Intrapartum CH 8-11 Durham EXAM 2

A nurse monitoring fetal heart rate (FHR) finds the results to be Category I, normal. Which of the following should be true of the FHR tracings in such a finding? 1. Baseline rate of 110 to 160 beats per minute 2. Baseline variability moderate 3. Late or variable deceleration absent 4. Early decelerations present 5. Sinusoidal pattern

1,2,3,4 Feedback 1: A baseline rate of 110 to 160 beats per minute is consistent with a normal FHR. Feedback 2: Baseline variability being moderate is consistent with a normal FHR. Feedback 3: Late or variable deceleration being absent is consistent with a normal FHR. Feedback 4: Early decelerations are consistent with a normal FHR. Feedback 5: An abnormal, Category III, FHR pattern is one in which the FHR tracings have either: 1) absent variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia; or 2) a sinusoidal pattern. XXXX

At an antepartum office visit late in her third term, a patient tells the nurse that several of her friends have had cesarean sections in the past year or two. She asks why cesarean births are typically performed. Which of the following should the nurse mention as primary indications for cesarean birth? 1. Previous cesarean birth 2. Ineffective uterine contractions 3. Cephalopelvic disproportion 4. Breech presentation 5. Vertex presentation

1,2,3,4 Feedback 1: Previous cesarean birth is a major indication for repeat cesarean birth, due in large part to the perception of increased risks of a vaginal birth after cesarean, such as for uterine rupture. Feedback 2: Ineffective uterine contractions that lead to prolonged first stage of labor are an indication for cesarean birth. Feedback 3: Cephalopelvic disproportion, in which the fetal head does not fit properly through the woman's pelvis, is an indication for cesarean birth. Feedback 4: Malpresentation or malposition of the fetus, such as breech presentation, transverse lie, or persistent occiput posterior position, is an indication for cesarean birth. Feedback 5: Cephalic vertex presentation of the fetus is the normal presentation and thus is not an indication for cesarean birth. XXXXX

A patient is having a slower-than-normal labor, and the obstetrician is considering a cesarean section. Which of the following should the assisting nurse recognize as risk factors in this patient for dystocia? 1. Congenital uterine abnormalities 2. Failure to administer analgesia or anesthesia early in labor 3. Cephalic face presentation 4. Cephalopelvic disproportion 5. Maternal fatigue and dehydration

1,3,4,5 Feedback 1: Congenital uterine abnormalities are a risk factor for dystocia. Feedback 2: Administration of analgesia or anesthesia early in labor is a risk factor for dystocia, not the failure to do so. Feedback 3: Cephalic face presentation is a malpresentation, which is a risk factor for dystocia. Feedback 4: Cephalopelvic disproportion, in which the head of the fetus does not fit through the mother's pelvis, is a risk factor for dystocia. Feedback 5: Maternal fatigue and dehydration are risk factors for dystocia. XXXX

A nurse is explaining to a patient the maternal factors that trigger labor. Which of the following should the nurse mention? 1. Stretching of uterine muscles 2. Desire of the mother 3. Pressure on the cervix 4. Release of oxytocin 5. Increase in estrogen

1,3,4,5 Feedback 1: Uterine muscles are stretched to the threshold point, leading to release of prostaglandins that simulate contractions. Feedback 2: The desire of the mother is not a labor trigger, unfortunately. Feedback 3: Increased pressure on the cervix stimulates the nerve plexus, causing release of oxytocin by the maternal pituitary gland, which then stimulates contractions. Feedback 4: Oxytocin stimulates myometrial contractions. Oxytocin and prostaglandin work together to inhibit calcium binding in muscle cells, raising intracellular calcium levels and activating contractions. Feedback 5: Estrogen increases, stimulating the uterine response. XXXX

A primary care provider has approved oxytocin induction in a patient who is 2 weeks post-term. Which of the following doses should the nurse administer to this patient? 1. 0.5 mU/min initially and increasing by 1 to 2 mU/min every 30 to 60 minutes 2. 1 mU/min initially and increasing by 0.5 to 1 mU/min every 30 to 60 minutes 3. 2 mU/min initially and increasing by 2 to 4 mU/min every 30 to 60 minutes 4. 4 mU/min initially and decreasing by 0.5 to 1 mU/min every 30 to 60 minutes XXXXX

1. 0.5 mU/min initially and increasing by 1 to 2 mU/min every 30 to 60 minutes Current dose recommendations are for low-dose oxytocin, starting at 0.5 mU/min and increasing the dose by 1 to 2 mU/min every 30 to 60 minutes until adequate labor progress is achieved.

A nurse is using a fetoscope to externally listen to fetal heart rate (FHR) without the use of a paper recorder. The nurse is using which of the following types of fetal and uterine monitoring? 1. Auscultation 2. Palpation 3. External electronic fetal and uterine monitoring 4. Internal electronic fetal and uterine monitoring XXXX

1. Auscultation Auscultation is the use of the fetoscope or Doppler to hear the FHR by externally listening without the use of a paper recorder.

A nurse performs effleurage on a laboring patient to help distract her from her pain. This intervention is an example of which type of pain management? 1. Cutaneous stimulation 2. Thermal stimulation 3. Mental stimulation 4. Social stimulation XXXXXX

1. Cutaneous stimulation Effleurage is cutaneous stimulation done by lightly stroking the abdomen in rhythm with breathing during contractions.

While a patient is early in labor, she explains to her nurse that she and her husband have taken childbirth classes that that focus on birth without fear by education and environmental control and relaxation. The nurse recognizes that this couple most likely attended which type of classes? 1. Dick-Read method 2. Lamaze 3. Bradley 4. Aromatherapy XXXXXXXX

1. Dick-Read method The Dick-Read method advocates birth without fear by education and environmental control and relaxation.

A nurse is evaluating fetal heart rate (FHR) monitor results and notes a gradual decrease in FHR below the baseline, with the nadir (lowest point) occurring at the same time as the peak of the uterine contraction (UC). The onset, nadir, and recovery of this decrease mirror those of the UC of the mother. The nurse should recognize this FHR pattern as which of the following? 1. Early deceleration 2. Late deceleration 3. Tachycardia 4. Bradycardia XXXX

1. Early deceleration Early deceleration is a visually apparent gradual decrease in FHR below the baseline, with the nadir occurring at the same time as the peak of the UC. The onset, nadir, and recovery of the deceleration mirror the onset, peak, and recovery of the UC of the mother.

A woman entering the second stage of labor reports that she feels the urge to bear down. The nurse recognizes that this phenomenon is known as which of the following? 1. Ferguson's reflex 2. Valsalva technique 3. Lightening 4. Braxton-Hicks contraction XXXX

1. Ferguson's reflex The urge to push or bear down is known as Ferguson's reflex.

While assisting a patient who is in active labor, the nurse assesses her uterine contractions and observes the following: the time from one contraction starting to the time the next one starts is about 4 minutes; the time from the beginning of a contraction to the end of the same contraction is about 40 seconds; and the uterine wall is resistant to indentation when the nurse presses on it with her thumb. How would the nurse sum up these observations? 1. Frequency: 4 minutes; duration: 40 seconds; intensity: moderate 2. Frequency: 40 seconds; duration: 4 minutes; intensity: mild 3. Frequency: 4 minutes; duration: 40 seconds; intensity: strong 4. Frequency: 40 seconds; duration: 4 minutes; intensity: strong XXXXXXX

1. Frequency: 4 minutes; duration: 40 seconds; intensity: moderate Frequency is the time from the beginning of one contraction to the beginning of another, which in this case is 4 minutes. Duration is the time from the beginning of a contraction to the end of the same contraction, which in this case is 40 seconds. Intensity is the strength of the contraction, with mild referring to a uterine wall that is easily indented during a contraction, moderate being resistant to indentation (which is the case here), and strong being unable to indent.

A nurse is helping a woman in labor manage her pain. Which of the following pain relief measures would best indicate the nurse's understanding of the gate control theory of pain? 1. Gently stroking the woman's abdomen 2. Assisting with the administration of an epidural 3. Dispensing an analgesic ordered by the primary care provider 4. Encouraging the patient to meditate

1. Gently stroking the woman's abdomen The gate control theory of pain states that sensation of pain is transmitted from the periphery of the body along ascending nerve pathways to the brain. Because of the limited number of sensations that can travel along these pathways at any given time, an alternate activity can replace travel of the pain sensation, thus closing the gate control at the spinal cord and reducing pain impulses traveling to the brain. Based on this premise, the application of pressure to certain areas of the body, the cutaneous stimulation such as effleurage (gentle stroking of the abdomen), or the use of heat or cold can have a direct effect on closing the gate, which then limits the transmission of pain. XXXXXX

A woman in labor is dilated 2 cm, effaced 30%, and has contractions that occur every 7 minutes and last 35 seconds. She describes the contractions as feeling like "bad cramps" but is still talkative and able to relax. The nurse recognizes that this woman is in which phase of the first stage of labor? 1. Latent phase 2. Active phase 3. Transitional phase 4. Expulsive phase

1. Latent phase The latent phase is the early and slower part of labor with an average length of 9 hours for primiparous and 5 hours for multiparous women. Women in this phase are talkative and able to relax with the contractions. Characteristics of this phase are cervical dilation from 0 to 3 cm with effacement from 0% to 40%, along with contractions occurring every 5 to 10 minutes, lasting 30 to 45 seconds, and being of mild intensity. Women often describe these contractions as feeling like strong menstrual cramps. XXXXXXX

While performing a vaginal examination of a woman who is in early labor, the nurse observes a pulsating mass protruding from the vagina and notes sudden fetal bradycardia on the fetal heart rate monitor. Which of the following actions should the nurse perform next in this situation? 1. Lift the fetal head off of the occluded umbilical cord 2. Perform the McRoberts maneuver 3. Use forceps to expedite delivery 4. Administer oxytocin to augment labor XXXX

1. Lift the fetal head off of the occluded umbilical cord Occlusion of the cord due to prolapse may be partially relieved by lifting the presenting part off the cord during a vaginal exam.

While assisting in the delivery of a baby, the nurse observes the fetal head retract back into the maternal perineum after it had been delivered. The nurse should recognize this as a sign of which of the following obstetrical emergencies? 1. Shoulder dystocia 2. Prolapse of the umbilical cord 3. Ruptured vasa previa 4. Rupture of the uterus XXXXX

1. Shoulder dystocia Shoulder dystocia refers to difficulty encountered during delivery of the shoulders after the birth of the head. The first sign is a retraction of the fetal head against the maternal perineum after delivery of the head, sometimes referred to as turtle sign.

A nurse is assisting a patient recovering from cesarean section with breastfeeding her newborn. Which position should the nurse recommend to the patient to prevent pressure on the abdomen during breastfeeding? 1. Side-lying 2. Semi-recumbent 3. Supine 4. Sitting XXXXX

1. Side-lying The nurse should assist the patient into a comfortable position for infant feeding. Breastfeeding mothers may be more comfortable in a side-lying position, or football hold, which prevents pressure on the abdomen.

In explaining to a patient factors that help the fetal head to mold during labor and birth and thus fit through the maternal pelvis, which of the following should the nurse mention? 1. The presence of membranous spaces between the bones (sutures) and fontanels of the fetal skull 2. The action of estrogen to soften cartilage and increase elasticity of the ligaments 3. The action of relaxin to soften cartilage and increase elasticity of the ligaments 4. The gender of the fetus XXXXX

1. The presence of membranous spaces between the bones (sutures) and fontanels of the fetal skull Molding is the ability of the fetal head to change shape to accommodate/fit through the maternal pelvis. The membranous spaces between the bones (sutures) and fontanels of the fetal skull (intersections of these sutures) allow the skull bones to overlap and mold to fit through the birth canal.

A woman in active labor is experiencing excessive uterine activity, or tachysystole. Which of the following nursing actions would be effective in reducing uterine activity? 1. Administering oxytocin 2. Changing maternal position 3. Providing hydration 4. Reducing maternal anxiety or pain 5. Administering a tocolytic

2,3,4,5 Feedback 1: Most commonly, tachysystole can be caused by medications used for cervical ripening, induction, and augmentation of labor, including oxytocin. Thus, discontinuing oxytocin per doctor's orders, not administering it, would help reduce uterine activity. Feedback 2: Changing maternal position would help reduce uterine activity. Feedback 3: Providing hydration would help reduce uterine activity. Feedback 4: Reducing maternal anxiety or pain would help reduce uterine activity. Feedback 5: Administering a tocolytic would help reduce uterine activity. XXXX

A patient has just entered the third stage of labor, and the nurse is awaiting delivery of the placenta. Which of the following should the nurse expect as a sign that delivery of the placenta is imminent? 1. The further descent of the uterus 2. Shortening of the umbilical cord at the introitus 3. A sudden gush of blood from the vagina 4. Rupture of membranes XXXX

3. A sudden gush of blood from the vagina A sign that signifies the impending delivery of the placenta includes a sudden gush of blood from the vagina.

A woman is recovering from cesarean section in the labor and birthing recovery unit. During surgery, the woman received intrathecal morphine for postoperative pain management. Which of the following complications related to morphine should the nurse expect to find in this patient? 1. Hypertension 2. Pruritus 3. Nausea and vomiting 4. Lower back pain 5. Urinary retention

2,3,5 Feedback 1: Hypertension is not a side effect of intrathecal morphine. Feedback 2: The primary side effects of intrathecal morphine are pruritus (itching), nausea and vomiting, urinary retention, and respiratory depression. Feedback 3: The primary side effects of intrathecal morphine are pruritus (itching), nausea and vomiting, urinary retention, and respiratory depression. Feedback 4: Lower back pain is not a side effect of intrathecal morphine. Feedback 5: The primary side effects of intrathecal morphine are pruritus (itching), nausea and vomiting, urinary retention, and respiratory depression. XXXX

A patient who is in labor has just experienced rupture of membranes. Which of the following should be priority actions for the nurse to take at this time? 1. Assist the patient into the lithotomy position 2. Assess the fetal heart rate 3. Assess the amniotic fluid for color, amount, and odor 4. Instruct the woman to bear down with the urge to push 5. Document the date and time of rupture of membranes

2,3,5 Feedback 1: Just because the patient's membranes have ruptured does not mean that she is ready to deliver the baby immediately, which would warrant the lithotomy position. Feedback 2: The nurse should assess the fetal heart rate as there is an increased risk of umbilical cord prolapse with rupture of membranes. Feedback 3: The nurse should assess the amniotic fluid for color, amount, and odor, as meconium-stained fluid may be an indication of fetal compromise in utero. Feedback 4: The woman should not be instructed to bear down with the urge to push until she is fully effaced and dilated, which do not necessarily coincide with the rupture of membranes. Feedback 5: The nurse should document the date and time of the rupture of membranes, characteristics of the fluid, and the fetal heart rate. XXXX

A woman with her first pregnancy believes she is in labor and calls her obstetrician's office. Which of the following criteria for going to the birthing facility should the nurse mention to the woman? 1. Contractions are 10 minutes apart 2. Rupture of membranes occurs 3. Contractions last at least 30 seconds 4. She experiences intense pain 5. Increase in bloody show

2,4,5 Feedback 1: A general rule of thumb for first-time pregnancy with no risk factors is to wait until contractions are 5 minutes apart, lasting 60 seconds, and are regular. Feedback 2: The woman should go to the birthing center when her membrane ruptures (water breaks). Feedback 3: A general rule of thumb for first-time pregnancy with no risk factor is to wait until contractions are 5 minutes apart, lasting 60 seconds, and are regular. Feedback 4: The woman should go to the birthing center when she experiences intense pain. Feedback 5: The woman should go to the birthing center when there is an increase of bloody show. XXXXX

A nurse is working with a woman in labor who is obese. What risks at delivery should the nurse be prepared for related to the woman's obesity? 1. Small for gestational age neonate 2. Fetal microsomia 3. Shoulder dystocia 4. Down syndrome neonate 5. Delayed wound healing

2,4,5 Feedback 1: Maternal obesity is associated with increased risk for fetal microsomia (smaller than normal fetus size), not small for gestational age neonate, at delivery. Feedback 2: Maternal obesity is associated with increased risk for fetal microsomia (smaller than normal fetus size). Feedback 3: Maternal obesity is associated with increased risk for shoulder dystocia. Feedback 4: Maternal obesity is not associated with increased risk for Down syndrome, which is a genetic disorder. Feedback 5: Maternal obesity is associated with increased risk for delayed wound healing. XXXX

A nurse assisting a woman in labor has just learned that the woman will be undergoing an emergency cesarean section due to prolapse of the umbilical cord. In this situation, the nurse should understand that the patient needs to be completely prepared for surgery within how many minutes? 1. 15 2. 30 3. 45 4. 60 XXXX

2. 30 The nurse should facilitate the transition to unscheduled surgical birth in a timely manner. Specifically, response to such obstetrical emergencies should occur within 30 minutes, hence the 30-minute "decision to incision" rule.

A patient who is near term has called the obstetrician's office saying that she's nervous that she may be in labor. The nurse should tell the patient that true labor is characterized by which of the following? 1. Lightening and contractions that vary in frequency, duration, and intensity 2. Contractions that occur at regular intervals and increase in frequency, duration, and intensity 3. Occurrence on or within a day or two of the estimated due date 4. Rupture of membranes XXXX

2. Contractions that occur at regular intervals and increase in frequency, duration, and intensity True labor contractions occur at regular intervals and increase in frequency, duration, and intensity.

A nurse is monitoring a woman's progress during active labor. The nurse observes that the woman's cervix has thinned and shortened dramatically in the past 15 minutes. The nurse recognizes that this phenomenon is known as which of the following? 1. Dilation 2. Effacement 3. Bearing down 4. Lightening XXXXX

2. Effacement Effacement is the shortening and thinning of the cervix. Before the onset of labor, the cervix is 2 to 3 cm long and approximately 1 cm thick. The degree of effacement is measured in percentage and goes from 0% to 100%.

A nurse is caring for a patient who is in the active phase of the first stage of labor. How often should the nurse monitor fetal heart rate and contractions during this phase? 1. Every 5 to 10 minutes 2. Every 15 to 20 minutes 3. Every 30 to 40 minutes 4. Every 45 to 60 minutes XXXXX

2. Every 15 to 20 minutes The nurse should monitor fetal heart rate and contractions every 15 to 20 minutes in the active phase of the first stage of labor.

A multiparous patient passes through the latent phase of pregnancy normally, with cervical dilation and effacement progressing and contractions gradually increasing in frequency, duration, and intensity. Once she reaches the active phase, however, the contractions decrease in these three measures, and progress in dilation ceases. The nurse recognizes this dysfunction of labor as which of the following? 1. Hypertonic uterine dysfunction 2. Hypotonic uterine dysfunction 3. Precipitous labor 4. Fetal dystocia XXXXX

2. Hypotonic uterine dysfunction Hypotonic uterine dysfunction occurs when the pressure of the uterine contraction is insufficient to promote cervical dilation and effacement. Typically, the woman makes normal progress during the latent phase of labor, but during active labor the uterine contractions become weaker and less effective for cervical changes and labor progress, which is the case here.

A woman has just begun emergency cesarean birth when she complains of ringing in her ears, a metallic taste in her mouth, and a feeling like she is about to pass out. Which of the following complications of cesarean birth should the nurse most suspect in this case? 1. Maternal respiratory depression related to anesthesia 2. Inadvertent injection of the anesthetic agent into the maternal bloodstream 3. An allergic reaction to the anesthesia 4. Trauma to the bowel and subsequent hemorrhage XXXXX

2. Inadvertent injection of the anesthetic agent into the maternal bloodstream When the anesthetic agent is inadvertently injected into the maternal bloodstream, the woman experiences ringing in her ears, a metallic taste in her mouth, and hypotension that can lead to unconsciousness and cardiac arrest.

A nurse has just assisted in a vaginal birth that required vacuum extraction. A large cephalohematoma is evident on the neonate's head as a result of this method of delivery. What other condition should the nurse expect to see in this neonate that is associated with cephalohematoma? 1. Cyanosis 2. Jaundice 3. Microsomia 4. Lanugo XXXXX

2. Jaundice A risk for the newborn associated with vacuum-assisted delivery is cephalohematoma and therefore increased risk of jaundice, which is a yellowish discoloration of the skin.

Early in labor, a patient tells the nurse that she would like an unmedicated birth, in general, but would like some pain relief that is fast-acting, that she can administer herself, and that will not interfere with the normal physiology and progress of labor. Which of the following should the nurse suggest to the patient? 1. Parenteral opioids 2. Nitrous oxide 3. Epidural anesthesia 4. General anesthesia XXXX

2. Nitrous oxide Nitrous oxide is a combination of oxygen and nitrous oxide gas that is self-administered by the laboring woman using a mouth tube or face mask, when she determines that she needs it. It can be started and stopped at any point during labor, according to the needs and preferences of the woman. It takes effect in about 50 seconds after the first breath, and the effect is transient. It is has no adverse effects on the normal physiology and progress of labor.

A nurse is placing her fingertips on the fundus of the uterus of a patient who is in labor and assessing the degree of tension as the contractions occur. The nurse is using which of the following types of fetal and uterine monitoring? 1. Auscultation 2. Palpation 3. External electronic fetal and uterine monitoring 4. Internal electronic fetal and uterine monitoring XXXX

2. Palpation When the uterus contracts, the musculature becomes firm and tense and can be palpated with the fingertips by the nurse. The frequency, duration, tone, and intensity of contractions can be assessed using palpation, which is what is being done in this situation.

A patient is undergoing a scheduled cesarean birth. It is the third cesarean section she has had. Which of the following should the nurse recognize as the most significant long-term complication of repeat surgical birth? 1. Prolapse of umbilical cord 2. Placenta accreta 3. Malpresentation of the fetus 4. Hypotonic uterine dysfunction

2. Placenta accreta The most significant long-term complication of repeat surgical birth is placenta accreta, in which the placenta penetrates the myometrium of the uterus in part or completely. In all forms of placenta accreta, the placenta does not separate from the uterine wall after delivery, potentially leading to excessive hemorrhage, disseminated intravascular coagulopathy, organ failure, and, in severe cases, death. XXXXX

A woman with her first pregnancy has been in the second stage of labor for 2 hours with lack of continuing progress. The primary care provider has made three attempts so far to deliver the infant using vacuum extraction. Which of the following interventions should the nurse expect next? 1. Continued use of vacuum extraction until the cup pops off the fetal head 2. Preparation of the patient for cesarean section 3. Administration of oxytocin 4. Use of forceps to deliver the baby XXXX

2. Preparation of the patient for cesarean section The physician should proceed with a cesarean birth when vacuum attempts are not successful.

After assessing the cervical status of a patient who is being considered for oxytocin induction, the nurse finds that dilation is 1 cm, effacement at 20%, station at -2, consistency of cervix medium, and cervical position medium. The patient has had a prior uterine incision and has already experienced rupture of membranes. Which of the following actions does the nurse expect to perform next? 1. Prepare the patient for cesarean section 2. Prepare the patient for insertion of a balloon catheter 3. Prepare the patient for administration of a dinoprostone insert 4. Prepare the patient for amniotomy XXXXX

2. Prepare the patient for insertion of a balloon catheter The results of the cervical assessment indicate a Butler score of only 4. A score of less than 6 indicates that cervical ripening should be considered before induction is implemented. Because the woman has had a prior uterine incision, pharmacological cervical ripening methods are contraindicated. Thus, mechanical cervical ripening via a balloon catheter is indicated.

While assisting in the delivery of a baby, the nurse observes sudden fetal bradycardia (a prolonged deceleration on the fetal heart monitor). The nurse should recognize this as a sign of which of the following obstetrical emergencies? 1. Shoulder dystocia 2. Prolapse of the umbilical cord 3. Ruptured vasa previa 4. Rupture of the uterus XXXX

2. Prolapse of the umbilical cord Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus, becomes entrapped, and circulation is occluded, resulting in fetal heart rate bradycardia.

As a nurse is monitoring a fetal heart rate (FHR), the nurse observes a sudden increase in FHR. Which of the following factors could account for this change? 1. Stimulation of the parasympathetic nervous system 2. Stimulation of the sympathetic nervous system 3. Stimulation of a vagal response due to increased pressure applied to the baroreceptors in the aortic arch 4. Stimulation of chemoreceptors in the aortic arch due to a decrease in O₂ and increase in CO₂ XXXX

2. Stimulation of the sympathetic nervous system Sympathetic nervous system stimulation increases the FHR.

A woman who is 1 week past her due date has requested to have labor induced. Which of the following would be a contraindication to induction by oxytocin for this patient? 1. Pregnancy-induced hypertension 2. Pre-eclampsia 3. Abnormal fetal position 4. Premature rupture of membranes XXXX

3. Abnormal fetal position Abnormal fetal position is a contraindication for oxytocin induction, as cesarean section, not vaginal birth, is typically required in such cases.

Immediately after a newborn has been delivered, the nurse draws blood from the umbilical vein and one of the umbilical arteries. Which of the following is the proper rationale for this intervention? 1. To determine blood glucose level in the newborn 2. To determine acid-based balance in the newborn 3. To determine blood cholesterol levels in the newborn 4. To determine white blood cell count in the newborn

2. To determine acid-based balance in the newborn Umbilical cord blood acid-base acidosis analysis can be a useful objective way to quantify fetal acid-base balance at birth. Shortly after birth, blood is drawn from the umbilical vein and one of the umbilical arteries. The umbilical vein represents oxygen supply available to the fetus, and the arterial blood best represents fetal usage of oxygen because it is the end point of fetal metabolism as blood returns to the placenta. XXXX

A patient is in the first stage of labor. Which position should the nurse encourage the patient to assume to increase the pelvic outlet and aid the descent of the fetus? 1. Lithotomy 2. Upright 3. Supine 4. Prone XXXXXX

2. Upright The upright position has shown benefits of aiding in the descent of the infant and more effective contractions that result in shorter labor. It has also been shown to increase the pelvic outlet and better align the fetus with the pelvic inlet.

A nurse is assisting a woman in labor who has just learned that her fetus is in persistent occiput posterior position. The primary care provider is recommending cesarean section. The nurse recognizes that this cesarean birth is an example of which type? 1. Emergent 2. Urgent 3. Nonurgent 4. On maternal request XXXXX

2. Urgent Urgent cesarean birth indicates a need for rapid delivery of the fetus such as with malpresentation diagnosed after labor has begun (which is the case here) or placenta previa with mild bleeding and with normal Category 1 fetal heart rate.

A nurse is working with a patient from Pakistan who is in her third trimester and is experiencing a high-risk pregnancy. Which of the following approaches should the nurse take in caring for this patient? 1. Take precisely the same approach the nurse would take with any other client 2. Use the beliefs, values, customs, and expectations of the woman to shape her plan of care 3. Avoid using nonverbal communication 4. Base care on the understanding that this woman's needs are the same as those of other Pakistani women the nurse has worked with XXXX

2. Use the beliefs, values, customs, and expectations of the woman to shape her plan of care Culture influences all aspects of a woman's response to labor. Thus, the nurse should use the beliefs, values, customs, and expectations of the woman to shape her plan of care for labor and birth, as much as possible.

About a few weeks before her due date, a patient who is in her first pregnancy calls her obstetrician's office and says that it feels like the baby has moved down in her abdomen and that she can breathe more easily, although she feels like she needs to urinate all the time now. She wonders whether this means that she is about to go into labor. Which of the following should the nurse tell her? 1. "That is called a Braxton-Hicks contraction. It is harmless and not a sign of true labor." 2. "That is called nesting. It means that you will likely begin labor within 24 hours." 3. "That is called lightening. It means that you are probably just a couple of weeks away from labor." 4. "That is called a true contraction. It means that you are in labor. Get to the hospital as soon as possible." XXXXXXX

3. "That is called lightening. It means that you are probably just a couple of weeks away from labor." Lightening refers to the descent of the fetus into the true pelvis that occurs approximately 2 weeks before term in first-time pregnancies. The woman may feel she can breathe more easily but may experience urinary frequency from increased bladder pressure. In subsequent pregnancies, this may not occur until labor begins.

A nurse is determining the Apgar score of a newborn. The nurse observes that the newborn has slow, irregular respiratory effort, a heart rate of 90 beats per minute, some flexion of extremities, a grimace, and a pink body with blue extremities. Which Apgar score should the nurse report? 1. 1 2. 3 3. 5 4. 7 XXXXXX

3. 5 Each of the five signs reported in this scenario warrants a score of "1," which results in a total neonatal Apgar score of "5."

A woman's primary care provider has just applied dinoprostone gel to her cervix to ripen it. The woman would like to know how long she must wait until oxytocin can be administered. Which of the following should the nurse tell the patient? 1. 1 hour after dose 2. 2 to 4 hours after dose 3. 6 to 12 hours after dose 4. 24 hours after dose XXXXX

3. 6 to 12 hours after dose Oxytocin should be delayed for 6 to 12 hours after a dose of dinoprostone gel has been administered for cervical ripening.

A woman is recovering from a cesarean birth in a labor and birthing recovery unit. Her partner asks the nurse how long it will take her to recover from the surgery. Which of the following should the nurse say? 1. 2 weeks 2. 4 weeks 3. 6 weeks 4. 8 weeks XXXXX

3. 6 weeks Instruct the family that they need to assist the woman with infant care and housework, as she needs 6 weeks to recover from surgery.

A nurse is assisting a woman in the second stage of labor who is experiencing inadequate expulsive forces. Which of the following actions would be most appropriate for the nurse to take in this case? 1. Explain to the woman that it would be safest to deliver the baby within 2 hours after entering the second stage of labor 2. Encourage the woman to use the Valsalva maneuver when bearing down 3. Coach the woman to keep an open glottis when bearing down 4. Help the woman into a supine position to facilitate fetal descent XXXX

3. Coach the woman to keep an open glottis when bearing down The nurse should encourage the woman to minimize the Valsalva maneuver by using open glottis push strategies.

A patient with a fever is in the active phase of the first stage of labor. According to the Association of Women's Health Obstetric and Neonatal Nurses (AWHONN), standards for frequency of assessment of fetal heart rate (FHR), the nurse should perform FHR monitoring in which of the following ways for this patient? 1. Intermittent auscultation every hour 2. Intermittent auscultation every 5 to 30 minutes 3. Continuous electronic fetal monitoring 4. Intermittent electronic fetal monitoring every 30 minutes XXXX

3. Continuous electronic fetal monitoring In the presence of risk factors (e.g., when there is thick meconium, the mother has a fever, or there is an obvious problem with the placenta, or when the fetus is not tolerating the stress of labor well as evidenced by later decelerations), continuous electronic fetal monitoring is recommended.

A patient in her 36th week of gestation has just learned that her fetus has died. The nurse explains that the labor will need to be induced within 24 to 48 hours and the fetus delivered. The patient is devastated. She explains that her husband is out of the country and asks whether induction can be postponed a few days more until he returns. Which of the following should the nurse mention as a risk of prolonged retention of the dead fetus? 1. Rupture of the uterus 2. Prolapse of the umbilical cord 3. Disseminated intravascular coagulation 4. Eclampsia XXXX

3. Disseminated intravascular coagulation Prolonged retention of the dead fetus may lead to the development of disseminated intravascular coagulation in the mother and puts the mother at higher risk for infection, which can result in sepsis or endometritis.

Early in labor, a patient tells the nurse that she had an awful experience with pain in her last pregnancy and would like strongest pain relief option available for a vaginal birth. Which of the following should the nurse suggest to the patient? 1. Parenteral opioids 2. Nitrous oxide 3. Epidural anesthesia 4. General anesthesia XXXXX

3. Epidural anesthesia Epidural anesthesia involves placement of a very small catheter and injection of local anesthesia and/or analgesia between the fourth and fifth vertebrae into the epidural space. It has the potential of 100% blockage of pain.

A woman is rushed to the hospital in labor. She says labor began about an hour ago and has progressed rapidly. She is already dilated to 8 cm, and her contractions occur every 2 minutes and last about 70 seconds. The nurse recognizes this dysfunction of labor as which of the following? 1. Hypertonic uterine dysfunction 2. Hypotonic uterine dysfunction 3. Precipitous labor 4. Fetal dystocia XXXXX

3. Precipitous labor Precipitous labor is a labor that lasts fewer than 3 hours from onset of labor to birth. This type of labor is characterized by hypertonic uterine contractions that occur every 2 minutes or more and last more than 60 seconds. Unlike in hypertonic uterine dysfunction, however, the hypertonic contractions in precipitous labor result in rapid cervical dilation.

A nurse is evaluating fetal heart rate (FHR) monitor results and notes that the baseline FHR is 170 beats per minute. The nurse should recognize this FHR pattern as which of the following? 1. Early deceleration 2. Late deceleration 3. Tachycardia 4. Bradycardia XXXX

3. Tachycardia Tachycardia is a condition in which the baseline FHR is greater than 160 beats per minute, lasting 10 minutes or longer.

A nurse is assisting a patient who has finished delivering her baby vaginally and is now delivering the placenta. The nurse recognizes that the woman is in which stage of labor? 1. First 2. Second 3. Third 4. Fourth XXXXXX

3. Third The third stage begins after delivery of the baby and ends with delivery of the placenta.

A nurse is preparing a patient for a scheduled cesarean birth. Shortly before the procedure, the nurse administers an anticoagulant to the patient, per the primary care provider's instructions. Which of the following is the appropriate rationale for this intervention? 1. To reduce the risk of bacterial infection in all women 2. To decrease blood pressure in women who are hypertensive 3. To reduce the risk of venous thromboembolism in women who are prone to thrombosis 4. To decrease blood glucose level in women who are diabetic XXXXX

3. To reduce the risk of venous thromboembolism in women who are prone to thrombosis Preoperative anticoagulant therapy may be necessary for women classified as moderate or high risk or with a history of recurrent thrombosis.

A woman in labor is dilated 9 cm, effaced 100%, and has contractions that occur almost every minute and last 90 seconds. She is exhausted and has trouble concentrating. The nurse recognizes that this woman is in which phase of the first stage of labor? 1. Latent phase 2. Active phase 3. Transitional phase 4. Expulsive phase XXXXXXX

3. Transitional phase The transition phase is characterized by cervical dilation of 8 to 10 cm with complete (100%) effacement. Contractions are intense, occur every 1 to 2 minutes, and last 60 to 90 seconds. It is the shortest but most difficult phase of the first stage of labor, and the woman is typically exhausted and has trouble concentrating

A patient who is near full term has just gone into labor, and an ultrasound shows that the fetus' buttocks are presenting, with thighs and legs completely flexed. The nurse recognizes that this fetal presentation is which of the following? 1. Cephalic vertex 2. Cephalic brow 3. Complete breech 4. Frank breech XXXXXXXX

4. Frank breech In a breech presentation, the presenting part is the buttock. In a frank breech, the thighs and legs are completely flexed.

A woman who has had a previous birth via cesarean section is now being considered for a vaginal birth after a cesarean (VBAC). Which of the following should the nurse recognize as a contraindication to VBAC in this woman? 1. A prior low transverse cesarean birth 2. A clinically adequate pelvis 3. Age 38 years 4. Prior vertical uterine incision XXXX

4. Prior vertical uterine incision Prior vertical (classical) or T-shaped uterine incision or other uterine surgery is a contraindication for VBAC.

A nurse is assisting a couple who has just learned that the laboring woman will be undergoing emergency cesarean birth. What should the nurse instruct the patient's partner to do while the woman is undergoing surgery? 1. Go to the waiting room and remain there until the operation is over 2. Watch the procedure, if desired, through a window in an adjacent room 3. Stand at the foot of the operating room table and observe the procedure 4. Remain on a stool next to the woman's head and offer support XXXXX

4. Remain on a stool next to the woman's head and offer support The nurse should position the expectant father or support person on a stool next to the woman's head and instruct this person to remain seated there during the procedure, offering support to the woman.

A patient needs continuous electronic fetal monitoring while at the same time the freedom to walk about the birth center and have a bath. Which form of monitoring should the nurse expect to arrange for this patient? 1. Palpation 2. Auscultation 3. Portable electroencephalogram (EEG) 4. Telemetry XXXX

4. Telemetry Telemetry is a type of continuous electronic fetal monitoring that involves connecting the patient to a radio frequency transmitter that allows the patient to walk and take a bath without having to be connected to the monitor. Nurses can oversee the fetal and uterine information as if the patient were connected directly to the monitor.

A nurse is assisting a patient in the fourth stage of labor. The nurse recognizes that which of the following is the primary means by which bleeding is stopped and hemostasis achieved during this stage? 1. Application of an ice pack to the perineum 2. Administration of a coagulant 3. Compression with a large bandage 4. Vasoconstriction produced by a well-contracted myometrium XXXXXXX

4. Vasoconstriction produced by a well-contracted myometrium After the placenta delivers, the primary mechanism by which hemostasis is achieved at the placental site is vasoconstriction produced by a well-contracted myometrium.