Prepu intrapartum
A nurse notices repetitive late decelerations on the fetal heart monitor. The best initial actions by the nurse include: a) notify the provider, explain findings to the client, and begin pushing. b) reposition the client, apply oxygen, and increase IV fluids. c) perform sterile vaginal examination, increase IV fluids, and apply oxygen. d) prepare for birth, reposition the patient, and begin pushing.
B
Which physiologic change during labor makes it necessary for the nurse to assess blood pressure frequently? a) Decreased blood pressure is the first sign of preeclampsia. b) Alterations in cardiovascular function affect the fetus. c) Blood pressure decreases as a sign of maternal pain. d) Blood pressure decreases at the peak of each contraction.
B
Question: After several hours of induction with intravenous oxytocin administered along with a primary intravenous solution of lactated Ringer's solution, assessment of a primigravida at 42 weeks' gestation reveals a fetal heart rate near the baseline at 120 bpm and strong contractions occurring every 2 to 2.5 minutes and lasting 90 to 100 seconds. In what order from first to last should the nurse perform the required actions? All options must be used. 1 2 3 4 Stop the intravenous flow of oxytocin. Contact the primary care provider for further prescriptions. Administer oxygen at a rate of 8 to 10 L/min. Position the client in a lateral position.
1 4 3 2
Which behavior should cause the nurse to suspect that a client's labor is moving quickly and that the physician should be notified? a) An increased sense of rectal pressure b) Episodes of nausea and vomiting c) A decrease in intensity of contractions d) An increase in fetal heart rate variability
A
A nurse needs to obtain a good monitor tracing on a client in labor The client lies in a supine position. Suddenly, she complains of feeling light-headed and becomes diaphoretic. Which action should the nurse perform first? a) Increase the I.V. fluids to correct the client's dehydration. b) Immediately take the client's blood pressure and summon the physician. c) Reposition the client to her left side. d) Start oxygen at 6 L via nasal cannula.
C
The primigravid client is at +1 station and 9 cm dilated. Based on these data, the nurse should first: a) ask the anesthesiologist to increase epidural rate. b) assist the client to push if she feels the need to do so. c) encourage the client to breathe through the urge to push. d) support family members in providing comfort measures.
C
The nurse is working with four clients on the obstetrical unit. Which client will be the highest priority for a cesarean section? a) client at 37 weeks' gestation with fetus in ROP position b) client at 32 weeks' gestation with fetus in breech position c) client at 40 weeks' gestation whose fetus weighs 8 lb (3,630 g) by ultrasound estimate d) client at 38 weeks' gestation with active herpes lesions
D
What data indicates to the nurse that placental detachment is occurring? a) An abrupt lengthening of the cord b) Decreased vaginal bleeding c) A decrease in the number of contractions d) Relaxation of the uterus
A
When assessing the fetal heart rate tracing, a nurse becomes concerned about the fetal heart rate pattern. In response to the loss of variability, the nurse repositions the client to her left side and administers oxygen. These actions are likely to improve: a) fetal hypoxia. b) the contraction pattern. c) the status of a trapped cord. d) maternal comfort.
A
A 15-year-old client is 4 cm dilated and 100% effaced and is in active labor with her first baby. The nurse contacts the physician to communicate the findings of fetal heart rate decelerations, thick meconium in the amniotic fluid, and low fetal scalp pH results. What is the most appropriate nursing action at this time? a) Increase the oxygen to 7 L/min. b) Prepare the client for an assisted or cesarean birth. c) Encourage the client to get into the right lateral position. d) Contact the social worker to inform him/her of imminent birth.
B
A client at 33 weeks' gestation is admitted in preterm labor. She is given betamethasone 12 mg IM q 24 hours × 2. What is the expected outcome of this drug therapy? a) The client will give birth to a full-term neonate. b) The contractions will end within 24 hours. c) The client will give birth to a neonate without infection. d) The neonate will be born with mature lungs.
D
The nurse is caring for a full-term, nonmedicated, primiparous client who is in the transition stage of labor. The client is writhing in pain and saying, "Help me, help me!" Her last vaginal exam 1 hour ago showed that she was 8 cm dilated, +1 station, and in what appeared to be a comfortable position. What does the nurse anticipate as the highest priority intervention in caring for this client? a) Help the client through contractions until a narcotic can be given. b) Ask the client for suggestions to make her more comfortable. c) Palpate the bladder to see if it has become distended. d) Perform a vaginal examination to determine if the client is fully dilated.
D
What assessment data of a laboring woman would require further intervention by the nurse? a) Moderate contractions 3 minutes apart b) Fetal heart rate (FHR) 150 beats/minute c) Temperature of 99.1° F (37.27° C) d) Maternal heart rate 125 beats/minute
D
The cervix of a 15-year-old primigravid client admitted to the labor area is 2 cm dilated and 50% effaced. Her membranes are intact, and contractions are occurring every 5 to 6 minutes. Which intervention should the nurse recommend at this time? a) walking around in the hallway b) resting in the right lateral recumbent position c) sitting in a comfortable chair for a period of time d) lying in the left lateral recumbent position
A
While a 31-year-old multigravida at 39 weeks' gestation in active labor is being admitted, her amniotic membranes rupture spontaneously. The client's cervix is 5 cm dilated, the presenting part is at 0 station, and the electronic fetal heart rate pattern is reassuring. What should the nurse do first? a) Perform a vaginal examination to determine dilation. b) Prepare the client for imminent birth. c) Note the color, amount, and odor of the amniotic fluid. d) Auscultate the client's blood pressure.
C
