Questions to Re-look at

A client is in the third stage of labor. Which of the following assessments should the nurse make/observe for? Select all that apply. 1. Lengthening of the umbilical cord. 2. Fetal heart assessment after each contraction. 3. Uterus rising in the abdomen and feeling globular. 4. Rapid cervical dilation to ten centimeters. 5. Maternal complaints of intense rectal pressure.

1 & 3 1. This is a sign of placental separation. 2. Once second stage is complete, the baby is no longer in utero. 3. This is a sign of placental separation. 4. Dilation and effacement are complete before second stage begins. 5. Rectal pressure is usually a sign of fetal descent. Once the second stage is complete, the baby is no longer in utero.

A client just spontaneously ruptured membranes. Which of the following factors makes her especially at high risk for having a prolapsed cord? Select all that apply. 1. Breech presentation. 2. Station -3. 3. Oligohydramnios. 4. Dilation 2 cm. 5. Transverse lie.

1, 2, 5

Immediately after a woman spontaneously ruptures her membranes, the nurse notes a loop of the umbilical cord protruding from the woman's vagina. Which of the following actions should the nurse perform first? 1. Put the client in the knee-chest position. 2. Assess the fetal heart rate. 3. Administer oxygen by tight face mask. 4. Telephone the obstetrician with the findings.

1. Put the client in the knee-chest position.

A woman is in the second stage of labor with a strong urge to push. Which of the following actions by the nurse is appropriate at this time? 1. Assess the fetal heart rate between contractions every 60 minutes. 2. Encourage the woman to grunt during contractions. 3. Assess the pulse and respirations of the mother every 5 minutes. 4. Position the woman on her back with her knees on her chest.

2. Encourage the woman to grunt during contractions. During second stage labor, the woman should push on an open glottis to prevent the vasovagal response. Research has shown that when women push without being coached, they do not hold their breath to bear down, but instead grunt during the second stage.

A doctor orders a narcotic analgesic for a laboring client. Which of the following situations would lead a nurse to hold the medication? 1. Contraction pattern is every 3 min x 60 sec. 2. Fetal monitor tracing shows late decelerations. 3. Client sleeps between contractions. 4. The blood pressure is 150/90.

2. Fetal monitor tracing shows late decelerations. Late decelerations are indicative of uteroplacental insufficiency and indicate fetal distress. It is inappropriate to administer a central nervous system (CNS) depressant to the mother at this time.

A G1 P0, 8 cm dilated, is to receive pain medication. The health care practitioner has decided to order an opiate analgesic with an analgesic-potentiating medication. Which of the following medications would the nurse expect to be ordered as the analgesic-potentiating medication? 1. Seconal (secobarbital). 2. Vistaril (hydroxyzine). 3. Benadryl (diphenhydramine). 4. Tylenol (acetaminophen).

2. Vistaril (hydroxyzine). 1. Seconal is a barbiturate sedative. It is not used as an analgesic potentiator. 2. Vistaril can be used as an analgesic potentiator. 3. Benadryl is an antihistamine that is not used as an analgesic potentiator. 4. Tylenol is a nonsteroidal anti-inflammatory drug that is ineffective as an analgesic in labor.

A woman is in active labor and is being monitored electronically. She has just received Stadol 2 mg IM for pain. Which of the following fetal heart responses would the nurse expect to see on the internal monitor tracing? 1. Variable decelerations. 2. Late decelerations. 3. Decreased variability. 4. Transient accelerations.

3. Decreased variability. It is important for the test taker to remember the side effects of commonly used medications. The analgesics used in labor are opiates. The CNS-depressant effect of the opiates is therapeutic for the mother who is in pain, but the baby is also affected by the medication, often exhibiting decreased variability.

A nurse is caring for a gravid client who is G1 P0000, 35 weeks' gestation. Which of the following would warrant the nurse to notify the woman's health care practitioner that the client is in preterm labor? Select all that apply. 1. Contraction frequency every 15 minutes. 2. Effacement 10%. 3. Dilation 3 cm. 4. Cervical length of 2 cm. 5. Contraction duration of 30 seconds.

3. Dilation 3 cm. 4. Cervical length of 2 cm. Preterm labor is defined as labor before 38 weeks' gestation with 3 or more contractions occurring within a 30-minute period PLUS cervical change of one of the following: cervical effacement greater than 80%, cervical dilation greater than 1 cm, or cervical length of less than 2.5 cm. The change in cervical length is diagnosed by transvaginal ultrasound.

A woman is scheduled to have an external version for a breech presentation. The nurse carefully assesses the client's chart knowing that which of the following is a contraindication to this procedure? 1. Station -2. 2. 38 weeks' gestation. 3. Reactive NST. 4. Previous cesarean section.

4. Previous cesarean section. During external version, the health care practitioner moves the fetus from a malpresentation—usually breech— to a vertex presentation. To accomplish the movement, the physician manually palpates the fetus externally through the mother's abdominal and uterine walls. Because significant stress is placed on the uterine body, the presence of a cesarean scar is a contraindication to the procedure.

A client, G3 P2002, is immediately postexternal version. The nurse monitors this client carefully for which of the following? 1. Decreased urinary output. 2. Elevated blood pressure. 3. Severe occipital headache. 4. Variable fetal heart decelerations.

4. Variable fetal heart decelerations. The umbilical cord can become compressed during an external version. Variable decelerations are caused by umbilical cord compression. If the cord were to become compressed, the nurse would note variable decelerations on the fetal heart monitor tracing.

The nurse is admitting four full-term primigravid clients to the labor and delivery unit. The nurse requests pre-cesarean section orders from the health care practitioner for which of the clients? The client who has: Select all that apply. 1. Cervical cerclage. 2. FH 156 with beat-to-beat variability. 3. Maternal blood pressure of 90/60. 4. Full effacement. 5. Active herpes simplex 2

1 & 5 1. Cervical cerclage, a stitch encircling the cervix, is incompatible with vaginal delivery. 2. This FH is well within normal limits. 3. This BP is well within normal limits. 4. A fully effaced cervix is essential for a vaginal delivery. It is not an indication for a cesarean section. 5. Active herpes simplex 2 is an absolute indi- cator for a cesarean delivery.

A baby is entering the pelvis in the vertex presentation and in the extended attitude. The nurse determines that which of the following positions is consistent with this situation? 1. LMA (left mentum anterior). 2. LSP (left sacral posterior). 3. RScT (right scapular transverse). 4. ROP (right occiput posterior).

1. LMA (left mentum anterior). To conceptualize the relationship between attitude, presentation, and position, the test taker must first thoroughly understand the three concepts. The vertex presentation is a head-down presentation; both occipital and mentum presentations are vertex presentations. When the attitude is extended in a head-down presentation, the front of the head or the face is the presenting part, whereas when the head is flexed, the back of the head, or occiput, is presenting. When the scapula is presenting, the baby is lying sideways in utero, called transverse lie.

The nurse is caring for a laboring gravida who is 43 weeks pregnant. For which of the following should the nurse carefully monitor this client and fetus? 1. Late decelerations. 2. Hyperthermia. 3. Hypotension. 4. Early decelerations.

1. Late decelerations The test taker must attend to all important information in the question. The gestational age of this fetus is 43 weeks. The baby and placenta, therefore, are both postdates. Placental function usually deteriorates after 40 weeks' gestation. As late decelerations result from poor uteroplacental blood flow, the nurse should monitor this client carefully for late decelerations.

A primigravid client received Cervidil (dinoprostone) for induction 8 hours ago. The Bishop score is now 10. Which of the following actions by the nurse is appropriate? 1. Perform nitrazine analysis of amniotic fluid. 2. Report abnormal findings to the obstetrician. 3. Place woman on her side. 4. Monitor for onset of labor.

4. Monitor for onset of labor.

A pregnant woman is discussing positioning and the use of leg stirrups for delivery with a labor nurse. Which of the following client responses indicates that the client understood the information? Select all that apply. 1. When the client states, "I am glad that deliveries can take place in a variety of places, including a Jacuzzi bathtub." 2. When the client says, "I heard that for doctors to deliver babies safely, it is essential to have the mother's legs up in stirrups." 3. When the client states, "I understand that if the fetus needs to turn during labor, I may end up delivering the baby on my hands and knees." 4. When the client says, "During difficult deliveries it is sometimes necessary to put a woman's legs up in stirrups." 5. When the client states, "I heard that midwives often deliver their patients either in the side-lying or squatting position."

Everything but 2

The nurse is caring for four women who are in labor. The nurse is aware that he or she will likely prepare which of the women for cesarean delivery? Select all that apply. 1. Fetus is in the left sacral posterior position. 2. Placenta is attached to the posterior portion of the uterine wall. 3. Fetus has been diagnosed with meningomyelocele. 4. Client is hepatitis B surface antigen positive. 5. The lecithin/sphingomyelin ratio in the amniotic fluid is 1.5:1.

1 & 3 1. The baby in the LSP position is in a breech presentation. Most breech babies are delivered by cesarean section. 2. The placenta usually attaches to the poste- rior portion of the uterine wall. 3. The meningomyelocele sac could easily rupture during a vaginal delivery. When a fetus has been diagnosed with the defect, a cesarean is usually performed. 4. Maternal hepatitis B antigen positive status is not an indication for cesarean delivery. 5. The L/S ratio of 1.5:1 indicates that the baby's lung fields are not yet mature.

Which of the following situations in a fully dilated client is incompatible with a forceps delivery? Select all that apply. 1. Maternal history of asthma. 2. Right occiput posterior position at +4 station. 3. Transverse fetal lie. 4. Fetal heart rate of 60 beats per minute at -1 station. 5. Maternal history of cerebral palsy.

3 & 4 1. Asthmatic clients, although needing careful monitoring, are able to deliver vaginally. 2. It would be appropriate to deliver a baby whose position and station are ROP and +4 via forceps. 3. A baby in transverse lie is physically incapable of delivering vaginally. 4. It is not appropriate to deliver a baby vaginally who is at -1 station. The baby has yet to engage. This baby would likely be delivered by cesarean section for prolonged fetal distress. 5. Clients with cerebral palsy may be delivered with forceps. TEST-TAKING TIP: It is unsafe to use forceps to deliver a baby when the baby's station is above +2. When the baby is above that station, it is unknown whether or not there is sufficient room in the pelvis for the baby to pass. If there should be too little space, very serious fetal complications could arise, including fractured skull and subdural hematoma.

A client with an internal fetal monitor catheter in place has just received IV butorphanol (Stadol) for pain relief. Which of the following monitor tracing changes should the nurse anticipate? 1. Early decelerations. 2. Late decelerations. 3. Diminished short- and long-term variability. 4. Accelerations after contractions.

3. Diminished short- and long-term variability. Variability is an indicator of fetal well-being. It reflects the competition between the sympathetic and the parasympathetic nervous systems' effects on the fetal heart rate. When the CNS is depressed from the administration of a narcotic analgesic, therefore, the nurse should expect to see diminished variability.

A nurse is coaching a woman who is in the second stage of labor. Which of the following should the nurse encourage the woman to do? 1. Hold her breath for twenty seconds during every contraction. 2. Blow out forcefully during every contraction. 3. Push between contractions until the fetal head is visible. 4. Take a slow cleansing breath before bearing down.

4. Take a slow cleansing breath before bearing down. 1. Holding the breath for 20 seconds during each contraction can stimulate the Valsalva maneuver, which can lead to a sudden drop in blood pressure and fainting. 2. One cannot push and blow out at the same time. This will not facilitate the delivery of the baby. 3. Pushing should be done only during contractions, not between contractions. 4. By taking a slow, cleansing breath before pushing, the woman is waiting until the contraction builds to its peak. Her pushes will be more effective at this point in the contraction.