivery. 5. The 1:40 pm FHR baseline should be corrected immediately.
1,5
The nurse is providing care to a patient who is in labor. The patient's membranes rupture spontaneously, and the nurse notices meconium-stained amniotic fluid. Which actions does the nurse immediately perform? Select all that apply. 1. Alert the neonatal team of a possible meconium aspiration neonate. 2. Promote fetal well-being by placing the patient on her left side. 3. Test the stained fluid for percentage of meconium content. 4. Administer oxygen to the mother to help prevent fetal hypoxia. 5. Notify the primary care provider about the presence of meconium.
1.5
A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (CVAC) screening. The nurse is aware that which patient information will likely disqualify the patient for CVAC? 1. A low transverse uterine scar 2. Cesarean due to pelvic abnormalities 3. First labor needed to be induced 4. Patient asks multiple questions
2
A postpartum patient calls the OB office 8 days following a vaginal delivery. The patient reports concern regarding vaginal bleeding. Which patient-reported symptom causes the nurse concern? 1. Increased flow noticed with physical activity 2. A description of the lochia as being red in color 3. Discharge that is noted to have a fleshy odor 4. Bleeding that is described as scant
2
An emergency cesarean is being implemented. The patient describes tingling in her ears and a metallic taste with the administration of regional anesthesia. The nurse is aware that which incidence has occurred? 1. Manifestation of maternal respiratory depression related to anesthesia 2. Inadvertent injection of the anesthetic agent into the maternal bloodstream 3. Maternal hypotension is occurring related to administration of anesthesia 4. Expected manifestations related to anesthetic medications are present
2
Dayton et al. (2016) performed qualitative research regarding expectant fathers' beliefs and expectations. The nurse identifies which theme as emerging from this research? 1. Men felt that the role of being a father can be learned. 2. Men described fathering as an extremely difficult task. 3. Men rely on other men to support the fathering role. 4. Men believe that the nurturing role is always the mother's.
2
Prior to discharge from the birthing center, the nurse informs the patient that she will receive vaccines for rubella, hepatitis B, pertussis, and influenza. For which reason does the nurse explain the need for the vaccinations? 1. Discharge with a neonate is discouraged if the mother is not vaccinated. 2. Vaccinating the mother will protect the neonate from serious illnesses. 3. The mother's immune system has been suppressed during pregnancy. 4. Vaccination is more easily accomplished while the mother is under medical care.
2
The nurse in labor and delivery is preparing to initiate labor induction with the administration of oxytocin. After research about oxytocin, the nurse is aware of which fact about the drug? 1. Hypothalamus stimulation increases circulating oxytocin. 2. Synthetic oxytocin is identical to endogenous oxytocin. 3. The half-life of oxytocin is 1 hour, supporting close monitoring. 4. Action from IV oxytocin administration is less than 1 minute.
2
The nurse in the post-delivery unit is encouraging skin-to-skin contact for a mother and neonate after cesarean delivery. Which action, if noticed by the nurse, requires immediate intervention by the nurse? 1. Mother is sitting up with the neonate prone on her chest. 2. Mother is supine with the neonate prone on her chest. 3. The neonate is prone on mother's chest and facing to the side. 4. Neonate is prone with mother resting in semi-Fowler's position.
2
The nurse is aware that some parenting skills are acquired through the process of intentional learning. Which activity does the nurse associate with intentional learning? 1. The couple observes other individuals who are mothers and fathers. 2. The couple attends hospital classes addressing newborn and infant care. 3. The couple discusses with each other how they were parented. 4. The couple watches media containing parenting roles.
2
The nurse is observing a new mother interact with her baby and notices the mother holding the baby close to her body. However, the nurse also notices that the mother does not hold the baby in an enface position. Which question is most appropriate for the nurse to ask? 1. "Can I help you with a nice position in which to hold your baby?" 2. "What can you tell me about your family's beliefs with new babies?" 3. "Is there some reason that I have not seen you look into your baby's eyes?" 4. "Your baby is so expressive, have you looked into his eyes yet?"
2
The nurse is preparing a postpartum patient for discharge. Which patient teaching is most important for the nurse to provide? 1. The signs and symptoms of uterine infection 2. The signs and symptoms of secondary hemorrhage 3. The signs and symptoms of postpartum depression 4. The signs and symptoms of a boggy uterus
2
The nurse is providing care for a prenatal patient who is told she will require a cesarean delivery because of cephalopelvic disproportion. Which explanation of the condition will the nurse provide to the patient? 1. The patient has a preexisting medical condition that supports cesarean birth. 2. The size and/or shape of either the fetal head or patient pelvis is an issue. 3. The placenta is implanted in an unfavorable position in the uterus. 4. The patient had a surgery with an incision through the myometrium of the uterus.
2
The nurse is providing care to a patient who is postpartum. Using anatomy and physiology knowledge, which expectation does the nurse relate to the cardiovascular system? 1. Patient reporting of being cold related to blood loss 2. WBC laboratory level of 30,000/mm a few hours after delivery 3. Risk for hemorrhage due to decrease in circulating clotting factors 4. A normal postpartum hemoglobin laboratory value of less than 11 g/dL
2
The nurses in a labor and delivery unit are concerned about the high incidence of cesarean deliveries at their facility and initiate an internal study. Which is the most likely condition the nurses will recognize as a contributor to the rate of cesarean births? 1. The facility has a high rating for managing high-risk pregnancies. 2. Policies and parameters for cesarean need to be reviewed and refined. 3. Community education about the advantages of vaginal birth is deficient. 4. The incidence of maternal requests for cesarean delivery is increasing.
2
Which behavior does the nurse identify as a demonstration of unidirectional bonding between a parent and infant? 1. The parents respond to the baby's cry. 2. The parents call the baby by name. 3. The baby responds to comforting measures. 4. The parents stimulate and entertain the baby.
2
he nurse is collecting the urine of a postpartum patient who is passing large clots. For which reason does the nurse examine the large collected clots? 1. To validate the presence of clotting 2. To determine the presence of tissue 3. To obtain an accurate description 4. To document the number of clots
2
While providing care for a patient, the nurse notices an erratic FHR recording. What action should the nurse take next? 1. Help the patient move around to help obtain the signal. 2. Place the transducer in a different position. 3. Check the mother's cervical progress to see if she is in the second stage of labor. 4. Remove some of the ultrasound gel from the transducer.
2, Place the transducer in a different position.
The nurse is looking at an EFM strip and sees that the patient is having contractions that are measuring 150 MVU every 10 minutes for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps? 1. The patients' contractions are adequate, so the main focus should be on resuscitating the fetus with maternal oxygen and maternal position change. 2. The patients' contractions are inadequate; the provider could consider an amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective. 3. The patients' contractions are adequate, so the main focus should be on determining her progress through cervical change. 4. The patients' contractions are inadequate; the provider could consider augmenting with Pitocin to be more effective.
2, The patients' contractions are inadequate; the provider could consider an amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective.
The nurse preceptor is teaching a nursing student about the physiology of the fetal heart rate (FHR) pattern. Which statement by the student indicates successful teaching about this concept? 1. "Vagus nerve stimulation increases FHR and helps maintain variability." 2. "The sympathetic nervous system is responsible for heart rate variability." 3. "Action of the FHR occurs through the absence of norepinephrine." 4. "Baroreceptors are responsible for increasing FHR and fetal blood pressure."
2, The sympathetic nervous system is responsible for heart rate variability."
8. The nursing preceptor is teaching the nursing student about fetal bradycardia. Which is true of the maternal reasons for fetal bradycardia? Select all that apply. 1. A maternal fever in labor is usually due to dehydration and therefore should be treated with a fluid bolus. 2. Administering terbutaline to the mother for uterine tachysystole; this is self-limiting to when the drug is affecting the mother. 3. A urine toxicology screen may reveal recent cocaine use; the nurse should also monitor for placental abruption. 4. Check the chart for a history of maternal mental illness, particularly maternal anxiety; speak with the patient regarding her anxiety and take steps to ease her anxieties. 5. Check the maternal blood pressure, as hypertension is linked to fetal tachycardia; identify the on-call provider and correct with lisinopril as necessary.
2,3,4,5
The nurse is aware that there are multiple classifications for cesarean deliveries. Which situations does the nurse classify as an unscheduled cesarean birth? Select all that apply. 1. Patient had a previous cesarean delivery. 2. There is evidence of a prolapsed cord with membrane rupture. 3. The cervix fails to fully dilate after prolonged labor. 4. Patient has a preexisting cardiac health condition. 5. There is recognition of placenta previa with mild bleeding.
2,3,4,5
The nurse is attending to a patient who just delivered a term fetus who was stillborn. Which nursing interventions will the nurse use to provide emotional support to the couple? Select all that apply. 1. Express the belief that a little angel was sent to heaven. 2. Cut a lock of the neonate's hair and get foot and hand prints. 3. Ask the parents what name they are giving their baby. 4. Inquire if the patient had any warning of fetal death. 5. Allow parents unlimited time to hold and touch the neonate.
2,5
The nurse is caring for a baby who is experiencing fetal tachycardia. Which action should the nurse take next? 1. Perform fetal scalp stimulation for 5 seconds. 2. Check maternal allergies in the patient chart. 3. Apply heat packs to the maternal chest and head. 4. Stimulate the fetus with a vibroacoustic device.
2. Check maternal allergies in the patient char
The nurse is using the Parer and Ikeda five-tier system. A co-worker is concerned about a patient whose fetus has an acceptably low risk of acidemia and evidence of impending fetal asphyxia. What is the next best step for the nurse? 1. Perform conservative measures. 2. Prepare for urgent delivery. 3. Assist provider in immediate delivery. 4. Increase surveillance of patient.
2. Prepare for urgent delivery.
A patient is being prepared for an unplanned cesarean section. Which pre-procedure information is most important for the nurse to report before the administration of regional anesthesia? 1. Hypovolemia corrected with IV fluid administration 2. Inability of the patient to sit on the bedside and flex forward 3. Laboratory value indicating a low platelet count 4. History of patient experiencing headaches after a spinal
3
A patient who is at 39 weeks gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure? 1. Ultrasound indicates the umbilical cord is away from the cervix. 2. The nurse must have certification to perform the procedure. 3. The fetal head is currently engaged in the maternal pelvis. 4. Prior amniotic fluid leakage must be validated before the procedure.
3
In an attempt to improve the effectiveness of postpartum teaching, the nurse uses the AWHONN acronym POST BIRTH. Which teaching points require the patient to call for 911 assistance? Select all that apply. 1. Bleeding that soaks a pad per hour 2. A bad headache with vision changes 3. Thoughts of hurting self or baby 4. Signs an incision is not healing 5. A red, swollen leg painful to touch
3
The nurse in a postpartum unit frequently teaches patients regarding breast care. Which teaching is most helpful to the breastfeeding patient? 1. Run warm water over breasts while in the shower. 2. Wear a supportive bra for 24 hours a day. 3. Express milk by a breast pump or manually. 4. Take analgesics for breast pain management.
3
The nurse is discussing contraception with a couple before discharge following the birth of a first child. The couple are uncertain about the method but are certain about avoiding pregnancy for at least 2 years. Which method does the nurse recommend? 1. Emergency contraceptives 2. Oral estrogen/progesterone pill 3. Depo-Provera 4. Natural family planning
3
The nurse is monitoring a patient who has been in prolonged labor. Which assessment finding will result in the nurse notifying the health care provider about the development of an emergent situation requiring a cesarean delivery? 1. Maternal blood pressure indicative of hypotension 2. Maternal exhaustion from prolonged uterine activity 3. Recognition of a Category II fetal heart rate pattern 4. Increased maternal temperature related to infection
3
The nurse is providing care for a patient who is admitted for cervical ripening. The health care provider has prescribed the use of a hygroscopic dilator. Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening? 1. This method is quicker than hormonal ripening. 2. The patient has a history of cesarean childbirth. 3. The method may be indicative of fetal demise. 4. This patient is being treated for active herpes.
3
The nurse is providing care to a patient who is diagnosed with dystocia related to hypertonic uterine dysfunction. Which medical intervention does the nurse implement for this patient? 1. Explain to the family that the patient needs rest before labor continues. 2. Assist the patient to relax by providing back and neck massage. 3. Administer morphine to decrease contractions and promote uterine rest. 4. Discuss how the patient's fear is interfering with the progression of labor.
3
The nurse is providing postpartum care to a patient 24 hours after a vaginal delivery. Which action does the nurse perform prior to assessing the patient's uterus? 1. Place the patient on the left side. 2. Assess the passage of lochia. 3. Ask the patient to void. 4. Administer a dose of oxytocin.
3
The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor? 1. Fear promotes feelings of exhaustion. 2. Mothers cannot enjoy the actual birth. 3. Dystocia is associated with extreme fear. 4. Fear during labor causes postpartum depression.
3
The postpartum nurse is planning a home visit to a mother who delivered her baby 1 week ago. Which finding indicates to the nurse a possible problem with mother-infant bonding? 1. The mother is pleased to have the nurse visit her home and baby. 2. The baby's grandmother is present and involved with mother/baby care. 3. The mother focuses the visit on her physical recovery and concerns. 4. The baby's father is on "paternity leave" and involved with the baby.
3
the nurse is providing care for a primip patient in active labor. Cervical dilation has progressed 0.5 cm in 2 hours. Intrauterine pressure catheter reading is 20 mm Hg. Which action does the nurse anticipate next? 1. Rupture of uterine membranes by the nurse 2. Preparation for a cesarean delivery due to signs of fetal distress 3. Augmentation of labor with oxytocin per health care provider's order 4. Medicating the patient with pain medication to promote uterine rest `
3
A nurse-preceptor is explaining to a new nurse about the tocodynamometer. The new nurse is looking at the EFM paper and sees that, of the two tracked heart rates, the one on the bottom is in the 80s; she is concerned that the fetal heart rate is bradycardic. Which of the following should the nurse do first? 1. Give the mother oxygen to increase the fetal heart rate. 2. Immediately call the provider into the room. 3. Check to make sure that the maternal radial pulse is being recorded correctly. 4. Adjust the monitor on the maternal abdomen.
3, Check to make sure that the maternal radial pulse is being recorded correctly.
While reviewing the birth plan of an uncomplicated and healthy patient in active labor, the nurse notices that she would like to have a natural labor and potentially experience hydrotherapy. Which option should the nurse suggest for the patient? 1. IUPC to make sure that her contractions are adequate to keep labor progressing 2. FSE to make sure that her fetus is tolerating the hydrotherapy 3. Telemetry to allow for the patient to accomplish her birth plan 4. External EFM to make sure that there is continuous monitoring
3, Telemetry to allow for the patient to accomplish her birth plan
A new mother expresses frustration about how to know what her baby wants. The mother states, "I don't know what I expect, but then, the baby doesn't know either." Which situation does the nurse use as an example of neonate communication? 1. The baby is content to lie still on the mother's abdomen. 2. The baby is easily awakened if irritated by loud noises. 3. The baby resists eye contact if bored or disinterested. 4. The baby roots for the breast when the cheek is stroked.
4
A patient who is 12 hours postpartum after a vaginal delivery continues to have difficulty in initiating urination. The nurse is aware that an integrative method used when a woman is unable to void is peppermint oil. In which manner will the peppermint oil be used? 1. A thin layer is applied to the urinary meatus. 2. A small amount on a cotton ball is left at the bedside. 3. A small amount is added to the water of a vaporizer. 4. A saturated cotton ball is placed in a "hat" on the toilet.
4
A patient who is expecting her first baby tells the nurse, "I am afraid of the whole birth experience and plan to ask the doctor for a cesarean delivery." Which response by the nurse is most appropriate? 1. "I will get you some material about how labor pain is managed." 2. "Most women avoid cesarean births unless it is an emergency." 3. "I suggest you talk with the physician and get another opinion." 4. "Cesarean will cause you issues with additional pregnancies."
4
As a result of the previously mentioned research study, the nurses in a postpartum facility will implement which evidence-based change? 1. Continue to assess the level of fatigue for the mother during postpartum period. 2. Assist fathers in recognizing and managing stress and depressive symptoms. 3. Encourage the father to go home and rest while the mother is hospitalized. 4. Promote strategies to decrease fatigue during both prenatal and postnatal periods.
4
In a research study performed by Schneuder, L., Crenshaw, J., and Gilder, R. (2017), which action by the nurse will be implemented following a cesarean delivery? 1. Allow the birth partner to hand the neonate to the mother. 2. Assist the mother and partner to cut the umbilical cord. 3. Move the neonate into the visual field of the mother. 4. Encourage skin-to-skin contact between the mother and neonate.
4
The nurse is assisting the primary care provider with a vacuum-assisted delivery because of a prolonged second stage of labor. The nurse will inform the primary care provider when which guideline of the procedure is met? 1. Extension of the episiotomy is performed. 2. Signs of fetal compromise have resolved. 3. Patient is under full anesthesia status. 4. The "three-pull rule" has been achieved.
4
The nurse is assisting with the preparation of a patient admitted for a planned cesarean birth. The patient has signed the consent form and discussed the elected regional anesthesia with the nurse anesthetist. Which is the most important action for the nurse related to anesthesia? 1. Verify the patient has been NPO for 6 to 8 hours. 2. Start an IV line and administer an IV fluid as ordered. 3. Administer preoperative medications per orders. 4. Obtain a baseline fetal heart rate monitor strip.
4
The nurse is providing postpartum care for an adolescent mother and her family. Which factor is most important for the nurse to consider when planning teaching about neonatal care? 1. The grandparents decided they want to be involved. 2. The parents need to discuss their expectations of each other. 3. The mother is determined the father should be involved. 4. Information must be presented on an age-appropriate level.
4
he nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis? 1. To prevent uterine prolapse. 2. To prevent uterine movement 3. To prevent uterine hemorrhage 4. To prevent uterine inversion
4
An internal fetal monitor has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1 day gestation. Her medical history is significant for a history of pregnancy-induced hypertension. Her laboratory values are as follows: H/H 11/30, O negative, RPR negative, GBS positive. Based on Chrissy's history and presentation, what action should the nurse take next? 1. Prepare Chrissy for the placement of an internal monitor. 2. Take the required two blood pressure readings every 15 minutes prior to insertion of the internal fetal monitor due to her pregnancy-induced hypertension. 3. Discuss with the health care provider the fact that Chrissy's blood type is O negative and she should therefore receive Rhogam before insertion of an internal monitor. 4. Discuss with the health care provider that Chrissy is GBS positive and therefore should not receive an internal monitor.
4, Discuss with the health care provider that Chrissy is GBS positive and therefore should not receive an internal monitor.
The nurse is explaining telemetry to the patient, who has just begun active labor. The patient would like to have a labor in which she is mobile, able to change positions, and use hydrotherapy. Which response by the nurse is most appropriate? 1. "Telemetry is used mostly for women who are laboring in bed and changing positions every half hour or so." 2. "Unfortunately, you will not be able to use the shower while using telemetry." 3. "The nurses will need to come in and check your telemetry reading every half hour." 4. "We can start using telemetry now, and if there are no problems with the signal, we can continue it throughout your labor until delivery."
4, . "We can start using telemetry now, and if there are no problems with the signal, we can continue it throughout your labor until delivery."
The nurse-educator is instructing on the physiology of fetal heart rate (FHR) patterns. He is showing the students an EFM strip, and there is a tracing that is classified as baseline 140 bpm, moderate variability, accelerations, and 2 decelerations. A half hour later the baseline is 150 bpm, there is minimal variability, accelerations, and 3 decelerations. Which of these findings would the nurse attribute to the parasympathetic nervous system? 1. The baseline changes from 140 bpm to 150 bpm. 2. The change from moderate variability to minimal variability. 3. The consistent presence of accelerations. 4. The presence of 2 and then 3 decelerations.
4, The presence of 2 and then 3 decelerations
The nurse in labor and delivery notices an increase in the number of women requesting cesarean births. Which are the parameters and criteria used when making the decision to perform a cesarean delivery on maternal request (CDMR)? Select all that apply. 1. Patient is able to self-pay for the procedure. 2. Patient is willing to defer from legal litigation. 3. Mother is planning to only have one child. 4. Patient is aware of possible neonatal complications. 5. Procedure is performed after 39 weeks gestation.
4,5
The obstetric nurse is managing her patients while covering for another nurse who is on a break. Which patient is the lowest priority? 1. A patient with a previous cesarean section 2. A patient with an epidural in place 3. A patient with decreased fetal activity 4. A patient with Category I FHR tracings
4,A patient with Category I FHR tracings
The nurse is monitoring a patient when the EFM strip conveys fetal bradycardia. Which action would be the most urgent for the nurse to take? 1. Check the patient's input and output. 2. Take a blood pressure to determine if the mother has hypotension. 3. Change the mother's position from supine to left lateral. 4. Check the mother for vaginal bleeding and severe abdominal pain.
4. Check the mother for vaginal bleeding and severe abdominal pain.
The EFM tracing shows the following: FHR baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the five-tier FHR interpretation system, how should the nurse interpret this tracing? 1. Green: very low risk of evolution, no action 2. Red: unacceptably high risk of acidemia, deliver 3. Yellow: moderate risk of evolution, increase surveillance 4. Orange: acceptable low risk of acidemia, prepare for possible urgent delivery
4. Orange: acceptable low risk of acidemia, prepare for possible urgent delivery
The first sign of shoulder dystocia is the ____________________ of the fetal head against the maternal perineum after delivery of the head.
Retraction
The nurse understands that logically ____________________ cesarean births are an influential factor related to the overall incidence of cesarean births.
previous
After pregnancy and birth, a mother may notice a condition called diastasis recti abdominis, which is a(n) ____________________ of the rectus muscle.
seperation