OB EXAM 2 EVOLVE QUESTIONS

A woman who is 27 weeks pregnant calls the clinic and complains of constant low backache. The nurse should A. have the woman come in to be evaluated. B. have the woman call back in 1 day if the backache does not improve. C. have the woman call back if the pain increases. D. tell the woman to drink plenty of fluids and maintain bed rest.

A A constant low backache is a common symptom of preterm labor. She needs to be evaluated as soon as possible. Drinking fluids has not been proven to stop preterm labor but decreases uterine irritability.

A multigravida at 37 weeks of gestation is admitted to the labor room. She has contractions every 3 to 4 minutes lasting 40 to 50 seconds and no history of clear fluid leakage from the vagina, but complains of bright red bleeding for the past hour. The fetal heart rate is 145 beats/minute (bpm). What should be the nurse's next intervention? A. Call the physician promptly. B. Perform a vaginal exam to determine imminence of birth. C. Continue to monitor contractions and fetal heart rate. D. Administer an enema according to protocol of the agency.

A Bright red bleeding is a sign of complications, and the physician or primary health care provider should be notified immediately. Vaginal exams or enemas are contraindicated in the presence of bleeding. Continuing to monitor the mother and fetus is important after notifying the health care provider.

A woman with an epidural has been pushing for the past 2 hours with very little progression. An appropriate nursing action at this point is to A. assess for a full bladder. B. assess for a full colon. C. allow the woman to rest for two or three contractions before starting to push again. D. change positions of the woman and attempt to push again.

A During labor, a full bladder is a common soft tissue obstruction. Bladder distention reduces available space in the pelvis and intensifies maternal discomfort. An epidural decreases the woman's sensation of the need to void, and the extra fluids administered in preparation for the epidural increase her urinary output.

A nurse is reviewing the charts of antepartal patients. A 28-week-gestation woman's fetal fibronectin report has returned, with negative results. The nurse should A. document this report. B. notify the health care provider. C. document the need to do patient teaching on the signs of preterm labor during the woman's next visit. D. alter this woman's plan of care to include teaching about increasing protein intake in her diet.

A Fetal fibronectin is normally found in the vaginal secretions until about 20 weeks' gestation and again at term. If it is found between those dates, it suggests early labor. A negative report indicates that the woman is at low risk for labor at this time.

A woman is receiving magnesium sulfate intravenously to control preterm labor. She is at the maximum dose and the contractions have slowed to eight/hr. The nurse is assessing the woman's vital signs every hour. In addition to blood pressure, pulse, and respirations, what other assessments should be carried out hourly? A. Lung sounds B. Edema in lower extremities C. Bowel sounds D. Range of motion to the lower extremities

A Magnesium sulfate can lead to fluid overload, which can cause pulmonary edema. Assessing lung sounds every hour will alert the nurse to changes. Bowel sounds should be checked every 4 to 8 hours. Magnesium sulfate should not affect the lower extremities.

Immediately following an amniotomy to observe for complications, the nurse must assess the A. fetal heart rate. B. maternal blood pressure. C. maternal pulse. D. fetal heart rate variability.

A One complication of an amniotomy is prolapse of the umbilical cord. Cord compression can be diagnosed by observing for variable decelerations or a decrease in the fetal heart rate. Maternal blood pressure, pulse, and fetal variability are all necessary to assess, but are not the immediate concerns.

A fetus is in the posterior position. The woman is complaining of back labor and the labor is prolonged. The nurse can best assist the mother with this problem by A. placing her in a hands and knees position. B. placing her in a prone position. C. massaging her back. D. encouraging her to use the whirlpool bath.

A The hands and knees position encourages the fetus to rotate into an anterior position. This will decrease the back pain and increase the descent of the fetal head. A prone position is contraindicated with a pregnant woman. Massaging her back and the whirlpool are comfort measures, but will not help correct the problem.

A woman delivered a baby boy 30 minutes ago. The labor and birth were uneventful. The nurse is assessing the woman's vital signs when the woman suddenly complains of chest pain and difficulty breathing. The vital signs show a decreased blood pressure and a slightly increased pulse. The nurse's next action should be to A. call for assistance. B. have the woman sit up and assist her to take deep breaths to help her relax. C. administer pain medication. D. increase the routine assessments to every 15 minutes until the vital signs stabilize.

A These are symptoms of an anaphylactoid syndrome or an embolism. The nurse should remain with the woman, but needs assistance to notify the health care provider and start oxygen. The woman may be in need of cardiopulmonary resuscitation and support, so it is important not to leave her at this time.

1. The patient is admitted in early labor. Her support person tells the nurse that the contractions have the following pattern: started 1232, ended 1233; started 1235, ended 1236; started 1239, ended 1240; started 1243, ended 1244. From this information, the nurse determines that the frequency of the contractions is A. every 3 to 4 minutes. B. every 2 to 3 minutes. C. lasting a minute. D. unable to be determined with this information.

A The frequency of a contraction is measured from the beginning of one contraction until the beginning of the next contraction. The contractions started at 1232, 1235, 1239, and 1243. This would put the contractions every 3 to 4 minutes. The duration of the contractions is from the beginning of a contraction until the end of the same contraction. The duration for this pattern would be 1 minute.

During a vaginal exam, the physician stimulates the fetal scalp. The fetal heart rate accelerated from 140 to 155 bpm for about 30 seconds. The nurse should A. record this fetal reaction. B. notify the physician because this reaction is normal. C. assist the woman into a side-lying position. D. administer oxygen at 8 to 10 L/minute.

A. It is normal for the heart rate to elevate 15 bpm for at least 15 seconds with fetal scalp stimulation. The nurse should record the finding. No other intervention is necessary at this time.

Upon completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, ?2-1. Which one of the following is a correct interpretation of the data? A. Fetal presenting part is 1 cm above the ischial spines. B. Effacement is 4 cm from completion. C. Dilation is 50% completed. D. Fetus has passed through the ischial spines.

A. A station of ?2-1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. A station of 0 would indicate that the presenting part has passed through the inlet and is at the level of the ischial spines or is engaged. Passage through the ischial spines with internal rotation would be indicated by a plus station, such as +1. Progress of effacement is referred to by percentages, with 100% indicating full effacement, and dilation by centimeters (cm), with 10 cm indicating full dilation.

On review of a fetal monitor tracing, the nurse notes that for several contractions the FHR decelerates as a contraction begins and returns to baseline just before it ends. The nurse should A. describe the finding in the notes. B. reposition the woman onto her side. C. call the physician for instructions. D. administer oxygen at 8 to10 L/minute with a tight face mask.

A. An early deceleration pattern from head compression is described. No action other than documentation of the finding is required because this is an expected reaction to compression of the fetal head as it passes through the cervix. The other responses would be implemented when ominous changes are noted.

To obtain an accurate blood pressure of a woman in labor, the nurse should assess the blood pressure A. between contractions, with the woman lying on her side. B. between contractions, with the woman lying on her back. C. with a contraction while the woman is lying on her side. D. with a contraction while the woman is lying on her back.

A. During uterine contractions, blood flow to the placenta gradually decreases, causing a relative increase in the woman's blood volume. This temporary change increases her blood pressure slightly. If the woman lies on her back, the weight of the fetus, placenta, and fluid may decrease blood flow, causing supine hypotension. Therefore her blood pressure is more accurate when taken between contractions, with her lying on her side.

During active labor, the woman complains about tingling in her hands. The nurse's next action should be to A. help the woman slow down her breathing and breathe into her cupped hands. B. assess vital signs for changes. C. check cervical dilation. D. change the woman's position.

A. Hyperventilation may occur during active labor as the woman breathes rapidly. She may feel tingling in her hands and feet and dizziness. By having the woman slow her breathing and breathe into a paper bag or her cupped hands, her carbon dioxide levels will return to normal and relieve the symptoms.

The nurse should tell a primigravida that the definitive sign indicating labor has begun is A. progressive uterine contractions. B. lightening C. rupture of membranes. D. passage of the mucus plug.

A. Regular, progressive uterine contractions that increase in intensity and frequency are a sign of true labor. Responses b and d are premonitory signs indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself.

After a planned cesarean section, the woman is being admitted back to the postpartum unit. The nurse notices that the patient is rubbing her nose and eyes continually. Being aware that the woman has been given epidural opioids, the nurse's next action should be to A. offer the woman some medication to relieve the itching. B. notify the anesthesiologist immediately. C. monitor for signs of respiratory depression. D. monitor the patient's temperature.

A. Pruritus of the face and neck is an annoying side effect that may occur with epidural opioids. Medications may be used to relieve the itching and make the woman more comfortable.

Why is a cleansing breath at the beginning and end of contractions important? (Select all that apply.) A. Helps the woman release tension B. Provides oxygen to reduce myometrial hypoxia C. Provides a diversional activity for the woman D. Helps the fetus to release tension

AB Each contraction begins and ends with a deep inspiration and expiration known as the cleansing breath. Like a sigh, a cleansing breath helps the woman release tension. It provides oxygen to help reduce myometrial hypoxia, one cause of pain in labor. The cleansing breath also helps the woman clear her mind to focus on relaxing and signals her labor partner that the contraction is beginning or ending.

Which one(s) of the following are important points when teaching a patient the proper method for pushing during the second stage of labor? (Select all that apply.) A. Begin and end by taking a deep breath and exhaling. B. Push for 4 to 6 seconds at a time. C. Take a deep breath and then push while holding her breath. D. Push at least five or six times with each contraction.

AB Support the woman's spontaneous pushing techniques if they are effective. The woman should push with her abdominal muscles while relaxing her perineum. If she needs coaching, teach her to begin by taking a breath and exhaling and then to take another breath and exhale while pushing for 6 seconds at a time. Sustained pushing while holding a breath (Valsalva maneuver or "purple pushing") or pushing more than four times per contraction reduces blood flow to the placenta, increases intrathoracic pressure, is fatiguing and should be discouraged.

An intravenous access is started in most labor patients because of which one(s) of the following? (Select all that apply.) A. To have quick access if drugs are needed B. To provide fluids to prevent dehydration C. In case an epidural block is administered D. To provide a route for pain medications for the 48-hour postpartum period

ABC An IV line provides quick access if fluids or medications are needed. Continuous fluid infusion prevents and reduces dehydration and is necessary if epidural analgesia is used. By 48 hours postpartum, mothers are expected to be on oral pain medication.

Which one(s) of these conditions might cause late decelerations in the fetal heart rate? (Select all that apply.) A. Maternal hypotension B. Excessive uterine activity C. Maternal hypertension D. Fever E. Maternal overhydration F. Prolapsed cord

ABC Late decelerations are thought to occur with decreased blood flow through the intervillous space due to maternal, fetal factors, or placental factors resulting in fetal hypoxia. They can be a reflex to transient fetal hypoxia caused by an interruption anywhere along the oxygen pathway such as maternal hypotension. The peak of a uterine contraction produces a temporary cessation of uterine blood flow and oxygen delivery to the intervillous space. Uterine hypertonus may also impact oxygen delivery. Typically, residual oxygen in the intervillous space is adequate enough for the fetus to tolerate these changes. Tachysystole, prolonged contractions, hypertonus, or inadequate relaxation time between contractions may result in FHR changes that are the result of fetal hypoxia. Fever and maternal overhydration would not affect FHR. Prolapsed cord would result in an absence of FHR.

Relaxation of the mother during labor is important for several reasons. Which one(s) of the following are reasons that promoting relaxation is important? (Select all that apply.) A. Promotes uterine blood flow B. Improves fetal oxygenation C. Promotes efficient uterine contractions D. Reduces tension that increases pain E. Inhibits rapid fetal descent

ABCD Promoting relaxation is a basis for all other methods, both nonpharmacologic and pharmacologic, because it achieves the following: (1) promotes uterine blood flow, improving fetal oxygenation, (2) promotes efficient uterine contractions, (3) reduces tension that increases pain perception and decreases pain tolerance (maximum pain one is willing to endure), and (4) reduces tension that can inhibit fetal descent.

Labor pain management may include which one(s) of the following interventions? (Select all that apply.) A. Cool, damp washcloths on the face and neck B. Decreasing bright lights in the room C. Keeping the woman clean and dry D. Administering pain medication as ordered E.Offering simple snacks every 2 hours

ABCD Providing comfort measures are important during labor. A laboring woman may have clear liquids by mouth but no solid food during active labor.

Which one(s) of the following actions should be included in nursing care during labor? (Select all that apply.) A. Offer ice chips in small amounts to relieve a dry mouth. B. Monitor for a full bladder because the woman may have a decreased sensation of the urge to void. C. Keep the woman in a side-lying position to prevent supine hypotension. D. Offer small bland meals if the woman is in early labor to help maintain proper blood sugar levels. E. Monitor the fetal heart rate for changes from normal.

ABCE Oral intake of clear liquids such as ice chips, juices, and popsicles is appropriate in low risk laboring women; solid foods should be avoided. A full bladder can inhibit fetal descent because it occupies space in the pelvis. Bladder status should be evaluated throughout labor for distention. Alterations in the rate and rhythm of the fetal heart may result from normal labor effects or suggest fetal intolerance to the stress of labor and should be monitored. Supine hypotension may occur during labor if the woman lies on her back due to aortocaval compression. The woman should be encouraged to rest in lateral positions to promote blood return to her heart and thus enhance blood flow to the placenta and promote fetal oxygenation.

During the labor process, the patient's membranes rupture. Select all the assessments that are necessary for the nurse to carry out at this time. (Select all that apply.) A. Color of amniotic fluid B. Odor of amniotic fluid C. Fetal heart rate D. Cervical dilation E. Cervical effacement F. Time the membranes ruptured

ABCF The time of rupture of membranes, fetal heart rate, color, odor, and quantity of the amniotic fluid are noted and charted.

Which one(s) of the following are considered abnormal (Category III) heart rate patterns? (Select all that apply.) A. Bradycardia B. Absent variability C. Early decelerations D. Recurrent variable decelerations

ABD Category III or abnormal fetal heart rate patterns include: absent variability AND recurrent late decelerations OR recurrent variable decelerations OR bradycardia OR sinusoidal pattern.

Variability can be reduced by which one(s) of the following factors? (Select all that apply.) A. Sleep B. Narcotics C. Gestation longer than 39 weeks D. Fetal anomalies that affect the central nervous system

ABD The fetal sleep cycle, fetal tachycardia, general anesthesia, prematurity and preexisting neurologic injury can reduce variability. Gestation at or near term by itself has no effect on variability.

How does childbirth pain differs from other types of pain? (Select all that apply.) A. It is a normal process. B. There is preparation time. C. It is stronger than most other types of pain. D. It is self-limiting. E. It is intermittent. F. It is always a dull, achy type of pain.

ABDE Childbirth pain differs from other types of pain in several important respects: (1) it is part of a normal process, whereas other types of pain relate to injury or illness, (2) preparation time exists; the pregnant woman has several months to prepare for labor, including acquiring skills to help manage pain; (3) it is self-limiting and has a foreseeable end, (4) labor pain is not constant, but intermittent, and (5) labor ends with the birth of a baby.

To ensure adequate fetal oxygenation, which one(s) of the following are needed? (Select all that apply.) A. Normal maternal blood flow and volume to the placenta B. Normal oxygen saturation in maternal blood C. Normal carbon dioxide saturation in the maternal blood D. Adequate exchange of oxygen and carbon dioxide in the placenta E. Normal fetal circulatory and oxygen-carrying functions F. Normal blood glucose levels in the fetal circulation

ABDE Fetal oxygenation involves (1) oxygen transfer from the environment to the fetus, and (2) the fetus responses to this interruption of oxygen transfer. This necessitates normal maternal blood flow of oxygenated blood, exchange of oxygen and carbon dioxide in the placenta, and normal fetal circulation of oxygen-carrying blood components.

Which one(s) of the following are considered theories about the onset of labor? (Select all that apply.) A. Changes in the relative effects of estrogen and progesterone B. An increase in prostaglandins C. Increased secretion of prolactin D. Decreased secretion of oxytocin E. Stretching and irritation of the uterus and cervix

ABE Factors that appear to have a role in starting labor include: (1) changes in the ratio of maternal estrogen to progesterone so that estrogen levels are higher than progesterone levels, (2) prostaglandins produced by the decidua and membranes may have a role in preparing the uterus for oxytocin stimulation at term, (3) increased secretion of natural oxytocin does not appear to start labor but appears to maintain labor once it has begun, (4) the fetal membranes release prostaglandin in high concentrations during labor and large quantities of cortisol are secreted by the fetal adrenal glands, possibly acting as a uterine stimulant, and (5) stretching, pressure, and irritation of the uterus and cervix increase as the fetus reaches term size.

Which physical factors contribute to pain during labor and birth? (Select all that apply.) A. Tissue ischemia B. Cutting of the nerves with dilation C. Cervical dilation D. Distention of the vagina and perineum E. Height of the woman in relation to fetal size.

ACD A variety of physical factors such as tissue ischemia, cervical dilation, pressure and pulling on pelvic structures, and distention of the vagina and perineum contribute to pain in labor and birth. Nerves will not be cut during dilation and height of the mother in relation to fetal size is not a factor.

Which one(s) of the following are used to assist with the cervical ripening process prior to induction of labor? (Select all that apply.) A. Prostaglandin B. Oxytocin C. Misoprostol (Cytotec) D. Laminaria tents E. Terbutaline

ACD Prostaglandin E2 (PGE2) preparations may be given as an intravaginal gel, an intracervical gel, or a timed-release vaginal insert to ripen the cervix. Misoprostol can be used for both cervical ripening and induction of labor. Mechanical methods for cervical ripening are efficacious and have decreased risk of excessive uterine activity. These methods include placement of a transcervical balloon catheter, membrane stripping, or placement of hydroscopic inserts (i.e., Laminaria—sterile cone-shaped preparations of dried seaweed).

Which one of the following laboring women is at highest risk for a prolapsed cord? All the women have intact membranes and are cephalic presentations. A. Gravida 3, station +2, cervix 7 cm, and 100% effaced B. Gravida 1, station ?2-2, cervix 3 cm, and 50% effaced C. Gravida 2, station 0, cervix 2 cm, and 60% effaced D. Gravida 6, station 0, cervix 9 cm, and 100% effaced

B A fetus that is in a high station is at high risk for a prolapsed cord when the membranes rupture.

A 39-week primigravida calls the birthing center and tells the nurse she has contractions that are 10 to 15 minutes apart and had a small gush of fluid about 1 hour ago. The nurse should tell her to A. wait until the contractions are about 5 minutes apart and come to the center. B. come to the birthing center now. C. come to the birthing center in about an hour if she lives farther than 1 hour away. D. come to the birthing center if the baby stops moving.

B A gush or trickle of fluid from the vagina should be evaluated as soon as possible. Waiting until the contractions are 5 minutes apart is appropriate for a primigravida if the membranes have not ruptured.

A 39-week-gestation gravida 1 is 6 cm dilated. Membranes are intact. The labor contractions have decreased in intensity, and she has not dilated in the past 2 hours. A diagnosis of hypotonic dysfunctional labor has been made. The nurse can anticipate which of the following actions? A. Immediate cesarean section B. Amniotomy C. Narcotic administration D. Having her walk around

B Amniotomy may be used to stimulate labor that slows after it is established.

While caring for a woman who is 10 cm dilated, is pushing, but is fatigued and her pushing efforts are ineffective, the nurse notices that the fetal heart rate has dropped to 85 bpm. The station is +3. The nurse can anticipate A. a cesarean section. B. a low operative vaginal birth. C. a midpelvis operative vaginal birth. D. no change in the birth plan.

B Because of the drop in the fetal heart rate, the fetus should be delivered quickly. Since the woman is fatigued and no longer pushing effectively, assistance is needed. The head is at +3 station, so a low operative vaginal birth is quicker than preparing the woman for a cesarean section. The fetal head is too low for a midpelvis operative vaginal birth.

A woman came in for a prenatal check up on March 15. She tells the nurse that her last normal menstrual period was June 2. The nurse is aware that she will be scheduled for A. immediate birth. B. testing to determine fetal well-being. C. follow-up appointments every week until birth. D. ultrasound to determine fetal age.

B By dates, her EDD was March 9. To determine proper management of her pregnancy, it will be necessary to determine whether the fetus is thriving in the uterus. Ultrasounds at this stage are not accurate for fetal age.

Which one of the following measures will help prevent complications from an episiotomy? A. Pain medication every 3 to 4 hours as needed B. Cold applications after birth C. Warm applications after birth D. Early ambulation

B Cold applications for the first 12 hours after birth may help prevent hematomas and edema. Pain medication helps treat, not prevent, the complication of pain. Early ambulation helps prevent other complications. Warm applications are contraindicated after birth; they may be used after 12 hours.

A woman has reached 10 cm and is attempting to push. She had an epidural and is unable to feel the urge to push. The nurse can best assist her by A. allowing the epidural to wear off and then have her push. B. letting her labor down, that is delaying pushing until she feels the reflexive urge to push. C. changing her position to a side-lying. D. preparing her for a forceps birth.

B Epidural analgesia may cause a loss of sensation, so the woman cannot feel the urge to push. The practice of laboring down, or delayed pushing—encouraging the woman to wait until she feels the reflexive urge to push—has shown a lower incidence of adverse effects than pushing immediately on full cervical dilation. She can later be coached to push with each contraction and feedback given on the effectiveness of the pushing.

Which one of the following findings during the fourth stage would require immediate interventions by the nurse? A. Fundus firm and at midline B. Fundus firm, deviated to the right, with slight distention over the symphysis pubis C. Blood pressure and pulse slightly lower than reading during second stage of labor D. Lochia is bright red, with a few small clots

B Even though the fundus is firm, it is not midline and the bladder is filling. A full bladder will interfere with contraction of the uterus and lead to increased bleeding. The rest of the answer choices are within normal limits for this stage.

Which one of the following women can the nurse anticipate having difficulty dealing with labor pain? A. Primigravida who has attended childbirth preparation classes B. A woman having her second baby; the first child was in a posterior position and the labor lasted 18 hours. C. A woman having her sixth child and who has not attended any prenatal teaching classes D. Primigravida who has her mother as her birth support person. The mother is encouraging her with every contraction.

B Previous experiences with pain can alter a woman's perception of labor pain. The woman with a prolonged labor and posterior position with the last birth will come to this labor anxious about the outcome and amount of pain. Preparation for labor and previous positive experiences will help the woman tolerate the pain. A support person who has been through the process and is encouraging can also assist the woman in a positive way.

The nurse is preparing to auscultate the fetal heart rate using a Doppler transducer. When performing the Leopold maneuver, the nurse felt the buttocks near the fundus and the back along the left side of the mother. The best position for the Doppler would be in the mother's A. left upper quadrant. B. left lower quadrant. C. right upper quadrant. D. right lower quadrant.

B The fetal heart is best heard through the fetus's upper back. Because this fetus is in a cephalic position, with the back toward the mother's left side, the Doppler should be placed in the left lower quadrant of the mother's abdomen.

After birth, the nurse assesses the newborn. The heart rate is 90 bpm, the body is flexed, there is vigorous movement, the newborn is actively crying when stimulated, and has bluish coloration in the feet and hands. The proper Apgar score for this newborn should be A. 7. B. 8. C. 9. D. 10.

B The heart rate less than 100 bpm gets a score of 1, a lusty cry will give a score of 2 for both respiratory effort and reflex response, the flexed posture and vigorous movements give a score of 2, and the bluish coloration of the hands and feet will give a score of 1.

In caring for a low-risk woman in the active phase of labor, the nurse realizes the assessment of fetal well-being should occur A. every 15 minutes. B. every 30 minutes. C. every 5 minutes. D. every hour.

B. For low-risk women, the nurse should evaluate the fetal monitoring strip or assessment fetal well-being at least every 30 minutes during the active phase of labor and every 15 minutes during the second stage. For the high-risk woman, monitoring should occur every 15 minutes during the active phase and every 5 minutes during the second stage.

Firm sacral pressure is likely to be most helpful in which situation? A. Rapid labor and birth B. Fetal occiput posterior position C. Oxytocin induction of labor D. If analgesics should be avoided

B. A posterior position of the vertex will cause pressure against the sacrum. This pressure increases back pain during and between contractions. Firm sacral pressure may help relieve some of the pressure.

As the nurse is admitting a woman in labor, she notices that the woman is happy and excited that she is in labor. The contractions are 5 minutes apart, lasting 30 to 35 seconds. The nurse can anticipate that the patient is in which phase of labor? A. Second B. Latent C. Active D. Transition

B. During the latent phase of the first stage of labor, the woman is usually sociable, excited, and cooperative. The contractions are about 5 minutes apart.

During the latent phase of labor, the nurse suggests that the woman play cards with her husband. The nurse is aware that this will help the woman deal with the pain of contractions. The effectiveness of this technique is explained by A. cutaneous stimulation. B. the gate control theory. C. thermal stimulation. D. hydrotherapy.

B. In the gate control theory of pain, the use of visual and auditory stimulation techniques such as playing cards can affect the perception of stimuli as painful. Diversional activities in early labor and focal points or breathing techniques later in labor are examples of the gate control theory of pain. Other examples of gate control theory are cutaneous stimulation using touch to relax muscles, thermal stimulation using warmth to relax muscles, and hydrotherapy using water for relaxation.

During each contraction, the nurse notices that the woman stops talking and stares at a picture on the wall. The nurse realizes that the woman is using the picture as a A. point of imagery. B. focal point. C. distraction.

B. The focal point is an object on which the woman centers her attention during contractions. It helps her direct her thoughts away from the contractions. Imagery is a technique for relaxation when the woman imagines specific scenes that are relaxing. Distraction can be used in the early phase of labor. The woman concentrates on something else, such as playing cards or watching a favorite movie.

The midwife has just examined a labor patient and states that she is 10 cm dilated. The nurse is aware that this patient is in which stage of labor? A. First B. Second C. Third D. Fourth

B. The second stage begins with complete dilation (10 cm) and ends with the birth of the baby.

The nurse notices on the admission record that the fetus is in a cephalic military presentation. The nurse realizes that the fetus A. is coming feet first into the birth canal. B. has the head in the birth canal first, but the head is not flexed. C. has the head in the birth canal first, and the head is in a flexed presentation. D. has both feet coming into the birth canal first.

B. Cephalic presentation shows that the head is coming into the birth canal first. The military presentation means that the head is in a neutral position, neither flexed nor extended.

Which one of the following characteristics is associated with false labor contractions? A. Painless B. Decrease in intensity with ambulation C. Regular pattern of frequency is established D. Progressive in terms of intensity and duration

B. False labor contractions decrease with activity, but true labor contractions are enhanced or stimulated with activity such as ambulation. False labor contractions are painful. Responses c and d are characteristics of true labor contractions, which increase in intensity with activities such as ambulation.

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of oxytocin (Pitocin). The woman is in a side-lying position and her vital signs are stable and within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's immediate action would be to A. change the woman's position. B. stop the oxytocin. C. elevate the woman's legs. D. administer oxygen via a tight mask at 8 to 10 L/minute.

B. The late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the oxytocin infusion because oxytocin stimulates the uterus to contract. The woman is already in an appropriate position for uteroplacental perfusion. Elevating her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.

When admitting a patient for induction of labor, the nurse will question the procedure if which one of the following observations is on the patient's prenatal record? 1. Spontaneous rupture of membranes 24 hours ago, with no labor 2. 42-week gestation 3. Placenta previa 4. Maternal heart disease that is worsening

C An induction of labor would be contraindicated in a woman with placenta previa. The labor would most likely result in hemorrhaging. Options a, b, and d are all indications for induction.

A pregnant patient walks into the birthing center complaining of contractions. After getting her to bed, the first thing the nurse should do is A. assess the mother's pulse and respirations. B. gather information about her medical history. C. assess the fetal heart rate. D. start an intravenous line.

C Assessment priorities on admission of a labor patient are to determine the condition of the mother and fetus and whether birth is imminent. Checking the fetal heart rate is one of the first assessments that should be carried out. Along with assessing the fetus, the nurse should also check the maternal blood pressure and temperature.

A woman had premature rupture of the membranes at 37 weeks of gestation. She went into labor within 10 hours and delivered a 7 lb, 12 oz boy after a 12-hour labor. In planning care for the newborn, it is important to monitor him for A. respiratory distress syndrome. B. transient tachypnea of the newborn. C. infections. D. cardiac anomalies.

C Both mother and newborn are at risk for infection during the postpartum period after premature rupture of the membranes.

Which type of uterine rupture may go undiagnosed during labor and the postpartum period? A. Complete rupture B. Incomplete rupture C. Dehiscence D. All the ruptures are detectable by electronic uterine monitoring.

C During a dehiscence of an old uterine scar, little or no bleeding may occur. No signs or symptoms may exist, and the rupture may be found incidentally during a subsequent cesarean birth or other abdominal surgery.

During birth, shoulder dystocia was diagnosed. After the birth and the newborn has been stabilized, it is important for the nurse to assess the newborn for A. hip dysplasia. B. lung excursion. C. fractured clavicles. D. clubfoot.

C During shoulder dystocia, the shoulders of the fetus are pushed hard against the symphysis and fractures of the clavicle may occur during the birth. The infant's clavicles should be checked for crepitus, deformity, and bruising, which suggest fractures.

A gravida 1 woman who is 39 weeks of gestation and has had no prenatal care is admitted into the labor unit in early labor. During the assessment, the nurse finds the fetal heart tones in the right upper quadrant. The nurse should anticipate A. a precipitous labor. B. a prolonged first stage of labor. C. a cesarean birth. D. rupture of membranes.

C Fetal heart tones are located in the upper quadrants when the fetus is in a breech presentation. A cesarean birth is usually performed for breech presentations in primigravid women to avoid complications, such as a prolapsed cord.

A woman admitted with preterm labor is started on nifedipine (Procardia) to reduce uterine muscle contractions. The nurse should include in this woman's care plan a nursing diagnosis of A. risk for deficient fluid volume. B. risk for infection. C. risk for injury. D. activity intolerance.

C Nifedipine is a vasodilator, so the woman may be prone to postural hypotension. She needs to be assisted when sitting or standing and taught about the effects of postural hypotension.

A woman who has been admitted for preterm labor is started on terbutaline (Brethine) to decrease uterine irritability. Within 24 hours, the contractions have stopped and the woman is resting comfortably. During vital sign assessment the nurse records a blood pressure reading of 125/74 mm Hg, pulse, 95 bpm, and respirations, 12 breaths per minute. The blood pressure and respirations are within limits of previous readings, but the pulse has increased from a previous reading of 74 to 80 bpm. The nurse's next action should be to A. assess for internal bleeding. B. continue to monitor the pulse rate at regular intervals. C. assess the fetal heart rate. D. reassess the vital signs in 1 hour.

C The most common side effect of terbutaline is maternal and fetal tachycardia.

Misoprostol (Cytotec), 50 mcg, has been ordered for a woman to assist with the ripening of the cervix. The nurse's action should be to A. administer the medication vaginally. B. administer the medication orally. C. question the dosage amount. D. monitor for contractions before administering the medication.

C The normal dose of misoprostol for cervical ripening is 25 mcg. A 50-mcg dose is associated with hypertonic contractions.

A patient is being discharged, having been diagnosed with false labor. The nursing diagnosis for her is Deficient Knowledge: characteristics of true labor. An appropriate expected outcome for this diagnosis is that the A. Patient will return to the hospital when she is in true labor. B. Patient will define true labor. C. Patient will describe reasons for returning to the hospital for evaluation. D. Patient will be able to determine false from true labor.

C The patient may not be able to determine true from false labor; however, she should be made aware of what signs to look for that may indicate the need for evaluation.

A primigravida is admitted in early labor. The nurse notices on the prenatal record that the position of the fetus is left occiput posterior. Because of this information, the nurse can anticipate A. a cesarean section. B. a short labor and birth process. C. increased back pain with labor. D. a short labor with a prolonged birth process.

C When the fetus is in the posterior position, the labor may be longer and more uncomfortable. Back discomfort increases with contractions and will continue between contractions. The fetus may not be able to deliver until it rotates into the anterior position.

A laboring woman just had an amniotomy performed to augment labor. The nurse is aware that the assessment times for which vital signs will be altered? A. Maternal blood pressure B. Maternal pulse C. Maternal temperature D. Maternal respiration

C With interruption of the membrane barrier, vaginal organisms have free access to the uterine cavity and may cause chorioamnionitis. Assessing the maternal temperature every 2 to 4 hours will be necessary to monitor for signs of infection.

On admission to the labor suite, a woman begins to cry out loudly, "Lord help me, I am going to die." She repeats this phrase loudly with each contraction. The nurse's best response would be to A. explain to the woman that she is disturbing other patients. B. praise her between contractions when she is quiet. C. understand that this may be a cultural mannerism and accept her individual response to labor. D. understand that this may be a cultural mannerism and do patient teaching to help her understand other ways of expressing her fear and pain.

C Women should be encouraged to express themselves in any way they find comforting. The cultural diversity of their expressions must be respected. Accepting a woman's individual response to labor and pain promotes a therapeutic relationship. Belittling her, praising her falsely, or trying to show her a "better way" of dealing with the pain will interfere with the therapeutic relationship and lower the woman's self-esteem.

All of the following women in labor are requesting pain medication. To which one should the nurse administer an opioid analgesic first? A. Primigravida, 2 cm dilated, 50% effaced, grimacing slightly with each contraction B. Gravida 4, 9 cm dilated, 100% effaced, wants to push with each contraction C. Gravida 2, 6 cm dilated, 100% effaced, rocks back and forth in bed with each contraction D. Primigravida, 1 cm dilated, moans loudly with each contraction, has present history of heroin use

C. The gravida 2 is well established into the labor and the medication will not slow the contractions. The primigravida who is 2 cm dilated is too early into the labor; the medication may slow or stop her contractions. The gravida 4 is too near birth and the medication may affect the newborn's respiratory effort. The primigravida who is 1 cm dilated has a history of heroin use; further opioid medication is not recommended.

A woman is receiving oxytocin for labor induction. The nurse notices the woman is having contractions every 2 minutes lasting for 100 seconds. The fetal heart rate is 120 to 130 bpm, with moderate variability. The nurse's next action should be to A. continue to monitor. B. notify the physician. C. turn off the oxytocin. D. turn the oxytocin up to a stronger level.

C. The uterine resting tone should have at least 30 seconds between contractions. This woman has a resting time of 20 seconds. The fetal heart rate and variability show no compromise at this time; however, hypertonic contractions can lead to decreased fetal oxygenation. The physician may need to be notified, but after corrective actions have been taken.

During labor, the nurse notices that the woman's support partner touches her lightly during contractions. When the woman is touched, she relaxes her muscles. The nurse realizes that the couple is using the technique of A. progressive relaxation. B. neuromuscular disassociation. C. touch relaxation. D. relaxation against pain.

C. During touch relaxation, the woman loosens taut muscles when they are touched by her partner. After practice during the pregnancy, the woman becomes conditioned to recognize the touch of her partner as a signal for the release of tension.

During the active stage of labor the woman is using a rapid "pant-blow" breathing pattern. She starts to complain of feeling dizzy and has some numbness in her fingers. The nurse's next action should be to A. notify the physician. B. do a vaginal exam to check for the progression of labor. C. have the woman breathe into a paper bag. D. offer pain medication.

C. Hyperventilation is common when breathing techniques are used. It results from rapid deep breathing that causes excessive loss of carbon dioxide and therefore respiratory alkalosis. Having the woman blow into a paper bag or her own cupped hands will increase her carbon dioxide level by having her rebreathe her exhaled air.

A woman is admitted in early labor. The prenatal record states that the fetus is in a transverse lie with a shoulder presentation. The nurse can anticipate a A. frequent change of positions for the mother to alter the fetal position. B. need for early fetal monitoring to assess for fetal heart changes. C. cesarean birth. D. prolonged second stage of labor.

C. A transverse lie with a shoulder presentation almost always ends with a cesarean birth.

A primigravida is in the latent phase of labor and is at low risk for complications of labor. She asks the nurse if she may walk for a few minutes. The nurse is aware that this is (is not) possible because A. continuous fetal monitoring is required. B. continuous monitoring of the contractions is necessary at this stage of labor. C. intermittent auscultation of fetal heart rate is appropriate for her. D. there is no need to assess fetal heart rate at this early stage of labor.

C. Continuous fetal and uterine monitoring is not necessary for the latent phase of labor in women who are at low risk for complications.

A woman must have general anesthesia for a planned cesarean birth because of a previous back surgery. The nurse should therefore expect to administer A. naltrexone (Trexan). B. an oral barbiturate. C. ranitidine (Zantac). D. promethazine (Phenergan).

C. During general anesthesia, there is a risk for maternal aspiration. To prevent lung injury if aspiration occurs, drugs such as ranitidine may be given to raise the gastric pH and make secretions less acidic. Naltrexone is an opioid antagonist, promethazine is used to relieve nausea, and barbiturates are sedating.

3. The midwife records that the patient's cervix is "100%, 5 cm." The nurse understands that the patient's cervix is A. completely dilated and effaced. B. completely dilated and half-effaced. C. completely effaced and half-dilated. D. half-dilated and half-effaced.

C. Effacement is measured in percentages. The fully thinned cervix is 100% effaced. The dilation is measured in centimeters; dilation goes from closed to 10 cm. This patient is completely effaced and halfway dilated.

A woman who is about 37 weeks' gestation tells the nurse that for some reason this morning she can breathe easier. The nurse can best explain this as being a A. concern, and the fetus needs to be assessed. B. normal change toward the end of the pregnancy caused by a decreased use of oxygen by the fetus. C. normal change because of the fetus's dropping down into the pelvis region, relieving the pressure on her diaphragm. D. normal change caused by the maternal cardiac output increasing as she gets closer to labor.

C. Lightening occurs toward the end of the pregnancy as the fetus descends toward the pelvic inlet. When this occurs, the woman notices that she breathes more easily because upward pressure on her diaphragm is reduced.

After birth, the woman complains of chills. The first intervention by the nurse should be to A. monitor the maternal temperature. B. monitor the maternal blood pressure. C. place a warm blanket on the woman. D. explain to the woman this is caused by the excitement of birth and will stop in about 30 minutes.

C. Many women are chilled after birth. The cause of this reaction is unknown but probably relates to the sudden decrease in effort, loss of the heat produced by the fetus, decrease in intraabdominal pressure, and fetal blood cells entering the maternal circulation. The chill lasts for about 20 minutes and subsides spontaneously. A warm blanket may help shorten the chill.

Firm contractions that occur every 3 minutes and last 100 seconds may reduce fetal oxygen supply because they A. cause fetal bradycardia and reduce oxygen concentration. B. activate the fetal sympathetic nervous system. C. limit the time for oxygen exchange in the placenta. D. suppress the normal variability of the fetal heart.

C. The resting time between these contractions is about 80 seconds, which reduces the time available for exchange of oxygen and waste products in the placenta. This will reduce the fetal oxygen supply. The other choices can all be results of the decreased oxygen supply.

When doing a vaginal exam, the nurse notes a triangular-shaped depression toward the mother's left side and pointing up toward her abdomen. The nurse can record the fetal position as A. LOP. B. ROP. C. LOA. D. ROP

C. The triangular shape is the posterior fontanel, which makes the positioning part the occiput. The posterior fontanel is toward the mother's left side and anterior. This makes the position left occiput anterior (LOA).

During contractions the fetus has mechanisms in place to protect it from the decrease in blood flow. Those mechanisms include A. fetal hemoglobin levels that are more resistant to oxygen. B. lower hemoglobin and hematocrit levels. C. a high cardiac output level. D. a higher respiratory level.

C. To prepare for labor, the fetus develops hemoglobin levels that readily take on oxygen and release carbon dioxide. The fetal hemoglobin and hematocrit levels are higher to have more oxygen-carrying capacity. The fetus has a higher cardiac output level. The fetus does not breathe yet, so there is no respiratory count.

Which one(s) of the following would be an indication for a cesarean birth? (Select all that apply.) A. Maternal coagulation defects B. Fetal death C. Cephalopelvic disproportion D. Active genital herpes E. Persistent nonreassuring FHR patterns

CDE Possible indications for cesarean birth include, but are not limited to, the following: dystocia; cephalopelvic disproportion; hypertension, if prompt delivery is necessary; maternal diseases such as diabetes, heart disease, or cervical cancer, if labor is not advisable; active genital herpes; some previous uterine surgical procedures such as a classic cesarean incision or removal of fibroid tumors; persistent indeterminate or abnormal FHR patterns; prolapsed umbilical cord; fetal malpresentations such as breech or transverse lie; hemorrhagic conditions such as abruptio placentae or placenta previa; and maternal request.

Research has found that bed rest as an intervention for preventing preterm labor can result in A. maternal weight gain. B. diarrhea. C. increased maternal plasma volume and cardiac output. D. bone demineralization, with calcium loss.

D Calcium loss from bones can begin as early as 3 days after the onset of bed rest. Weight loss, constipation, and a decrease in plasma volume and cardiac output are associated with bed rest.

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia would be A. severe postpartum headache. B. limited perception of bladder fullness. C. increase in respiratory rate. D. hypotension.

D. Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure. Headache is not a common side effect because the spinal fluid is not normally disturbed by this anesthetic as it would be with a low spinal anesthetic. Option B is an effect of epidural anesthesia but is not the most harmful. Respiratory depression is a potentially serious complication.

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe which one of the following? A. Weight gain of 1 to 3 lb B. Quickening C. Fatigue and lethargy D. Bloody show

D. Premonitory signs of labor (prodromal labor) include weight loss of 1 to 3 lb, a burst of energy or the nesting instinct, and passage of the mucus plug (also termed pink or bloody show) as the cervix ripens. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks' gestation.

Which one of the following findings meets the criteria of a Category I FHR pattern? A. The FHR does not change as a result of fetal activity. B. The average baseline rate ranges between 90 and 110 bpm. C. Mild late deceleration patterns occur with some contractions. D. Variability averages between 6 and 25 bpm.

D. Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system. The FHR should accelerate with fetal movement. Baseline range for the FHR is from 110 to 160 bpm. Late deceleration patterns are never reassuring.

As full term nears, the cervix softens because of the effects of the hormone relaxin and increased water content. This cervical change is termed_______________.

RIPENING

When pressure is applied to the fetal chin through the perineum at the same time pressure is applied to the occiput of the fetal head, it is termed the _______________.

Ritgen maneuver

Fluctuations in the baseline FHR that cause the printed line to have an irregular rather than a smooth appearance is termed ___________________.

VARIABILITY

A vaginal birth after cesarean is often abbreviated __________.

VBAC

The technique of delaying pushing until the reflex urge to push occurs may be called _____________________.

delayed pushing, laboring down, rest and descend, or passive pushing

The laboring woman may rub her abdomen during a contraction to counteract discomfort. This is called ______________________.

effleurage

The term that describes a labor lasting 3 hours or less is ____________.

precipitous labor

If the head retracts against the perineum after the birth, it is commonly referred to as the __________________.

turtle sign