OB Exam 3

Which of the following is an appropriate response about the use of narcotics during labor? Select all that apply. A. "Narcotics may prolong labor if given too early." B. "Narcotics can decrease uterine activity." C. "Narcotics are very effective in early labor."

AB

What are the possible complications that a newborn can get from a mother positive for GBS during the birthing process? A. Sepsis B. Jaundice C. Meningitis D. Pneumonia

ACD

Select all the factors which put a patient at risk for umbilical cord prolapse: A. Abnormal fetal presentation, i.e. breech B. Fetal macrosomia C. Fetus in lower station at time of membrane rupture D. Preterm labor E. Twins

ADE

Which of the following are examples of mechanical induction? A. Stripping of membranes B. Laminaria C. Artificial rupture of membranes (amniotomy) D. Intercourse

B (A&C = surgical)

There are four essential components of labor. The first is the passageway. Which of the following are components of the passageway? A. uterus B. vagina C. cervix D. bony pelvis

BCD

This type of cervical ripening technique cannot be used in patients with previous uterine scars A. Alternative therapies B. Mechanical intervention C. Surgical intervention D. Pharmalogical (Prostaglandins)

D

When the cervix thins to allow the presenting fetal part to descend into the vagina

Effacement

True or false labor? Contractions are irregular and not occurring close together

False

These drugs promote uterine relaxation by interfering with uterine contraction

Tocolytic

A fetus is assessed at 2 cm above the ischial spines. How would the nurse document the fetal station?

-2

A woman is having contractions every 5-10 min and she is at 2 cm dilation, 50% effacement, and -2 station. What phase of labor is she in? A. First stage, latent phase B. First stage, transitional phase C. First stage, active phase D. Second stage

A

During this phase the patient will often be talkative, excited, and/or anxious A. First stage - latent phase B. First stage - active phase C. First stage - transitional phase D. Second stage - pelvic phase E. Second stage - perineal phase

A

In which position(s) can the fetus be delivered vaginally? Select all that apply: A. longitudinal B. transverse C. oblique

A

This med must be kept cold. It stimulates the uterus and is used to prevent/treat postpartum hemorrhage due to atony A. Methylergonovine maleate (Methergine) B. Oxytocin (Pitocin) C. Misoprostol (Cytotec) D. Carboprost (Hemabate) E. Tranexamic acid (TXA)

A

In what situation(s) would you expect a pudendal block to be used? Select all that apply: A. per mother's request for pain control B. forcep/vacuum assisted delivery C. episiotomy D. after an epidural E. for emergent c-section

ABC

Which of the following are common fetal/neonatal injuries seen after shoulder dystocia? A. Fractured clavicle B. Erb's palsy C. Asphyxia D. Fractured femur E. Talipes equinovarus

ABC

The nurse is discussing pain relief methods for a pregnant first-time mother. The discussion should include which labor support methods? Select all that apply. A. effleurage B. progressive relaxation C. guided imagery D. positive reinforcement

ABC (effleurage = method of light massage)

A primigravida states, "I think my water just broke." What should the nurse do? Select all that apply. A. Perform a nitrazine test to confirm that the membranes are ruptured. B. Monitor the fetal heart rate and pattern. C. Assess maternal temperature. D. Prepare the client for childbirth.

ABC (temp should be assessed every 1 to 2 hours so infection can be identified early)

The labor and delivery nurse is admitting a client at 39 weeks' gestation who is in early labor. The nurse performs the Leopold maneuver and discovers the fetus is in a transverse lie. What action(s) should the nurse take based on this information? A. Notify the health care provider. B. Place the doppler for monitoring fetal heart rate (FHR). C. Establish intravenous access. D. Draw blood for complete blood count, type, and crossmatch.

ABCD (note, a fetus in a transverse lie cannot be delivered vaginally)

The health care provider (HCP) has performed an amniotomy on a laboring client. Which details must be included in the documentation of this procedure? Select all that apply. A. odor and amount of fluid B. color and clarity of fluid C. time of rupture D. size of amnio-hook used during the procedure E. fetal heart rate (FHR) and pattern before and after the procedure

ABCE (there is only one size of hook)

What assessment findings indicate that the multiparous client is in the transitional phase of the first stage of labor? Select all that apply. A. contractions hard by palpation B. cervix dilated to 8 cm C. contractions occurring every 5-10 minutes and last approximately 60 seconds D. cervix effaced at 80%

ABD

While a client is being admitted to the birthing unit she states, "My water broke last night, but my labor started two hours ago." Which findings are a concern? Select all that apply. A. client stating, "This baby wants out—he keeps kicking me." B. peripad stained with green fluid C. blood and mucus on perineal pad D. baseline fetal heart rate of 140 with a range between 110 and 160 with contractions

ABD (range of fetal HR fluctuating too high and low could indicate distress)

A nurse is monitoring a full-term laboring client on oxytocin. What interventions would be priorities for the nurse if the client experiences late decelerations? Select all that apply A. Position the client on her left side B. Report the findings to the heath care professional (HCP) C. Perform a vaginal examination for prolapsed cord D. Give oxygen E. Stop the infusion of oxytocin

ABDE (late decelerations indicate the fetus is affected by placental insufficiency)

A pt w/ ruptured fetal membranes has been in labor for several hours. Which S/S of infection would the nurse report to the primary provider? A. Cloudy, foul smelling discharge B. Maternal BP of 104/62 C. Fetal HR 168 bpm D. Maternal temp of 100.2

AC

For which purposes are Leopold maneuvers performed? Select all that apply. A. determining the position of the fetus B. determining the weight of the fetus C. determining the lie of the fetus D. determining the presentation of the fetus E. determining the size of the fetus

ACD

In which cases is carboprost (Hemabate) contraindicated? Select all that apply A. History of asthma B. Colitis C. ESRD D. CHF E. History of PCOS

ACD (contraindicated in pt's w/ Hx asthma or active cardiac, pulmonary, renal, or hepatic disease)

The nurse is caring for a client in early labor. The client reports sudden abdominal pain and is noted to have bright red bleeding. What would the nurse include in the client's plan of care? Select all that apply. A. Examine the fetal heart monitoring tracing. B. Examine the client's cervix. C. Call the healthcare provider. D. Administer oxygen to the client.

ACD (examining the cervix w/ active bleeding is contraindicated without further info)

A nurse is assigned to assist with the admission of a laboring client. Which of the following actions are appropriate? Select all that apply. A. asking about the estimated date of childbirth B. estimating fetal size C. taking maternal and fetal vital signs D. administering an analgesic E. asking about the amount of time between contractions

ACE

The nurse is caring for a client in labor. Which assessment findings would prompt the nurse to f the healthcare provider? Select all that apply. A. The client's membranes rupture and the amniotic fluid is green B. Blood-tinged mucous is noted upon internal examination C. Fetal HR between 140 and 150 beats/min D. Late decelerations are noted on the external fetal monitor strip E. Maternal anxiety

AD

This occurs when labor has started but slowed/halted and delivery is necessary

Augmentation

In nullipara this stage lasts up to 6 hours, with multipara it lasts about 4 hours A. First stage - latent phase B. First stage - active phase C. First stage - transitional phase D. Second stage - pelvic phase E. Second stage - perineal phase

B

The nurse is monitoring a client who is in the second stage of labor, at +2 station, and anticipating birth within the hour. The client is now reporting the epidural has stopped working and is begging for something for pain. Which action should the nurse prioritize? A. Call the primary care provider, and obtain a reduced dose of meperidine B. encourage her through the contractions, explaining why she cannot receive any pain medication C. Give the meperidine because she needs pain relief now D. call the anesthetist from the nurse's station to retry the epidural.

B (At this point, any medication would be contraindicated as it would pass to the fetus and may cause respiratory depression)

The nurse is caring for a client who is in the third stage of labor. Which behaviors by the client does the nurse assess as expected at this stage? Select all that apply. A. exhausted from continued pushing B. reports discomfort from uterine cramping C. focused on the neonate's condition D. apprehension about the future

BC (In the third stage of labor, the neonate is delivered, and the placenta has yet to be expelled. A this time, the client is usually focused on the neonate's condition. Before the placenta is expelled, she may also state that she is experiencing discomfort from uterine contractions)

When discussing adverse side effects of oxytocin, which conditions would the graduate nurse notify the registered nurse of immediately? A. jaundice in the sclera B. fluid overload with crackles in the lung fields C. palpable uterine tetany D. a blood pressure of 170/92 mm Hg E. bradycardia

BCD (The antidiuretic effect of oxytocin increases renal reabsorption of water, leading to fluid overload)

A client who is 29 weeks pregnant comes to the labor and childbirth unit. She states that she is having contractions every 8 minutes. The client is also 3 cm dilated. Which can the nurse expect to administer? Select all that apply. A. nalbuphine B. a β-2 agonist C. betamethasone D. intravenous fluids E. folic acid

BCD (a β-2 agonist will relax smooth muscle to halt contractions; betamethasone, a corticosteroid, will be administered to decrease the risk of respiratory distress to the neonate if preterm birth occurs; and IV fluids will be given to expand the intravascular volume and decrease contractions if dehydration is the cause)

A client in labor is given 25 mg of intravenous (IV) meperidine for labor pain. The nurse should monitor the client for which adverse effects of the drug? Select all that apply. A. hypertension B. nausea and vomiting C. respiratory depression D. tachycardia E. urinary retention

BCDE

List the 3 medications that ALL perioperative patients get: A. oxytocin (Pitocin) B. metoclopramide (Reglan) C. ondasetron (Zofran) D. morphine (MS Contin) E. sodium citrate (Bicitra)

BCE

The nurse is caring for a client in labor who has requested epidural anesthesia. Which will the nurse include in the client's plan of care? Select all that apply A. monitoring blood pressure every 4 hours B. infusing fluid bolus prior to epidural anesthesia C. maintaining client in a Fowler's position after epidural insertion D. applying continuous external fetal heart monitoring E. applying oximetry during insertion of epidural anesthesia

BDE (epidural anesthesia can drop a pt's BP and will affect the fetal HR, BP should be monitored ~ Q30 min)

Shoulder dystocia is a complication of labor related to which factor? A. Uterine contractions of inadequate strength B. The volume of amniotic fluid C. Prolonged second stage of labor D. Prolonged active phase of labor

C

The mother is asking to nurse her baby but the nurse notices the newborn shivering in the warmer. What action will the nurse take next? A. Assess lung sounds B. Offer emotional support to mother C. Obtain a blood glucose level D. Instruct the mother to keep the newborn wrapped in a blanket E. Call the doctor

C

The posturing (flexion/extension) of the joints and the relationship of fetal parts to one another A. Fetal presentation B. Fetal lie C. Fetal attitude D. Fetal station E. Fetal engagement

C

Which pain-relief measure is used for c-section? Select all that apply: A. Epidural B. Pudendal block C. Spinal anesthesia D. Oral analgesics

C (numbs from the chest down)

A pt asks the nurse about the use of narcotics. Which of the following is the nurse's appropriate response about the use of narcotics? Select all that apply. A. "Narcotics cause variable fetal heart rate accelerations." B. "Narcotics are very effective in early labor." C. "Narcotics can decrease uterine activity." D. "Narcotics may prolong labor if given too early."

CD

Maternal postpartum fever is common using this type of cervical ripening technique A. Alternative therapies B. Mechanical intervention C. Surgical intervention D. Pharmalogical (Prostaglandins)

D

To assess the frequency of a woman's labor contractions, the nurse would time: A. the interval between the acme of two consecutive contractions B. the end of one contraction to the beginning of the next C. how many contractions occur in 1 minute D. the beginning of one contraction to the beginning of the next

D

What is the purpose of the Bishop score? A. Rules out placental insufficiency B. To check for fetal station C. To evaluate dilation D. To check for cervical ripeness

D

Active pushing occurs in this phase A. First stage - latent phase B. First stage - active phase C. First stage - transitional phase D. Second stage - pelvic phase E. Second stage - perineal phase

E

This med reduces bleeding by inhibiting the enzymatic breakdown of fibrin blood clots. Side effects include N/V and diarrhea A. Methylergonovine maleate (Methergine) B. Oxytocin (Pitocin) C. Misoprostol (Cytotec) D. Carboprost (Hemabate) E. Tranexamic acid (TXA)

E

When the presenting part of the fetus reaches 0 station, __________ has occurred. A. Fetal presentation B. Fetal lie C. Fetal attitude D. Fetal station E. Fetal engagement

E

True or false: a newborn's chest circumference is usually 1 to 2 cm larger than the head circumference.

False (chest circumference is generally 1-2 cm smaller than head circumference)

A ____________ refers to a transient fall in fetal heart rate due to stimulation of the parasympathetic nervous system.

deceleration

While caring for a client in the transition phase of labor, the nurse notes that the fetal monitor tracing shows moderate variability with a baseline of 142 beats per minute (bpm). Is this normal or abnormal?

normal

In a cephalic presentation, the presenting part is usually the ________ portion of the fetal head.

occipital

_______________ labor is one that is completed in less than 3 hours

precipitous