Maternity Exam II

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present?

3.Uterine tenderness/pain

Which of the following would the nurse assess in a client experiencing abruptio placenta? A) Palpable fetal outline B Concealed or external dark red bleeding C) Bright red, painless vaginal bleeding D) Soft and nontender abdomen

A client with abruptio placentae may exhibit concealed or dark red bleeding, possibly reporting sudden intense localized uterine pain. The uterus is typically firm to boardlike, and the fetal presenting part may be engaged. Bright red, painless vaginal bleeding, a palpable fetal outline and a soft nontender abdomen are manifestations of placenta previa.

Which of the following would cause a false-positive result on a pregnancy test? A The test was performed less than 10 days after an abortion B The urine sample was stored too long at room temperature C The test was performed too early or too late in the pregnancy D A spontaneous abortion or a missed abortion is impending

A false-positive reaction can occur if the pregnancy test is performed less than 10 days after an abortion. Performing the tests too early or too late in the pregnancy, storing the urine sample too long at room temperature, or having a spontaneous or missed abortion impending can all produce false-negative results.

When preparing a client for cesarean delivery, which of the following key concepts should be considered when implementing nursing care? A Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth B Arrange for a staff member of the anesthesia department to explain what to expect postoperatively C Explain the surgery, expected outcome, and kind of anesthetics D Instruct the mother's support person to remain in the family lounge until after the delivery

A key point to consider when preparing the client for a cesarean delivery is to modify the preoperative teaching to meet the needs of either a planned or emergency cesarean birth, the depth and breadth of instruction will depend on circumstances and time available. Allowing the mother's support person to remain with her as much as possible is an important concept, although doing so depends on many variables. Arranging for necessary explanations by various staff members to be involved with the client's care is a nursing responsibility. The nurse is responsible for reinforcing the explanations about the surgery, expected outcome, and type of anesthetic to be used. The obstetrician is responsible for explaining about the surgery and outcome and the anesthesiology staff is responsible for explanations about the type of anesthesia to be used.

Which of the following prenatal laboratory test values would the nurse consider as significant? A One hour glucose challenge test 110 g/dL B White blood cells 8,000/mm3 C Hematocrit 33.5% D Rubella titer less than 1:8

A rubella titer should be 1:8 or greater. Thurs, a finding of a titer less than 1:8 is significant, indicating that the client may not possess immunity to rubella. A hematocrit of 33.5% a white blood cell count of 8,000/mm3, and a 1 hour glucose challenge test of 110 g/dl are with normal parameters.

1. A newborn infant weighing 8 lb needs naloxone (Narcan). This infant should receive approximately _____ mg.

ANS: 0.36 The dose of naloxone is 0.1 mg/kg. This baby weighs 3.6 kg, so 0.1 × 3.6 = 0.36 mg.

1. The labor and delivery nurse must be cognizant of the specific conditions appropriate for labor induction, including which of the following? (Select all that apply.) a. Rupture of membranes at or near term b. Convenience of the woman or her physician c. Chorioamnionitis d. Postterm pregnancy e. Fetal death

ANS: A, C, D, E Rupture of membranes at or near term, chorioamnionitis, postterm pregnancy, and fetal death are all appropriate indications for induction of labor. Convenience is not.

2. The nurse teaches a student that indications for percutaneous umbilical cord sampling (PUBS) include which of the following? (Select all that apply.) a. Rh disease b. Fetal well-being c. Infection d. Lung maturity e. Karyotyping

ANS: A, C, E Rh disease, infection, and, infrequently, for karyotyping are all indications for PUBS. NST or BPP are used to determination fetal well-being. An amniocentesis is done in order to determine lung maturity.

15. The laboring woman who imagines her body opening to let the baby out is using a mental technique called a. dissociation. b. effleurage. c. imagery. d. distraction.

ANS: C Imagery is a technique of visualizing images that will assist the woman in coping with labor. Dissociation helps the woman learn to relax all muscles except those that are working. Effleurage is self-massage. Distraction can be used in the early latent phase by having the woman involved in another activity.

1. A pregnant woman has the following assessments determined from a biophysical profile: reactive nonstress test, 3 fetal breathing movements within 30 minutes, 1 trunk movement in 30 minutes, opened and closed hand twice in 30 minutes, largest amniotic pocket of 1 cm. Calculate this woman's score. This woman's score is _____.

ANS: 8 The scoring is as follows for each criteria: 2-2-1-2-1 = 8.

1. A nurse assesses a woman and gathers the following data: Dilation: 4 cm Effacement: 60% Fetal station: 0 Cervical consistency: medium Cervical position: middle Calculate this woman's Bishop score ____________

ANS: 8 This scoring system evaluates the woman's cervix and how easily labor can be induced. The individual components are: 2-2-2-1-1 = 8.

20. The new nurse learns that which condition related to decreased variability is considered benign? a. A periodic fetal sleep state b. Extreme prematurity c. Fetal hypoxemia d. Preexisting neurologic injury

ANS: A When the fetus is temporarily in a sleep state there is minimal variability present. Periodic fetal sleep states usually last no longer than 30 minutes. The other conditions would be considered conducive to abnormal variability.

4. When is the best time to determine gestational age based on biparietal diameter through ultrasound? a. First trimester only b. Second trimester only c. Any time d. Second half of pregnancy

ANS: D The biparietal diameter is used to determine gestational age during the second half of pregnancy.

24. A woman is receiving oxytocin to augment labor. The nurse notes that the Montevideo units are measured at 560 and the fetus is showing late decelerations. What action by the nurse takes priority? a. Notify the charge nurse of the situation. b. Document the findings in the chart. c. Increase the rate of oxytocin slowly. d. Stop the oxytocin infusion.

ANS: D This woman is showing signs of uterine tachysystole. The nurse first turns the oxytocin infusion off. Notifying the charge nurse and documentation are important but not the priority. The nurse would not increase the rate of the infusion.

When assessing the adequacy of sperm for conception to occur, which of the following is the most useful criterion? A Sperm maturity B Sperm motility C Semen volume D Sperm count

Although all of the factors listed are important, sperm motility is the most significant criterion when assessing male infertility. Sperm count, sperm maturity, and semen volume are all significant, but they are not as significant sperm motility.

A client at 36 weeks' gestation is schedule for a routine ultrasound prior to an amniocentesis. After teaching the client about the purpose for the ultrasound, which of the following client statements would indicate to the nurse in charge that the client needs further instruction? A. The ultrasound will help to locate the placenta B. The ultrasound identifies blood flow through the umbilical cord C. The test will determine where to insert the needle D. The ultrasound locates a pool of amniotic fluid

B

The laboring patient has rated her pain at 9 on scale of 1-10 and requests IV pain medication. Which statement is most important for the nurse to make? Narcotic medications:

Can make you instead. You need to ask for help when you get up.

Cervical softening and uterine souffle are classified as which of the following? A Positive signs B Probable signs C Diagnostic signs D Presumptive signs

Cervical softening (Goodell sign) and uterine soufflé are two probable signs of pregnancy. Probable signs are objective findings that strongly suggest pregnancy. Other probable signs include Hegar sign, which is softening of the lower uterine segment; Piskacek sign, which is enlargement and softening of the uterus; serum laboratory tests; changes in skin pigmentation; and ultrasonic evidence of a gestational sac. Presumptive signs are subjective signs and include amenorrhea; nausea and vomiting; urinary frequency; breast tenderness and changes; excessive fatigue; uterine enlargement; and quickening.

On which of the following areas would the nurse expect to observe chloasma? A Cheeks, forehead, and nose B Breast, areola, and nipples C Chest, neck, arms, and legs D Abdomen, breast, and thighs

Chloasma, also called the mask of pregnancy, is an irregular hyperpigmented area found on the face. It is not seen on the breasts, areola, nipples, chest, neck, arms, legs, abdomen, or thighs.

Which of the following assessment findings would the nurse expect if the client develops DVT? A Chills, fever, malaise, occurring 2 weeks after delivery B Midcalf pain, tenderness and redness along the vein C Chills, fever, stiffness, and pain occurring 10 to 14 days after delivery D Muscle pain the presence of Homans sign, and swelling in the affected limb

Classic symptoms of DVT include muscle pain, the presence of Homans sign, and swelling of the affected limb. Midcalf pain, tenderness, and redness, along the vein reflect superficial thrombophlebitis. Chills, fever and malaise occurring 2 weeks after delivery reflect pelvic thrombophlebitis. Chills, fever, stiffness and pain occurring 10 to 14 days after delivery suggest femoral thrombophlebitis.

Which of the following would the nurse identify as a classic sign of PIH? A Early morning headache B Weight gain of 1 lb/week C Edema of the hands and face D Edema of the feet and ankles

Edema of the hands and face is a classic sign of PIH. Many healthy pregnant woman experience foot and ankle edema. A weight gain of 2 lb or more per week indicates a problem. Early morning headache is not a classic sign of PIH.

Which of the following danger signs should be reported promptly during the antepartum period? A Constipation B Breast tenderness C Nasal stuffiness Leaking amniotic fluid

Danger signs that require prompt reporting leaking of amniotic fluid, vaginal bleeding, blurred vision, rapid weight gain, and elevated blood pressure. Constipation, breast tenderness, and nasal stuffiness are common discomforts associated with pregnancy.

An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that aburptio placentae is present. On the basis of these findings, the nurse should prepare the client for which anticipated prescription?

Delivery of the fetus

Which of the following factors is the underlying cause of dystocia? A Nurtional B Medical C Environmental D Medical

Dystocia is difficult, painful, prolonged labor due to mechanical factors involving the fetus (passenger), uterus (powers), pelvis (passage), or psyche. Nutritional, environment, and medical factors may contribute to the mechanical factors that cause dystocia.

When PROM occurs, which of the following provides evidence of the nurse's understanding of the client's immediate needs? Nursing care is based on fetal viability and gestational age. PROM removes the fetus most effective defense against infection C PROM is associated with malpresentation and possibly incompetent cervix D The chorion and amnion rupture 4 hours before the onset of labor.

PROM can precipitate many potential and actual problems; one of the most serious is the fetus loss of an effective defense against infection. This is the client's most immediate need at this time. Typically, PROM occurs about 1 hour, not 4 hours, before labor begins. Fetal viability and gestational age are less immediate considerations that affect the plan of care. Malpresentation and an incompetent cervix may be causes of PROM.

A nurse is admitting a client who is at 36 weeks gestation on and has painless, bright red vag bleeding.

Placenta previa

Which of the following are the most commonly assessed findings in cystitis? Frequency, urgency, dehydration, nausea, chills, and flank pain B High fever, chills, flank pain nausea, vomiting, dysuria, and frequency C Dehydration, hypertension, dysuria, suprapubic pain, chills, and fever Nocturia, frequency, urgency dysuria, hematuria, fever and suprapubic pain

Question 45 Explanation: Manifestations of cystitis include, frequency, urgency, dysuria, hematuria nocturia, fever, and suprapubic pain. Dehydration, hypertension, and chills are not typically associated with cystitis. High fever chills, flank pain, nausea, vomiting, dysuria, and frequency are associated with pvelonephritis.

Which of the following statements best describes hyperemesis gravidarum? A Loss of appetite and continuous vomiting that commonly results in dehydration and ultimately decreasing maternal nutrients B Severe anemia leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. C Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal bleeding D Severe nausea and vomiting leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems.

The description of hyperemesis gravidarum includes severe nausea and vomiting, leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. Hyperemesis is not a form of anemia. Loss of appetite may occur secondary to the nausea and vomiting of hyperemesis, which, if it continues, can deplete the nutrients transported to the fetus. Diarrhea does not occur with hyperemesis.

Before birth, which of the following structures connects the right and left auricles of the heart? A Umbilical vein B Ductus arteriosus C Ductus venosus D Foramen ovale

The foramen ovale is an opening between the right and left auricles (atria) that should close shortly after birth so the newborn will not have a murmur or mixed blood traveling through the vascular system. The umbilical vein, ductus arteriosus, and ductus venosus are obliterated at birth.

Which of the following is the nurse's initial action when umbilical cord prolapse occurs? A) Notify the physician and prepare the client for delivery B) Begin monitoring maternal vital signs and FHR C) Apply a sterile warm saline dressing to the exposed cord D) Place the client in a knee-chest position in bed

The immediate priority is to minimize pressure on the cord. Thus the nurse's initial action involves placing the client on bed rest and then placing the client in a knee-chest position or lowering the head of the bed, and elevating the maternal hips on a pillow to minimize the pressure on the cord. Monitoring maternal vital signs and FHR, notifying the physician and preparing the client for delivery, and wrapping the cord with sterile saline soaked warm gauze are important. But these actions have no effect on minimizing the pressure on the cord.

Which of the following actions demonstrates the nurse's understanding about the newborn's thermoregulatory ability? A Suctioning with a bulb syringe B Placing the newborn under a radiant warmer. C Obtaining an Apgar score D Inspecting the newborn's umbilical cord

The newborn's ability to regulate body temperature is poor. Therefore, placing the newborn under a radiant warmer aids in maintaining his or her body temperature. Suctioning with a bulb syringe helps maintain a patent airway. Obtaining an Apgar score measures the newborn's immediate adjustment to extrauterine life. Inspecting the umbilical cord aids in detecting cord anomalies.

When assessing the newborn's heart rate, which of the following ranges would be considered normal if the newborn were sleeping? A 140 beats per minute B 100 beats per minute C 120 beats per minute D 80 beats per minute

The normal heart rate for a newborn that is sleeping is approximately 100 beats per minute. If the newborn was awake, the normal heart rate would range from 120 to 160 beats per minute.

A client LMP began July 5. Her EDD should be which of the following? A April 12 B March 28 C October 12 D January 2

To determine the EDD when the date of the client's LMP is known use Nagele rule. To the first day of the LMP, add 7 days, subtract 3 months, and add 1 year (if applicable) to arrive at the EDD as follows: 5 + 7 = 12 (July) minus 3 = 4 (April). Therefore, the client's EDD is April 12.

Which of the following fundal heights indicates less than 12 weeks' gestation when the date of the LMP is unknown? A Uterus in the abdomen B Uterus in the pelvis C Uterus at the xiphoid D Uterus at the umbilicus

When the LMP is unknown, the gestational age of the fetus is estimated by uterine size or position (fundal height). The presence of the uterus in the pelvis indicates less than 12 weeks' gestation. At approximately 12 to 14 weeks, the fundus is out of the pelvis above the symphysis pubis. The fundus is at the level of the umbilicus at approximately 20 weeks' gestation and reaches the xiphoid at term or 40 weeks.

Which of the following characteristics of contractions would the nurse expect to find in a client experiencing true labor? Increasing intensity with walking B Occurring at irregular intervals C Gradually increasing intervals D Starting mainly in the abdomen

With true labor, contractions increase in intensity with walking. In addition, true labor contractions occur at regular intervals, usually starting in the back and sweeping around to the abdomen. The interval of true labor contractions gradually shortens.

When uterine rupture occurs, which of the following would be the priority? A) Inserting a urinary catheter B) Limiting hypovolemic shock C) Instituting complete bed rest D) Obtaining blood specimens

With uterine rupture, the client is at risk for hypovolemic shock. Therefore, the priority is to prevent and limit hypovolemic shock. Immediate steps should include giving oxygen, replacing lost fluids, providing drug therapy as needed, evaluating fetal responses and preparing for surgery. Obtaining blood specimens, instituting complete bed rest, and inserting a urinary catheter are necessary in preparation for surgery to remedy the rupture.

which of the following is likely an indication of fetal intolerance to labor

absent variability

nurse in prenatal clinic, caring for client suspected of having a hydatidform mole. findings to expect?

excessive uterine enlargement

A primigravida in active labor is about 9 days post-term. The client desires a pudendal block anesthesia before delivery. after the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate the nurse that the teaching was effective?

perineum

In evaluating the effectiveness of IV pitocin for a client with secondary dystocia. The nurse should expect

progressive cervical dilation

6. While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy as early as _____ weeks. a. 4 b. 8 c. 10 d. 12

ANS: C CVS is usually performed between 10 and 13 weeks of gestation to diagnose fetal chromosomal, metabolic, or DNA abnormalities.

19. What order should the nurse expect for a patient admitted with a threatened abortion? a. Abstinence from sexual activity b. Pitocin IV c. NPO d. Narcotic analgesia every 3 hours, prn

ANS: A The woman may be counseled to avoid sexual activity with a threatened abortion. Activity restrictions were once recommended, but they have not shown effectiveness as treatment. Pitocin would be contraindicated. There is no reason for the woman to be NPO. In fact, hydration is important. Narcotic analgesia is not indicated.

27. The nurse learns that which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities b. Infections c. Endocrine imbalance d. Immunologic factors

ANS: A Around 60% of pregnancy losses from spontaneous abortion in the first trimester result from chromosomal abnormalities that are incompatible with life. Maternal infection, endocrine imbalances, and immunologic factors may also be causes of early miscarriage.

4. A nurse manager plans staffing for the Labor and Delivery unit. How does the available staff influence the selection of either continuous electronic or intermittent auscultation as the fetal monitoring method? a. There must be a 1:1 nurse-to-patient ratio regardless of the method used. b. Staffing patterns do not influence fetal monitoring choices. c. Use of intermittent auscultation requires a lower nurse-to-patient ratio. d. More nurses are needed when electronic fetal monitoring is used.

ANS: A A one-to-one ratio is needed during the second stage of labor or if a high-risk condition exists, regardless of the monitoring method used. Intermittent auscultation is more staff-intensive. Less nursing time is needed with electronic monitoring, giving the nurse more time for teaching and supporting the laboring woman.

11. Before the physician performs an external version, the nurse should expect an order for a a. tocolytic drug. b. contraction stress test (CST). c. local anesthetic. d. indwelling catheter.

ANS: A A tocolytic drug will relax the uterus before and during version, making manipulation easier. A contraction stress test, local anesthetics, and indwelling catheters are not needed.

8. The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is a. respiratory depression. b. bradycardia. c. acrocyanosis. d. tachypnea.

ANS: A An infant delivered within 5 hours of maternal analgesic administration (timing depends on drug used) is at risk for respiratory depression from the sedative effects of the opioid. Bradycardia, acrocyanosis, and tachypnea are not anticipated side effects of maternal analgesics.

22. In the low-risk patient assessments for variability and periodic changes if using the fetal monitor should be done how often? a. Every 15 to 30 minutes b. Every 5 to 15 minutes c. Every 30 to 60 minutes d. Only before and after ambulation

ANS: A During the active first stage of labor, FHR should be assessed every 15 to 30 minutes just after a contraction.

3. The nursing student is planning to assess a fetal heart rate. The registered nurse reminds the student to get gel. Which method of assessing the fetal heart rate is the student planning on conducting? a. Fetoscope b. Tocodynamometer c. Doppler d. Scalp electrode

ANS: C Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it requires use of a gel.

10. The major advantage of chorionic villus sampling (CVS) over amniocentesis is that it a. is not an invasive procedure. b. does not require hospitalization. c. has less risk of spontaneous abortion. d. is performed earlier in pregnancy.

ANS: D CVS is performed between 10 and 13 weeks of gestation, providing earlier results than amniocentesis, which is normally done during the second and third trimesters, although it can be done as early as 11 weeks if needed. The woman does not need hospitalization for this invasive procedure, and the risk of spontaneous abortion is about the same for both procedures.

a nurse is admitting a client who is in labor. the client admits to recent cocaine use. For which of the following complications should the nurse assess?

Abruptio placenta

Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage? A Placenta previa B Ectopic pregnancy C Incompetent cervix D Abruptio placentae

Abruptio placentae is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage. Placenta previa refers to implantation of the placenta in the lower uterine segment, causing painless bleeding in the third trimester of pregnancy. Ectopic pregnancy refers to the implantation of the products of conception in a site other than the endometrium. Incompetent cervix is a conduction characterized by painful dilation of the cervical os without uterine contractions.

Which of the following best reflects the frequency of reported postpartum "blues"? A Between 25% and 70% of all new mothers report some form of postpartum blues B Between 30% and 50% of all new mothers report some form of postpartum blues C Between 10% and 40% of all new mothers report some form of postpartum blues D Between 50% and 80% of all new mothers report some form of postpartum blues

According to statistical reports, between 50% and 80% of all new mothers report some form of postpartum blues. The ranges of 10% to 40%, 30% to 50%, and 25% to 70% are incorrect.

During which of the following stages of labor would the nurse assess "crowning"? A First stage B Third stage C Second stage D Fourth stage

Crowing, which occurs when the newborn's head or presenting part appears at the vaginal opening, occurs during the second stage of labor. During the first stage of labor, cervical dilation and effacement occur. During the third stage of labor, the newborn and placenta are delivered. The fourth stage of labor lasts from 1 to 4 hours after birth, during which time the mother and newborn recover from the physical process of birth and the mother's organs undergo the initial readjustment to the nonpregnant state.

Which of the following common emotional reactions to pregnancy would the nurse expect to occur during the first trimester? A Introversion, egocentrism, narcissism B) Ambivalence, fear, fantasies C) Awkwardness, clumsiness, and unattractiveness D Anxiety, passivity, extroversion

During the first trimester, common emotional reactions include ambivalence, fear, fantasies, or anxiety. The second trimester is a period of well-being accompanied by the increased need to learn about fetal growth and development. Common emotional reactions during this trimester include narcissism, passivity, or introversion. At times the woman may seem egocentric and self-centered. During the third trimester, the woman typically feels awkward, clumsy, and unattractive, often becoming more introverted or reflective of her own childhood.

A pregnant client states that she "waddles" when she walks. The nurse's explanation is based on which of the following as the cause? A Pressure on the pelvic muscles B Relaxation of the pelvic joints C The large size of the newborn D Excessive weight gain

During pregnancy, hormonal changes cause relaxation of the pelvic joints, resulting in the typical "waddling" gait. Changes in posture are related to the growing fetus. Pressure on the surrounding muscles causing discomfort is due to the growing uterus. Weight gain has no effect on gait.

Which of the following nursing interventions would the nurse perform during the third stage of labor? A Promote parent-newborn interaction. B Coach for effective client pushing C Assess uterine contractions every 30 minutes. D Obtain a urine specimen and other laboratory tests.

During the third stage of labor, which begins with the delivery of the newborn, the nurse would promote parent-newborn interaction by placing the newborn on the mother's abdomen and encouraging the parents to touch the newborn. Collecting a urine specimen and other laboratory tests is done on admission during the first stage of labor. Assessing uterine contractions every 30 minutes is performed during the latent phase of the first stage of labor. Coaching the client to push effectively is appropriate during the second stage of labor.

Which of the following best describes preterm labor? A Labor that begins after 24 weeks gestation and before 28 weeks gestation B Labor that begins after 15 weeks gestation and before 37 weeks gestation C Labor that begins after 28 weeks gestation and before 40 weeks gestation Labor that begins after 20 weeks gestation and before 37 weeks gestation

Preterm labor is best described as labor that begins after 20 weeks' gestation and before 37 weeks' gestation. The other time periods are inaccurate.

Which of the following best describes thrombophlebitis? A Inflammation and blood clots that eventually become lodged within the pulmonary blood vessels B Inflammation and blood clots that eventually become lodged within the femoral vein C Inflammation of the vascular endothelium with clot formation on the vessel wall D Inflammation and clot formation that result when blood components combine to form an aggregate body

Thrombophlebitis refers to an inflammation of the vascular endothelium with clot formation on the wall of the vessel. Blood components combining to form an aggregate body describe a thrombus or thrombosis. Clots lodging in the pulmonary vasculature refers to pulmonary embolism; in the femoral vein, femoral thrombophlebitis.

Which of the following describes the Babinski reflex? A The newborn will attempt to crawl forward with both arms and legs when he is placed on his abdomen on a flat surface B The newborn abducts and flexes all extremities and may begin to cry when exposed to sudden movement or loud noise. C The newborn's toes will hyperextend and fan apart from dorsiflexion of the big toe when one side of foot is stroked upward from the ball of the heel and across the ball of the foot. D The newborn turns the head in the direction of stimulus, opens the mouth, and begins to suck when cheek, lip, or corner of mouth is touched.

With the babinski reflex, the newborn's toes hyperextend and fan apart from dorsiflexion of the big toe when one side of foot is stroked upward form the heel and across the ball of the foot. With the startle reflex, the newborn abducts and flexes all extremities and may begin to cry when exposed to sudden movement of loud noise. With the rooting and sucking reflex, the newborn turns his head in the direction of stimulus, opens the mouth, and begins to suck when the cheeks, lip, or corner of mouth is touched. With the crawl reflex, the newborn will attempt to crawl forward with both arms and legs when he is placed on his abdomen on a flat surface.

While monitoring your full-term labor patient, you notice persistent variable decelerations. your first intervention for maximizing fetal oxygenation is to:

change maternal position

Heartburn and flatulence, common in the second trimester, are most likely the result of which of the following? A) Decreased intestinal motility B) Increased plasma HCG levels C) Decreased gastric acidity D) Elevated estrogen levels

reduction in gastric acidity

Which of the following factors would the nurse suspect as predisposing a client to placenta previa? A Abdominal trauma Multiple gestation C Uterine anomalies D Renal or vascular disease

Multiple gestation is one of the predisposing factors that may cause placenta previa. Uterine anomalies abdominal trauma, and renal or vascular disease may predispose a client to abruptio placentae.

5. A nursing faculty member explains to students that which patient status is an acceptable indication for serial oxytocin induction of labor? a. Past 42 weeks' gestation b. Multiple fetuses c. Polyhydramnios d. History of long labors

ANS: A Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses and polyhydramnios overdistend the uterus, making induction of labor high risk. History of rapid labors is a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances.

4. Which of the following factors place the intrapartum woman at risk for complications during labor and delivery? (Select all that apply.) a. Prolonged rupture of membranes b. Chorioamnionitis c. Fever d. History of stillbirth e. Drug use

ANS: A, B, C Prolonged rupture of membranes, Chorioamnionitis, and fever are specific to the intrapartum period. Stillbirths and drug use are problems found in the antepartum period.

7. An indication for an episiotomy would be a woman who a. has a routine vaginal birth. b. has fetal shoulder dystocia. c. is delivering a preterm infant. d. has a history of rapid deliveries.

ANS: B An episiotomy is indicated in the situation where the shoulder of the fetus becomes lodged under the mother's symphysis pubis during birth. The other situations are not indications for an episiotomy.

3. The nursing student learns that spontaneous termination of a pregnancy is considered to be an abortion if a. the pregnancy is less than 20 weeks. b. the fetus weighs less than 1000 g. c. the products of conception are passed intact. d. no evidence exists of intrauterine infection.

ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of a fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection.

4. Excessive anxiety in labor heightens the woman's sensitivity to pain by increasing a. muscle tension. b. blood flow to the uterus. c. the pain threshold. d. rest time between contractions.

ANS: A Anxiety and fear increase muscle tension, diverting oxygenated blood to the woman's brain and skeletal muscles. Prolonged tension results in general fatigue, increased pain perception, and reduced ability to use coping skills. It can also decrease blood flow to the uterus, the pain threshold, and the amount of rest the mother gets between contractions.

7. The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to a. assess fetal heart rate (FHR) and maternal vital signs. b. perform a venipuncture for hemoglobin and hematocrit levels. c. place clean disposable pads to collect any drainage. d. monitor uterine contractions.

ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The blood levels can be obtained later. It is important to assess future bleeding and provide for comfort, but the top priority is mother/fetal well-being. Monitoring uterine contractions is important but not the top priority.

20. What data on a patient's health history places her at risk for an ectopic pregnancy? a. Use of oral contraceptives for 5 years b. Recurrent pelvic infections c. Ovarian cyst 2 years ago d. Heavy menstrual flow of 4 days' duration

ANS: B Infection and subsequent scarring of the fallopian tubes prevents normal movement of the fertilized ovum into the uterus for implantation. Oral contraceptives, ovarian cysts, and heavy menstrual flows do not increase risk.

8. The greatest risk to the newborn after an elective cesarean birth is a. trauma due to manipulation during delivery. b. tachypnea due to maternal anesthesia. c. prematurity due to miscalculation of gestation. d. tachycardia due to maternal narcotics.

ANS: C Regardless of the many criteria used to determine gestational age, inadvertent preterm birth still occurs. There is reduced trauma with a cesarean birth. Maternal anesthesia may cause respiratory distress. Maternal narcotics may cause respiratory distress.

13. After an amniotomy, which action by the nurse takes priority? a. Assess the color of the amniotic fluid. b. Change the patient's gown. c. Estimate the amount of amniotic fluid. d. Assess the fetal heart rate.

ANS: D The fetal heart rate must be assessed immediately after the rupture of the membranes to determine whether cord prolapse or compression has occurred. Assessing the amniotic fluid color, changing the patient's gown, and estimating the amount of amniotic fluid lost are all appropriate interventions but not the priority.

9. The nurse practicing in a labor setting knows that the woman most at risk for a uterine rupture is a gravida a. 3 who has had two low-segment transverse cesarean births. b. 2 who has had a low-segment vertical incision for delivery of a 10-pound infant. c. 5 who has had two vaginal births and two cesarean births. d. 4 who has had four cesarean births.

ANS: D The risk of uterine rupture increases as the number of prior uterine incisions increases. More than two previous cesarean births places the woman at increased risk for uterine rupture. The other women are not high-risk candidates.

21. A nurse might be called on to stimulate the fetal scalp a. as part of fetal scalp blood sampling. b. in response to tocolysis. c. in preparation for fetal oxygen saturation monitoring. d. to elicit an acceleration in the FHR.

ANS: D The scalp can be stimulated using digital pressure during a vaginal examination, which should cause an increase in FHR. Stimulating the fetal scalp is not part of blood sampling, assessing the response to tocolysis, or in preparation for oxygen saturation monitoring.

11. The nurse assesses the fetal monitor and sees the following strip. What action by the nurse is most appropriate? a. Administer oxygen by nasal cannula. b. Reposition the woman. c. Apply a fetal scalp electrode. d. Record this reassuring pattern.

ANS: D This is a reassuring pattern and no intervention is necessary beyond documentation.

22. What routine nursing assessment is contraindicated in the patient admitted with suspected placenta previa? a. Monitoring FHR and maternal vital signs b. Observing vaginal bleeding or leakage of amniotic fluid c. Determining frequency, duration, and intensity of contractions d. Determining cervical dilation and effacement

ANS: D Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage and is therefore contraindicated. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this woman. Monitoring for bleeding and rupture of membranes is not contraindicated in this woman. Monitoring contractions is not contraindicated in this woman.

12. When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern? a. Increase in baseline variability b. Nonperiodic accelerations c. Early decelerations d. Variable decelerations

ANS: D When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a variable deceleration pattern. This is not an expected occurrence after the rupture of membranes. Accelerations are considered reassuring; they are not a concern after rupture of membranes. Early declarations are considered reassuring; they are not a concern after rupture of membranes.

Barbiturates are usually not given for pain relief during active labor for which of the following reasons? A These drugs readily cross the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. B The neonatal effects include hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days. C Adverse reactions may include maternal hypotension, allergic or toxic reaction or partial or total respiratory failure D They rapidly transfer across the placenta, and lack of an antagonist make them generally inappropriate during labor.

Barbiturates are rapidly transferred across the placental barrier, and lack of an antagonist makes them generally inappropriate during active labor. Neonatal side effects of barbiturates include central nervous system depression, prolonged drowsiness, delayed establishment of feeding (e.g. due to poor sucking reflex or poor sucking pressure). Tranquilizers are associated with neonatal effects such as hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days. Narcotic analgesic readily cross the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. Regional anesthesia is associated with adverse reactions such as maternal hypotension, allergic or toxic reaction, or partial or total respiratory failure.

Which of the following groups of newborn reflexes below are present at birth and remain unchanged through adulthood? Blink, cough, sneeze, gag B Blink, cough, rooting, and gag C Rooting, sneeze, swallowing, and cough D Stepping, blink, cough, and sneeze

Blink, cough, sneeze, swallowing and gag reflexes are all present at birth and remain unchanged through adulthood. Reflexes such as rooting and stepping subside within the first year.

During which of the following would the focus of classes be mainly on physiologic changes, fetal development, sexuality, during pregnancy, and nutrition? A Second trimester B Prepregnant period C Third trimester D First trimester

First-trimester classes commonly focus on such issues as early physiologic changes, fetal development, sexuality during pregnancy, and nutrition. Some early classes may include pregnant couples. Second and third trimester classes may focus on preparation for birth, parenting, and newborn care.

Which of the following may happen if the uterus becomes overstimulated by oxytocin during the induction of labor? A) Tetanic contractions prolonged to more than 90 seconds B) Increased restlessness and anxiety C) Weak contraction prolonged to more than 70 seconds D) Increased pain with bright red vaginal bleeding

Hyperstimulation of the uterus such as with oxytocin during the induction of labor may result in tetanic contractions prolonged to more than 90seconds, which could lead to such complications as fetal distress, abruptio placentae, amniotic fluid embolism, laceration of the cervix, and uterine rupture. Weak contractions would not occur. Pain, bright red vaginal bleeding, and increased restlessness and anxiety are not associated with hyperstimulation.

Which of the following amounts of blood loss following birth marks the criterion for describing postpartum hemorrhage? A More than 200 ml B More than 500 ml C More than 300 ml D More than 400 ml

Postpartum hemorrhage is defined as blood loss of more than 500 ml following birth. Any amount less than this not considered postpartum hemorrhage.

Which of the following is true regarding the fontanels of the newborn? A The anterior is large in size when compared to the posterior fontanel. B The posterior closes at 18 months; the anterior closes at 8 to 12 weeks. C The anterior is bulging; the posterior appears sunken. D The anterior is triangular shaped; the posterior is diamond shaped.

The anterior fontanel is larger in size than the posterior fontanel. Additionally, the anterior fontanel, which is diamond shaped, closes at 18 months, whereas the posterior fontanel, which is triangular shaped, closes at 8 to 12 weeks. Neither fontanel should appear bulging, which may indicate increased intracranial pressure, or sunken, which may indicate dehydration.

Which of the following represents the average amount of weight gained during pregnancy? A 24 to 30 lb B 12 to 22 lb C 25 to 40 lb D 15 to 25 lb

The average amount of weight gained during pregnancy is 24 to 30 lb. This weight gain consists of the following: fetus - 7.5 lb; placenta and membrane - 1.5 lb; amniotic fluid - 2 lb; uterus - 2.5 lb; breasts - 3 lb; and increased blood volume - 2 to 4 lb; extravascular fluid and fat - 4 to 9 lb. A gain of 12 to 22 lb is insufficient, whereas a weight gain of 15 to 25 lb is marginal. A weight gain of 25 to 40 lb is considered excessive.

Which of the following when present in the urine may cause a reddish stain on the diaper of a newborn? A Bilirubin B Excess iron C Uric acid crystals D Mucus

Uric acid crystals in the urine may produce the reddish "brick dust" stain on the diaper. Mucus would not produce a stain. Bilirubin and iron are from hepatic adaptation.

Which of the following would be disadvantage of breast feeding? A) The father may resent the infant's demands on the mother's body B) The incidence of allergies increases due to maternal antibodies C) There is a greater chance for error during preparation D) Involution occurs more rapidly

With breast feeding, the father's body is not capable of providing the milk for the newborn, which may interfere with feeding the newborn, providing fewer chances for bonding, or he may be jealous of the infant's demands on his wife's time and body. Breast feeding is advantageous because uterine involution occurs more rapidly, thus minimizing blood loss. The presence of maternal antibodies in breast milk helps decrease the incidence of allergies in the newborn. A greater chance for error is associated with bottle feeding. No preparation is required for breast

Which of the following is the primary predisposing factor related to mastitis? A Breast injury caused by overdistention, stasis, and cracking of the nipples B Epidemic infection from nosocomial sources localizing in the lactiferous glands and ducts C Temporary urinary retention due to decreased perception of the urge to avoid D Endemic infection occurring randomly and localizing in the periglandular connective tissue

With mastitis, injury to the breast, such as overdistention, stasis, and cracking of the nipples, is the primary predisposing factor. Epidemic and endemic infections are probable sources of infection for mastitis. Temporary urinary retention due to decreased perception of the urge to void is a contributory factor to the development of urinary tract infection, not mastitis.

1. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for which symptoms? (Select all that apply.) a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E Early signs of ectopic pregnancy include pelvic pain, abdominal pain, spotting or light bleeding, and a woman's report of a "missed period." Heavy bleeding is a later sign and occurs after the tube has ruptured.

17. Rh incompatibility can occur if the woman is Rh negative and her a. fetus is Rh positive. b. husband is Rh positive. c. fetus is Rh negative. d. husband and fetus are both Rh negative.

ANS: A For Rh incompatibility to occur, the mother must be Rh negative and her fetus Rh positive. The husband's Rh factor is a concern only as it relates to the possible Rh factor of the fetus. If the fetus is Rh negative, the blood types are compatible and no problems should occur. If the fetus is Rh negative, the blood type with the mother is compatible. The husband's blood type does not enter into the problem.

3. The nurse providing care for the pregnant woman understands that a factor indicating the need for fetal diagnostic procedures is a. maternal diabetes. b. maternal age older than 30 years. c. previous infant more than 3000 g at birth. d. weight gain of 25 pounds.

ANS: A Diabetes is a risk factor in pregnancy because of possible impairment of placental perfusion. Other indications for testing include a maternal age greater than 35 years, having had another infant weighing greater than 4000 g at birth, or excessive weight gain. A weight gain of 25 to 35 pounds is recommended for the woman who begins pregnancy at a normal weight.

30. A woman has received an epidural block. What action by the nurse takes priority? a. Instruct her to call for help when getting out of bed. b. Assess the woman for a post-procedure headache. c. Determine type and time of last oral intake. d. Administer metoclopramide within the first hour.

ANS: A Due to variable leg strength and sensation with an epidural block, the woman who is able to get out of bed needs to call for assistance for safety. Post-procedure headaches are associated with subarachnoid blocks. Oral intake and pro-motility agents are important for the woman having general anesthesia.

21. While assisting with a vacuum extraction birth, what should the nurse immediately report to the provider? a. Persistent fetal bradycardia below 100 bpm b. Maternal pulse rate of 100 bpm c. Maternal blood pressure of 120/70 mm Hg d. Decrease in intensity of uterine contractions

ANS: A Fetal bradycardia may indicate fetal distress and may require immediate intervention. Maternal pulse rate may increase due to the pushing process. This blood pressure is within expected norms for this stage of labor. The birth is imminent at this point.

12. A maternal indication for the use of vacuum extraction is a. a wide pelvic outlet. b. maternal exhaustion. c. a history of rapid deliveries. d. failure to progress past 0 station.

ANS: B A mother who is exhausted will be unable to assist with the expulsion of the fetus and is a candidate for vacuum extraction. With a wide pelvic outlet and rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum extraction.

28. Which technique could the support person use when the laboring woman appears to be losing control? a. Have the nurse take over the role of support. b. Tell the woman that she is causing stress to her baby and herself. c. Wait for the contraction to end and discuss the problem with her. d. Make eye contact with the woman and breathe along with her.

ANS: D Making eye contact and breathing along with the laboring woman to help pace her breathing will assist her in remaining calm. The woman already has a trusting relationship with the support person so they should stay in that position if possible. Telling the woman she is stressing herself and the baby is very uncaring and will not be helpful. A woman who has lost control will not be able to engage in a productive discussion.

9. A woman received 50 mcg of fentanyl intravenously 1 hour before delivery. What drug should the nurse have readily available? a. Promethazine (Phenergan) b. Nalbuphine (Nubain) c. Butorphanol (Stadol) d. Naloxone (Narcan)

ANS: D Naloxone reverses narcotic-induced respiratory depression, which may occur with administration of narcotic analgesia. Phenergan is normally given for nausea. Nubain and Stadol are analgesics that can be given to women in labor.

14. Which method of pain management does the nurse plan for a gravida 3 para 2 admitted at 8-cm cervical dilation? a. Epidural anesthesia b. Narcotics c. Spinal block d. Breathing and relaxation techniques

ANS: D Nonpharmacologic methods of pain management may be the best option for a woman in advanced labor. There is probably not enough remaining time to administer epidural anesthesia or spinal anesthesia. A narcotic given at this time may reach its peak about the time of birth and result in respiratory depression in the newborn.

26. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that a. bed rest and analgesics are the recommended treatment. b. she will be unable to conceive in the future. c. a D&C will be performed to remove the products of conception. d. hemorrhage is the major concern.

ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before hemorrhaging. If the tube must be removed, her fertility will decrease but she will not be infertile. A D&C is done on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes.

11. Which clinical sign is not included in the symptoms of preeclampsia? a. Hypertension b. Edema c. Proteinuria d. Glycosuria

ANS: D Spilling glucose into the urine is not one of the three classic symptoms of preeclampsia. Hypertension is usually the first sign noted. Edema occurs but is considered a non-specific sign. Edema can lead to rapid weight gain. Proteinuria should be assessed through a 24- hour UA.

12. An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed a. nonreactive. b. positive. c. negative. d. reactive.

ANS: D The NST is reactive (normal) when two or more FHR accelerations of at least 15 bpm (each with a duration of at least 15 seconds) occur in a 20-minute period. A nonreactive result means that the heart rate did not accelerate during fetal movement. Positive and negative are not results given with this test.

Immediately before expulsion, which of the following cardinal movements occur? A Descent B Flexion C Extension D External rotation

Immediately before expulsion or birth of the rest of the body, the cardinal movement of external rotation occurs. Descent flexion, internal rotation, extension, and restitution (in this order) occur before external rotation.

In which of the following types of spontaneous abortions would the nurse assess dark brown vaginal discharge and a negative pregnancy tests? A Missed B Threatened C Incomplete D Imminent

In a missed abortion, there is early fetal intrauterine death, and products of conception are not expelled. The cervix remains closed; there may be a dark brown vaginal discharge, negative pregnancy test, and cessation of uterine growth and breast tenderness. A threatened abortion is evidenced with cramping and vaginal bleeding in early pregnancy, with no cervical dilation. An incomplete abortion presents with bleeding, cramping, and cervical dilation. An incomplete abortion involves only expulsion of part of the products of conception and bleeding occurs with cervical dilation.

Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester? A Incontinence B Dysuria Frequency D Burning

Pressure and irritation of the bladder by the growing uterus during the first trimester is responsible for causing urinary frequency. Dysuria, incontinence, and burning are symptoms associated with urinary tract infections.

25. A woman taking magnesium sulfate has respiratory rate of 10 breaths/min. In addition to discontinuing the medication, the nurse should a. vigorously stimulate the woman. b. instruct her to take deep breaths. c. administer calcium gluconate. d. increase her IV fluids.

ANS: C Calcium gluconate reverses the effects of magnesium sulfate. Stimulation, instruction on taking deep breaths, and increasing her fluid rate will not increase the respirations.

23. The primary symptom present in abruptio placentae that distinguishes it from placenta previa is a. vaginal bleeding. b. rupture of membranes. c. presence of abdominal pain. d. changes in maternal vital signs.

ANS: C Pain in abruptio placentae occurs in response to increased pressure behind the placenta and within the uterus. Placenta previa manifests with painless vaginal bleeding, but both may have vaginal bleeding. Rupture of membranes may occur with both conditions. Maternal vital signs may change with both if bleeding is pronounced.

31. What statement by the woman after a childbirth education class demonstrates that she needs more information? a. "I'm having a pudendal block so control my labor pain." b. "I may get a headache after a subarachnoid block." c. "I don't want IV opioids as they may cause breathing problems." d. "Some anesthetic agents may cause itching but it can be treated."

ANS: A A pudendal block numbs the lower vagina and perineum for vaginal birth. There is no relief of labor pain because it is done just before birth. This woman needs further education. The other statements are all accurate.

12. A nurse is assessing a woman receiving magnesium sulfate. The nurse assesses her deep tendon reflexes at 0 and 1+. What action by the nurse is best? a. Hold the magnesium sulfate. b. Ask the provider to order a 24-hour UA. c. Assess the woman's temperature. d. Take the woman's blood pressure.

ANS: A Absent or hypoactive deep tendon reflexes are indicative of magnesium sulfate toxicity. The nurse should hold the magnesium and notify the provider. There is no need for a 24- hour UA at this point. Temperature changes are not related to magnesium. Blood pressure can be assessed, but that is not the priority.

23. The nurse teaching a childbirth preparation class teaches the participants that the first type of breathing technique used in labor is called a. slow-paced. b. modified-paced. c. patterned-paced. d. pant-blow.

ANS: A Breathing for the first stage of labor consists of a cleansing breath and various breathing techniques known as paced breathing. The first type used in labor is the slow-paced. Modified-paced breathing is used when the slow-paced breathing is no longer effective Patterned-paced breathing is used later in the labor and has the woman focusing on a pattern of breathing. Pant-blow breathing can be used to prevent pushing before the cervix is completely dilated.

17. Immediately after the forceps-assisted birth of an infant, which action by the nurse is next? a. Assess the infant for signs of trauma. b. Give the infant prophylactic antibiotics. c. Apply a cold pack to the infant's scalp. d. Measure the circumference of the infant's head.

ANS: A Forceps delivery can result in local irritation, bruising, or lacerations of the fetal scalp. Prophylactic antibiotics a re not necessary with a forceps delivery. This would put the infant at risk for cold stress and would be contraindicated. Measuring the circumference of the head is part of the initial nursing assessment.

2. Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Multiple-marker screening b. Lecithin/sphingomyelin (L/S) ratio c. Biophysical profile d. Type and crossmatch of maternal and fetal serum

ANS: A Maternal serum can be analyzed for abnormal levels of alpha-fetoprotein, human chorionic gonadotropin, and estriol. This multiple-marker screening may predict chromosomal defects in the fetus. The L/S ratio is used to determine fetal lung maturity. A biophysical profile is used for evaluating fetal status during the antepartum period. Five variables are used, but none is concerned with chromosomal problems. The blood type and crossmatch will not predict chromosomal defects in the fetus.

18. A nurse is teaching a woman how to do "kick counts." What information about this assessment is most appropriate? a. Notify your provider if the baby's movement patterns change. b. Count the number of fetal movements over 2 hours. c. Call the OB triage area if there are fewer than 10 movements/hour. d. Have your partner verify your count at the same time you perform it.

ANS: A Since there is no consensus on how the mother should be taught to perform this assessment, it is more important that she become familiar with her baby's movements and patterns and notify the provider about any change from normal.

18. Which statement correctly describes the nurse's responsibility related to electronic monitoring? a. Teach the woman and her support person about the monitoring equipment, and discuss any questions they have. b. Report abnormal findings to the physician before initiating corrective actions. c. Inform the support person that the nurse will be responsible for all comfort measures when the electronic equipment is in place. d. Document the frequency, duration, and intensity of contractions measured by the external device.

ANS: A Teaching is an essential part of the nurse's role. Corrective actions should be initiated first in order to correct abnormal findings as quickly as possible. The support person should be encouraged to assist with the comfort measures. Electronic monitoring will record the contractions and FHR response.

13. The fetal heart rate baseline increases 15 beats per minute after vibroacoustic stimulation. What action by the nurse is most appropriate? a. Reassure the family the finding is normal. b. Prepare to assist with obtaining cord blood gases. c. Position the woman on her left side. d. Administer oxygen at 4 L via nasal cannula.

ANS: A The fetus with adequate reserve for the stress of labor will usually respond to vibroacoustic stimulation with a temporary increase in the fetal heart rate (FHR) over baseline of 15 bpm for 15 seconds or more. The nurse reassures the family that this finding is normal. The other actions are not warranted.

7. The best time to teach nonpharmacologic pain control methods to an unprepared laboring woman is during which phase? a. Latent phase b. Active phase c. Transition phase d. Second stage

ANS: A The latent phase of labor is the best time for intrapartum teaching, because the woman is usually anxious enough to be attentive, yet comfortable enough to understand the teaching. During the active phase, the woman is focused internally and unable to concentrate on teaching. During transition, the woman is focused on keeping control; she is unable to focus on anyone else or learn at this time. During the second stage, the woman is focused on pushing. She normally handles the pain better at this point because she is active in doing something to hasten the delivery.

1. A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is a. "The test results are within normal limits." b. "Immediate delivery by cesarean birth is needed." c. "Further tests are needed to determine the meaning of this score." d. "We will inform you of your options within the next week."

ANS: A The normal biophysical score ranges from 8 to 10 points if the amniotic fluid volume is adequate. A normal score allows conservative treatment of high-risk patients. Delivery can be delayed if fetal well-being is indicated. An immediate delivery is not needed. The results of the biophysical profile are usually available immediately after the procedure is performed.

10. In which situation is a baseline fetal heart rate of 160 to 170 beats per minute considered a normal finding? a. The fetus is at 28 weeks of gestation. b. The mother has been given an epidural block. c. The mother has a history of fast labors. d. The mother has mild preeclampsia but is not in labor.

ANS: A The normal preterm fetus may have a baseline rate slightly higher than the term fetus because of an immature parasympathetic nervous system that does not yet exert a slowing effect on the fetal heart rate (FHR). Any change in the FHR with an epidural is not considered an expected outcome. Fast labors should not alter the FHR normally. Preeclampsia should not cause a normal elevation of the FHR.

25. A woman is going to have a vaccum extraction delivery. What nursing intervention is most important to prevent complications? a. Empty the woman's bladder. b. Apply cold packs to the perineum. c. Assess vital signs after the procedure. d. Monitor the woman's temperature.

ANS: A The nurse should empty the woman's bladder prior to vacuum extraction delivery. Ice packs can help with pain and prevent or limit the size of hematomas, but that is not the most important safety measure. Assessing vital signs will not prevent complications from occurring but will help identify them when they occur.

19. The priority nursing intervention for the patient who has received an epidural narcotic is a. monitoring respiratory rate hourly. b. administering analgesics as needed. c. monitoring blood pressure every 4 hours. d. assessing the level of anesthesia.

ANS: A The possibility of respiratory depression exists for up to 24 hours after administration of an epidural narcotic. The nurse should monitor the woman's respiratory rate hourly during this time frame. Epidural narcotic should be enough pain relief that further medication is not necessary. Administering any other narcotic may cause an overdose. The patient's blood pressure needs to be monitored. However, that is not the major concern with this medication. The epidural narcotic should provide pain relief but not anesthesia.

2. The labor and delivery nurse learns that recommendations from ACOG related to VBAC risks include which of the following? (Select all that apply.) a. Immediate availability of the obstetric provider b. Delivery at a tertiary care center c. Availability of anesthesia personnel d. Personnel who can assist with the cesarean birth e. Use of misoprostol for cervical ripening

ANS: A, C, D A VBAC delivery should only be attempted with the obstetric provider in house and anesthesia along with operative personnel readily available to perform a cesarean birth. VBAC deliveries may be done in community hospitals if appropriate policies and guidelines for care are in place. Misoprostol administration is contraindicated in a patient with a previous uterine scar.

22. A woman had spinal anesthesia for delivery. Now she complains of a pounding headache rated 7/10. What action by the nurse is most appropriate? a. Prepare to assist with a blood patch procedure. b. Give the woman IV opioid pain medications. c. Increase the rate of her nonadditive IV fluids. d. Place a cool cloth on her forehead and dim the room lights.

ANS: A The subarachnoid block may cause a postspinal headache due to loss of cerebrospinal fluid from the puncture in the dura. When blood is injected into the epidural space in the area of the dural puncture ("blood patch"), it forms a seal over the hole to stop leaking of cerebrospinal fluid. The spinal anesthesia makes further narcotic administration inadvisable at this time. Increasing IV fluid rate is not needed for headache. A cool cloth and dim lights may be very comforting but will not eliminate this severe headache.

21. The student nurse is working with a laboring woman. What action by the student requires the registered nurse to intervene? a. Placing the woman in a supine position b. Assisting the woman to a sitting position c. Turning the woman to a side-lying position d. Providing safety while the woman labors while standing

ANS: A The supine position allows the heavy uterus to compress the inferior vena cava and can reduce placental blood flow, compromising fetal oxygen supply. The nurse should intervene to position the woman in any of the other positions, which are all appropriate for labor if no contraindications exist.

5. A student nurse is placing a tocotransducer on a woman for electronic fetal monitoring. What action by the student indicates to the registered nurse that the student understands the procedure? a. Places the tocotransducer over the uterine fundus b. Prepares sterile field for fetal scalp electrode placement c. Positions the tocotransducer on the woman's upper arm d. Attaches the tocotransducer to the woman's lower abdomen

ANS: A The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. No sterile field is needed. The tocotransducer is not placed on the upper arm or lower abdomen.

2. In order to help patients manage discomfort and pain during labor, nurses should be aware that a. the predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen. b. somatic pain is the extreme discomfort between contractions. c. the somatic pain of the second stage of labor is more generalized and related to fatigue. d. pain during the third stage is a somewhat milder version of the second stage.

ANS: A This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia. Somatic pain is a faster, sharp pain. Somatic pain is most prominent during late first-stage labor and during second-stage labor as the descending fetus puts direct pressure on maternal tissues. Second-stage labor pain is intense, sharp, burning, and localized. Third-stage labor pain is similar to that of the first stage.

1. The nurse sees this pattern on the fetal monitor. What action by the nurse is most appropriate? a. Apply oxygen via face mask, and position the woman on her left side. b. Document the findings in the chart along with maternal vital signs. c. Prepare to start an infusion of oxytocin per unit protocol. d. Decrease the rate of the woman's IV maintenance fluids.

ANS: A This tracing shows a late deceleration. The mother should be given oxygen and positioned on her left side. The findings should be documented, but only after interventions have occurred. Oxytocin would increase uterine activity (and increase stress on the fetus) so should not be started, or if already running, discontinued. IV fluids should be increased.

2. Which maternal condition is considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes b. Cervix is dilated to 4 cm c. External monitors are currently being used d. Fetus has a known heart defect

ANS: A To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4 cm permits the insertion of fetal scalp electrodes and intrauterine catheter. The external monitor can be discontinued after the internal ones are applied. A compromised fetus should be monitored with the most accurate monitoring devices.

1. A patient is at 6 weeks' gestation and is having a transvaginal ultrasound. While preparing the patient for this procedure, she expresses concerns over the necessity for this test. The nurse explains that this diagnostic test may be necessary to determine which of the following? (Select all that apply.) a. Multifetal gestation b. Bicornuate uterus c. Presence and location of pregnancy (intrauterine or elsewhere) d. Amniotic fluid volume e. Presence of ovarian cysts

ANS: A, B, C, E A transvaginal ultrasound done in the first trimester can detect multifetal gestations, bicornuate uterus, presence and location of pregnancy, and presence of ovarian cysts. Amniotic fluid volume is assessed during the second and third trimesters.

1. While developing an intrapartum care plan for the patient in early labor, it is important that the nurse recognize that psychosocial factors may influence a woman's experience of pain. These include (Select all that apply.) a. culture. b. anxiety and fear. c. previous experiences with pain. d. intervention of caregivers. e. support systems.

ANS: A, B, C, E Culture: a woman's sociocultural roots influence how she perceives, interprets, and responds to pain during childbirth. Some cultures encourage loud and vigorous expressions of pain, whereas others value self-control. The nurse should avoid praising some behaviors (stoicism) while belittling others (noisy expression). Anxiety and fear: extreme anxiety and fear magnify sensitivity to pain and impair a woman's ability to tolerate it. Anxiety and fear increase muscle tension in the pelvic area, which counters the expulsive forces of uterine contractions and pushing efforts. Previous experiences with pain: fear and withdrawal are a natural response to pain during labor. Learning about these normal sensations ahead of time helps a woman suppress her natural reactions of fear regarding the impending birth. If a woman previously had a long and difficult labor, she is likely to be anxious. She may also have learned ways to cope and may use these skills to adapt to the present labor experience. Support systems: an anxious partner is less able to provide help and support to a woman during labor. A woman's family and friends can be an important source of support if they convey realistic and positive information about labor and delivery. Although this may be necessary for the well-being of the woman and her fetus, some interventions add discomfort to the natural pain of labor (i.e., fetal monitor straps).

31. A woman is in the emergency department with severe abdominal pain. When her pregnancy test comes back positive, she yells "I can't be pregnant! I had a tubal ligation two months ago!" What action by the nurse is the priority? a. Provide emotional support to the woman. b. Facilitate an ultrasound examination. c. Call the lab to have them repeat the test. d. Administer an opioid pain medication.

ANS: B A failed tubal ligation is a risk factor for ectopic pregnancy. After a blood pregnancy test, a transvaginal ultrasound is needed to look for a gestational sac within the uterus. Of course the nurse provides emotional support, but that is not the priority. There is no need to repeat the test. Pain medications may be contraindicated if surgery is needed and consents have not yet been signed.

10. The nerve block used in labor that provides anesthesia to the lower vagina and perineum is called a(n) a. epidural. b. pudendal. c. local. d. spinal block.

ANS: B A pudendal block anesthetizes the lower vagina and perineum to provide anesthesia for an episiotomy and use of low forceps if needed. An epidural provides anesthesia for the uterus, perineum, and legs. A local provides anesthesia for the perineum at the site of the episiotomy. A spinal block provides anesthesia for the uterus, perineum, and down the legs.

32. A woman who is 8 months pregnant is brought to the emergency department after a serious motor vehicle crash. Although she has no apparent injuries, she is admitted to the hospital. Her partner is upset and wants to know why she just can't come home. What response by the nurse is best? a. "This is standard procedure for all pregnant crash victims." b. "She needs to be monitored for some potential complications." c. "We may have to deliver the baby at any time now." d. "We are giving her medicine to keep her from laboring."

ANS: B After serious trauma, a woman may be admitted and observed because an abruptio placentae may take up to 24 hours to become apparent. Not all motor vehicle crash patients will need to be admitted. The baby may or may not need to be delivered at any time, but this statement will frighten the partner. There is no indication the patient is in labor.

20. What is an appropriate response to a woman's comment that she is worried about having a cesarean birth? a. "Don't worry. Everything will be okay." b. "What are your feelings about having a cesarean birth?" c. "I know you're worried, but this is a routine procedure." d. "Patients commonly worry about surgery."

ANS: B Allowing the patient to express her feelings is the most appropriate nursing response. The nurse should never provide the patient with false reassurance or disregard or belittle her feelings, which is what the other options do.

5. The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine if the fetus has a. hemophilia. b. a neural tube defect. c. sickle cell anemia. d. a normal lecithin/sphingomyelin (L/S) ratio.

ANS: B An open neural tube allows a high level of AFP to seep into the amniotic fluid and enter the maternal serum. Hemophilia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. Sickle cell is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis. L/S ratios are determined with an amniocentesis, which is usually done in the third trimester.

9. A woman with severe preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a. tocolytic. b. anticonvulsant. c. antihypertensive. d. diuretic.

ANS: B Anticonvulsant drugs act by blocking neuromuscular transmission and depress the central nervous system to control seizure activity. A tocolytic drug does slow the frequency and intensity of uterine contractions, but it is not used for that purpose in this scenario. Decreased peripheral blood pressure is a therapeutic response (side effect) of the anticonvulsant magnesium sulfate. Diuresis is a therapeutic response to magnesium sulfate.

25. Which patient is most likely to experience pain during labor? a. Gravida 2 who has not attended childbirth preparation classes b. Gravida 2 who is anxious because her last labor was difficult c. Gravida 1 whose fetus is in a breech presentation d. Gravida 3 who is using Lamaze breathing techniques

ANS: B Anxiety affects a woman's perception of pain. Tension during labor causes tightening of abdominal muscles, impeding contractions and increasing pain by stimulation of nerve endings. The gravida 2 has previous experience, and this will decrease anxiety. This woman will have more pain than if the infant is in vertex. Also, there is an increased likelihood that she will have a cesarean section and not go through labor. The gravida 3 has previous experience and has prepared herself for the labor.

23. A new nurse notes a fetal heart rate pattern of late deceleration with minimal variability in a laboring woman with vaginal bleeding. Which action by the new nurse warrants intervention by the charge nurse? a. Assesses maternal blood pressure b. Assesses for a prolapsed cord c. Prepares to administer terbutaline d. Discontinues oxytocin

ANS: B Assessing for a prolapsed cord requires a vaginal examination, which is contraindicated when the woman has active vaginal bleeding. The other actions are appropriate.

6. The nurse working with a pregnant woman explains that a major advantage of nonpharmacologic pain management is that a. more complete pain relief is possible. b. no side effects or risks to the fetus are involved. c. the woman remains fully alert at all times. d. a more rapid labor is likely.

ANS: B Because nonpharmacologic pain management does not include analgesics, adjunct drugs, or anesthesia, it is harmless to the mother and the fetus. There is less pain relief with nonpharmacologic pain management during childbirth. The woman's alertness is not altered by medication, but the increase in pain will decrease alertness. Pain management may or may not alter the length of labor. At times when pain is decreased, the mother relaxes and labor progresses at a quicker pace.

18. A woman received an epidural anesthetic and now her blood pressure is 88/64 mm Hg. What action by the nurse takes priority? a. Turn the woman to the left side. b. Place a wedge under the woman's right hip. c. Call the provider or nurse-anesthetist immediately. d. Decrease the intravenous infusion rate.

ANS: B If hypotension occurs after administration of an epidural, turn the patient to the left lateral side-lying position, and infuse intravenous crystalloids. These actions will improve placental blood flow. Oxygen administration is also recommended, but placing the patient on the left side takes priority. The providers should be notified after corrective actions have occurred.

1. The perinatal nurse is giving discharge instructions to a woman, status post suction and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse is a. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult." c. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." d. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

ANS: B Beta-hCG levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it may obscure the presence of the potentially carcinogenic cells. Any contraceptive method except an IUD is acceptable.

1. The nurse knows that a urinary catheter is added to the instrument table if a forceps-assisted birth is anticipated. What is the correct rationale for this intervention? a. Spontaneous release of urine might contaminate the sterile field. b. An empty bladder provides more room in the pelvis. c. A sterile urine specimen is needed preoperatively. d. A Foley catheter prevents the membranes from spontaneously rupturing.

ANS: B Catheterization provides room for the application of the forceps blades and limits bladder trauma. Urine is sterile. A clean-catch urinalysis is usually sufficient for preoperative treatment. The membranes must be ruptured and the cervix completely dilated for a forceps-assisted birth.

3. The nurse caring for women in labor understands that childbirth pain is different from other types of pain in that it is a. more responsive to pharmacologic management. b. associated with a physiologic process. c. designed to make one withdraw from the stimulus. d. less intense.

ANS: B Childbirth pain is part of a normal process, whereas other types of pain usually signify an injury or illness. Childbirth pain is not more or less responsive to medication. The pain with childbirth is a normal process; it is not caused by the type of injury when withdrawal from the stimuli is seen. Childbirth pain is not less intense than other types of pain.

24. Which laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Positive KB test b. Presence of fibrin split products c. Thrombocytopenia d. Positive drug screen

ANS: B Degradation of fibrin leads to the accumulation of multiple fibrin clots throughout the body's vasculature. The other lab tests are not indicative of DIC.

9. Which nursing intervention is necessary before a second trimester transabdominal ultrasound? a. Place the woman NPO for 12 hours. b. Instruct the woman to drink 1 to 2 quarts of water. c. Administer a soapsuds enema. d. Perform an abdominal prep.

ANS: B During the second trimester, a full bladder may be needed to displace the intestines and elevate the uterus for better visibility. If indicated, the woman should be instructed to drink several glasses of clear fluid an hour before the time of the examination and to delay urination until the examination is completed. Since she needs to fill her bladder, being NPO is not appropriate. Enemas and abdominal preps are not necessary for this procedure.

2. After a forceps-assisted birth, the mother is observed to have continuous bright red lochia but a firm fundus. What other finding is important to correlate with these data? a. Mild, intermittent perineal pain b. Edema and discoloration of the labia and perineum c. Lack of an episiotomy d. Lack of pain in the perineal area

ANS: B Edema and discoloration of the labia and perineum along with continuous bright red lochia and firm fundus are correlated with a vaginal wall hematoma. Perineal pain, lack of episiotomy, and lack of pain are not correlated with a hematoma.

16. Which event indicates a complication of an external version? a. Maternal pulse rate of 100 bpm b. Fetal bradycardia persisting 10 minutes after the version c. Fetus returning to the original position d. Increased maternal anxiety after the version

ANS: B Fetal bradycardia after a version may indicate that the umbilical cord has become compressed, and the fetus is having hypoxia. There are few risks to the woman during an external version. The fetus may return to the original position, but this is not a complication of the version. Anxiety may occur before the version but should decrease after the procedure is completed.

6. A student nurse is preparing to administer misoprostol (Cytotec). What action by the student seen by the registered nurse demonstrates adequate knowledge about this medication? a. Assesses maternal blood pressure 30 minutes after administration b. Assesses fetal heart tones prior to administering the medication c. Documents the drug administration in the woman's chart d. Takes and records an apical pulse for 1 minute prior to administration

ANS: B Fetal heart tones should be assessed prior to giving cervical ripening agents such as misoprostol. It is not necessary to assess maternal blood pressure afterward or an apical pulse prior to administering the medication. Documentation of all medications is a legal requirement but is not related specifically to this drug.

27. A woman is experiencing most of her labor pain in her back. What action by the nurse is best? a. Positioning the woman lying supine with head slightly elevated b. Showing the support person how to apply firm pressure to the sacrum c. Assisting the woman to sit upright with the legs straight d. Massaging her upper back during a contraction

ANS: B Firm pressure against the sacrum may be helpful in relieving the discomfort associated with back labor. The nurse can provide this action, but including the support person (if desired) is beneficial. The woman should not lie on her back. Sitting up with legs straight would put more pressure onto the lower back area. The massage should be in the lower back where the pain is located.

16. A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate a. Anxiety due to hospitalization b. Worsening disease and impending seizure c. Effects of magnesium sulfate d. Gastrointestinal upset

ANS: B Headache and visual disturbances are due to increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a seizure is imminent. These sign are not due to anxiety or magnesium sulfate or related to gastrointestinal upset.

2. Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae b. Total placenta previa c. Ectopic pregnancy d. Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. In a partial abruptio placentae, if the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted. If the fetus has died, a vaginal delivery 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.

29. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment involves a. corticosteroids to reduce inflammation. b. IV therapy to correct fluid and electrolyte imbalances. c. an antiemetic, such as pyridoxine, to control nausea and vomiting. d. enteral nutrition to correct nutritional deficits.

ANS: B Initially, the woman who is unable to down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids are not the expected treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient.

16. The registered nurse explains to the student that when giving a narcotic to a laboring woman, the nurse should inject the medication at the beginning of a contraction so that a. full benefit of the medication is received during that contraction. b. less medication will be transferred to the fetus. c. the medication will be rapidly circulated. d. the maternal vital signs will not be adversely affected.

ANS: B Injecting at the beginning of a contraction, when blood flow to the placenta is normally reduced, limits transfer to the fetus. The full benefit will be received by the woman; however, it will decrease the amount reaching the fetus. It will not increase the circulation of the medication. It will not alter the vital signs any more than giving it at another time.

7. A woman has a history of hypertension during pregnancy. What method of intrapartum fetal monitoring does the nurse initiate? a. Continuous auscultation with a fetoscope b. Continuous electronic fetal monitoring c. Intermittent assessment with a Doppler transducer d. Intermittent electronic fetal monitoring for 15 minutes each hour

ANS: B Maternal hypertension may reduce placental blood flow through vasospasm of the spiral arteries. Reduced placental perfusion is best assessed with continuous electronic fetal monitoring to identify patterns associated with this condition. It is not practical to provide continuous auscultation with a fetoscope. This fetus needs continuous monitoring because it is at high risk for complications.

4. An abortion in which the fetus dies but is retained in the uterus is called ________ abortion. a. inevitable b. missed c. incomplete d. threatened

ANS: B Missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

23. A new graduate nurse is preparing to hang oxytocin for a woman to augment her labor. What action by the new nurse warrants intervention from the preceptor? a. Adds oxytocin to the IV as a piggyback b. Programs the IV pump for a primary infusion c. Assesses FHR and uterine activity prior to starting the infusion d. Attaches the infusion line to the proximal port

ANS: B Oxytocin is run as a secondary infusion on a pump. When the new nurse programs it as the primary infusion, the preceptor should intervene. Oxytocin should be added to the most proximal IV port. FHR and uterine activity should be assessed prior to starting the infusion.

13. The purpose of initiating contractions in a CST is to a. determine the degree of fetal activity. b. apply a stressful stimulus to the fetus. c. identifying fetal acceleration patterns. d. increase placental blood flow.

ANS: B The CST involves recording the response of the FHR to stress induced by uterine contractions. The NST and biophysical profiles look at fetal movements. The NST looks at fetal heart accelerations with fetal movements. The CST records the fetal response to stress. It does not increase placental blood flow.

3. Prior to cesarean birth, the nurse places the indwelling catheter and tubing in which manner? a. Placed on the floor on a sterile drape b. Placed near the head of the table c. Clamped during the cesarean section d. Positioned at the foot of the bed

ANS: B The anesthesia clinician must monitor urine output during the surgery so the catheter and tubing are placed near the head of the table. They are not placed on the floor, even on a sterile drape. The catheter is not clamped because urinary output must be monitored continuously. An early sign of hypovolemia is a decreasing urinary output.

24. When instructing the woman in early labor, the nurse teaches her that an important aspect of proper breathing technique is a. breathing no more than three times the normal rate. b. beginning and ending with a cleansing breath. c. holding the breath no longer than 10 seconds. d. adhering exactly to the techniques as they were taught.

ANS: B The cleansing breath helps the woman clear her mind to focus on relaxing and signals the coach that the contraction is beginning or ending. It is important to prevent hyperventilation; however, the cleansing breaths are the most important aspect of the breathing techniques. The woman should hold her breath for no more than 6 to 8 seconds. The woman needs to be flexible and change her breathing techniques as needed to keep her comfortable.

8. Why is continuous electronic fetal monitoring usually used when oxytocin is administered? a. The mother may become hypotensive. b. Uteroplacental exchange may be compromised. c. Maternal fluid volume deficit may occur. d. Fetal chemoreceptors are stimulated.

ANS: B The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This response reduces entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves. Hypotension is not a common side effect of oxytocin. All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk. Oxytocin affects the uterine muscles.

14. For which patient should the oxytocin (Pitocin) infusion be discontinued immediately? a. A woman in active labor with contractions every 31 minutes lasting 60 seconds each b. A woman in transition with contractions every 2 minutes lasting 90 seconds each c. A woman in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each d. A woman in early labor with contractions every 5 minutes lasting 40 seconds each

ANS: B This woman's contraction pattern represents hyperstimulation, and inadequate resting time occurs between contractions to allow placental perfusion. The other women can continue to use the oxytocin at this point.

15. A nurse is preparing a woman for a nonstress test (NST). What nursing action is most appropriate? a. Position the woman on her left side. b. Seat the woman comfortably in a recliner. c. Have the woman to drink 1 liter of water prior to the test. d. Place conduction gel on the obese woman's abdomen.

ANS: B To correctly position the pregnant patient for an NST, the woman usually sits in a reclining chair. Alternatively she can be in a semi-Fowler position with a lateral tilt. This will optimize uterine perfusion and prevent supine hypotension. The woman does not need to drink water. Conduction gel is used in all NST tests.

29. A nurse admits a woman to the labor and delivery unit who has a history of IV drug abuse. In planning care for this patient, the nurse explains to the student that which pain control plan is contraindicated for this woman? a. Epidural anesthesia b. Bolus administration of butorphanol (Stadol) c. Promethazine (Phenergan) for opioid-induced nausea d. Naloxone (Narcan) if needed for respiratory depression

ANS: B Women who are opiate-dependent should not receive analgesics having mixed agonist and antagonist actions (butorphanol and nalbuphine). Epidural anesthesia not using these drugs is appropriate as are promethazine and naloxone if needed.

3. A woman has several relatives who had gestational hypertension and wants to decrease her risk for it. What information does the nurse provide this woman? (Select all that apply.) a. There is no way to reduce risk factors for gestational hypertension. b. Losing weight before you get pregnant will help prevent it. c. Eating a diet high in protein and iron may help prevent it. d. The father contributes no risk factors for hypertension in pregnancy e. Waiting until you are 35 to get pregnant cuts the risk in half.

ANS: B, C There are many risk factors for gestational hypertension, including obesity and anemia. The woman can take action to address these factors prior to becoming pregnant. The father's risks include the first baby and having fathered other preeclamptic pregnancies. Maternal age >35 increases the risk.

2. What assessment findings indicate to the nurses that a woman's preeclampsia should now be considered severe? (Select all that apply.) a. Urine output 40 mL/hour for the past 2 hours b. Serum creatinine 3.1 mg/dL c. Seeing "sparkly" things in the visual field d. Crackles in both lungs e. Soft, non-tender abdomen

ANS: B, C, D Signs of severe preeclampsia include elevated creatinine, seeing sparkles, and pulmonary edema (manifested by crackles). The urine output is above the minimum requirements, and a soft non-tender abdomen is a reassuring sign.

1. A Labor and Delivery nurse knows that four of the five fetal factors that interact to regulate the heart rate are which of the following? (Select all that apply.) a. Uterine activity b. Autonomic nervous system c. Baroreceptors d. Chemoreceptors e. Adrenal glands

ANS: B, C, D, E The sympathetic and parasympathetic branches of the autonomic nervous system are balanced forces that regulate FHR. Sympathetic stimulation increases the heart rate, while parasympathetic responses, through stimulation of the vagus nerve, reduce the FHR and maintain variability. The baroreceptors stimulate the vagus nerve to slow the FHR and decrease the blood pressure. These are located in the carotid arch and major arteries. The chemoreceptors are cells that respond to changes in oxygen, carbon dioxide, and pH. They are found in the medulla oblongata and the aortic and carotid bodies. The adrenal medulla secretes epinephrine and norepinephrine in response to stress, causing an acceleration in FHR. Uterine activity is a maternal factor.

3. A new nurse to Labor and Delivery learns about the three categories of fetal heart rate patterns. Which characteristics of the fetal heart belong in Category III? (Select all that apply.) a. Baseline rate of 110 to 160 bpm b. Tachycardia c. Absent baseline variability NOT accompanied by recurrent decelerations d. Variable decelerations with other characteristics such as shoulders or overshoots e. Absent baseline variability with recurrent variable decelerations f. Bradycardia

ANS: B, D, E, F These characteristics are all considered non-reassuring or abnormal and belong in Category III. A fetal heart rate of 110 to 160 bpm is considered normal and belongs in Category I. Absent baseline variability not accompanied by recurrent decelerations is a Category II characteristic.

6. The student nurse is assessing a woman with abruptio placentae. The student reports to the registered nurse "I can't really palpate her abdomen, it's as hard as a board." What action by the nurse is the priority? a. Tell the student to document the findings. b. Have the student teach the woman relaxation techniques. c. Assess the woman's fundal height and vital signs. d. Administer a dose of opioid pain medication.

ANS: C A hard, board-like abdomen in this setting is characteristic of concealed hemorrhage. The nurse assesses the woman's fundal height (which will rise with bleeding) and vital signs to detect shock. Documentation occurs after interventions are complete. Relaxation techniques may help the woman cope with the situation, but anxiety is not the reason for the findings. The woman may or may not need pain medication, and if she is going to need surgery, she should not get opioids until consents are signed.

4. The nurse understands that which condition is a contraindication for an amniotomy? a. Dilation less than 3 cm b. Cephalic presentation c. -2 station d. Right occiput posterior position

ANS: C A prolapsed cord can occur if the membranes artificially rupture when the presenting part is not engaged. Engagement is assumed at zero station. The other conditions are not contraindications to this procedure.

15. The priority nursing care associated with an oxytocin (Pitocin) infusion is a. measuring urinary output. b. increasing infusion rate every 30 minutes. c. monitoring uterine response. d. evaluating cervical dilation.

ANS: C Because of the risk of hyperstimulation, which could result in decreased placental perfusion and uterine rupture, the nurse's priority intervention is monitoring uterine response. Monitoring urinary output and cervical dilation is appropriate but not the priority. The infusion rate may be increased but only after proper assessment determines that it is appropriate.

11. What is the purpose of amniocentesis for the patient hospitalized at 34 weeks with pregnancy-induced hypertension? a. Identification of abnormal fetal cells b. Detection of metabolic disorders c. Determination of fetal lung maturity d. Identification of sex of the fetus

ANS: C During the third trimester, amniocentesis is most often performed to determine fetal lung maturity. In pregnancy-induced hypertension, preterm delivery may be necessary because of changes in placental perfusion. It is not done to identify abnormal fetal cells, detect metabolic disorders, or identify the sex of the fetus.

14. The nurse is explaining how to assess edema to the nursing students working on the antepartum unit. Which score indicates edema of lower extremities, face, hands, and sacral area? a. +1 edema b. +2 edema c. +3 edema d. +4 edema

ANS: C Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is termed +2 edema. Generalized massive edema (+4) includes accumulation of fluid in the peritoneal cavity.

11. A laboring woman has been given an injection of epidural anesthesia. Which assessment by the nurse takes priority? a. Urinary output b. Contraction pattern c. Maternal blood pressure d. Intravenous infusion rate

ANS: C Epidural anesthesia may produce maternal hypotension due to vasodilation so the priority assessment by the nurse is maternal blood pressure. The other assessments are important for this woman but are not directly related to the anesthetic injection.

8. A pregnant woman has been diagnosed with gestational hypertension and is crying. She asks the nurse if this means she has to take blood pressure medicine for the rest of her life. What answer by the nurse is best? a. "Yes, you will have hypertension for the rest of your life." b. "No, this always goes away after you deliver." c. "Maybe, we have to wait and see at your 6-week postpartum checkup." d. "I don't know. But if you need medicine you should take it."

ANS: C Gestational hypertension can last after delivery. If it has not resolved by postpartum week 6, it is considered chronic, and the woman will probably have to take medication. It may or may not resolve, but the nurse should not provide false reassurance or state that he or she does not know without finding more information. Telling the woman to take medicine if she needs it belittles her concerns.

13. Which woman will most likely have increased anxiety and tension during her labor? a. Gravida 1 who did not attend prepared childbirth classes b. Gravida 2 who refused any medication c. Gravida 2 who delivered a stillborn baby last year d. Gravida 3 who has two children younger than 3 years

ANS: C If a previous pregnancy had a poor outcome, the woman will probably be more anxious during labor and delivery. The woman is not prepared for labor and will have increased anxiety during labor. However, the woman with a poor previous outcome is more likely to experience more anxiety, and good teaching by the nurse will diminish some of the anxiety. A gravida 2 has previous experience and can anticipate what to expect. By refusing any medication, she is taking control over her situation and will have less anxiety. This gravida 3 has previous experience and is aware of what to expect.

10. What is the only known cure for preeclampsia? a. Magnesium sulfate b. Antihypertensive medications c. Delivery of the fetus d. Administration of acetylsalicylic acid (ASA) every day of the pregnancy

ANS: C If the fetus is viable and near term, delivery is the only known definitive treatment for preeclampsia. Magnesium sulfate is one of the medications used to treat but not to cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of ASA (81 mg) have been administered to women at high risk for developing preeclampsia.

15. The nurse notes a pattern of late decelerations on the fetal monitor. The most appropriate action is to a. continue observation of this reassuring pattern. b. notify the physician or nurse-midwife. c. give the woman oxygen by face mask. d. place the woman in a Trendelenburg position.

ANS: C Late decelerations are associated with reduced placental perfusion. Giving the laboring woman oxygen increases the oxygen saturation in her blood, making more oxygen available to the fetus. This is not a reassuring pattern; interventions are needed. Nursing interventions should be initiated before notifying the health care provider. The Trendelenburg position will not increase the placental perfusion.

22. To monitor for potential hemorrhage in the woman who has just had a cesarean birth, what action by the recovery room nurse is most appropriate? a. Maintain an intravenous infusion at 100 mL/hr. b. Assess the abdominal dressings for drainage. c. Assess the uterus for firmness every 15 minutes. d. Monitor her urinary output.

ANS: C Maintaining contraction of the uterus is important in controlling bleeding from the placental site. Maintaining proper fluid balance will not control hemorrhage. Assessing abdominal dressings is an important assessment, but hemorrhage will first be noted vaginally. Urinary output typically drops in hemorrhage, but this is a later finding.

28. Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 3.5 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole, a missed abortion, or abruptio placentae.

17. A woman is scheduled for an ultrasound and is asking the nurse questions about this test. Which statement by the nurse regarding ultrasonography during pregnancy is most accurate? a. Ultrasonography uses infrared technology to create an image. b. Ultrasonography is only utilized as an adjunct to more invasive tests. c. Ultrasonography is not harmful to the fetus. d. Ultrasonography is not a component of biophysical profile testing.

ANS: C Most women look forward to the results of this test, which causes no harm to the fetus. Ultrasonography uses sound waves to create an image. As an adjunct to more invasive tests, ultrasonography can provide visual guidance for increased safety. It can be done as a standalone test. Ultrasonography is a component of biophysical profile testing.

19. Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? a. Amniotomy b. Intravenous Pitocin c. Transcervical catheter d. Vaginal insertion of prostaglandins

ANS: C Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include Laminaria tents, Dilapan, and Lamicel. Amniotomy is a surgical method of augmentation and induction. Intravenous Pitocin is a medical method of induction. Insertion of prostaglandins is a medical method of induction.

1. Childbirth preparation can be considered successful if the outcome is described as follows: a. Labor and delivery were pain-free. b. The woman's partner participated eagerly. c. The woman rehearsed labor and practiced skills to master pain. d. Only nonpharmacologic methods for pain control were used.

ANS: C Preparation allows the woman to rehearse for labor and to learn new skills to cope with the pain of labor and the expected behavioral changes. Childbirth preparation does not guarantee a pain-free labor. A woman should be prepared for pain and anesthesia/analgesia realistically. The partner's role and participation level should be established by the couple. Women will not always achieve their desired level of pain control by using nonpharmacologic methods alone.

15. The prenatal clinic nurse monitored women for preeclampsia. If all four women were in the clinic at the same time, which one should the nurse see first? a. Blood pressure increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. A dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day

ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ is indicative of severe preeclampsia and should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or higher. Preeclampsia may be manifested as a rapid weight gain. Gaining 0.5 kg during the past 2 weeks does not qualify as rapid. Edema occurs in many normal pregnancies as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

32. A woman had an epidural place an hour ago and is now complaining of severe itching. What action by the nurse is most appropriate? a. Discontinue the epidural infusion at once. b. Notify the anesthesia provider. c. Prepare to administer diphenhydramine (Benedryl). d. Prepare to administer promethazine (Phenergan).

ANS: C Pruritis (itching) is a common side effect of epidural medications. The nurse should be prepared to administer diphenhydramine. There is no need to discontinue the epidural infusion or notify the anesthesia provider. Promethazine is used for nausea.

14. The nurse notes a nonreassuring pattern of the fetal heart rate. The mother is already lying on her left side. What nursing action is indicated? a. Lower the head of the bed. b. Place the mother in a Trendelenburg position. c. Change her position to the right side. d. Place a wedge under the left hip.

ANS: C Repositioning on the opposite side may relieve compression on the umbilical cord and improve blood flow to the placenta. The other actions are not warranted.

14. A pregnant woman states "This test isn't my idea, but my husband insists." Which response by the nurse is most appropriate? a. "Don't worry. Everything will be fine." b. "Why don't you want to have this test?" c. "You're concerned about having this test?" d. "It's your decision."

ANS: C The nurse should clarify the statement and assist the patient in exploring her feelings about the test. Stating that everything will be fine is giving false reassurance and belittles the woman's concerns. "Why" questions usually put people on the defensive and are not therapeutic. Of course having the test is the woman's decision, but this closed statement does not encourage the woman to express her feelings.

7. The nurse's role in diagnostic testing is to provide a. advice to the couple. b. assistance with decision making. c. information about the tests. d. reassurance about fetal safety.

ANS: C The nurse should provide the couple with all necessary information about a procedure so that the couple can make an informed decision. The nurse's role is to inform, not to advise the couple. Decision making should always lie with the couple involved. Ensuring fetal safety is not possible with all of the diagnostic testing. To offer this is to give false reassurance to the parents.

17. Which nursing action is correct when initiating electronic fetal monitoring? a. Lubricate the tocotransducer with an ultrasound gel. b. Inform the patient that she should remain in the semi-Fowler's position. c. Securely apply the tocotransducer with a strap or belt. d. Determine the position of the fetus before attaching the electrode.

ANS: C The tocotransducer should fit snugly on the abdomen to monitor uterine activity accurately. The tocotransducer does not need gel to operate appropriately. The patient should be encouraged to move around during labor. The tocotransducer should be placed at the fundal area of the uterus.

21. What finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Many women have nausea in the first trimester. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. The history of bleeding is normally described as being brownish.

13. The labor of a pregnant woman with preeclampsia is going to be induced. The nurse reviews the woman's latest laboratory test findings, which reveal a low platelet count, an elevated aspartate transaminase (AST) level, and a falling hematocrit. What action by the nurse is most important? a. Palpate the woman's abdomen for tenderness. b. Document findings and begin the Pitocin infusion. c. Instruct the woman to ask for help getting out of bed. d. Assess the woman's drinking history.

ANS: C This woman has HELLP syndrome, with is characterized by low platelet counts and hepatic dysfunction. She is at risk for bleeding, so the nurse instructs her to call for assistance in getting in and out of bed. The nurse does not palpate the abdomen even though the woman may complain of abdominal pain because of possible rupture of a subcapsular hematoma. The findings should be documented but the nurse should intervene based on the abnormal findings. The liver enzymes are not elevated because of alcohol intake.

12. Which statement is true about the physiologic effects of pain in labor? a. It usually results in a more rapid labor. b. It is considered to be a normal occurrence. c. It may result in decreased placental perfusion. d. It has no effect on the outcome of labor.

ANS: C When experiencing excessive pain, the woman may react with a stress response that diverts blood flow from the uterus and the fetus. Excessive pain may prolong the labor due to increased anxiety in the woman. Pain is considered normal for labor, however; this statement does not explain the physiologic effects. Pain may affect the outcome of the labor depending on the cause and the effect on the woman.

10. The nurse caring for a woman in labor understands that the primary risk associated with an amniotomy is a. maternal infection. b. maternal hemorrhage. c. prolapse of the umbilical cord. d. separation of the placenta.

ANS: C When the membranes are ruptured, the umbilical cord may come downward with the flow of amniotic fluid and become trapped in front of the presenting part. Infection is a risk of amniotomy but not the primary concern. Maternal hemorrhage is not associated with amniotomy. Separation of the placenta may occur if the uterus is overdistended before the amniotomy, but it is not the major concern.

2. The nurse is caring for a laboring patient who develops a fever after she has had her epidural initiated. What actions by the nurse are appropriate? (Select all that apply.) a. Palpate the woman's bladder distention. b. Assess the woman's blood pressure. c. Observe the woman for shivering. d. Check the skin for color and warmth. e. Prepare to assist with a blood patch.

ANS: C,D Heat dissipation is reduced as a result of decreased hyperventilation, sweating, and activity after the onset of pain relief. Vasodilation redistributes heat from the core to the periphery of the body, where it is lost to the environment. Assessing the skin will demonstrate findings consistent with vasodilation. Shivering often occurs with sympathetic blockade accompanied by a dissociation between warm and cold sensations. In essence, the body believes that the temperature is lower than it actually is and turns up the "thermostat." Bladder distention is an anticipated effect of having an epidural. A woman's bladder fills quickly because of the large quantity of IV solution, yet her sensation to void is reduced. Maternal hypotension is an expected side effect of epidural initiation. The nurse should assess the bladder and blood pressure, but these actions are not related to the fever. A blood patch procedure is not warranted for this patient.

2. The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alterations? (Select all that apply.) a. Spontaneous fetal movement b. Compression of the fetal head c. Placental abruption d. Cord around the baby's neck e. Maternal supine hypotension

ANS: C,E Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure, and abdominal palpation are all likely to cause accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination and placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression. This may happen when the cord is around the baby's neck, arm, leg or other body part, a short cord, a knot in the cord, or a prolapsed cord.

5. A placenta previa in which the placental edge just reaches the internal os is called a. total. b. partial. c. complete. d. marginal.

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa the placenta completely covers the os. With a partial previa the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os.

8. The nurse teaches a pregnant woman that which diagnostic test evaluates the effect of fetal movement on fetal heart activity? a. Contraction stress test (CST) b. Sonography c. Biophysical profile d. Nonstress test (NST)

ANS: D An NST evaluates the ability of the fetal heart to accelerate either spontaneously or in association with fetal movement. CST evaluates the fetal reaction to contractions. Sonographic examinations visualize the fetus and are done for various other reasons. The biophysical profile evaluates fetal status using many variables.

20. One of the greatest risks to the mother during administration of general anesthesia is a. respiratory depression. b. uterine relaxation. c. inadequate muscle relaxation. d. aspiration of stomach contents.

ANS: D Aspiration of acidic gastric contents and possible airway obstruction is a potentially fatal complication of general anesthesia. Respirations can be altered during general anesthesia, and the anesthesiologist will take precautions to maintain proper oxygenation. Uterine relaxation can occur with some anesthesia, but this can be monitored and prevented. Inadequate muscle relaxation can be altered. This is not the greatest risk for the mother.

18. In which situation is a dilation and curettage (D&C) indicated? a. Complete abortion at 8 weeks b. Incomplete abortion at 16 weeks c. Threatened abortion at 6 weeks d. Incomplete abortion at 10 weeks

ANS: D D&C is used to remove the products of conception from the uterus and can be used safely until week 14 of gestation. After that there is a greater risk of excessive bleeding, and this procedure may not be used. If all the products of conception have been passed (complete abortion), a D&C is not used. If the pregnancy is still viable (threatened abortion), a D&C is not used.

26. Which type of cutaneous stimulation involves massage of the abdomen? a. Thermal stimulation b. Imagery c. Mental stimulation d. Effleurage

ANS: D Effleurage is massage usually performed on the abdomen during contractions. Thermal stimulation is the use of warmth to provide comfort, such as showers and baths. Imagery involves the woman creating a relaxing mental scene and dissociating herself from the painful aspects of labor. Mental stimulation occupies the woman's mind and competes with pain stimuli.

16. The nurse explains to the student that increasing the infusion rate of non-additive intravenous fluids can increase fetal oxygenation primarily by a. maintaining normal maternal temperature. b. preventing normal maternal hypoglycemia. c. increasing the oxygen-carrying capacity of the maternal blood. d. expanding maternal blood volume.

ANS: D Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension. Increasing fluid volume may alter the maternal temperature only if she is dehydrated. Most intravenous fluids for laboring women are isotonic and do not improve hypoglycemia. Oxygen-carrying capacity is increased by adding more red blood cells.

18. When preparing a woman for a cesarean birth, the nurse's care should include a. injection of narcotic preoperative medications. b. full perineal shave preparation. c. straight catheterization to empty the bladder. d. administration of an oral antacid.

ANS: D General anesthesia may be needed unexpectedly for cesarean birth. An oral antacid neutralizes gastric acid and reduces potential lung injury if the woman vomits and aspirates gastric contents during anesthesia. A narcotic at this point would put the fetus at high risk for respiratory distress. Perineal preparation is not necessary for a cesarean section. Some agencies will do an abdominal prep just before the surgery. The catheterization should be indwelling in order to keep the bladder small during the surgery.

30. A woman with preeclampsia has a seizure. What action by the nurse takes priority? a. Insert an oral airway. b. Suction the mouth to prevent aspiration. c. Administer oxygen by mask. d. Stay with the patient and call for help.

ANS: D If a patient seizes, the nurse should stay with her and call for help. Nursing actions during a seizure are directed toward ensuring a patent airway and patient safety. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the patient's mouth. Oxygen may or may not be needed after the seizure has ended.

5. When providing labor support, the nurse knows that which fetal position might cause the laboring woman more back discomfort? a. Right occiput anterior b. Left occiput anterior c. Right occiput transverse d. Left occiput posterior

ANS: D In the left occiput posterior position, each contraction pushes the fetal head against the mother's sacrum, which results in intense back discomfort. The other fetal positions do not cause more back discomfort.

6. The standard of care for obstetrics dictates that an internal version might be used to manipulate the a. fetus from a breech to a cephalic presentation before labor begins. b. fetus from a transverse lie to a longitudinal lie before cesarean birth. c. second twin from an oblique lie to a transverse lie before labor begins. d. second twin from a transverse lie to a breech presentation during vaginal birth.

ANS: D Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally. For internal version to occur, the cervix needs to be completely dilated; the cervix is not dilated before labor begins. An internal version would not be done in the case of a cesarean birth.

17. The method of anesthesia in labor considered the safest for the fetus is the a. pudendal block. b. epidural block. c. spinal (subarachnoid) block. d. local infiltration.

ANS: D Local infiltration of the perineum rarely has any adverse effects on either the mother or the fetus. The fetus can be affected by maternal side effects of the other types of anesthesia.

19. The precepting nurse explains to the newly hired nurse that when using IA for FHR which situation is unit protocol? a. The nurses can be expected to cover only two or three patients when IA is the primary method of fetal assessment. b. The best course is to use the descriptive terms associated with EFM when documenting results. c. If the heartbeat cannot be found immediately, a shift must be made to electronic monitoring. d. Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

ANS: D Locating fetal heartbeats often takes time. Mothers can be reassured verbally and by the ultrasound pictures if that device is used to help locate the heartbeat. When used as the primary method of fetal assessment, auscultation requires a nurse-to-patient ratio of one to one. Documentation should use only terms that can be numerically defined; the usual visual descriptions of EFM are inappropriate. Electronic monitoring is not needed at this point.

16. Which statement regarding various biochemical assessments used during pregnancy is correct? a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended between 10 and 12 weeks of gestation in order to give parents time to consider options. c. Percutaneous umbilical blood sampling (PUBS) is one of the multiple marker screen tests for Down syndrome. d. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

ANS: D MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP. CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. Screening is recommended between 15 and 20 weeks of gestation. Abnormal findings give parents time to have additional tests done.

A couple who wants to conceive but has been unsuccessful during the last 2 years has undergone many diagnostic procedures. When discussing the situation with the nurse, one partner states, "We know several friends in our age group and all of them have their own child already, Why can't we have one?". Which of the following would be the most pertinent nursing diagnosis for this couple? A Self-esteem disturbance related to infertility. B Ineffective family coping related to infertility. C Pain related to numerous procedures. D Fear related to the unknown

Based on the partner's statement, the couple is verbalizing feelings of inadequacy and negative feelings about themselves and their capabilities. Thus, the nursing diagnosis of self-esteem disturbance is most appropriate. Fear, pain, and ineffective family coping also may be present but as secondary nursing diagnoses.

When talking with a pregnant client who is experiencing aching swollen, leg veins, the nurse would explain that this is most probably the result of which of the following? A Pressure on blood vessels from the enlarging uterus B The force of gravity pulling down on the uterus C Thrombophlebitis D Pregnancy-Induced hypertension

Pressure of the growing uterus on blood vessels results in an increased risk for venous stasis in the lower extremities. Subsequently, edema and varicose vein formation may occur. Thrombophlebitis is an inflammation of the veins due to thrombus formation. Pregnancy-induced hypertension is not associated with these symptoms. Gravity plays only a minor role with these symptoms.

Which of the following would the nurse identify as a presumptive sign of pregnancy? A Hegar sign B Skin pigmentation changes C Positive serum pregnancy test D Nausea and vomiting

Presumptive signs of pregnancy are subjective signs. Of the signs listed, only nausea and vomiting are presumptive signs. Hegar sign,skin pigmentation changes, and a positive serum pregnancy test are considered probably signs, which are strongly suggestive of pregnancy.

FHR can be auscultated with a fetoscope as early as which of the following? A 15 weeks gestation B 10 weeks gestation C 5 weeks gestation D 20 weeks gestation

The FHR can be auscultated with a fetoscope at about 20 week's gestation. FHR usually is ausculatated at the midline suprapubic region with Doppler ultrasound transducer at 10 to 12 week's gestation. FHR, cannot be heard any earlier than 10 weeks' gestation.