Exam One Review Sheets
1) Why should the nurse regularly check the woman's bladder at the following times a) During labor:
A full bladder increases pain and interferes with fetal descent
3) Describe the most common variations in a) Fetal lie:
Longitudinal (common) or transvers (rare); oblique lie is at some angle to a longitudinal or transvers lie
6) What causes the heartburn that often occurs in pregnancy?
Relaxation of the lower sphincter of the esophagus allows acids to move into the esophagus causing heartburn.
1) Why should the nurse regularly check the woman's bladder at the following times b) During the early postpartum period:
A full bladder interferes with the uterine contractions that compress open vessels and control bleeding
Explain how each of the following factors can reduce fetal oxygenation. How would you explain each in simple terms to a laboring woman? maternal hypoxia
A lower maternal oxygen tension may result from respiratory disorders such as asthma or from smoking.
Shawna is an 18 year old primigravida admitted to the birth center at 27 weeks of gestation in probably preterm labor. Her membranes are intact. The physician writes the following orders: NPO except ice chips or clear fluids CBC Catheterized urine for routine analysis and culture and sensitivity IV fluids: LR 200mL/hour for 1 hour then 125 mL/hr Routine fetal monitoring and maternal vital signs 1) What position is appropriate for Shawna? Why?
A side-lying position with the head of the bed low increases placental blood flow and reduces pressure of the fetal presenting part on the cervix. Bed rest may reduce uterine activity.
12) Explain the purpose of each aspect of care for the woman having external version a. Tocolytic drug:
A tocolytic drug relaxes the uterus to make the version easier to perform.
13) Describe nursing care associated with a forceps or vacuum extractor assisted birth. What is the rationale for each? Are there contraindications for either method? a. Maternal:
Add a catheter to the delivery table to empty the mother's bladder (if she is not already catheterized) making more room for the instrument assisted birth. In the postpartum period, observe for trauma, usually lacerations (bright red bleeding with a firm fundus), or hematoma (excessive pain, edema, discoloration) Cold packs to the perineal area limit bruising and edema.
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 4) The nurse determines that Erin's contractions are every 5 minutes, are of moderate intensity, and last 40 seconds. The fetus is active during the initial assessment. Fetal heart rate is 140 bpm, with accelerations. Amniotic fluid is light green with small white flecks in it. Vaginal examination reveals that the cervix ids dilated 5 cm and 100% effaced. The fetal presenting part is hard and round. What stage (and phase, if applicable) of labor is Erin in?
Active phase of first-stage labor
8) Fetal rebound in the amniotic fluid when the cervix is tapped
Ballottement
10) Describe fetal and maternal nursing assessments associated with oxytocin infusion. What are signs of problems? a. Fetal assessments:
Asses the FHR every 15 minutes during first stage labor and every 5 minutes during second stage labor. Problems may be indicated by tachycardia, bradycardia, late decelerations, and reduced FHR variability.
3) Fetal heart rate when the uterus is at rest
Baseline fetal heart rate
5) Fall in hemoglobin and hematocrit that occurs because plasma volume expands more than red blood cell volume
Physiologic anemia of pregnancy
6) Drug that reduces uterine muscle contractions
Tocolytic
5) Muscle tension when the uterus is not contracting
Uterine resting tone
6) Poor weight gain during pregnancy is associated with a) Preeclampsia b) Congenital heart defects c) Preterm labor and birth d) Postpartum hemorrhage
c
1) When during pregnancy does each of these markers in fundal height occur? a) Uterus can first be palpated above the symphysis pubis:
12 weeks
1) When during pregnancy does each of these markers in fundal height occur? b) Fundus can be palpated about hallway between the symphysis pubis and umbilicus:
16 weeks
1) When during pregnancy does each of these markers in fundal height occur? c) Fundus is at the level of umbilicus:
20 weeks
1) When during pregnancy does each of these markers in fundal height occur? d) Fundus is at xiphoid process:
36 weeks
Ann is admitted at 33 weeks of gestation saying that she thinks her "water broke." This is her fourth pregnancy. Two of her infants were preterm, born at 32 and 27 weeks of gestation, and she has had one termination of pregnancy. She has had regular prenatal care since 6 weeks of gestation. 4) The nurse notes that a small amount of fluid with a strong odor is draining from Ann's vagina. Using a speculum examination to obtain fluid, the pH test turns blue-black on contact with the fluid and a fern test is positive. Maternal vital signs are: temp 99 F, pulse 86, resp 22, BP 132/80. The fetal heart rate is 165 bpm. Ann occasionally has a contraction lasting 20 to 30 seconds. Would you perform a vaginal examination at this point? Why or why not?
A vaginal examination is not advised at this time because the vaginal discharge is typical of amniotic fluid (meaning that membranes are truly ruptured), there already appears to be an infection, Ann's gestation is preterm, and she is already having contractions. Little information is likely to be gained from the examination, and an examination might introduce more microorganisms into the uterus and may increase contractions. The physician may perform a speculum or vaginal examination or specifically order one.
Explain the purpose of each aspect of care for the woman having external version b. Rh immune globulin:
Administering Rh immune globulin destroys fetal Rh-positive red blood cells that might stimulate anti-Rh antibodies in the Rh-negative woman. These may enter the mother's bloodstream because of tiny placental disruptions during the version.
Postbirth uterine contractions
Afterpains
4) Infusion of a sterile solution into the amniotic cavity to reduce cord compression
Amnioinfusion
2) What maternal and fetal conditions can reduce fetal tolerance for the intermittent interruption in placental blood flow that occurs during contractions?
Any maternal condition that reduces perfusion of the placenta, such as diabetes, hypertension or fetal anemia, which reduces oxygen-carrying capacity, can reduce tolerance for even normal labor contractions
23) What are the primary nursing assessments related to each of these drugs used in the treatment of preterm labor: e. Corticosteroids:
Assess lung sounds; teach woman to report chest pain or heaviness or any difficulty in breathing.
10) Describe fetal and maternal nursing assessments associated with oxytocin infusion. What are signs of problems? b. Maternal assessments:
Assess uterine activity for contractions that are too frequent or too long or a uterus that does not relax for at least 30-60 seconds between contractions. Blood pressure and pulse identify changes from the baseline; temperature assessment identifies infection that may occur with ruptured membranes. Intake and output, assessment for headache, blurred vision, behavioral changes, increased blood pressure and respirations, decreased pulse, rales, wheezing and coughing identify possible water intoxication. Postpartum hemorrhage may occur if an overstimulated uterus cannot contract effectively after birth.
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 7) Erin complains of back discomfort during each contraction. What intervention might make this discomfort more tolerable?
Assuming any of several upright positions and leaning forward during contractions; hand and knees; firm sacral pressure
7) What changes in the urinary system make the pregnant woman more susceptible to infection?
Bladder tone decreases, and bladder capacity increases; the ureters, kidneys, and pelvis may dilate, and flow of urine may be partially obstructed, leading to stasis of urine.
Maternal substances secreted in response to stress
Catecholamines
Explain how each of the following factors can reduce fetal oxygenation. How would you explain each in simple terms to a laboring woman? e. Placental disruptions
Conditions such as abruptio placentae (partial separation before birth) and infarcts reduce the placental surface area available for exchange. The amount and location of placental disruption relate to the degree of impairment in uteroplacental exchange. Large infarcts or separations cause greater impairment than smaller ones. Central infarcts or separations usually cause greater impairment than those on edges of the placenta.
13) Describe nursing care associated with a forceps or vacuum extractor assisted birth. What is the rationale for each? Are there contraindications for either method? c. Contraindications:
Conditions that may make a cesarean birth preferable to speed delivery or reduce trauma, such as sever fetal compromise, acute maternal conditions, high fetal station, and conflict between fetal and pelvic sizes.
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 8) After 4 hours of labor in the birth center, Erin's cervix is completely dilated and effaced, and the fetal station is +1. Erin feels the need to push during some contractions. What is the safest way to advise Erin to push?
Delayed pushing may be encourage until Erin has a more intense urge to push. When Erin pushes, she should avoid prolonged breath-holding. She can be taught to take a deep breath and exhale it and then take another deep breath and push for 4-6 seconds at a time while exhaling. A final deep breath at the end of the contraction helps her relax.
16) List three characteristics of tetanic (hypertonic) contractions. Why is it important to watch for this type of contraction?
Duration longer than 90-120 seconds; intervals shorter than 30 seconds; incomplete uterine relaxation between contractions. If tetanic, or hypertonic, contractions are too long or too frequent, or if too little uterine relaxations exist, fetal oxygenation may be reduced.
15) Explain the rationale for each intervention associated with cesarean birth e. Indwelling catheter:
Keeps bladder out of the way of uterine incision.
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 3) What test might the nurse use to verify that Erin's membranes have indeed ruptured?
Either a pH or fern test or both are the two tests that are often used to evaluate whether the membranes have ruptured.
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 6) Amniotic fluid is light green with small white flecks in it. Is the amniotic fluid normal?
Expect for the greenish color, the amniotic fluid is normal. The amniotic fluid is green because the fetus passed meconium before birth. Fetal problems may or may not exist.
Explain the purpose of each aspect of care for the woman having external version c. Fetal heart monitoring:
FHR monitoring evaluates how the fetus is tolerating the version and when the fetal condition returns to baseline afterward.
14) List important nursing assessments after the membranes rupture. Describe normal and abnormal assessment results.
Fetal heart rate for at least 1 minute; time of rupture; whether rupture was spontaneous or artificial; color of fluid (clear, possibly with bits of vernix, is normal; green indicates fetal meconium passage; yellow or cloudy suggests infection); odor (foul or strong odor suggests infection)
4) Why is it important that the uterus remain firmly contracted after birth?
Firm uterine contraction compresses bleeding vessels at the placental site to prevent hemorrhage.
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 10) What nursing assessments are needed to observe for hemorrhage?
Firmness, height and position of the uterine fundus; vital signs; amount of lochia; and observing the intervening for a full bladder help prevent hemorrhage caused by the bladder's interference with uterine contraction.
Ann is admitted at 33 weeks of gestation saying that she thinks her "water broke." This is her fourth pregnancy. Two of her infants were preterm, born at 32 and 27 weeks of gestation, and she has had one termination of pregnancy. She has had regular prenatal care since 6 weeks of gestation. 2) The nurse notes that a small amount of fluid with a strong odor is draining from Ann's vagina. Using a speculum examination to obtain fluid, the pH test turns blue-black on contact with the fluid and a fern test is positive. Maternal vital signs are: temp 99 F, pulse 86, resp 22, BP 132/80. The fetal heart rate is 165 bpm. Ann occasionally has a contraction lasting 20 to 30 seconds. What data from the assessment is most relevant?
Fluid draining from the vagina; positive pH (7.5) and fern tests; fluid with a strong odor; fetal tachycardia; occasional contraction
List suggested pregnancy weight gains for each category A. Normal pre-pregnancy weight (BMI 18.5 to 24.9):
Gain 11.5 to 16kg (25-35 lb)
List suggested pregnancy weight gains for each category B. Pre-pregnancy weight underweight (BMI < 18.5):
Gain 12.5 to 18 kg (28-40 lb)
List suggested pregnancy weight gains for each category D. Pre-pregnancy weight obese (BMI > 30):
Gain 5-9 kg (11-20 lb)
List suggested pregnancy weight gains for each category C. Pre-pregnancy weight overweight (BMI 25-29.9):
Gain 7-11.5 kg (15-25 lb)
Explain how each of the following factors can reduce fetal oxygenation. How would you explain each in simple terms to a laboring woman? hypertonic uterine activity
Hypertonic uterine activity reduces the time available for exchange of oxygen and waste products in the placenta.
Explain how each of the following factors can reduce fetal oxygenation. How would you explain each in simple terms to a laboring woman? maternal hypotension
Hypotension results, with reduction of placental blood flow.
11) List nursing interventions if fetal or maternal assessments are not reassuring when oxytocin induction or augmentation of labor is being performed
In addition to identifying the true cause of the nonreassuring assessments, interventions may include stopping the oxytocin infusion, increasing the rate of the non-additive infusion, positioning to avoid aortocaval compression, and giving oxygen by face mask. Internal monitoring may be initiated if not already in place. The physician may also order a tocolytic drug if uterine hyperactivity is the problem.
33) A few minutes after a woman's membranes rupture during labor, the fetal heart rate drops from a baseline of 140 to 75. The priority nursing action is to: a. Phone the physician to report the fetal heart rate b. Assess for other signs that indicate chorioamnionitis c. Perform a vaginal examination and palpate for prolapsed cord d. Insert an indwelling catheter to assess fluid balance
c
2) Why does the pregnancy induced change in fibrinogen levels and other clotting factors have a protective effect yet also increase risk?
Increased fibrinogen and clotting factors offer protection from excess blood loss but also predisposes the woman to thrombus formation.
Shawna is an 18 year old primigravida admitted to the birth center at 27 weeks of gestation in probably preterm labor. Her membranes are intact. The physician writes the following orders: NPO except ice chips or clear fluids CBC Catheterized urine for routine analysis and culture and sensitivity IV fluids: LR 200mL/hour for 1 hour then 125 mL/hr Routine fetal monitoring and maternal vital signs 4) Contractions stop and Shawna will begin taking oral terbutaline. What nursing observations are essential related to use of oral terbutaline?
Maintain even spacing of the drug; except side effects such as palpitations, tremors, restlessness, weakness or headache. Report heart rate greater than 110 bpm, chest pain, or dyspnea.
22) List side effects that may occur with beta-adrenergic drugs, such as terbutaline.
Maternal and fetal tachycardia, decreased blood pressure, wide pulse pressure, dysrhythmias, myocardial ischemia, chest pain, pulmonary edema, hyperglycemia and hypokalemia, headache, tremors, and restlessness
Explain how each of the following factors can reduce fetal oxygenation. How would you explain each in simple terms to a laboring woman? maternal hypertension
Maternal hypertension may reduce blood flow to the placenta because of vasospasm and narrowing of the spiral arteries.
8) Use Nagele's rule to calculate estimated dates of delivery for each of these dates, which represent the first day of the last normal menstrual periods: b) August 2, 2011:
May 9, 2012
15) Explain the rationale for each intervention associated with cesarean birth a. Maintaining NPO status:
NPE status reduces the risk for aspiration of gastric contents if a general anesthetic becomes necessary.
8) Use Nagele's rule to calculate estimated dates of delivery for each of these dates, which represent the first day of the last normal menstrual periods: a) February 4, 2011:
November 11, 2011
2) Cord around the fetus's neck
Nuchal cord
23) What are the primary nursing assessments related to each of these drugs used in the treatment of preterm labor: c. Indomethacin:
Observe for nausea, vomiting, heartburn, skin rash and prolonged bleeding; observe for signs of infection other than fever; check fundal height; have woman do kick counts to identify fetal movements.
13) Describe nursing care associated with a forceps or vacuum extractor assisted birth. What is the rationale for each? Are there contraindications for either method? b. Fetal/neonatal:
Observe for reddening, mild bruising or small lacerations where forceps were applied. Facial asymmetry usually seen when the infant is crying, suggests nerve damage that resolves more slowly.
23) What are the primary nursing assessments related to each of these drugs used in the treatment of preterm labor: b. Magnesium Sulfate:
Observe for urine output of at least 30 mL/hr, presence of deep tendon reflexes, and respirations of at least 12 breaths per minute; assess heart and lung sounds; observe bowel sounds and assess for constipation; have calcium gluconate available.
23) What are the primary nursing assessments related to each of these drugs used in the treatment of preterm labor: a. Terbutaline:
Observe maternal blood pressure, pulse and respirations and fetal heart rate to identify tachycardia or hypotension; assess lung sounds assess for presence of dyspnea or chest pain to identify pulmonary edema or myocardial ischemia; obtain ordered glucose and potassium levels.
Division between the upper and lower uterine segments
Physiologic retraction ring
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 2) The nurse decides that Erin may be in true labor and tells her to come to the birth center. On arrival, Erin says she thinks her "water broke" What is the priority nursing care at this time?
Priorities are to: assess the FHR and if membranes have ruptured, the color, odor, and character of the amniotic fluid; Assess Erin's vital signs and determine the nearness to birth by evaluating contractions and cervical dilation.
9) What routine urine testing is done during prenatal visits?
Protein, glucose, ketones, and bacteria
15) Explain the rationale for each intervention associated with cesarean birth d. Intravenous antibiotic:
Reduces risk for postpartum infection.
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 1) What information should the nurse obtain to help determine whether Erin is in true labor?
Regular contractions that have increased in duration, intensity, and frequency suggest true labor. Irregular contractions and those that do not intensify suggest false labor. In addition, discomfort is usually felt in her back or sweeping around to her lower abdomen. Erin should be instructed to come to the birth center if she thinks her membranes may have ruptured, even if she is not having contractions.
24) What are the two objectives if umbilical cord prolapse occurs or is suspected?
Relieve pressure on the cord by any of several measures, including positioning the woman so that her hips are higher than her head and pushing the fetal presenting part upward; increase oxygen delivery to the placenta. Handling the cord may induce arterial spasm in the cord vessels.
4) Irregular reddish streaks caused by tears in connective tissue
Striae gravidarum
23) What are the primary nursing assessments related to each of these drugs used in the treatment of preterm labor: d. Nifedipine:
Teach about flushing of the skin and headache; observe maternal pulse rate (report if over 120); fetal heart rate; and maternal blood pressure; warn of postural hypotension, and teach woman to assume a sitting or standing position slowly after lying down.
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 5) Fetal heart rate is 140 bpm, with accelerations. How should the fetal heart rate be interpreted?
The FHR is normal for a term fetus and it is reassuring that the FHR accelerates
Erin is an 18 year old primigravida who calls the intrapartum unit because she thinks she may be in labor. 9) Erin successfully gives birth to a boy. Shortly after the placenta is delivered. She is now in the fourth stage of labor. She and her husband are getting acquainted with their baby, Noah. What time period does the fourth stage involve?
The first 1-4 hours after the placenta delivers is the fourth stage of labor
4) What factors contribute to a woman's sense of dyspnea?
The growing uterus eventually lifts the diaphragm and reduces lung expansion. The respiratory center becomes more sensitive to carbon dioxide and the mother hyperventilates slightly.
14) Explain why cesarean birth is not always easy for the newborn
The infant may be born preterm if a cesarean birth is scheduled. Transient tachypnea may occur, caused by delayed absorption of lung fluid or persistent pulmonary hypertension. Injury such as lacerations or bruising can occur.
Ann is admitted at 33 weeks of gestation saying that she thinks her "water broke." This is her fourth pregnancy. Two of her infants were preterm, born at 32 and 27 weeks of gestation, and she has had one termination of pregnancy. She has had regular prenatal care since 6 weeks of gestation. 1) What are the most important additional assessments that the nurse should make?
The nurse must attempt to verify whether Ann's membranes have ruptured, but without performing a vaginal examination; determine when they are ruptured; assess maternal vital signs and fetal heart rate, looking specifically for signs of infection; assess for contractions that may indicate preterm labor as well as preterm premature rupture of membranes.
3) What changes allow the woman to obtain the increased oxygen needed during pregnancy?
The pregnant woman breathes more deeply and airway resistance is reduced by progesterone and prostaglandins.
Explain how each of the following factors can reduce fetal oxygenation. How would you explain each in simple terms to a laboring woman? f. Umbilical cord blood flow compression
The thin-walled umbilical vein is compressed initially, resulting in a reduced inflow of more highly oxygenated blood to the fetus. This results in initial hypoxia with hypotension. Baroreceptors and chemoreceptors respond by accelerating the FHR. Flow through the firmer-walled umbilical arteries that carry blood from the fetus to the placenta is reduced as cord compression continues, resulting in hypertension. Baroreceptors respond to hypertension by stimulating the vagus nerve, thus reducing blood pressure and slowing the fetal heart. The FHR again accelerates as pressure is relieved on the umbilical arteries and then on the umbilical vein.
Ann is admitted at 33 weeks of gestation saying that she thinks her "water broke." This is her fourth pregnancy. Two of her infants were preterm, born at 32 and 27 weeks of gestation, and she has had one termination of pregnancy. She has had regular prenatal care since 6 weeks of gestation. 3) The nurse notes that a small amount of fluid with a strong odor is draining from Ann's vagina. Using a speculum examination to obtain fluid, the pH test turns blue-black on contact with the fluid and a fern test is positive. Maternal vital signs are: temp 99 F, pulse 86, resp 22, BP 132/80. The fetal heart rate is 165 bpm. Ann occasionally has a contraction lasting 20 to 30 seconds. What is the main judgment you would make from these data? What is the basis for that judgment?
The vaginal fluid drainage and the positive pH and fern tests suggest that Ann's membranes have ruptured. Infection is suggested by the strong fluid odor and fetal tachycardia. Contractions suggest possible preterm labor.
15) Explain the rationale for each intervention associated with cesarean birth c. Complete blood count, coagulation studies, blood type and crossmatch:
These tests identify reserve to tolerate blood loss, risk for poor blood clotting to control hemorrhage, and blood type for possible transfusion, they prepare blood to be ready immediately if the need for transfusion arises.
15) Why is it important to place a small pillow under one hip if the mother must lie briefly on her back?
To prevent supine hypotension from aortocaval compression by the heavy uterus
Shawna is an 18 year old primigravida admitted to the birth center at 27 weeks of gestation in probably preterm labor. Her membranes are intact. The physician writes the following orders: NPO except ice chips or clear fluids CBC Catheterized urine for routine analysis and culture and sensitivity IV fluids: LR 200mL/hour for 1 hour then 125 mL/hr Routine fetal monitoring and maternal vital signs 2) What is the purpose for a urinalysis and a urine culture and sensitivity?
Urinary tract infection is associated with preterm labor and reduces the effectiveness of measures to stop preterm labor.
Shawna is an 18 year old primigravida admitted to the birth center at 27 weeks of gestation in probably preterm labor. Her membranes are intact. The physician writes the following orders: NPO except ice chips or clear fluids CBC Catheterized urine for routine analysis and culture and sensitivity IV fluids: LR 200mL/hour for 1 hour then 125 mL/hr Routine fetal monitoring and maternal vital signs 3) Shawna will receive magnesium sulfate for tocolysis. What nursing observations are essential in relationship to magnesium sulfate? Why?
Urine output of at least 30 mL/hr, presence of deep tendon reflexes, and respiratory rate of at least 12 breaths per minute suggest that the magnesium is within safe limits. Serum magnesium levels will also be ordered
Explain the purpose of each aspect of care for the woman having external version d. Uterine activity monitoring:
Uterine activity monitoring identifies persistent contractions that may herald the onset of labor following the version.
1) Fluctuations in the baseline fetal heart rate
Variability
5) What nasal changes are common during pregnancy? What causes them?
Vasocongestion from estrogen's effects causes increased vascularity and edema leading to nasal stuffiness, nosebleeds, and voice changes. It can also result in ear fullness or earaches.
15) Explain the rationale for each intervention associated with cesarean birth b. Placing a wedge under one hip:
Wedge under hip (or tilting the table) avoids aortocaval compression by
11) What is the primary benefit of the stress of labor to the newborn? a) It stimulates breathing and elimination of lung fluid b) It increases alertness and enhances parent-infant bonding c) It speeds peristalsis to eliminate meconium quickly d) It enhances tolerance of microorganisms from others
a
12) Choose the abbreviation that represents the fetal presentation and position that is most favorable for vaginal birth: a) LOA b) RMP c) LST d) ROP
a
17) A method to prepare the cervix for induction of labor is a. Prostaglandin vaginal inserts b. Fetal fibronectin c. Oral oxytocin tablets d. Amniotomy
a
19) A woman's membranes rupture during a contraction. The priority nursing action is to: a) Assess the fetal heart rate b) Note the color of discharge c) Check the woman's vital signs d) Determine whether the fluid has a foul odor
a
19) Parents of an infant born with a forceps-assisted vaginal birth ask about small reddened areas on the infant's cheeks. The nurse should tell them that the areas a. Are temporary and will disappear b. Are typical of all vaginal births c. Will be reported to the physician d. May lead to serious infection
a
2) The nurse will be concerned about anemia that is not physiologic anemia of pregnancy if a woman in her second trimester has a hemoglobin level less than: a) 10.5g b) 11g c) 12 g d) 12.5 g
a
27) Choose the primary nursing measure to promote fetal descent a. Remind the woman to empty her bladder every 1 to 2 hours b. Assist fetal head rotation while do a vaginal examination c. Have the woman push at least three times with each contraction d. Promote intake of glucose-containing fluids during labor
a
3) The nurse notes a pattern of variable decelerations to 75 bpm on the fetal monitor. The initial nursing action should be to: a. Reposition the woman b. Administer oxygen c. Increase the IV infusing d. Stimulate the fetal scalp
a
4) A pregnant woman has a blood glucose screening at 26 weeks of gestation. The result is 128 mg/dl. The nurse should expect that a) No additional glucose testing will be needed b) Insulin injections will be needed by 30 weeks of gestation c) Oral drugs may be prescribed to lower her glucose level d) More testing is needed to determine appropriate therapy
a
7) To reduce the incidence of neural tube defects such as spina bifida, it is recommended that women of childbearing age consume a) 400 mcg of folic acid per day in foods and supplements b) 300 extra calories near the expected conception date c) 60 mg of supplemental iron in addition to high-iron foods d) 2 added servings of foods that are high in vitamin C
a
9) The main risk to a woman who practices pica during pregnancy is a) Inadequate intake of essential nutrients b) Rapid absorption of nutrients such as iron c) Reduced fluid intake and dehydration d) Non-acceptance of the practice of caregivers
a
1) A pregnant woman expects to give birth to her first baby in approximately 1 week. She asks the nurse whether she has a bladder infection, because she urinates so much, even though urination causes no discomfort. The nurse should explain to her that: a) Her urine will be tested because urinary tract infections are common in pregnancy b) Her fetus is probably lower in her pelvis, and this puts more pressure on her bladder. c) She should limit her fluid to reduce the number of times she must urinate d) Frequent urination is a sign that labor will probably start in a few days
b
16) After the physician performs an amniotomy, the fluid is dark green with a mild odor and the FHR is 135 bpm. The most appropriate nursing care it to a. Take the woman's temperature hourly until delivery b. Monitor the fetus more closely for nonreassuring signs c. Tell the woman that she cannot have anything by mouth d. Observe the woman closely for hypotension
b
17) Bloody show differs from active vaginal bleeding in that blood show: a) Quickly clots on the perineal pad b) Is dark red and mixed with mucus c) Flows freely during vaginal examination d) Decreases in quantity as labor progresses
b
2) The expected response of the fetal heart rate of a term fetus to movement is a. Suppression of normal variability for at least 15 seconds b. Accelerations of 1 or more beats per minute for 15 seconds c. Increase in variability by 15 bpm for 10 minutes d. Acceleration followed by deceleration of the heart rate
b
22) A woman having her third baby planned epidural analgesia for labor and birth. However, her labor was so rapid that she did not have the epidural. What is the best initial nursing approach in this case? a) Congratulate her on having a labor that was quicker than expected b) Use open-ended questions to clarify her true feelings about the experience c) Tactfully explain why a non-epidural labor and birth are actually better d) Explain that it is often difficult to time epidural analgesia for labor
b
25) A woman with an otherwise uncomplicated pregnancy is very frustrated because of hypotonic labor. What nursing measure is most appropriate for her? a. Do not allow any oral intake b. Start oxytocin at a low rate c. Offer her a warm shower or bath d. Reassure her that her problem is common
b
26) A woman has shoulder dystocia when giving birth. The nurse should expect a. Immediate forceps delivery b. Application of suprapubic pressure c. Oxytocin labor augmentation d. Turning in a hands-and-knees position
b
30) Choose the nursing assessment that most clearly suggest intrauterine infection a. Fetal heart rate of 145 bpm b. Cloudy amniotic fluid c. Maternal temperature of 100 F d. Increased bloody show
b
32) A woman is receiving magnesium sulfate to stop preterm labor. In addition to fetal heart rate, the essential nursing assessment related to this drug is a. For intensity and duration of uterine contractions b. Hourly vital signs, heart sounds, and lung sounds c. For presence of fetal movements with contractions d. Vaginal examination for cervical dilation, effacement, and station
b
5) The tocotransducer should be placed a. In the suprapubic area b. In the fundal area c. Over the xiphoid process d. Within the uterus
b
8) The abbreviation LOA means that the fetal occiput is: a) On the examiner's left and in the front of the pelvis b) In the left front part of the mother's pelvis c) Anterior to the fetal breech d) Lower than the fetal breech
b
8) When teaching an adolescent about nutrition during pregnancy, the nurse should: a) Focus on the girl's responsibility to her fetus b) Provide as many choices as possible from nutritious foods c) Ask the girl to limit snacking and fast foods d) Explain how a good pregnancy diet will improve her health
b
9) Choose the most reliable evidence that true labor has begun a) Regular contractions that occur every 15 minutes b) Change in the amount of cervical thinning c) Increased ease of breathing with frequent urination d) A sudden urge to do household tasks
b
Explain how each of the following factors can reduce fetal oxygenation. How would you explain each in simple terms to a laboring woman? g. Fetal bradycardia or tachycardia
bradycardia can result in less blood flow and less oxygen resulting in hypoxia tachycardia
1) Firm contractions that occur every 2 to 2.5 minutes and last 100 seconds may reduce fetal oxygen supply because they: a. Cause fetal bradycardia and reduce oxygen concentration b. Activate the fetal sympathetic nervous system c. Reduce time for oxygen exchange in the placenta d. Suppress the normal variability of the fetal heart rate
c
10) A nurse should note how long the interval between contractions lasts because: a) Maternal cells restore their glucose levels during the interval b) A very short interval requires earlier administration of analgesia c) Most exchange of fetal oxygen and waste products occurs then d) The interval becomes longer as cervical dilation increases
c
18) Choose the nursing assessment that is most likely to occur with hypertonic uterine contractions a. Foul smelling amniotic fluid b. Contraction interval of 90 seconds c. FHR of 90 bpm d. Maternal pulse of 80-90 bpm
c
20) Choose correct preoperative teaching before planned cesarean birth a. Oral intake will be limited to clear fluids for 12 hours before surgery b. IV fluids are usually continued for 2 days after birth c. The woman will be asked to take deep breaths and cough regularly after birth d. The nurse will help her ambulate to the restroom to urinate 4 hours after birth
c
20) When palpating labor contractions, the nurse should: a) Use the palm of one hand while palpating the lower uterus b) Avoid palpating during the period of maximum intensity c) Place the fingertips over the fund of the uterus d) Limit palpation to three consecutive contractions
c
28) An infant weighing 3912 gm is born vaginally. Should dystocia occurred at birth. Because of this problem, the nurse should assess the infant for a. Head swelling that does not extend beyond the skull bones b. Inward turning of the feet or legs c. Creaking sensation when the clavicles are palpated d. Limited abduction of one or both hips
c
5) Choose the maternal behavior that best describes role playing during pregnancy: a) The woman shifts from saying "I am pregnant" to "I am having a baby" b) The woman begins calling her fetus by a name rather than "it" c) The woman tries to care for infants while an experienced mother watches d) The woman becomes less absorbed in her own needs and focuses on the fetus
c
5) When assessing a laboring woman's blood pressure, the nurse should: a) Inflate the cuff at the beginning of a contraction b) Check the blood pressure between two contractions c) Expect a slight elevation of the blood pressure d) Position the woman on her back with her knees bent
c
6) The nurse should respond to incomplete uterine relaxation between contractions by a. Increasing the rate of IV fluids b. Having the woman push with contractions c. Contacting the physician for a tocolytic order d. Initiating an amnioinfusion with Ringer's lactate
c
7) The most appropriate time for the nurse to assist a laboring woman to push is a) During the interval between contractions b) During first-stage labor c) During second-stage labor d) Whenever she feels the need
c
3) Describe the most common variations in c) Fetal presentation:
cephalic (common), breech (appox 3%) or shoulder (rare, less than 0.2%)
10) Choose the correct nursing approach regarding caffeine use during pregnancy a) Teach that caffeine has not been shown to be a risk b) Limit total intake of caffeine-containing drinks to four daily c) Drink two glasses of water for each caffeine-containing drink d) Discuss sources of caffeine in addition to coffee and tea
d
13) A station of +1 means that the a) Maternal cervix is open 1 cm b) Mother's ischial spines project into her pelvis 1 cm c) Fetus is unlikely to be born vaginally because the pelvis is small d) Fetal presenting part is 1 cm below the mother's ischial spines
d
18) A laboring woman who has not taken pain medication abruptly stops her previous breathing techniques during a contraction and makes low-pitched grunting sounds. The priority nursing action is to: a) Ask her whether she needs pain medication b) Turn her to her left side c) Assess contraction duration d) Look at her perineum
d
21) When auscultating the fetal heart rate of a term fetus during labor, the nurse notes a rate of 135 bpm with occasional accelerations in the rate. How should the nurse interpret the data? a) The baseline rate is slightly high for a term fetus b) Accelerations in the rate suggest intermittent hypoxia c) Labor usually causes the fetal heart to be slower d) These assessments are normal for a term fetus during labor
d
23) A woman having her first baby has been observed for 2 hours for labor but is having false labor contractions. Choose the most appropriate teaching before she returns home: a) "It is unlikely that your labor will be fast, so you can stay home until your water breaks." b) "If your water breaks, you can wait until contractions are 5 minutes apart or closer." c) "As long as the baby is active, there is no hurry to return to the birth center." d) "Your contractions will usually be 5 minutes apart or closer for 1 hour if labor is real"
d
29) A woman is having very rapid labor with her fourth child. What nursing measure is most appropriate to help her manage pain? a. Offer Stadol when she reaches 5 cm cervical dilation b. Keep her in an upright position until full cervical dilation c. Avoid vaginal examinations during the peak of a contractions d. Coach her to use breathing techniques with each contraction as it occurs
d
3) A pregnant woman complains that her hands become numb at times. Neither hand is inflamed or discolored. The nurse should explain to the woman that a) She probably injured her hands and does not recall doing so b) Undiagnosed fractures may have healed improperly c) Osteoarthritis often has its onset during pregnancy d) Increased tissue fluid is causing compression of a nerve
d
31) A woman phones the labor unit and says she has been having back discomfort all day. She is at 32 weeks of gestation. The nurse should tell the woman that she a. Is having discomfort that is typical of the third trimester b. Should come to the hospital if she has increased vaginal drainage c. Can increase her fluid intake to reduce Braxton Hicks contractions d. Should come to the hospital for further evaluation
d
34) A woman phones the labor unit saying that she has had an abrupt onset of pain between her shoulder blades that is worse when she breaths in. She is scheduled to have a repeat cesarean birth in 1 week. The nurse should a. Ask her whether she has had a recent upper respiratory infection b. Explain that the growing fetus reduces space to breathe c. Have her palpate her uterus from frequent contractions d. Tell her that she should come to the hospital promptly
d
4) The woman who uses cocaine is more likely to have which pattern on the electronic fetal heart monitor? a. Intermittent tachycardia b. Accelerations c. Variable decelerations d. Late decelerations
d
6) A woman is admitted in active labor. Her leukocyte count is 14,500. Based on this information, the nurse should: a) Assess the woman for other evidence of infection b) Inform the nurse-midwife of the results promptly c) Use isolation techniques to limit spread of infection d) Record the expected results in the woman's chart
d
7) A woman is admitted in possible labor at 34 weeks of gestation. She is monitored with the external fetal monitor while on her left side. The nurse should periodically assess the contractions by palpation, primarily because: a. It makes the woman feel more like her pregnancy is normal b. Palpation identifies whether the fetus has changed its presentation c. Contractions may not be sensed by the tocotransducer while she is on her side d. The tocotransducer is not accurate for actual intensity and uterine resting tone
d
8) The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction begins and returns to baseline just before the contraction is over. The correct nursing response is to: a. Give the woman oxygen by face mask at 8 to 10L/min b. Position the woman on her opposite side c. Increase the rate of the woman's IV fluid d. Continue to observe and record the normal pattern
d
9) Firm sacral pressure is likely to be most helpful in which situation? a. Rapid labor and birth b. Fetal occiput posterior position c. Oxytocin induction of labor d. If analgesics should be avoided
d
Opening of the cervix
dialation
Thinning of the cervix
effacement
3) Describe the most common variations in b) Fetal attitude:
flexion (common) or extension (uncommon)
2) Excess blood in a body part
hyperemia
1) Descent of the fetus into the pelvis, reducing pressure on the diaphragm
lightening
7) Brownish discoloration of the face
melasma
Change in the shape of the fetal head during birth
molding
3) Women who has given birth once after a
primipara
6) First fetal movements felt by the mother
quickening
Hormone that causes cartilage to soften
relaxin
Measurement of descent of the fetal presenting part into the pelvis
station