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What are the two powers of labor?

Uterine Contractions, Maternal Pushing

3 Types of Breech Presentation

1) Frank Breech 2) Complete Breech 3) Footling Breech

How much folic acid does the CDC recommend that all women of reproductive age to take to help prevent some major birth defects of the baby's brain (anencephaly) and spine (spina bifida)?

400 micrograms CDC urges all women of reproductive age to take 400 micrograms (mcg) of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent some major birth defects of the baby's brain (anencephaly) and spine (spina bifida).

After a delivery of twins, a client may be predisposed to experiencing a post-partum hemorrhage. Which is the most likely cause of hemorrhage in the client: A. Atony of the uterus B. Secondary infection C. Laceration of the cervix D. Retained placental fragments

A

A client who has experienced a spontaneous abortion at 8 weeks asks the nurse why this happened. What would the nurse include in a response to address the most common cause of "miscarriage"? A. Chromosome Abnormalities B. Environmental Teratogens C. Poor Diet D. Smoking

A. Chromosomal Abnormalities

A client in the prenatal clinic complains of nausea and vomiting. Which intervention should the nurse suggest? A. Eat dry crackers or toast before arising in the morning. B. Consume liquids with meals. C. Eat foods high in fiber. D. Brush teeth right after eating.

A. Eat dry crackers or toast before arising in the morning.Rationale: Eating dry crackers or toast before arising in the morning is a good intervention for aclient complaining of prenatal nausea. Foods high in fiber help with constipation problems, notwith nausea. Brushing teeth after meals can trigger vomiting. Consuming liquids with meals cancause over-distention of the stomach.

Which of the following indicates a genetic risk factor? A. Family History of Cystic Fibrosis B. Maternal Age Under 18 C. Placenta Accreta in Previous Pregnancy D. Frequent Alcohol Use

A. Family History of Cystic Fibrosis Risk Factors for Genetic Disorders: * Family history of a genetic disorder * Prior child with a genetic disorder * One parent has a chromosomal abnormality * Advanced maternal age (35 or older) * Advanced paternal age (40 or older) * Multiple miscarriages or prior stillbirth

Fifteen minutes after the initial assessment on a postpartum woman, the nurse finds per patient disoriented and lying on her back in a pool of vaginal blood. Which action is most important for the nurse to implement immediately? A. Massage the patient's fundus. B. Take vital signs. C. Decrease the rate of IV oxytocin. D. Check the bladder.

A. Massage the fundus.(Since a boggy fungus is the most likely reason for this client's hemorrhaging, massaging the fungus is the most important intervention. The nurse should also call for assistance due to the amount of blood that has pooled under the client)

During the recovery stage after labor, which of the following would be considered abnormal? A. The mother's fundus is soft, below the umbilicus and is midline. B. The perineal pad is saturated every 3 hours. C. The mother is leaking colostrum from her breasts. D. The patient does not want visitors.

A. The mother's fundus is soft, below the umbilicus and is midline.

A laboring woman is lying in the supine position. The most appropriate nursing action is to: A. Ask her to turn to one side. B. Elevate her feet and legs. C. Take her blood pressure. D. Determine whether there is fetal tachycardia.

A. The weight of the enlarged uterus may put pressure on the vena cava. reducing blood to her heart.

A pregnant patient tells the nurse that the first day of her last menstrual period was August 2, 2022. Based on Nagele's rule, what is the estimated date of delivery? A. April 25, 2023 B. May 9, 2023 C. May 29, 2023 D. June 2, 2023

B. May 9, 2023

Which of the following are "maternal tasks" during the role transition of pregnancy? (Select all that apply). A.Seeking acceptance of self in maternal role to infant (also known as "binding in"). B.Learning to give of oneself. C.Creating the role of the involved father. D.Ensuring safe passage throughout pregnancy and birth. E. Ensuring acceptance of the child.

Answer(s): A, B, D, E Four tasks in pregnancy to achieve maternal identity 1) ensuring safe passage for mother and child 2) ensuring acceptance of the child 3) binding-in 4) giving of oneself.

Huntington's Disease is an example of which type of genetic disorder? A. Multifactorial B. Autosomal Dominant C. Monosomy D. Autosomal Recessive

Answer: B. Autosomal Dominant Huntington's disease is caused by an inherited difference in a single gene. Huntington's disease is an autosomal dominant disorder, which means that a person needs only one copy of the nontypical gene to develop the disorder. A parent with a nontypical gene could pass along the nontypical copy of the gene or the healthy copy. Each child in the family, therefore, has a 50% chance of inheriting the gene that causes the genetic disorder.

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? S. Hypoglycemia B. Hypercalcemia C. Hypoinsulinemia D. Hypobilirubinemia

Answer: A he neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops, and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia. Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate's circulation,which results in hyperbilirubinemia.

What period of development occurs at the beginning of the 3rd week though the 8th week after conception? Why is this period of development significant? A. Embryonic B. Preembryonic C. Fetal D. Implantation

Answer: A. Embryonic During the embryonic period of development, all major body organs are completed. Because of this, embryos are more susceptible to birth defects caused by teratogens.

What is the most common cause of postpartum hemorrhage? A. Uterine Atony B. Cervical Laceration C. Forceps Delivery D. Macrosomia

Answer: A. Uterine Atony

Which of the following are considered passenger components of birth? A. Maternal Pushing Efforts and Contractions. B. Fetus, Membranes, and Placenta. C. A Woman's Psychological Response to Labor. D. Maternal Pelvis and Soft Tissue.

Answer: B Components of the Birth Process: Powers 🠞 Uterine Contractions & Maternal Pushing Efforts Passage 🠞 Maternal Pelvis and Soft Tissue Passenger 🠞 Fetus, Membranes and Placenta Psyche 🠞 Women's Psychological Response

Which assessment by the nurse would differentiate a placenta previa from a placental abruption? A. Saturated perineal pad in 1 hour B. Pain level 0 on a scale of 0 to 10 C. Cervical dilation at 2 cm D. Fetal heart rate at 160 bpm

Answer: B The classic sign of placenta previa is the sudden onset of painless uterine bleeding, whereas abruptio placentae results in abdominal pain and uterine tenderness; heavy bleeding, cervical dilation, and fetal heart rate of 160 bpm could be associated with both conditions.

Which maternal condition always necessitates delivery by cesarean birth? A. Partial abruptio placentae B. Total placenta previa C. Ectopic pregnancy D. Eclampsia

Answer: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if vaginal birth occurred. If the patient has stable vital signs and the fetus is alive, a vaginal birth can be attempted. If the fetus has already expired, a vaginal birth is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

As a nurse caring for a mother in the 3rd stage of labor, you recognize that a shoulder dystocia has occurred. The physician asks you to perform Suprapubic Pressure. Which of the following actions describes this process? A. Press firmly on the fundus. B. Apply downward pressure over the pubic bone. C. Help the patient into a knee-chest position. D. Flex the patient's thighs toward her shoulders while she is lying on her back.

Answer: B. Apply downward pressure over the pubic bone.

A 24 year-old G4P3 is 35 weeks pregnant and is complaining of severe lower back pain, fatigue, nausea, and hematuria. Upon assessment, the nurse notes the following: Blood Pressure: 118/58 Pulse: 121 bpm Respirations: 18 Temperature: 101.3 (oral) 2+ Deep Tendon Reflexes Bilateral Lower Edema Fetal Heart Rate 170 bpm Positive Fetal Movement Which of the following is this patient most likely experiencing? A. Oligohydramnios B. Pyelonephritis C. Umbilical Cord Prolapse D. Kidney Stone

Answer: B. Pyelonephritis Due to the physical changes involving the kidneys during pregnancy, women are at an increased risk for urinary tract and kidney infections as well as kidney stones. None of these findings indicate oligohydramnios. While chorioamnionitis can cause fever and tenderness, it does not cause hematuria. Signs and symptoms associated with kidney stones include severe flank pain, hematuria, nausea, vomiting, but NOT fever.

The nurse is systematically palpating a woman's pregnant abdomen to determine the position, presentation, and engagement of the fetus. What is she doing? A. Assessing the fundal height. B. Suprapubic Pressure C. Leopold's maneuvers D. Fundal Pressure

Answer: C

Which of the following would indicate excessive uterine activity? A. More than 3 contractions in 10 minutes. B. MVU's of 240. C. 50 seconds of uterine relaxation between contractions. D. Contraction duration of 90 seconds.

Answer: C. Uterine hyperstimulation, defined as contractions occurring more often than every 2 minutes or lasting longer than 90 seconds. Adequate MVU's = 200 to 280 adequate for labor. More than 300 is excessive. Uterine tachysystole is defined as more than 5 contractions in 10 minutes, averaged over a 30-minute window. Uterine hypertonus is described as a single contraction lasting longer than 2 minutes.

A nurse receives a shift change report for a newborn who is 12 hours post-vaginal delivery. In developing a plan of care, the nurse should give the highest priority to which finding? A. Cyanosis of the hands and feet B. Skin color that is slightly jaundiced C. Tiny white papules on the nose or chin D. Red patches on the cheeks and trunk

Answer: C. (C) reassures the mother that this is normal in the newborn and provides correct information regarding the return to a normal shape. Although (A) is correct, it implies that the client should not worry. Any implied or spoken "don't worry" is usually the wrong answer. (B) is condescending and dismissing; the mother is seeking reassurance and information. (D) is a negative statement and implies that molding is the mother's fault.

Why is the incidence of ectopic pregnancy increasing in the United States? A. The state of poor nutrition in the United States is worsening. B. More women are using oral contraceptives. C. The rate of pelvic inflammatory disease caused by STD's is increasing. D. The incidence of cervical cancer is increasing.

Answer: C. Pelvic inflammatory disease (PID) is a major cause of tubal (ectopic) pregnancy. An ectopic pregnancy can occur when untreated PID has caused scar tissue to develop in the fallopian tubes. The scar tissue prevents the fertilized egg from making its way through the fallopian tube to implant in the uterus. Pelvic inflammatory disease is an infection of a woman's reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID.

Which of the following is NOT considered to be a subdivision of a true pelvis? A. The inlet (upper pelvic opening) B. The mid-pelvis (pelvic cavity) C. The deep pelvic inlet (pelvic pocket) D. The outlet (lower pelvic opening)

Answer: C. There are three parts to the true (lesser) pelvis: 1. The inlet (upper pelvic opening) 2. The mid-pelvis (pelvic cavity) 3. The outlet (lower pelvic opening)

A new mother who has just had her first baby says to the nurse, "I saw the baby in the recovery room. She sure has a funny-looking head." Which response by the nurse is best? A. "This is not an unusually shaped head, especially for a first baby." B. "It may look odd, but newborn babies are often born with heads like that." C. "That is normal. The head will return to a round shape within 7 to 10 days." D. "Your pelvis was too small, so the head had to adjust to the birth canal."

Answer: C. "That is normal. The head will return to a round shape within 7 to 10 days."

The fetus, membranes, and placenta are considered to be which of the four major factors of labor and childbirth? A. Powers B. Passage C. Passenger D. Psyche

Answer: C. Passenger

What obstetrical emergency should the nurse consider when the physician is performing and amniotomy? A. Shoulder Dystocia B. Uterine Inversion C.Placenta Accreta D. Umbilical Cord Prolapse

Answer: D. Umbilical cord prolapse is a potentially fatal obstetric emergency. When this occurs during labor or delivery the prolapsed cord is compressed between the fetal presenting part and the cervix. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth. Risk Factors: Breech presentation - in a footling breech, the cord can easily slip between and past the fetal feet and into the pelvis. Unstable lie - this is where the presentation of the fetus changes between transverse/oblique/breech and back.If >37 weeks gestation, consider inpatient admission until delivery due to risk of cord prolapse. Artificial rupture of membranes - particularly when the presenting part of the fetus is high in the pelvis. Polyhydramnios - excessive amniotic fluid around the fetus. Prematurity.

The nurse is monitoring a new mother in the postpartum period for signs of hemorrhage. Which of the following signs, if noted in the mother, would be an early sign of excessive blood loss? A. A temperature of 100.7*F B. An increase in the pulse from 88 to 102 BPM C. An increase in the respiratory rate from 18 to 22 breaths per minute D. A blood pressure change from 130/88 to 124/80 mm hg

B

A nurse is explaining to a young woman who is trying to become pregnant about the process of conception. Which organ should the nurse mention as the site at which fertilization takes place? A. Ovaries B. Fallopian Tube C. Uterus D. Cervix

B. Fallopian Tube

Which of the following is NOT an example of an autosomal-recessive disorders? A. Sickle Cell Anemia B. Huntington's Disease C. PKU D. Cystic Fibrosis

B. Huntingtons's Disease

A nurse is providing discharge teaching to the parents of a newborn. Which of the following should be included when teaching the parents how to care for the baby's umbilical cord? A. Cleanse it with hydrogen peroxide if it starts to smell. B. Remove it with sterile tweezers at one week of age. C. Call the doctor if greenish drainage appears. D. Cover it with sterile dressings until it falls off.

C

The nurse is caring for a client in labor. Which assessment finding indicates to the nurse that the client is beginning the second stage of labor? A. The contractions are regular. B. The membranes have ruptured. C. The cervix is dilated completely. D. The client begins to expel clear vaginal fluid.

C

The nurse is monitoring a client who is receiving oxytocin (Pitocin) to induce labor. Which assessment finding would cause the nurse to immediately discontinue the oxytocin infusion? A. Fatigue B. Drowsiness C. Uterine hyperstimulation D. Early decelerations of the fetal heart rate

C

The nurse is monitoring a woman in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction? A. Accelerations B. Variability C. Variable Decelerations D. Late Decelerations

C

Which of the following circumstances is most likely to cause uterine atony and lead to postpartum hemorrhage? A. Hypertension B. Cervical and vaginal tears C. Urine retention D. Endometritis

C. A full bladder is a common cause of uterine atony.

During a vaginal assessment on a patient who is 8 weeks pregnant, you note a bluish coloration of the mucous membrane of the cervix, vagina, and vulva. You would document this finding as what?* A. Hegar's Sign B. Ballottement C. Chadwick's Sign D. Goodell's Sign

C. Chadwick's Sign

The nurse is preparing a laboring client for an amniotomy. Immediately after the procedure is completed, it is most important for the nurse to obtain which information? A. Maternal blood pressure B. Maternal temperature C. Fetal heart rate (FHR) D. White blood cell count (WBC)

C. Fetal heart rate (FHR) Be alert for possibility of cord prolapse.

A nurse observes a patient, who has recently given birth, interacting with her mother, who is visiting her and the baby. The patient and her mother both share the same eye and hair color and are about the same height. The nurse knows that these traits are examples of which of the following? A. Genotypes B. Genomes C. Phenotypes D. Karyotypes

C. Phenotypes

The nurse is caring for a primigravida at about 2 months and 1-week gestation. After explaining self-care measures for common discomforts of pregnancy, the nurse determines that the client understands the instructions when she says: A. "Nausea and vomiting can be decreased if I eat a few crackers before rising." B. "If I start to leak colostrum, I should cleanse my nipples with soap and water." C. "If I have a vaginal discharge, I should wear nylon underwear." D. "Leg cramps can be alleviated if I put an ice pack on the area."

Correct Answer: A. "Nausea and vomiting can be decreased if I eat a few crackers before arising" Eating dry crackers before arising can assist in decreasing the common discomfort of nausea and vomiting. Avoiding strong food odors and eating a high-protein snack before bedtime can also help. Option B: Colostrum is a milky fluid that's released by mammals that have recently given birth before breast milk production begins. Option C: Cotton underwear is breathable and absorbent, which can help prevent yeast infections. Option D: A heating pad or hot pack may help relieve tight muscles in leg cramps.

A patient is in her last trimester of pregnancy. Nurse Vickie should instruct her to notify her primary health care provider immediately if she notices: A. Blurred vision B. Hemorrhoids C. Increased vaginal mucus D. Shortness of breath on exertion

Correct Answer: A. Blurred vision Blurred vision or other visual disturbance, excessive weight gain, edema, and increased blood pressure may signal severe preeclampsia. This condition may lead to eclampsia, which has potentially serious consequences for both the patient and fetus. Option B: Although hemorrhoids may be a problem during pregnancy, they do not require immediate attention. Hemorrhoids occur when the external hemorrhoidal veins become varicose (enlarged and swollen), which causes itching, burning, painful swellings at the anus, dyschezia (painful bowel movements), and bleeding. Option C: Almost all women have more vaginal discharge in pregnancy. This is normal, and helps prevent any infections travelling up from the vagina to the womb. Towards the end of pregnancy, the amount of discharge increases further. In the last week or so of pregnancy, it may contain streaks of sticky, jelly-like pink mucus. Option D: Dyspnea can begin before any upward displacement of the diaphragm, suggesting that factors other than mechanical pressure may be involved. It probably results from the subjective awareness of hyperventilation that is universally present in pregnancy. Hyperventilation in pregnancy is predominantly due to an increase in the depth of the tidal volume, with little change in the respiratory rate

Normal lochial findings in the first 24 hours post-delivery include: A. Bright red blood B. Large clots or tissue fragments C. A foul odor D. The complete absence of lochia

Correct Answer: A. Bright red blood Lochia should never contain large clots, tissue fragments, or membranes. A foul odor may signal infection, as may absence of lochia. Option B: The blood clots in the lochia should get smaller and happen less often as the bleeding gets less over the first few days. Option C: Lochia with offensive odor may indicate infection. Option D: Complete absence of lochia might be a sign of infection.

The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first? A. Change the client's position. B. Prepare for an emergency cesarean section. C. Check for placenta previa. D. Administer oxygen.

Correct Answer: A. Change the client's position. Variable decelerations in fetal heart rate are an ominous sign, indicating compression of the umbilical cord. Changing the client's position from supine to side-lying may immediately correct the problem. Option B: An emergency cesarean section is necessary only if other measures, such as changing position and amnioinfusion with sterile saline, prove unsuccessful. Option C: Common causes of variable decelerations include vagal reflex triggered by head compression during pushing and cord compression such as that caused by short cord, nuchal cord, body entanglement, prolapsed cord, decreased amniotic fluid, and fetal descent. It does not include placenta previa. Option D: Administering oxygen may be helpful, but the priority is to change the woman's position and relieve cord compression. The fetus already has a surplus of oxygen due to high basal blood flow to its organs and vascular shunts.

When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to: A. Prevent seizures. B. Reduce blood pressure. C. Slow the process of labor. D. Increase diuresis.

Correct Answer: A. Prevent seizures The chemical makeup of magnesium is similar to that of calcium and, therefore, magnesium will act like calcium in the body. As a result, magnesium will block seizure activity in a hyper-stimulated neurologic system by interfering with signal transmission at the neuromuscular junction. Option B: Magnesium sulfate may attenuate blood pressure by decreasing the vascular response to pressor substances. Option C: Since the primary therapeutic goal of tocolysis is to delay preterm delivery within 48 hours from the initiation of steroid prophylaxis, little evidence suggests that extended MgSO4 therapy is beneficial. Option D: There are rare cases of pregnant women who develop polyuria after receiving intravenous therapy of magnesium sulfate. It can be considered as another cause of solute diuresis

When the nurse on duty accidentally bumps the bassinet, the neonate throws out its arms, hands open, and begins to cry. The nurse interprets this reaction as indicative of which of the following reflexes? A. Startle reflex B. Babinski reflex C. Grasping reflex D. Tonic neck reflex

Correct Answer: A. Startle reflex The Moro, or startle, reflex occurs when the neonate responds to stimuli by extending the arms, hands open, and then moving the arms in an embracing motion. The Moro reflex, present at birth, disappears at about age 3 months. Option B: Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toe fan out. Option C: Palmar grasp reflex appears around 16 weeks of gestation and can be elicited in preterm infants as young as 25 weeks of postconceptional age. To elicit the reflex, the infant is laid in a symmetrical supine and the examiner strokes the palm of the infant with his or her index finger. The response to this stimulus comprises two phases: finger closing and clinging. Option D: When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. The tonic neck reflex lasts until the infant is about 5 to 7 months old.

When evaluating a client's knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse in charge that the client understands the information given to her? A. "I'll report increased frequency of urination." B. "If I have blurred or double vision, I should call the clinic immediately." C. "If I feel tired after resting, I should report it immediately." D. "Nausea should be reported immediately."

Correct Answer: B. "If I have blurred or double vision, I should call the clinic immediately." Blurred or double vision may indicate hypertension or preeclampsia and should be reported immediately. It can affect the visual pathways, from the anterior segment to the visual cortex. Option A: Urinary frequency is a common problem during pregnancy caused by increased weight pressure on the bladder from the uterus. The anatomical and physiological changes affecting the lower urinary tract in pregnancy, as well as the hormonal milieu of pregnancy, have been postulated to underlie the pathogenesis of lower urinary symptoms in pregnancy Option C: Clients generally experience fatigue during pregnancy. Pregnancy is accompanied by several psychological, emotional, and physical changes that may predispose the woman to fatigue, which can range from mild tiredness to severe exhaustion. Option D: The pathophysiology of nausea and vomiting during early pregnancy is unknown, although metabolic, endocrine, GI, and psychologic factors probably all play a role. Estrogen may contribute because estrogen levels are elevated in patients with hyperemesis gravidarum.

Following a precipitous delivery, examination of the client's vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client? A. Applying cold to limit edema during the first 12 to 24 hours. B. Instructing the client to use two or more peri pads to cushion the area. C. Instructing the client on the use of sitz baths if ordered. D. Instructing the client about the importance of perineal (Kegel) exercises.

Correct Answer: B. Instructing the client to use two or more peri pads to cushion the area Using two or more peripads would do little to reduce the pain or promote perineal healing. A fourth-degree perineal laceration is the injury to the perineum involving the anal sphincter complex and anorectal mucosa. Option A: Ice packs can help reduce pain and swelling in the perineum. Use ice cubes in a clean, disposable glove. Wrapped in a damp cloth or place the ice pack inside a pad. Never apply directly on skin. Apply for 10-20 minutes. Repeat every 2-3 hours until pain and swelling decrease. Option C: Hot sitz bath may help speed up the healing process. Use sitz baths a few times a day, 24 hours after giving birth. Sit in water that covers the vulvar area. Option D: The muscles lie deep in the pelvis and support the pelvic organs and control the bladder and bowel function. The pelvic floor muscles attach to the pubic bone at the front, tail bone at the back, and from one sitting bone to the other sitting bone. It is important to retrain the muscles after a tear, to prevent problems such as incontinence.

Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta? A. Excessive vaginal bleeding B. Rigid, board-like abdomen C. Tetanic uterine contractions D. Premature rupture of membranes

Correct Answer: B. Rigid, board-like abdomen The most common assessment finding in a client with abruption placenta is a rigid or boardlike abdomen. Pain, usually reported as a sharp stabbing sensation high in the uterine fundus with the initial separation, also is common. Option A: It's possible for the blood to become trapped inside the uterus, so even with a severe placental abruption, there might be no visible bleeding. Option C: Uterine contractions are a common finding with placental abruption. Contractions progress as the abruption expands, and uterine hypertonus may be noted. Contractions are painful and palpable. Option D: Increased frequency of placental abruption was found in patients with early rupture of membranes. The incidence was 50% and 44% when rupture of the membranes occurred before 20 weeks or between 20-24 weeks of pregnancy, respectively.

The nurse in-charge is reviewing a patient's prenatal history. Which finding indicates a genetic risk factor? A. The patient is 25 years old. B. The patient has a child with cystic fibrosis. C. The patient was exposed to rubella at 36 weeks' gestation. D. The patient has a history of preterm labor at 32 weeks' gestation.

Correct Answer: B. The patient has a child with cystic fibrosis Cystic fibrosis is a recessive trait; each offspring has a one in four chance of having the trait or the disorder. Option A: Maternal age is not a risk factor until age 35, when the incidence of chromosomal defects increases. Option C: Maternal exposure to rubella during the first trimester may cause congenital defects. Option D: Although a history or preterm labor may place the patient at risk for preterm labor, it does not correlate with genetic defects.

After completing a second vaginal examination of a client in labor, the nurse-midwife determines that the fetus is in the right occiput anterior position and at (-1) station. Based on these findings, the nurse-midwife knows that the fetal presenting part is: A. 1 cm below the ischial spines. B. Directly in line with the ischial spines. C. 1 cm above the ischial spines. D. In no relationship to the ischial spines.

Correct Answer: C. 1 cm above the ischial spines. Fetal station — the relationship of the fetal presenting part to the maternal ischial spines — is described in the number of centimeters above or below the spines. A presenting part above the ischial spines is designated as -1, -2, or -3. Option A: A presenting part below the ischial spines, as +1, +2, or +3. Option B: 0 station is when the baby's head is even with the ischial spines. The baby is said to be "engaged" when the largest part of the head has entered the pelvis. Option D: If the head is high and not yet engaged in the birth canal, it may float away from the physician's fingers during the vaginal exam.

What is the most important assessment for the nurse to conduct following the administration of epidural anesthesia to a client who is at 40-weeks gestation? A. Level of pain sensation B. Station of presenting part C. Variability of fetal heart rate D. Maternal blood pressure

D

The nurse is teaching care of the newborn to a childbirth preparation class and describes the need for administering antibiotic ointment into the eyes of the newborn. An expectant father asks, "What type of disease causes infections in babies that can be prevented by using this ointment?" Which response by the nurse is accurate? A. Herpes B. Trichomonas C. Gonorrhea D. Syphilis

Correct Answer: C. Gonorrhea Erythromycin ointment is instilled into the lower conjunctiva of each eye within 2 hours after birth to prevent ophthalmia neonatorum, an infection caused by gonorrhea (C), and inclusion conjunctivitis, an infection caused by Chlamydia. The infant may be exposed to these bacteria when passing through the birth canal. Option A: Antibiotics do not work for viruses like herpes. Taking antibiotics when they are not really needed increases the risk of getting infection later that resists antibiotic treatment. Option B: Trichomoniasis can be cured with a single dose of prescription antibiotic medication (either metronidazole or tinidazole), pills that can be taken by mouth. Option D: A single intramuscular injection of long-acting Benzathine penicillin G (2.4 million units administered intramuscularly) will cure a person who has primary, secondary, or early latent syphilis. Three doses of long-acting Benzathine penicillin G (2.4 million units administered intramuscularly) at weekly intervals is recommended for individuals with late latent syphilis or latent syphilis of unknown duration. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms? A. Proteinuria, headaches, vaginal bleeding B. Headaches, double vision, vaginal bleeding C. Proteinuria, headaches, double vision D. Proteinuria, double vision, uterine contractions

Correct Answer: C. Proteinuria, headaches, double vision A patient with pregnancy-induced hypertension complains of a headache, double vision, and sudden weight gain. A urine specimen reveals proteinuria. Option A: Pre-eclampsia increases the risk for placental abruption, a condition in which the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the baby and the mother. Option B: Any hypertensive disorder of pregnancy can result in preeclampsia. It occurs in up to 35% of women with gestational hypertension and up to 25% of those with chronic hypertension. The underlying pathophysiology that upholds this transition to, or superposition of, preeclampsia is not well understood; however, it is thought to be related to a mechanism of reduced placental perfusion inducing the systemic vascular endothelial dysfunction. Option D: Symptoms of preeclampsia may include visual disturbances, typically scintillations and scotomata, presumed to be due to cerebral vasospasm. The woman may describe new-onset headache that is frontal, throbbing, or similar to a migraine headache, and gastrointestinal complaints of sudden, new-onset, constant epigastric pain that may be moderate to severe in intensity and due to hepatic swelling and inflammation, with stretch of the liver capsule.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate? A. The fetus should be delivered within 24 hours. B. The client should repeat the test in 24 hours. C. The fetus isn't in distress at this time. D. The client should repeat the test in 1 week.

Correct Answer: C. The fetus isn't in distress at this time. The BPP evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. A normal response for each variable receives 2 points; an abnormal response receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus has a low risk of oxygen deprivation and isn't in distress. A fetus with a score of 6 or lower is at risk for asphyxia and premature birth; this score warrants detailed investigation. The BPP may or may not be repeated if the score isn't within normal limits. Option A: The biophysical profile is a test used to evaluate the well-being of the fetus. It is commonly done at the last trimester of pregnancy, but it does not indicate that the fetus should be delivered within 24 hours. Option B: If the score is 6, the health care provider will likely repeat the test within 24 hours. Option D: The test is most commonly done when there's an increased risk of problems that could lead to complications or pregnancy loss. The health care provider will determine the necessity and timing of a biophysical profile based on whether the baby could survive if delivered early, the severity of the mother's condition, and the risk of pregnancy loss.

When caring for a 3-day-old neonate who is receiving phototherapy to treat jaundice, the nurse in charge would expect to do which of the following? A. Turn the neonate every 6 hours B. Encourage the mother to discontinue breastfeeding. C. Notify the physician if the skin becomes bronze in color. D. Check the vital signs every 2 to 4 hours.

Correct Answer: D. Check the vital signs every 2 to 4 hours While caring for an infant receiving phototherapy for treatment of jaundice, vital signs are checked every 2 to 4 hours because hyperthermia can occur due to the phototherapy lights. Option A: Only one study reported the significance drop in serum bilirubin and shorter duration of phototherapy in the supine group. Keeping the jaundiced newborn in the supine position throughout phototherapy is as effective as turning them periodically based on appraised studies. Option B: The baby may be breastfed without interruption during phototherapy. Jaundice in breastfed babies is not a reason to stop breastfeeding as long as a baby is feeding well, gaining weight, and otherwise growing. Option C: Bronze baby syndrome is a rare complication seen in neonates with hyperbilirubinemia who are being treated with phototherapy. Affected neonates develop gray-brown skin, serum, and urine within a week of initiation of phototherapy.

1. Which type of lochia should the nurse expect to find in a client 2 days postpartum? A. Foul-smelling B. Lochia serosa C. Lochia alba D. Lochia rubra

D

A client is admitted with the diagnosis of total placenta previa. Which finding is most important for the nurse to report to the healthcare provider immediately? A) Fetal Movement B) Maternal Depression C) Pedal Edema D) Contractions

D

A nurse is assessing a 1-day postpartum woman who had her baby by cesarean section. Which of the following should the nurse report to the physician? a) Fundus at the umbilicus. b) Nodular breasts. c) Pulse rate 60 bpm. d) Pad saturation every 30 minute

D

Which action best explains the main role of surfactant in the neonate? A) Assists with ciliary body maturation in the upper airways B) Helps maintain a rhythmic breathing pattern C) Promotes clearing mucus from the respiratory tract D) Helps the lungs remain expanded after the initiation of breathing

D) Helps the lungs remain expanded after the initiation of breathingSurfactant works by reducing surface tension in the lung. Surfactant allows the lung to remain slightly expanded, decreasing the amount of work required for inspiration.

A postpartum nurse is taking the vital signs of a woman who delivered a healthy newborn infant 4 hours ago. The nurse notes that the mother's temperature is 100.1*F. Which of the following actions would be most appropriate? A) Retake the temperature in 15 minutes B) Notify the physician C) Document the findings D) Increase hydration by encouraging oral fluids

D) Increase hydration by encouraging oral fluids The mother's temperature may be taken every 4 hours while she is awake. Temperatures up to 100.4 (38 C) in the first 24 hours after birth are often related to the dehydrating effects of labor. The most appropriate action is to increase hydration by encouraging oral fluids, which should bring the temperature to a normal reading. Although the nurse would document the findings, the most appropriate action would be to increase the hydration.

While caring for a laboring client on continuous fetal monitoring, the nurse notes a fetal heart rate pattern that falls and rises abruptly with a "V" shaped appearance. What action should the nurse take first? A. Prepare for a potential cesarean. B. Allow the client to begin pushing. C. Administer oxygen at 10/L by mask. D. Change the maternal position.

D. Change the maternal position

Toxoplasmosis is an example of what type of teratogen? A. Environmental Pollutant B. Ionizing Radiation C. Maternal Disorder D. Maternal Infection

D. Maternal Infection

A nurse notes that a 6-hour-old neonate has cyanotic hands and feet. Which of the following actions by the nurse is appropriate? A. Place child in an isolette. B. Administer oxygen. C. Place socks and mittens on the baby. D. Continue to routinely monitor the baby and allow for bonding.

D. This is acrocyanosis and is a normal finding. With acrocyanosis, the baby's hands and feet are blue. This is normal right after birth. In fact, most newborns have some acrocyanosis for their first few hours of life. It happens because blood and oxygen are circulating to the most important parts of the body such as the brain, lungs, and kidneys rather than to the hands and feet. The problem goes away as the baby's body gets used to new blood circulation patterns

A woman who has autosomal dominant inherited disorder is exploring family planning options and the risk for transmission of the disorder to an infant. The nurse's response should be based on what information?

Each pregnancy carries a 50% chance of inheriting the disorder.

Why must the nurse carefully monitor the fetal heart rate following epidural administration?

Epidural anesthesia can cause hypotension, which will diminish placental perfusion and cause fetal distress.

What is considered to be the "passenger" during childbirth?

Fetus, membranes, placenta

How is the frequency of contractions measured?

From the beginning of one contraction to the beginning of the very next contraction.

What are the four "P"'s of childbirth?

Power Passage Passenger Psyche

What is given to Rh negative mothers to prevent the development of maternal antibodies that cause hemolysis of of fetal Rh positive RBC's?

When the blood of an Rh-positive fetus gets into the bloodstream of an Rh-negative woman, her body will recognize that the Rh-positive blood is not hers. Her body will try to destroy it by making anti-Rh antibodies. These antibodies can cross the placenta and attack the fetus's blood cells. This can lead to serious health problems, even death, for a fetus or a newborn. During pregnancy, a woman and her fetus do not usually share blood. But sometimes a small amount of blood from the fetus can mix with the woman's blood. This can happen during labor and birth. It can also happen with amniocentesis or chorionic villus sampling (CVS) bleeding during pregnancy, attempts to manually turn a fetus to be head-down for birth (move the fetus out of a breech presentation), trauma to the abdomen during pregnancy. Health problems usually do not occur during an Rh-negative woman's first pregnancy with an Rh-positive fetus. This is because her body does not have a chance to develop a lot of antibodies. But if treatment is not given during the first pregnancy and the woman later gets pregnant again with an Rh-positive fetus, she can make more antibodies. More antibodies put a future fetus at risk. Rh immunoglobulin (RhoGAM) is a medication that stops the body from making Rh antibodies if it has not already made them. This can prevent severe fetal anemia in a future pregnancy. RhoGAM is administered at 28 weeks of pregnancy—A small number of Rh-negative women may be exposed to Rh-positive blood cells from the fetus in the last few months of pregnancy and may make antibodies against these cells. RhoGAM given at 28 weeks of pregnancy destroys these Rh-positive cells in the woman's body. This prevents Rh-positive antibodies from being made. RhoGAM is also given within 72 hours after the delivery of an Rh-positive baby—The greatest chance that the blood of an Rh-positive fetus will enter the bloodstream of an Rh-negative woman happens during delivery. RhoGAM prevents an Rh-negative woman from making antibodies that could affect a future pregnancy. The treatment is good only for the pregnancy for which it is given. Each pregnancy and delivery of an Rh-positive baby requires a repeat dose of Rho-GAM