OB practice questions (3.3)

The nurse is caring for a client who had a classical uterine incision for her cesarean birth. The nurse knows that the client understands implications for future pregnancies that are secondary to her classical uterine incision when the client makes which of the following statements? A. "Every time I have a baby, I will have to have a cesarean delivery." B. "The next time I have a baby, I can try to deliver vaginally." C. "I can only have one more baby." D. "The risk of rupturing my uterus is too high for me to have any more babies."

A. "Every time I have a baby, I will have to have a cesarean delivery."

A parent asks the nurse why her infant is receiving a vitamin K injection. Which of the following responses by the nurse is appropriate? A. "It is given to prevent bleeding in the newborn." B. "It helps the baby get rid of meconium." C. "This medication helps the baby's liver develop." D. "This helps to stimulate the baby's immune system."

A. "It is given to prevent bleeding in the newborn."

The nurse is caring for an infant who is small for gestational age (SGA). Which of the following are complications of an SGA infant that the nurse should be aware of? Select all that apply. A. Hypothermia B. Hyperbilirubinemia C. Hypoxia D. Hypoglycemia E. Aspiration

A. Hypothermia C. Hypoxia D. Hypoglycemia E. Aspiration

The nurse is educating parents about safety precautions for their newborn. Which topics should the nurse discuss prior to discharge? Select all that apply. A. Keep a hand on the newborn when out of the crib. B. Bring the newborn to the nurses' station if parents feel weak or faint. C. Avoid leaving the newborn in the hospital room alone. D. Wash hands often to protect the newborn from germs. E. Ask hospital staff for identification if they are not wearing it.

A. Keep a hand on the newborn when out of the crib. C. Avoid leaving the newborn in the hospital room alone. D. Wash hands often to protect the newborn from germs. E. Ask hospital staff for identification if they are not wearing it.

The nurse is caring for a woman following a cesarean delivery with a low transverse incision. What are the advantages of a low transverse uterine incision versus a classical incision for a cesarean birth? Select all that apply. A. Less likely to rupture with subsequent pregnancies B. More appropriate for preterm births or multiple gestations C. Easier to repair surgically D. Less likely to cause bowel adhesions E. Involves less blood loss

A. Less likely to rupture with subsequent pregnancies C. Easier to repair surgically D. Less likely to cause bowel adhesions E. Involves less blood loss

Which nursing intervention will facilitate understanding of discharge teaching with a new mother who does not speak English? A. Requesting an interpreter for assistance B. Informing the client she will get instructions at the Health Department C. Speaking slowly and loudly D. Providing written instructions in English

A. Requesting an interpreter for assistance

The nurse is assessing a sleeping, 1-hour-old newborn. Which data would the nurse report to the provider as concerning? A. Respirations 78 breaths/min B. Temperature 97.9°F C. Heart rate 122 beats/min D. Brief periods of apnea lasting less than 5 seconds

A. Respirations 78 breaths/min

The nurse is preparing a checklist of educational topics for discharge teaching with new parents. Which topics will the nurse include? Select all that apply. A. Use of a bulb syringe B. Infant swaddling C. Skin and bathing care D. Circumcision care E. Maintaining a strict feeding schedule

A. Use of a bulb syringe B. Infant swaddling C. Skin and bathing care D. Circumcision care

A client who has undergone a vacuum-assisted birth asks the nurse how long the swelling on the infant's head will remain. Which would be the best response by thenurse? A. 12-24 hours B. 48-72 hours C. 8-12 hours D. 5-7 days

B. 48-72 hours

The nurse assesses excessive oral and nasal secretions in a newborn and begins suctioning. The nurse will monitor for which complication of mechanical suctioning? A. Increased blood pressure B. Decreased heart rate C. Decreased level of consciousness D. Increased temperature

B. Decreased heart rate

The nurse is caring for a client who is scheduled for induction of labor. Which of the following conditions are indications for induction? Select all that apply. A. Multiple gestation B. Diabetes mellitus C. Preeclampsia D. Post term gestation E. Fetal demise

B. Diabetes mellitus C. Preeclampsia D. Post term gestation E. Fetal demise

A client is going to have an external version for a transverse fetus and is concerned about the terbutaline she is about to receive. The nurse explains that terbutaline (a tocolytic) is used to do which of the following? A. Prevent preterm labor B. Relax the uterus C. Lower the maternal blood pressure D. Prevent abruptio placentae

B. Relax the uterus

The nurse is caring for an infant delivered at 32 weeks gestation. Oxygen therapy has been ordered. The nurse should identify which of the following as potential indications of the need for oxygen? Select all that apply. A. Hyperbilirubinemia B. Respiratory distress C. Aspiration syndrome D. Hypothermia E. Congenital diaphragmatic hernia

B. Respiratory distress C. Aspiration syndrome E. Congenital diaphragmatic hernia

A mother asks the nurse how she will know if her newborn is having difficulty breathing. The nurse would instruct the mother to monitor for which of the following signs? Select all that apply. A. Crying B. Retractions C. Nasal flaring D. Central cyanosis E. Grunting

B. Retractions C. Nasal flaring D. Central cyanosis E. Grunting

A mother asks the nurse when she can breastfeed her infant who has just been born. The nurse explains the optimal time to initiate the newborn's first feeding is when? A. Before the first bath B. Soon after birth, before the infant is taken to the nursery C. After the first bath D. After all prophylactic medications have been administered in the nursery

B. Soon after birth, before the infant is taken to the nursery

A woman has just delivered an 8 lb 8 oz baby boy. After the delivery, the nurse notices that the mother is chilly and her fundus has relaxed. The nurse administers the oxytocin that the heath care provider orders. What occurrence will alert the nurse that the oxytocin has the expected effect? A. The mother states she feels warmer now. B. The uterus becomes firm. C. The baby cries. D. The mother falls asleep.

B. The uterus becomes firm.

A client is going to have a cephalic version at 38 weeks gestation for a breech presentation. The nurse determines that the client has understanding of the procedure when the client makes which of the following statements? A. "The procedure cannot be stopped even if my baby shows signs of distress." B. "My baby's head will be turned slightly to make the delivery easier." C. "My baby will be turned to a head-down position." D. "After the baby is turned, I must remain in bed."

C. "My baby will be turned to a head-down position."

The nurse is caring for several postpartum families. Which of the following parents may not wish to have their child circumcised due to cultural or religious beliefs? Select all that apply. A. 31-year-old Muslim mother B. 30-year-old Jewish couple C. 27-year-old Asian mother D. 20-year-old Caucasian mother E. 34-year-old Hispanic female

C. 27-year-old Asian mother E. 34-year-old Hispanic female

An infant is born after an uneventful labor with Apgar scores of 5 and 6. Within 10 minutes of birth the infant has no respirations and is centrally cyanotic. What is the initial action of the nurse? A. Repeat the Apgar again in 10 minutes. B. Administer a glucose feeding. C. Begin neonatal resuscitation. D. Assess vital signs.

C. Begin neonatal resuscitation.

The health care provider of a client at 40 weeks gestation has ordered Cytotec for labor induction. The nurse should be aware that Cytotec will produce what change for this client? A. Decrease pain B. Rupture membranes C. Cervical ripening D. Decrease anxiety

C. Cervical ripening

Prior to discharge from the hospital, the nurse should ensure parents have which of the following safety measures in place? A. A dishwasher to sanitize all bottles B. Cabinet locks on all base units C. Properly installed infant car seat D. A baby-monitoring system

C. Properly installed infant car seat

The nurse is evaluating teaching about normal newborn care. Which statement by the parents indicates that further teaching is needed? A. "It is okay if I give the baby a bath every other day." B. "I will clean the baby's diaper area after each soiled diaper." C. "I will fold the top of the diaper down so it will not cover the cord." D. "I can use powder to help prevent diaper rash."

D. "I can use powder to help prevent diaper rash."

The nurse is instructing a laboring client on breathing for pushing. Which statement is appropriate to use when asking the client to perform directed pushing? A. "Take three quick breaths and one slow one with each push." B. "Exhale deeply with each push." C. "When the contraction starts, take two deep breaths and breathe through the pushing." D. "When your contraction starts, hold your breath for 10 seconds and push."

D. "When your contraction starts, hold your breath for 10 seconds and push."

The nurse is caring for four newborns. The nurse would question a health care provider's order for circumcision in which of the following newborns? A. 39-week male weighing 8 lb 4 oz. B. 40-week male with 5th digit on left toe C. 38-week male twins D. 35-week male newborn

D. 35-week male newborn Rationale Circumcision should not be performed on a newborn who is compromised in any way including prematurity. Also, circumcision should not be performed on a newborn with a penile deformity such as hypospadias or epispadias. A full-term infant with a 5th digit is not compromised such that circumcision is contraindicated. There is no a contraindication for performing circumcisions on male twins. There is no contraindication to performing a circumcision on a term infant with a healthy weight.

A newborn, at 1 minute after a vaginal delivery, has a heart rate of 140, has prompt response to stimulation with crying, is pink with blue hands and feet, has a lusty cry, and maintains minimal flexion with sluggish movement. What will the nurse record as the Apgar score? A. 7 B. 10 C. 9 D. 8

D. 8

A father brings his newborn, who weighed 7 lb 0 oz. at birth, in for a 1-week well-baby checkup. The nurse notices the newborn's weight today is 5 lb 1 oz. What is the appropriate action by the nurse? A. Notify the provider immediately. B. Document the weight as an expected finding. C. Prepare for IV administration of fluids. D. Collect information about feeding patterns from the father.

D. Collect information about feeding patterns from the father. Rationale The newborn may lose up to 10% of its birth weight during the first week of life. It is expected this will be regained within the first 2 weeks of life. The weight loss of this infant exceeds 10% of the birth weight. It is appropriate for the nurse to assess for information about infant feeding as the initial action. The nurse would document a weight loss of more than 10% of the birth weight as an expected finding. The nurse should collect further information about infant feeding and health status prior to discussing the concern with the provider. The nurse should not anticipate the need for administration of IV fluids unless the newborn is exhibiting signs of dehydration. The nurse would assess further before planning this intervention.

The client about to have a forceps-assisted delivery asks what complications can occur. The nurse understands that which of the following is a potential maternal complication of a forceps delivery? A. Maternal hypertension B. Uterine rupture C. Erb's palsy D. Postpartum infection

D. Postpartum infection

The nurse is assessing a laboring client. Which assessment finding provides objective information about the level of visceral pain the client may be experiencing? A. Shortness of breath B. Diarrhea C. Baseline fetal heart rate of 140 beats per minute D. Uterine activity

D. Uterine activity

What is the preferred type of pushing that will allow the woman and her fetus to maintain their oxygenation? A. Open glottis B. With contractions C. Structured D. Closed glottis

Open Glottis??? With contractions

A G3P2 client presents at 38 weeks gestation with a transverse lie. The nurse is preparing the client for an external version. Which client statement indicates that the client understands the procedure? Select all that apply. A. "I will need to get an IV started for the procedure." B. "I will have an ultrasound done after the procedure." C. "I will need a nonstress test before the procedure." D. "I will be starting labor after the procedure." E. "The procedure is uncomfortable."

A. "I will need to get an IV started for the procedure." B. "I will have an ultrasound done after the procedure." C. "I will need a nonstress test before the procedure." E. "The procedure is uncomfortable."

The nurse is caring for a client who will be having a cesarean delivery. Which of the following statements by the client would cause the nurse to determine that the client does not understand what to expect during a cesarean delivery? A. "I will receive a blood transfusion during surgery." B. "My husband can be present during birth." C. "I may be given an antacid before surgery." D. "An indwelling (Foley) catheter will be inserted before surgery."

A. "I will receive a blood transfusion during surgery."

The nurse is caring for several pregnant clients in the prenatal setting. Which of these clients should the nurse anticipate being most likely to have a newborn at risk for mortality or morbidity? A. 37-year-old G8 P2323, in her second marriage B. 28-year-old G2 P1001, history of gestational diabetes C. 16-year-old primip, began prenatal care at 30 weeks D. 23-year-old primip, low socioeconomic status, unmarried

A. 37-year-old G8 P2323, in her second marriage Rationale Risks factors associated with high-risk newborns include maternal demographic factors such as low socioeconomic status, younger than age 17 or older than age 35, the number of previous pregnancies and children the woman has delivered, access or lack of access to prenatal care, pre-existing maternal medical conditions such as hypertension or diabetes, and pregnancy complications such as pre-eclampsia, placenta previa or abruption, preterm labor, or premature rupture of membranes. The more risk factors a woman has, the greater risk for the infant.

The nurse is using the Ballard Assessment tool to assess the gestational age of a newborn delivered 2 hours ago. The infant is 36 weeks by early ultrasound and last menstrual period. What will the nurse include in this assessment of the newborn? A. Amount of lanugo, skin appearance, and arm recoil B. Heart rate, respiratory rate, and temperature C. First void, rooting reflex, and skin color D. Sleep pattern, strength of cry, and sucking reflex

A. Amount of lanugo, skin appearance, and arm recoil

How does meconium aspiration syndrome (MAS) present? A. As severe respiratory distress B. As severe hypoglycemia C. As severe jaundice D. There are no visible symptoms.

A. As severe respiratory distress

The health care provider has performed an amniotomy on a client in labor. Which interventions by the nurse are indicated when caring for this client during and immediately following the procedure? Select all that apply. A. Assessment of the amount of amniotic fluid B. Assessment of fetal heart rate C. Assessment of the amniotic fluid color D. Assessment for prolapse of umbilical cord E. Assessment for cervical dilation

A. Assessment of the amount of amniotic fluid B. Assessment of fetal heart rate C. Assessment of the amniotic fluid color D. Assessment for prolapse of umbilical cord

The cervix of a multigravida client in active labor who received epidural anesthesia 4 hours ago is now completely dilated, and the client is ready to begin pushing. Before the client begins to push, which of the following would the nurse assess? A. Bladder status B. Fetal heart rate variability C. Status of membranes D. Cervical dilation again

A. Bladder status

The nursery has been informed of the completion of an uncomplicated vaginal delivery at 15:30. The nurse prepares for her assessment of the newborn. When should this assessment be performed? A. By 17:30 B. At change of shift C. By 18:30 D. By 16:30

A. By 17:30

Wen was born with a congenital diaphragmatic hernia (CDH). Explain how you could help optimize the newborn's normal lung to function. A. By placing Wen with her head and chest elevated on the affected side B. By placing Wen with her feet elevated on the affected side C. By placing an orogastric tube to full suction D. By placing Wen with her head and chest elevated on the unaffected side

A. By placing Wen with her head and chest elevated on the affected side

Which of the following is a psychosocial factor that affects a laboring client's perception of pain? A. Childbirth education B. Intensity of labor C. Cervical readiness D. Fatigue

A. Childbirth education

The nurse is working with a student nurse during assessment of a 2-hour-old healthy newborn. Which action of the student nurse indicates that the student nurse understands neonatal assessment? A. Counts respirations and apical heart rate for 1 minute B. Obtains a blood pressure first C. Stimulates the newborn so the newborn will be alert for the assessment D. Listens to lung sounds when the newborn is crying

A. Counts respirations and apical heart rate for 1 minute

A woman who has been in labor for 5 hours is now 9 cm dilated and has intense contractions every 1 to 2 minutes. She is anxious and feels the need to bear down with her contractions. What is the best action for the nurse to take? A. Encourage panting through contractions to prevent pushing. B. Reposition her in a left side-lying position to make her more comfortable. C. Provide back rubs during contractions to distract her. D. Allow her to push so that delivery can be expedited.

A. Encourage panting through contractions to prevent pushing. Rationale The client is still in transition and not ready to deliver; encouraging her to pant will diminish the urge to push. Putting her in a left side-lying position at this time will probably not make her any more comfortable. She is feeling the pressure of the fetus on her rectum and turning her to the left side will not relieve this pressure. During transition most women do not like being touched.

A pregnant client expresses concern about the pain associated with labor. Which nursing interventions are appropriate? Select all that apply. A. Explaining the types of pain associated with labor B. Sharing information about the progressive nature of pain during labor C. Encouraging the client to receive an epidural for pain control D. Encouraging the client not to think about the pain while she is pregnant E. Suggesting a childbirth education class

A. Explaining the types of pain associated with labor B. Sharing information about the progressive E. Suggesting a childbirth education class

The nurse is caring for a client who had a cesarean section delivery 12 hours ago with a spinal block. Which of the following assessment findings would the nurse report to the provider? A. Headache that worsens with sitting up B. Mild breast tenderness with palpation C. Abdominal cramping rates as a 3 on a 1-10 scale D. Lochia rubra, moderate amount, fundus firm

A. Headache that worsens with sitting up

While attending a delivery, the provider asks the nurse to assist with a pudendal block. The nurse monitors the client for which of the following? Select all that apply. A. Hematoma formation B. Numbness or tingling in the back and upper legs C. Allergic response to the anesthetic agent D. Hypotension E. Puncture of the rectum

A. Hematoma formation B. Numbness or tingling in the back and upper legs C. Allergic response to the anesthetic agent E. Puncture of the rectum

The nurse in the special care nursery is caring for a newborn who has been diagnosed with a congenital diaphragmatic hernia. Which of the following positions would be best for the nurse to place the newborn in? A. High Fowler B. Prone C. Side lying D. Supine

A. High Fowler

The nurse is caring for a newborn born to a drug-addicted mother. Which of the following assessment findings would be common for this newborn? Select all that apply. A. Irritability B. Excessive sucking C. Tremors D. Depressed respiratory effort E. Decreased muscle tone

A. Irritability B. Excessive sucking C. Tremors Newborns born to drug-addicted mothers exhibit hyperactivity, high-pitched cry, irritability, inconsolability, excessive sucking, feeding problems, vomiting/diarrhea, skin excoriations, and tremors.

The student nurse is assessing a newborn to determine if the newborn is small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age (LGA). What should be included as part of this assessment? Select all that apply. A. Length B. Head circumference C. Weight D. Vital signs E. Ballard Assessment

A. Length B. Head circumference C. Weight E. Ballard Assessment

Which medication would the nurse expect to be used during repair of an episiotomy? A. Lidocaine B. Tylenol with codeine C. Mineral oil D. Nubain

A. Lidocaine

Which of the following would you associate with high-risk newborns? Select all that apply. A. Maternal age younger than 17 B. First pregnancy C. Preterm labor D. Placenta previa E. Maternal age older than 30

A. Maternal age younger than 17 C. Preterm labor D. Placenta previa

After reviewing the maternal record, the nurse is performing an assessment on a newborn. What maternal factors may contribute to the birth of an at-risk infant? Select all that apply. A. Maternal smoking B. Diabetes C. Preeclampsia D. Narcotic use E. Type of delivery

A. Maternal smoking B. Diabetes C. Preeclampsia D. Narcotic use

An infant with an omphalocele arrives in the special care nursery. What should the nurse include in the assessment of this infant? Select all that apply. A. Monitor cardiorespiratory status B. Monitor fluid volume balance C. Temperature readings D. Abdominal girth

A. Monitor cardiorespiratory status B. Monitor fluid volume balance C. Temperature readings

The nurse is preparing an educational brochure about nonpharmacologic pain relief measures during childbirth. Which of the following is considered an advantage of these methods? A. No side effects B. Take away need for medications C. Slowing of the labor process D. Minimally invasive

A. No side effects

After suctioning to clear the airway of a term neonate who appears in good condition after a spontaneous vaginal delivery, which of the following would the nurse do next? Select all that apply. A. Obtain the neonate's weight. B. Instill erythromycin in the eyes. C. Place the neonate in a radiant warmer. D. Put identification bracelets on each wrist.

A. Obtain the neonate's weight. B. Instill erythromycin in the eyes. D. Put identification bracelets on each wrist.

The nurse is caring for a primigravid client whose cervix is dilated at 8 cm, the fetus is at +1 station, and the client has no analgesia or anesthesia. Which of the following would be a priority for the nurse? A. Offering encouragement and support B. Providing frequent perineal cleansing C. Giving frequent sips of water D. Applying extra blankets for warmth

A. Offering encouragement and support

A newborn has been admitted to the neonatal intensive care unit (NICU) with sepsis. The nurse identifies which of the following symptoms present in an infant with sepsis? Select all that apply. A. Pallor B. Glucose instability C. Grunting D. Irritability E. Vomiting

A. Pallor B. Glucose instability C. Grunting D. Irritability

What are the chief discomforts a woman may experience during the initial postpartum period? Select all that apply. A. Perineal discomfort B. Hunger C. Nipple bleeding from nursing D. Exhaustion E. Severe cramping

A. Perineal discomfort B. Hunger D. Exhaustion

The nurse is caring for a preterm infant. When completing the nursing assessment, the nurse should be aware of which of the following as the most common complication associated with preterm births? A. Respiratory distress syndrome B. Bronchopulmonary dysplasia C. Persistent fetal circulation D. Periodic apnea

A. Respiratory distress syndrome

A preterm infant arrives in the nursery. What initial assessments should be made by the nurse? Select all that apply. A. Signs of respiratory distress B. Gestational age determination C. Blood glucose monitoring D. Core temperature readings E. Complete blood count

A. Signs of respiratory distress B. Gestational age determination D. Core temperature readings

Which of the following narcotic analgesics are used for pain control in the laboring client? Select all that apply. A. Stadol B. Nubain C. Reglan D. Morphine E. Demerol

A. Stadol B. Nubain D. Morphine E. Demerol

The nurse performs a gestational age assessment, as part of the newborn assessment, to evaluate physical characteristics. The nurse identifies which of these signs as a component of this assessment? A. The amount of breast tissue B. Scarf sign C. Rooting reflex D. Square window sign

A. The amount of breast tissue

What are among the first things you can teach a new mother during the initial postpartum period? Select all that apply. A. The importance of keeping her bladder empty B. How to perform pericare C. How to put the newborn to her breast D. How to bathe a newborn E. How to treat diaper rash

A. The importance of keeping her bladder empty B. How to perform pericare C. How to put the newborn to her breast

The nurse is assessing a newborn right after birth. Which assessment will be most helpful initially in identifying an at-risk newborn? A. The newborn's Apgar score B. The mother's pregnancy history C. The newborn's color D. The newborn's respiratory effort

A. The newborn's Apgar score

The nurse is caring for a high-risk infant and suspects a feeding intolerance. On assessment, which of the following would be documented by the nurse? A. Vomiting and abdominal distension B. Elevated temperature and diarrhea C. Drooling and constipation D. Mouth sores and crying

A. Vomiting and abdominal distension

The nurse is teaching a client about the pain associated with labor. Which statement is most appropriate to include when describing somatic pain during labor and birth? A. "The pain should be mild; your baby is small and your contractions aren't strong." B. "This type of pain occurs with pushing and bearing down during delivery." C. "You will need IV pain medication to control the pain." D. "Uterine contractions during labor cause somatic pain."

B. "This type of pain occurs with pushing and bearing down during delivery."

In assessing a newborn for at-risk status by gestational maturity, the nurse should know that an infant is considered term at how many weeks gestation? A. Greater than 42 weeks B. 38-41 completed weeks C. 37 completed weeks D. 34-36 completed weeks

B. 38-41 completed weeks

The nurse is preparing for delivery of a newborn with a myelomeningocele. In addition to resuscitative equipment, the nurse will need which of the following additional equipment or supplies? A. Infant footprint record B. A protective dressing C. Infant identification bands D. Antibiotics

B. A protective dressing Rationale The focus of nursing care of an infant with a myelomeningocele is the prevention of infection and trauma to the defect. The newborn should be placed in prone position and the defect wrapped in a saline moist dressing. Antibiotics are not needed. Infant identification bands and a footprint record are standard supplies needed at each delivery.

How would you describe Gastroschisis? A. An evisceration of the gut that is limited to bowel loops B. An abdominal wall defect C. An evisceration of the gut into the umbilical cord D. A neural tube defect

B. An abdominal wall defect

The nurse is assisting with the administration of an epidural to a laboring client. The nurse ensures that which of the following is available after the procedure? A. Respiratory therapy B. Blood pressure cuff C. Thermometer D. Suction

B. Blood pressure cuff

The use of parenteral pain medication in labor has which direct effect on the fetus? A. Maternal hypotension B. Decreased fetal heart rate variability C. Fetal hypoglycemia D. Rupture of membranes

B. Decreased fetal heart rate variability

Which factors contribute to the pain experienced during labor? Select all that apply. A. Length of the umbilical cord B. Distention of vagina and perineum C. Ischemia to uterus during contractions D. Stretching of pelvic structures E. Pressure on cervix by fetal presenting part

B. Distention of vagina and perineum C. Ischemia to uterus during contractions D. Stretching of pelvic structures E. Pressure on cervix by fetal presenting part

Which term would be documented to described maternal self-massage of the abdomen during labor? A. Physical therapy B. Effleurage C.Sacral counter pressure D. Water therapy

B. Effleurage

Which statement describes guided imagery that may be used during the labor and delivery process? A. Hypnosis that lasts during the labor and delivery process B. Form of distraction where the woman imagines herself in a pleasant place C. Method of breathing guided by the nurse midwife when pushing D. Aromatherapy used during early phase of labor

B. Form of distraction where the woman imagines herself in a pleasant place

The nurse is caring for an infant with gastroschisis. The nurse knows that the development of this anomaly is associated with which of the following conditions? Select all that apply. A. Enlarged stomach B. Intestinal atresia C. Decreased abdominal capacity D. Meconium ileus E. Malrotation of the intestine

B. Intestinal atresia C. Decreased abdominal capacity E. Malrotation of the intestine

The nurse monitors the laboring client for which of the following side effects of morphine? A. Blurred vision B. Itching C. Depression D. Dry mouth

B. Itching

What could you do to lessen the anxiety a woman may be feeling as she goes through the second stage of labor? Select all that apply. A. Tell her to push harder. B. Keep her apprised of her progress. C. Provide anti-anxiety medication. D. Praise her efforts. E. Offer ice chips.

B. Keep her apprised of her progress. D. Praise her efforts.

Jeremy was born at 35 weeks gestation weighing 8 lb 14 oz. and shows no signs of being a high-risk newborn. How would you classify him to help ensure he receives the proper care? A. Term and small for gestational age (SGA) B. Moderately preterm and large for gestational age (LGA) C. Healthy and in no need of special care D. Late preterm and hypoxic

B. Moderately preterm and large for gestational age (LGA)

The standing order for parenteral pain medication on the labor and delivery unit is Stadol or Nubain IV. A client is admitted in active labor and reports extreme pain. Assessment of her history includes gravida 3 para 2, 40 weeks, and positive for marijuana, cocaine, and heroin during pregnancy. What is the appropriate action of the nurse? A. Order a drug screen B. Notify the provider C. Refer her for counseling D. Initiate an IV line and administer Stadol per policy

B. Notify the provider

A client complains of extreme pain as her baby is crowning during pushing. The nurse understands that the perception of pain is caused by which of the following physiological processes? Select all that apply. A. Male gender of the fetus B. Pressure to the cervix caused by the presenting fetal part C. Stretching of the pelvic structures D. Distention of the vagina and perineum E. Tissue hypoxia caused by ischemia related to uterine contractions

B. Pressure to the cervix caused by the presenting fetal part C. Stretching of the pelvic structures D. Distention of the vagina and perineum E. Tissue hypoxia caused by ischemia related to uterine contractions

The nurse observes that the father of the newborn is reluctant to hold his new son. What would be the most therapeutic response of the nurse at this time? A. Ask the mother if she is concerned about the father's reaction to the baby. B. Provide instruction and demonstrate how to hold an infant. C. Acknowledge the father's anxiety. D. Verbalize the implied by stating, "I notice you will not hold your baby."

B. Provide instruction and demonstrate how to hold an infant.

The nurse is assessing the general appearance of a newborn. What will the nurse document as part of this assessment? Select all that apply. A. Apgar scoring B. Relationship of head size to body C. Rectal temperature D. Posture at rest E. Lung sounds

B. Relationship of head size to body D. Posture at rest

The nurse reviews an ultrasound report for a client just admitted in the early stages of labor. The report indicates that the fetus is in an occiput posterior position. The nurse plans to include which intervention in the client's plan of care based on this report? A. Aromatherapy B. Sacral counter pressure C. Amnioinfusion D. Cesarean section preparation

B. Sacral counter pressure

What is a potential adverse reaction that may be seen in the laboring client who receives a spinal block? A. Elevated temperature B. Spinal headache C. Hyperglycemia D. Hypertension

B. Spinal headache

A laboring client at 39 weeks gestation has been pushing for 2 hours. The nurse anticipates that the health care provider may choose to use forceps to assist in the delivery. What criteria must be met to consider forceps? Select all that apply. A. The maternal bladder should be full. B. The cervix must be fully dilated. C. Cephalopelvic disproportion should be present. D. Membranes must be ruptured. E. Adequate maternal anesthesia should be provided.

B. The cervix must be fully dilated. D. Membranes must be ruptured. E. Adequate maternal anesthesia should be provided.

The nurse is caring for a newborn who is small for gestational age (SGA). The nurse identifies the following to be characteristics of a newborn who is SGA: Select all that apply. A. The newborn had intrauterine exposure to bacteria. B. The newborn's weight falls below the 10th percentile. C. The newborn weighs less than 2,500 g (5.5 lb). D. The newborn may have suffered from intrauterine growth restriction (IUGR). E. The newborn's head circumference is in the 50th percentile.

B. The newborn's weight falls below the 10th percentile. D. The newborn may have suffered from intrauterine growth restriction (IUGR).

A client has just completed the second stage of labor. Which of the following signs would indicate the placenta is about to be delivered? Select all that apply. A. The umbilical cord shortens. B. The umbilical cord lengthens. C. The shape of the uterus changes from a disk to a globe. D. A gush of blood from the vagina is noted. E. The top of the uterus drops down to the level of the symphysis pubis.

B. The umbilical cord lengthens. C. The shape of the uterus changes from a disk to a globe. D. A gush of blood from the vagina is noted.

Why would you suction the mouth and oropharynx of a newborn before the nose? A. Because newborns breathe through their mouths B. To prevent the newborn from aspirating any contents of the nasopharynx C. To allow the newborn to cry D. The order is unimportant.

B. To prevent the newborn from aspirating any contents of the nasopharynx

A preterm male newborn has been admitted to the nursery. Which of the following may the nurse document on assessment of the infant? Select all that apply. A. Minimal lanugo B. Undescended testes C. Covered in vernix caseosa D. Thin skin E. Flexed extremities

B. Undescended testes C. Covered in vernix caseosa D. Thin skin Rationale Preterm infants' skin is thinner, allowing easy visualization of underlying vessels. This is due to their lack of adipose tissue. In males the testes are not descended and the scrotum has little to no rugae. They will be covered in vernix caseosa and lanugo, whereas a term newborn has little of either at birth. Term newborns lie in a flexed position; preterm newborns lie with their extremities in an extended position.

When planning the care of a newborn, it is important for the nurse to consider certain components of the intrapartum record. Which components of the intrapartum record should be included in the newborn's chart? Select all that apply. A. Previous spontaneous abortion B. Use of narcotics C. Duration of labor D. Use of vacuum to facilitate the birth E. Antibiotic treatment in labor for GBS

B. Use of narcotics C. Duration of labor D. Use of vacuum to facilitate the birth E. Antibiotic treatment in labor for GBS

A client is in the recovery room following a cesarean birth. She is stable and alert. Which of the following should be the nurse's focus for teaching during this time? A. When to follow up with her health care provider B. What to expect during the postpartum period C. How to bathe the newborn D. Future birth control options

B. What to expect during the postpartum period

When would you consider growth restriction to be symmetrical? A. When it occurs during the second half of pregnancy and is due to pre-eclampsia B. When it occurs during the first half of pregnancy and is the result of exposure to drugs C. When it occurs during the first half of pregnancy and is the result of poor maternal nutrition D. When the head, length, and brain growth are normal, but weight is in the 10th percentile

B. When it occurs during the first half of pregnancy and is the result of exposure to drugs

The nurse is caring for a laboring client who rates her pain as a 9 on a 1-10 scale. The nurse reviews the orders and notes that the client may receive Stadol and Phenergan for pain. Which statement by the nurse is appropriate to include when providing education about these medications? A. "Do you have any allergies?" B. "You won't feel the pain after you get these two medications." C. "These medications may take the edge off the pain, but they will not take the pain away completely." D. "How does your IV site feel?"

C. "These medications may take the edge off the pain, but they will not take the pain away completely."

There are five laboring clients on the obstetrical unit. The charge nurse understands that which of the following clients should not receive parenteral analgesia? Select all that apply. A. 40-year-old gravida 5 para 4 with baseline fetal heart rate of 140 B. 30-year-old, twin pregnancy with reactive fetal heart rate tracing C. 28-year-old in preterm labor with variable decelerations and minimal variability of fetal heart rate D. 42-year-old with fetal heart rate baseline of 170 E. 16-year-old primigravida with fetal heart rate baseline of 100

C. 28-year-old in preterm labor with variable decelerations and minimal variability of fetal heart rate D. 42-year-old with fetal heart rate baseline of 170 E. 16-year-old primigravida with fetal heart rate baseline of 100

A primigravid is in the fourth stage of labor. She and her new son are together in the room. What assessments are essential for the student nurse to make during this time? A. Assess the infant for obvious abnormalities. Assess the woman for blood loss and firm uterine contraction. B. Assess the woman's vital signs, fundus, bladder, perineal condition, and lochia. Return the infant to the nursery. C. Assess the woman's fundus, bladder, perineal condition, and lochia. Assess the infant's vital signs. D. Assess the pattern and frequency of contractions and the infant's vital signs.

C. Assess the woman's fundus, bladder, perineal condition, and lochia. Assess the infant's vital signs. Rationale During the fourth stage of labor the focus is on assessment of the mother, which includes elements related to her recovery from childbirth. It includes assessment of fundus, bladder, perineal condition, and lochia. Infant's assessment is focused on the transition to extrauterine life.

Which of the following physical characteristics would you see in a newborn with a congenital diaphragmatic hernia (CDH)? Select all that apply. A. Protruding abdomen B. Concave chest C. Barrel-shaped chest D. Scaphoid abdomen E. Absent breath sounds on the affected side

C. Barrel-shaped chest D. Scaphoid abdomen E. Absent breath sounds on the affected side

What causes somatic pain during labor? A. Weight of the fetus B. Uterine contractions in early labor C. Bearing down during second stage of labor D. Passage of the fetus into the pelvis

C. Bearing down during second stage of labor

Technically, how would you define hypoglycemia in newborns? A. Below 50 mg/dLl B. 46 mg/dL C. Below 45 mg/dL D. Below 60 mg/dL

C. Below 45 mg/dL

A 25-year-old primigravida is admitted to the labor room. She is 3 cm dilated and 80% effaced, and the head is at 0 station. Contractions are every 10 minutes lasting 20-30 seconds. Membranes are intact. Admitting vital signs are blood pressure 112/70, pulse 80, respirations 16, temperature 98.8°F, and fetal heart rate 148. What should the nurse monitor? A. Contractions, effacement and dilation of cervix, and fetal heart rate every hour B. Temperature, blood pressure, and contractions every 4 hours and fetal heart rate hourly C. Blood pressure hourly and contractions and fetal heart rate every 30 to 60 minutes D. Contractions, blood pressure, and fetal heart rate every 15 minutes

C. Blood pressure hourly and contractions and fetal heart rate every 30 to 60 minutes Rationale During early labor, blood pressure and contractions are monitored hourly and fetal heart rate is monitored every 30 to 60 minutes.

The nurse is caring for a woman in stage one of labor. The fetal position is left occiput anterior. The woman's membranes rupture. What should be the nurse's first action? A. Perform a vaginal exam. B. Notify the health care provider. C. Count the fetal heart rate. D. Measure the amount of fluid.

C. Count the fetal heart rate. Rationale When the membranes rupture the nurse's first action is to check the fetal heart rate. The time of rupture should be noted along with the color, odor, and consistency of the fluid. Prolapsed cord is a possible risk if the fetal head is not engaged, because the amniotic fluid coming through the cervix could wash the umbilical cord out through the cervix. A drop in the fetal heart rate would indicate an undetected prolapsed cord.

How can you enhance the bonding process between parents and newborn? Select all that apply. A. Turn up the room lights. B. Immediately administer eye prophylaxis. C. Delay the administering of eye prophylaxis. D. Turn down the room lights. E. Create a quiet space for the parents and newborn.

C. Delay the administering of eye prophylaxis. D. Turn down the room lights. E. Create a quiet space for the parents and newborn.

A laboring client at term is experiencing a prolonged second stage of labor. She has made no progress for more than 2 hours. The fetal scalp is visible between contractions. The client says,"I just can't push any longer, please help me!" The nurse notifies the health care provider and anticipates the need to do which of the following? A. Encourage the client to empty her bladder. B. Provide emotional support. C. Expect an instrument-assisted delivery. D. Provide perineal hygiene.

C. Expect an instrument-assisted delivery.

A nurse is caring for a newborn of a diabetic mother. Which of the following should be included in the nurse's plan of care for this newborn? A. Withhold feedings until IV glucose is given. B. Provide glucose water exclusively. C. Feed the infant soon after delivery. D. Evaluate blood glucose levels at 12 hours after birth.

C. Feed the infant soon after delivery. Rationale Early signs of hypoglycemia are managed with early feedings (breast or formula). If normal levels of glucose cannot be maintained, the newborn might require an intravenous infusion of glucose, along with oral feedings, to maintain normoglycemia. Most institutions require serial glucose levels on admission to the nursery.

A client at 37 weeks gestation is discharged after a successful external cephalic version. What aftercare instructions would be important to discuss with the client? Select all that apply. A. Maintaining clear liquids for 12 hours B. Performing fundal massage C. Monitoring for uterine contractions D. Observing for excessive fetal movement E. Recognizing signs of infection

C. Monitoring for uterine contractions D. Observing for excessive fetal movement

Which of the following would be the priority when caring for a primigravid client whose cervix is dilated at 10 cm and 100% effaced and the fetal head is crowning? A. Giving frequent sips of water B. Providing frequent perineal cleansing C. Offering encouragement and support D. Applying extra blankets for warmth

C. Offering encouragement and support

Madison was born with hyperbilirubinemia. As her nurse what should be your first responsibility? A. Preparing her for an exchange transfusion B. Assessing her for signs of kernicterus C. Performing a transcutaneous bilirubin (TcB) measurement in a cephalocaudal manner D. Informing her parents about the importance of outpatient follow-up

C. Performing a transcutaneous bilirubin (TcB) measurement in a cephalocaudal manner

How would you commonly treat hyperbilirubinemia? A. There is no need to treat most cases; they resolve on their own. B. Exchange transfusion C. Phototherapy D. Oxygen therapy

C. Phototherapy

A client delivered her infant daughter 2 hours ago. She had an episiotomy to facilitate delivery. As the nurse assigned to care for her, which of the following would be the most appropriate action for you to take? A. Administer analgesic medication as ordered. B. Apply a heat lamp to the perineum. C. Place an ice pack on the perineum. D. Take her for a sitz bath.

C. Place an ice pack on the perineum. Rationale During the first 24 hours after delivery ice is used on the perineum since it causes vasoconstriction and thereby prevents edema. Ice also provides pain relief through numbing the area. Heat lamps are not used. A heat lamp could burn the client's perineum. Sitz baths, which give warmth and comfort to the perineum, are not usually ordered for the first 24 hours after delivery. Analgesics may be administered, but ice would be more affected at this point.

The nurse is trying to determine if a newborn is appropriate for gestational age (AGA). What physical assessment findings would the nurse use to help determine gestational age? A. Milia present on bridge of nose B. Anterior and posterior fontanels non bulging C. Plantar creases present on anterior two thirds of sole D. Umbilical cord moist to touch

C. Plantar creases present on anterior two thirds of sole

A primigravid client in the second stage of labor feels the urge to push. The client has had no analgesia or anesthesia. Anatomically, which of the following would be the best position for the client to assume? A. Lithotomy B. Hands and knees C. Squatting D. Dorsal recumbent

C. Squatting Rationale Anatomically, the best position for the client to assume is the squatting position because it enhances pelvic diameters and allows gravity to assist in the expulsion stage of labor. This position also provides natural pressure anesthesia as the fetal presenting part presses on the stretched perineum. Dorsal recumbent is not considered the best position anatomically. Lithotomy may be ineffective and uncomfortable for the client who is ready to push. Hands and knees can cause discomfort to the arms and wrists and is tiring over a long period of time

The student nurse is assessing a newborn and notes that, when supine, once the infant's arm is drawn across the chest, the elbow does not cross the midline. How would the student nurse document this in the medical record? A. Recoil; the baby is full-term. B. The scarf sign; the baby is preterm. C. The scarf sign; the baby is full-term. D. The square window sign; the baby is full-term.

C. The scarf sign; the baby is full-term.

When would you consider growth restriction to be asymmetrical? A. When the growth of the fetus is permanently stunted B. When it occurs during the first half of pregnancy and is the result of a genetic condition C. When it occurs during the latter half of pregnancy and could be due to poor maternal nutrition D. When it occurs during the first half of pregnancy and is the result of an infection

C. When it occurs during the latter half of pregnancy and could be due to poor maternal nutrition

The nurse is assessing a client who delivered 3 hours ago. On completing a fundal assessment, the nurse notes the fundus is pushing against the client's left abdomen. Which action is appropriate? A. Straight catheterize the client immediately B. Call the client's health care provider for direction. C. Straight catheterize the client for half the volume of urine. D. Ask the client to empty her bladder.

D. Ask the client to empty her bladder.

The nurse is assisting the provider during the repair of a client's perineal laceration following a vaginal birth. The nurse prepares an injection of lidocaine. Which of the following effects is expected after injection of lidocaine in the perineal area? A. Urinary frequency B. Bradycardia C. Hypotension D. Burning sensation

D. Burning sensation

Which breathing technique is useful during the latent phase of the first stage of labor? A. Patterned paced breathing B. Breathing for pushing C. Modified paced breathing D. Cleansing breath

D. Cleansing breath

When does spina bifida cystica occur? A. During second trimester gestation B. Immediately after delivery C. During third trimester gestation D. During embryonic development

D. During embryonic development

During the fourth stage of labor, what should you do to help the mother avoid bladder distention? A. Pour cold water over the perineum. B. Palpate her fundus. C. Encourage her to get out of bed as soon as possible. D. Encourage her to void every 2 hours.

D. Encourage her to void every 2 hours.

A 38-week newborn is found to be small for gestational age (SGA). Which of the following nursing interventions must be included in the care of this newborn? A. Assess for facial paralysis. B. Monitor for signs of hyperglycemia. C. Monitor for necrotizing enterocolitis. D. Maintain a warm environment.

D. Maintain a warm environment.

In performing an assessment of a client who delivered 2 hours ago, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially? A. Administering ergonovine (Ergotrate) B. Preforming bimanual compressions C. Notifying the health care provider D. Massaging the fundus firmly

D. Massaging the fundus firmly

An infant has been diagnosed with hyperbilirubinemia. Nursing care for this infant should include which of the following? A. Avoid the use of pacifiers. B. Monitor blood glucose levels. C. Keep infant in the warmer. D. Monitor intake and output.

D. Monitor intake and output.

A nurse administers parenteral analgesia to a laboring client at 2:00 p.m. At 2:30 p.m., the client reports an urge to push. A sterile vaginal exam reveals that the client is fully dilated and 100% effaced, and the fetus is a +2 station. After notifying the provider, the nurse ensures that which of the following is available? A. Operating room B. Foley catheter C. Anesthesiologist D. Narcan

D. Narcan

The nurse is evaluating a new mother following a teaching session. The mother gently brushes the infant's cheek with her nipple and the newborn turns toward that side and opens the lips to suck. This demonstration of the rooting reflex is part of which assessment? A. Vital signs B. Physical maturity assessment C. Apgar score D. Neuromuscular

D. Neuromuscular

A newborn who is covered in vernix caseosa is most likely which of the following? A. Hypoxic B. Large for gestational age (LGA) C. Hypoglycemic D. Preterm

D. Preterm

A primigravida client whose cervix is 8 cm dilated with the fetus at +1 station and in a left occipitoposterior (LOP) position requests pain relief for severe back pain. In developing a plan of care for this client, the nurse would anticipate which of the following? A. Maintaining the client in a left side-lying position B. Preparing the client for precipitate delivery C. Preparing the client for a cesarean delivery D. Providing firm pressure to the client's sacral area

D. Providing firm pressure to the client's sacral area

The nurse in a prenatal care setting is caring for a woman at 39 weeks gestation. The health care provider is going to strip the client's amniotic membrane. The client asks the nurse what this will do. What would be the best response by the nurse? A. Stripping the membranes releases progesterone that will prevent preterm labor. B. Stripping the membranes will cause the fetus to drop lower in the pelvis. C. Stripping the membranes will help stimulate the fetus. D. Stripping the membranes releases prostaglandins that may help labor begin.

D. Stripping the membranes releases prostaglandins that may help labor begin.

The nurse is receiving the change of shift report from the night nurse, and one newborn she will be caring for has been determined small for gestational age (SGA). What would the nurse expect upon assessing this newborn? Select all that apply. A. No passage of meconium for 48 hours B. Difficulty feeding C. Head circumference below the 20th percentile D. Weight below the 10th percentile E. Length below the 10th percentile

D. Weight below the 10th percentile E. Length below the 10th percentile