Maternal 9/10/11
The nurse examines a postpartum pt and notes a mass protruding from the vagina. What is the nurses priority action?
Notify the provider
The nurse admits a women in labor after a motor vehicle accident that also involved her 14-month old child. Fetal monitoring show a nonreassuring fetal heart rate pattern with variable and late decelerations. Maternal examination reveals uterine tenderness and constant abdominal pain. After notifying the provider, which is the nurses priority of care?
Initiating an IV with an 18-gauge catheter
The nurse reviews the charts of patients who have expressed an interest in home birth and recommends which patient as a potential candidate?
A primipara with a history of infertility
A patient states, " I don't think my water broke; i didn't feel anything. I have noticed a small amount of fluid dripping from my vagina." which response by the nurse is best?
" When the membranes rupture, it is not always a big gush of fluid."
A nursing student asks the labor and delivery nurse what the role of the hormone relaxin is during labor. The best response by the nurse is:
"It relaxes ligaments in the pelvis, allowing some stretching to occur"
Which maternal hormones are suspected of contributing to the onset of labor? (Select all that apply.) 1) Increased oxytocin levels 2) Increased prostaglandin levels 3) Reduced progesterone levels 4) Increased cortisol levels 5) Uterine stretch theory
1,2,3
2. A 28-year-old woman is a primipara who is pregnant with triplets, is at 18 weeks' gestation, and is receiving regular prenatal care. The nurse identifies a risk for preterm labor related to which factor? 1)The patient's age 2)18 weeks' gestation 3)Multiple gestation 4)Previous obstetric history
2. ANS: 3
_ 20. The nurse is caring for a patient who delivered at 22 weeks' gestation and experienced a fetal demise when the newborn could not be resuscitated in the delivery room. Which actions will the postpartum nurse include in the immediate plan of care for this family? (Select all that apply.) 1)Clean and dress the baby 2)Allow the family to hold the baby 3)Obtain footprints and pictures of the baby 4)Encourage the parents to cry over their loss 5)Connect the family to a support group
20. ANS: 1, 2, 3, 5
A student nurse is observed providing care to a woman in active labor. The instructor recognizes the need for corrective action when the student makes which statement? 1) "You're doing great with your breathing during contractions." 2) "Your partner could roll tennis balls over your back during contractions to reduce pain." 3) "Only your obstetrician can tell you how far your cervix has dilated." 4) "I will stay with you as long as I can to help you manage labor pain."
3
3. The nurse questions an order to administer a tocolytic drug for which patient? 1)The patient under age 18 2)The patient with a history of multiple gestation's 3)The patient who is 2 cm dilated 4)The patient with acute vaginal bleeding
3. ANS: 4
A laboring patient begins to demonstrate irritability, snapping at her labor coach and complaining of pelvic pressure. The nurse suspects cervical assessment will reveal which dilation measurement? 1) 2 to 3 cm 2) 4 to 5 cm 3) 5 to 6 cm 4) 8 to 9 cm
4
While the doctor awaits delivery of the placenta after delivery of the newborn, the nurse documents that the patient is in which state of labor? 1) Latent 2) Second 3) Transition 4) Third
4
5. A patient is approaching 42 weeks' gestation and has been admitted for induction of labor. The patient tells the nurse she does not want an induction and prefers to wait for labor to begin naturally. Which is the nurse's best response? 1)"Waiting for labor to begin naturally could result in the death of your baby. 2)"The longer you wait, the bigger the baby gets and the harder delivery will be. "3)"Complications for you and your baby increase after 42 weeks of gestation. "4)"If you had controlled your weight gain during pregnancy, you might have gone into natural labor."
5. ANS: 3
7. A woman's labor is not progressing, and the fetus is found to be in the breech position. Which of the seven Ps of labor is involved with this woman's failure to progress? 1)Presentation 2)Passenger 3)Passage 4)Powers
7. ANS: 1
8. A laboring patient's water breaks, and the umbilical cord protrudes from the vagina. The nurse immediately places the patient in the Trendelenburg position. Which of the seven Ps is most impacted? 1)Passage2)Pain3)Powers4)Position
8. ANS: 3
when an emergency c-section is necessary. it is MOST important for the nurse to:
?
The nurse is assisting with the care of multiple patients in labor and recognizes the need to notify the health-care provider for which patient first?
A primipara who dilated to a 6cm, and then her contractions stopped
The nurse is aware that induction of labor is considered for which of the following situations? (Select all that apply.) a. PROM has occurred .b. Gestational hypertension is present .c. Maternal diabetes is present. d. A desired date of delivery is needed. e. Vaginal infection is present. f. Cephalic presentation occurs.
A. PROM has occured, B. Gestational HTN is present, C. Maternal diabetes is present
What is the significance of crowning? a. Birth is imminent .b. Labor must be induced within 12 to 24 hours. c. The placenta has separated from the wall of the uterus. d. The recovery stage of labor begins.
A. birth is imminent
When an emergency cesarean birth is necessary, it is MOST important for the nurse to: a. review with the client the events that necessitated this type of delivery b. tell the client this is a safer method of delivery for her and the baby c. allow the client to grieve for not being able to have a normal delivery d. give the client a chance to rest before the procedure begins
A. review with the client the events that necessitated this type of delivery
A new client is admitted with vaginal bleeding and cramping at 12 weeks' gestation. A vaginal examination reveals her cervix is partially dilated. The client appears to be experiencing which type of spontaneous abortion? a. complete b. inevitable c. missed d. threatened
B
A gravida II para I client who is at 40 weeks' gestation states, "I don't think I'm ready for labor. Last time, I experienced 'lightening' 2 weeks before now." Which of these responses should the nurse make? a. "Lightening is an unpredictable sign of impending labor."b. "Lightening may not occur in a multigravida until labor has started."c. "You may be correct. It always occurs about 2 weeks before labor begins."d. "You must have miscalculated your due date."
B. Lightening may not occur in a multigravida until labor has started
When analyzing a fetal heart strip, the nurse notes the absence of accelerations for the past 15 minutes. Which is the nurse's priority action?
Change the maternal position
In which of these situations is a forceps-assisted birth indicated? a. for a fetal vertex presentation b. when cephalopelvic disproportion is present c. for a mother with a history of heart disease d. for a fetal prolapsed umbilical cord
D. for a fetal prolapsed umbilical cord
When a prolapsed cord is identified, which of these nursing actions assumes priority? a. Assist client into a knee-chest position or modified Sims' position .b. Attempt to replace the cord into the uterus with a sterile gloved hand. c. Cover the cord with a sterile towel, and start oxygen via mask at 10 L per minute. d. Insert two fingers of a sterile gloved hand into the vagina, and put pressure on the presenting part to lift it off the cord.
D. insert two fingers of a sterile gloved hand into the vagina, and put pressure on the presenting part to lift it off the cord
When are labor clients urged to bear down?a. between each contraction as soon as the cervix is completely effaced b. between each contraction as soon as the membranes have ruptured c. with each contraction as soon as engagement has occurred d. with each contraction as soon as the cervix is completely dilated
D. with each contraction as soon as the cervix is completely dilated
A pregnant patient reports a decrease in fetal movement. The provider conducts an assessment and notifies the pt. of an absent fetal rate (FHR). The patient asks the provider to check again. What stage of grief is the patient displaying?
Denial
A fetal station score is used to assess the status of the cervix determining its response to induction. true or false
False
The nurse monitors the frequency of contractions time:
From the beginning of one contraction to the beginning of the next
A laboring pt women with a hx of sexual abuse is experiencing anxiety and flashback of previous abuse.Which of the 7 P's is impacting labor?
Psyche
When assessing maternal response to labor, the nurse sees the most significant responses in which system
Reproductive
A classic incision is rarely used for c-section birth because it involves more blood loss and is the most likely of the 3 types to rupture during another pregnancy
TRUE
The nurse questions an order to administer a tocolytic drug for which patient?
The patient with severe pre-eclampsia
When planning care, the nurse determines that which patient is appropriate for intermittent fetal monitoring?
The women whose pregnancy is at 38 weeks' gestation
Upon admitting a laboring patient, the nurse collects maternal assessment for which purpose?
To establish a baseline of the patient's condition.
Under which circumstances does the nurse avoid performing a cervical examination?
When vaginal bleeding is noted
A client with mild preeclampsia is ordered to stay on bed rest at home, lying on either side. Why is client teaching essential to improve her compliance with this plan of care? a. The client generally feels well and may not recognize the potential seriousness of this diagnosis. b. The client may feel guilty for having others care for her. c. The client may think that the symptoms of this condition are normal at this stage of pregnancy. d. The client will have alternating periods of vomiting and feeling well.
a. The client generally feels well and may not recognize the potential seriousness of this diagnosis.
When a client in the third trimester of pregnancy develops a rigid, painful abdomen, it is likely the client has developed which of these conditions? a. central abruptio placenta b. marginal abruptio placenta c. incomplete placenta previa d. placenta previa
a. central abruptio placenta
A pregnant client is admitted at 36 weeks' gestation with documented uterine contractions, ruptured membranes, and a 5-centimeter cervical dilation. The nurse should anticipate the health care provider will: a. attempt to stop labor by ordering tocolytics b. make no attempt to stop labor c. order complete bed rest in the Trendelenburg position d. start an oxytocin IV to facilitate delivery
b. make no attempt to stop labor
An 18-year-old primigravida's baseline blood pressure is 90/60. At her 24 weeks' gestation visit, her blood pressure is 100/70 and the next day the reading is 120/75. The nurse should recognize the client has developed which of these conditions? a. transient hypertension b. mild preeclampsia c. severe preeclampsia d. eclampsia
b. mild preeclampsia
A 35-year-old gravida V para IV is admitted at 36 weeks' gestation with a diagnosis of severe preeclampsia. She is started on magnesium sulfate (MgSO4) IV. Which of these signs would indicate to the nurse that the client has developed magnesium sulfate toxicity? a. Deep tendon reflexes are normal. b. Blood pressure remains unchanged. c. Respirations are 10 per minute. d. Urine output is 40 cc per hour.
c. Respirations are 10 per minute.
The contraction stress test (CST) is MOST often performed on the pregnant client who has: a. sickle-cell anemia b. heart disease c. pregnancy-induced hypertension d. diabetes
d. diabetes
The nurse encourages the labor client to void at least every 2 hours, primarily because a distended bladder may:
impede fetal descent
Which client position is preferred during the active and transition phases of labor because it promotes uteroplacental blood flow?
side-lying
