OB exam 2
Breathing patterns are effective in decreasing pain in labor
T
Labor contractions begin at a "pacemaker" point in the uterine myometrium
T
Molding is the overlapping of the skull bones along the suture lines, which facilitates passage through the pelvis
T
The amount of discomfort a woman experiences during contractions differs according to her expectations and preparation.
T
The cephalic presentation occurs 95% of the time
T
The goal of medication during labor is to relieve pain without interfering with the labor and birth
T
A nurse is caring for a client in 2nd stage of labor. The pt's labor has been progressing, and she is expected to deliver vaginally in 20 min. The provider is preparing to admin lidocaine for pain relief and perform an episoitomy. The nurse should know that which of the following regional anesthesia block is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical
A
A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A. Assist the pt into left-lateral position B. Apply a fetal scalp electrode C. Insert an IV catheter D. Perform a vaginal exam
A
A woman has just received IV sedation. What must the nurse tell the woman to do? A. Ambulate w/ assistance B. Ambulate w/in 15 min C. Sit on edge of bed with feet dangling before ambulating D. Remain in bed for at least 30 min
A
Although the time frame for labor differs which individual women, which time period would you find excessive for a nullipara woman? A. A latent phase of 24 hrs B. A deceleration phase of 2 hrs C. A phase of maximum slop of 1.5 cm per hour D. A fetal descent slope of 1 cm per hr
A
FHR 140/min, contractions every 8 min for 30-40 sec. The RN performs a vaginal exam, and finds she is 2 cm dilated, 50% effaced, and the fetus is at the -2 station. Which of the following stages and phases is the pt in? A. First Stage, Latent Phase B. First Stage, Active Phase C. First Stage, Transition Phase D. Second stage of Labor
A
If a fetus is in ROA position during labor, how would the nurse understand the fetus is positioned? A. In a longitudinal lie facing the L posterior B. Facing the R anterior abd quadrant C. In a common breech delivery position D. Presenting with the face as the presenting part
A
What are the two risks that are potentially associated with an epidural? A. Hypotension & prolonged 2nd stage of labor B. Severe headache & peripheral cyanosis C. Increased back pain & abrupt transitions D. Hypertension & reduced RBCs
A
What calorie intake is recommended during pregnancy? A. An additional 300 calories a day B. An average of 1500 calories, except for obese pts C. An increase of 30 g protein per day D. Individualization by multiplying 60 calories per kg of ideal body weight
A
Which of the following fetal positions is considered ideal and is most conductive to a birth that requires few interventions by the OB? A. Right occipitoanterior w/ full flexion B. Left transverse anterior in moderate flexion C. Right occipitioposterior w/ no flexion D. Left sacroanterior w/ full flexion
A
Which statement by a pt would best suggest she has developed pica? A. I eat erasers off pencils. It helps relieve heartburn B. I can't eat a thing before 11 am every morning C. I notice I've been hungry for lemon cookies D. I crave oranges; can't get enough of them
A
Which statement would concern a nurse about a pt developing PTSD? A. I'm feeling as if I'm losing my grasp on things B. I wish my husband was able to be here C. Pushing is harder to do that I thought it would be D. I wish this didn't hurt so much
A
Which would be appropriate teaching about the force that propels the fetus through the vagina during labor? A. It is a combination of fundal and abd pressure B. It is mainly gravitational from the superior fetal lie C. It is cervical contractions beginning with full dilation D. It is abd and perineal muscle contractions
A
Why might fat-soluble vitamins be harmful if taken in large quantities during pregnancy? A. They can be stored in the body, leading to toxic effects B. A low hemoglobin may develop C. They are not absorbed from the gastrointestinal tract D. They may render an oral contraceptive ineffective
A
A nurse is providing care for a client who is in active labor. Her cervix is dilated to 5 cm, and her membranes are intact. Based on the use of external fetal monitoring, the nurse notes a FHR of 115-125/min that lasts for 25 sec, and have a beat-to-beat variability of 20/min. There is no slowing of FHR from baseline. The nurse should recognize that his client is exhibiting signs of which of the following? A. Moderate variability B. FHR accelerations C. FHR decelerations D. Normal baseline FHR E. Fetal tachycardia
A, B, D
A nurse is caring for a client who is at 40 weeks gestation and experiencing contractions every 3-5 min and becoming stronger. A vaginal exam reveals that the pt's cervix is 3 cm dilated, 80% effaced, and at -1 station. The pt asks for pain meds. Which of the following actions should the nurse take? A. Encourage pt to use patterned breathing B. Insert an indwelling catheter. C. Administer opioids D. Suggest application of cold E. Provide ice chips
A, C, D
A nurse is caring for a client in the 3rd stage of labor. Which of the following findings indicate placental separation? A. Lengthening of the umbilical cord B. Swift gush of clear fluid C. Softening of lower uterine segment D. Appearance of dark blood from vagina E. Fundus firm upon palpation
A, D, E
Women should not use __________ during labor for pain due to its ability to interfere with blood coagulation
ASA
A 19 yo first time mother in the second stage of labor who has been given an epidural reports severe, unrelenting abd pain and rates it 10/10. As a nurse, what should you do? A. Proceed with standard care B. Call the OB C. Call the anesthetist D. Discuss pain meds with woman
B
A nurse in L&D is completing an admission assessment for a pt at 39 wks gestation. The pt reports she has been leaking fluid from her vagina for 2 days. Which of the following conditions is the client at risk for developing? A. Cord prolapse B. Infection C. Postpartum hemorrhage D. Hydramnios
B
A nurse is caring for a client who is in active labor. The client reports lower-back pain. The nurse suspects that this pain is r/t a persistent occiput posterior position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client? A. Abdominal effleurage B. Sacral counterpressure C. Showering if not contraindicated D. Back rub and massage
B
A nurse is caring for a client who is in the transition phase of labor and reports she needs to have a BM with the peak of contractions. Which of the following actions should the nurse make? A. Assist the pt to the bathroom B. Prepare for an impending delivery C. Prepare to remove fecal impaction D. Encourage the pt to take deep breaths
B
A nurse is caring for a pt who is having an induction of labor. Based on the external fetal monitoring, the nurse notes that the FHR variability is decreased and resembles a straight line. The pt has not received pain medications. Which of the following should occur first before the nurse can apply an internal scalp electrode? A. Dilation B. Rupture of membranes C. Effacement D. Engagement
B
A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of uterus B. Palpate the fundus of the uterus C. Grasp lower uterine segment between thumb & fingers D. Stand facing client's feet with fingertips outlining cephalic prominence.
B
A pt experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. Which of the following actions should the nurse take? A. Check the amniotic fluid for meconium B. Monitor FHR for distress C. Dry the client and make her comfortable D. Monitor uterine contractions
B
A pt has a BMI of 25 and is considered to be slightly overweight. The team should recommend what range of weight gain during her pregnancy? A. 10-12 lb B. 15-25 lb C. 30-35 lb D. 40-60 lb
B
A pt wants to know if she can safely use a warm water birth to help with pain, which is the best response? A. No. Chilling can result in hypothermia B. Yes, as long as membranes aren't ruptured C. No. Will separate you from partner D. Yes, warm water has no significant effect
B
What length of contraction would you report as indicative of a potential safety risk? A. Any length of contractions over 30 sec B. A contraction over 70 sec C. A contraction that peaks at 20 sec D. A contraction that appears intensely painful
B
Which of the following would you document as a late deceleration in FHR? A. The FHR began increasing 45 sec after contraction is over B. The FHR decreases in rate 30 sec after the start of a contraction C. The FHR decreased in strength after the 10th consecutive contraction D. A decrease in FHR occurs but it totally unrelated to timing of contractions
B
A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following statements should the nurse include in the teaching? A. It is considered non-invasive B. It can detect abnormal fetal heart tones early C. Can determine amount of amniotic fluid D. Allows for accurate readings with maternal movement E. Measure uterine contraction intensity
B, D, E
A health history document is being modified by an interprofessional group. To obtain the most accurate nutrition history from a pregnant pt, which should the nurse specify? A. Ask pt to tell you how much protein she eats daily B. Assess whether the pt feels satisfied with her nutrition C. Ask the pt to describe what she ate in the last 24 hrs D. Prompt the pt to describe her concept of ideal nutrition
C
A nurse is caring for a client and her partner during the second stage of labor. The client's partner asks the nurse to explain how he will know when crowning occurs. Which of the following responses should the nurse make? A. The placenta will protrude from the vagina B. Your partner will report a decrease in intensity of contractions C. The vaginal area will bulge as the baby's head appears D. Your partner will report less rectal pressure
C
A nurse is caring for a client following the admin of an epidural and is preparing to admin an IV bolus. The pt's partner asks about the purpose, what is the appropriate response? A. It is needed to promoted increased urine output B. Needed to counteract respiratory depression C. Needed to counteract hypotension D. Needed to prevent oligohydramnios
C
A nurse is caring for a pt in active labor and becomes nauseous and vomits. The pt is very irritable and feels the urge to have a BM. She state's "I've had enough. I can't do this anymore. I want to go home right now." Which of the following stages of labor is the pt experiencing? A. Second Stage B. Fourth Stage C. Transition Stage D. Latent Phase
C
A nurse is caring for a pt who had no prenatal care, is Rh-negative and will undergo an external version at 37 weeks gestation. The nurse anticipates a prescription for which of the following medications to be administered prior to the version? A. Prostaglandin gel (Cervidil) B. Magnesium sulfate C. Rh (D) immune globulin (RhoGAM) D. Oxytocin (Pitocin)
C
A pt asks if she should have hired a doula. What is the nurse's best answer? A. Definitely. Doula's time contractions and perform many tasks, taking burden off you B. Maybe. Doula's are good at telling you if you are doing everything correctly. C. That's an individual choice, but a doula can serve as an important person D. No. A second person giving advice is apt to cause conflic
C
A pt you care for is in labor asks you what causes labor to begin. Which of the following statements is a possible explanation? A. Progesterone levels rise at time to initiate contractions B. The ovary releases additional estrogen at term C. Prostaglandins may be the causative factor of labor D. Calcium is drawn from the bones to block relaxation fibers
C
Protein is found in large quantities in meat. How many meat servings per day are recommended for women during pregnancy? A. 1 B. 3 C. 6 D. 8
C
What drug would you give during anesthesia to reduce the risk of aspiration and vomitus? A. Valium B. phenobarbital C. Reglan D. Oxytocin
C
Which statement is best to advise a pt about foods during pregnancy? A. Protein makes you gain weight too rapidly so keep all your meat portions small B. Eat as much as you like all throughout pregnancy C. Make sure that you work plenty of leafy green veggies in your diet D. Fe causes constipation so limit your intake of Fe-rich foods
C
Which statement is best to help a pt in labor with controlled breathing? A. Lie on your back and breathe in slowly and repeat B. Hold your breath as long as you can, then exhale C. Breathe in slowly, breathe out just as slowly D. Pant rapidly as this lifts abd wall
C
The presentation of the fetus head is referred to as
Crowning
A Nurse in the L&D unit receives a phone call from a client who reports her contractions starts 2 hr ago and did not go away when she had 2 glasses of water and rested. They have become stronger, her contractions occur every 10 min and last about 30 sec. No fluid has leaked, however, she saw blood while voiding. Based on the report, which clinical finding should the nurse expect? A. Braxton-Hicks B. Rupture of Membranes C. Fetal Descent D. True Contractions
D
A nurse in L&D is planning care for a newly admitted pt who reports she is in labor and has been having vaginal bleeding for 2 weeks. Which of the following should the nurse include in the plan of care? A. Inspect the introitus for a prolapses cord B. Perform a test to identify the ferning pattern C. Monitor station of the presenting part D. Defer vaginal examination
D
A nurse is caring for a client in the 1st stage of labor and encouraging the client to void q2hr. Which of the following statements should the nurse make? A. A full bladder increases risk for fetal trauma B. A full bladder increases risk for bladder infection C. A distended bladder will be traumatized by frequent pelvic exams D. A distended bladder reduces the pelvic space needed for birth
D
A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A. Admin O2 via nasal cannula B. Apply a warm blanket C. Assist pt into side-lying position D. Place an O2 mask on pt's nose/mouth
D
A nurse is reviewing the electronic tracing of a client who is in active labor. The nurse should know that a fetus receives more O2 when which of the following appearing on the tracing? A. Peak of uterine contraction B. Moderate variability C. FHR acceleration D. Relaxation between uterine contractions
D
In order to best facilitate placental delivery, which action should the nurse take? A. Tug gently on umbilical cord B. Ask pt to continue pushing hard C. Push the lax fundus to cause placenta to loosen D. Assure her the placenta loosens quickly so the waiting time shouldn't be long
D
The nurse is assisting a woman through labor, monitoring her closely now that she has an epidural. The nurse would report which finding to the anesthesiologist? A. Dry, cracked lips B. Urinary retention C. Rapid progress of labor D. Inability to push
D
What should a pt be taught to recognize as a sign of true labor? A. Sudden loss of energy from epi release B. Nagging but consistent pain in lower back C. Urinary urgency from increased bladder pressure D. Show or release of the cervical mucus plug
D
Which is apt to be the greatest nutritional risk if she is a vegetarian? A. Lack of Fe B. Lack of Vit C C. Lack of folic acid D. Lack of Vit B12
D
Which statement best describes the best way to use music therapy in labor? A. I've brought techno music to play during the 2nd stage B. I'll need a distraction most just before I have to push C. I know music probably won't make a difference, but I enjoy it anyway D. I brought some romantic music to play during early labor to help me relax
D
Which statement from a website is most accurate about pregnant women? A. Best to take Fe pills with milk B. You can crush Fe pills to disguise taste C. Fe pills most effective when taken with soda D. Take Fe pills with orange juice to increase absorption
D
A _________ is a woman experienced in childbirth and postpartum support. Some pregnant women choose them as their support person
Doula
The shortening and thinning of the cervical canal
Effacement
Refers to the settling of the presenting part of the fetus far enough into the pelvis; it rests at the ischial spines
Engagement
The most common form of spinal anesthesia used during delivery is
Epidural
Dilation refers to the widening of the vagina to permit passage of the fetus
F
Labor normally begins between 39-42 wks of gestation
F
The Melzack-Wall gate control theory of pain proposes pain can be halted at four different locations.
F
Although not always a sign of fetal distress, __________ is highly correlated with it's occurrence
Meconium staining
Is the basic protective mechanism that alerts a person something threatening is happening to his/her body
Pain
Is the practice of stimulating the hands, feet, ears, as a form of therapy
Reflexology
The relationship of the presenting part of the fetus to the level of the ischial spine is referred to as
Station
