OB_Exam2_In class questions
43. What is transient tachypnea?
It consists of a period of rapid breathing (higher than the normal range of 40-60 times per minute). It is likely due to retained lung fluid, and is most often seen in 35+ week gestation babies who are delivered by caesarian section without labor.
On test, a contraction starts at 1200 ends 1201. Another 1205 to 1206
a. 5 min apart and last 1 minute
What's the purpose for relaxation during labor?
a. Allows woman to conserve energy and allow uterine muscles to work more efficiently
If mother comes in with water break, what's the first thing you do? Why?
a. Assess fetal heart rate and pattern for 1 minute because you want to make sure the cord doesn't prolapse. If the cord prolapse, FHR might decrease due to contractions on the cord
If you want to know how long a contraction is
a. Beginning to end of that contraction
27. ***what would you suspect immediate post deliver and a fundal check is above umbilicus and off to the side?
a. Bladder is full. It will lift and replace the uterus, it will prevent uterine contraction putting the woman at risk for hemorrhage b. It's IMPORTANT to keep bladder empty c. Make sure to check lochia, fundal, and bladder post delivery
If moms water broke, what do you ask?
a. COAT! Color, amount, odor, time i. Should not be odors, if so could be sign of infection ii. Color- normal if clear 1. Red bleeding, brown green mixed with baby BM
41. When the water breaks, what's the first thing a nurse should do?
a. Check the heart rate, if decreases, hold babies head up
32. After baby is delivered, what's the first thing a nurse would do?
a. Clear airways b. THEN dry the baby off for thermoregulation
What is powers?
a. Contractions
How to help with hyperventilation of pregnant woman
a. Cup and breath into hands
37. **What's the best sign of a successful labor?
a. Dilation due to contractions
Early phase, active phase, and transition phase uterus dilations and contractions
a. Early b. Active phase dilated 4-7 contractions 3-5 min c. TransitionDilated 7-10 contractions 1-3 min and lasting 60-90 sec
What's a true way to tell if the water has broken?
a. Ferning! Positive confirms rupture of membranes
What's the best type of pelvis?
a. Gynecoid
33. Nursing actions after birth (3)
a. KEEP BABY'S AIRWAY CLEAR; then dry the baby head and body for thermoregulation b. Ilotycin—(erythromycin)—prevent potential transmission of gonorrhea to the infant c. Vitamin K—administered to the neonate to prevent potential bleeding problems
31. What happens if you go in post immediate post delivery care, and the fundus is boggy (grapefruit with a sponge on it).what do you do?
a. Massage the fundus, watch the BP (last sign of hemorrhage) and tachycardia b. If it doesn't firm, what should you do? i. Call the DR c. What if shes having bright red vaginal bleeding and fundus is firm? i. Suspect vaginal or cervical care so call DR
What are the 4 P's?
a. Passenger b. Passageway c. Powers d. Physiological
34. When do you do an Apgar score? What's the process?
a. Perform and record Apgar score at 1 minute and 5 minutes b. If the score is less than 8 at 5 minutes, the Apgar score should be performed at 10 minutes c. Assess each of the five items to be scored and assign a value of 0 (very poor) to 2 (excellent) for each item
What helps make the birth experience more manageable?
a. Preparation for labor such as attending birthing classes, reading books, etc...
28. What do you do if a patient got an episiotomy
a. Put ice on it to slow swelling
What are ways to help with back labor?
a. Put mom on hands and knees or do lunges
From 18, what do you do if the cord prolapses?
a. Reach in a lift the babies up (don't push it back in) so circulation can go through the cord and have other nurses call DR
Powers are conclusive to what?
a. Signs of contractions are effective is dilation of cervix
How do you time contraction?
a. Start of first to the start of the next. Beginning to the beginning
30. What doing post partum assessment of fundus?
a. Support lower segment so uterus isn't messed up!
38. **The client asks the nurse if a pudendal block will relive her discomfort, what's the best result?
a. The anesthesia Is primarily for relief of perineal discomfort
What is station?
a. The measurement of the progress of descent in centimeters above or below the midplane from the presenting part to the ischial spines
What is attitude?
a. The relationship of the fetal body parts to one another b. Normal intrauterine attitude is flexion in which the fetal back is curved in a convex C shape, the head is forward on the chest, and the arms and legs are folded in against the body
What position promote effective pushing and take advantage of gravity?
a. Upright positions
39. Know the different between variability and variable heart rate
a. Variability is fluctuations in the baseline within a 10 min window
29. What do you do if they have chills?
a. Warm blankets?
42. If a mom has a C section, its important to educate her on what?
a. What direction was she cut? If she was cut vertically, she can NOT deliver vaginally because she is at a high risk for uterine abruption
36. When is sacral pressure done?
a. When the baby is in posterior position (back labor)
4 signs of placental separation
a. uterus has spherical shape b. uterus rises upward in abdomen as placenta descends into vagina c. **cord descends further from vagina d. **a gush a blood appears as blood trapped behind the placenta is released
A laboring client was given an epidural 30 minutes ago. The nurse identifies that the client is having late decelerations. List the following nursing actions in order of priority, beginning with the highest-priority action a. Increase IV fluids b. Reposition to side c. Reassess fetal heart rate pattern d. Document interventions and maternal/fetal response.
answer: B A C D
A client in labor has been pushing effectively for 1 hour. A nurse determines that the client's primary physiological need at this time is to a. Change positions frequently. b. Ambulate. c. Consume oral food and fluids. d. Rest between contractions
answer: D
A pregnant client is admitted to the labor room. An assessment is performed, and the nurse notes the the client's hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following? a. Anxiety b. Low self-esteem c. Hemorrhage d. Postpartum infection
answer: D.
If the fetus is LOA, in which maternal location should the nurse anticipate finding the fetal heart tones (FHT's)? a. Below the umbilicus on the left side. b. Below the umbilicus on the right side. c. Above the umbilicus on the left side. d. Above the umbilicus on the right side.
answer: a
The tocotransducer should be placed: a. in the suprapubic area b. in the fundal area c. over the xiphoid process d. within the uterus
answer: b
When examining the fetal monitor strip of a laboring client, whose membranes has ruptured several hours ago, the nurse notes variable declarations in the fetal heart rate. The nurse should a. Stop the oxytocin infusion b. Change the client's position c. Prepare for immediate delivery d. Take the client's blood pressure
answer: b
The fetal heart rate gradually slows during each contraction, returning to baseline by the end of the contraction. The nurse concludes that which of the following is occurring? a. The umbilical cord is becoming compressed. b. There is uteroplacental insufficiency. c. The fetal head is becoming compressed. d. The fetus is moving between contractions.
answer: c
The nurse would use which of the following as the most accurate method to assess the frequency, duration, and strength of contractions of a woman in active labor? a. Abdominal palpation b. Tocodynamometer c. Intrauterine pressure catheter (IUPC) d. Client's description
answer: c
The pelvic examination reveals the fetus to be at -1 station. What information does this indicate to the nurse about the presenting part of the fetus? a. Is visible on the perineum. b. Has not entered the true pelvis. c. Is above the ischial spines. d. Is to large to fit through the opening into the true pelvis.
answer: c
***The nurse notes a pattern of decelerations on the fetal monitor that begins after the contraction begins and returns to baseline just before the contraction is over. The correct nursing response is to a. give oxygen by face mask at 8-10 L/min b. position her on her opposite side c. increase the rate of the IV fluids d. continue to observe and record the normal pattern
answer: d
The client's fetal heart rate is 150 before the contraction begins. During the contraction, the heart rate falls to 110 and returns to baseline 30 second after the contraction ends. Which of the following is the priority nursing action in response to this finding? a. Place the client into a semi-Fowler's position b. Administer oxygen by nasal cannula at 2 liters per minute. c. Insert a Foley catheter and measure urinary output. d. Place the client in left lateral position.
answer: d
The fetal heart rate baseline is 145 beats per minute with 12 beats per minute (moderate) variability. The nurse should take which of the following actions? a. Notify the client's health care provider immediately. b. Obtain an order to start an IV of lactated Ringer solution. c. Reposition the client on her hands and knees. d. Encourage continued use of breathing and relaxation techniques.
answer: d
The fetal heart rate shows variable decelerations. Which of the following nursing actions could be implemented to decrease or eliminate this pattern? a. Encourage the woman to relax in a warm shower. b. Apply a fetal scalp electrode. c. Assist the client into a supine position. d. Begin an amnio-infusion of normal saline
answer: d
The nurse is caring for a client in labor. How are contractions timed? a. End of one to the beginning of the next. b. Beginning of one to the end of the next. c. End of one to the end of the next. d. Beginning of one to the beginning of the next.
answer: d
Which technique should the nurse use to assess the frequency, duration, and intensity of uterine contractions? a. Spread fingers of one hand lightly over the fundus. b. Move the fingers of one hand over the uterus, pressing into the muscle c. Hold fingers and palm of one hand over the area just below the umbilicus. d. Indent the uterus in several places, during and between contractions.
answer: d
45. A woman appears excited, euphoric, and eager to learn about her labor status. Her behavior supports the nursing assessment that she is progressing through which phase of labor? a. Latent b. Active c. Transitional d. Prodromal
i. Answer A
47. The nurse is checking a laboring client. Her assessment reveals the head at +3 station. What will the nurse do? a. Prepare for the delivery of the infant. b. Begin administration of oxygen at 6L/min. c. Determine if contractions are increasing. d. Determine the FHR.
i. Answer A
46. Nursing assessment of a woman in labor notes marked introspection, irritability, and inability to focus. She is diaphoretic, and cries, "I can't take this anymore." These behaviors are characteristic of which stage or phase of labor? a. Active phase b. Transitional phase c. Second stage d. Third stage
i. Answer B
44. The decision is made to encourage a woman in early labor to walk around the unit for a while, and to then reassess her status. Which assessment distinguishes between true and false labor? a. Confirmation of spontaneous rupture of membranes. b. Signs and symptoms of increasing discomfort. c. Evidence of cervical dilation. d. Presence of copious bloody vaginal discharge
i. Answer C
48. As a woman progresses through labor, she becomes increasingly irritable with her partner, complaining of lower-back pain and fatigue. Which nursing intervention is most appropriate now? a. Have the woman turn on her side and give her a back rub. b. Ask her if she would like the nurse to get an order for something for her discomfort. c. Reassure the partner that her is irritability is normal, and teach him to apply sacral pressure with contractions. d. Send the partner for a coffee break, and encourage the woman to try to get some rest.
i. Answer C
49. Health teaching during the prenatal period should emphasize that expectant primigravida mothers should go to the hospital when which pattern is evident? a. Contractions are 2-3 minutes apart, lasting 90 seconds, and membranes are b. Contractions are 3-5 minutes apart, accompanied by rectal pressure and bloody show c. Contractions are 5 minutes apart, lasting 60 seconds and increasing in intensity. d. Contractions are 5-10 minutes apart, lasting 30 seconds, and are felt as strong menstrual cramps.
i. Answer C
How many phases are in the first stage of labor? What are they?
i. Early/Latent Phase ii. Active Phase iii. Transition
What can we do to help relieve back discomfort?
i. Lower Sacral massage ii. Counter pressure
How many stages of labor?
i. Stage 1-4 Labor, Pushing/delivering, placenta, recovery
