Sexuality/Reproduction Practice Questions

In which of the following maternal locations would the nurse place the ultrasound transducer of the external electronic fetal heart rate monitor if a fetus at 34 weeks' gestation is in the left occipitoanterior (LOA) position? 1.Near the symphysis pubis. 2.Two inches (5.1 cm) above the umbilicus. 3.Below the umbilicus on the left side. 4.At the level of the umbilicus

3. As the uterus contracts, the abdominal wall rises and, when external monitoring is used, presses against the transducer. This movement is transmitted into an electrical current, which is then recorded. With the fetus in the LOA position, the cardiotransducer should be placed below the umbilicus on the side where the fetal back is located and uterine displacement during contractions is greatest. If the fetal back is near the symphysis pubis, the fetus is presenting as a transverse lie. If the fetus is in a breech position, the fetal back may be at or above the umbilicus.

When teaching a primigravid client with diabetes about common causes of hyperglycemia during pregnancy, which of the following would the nurse include? 1.Fetal macrosomia. 2.Obesity before conception. 3.Maternal infection. 4.Pregnancy-induced hypertension.

3. Maternal infection is the most common cause of maternal hyperglycemia and can lead to ketoacidosis, coma, and death. The client should notify the primary health care provider immediately if she experiences symptoms of an infection. Fetal macrosomia, obesity before conception, and pregnancy-induced hypertension are not associated with maternal hyperglycemia during pregnancy

The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? 1. Take the client's temperature. 2. Document the time of the client's last meal. 3. Obtain urine for urinalysis and culture. 4. Assess for complaint of dizziness or weakness.

4 1. Taking the client's temperature is important, but assessing for dizziness and weakness is more important. 2. Documenting the contents and timing of the client's last meal is not the most important action. 3. Obtaining urine for urinalysis and culture is not the most important action. 4. It is most important for the nurse to assess for complaints of dizziness or weakness. TAKING TIP: The nurse must prioritize care. When the question asks the test taker to decide which action is most important, all four possible responses are plausible actions. The test taker must determine which is the one action that cannot be delayed. In this situation, the most important action for the nurse to perform is to assess for complaints of dizziness or weakness. These symptoms are seen when clients develop hypovolemia from internal bleeding. Internal bleeding will be present if the client's fallopian tube has ruptured.

A woman has just had a macrosomic baby after a 12-hour labor. For which of the following complications should the woman be carefully monitored? 1. Uterine atony. 2. Hypoprolactinemia. 3. Infection. 4. Mastitis.

1 1. This client is at high risk for uterine atony. 2. The client is not at high risk for hypoprolactinemia. 3. The client is not at high risk for infection. 4. The client is not at high risk for mastitis. TEST-TAKING TIP: The uterus of a woman who delivers a macrosomic baby has been stretched beyond the usual pregnancy size. The muscle fibers of the myometrium, therefore, are stretched. After delivery the muscles are often unable to contract effectively to stop the bleeding at the placental separation site.

Before surgery to remove an ectopic pregnancy and the fallopian tube, which of the following would alert the nurse to the possibility of tubal rupture? 1.Amount of vaginal bleeding and discharge. 2.Falling hematocrit and hemoglobin levels. 3.Slow, bounding pulse rate of 80 bpm 4.Marked abdominal edema.

2. Falling hematocrit and hemoglobin levels indicate shock, which occurs if the tube ruptures. Other common symptoms of tubal rupture include severe knife-like lower quadrant abdominal pain and referred shoulder pain. The amount of vaginal bleeding that is evident is a poor estimate of actual blood loss. Slight vaginal bleeding, commonly described as spotting, is common. A rapid, thready pulse, a symptom of shock, is more common with tubal rupture than a slow, bounding pulse. Abdominal edema is a late sign of a tubal rupture in ectopic pregnancy

A multigravid client diagnosed with a probable ruptured ectopic pregnancy is scheduled for emergency surgery. In addition to monitoring the client's blood pressure before surgery, which of the following would the nurse assess? 1.Uterine cramping. 2.Abdominal distention. 3.Hemoglobin and hematocrit. 4.Pulse rate.

4. Fallopian tube rupture is an emergency situation because of extensive bleeding into the peritoneal cavity. Shock soon develops if precautionary measures are not taken. The nurse readying a client for surgery should be especially careful to monitor blood pressure and pulse rate for signs of impending shock. The nurse should be prepared to administer fluids, blood, or plasma expanders as necessary through an intravenous line that should already be in place. Because the fertilized ovum has implanted outside the uterus, uterine cramping is unlikely. However, abdominal tenderness or knife-like pain may occur. Abdominal fullness may be present, but abdominal distention is rare unless peritonitis has developed. Although the hemoglobin and hematocrit may be checked routinely before surgery, the laboratory results may not truly reflect the presence or degree of acute hemorrhage

The nurse who has just performed a vaginal examination notes that the fetus is in the LOP position. Which of the following clinical assessments would the nurse expect to note at this time? 1. Complaints of severe back pain 2. Rapid descent and effacement 3. Irregular and hypotonic contractions 4. Rectal pressure with bloody show

1 1. The nurse would expect the client to complain of severe back pain. 2. Descent is often slowed when the baby is in a posterior position. 3. The nurse would not expect to see hypotonic or irregular contractions. 4. The nurse would not expect rectal pressure or an increase in bloody show. TEST-TAKING TIP: When the fetus is in a posterior position, the occiput of the baby's head presses against the coccyx during every contraction. This action is very painful. None of the other responses is directly linked to a posterior fetal position.

A 30-week-gestation multigravida, G3 P1011, is admitted to the labor suite. She is contracting every 5 minutes × 40 seconds. Which of the comments by the client would be most informative regarding the etiology of the client's present condition? 1. "For the past day I have felt burning when I urinate." 2. "I have a daughter who is 2 years old." 3. "I jogged 1½ miles this morning." 4. "My miscarriage happened a year ago today."

1 1. This is the most important statement made by the client. 2. The age of her first child is not relevant. 3. Her exercise regimen is not relevant. 4. The date of her miscarriage is not relevant. TEST-TAKING TIP: Preterm labor is strongly associated with the presence of a urinary tract infection. Whenever an infection is present in the body, the body produces prostaglandins. Prostaglandins ripen the cervix and the number of oxytocin receptor sites on the uterine body increase. Preterm labor can then develop.

The primary health care provider prescribes betamethasone for a 34-year-old multigravid client at 32 weeks' gestation who is experiencing preterm labor. Previously, the client has experienced one infant death due to preterm birth at 28 weeks' gestation. The nurse explains that this drug is given for which of the following reasons? 1.To enhance fetal lung maturity. 2.To counter the effects of tocolytic therapy. 3.To treat chorioamnionitis. 4.To decrease neonatal production of surfactant.

1. Betamethasone therapy is indicated when the fetal lungs are immature. The fetus must be between 28 and 34 weeks' gestation and birth must be delayed for 24 to 48 hours for the drug to achieve a therapeutic effect. Antibiotics would be used to treat chorioamnionitis Betamethasone is not an antagonist for tocolytic therapy. It increases, not decreases, the production of neonatal surfactant

On arrival at the emergency department, a client tells the nurse that she suspects that she may be pregnant but has been having a small amount of bleeding and has severe pain in the lower abdomen. The client's blood pressure is 70/50 mm Hg and her pulse rate is 120 bpm. The nurse notifies the primary health care provider immediately because of the possibility of: 1.Ectopic pregnancy. 2.Abruptio placentae. 3.Gestational trophoblastic disease. 4.Complete abortion."

1. The client's signs and symptoms indicate a probable ectopic pregnancy, which can be confirmed by ultrasound examination or by culdocentesis. The primary health care provider is notified immediately because hypovolemic shock may develop without external bleeding. Once the fallopian tube ruptures, blood will enter the pelvic cavity, resulting in shock. Abruptio placentae would be manifested by a board-like uterus in the third trimester. Gestational trophoblastic disease would be suspected if the client exhibited no fetal heart rate and symptoms of pregnancy-induced hypertension before 20 weeks' gestation. A client with a complete abortion would exhibit a normal pulse and blood pressure with scant vaginal bleeding.

A macrosomic infant of a non-insulin dependent diabetic mother has been admitted to the neonatal nursery. The baby's glucose level on admission to the nursery is 30 mg/dL, and after a feeding of the mother's expressed breast milk it is 35 mg/dL. Which of the following actions should the nurse take at this time? 1. Nothing, because the glucose level is normal for an infant of a diabetic mother. 2. Administer intravenous glucagon slowly over five minutes. 3. Feed the baby a bottle of dextrose and water and reassess the glucose level. 4. Notify the neonatologist of the abnormal glucose levels.

1. Hypoglycemia in the neonate is defi ned as a glucose level less than 40 mg/dL. A level of 35 mg/dL, therefore, is not normal. 2. Glucagon may be ordered as a remedy for severe hypoglycemia. Although the glucose level is low, it is unlikely that glucagon is indicated. Plus, the nurse would not administer the medication without an order. 3. Both breast milk and formula contain lactose. If the glucose level has not risen to normal as a result of the feeding, the nurse must notify the physician. 4. If the glucose level has not risen to normal as a result of the feeding, the nurse should notify the physician and anticipate that the doctor will order an intravenous of dextrose and water. TEST-TAKING TIP: The normal glucose level of a neonate after delivery—40 mg/ dL to 90 mg/L—is much lower than the adult normal of 60 to 110 mg/dL. Hypoglycemia is a common problem seen in infants, especially macrosomic infants and infants of diabetic mothers. Protocols to monitor for hypoglycemia in infants of diabetic mothers exist in all well-baby nurseries and NICUs.

A multigravid client is admitted at 16 weeks' gestation with a diagnosis of hyperemesis gravidarum. The nurse should explain to the client that hyperemesis gravidarum is thought to be related to high levels of which of the following hormones? 1.Progesterone. 2.Estrogen. 3.Somatotropin. 4.Aldosterone.

2. Although the cause of hyperemesis is still unclear, it is thought to be related to high estrogen and human chorionic gonadotropin levels or to trophoblastic activity or gonadotropin production. Hyperemesis is also associated with infectious conditions, such as hepatitis or encephalitis, intestinal obstruction, peptic ulcer, and hydatidiform mole. Progesterone is a relaxant used during pregnancy and would not stimulate vomiting. Somatotropin is a growth hormone used in children. Aldosterone is a male hormone."

Three 30-week-gestation clients are on the labor and delivery unit in preterm labor. For which of the clients should the nurse question a doctor's order for beta agonist tocolytics? 1. A client with hypothyroidism. 2. A client with breast cancer. 3. A client with cardiac disease. 4. A client with asthma.

3 1. A history of hypothyroidism does not place a client who is to receive a beta agonist medication at risk. 2. A history of breast cancer does not place a client who is to receive a beta agonist medication at risk. 3. A history of cardiac disease would place a client who is to receive a beta agonist medication at risk. The nurse should question this order. 4. A history of asthma does not place a client who is to receive a beta agonist medication at risk. TEST-TAKING TIP: The test taker should remember that beta agonists stimulate the "fight-or-flight" response. The client's heart rate will increase precipitously, and there is a possibility that the potassium levels of the client may fall. These side effects place the client with heart disease at risk of heart failure and/or dysrhythmias. The client is also at high risk for pulmonary edema, so lung fi eld assessments should be done regularly.

Four women request to labor in the hospital bathtub. In which of the following situations is the procedure contraindicated? Select all that apply. 1. Woman during transition. 2. Woman during second stage of labor. 3. Woman receiving oxytocin for induction. 4. Woman with meconium-stained fluid. 5. Woman with fetus in the occiput posterior position.

3 and 4 are correct. 1. The transition phase is an excellent time to use hydrotherapy. 2. Many women do push during second stage in the water bath. 3. Women undergoing induction should not labor in a water bath. During induction, the fetus should be monitored continually by electronic fetal monitoring. 4. Meconium-stained amniotic fluid may indicate fetal distress. Continuous electronic fetal monitoring would, therefore, be indicated. 5. A posterior fetal position is not a contraindication for the use of a water bath. TEST-TAKING TIP: Hydrotherapy is an excellent complementary therapy for the laboring woman. The warm water is relaxing and many women fi nd that their pain is minimized. Induction and continuous electronic fetal monitoring, however, are incompatible with the intervention.

During a vaginal delivery, the obstetrician declares that a shoulder dystocia has occurred. Which of the following actions by the nurse is appropriate at this time? 1. Administer oxytocin intravenously per doctor's orders. 2. Flex the woman's thighs sharply toward her abdomen. 3. Apply oxygen using a tight-fi tting face mask. 4. Apply downward pressure on the woman's fundus.

2 1. Intravenous oxytocin administration is inappropriate. This would cause the uterus to contract markedly but would not assist with the delivery of the fetal shoulders. 2. Flexing the woman's hips sharply toward her abdomen, called McRoberts maneuver, is appropriate. 3. Oxygen administration will not assist with the delivery of the fetal shoulders. 4. Fundal pressure is inappropriate. TEST-TAKING TIP: Flexing the woman's hips sharply toward her abdomen increases slightly the diameter of the pelvic outlet and straightens the pelvic curve, both of which often enable the practitioner to successfully deliver the baby. It is especially important to note that fundal pressure is contraindicated because it may actually magnify the problem by wedging the shoulders into the pelvis even more deeply. Suprapubic pressure, on the other hand, is often helpful in assisting with the delivery.

During the delivery of a macrosomic baby, the woman develops a fourth-degree laceration. How should the nurse document the extent of the laceration in the woman's medical record? 1. Into the musculature of the buttock. 2. Through the urinary meatus. 3. Through the rectal sphincter. 4. Into the head of the clitoris.

3 1. A laceration into the musculature of the buttocks is defined as a second-degree laceration. 2. A fourth-degree laceration extends through the rectal sphincter. 3. A fourth-degree laceration extends through the rectal sphincter. 4. A fourth-degree laceration extends through the rectal sphincter. TEST-TAKING TIP: One of the many complications that can occur with the delivery of a macrosomic baby is a perineal laceration. If the laceration is extensive and it extends through the rectal sphincter, it is defi ned as a fourth degree. As a result, this client is at high risk for the development of a vaginal rectal fistula.

A 30-year-old, G2 P0010, in preterm labor, is receiving nifedipine (Procardia). Which of the following maternal assessments noted by the nurse must be reported to the healthcare practitioner immediately? 1. Heart rate of 100 bpm. 2. Wakefulness. 3. Audible rales. 4. Daily output of 2,000 mL.

3 1. Mild tachycardia is an expected side effect. 2. Wakefulness is an expected side effect. 3. Audible rales should be reported to the healthcare practitioner. 4. Daily output of 2,000 mL is within normal. TEST-TAKING TIP: The presence of audible rales is indicative of pulmonary edema, a serious side effect related to the medication. The pulmonary edema may be caused by the development of congestive heart failure. Whenever a client is on nifedipine, the nurse should regularly monitor the client's lung fi elds.

A client is 10 minutes postpartum from a forceps delivery of a 4,500-gram neonate with a cleft lip. The physician performed a right mediolateral episiotomy during the delivery. The client is at risk for each of the following nursing diagnoses. Which of the diagnoses is the highest priority at this time? 1. Ineffective breastfeeding. 2. Fluid volume deficit. 3. Infection. 4. Pain.

2 1. Because the baby has a cleft lip, this is an appropriate nursing diagnosis, but it is not the highest priority diagnosis. 2. This is the priority nursing diagnosis. Because the baby is macrosomic, the client is at high risk for uterine atony that could lead to heavy vaginal bleeding, possibly resulting in fluid volume deficit. 3. Although the client is at high risk for infection, it is not highest priority. Infections take time to develop and this client is only 10 minutes postdelivery. 4. Although the client is at high risk for pain, especially from the episiotomy, this is not the highest priority nursing diagnosis. TEST-TAKING TIP: If the test taker remembers CAB as taught in CPR class—circulation, airway, breathing—he or she would realize that the client's fluid volume—that is, circulation—must take precedence.

A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following intramuscular medications would the nurse expect to administer? 1. Decadron (dexamethasone). 2. Amethopterin (methotrexate). 3. Pergonal (menotropin). 4. Prometrium (progesterone).

2 1. Decadron is a steroid. It is not an appropriate therapy for this situation. 2. Methotrexate is the likely medication. 3. Pergonal is an infertility medication. It is not an appropriate therapy for this situation. 4. Progesterone injections are administered to some clients who have a history of preterm labor. It is not an appropriate therapy for this situation. TEST-TAKING TIP: Methotrexate is an antineoplastic agent. Even if the test taker were unfamiliar with its use in ectopic pregnancy but was aware of the action of methotrexate, he or she could deduce its effi cacy here. Methotrexate is a folic acid antagonist that interferes with DNA synthesis and cell multiplication. The conceptus is a ball of rapidly multiplying cells. Methotrexate interferes with that multiplication, killing the conceptus and, therefore, precluding the need for the client to undergo surgery.

A preterm labor client, 30 weeks' gestation, who ruptured membranes 4 hours ago is being given IM dexamethasone (Decadron). When she asks why she is receiving the drug, the nurse replies: 1. "To help to stop your labor contractions." 2. "To prevent an infection in your uterus." 3. "To help to mature your baby's lungs." 4. "To decrease the pain from the contractions."

3 1. Decadron is not a tocolytic. 2. Decadron is not an anti-infective. 3. Decadron is a steroid that hastens the maturation of the fetal lung fields. 4. Decadron is not an analgesic. TEST-TAKING TIP: Steroids (either IM betamethasone or IM dexamethasone) are given over a 2-day period to mothers in preterm labor. The medications have been shown to hasten the development of surfactant in the lung fields of fetuses. Babies whose mothers have received one of the medications experience fewer respiratory complications.

After instruction of a primigravid client at 8 weeks' gestation about measures to overcome early morning nausea and vomiting, which of the following client statements indicates the need for additional teaching? 1."I'll eat dry crackers or toast before arising in the morning." 2."I'll drink adequate fluids separate from my meals or snacks." 3."I'll eat two large meals daily with frequent protein snacks." 4."I'll snack on a small amount of carbohydrates throughout the day

3. The client needs further instructions when she says she should eat two meals a day with frequent protein snacks to decrease nausea and vomiting. The client should eat more frequent, smaller meals, with frequent carbohydrate snacks to decrease nausea and vomiting. Eating dry crackers or toast before arising, consuming fluids separately from meals, and avoiding greasy or spicy foods may also help to decrease nausea and vomiting." Excerpt From: Diane Billings

A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women to prevent which of the following high-risk complications of pregnancy? 1. Preterm birth. 2. Gestational diabetes. 3. Macrosomic babies. 4. Polycythemia.

1 1. Adolescents are at high risk for preterm labor. 2. Lifestyle issues and ethnicity are more important high-risk predictors of GDM than age. 3. Pregnant teens are at high risk for delivering babies who are small-forgestational age rather than macrosomic babies. 4. Pregnant teens are at high risk for anemia rather than for polycythemia. TEST-TAKING TIP: It is very important that pregnant teens learn the telltale signs of preterm labor, such as intermittent backache, cramping, discomfort low in the pelvic area, and the like. Because of their lifestyle choices, pregnant teens are at high risk for low-birth-weight, preterm births.

A gravid, married client, 24 weeks' gestation, is found to have bacterial vaginosis. Her healthcare practitioner has ordered metronidazole (Flagyl) to treat the problem. Which of the following educational information is important for the nurse to provide the woman at this time? 1. The woman must be careful to observe for signs of preterm labor. 2. The woman must advise her partner to seek therapy as soon as possible. 3. A common side effect of the medicine is a copious vaginal discharge. 4. A repeat culture should be taken two weeks after completing the therapy.

1 1. Clients with bacterial vaginosis are at high risk for preterm labor. 2. Male partners rarely need treatment. Female partners in lesbian relationships may, however, need to be treated. 3. Bacterial vaginosis is characterized by a discharge that is often foul-smelling. The discharge is not related to the therapy. 4. An initial, diagnostic microscopic and culture assessment is done. It is not required that a repeat test be done 2 weeks later. TEST-TAKING TIP: Bacterial vaginosis is quite common. The problem is characterized by a shift in the bacterial fl ora of the vagina, resulting in a copious, foul-smelling vaginal discharge. When cultured, the usual findings show a decrease in lactobacilli with an increase in Gardnerella vaginalis or other anaerobic bacteria

A client who works as a waitress and is 35 weeks' gestation telephones the labor suite after getting home from work and states, "I am feeling tightening in my groin about every 5 to 6 minutes." Which of the following comments by the nurse is appropriate at this time? 1. "Please lie down and drink about four full glasses of water or juice." 2. "You are having false labor pains so you need not worry about them." 3. "It is essential that you get to the hospital immediately." 4. "That is very normal for someone who is on her feet all day."

1 1. The first intervention for preterm labor is hydration. Clients who are dehydrated are at high risk for preterm labor. 2. This statement is inappropriate. The client may actually be in true labor. 3. After being hydrated it is possible that the client's cramping will stop. 4. It is not normal for a client to have rhythmic cramping even if she works on her feet. TEST-TAKING TIP: Preterm cramping should never be ignored. To assess whether or not a client is in true labor, clients are encouraged to improve their hydration. The client is encouraged to drink about 1 quart of fl uid and to lie on her side. If the contractions do not stop, she should proceed to the hospital to have her cervix assessed. If the cervix begins to dilate or efface, a diagnosis of preterm labor would be made. If the contractions stop, clients are usually allowed to begin light exercise. But if the contractions restart, the woman should proceed to the hospital to be assessed.

The nurse is developing a standard care plan for the administration of Mifeprex (mifepristone/misoprostol). Which of the following information should the nurse include in the plan? 1. Women should be evaluated by their healthcare practitioners 2 weeks after taking the medicine. 2. This is the preferred method for terminating an ectopic pregnancy when an intrauterine device is in place. 3. The only symptom clients should experience is bleeding 2 to 3 days after taking the medicine. 4. Women who experience no bleeding within 3 days should immediately take a home pregnancy test.

1 1. This is true. It is very important that women be evaluated to make sure that the pregnancy is terminated. Even when bleeding occurs, the pregnancy may still be intact. 2. This is not true. Mifeprex should not be used when an IUD is in place. The IUD should be removed before the medication is administered. 3. This is not true. Women usually complain of cramping, nausea, vomiting, and fatigue. A number of other complaints have also been made. 4. This is unnecessary. If there is no bleeding, she should be seen by the physician for additional treatment. TEST-TAKING TIP: Mifeprex is available for use for terminating unwanted pregnancies, completing incomplete spontaneous abortions, and terminating ectopic pregnancies. If the medicine should be ineffective and the pregnancy survives, there is a strong possibility that the fetus will be damaged. It is very important, therefore, that the client be assessed to make sure that she truly aborted the conceptus

A woman has gotten pregnant with a Copper T intrauterine device (IUD) in place. The physician has ordered an ultrasound to be done to evaluate the pregnancy. The client asks the nurse why this is so important. The nurse should tell the woman that the ultrasound is done primarily for which of the following reasons? 1. To assess for the presence of an ectopic pregnancy. 2. To check the baby for serious malformations. 3. To assess for pelvic inflammatory disease. 4. To check for the possibility of a twin pregnancy.

1 1. When pregnancy occurs with an IUD in place, an ectopic pregnancy should be ruled out. 2. Malformations of the fetus are uncommon. 3. Symptoms of PID are not similar to those of early pregnancy. The most common symptoms of PID are abdominal pain, dyspareunia, foul-smelling vaginal discharge or bleeding, and fever. 4. Twin pregnancies are no more common with a failed IUD than in general. TEST-TAKING TIP: There are two main reasons that pregnancies occurring with an IUD in place are frequently ectopic. First, because the IUD affects the receptivity of the endometrium to the embryo, the fertilized egg often stops its migration and implants in the fallopian tube. Second, sometimes the fallopian tubes become narrowed, preventing the migration of the embryo to the uterine cavity.

A macrosomic baby in the nursery is suspected of having a fractured clavicle from a traumatic delivery. Which of the following signs/symptoms would the nurse expect to see? Select all that apply. 1. Pain with movement. 2. Hard lump at the fracture site. 3. Malpositioning of the arm. 4. Asymmetrical Moro reflex. 5. Marked localized ecchymosis.

1, 2, 3, and 4 are correct. 1. The baby will complain of pain at the site. 2. If not in the immediate period after the injury, within a few days there will be a palpable lump on the bone at the site of the break. 3. Because of the break, the baby is likely to position the arm in an atypical posture. 4. Because of the injury to the bone, the baby is unable to respond with symmetrical arm movements. 5. It is very rare to see ecchymosis at the site of the break. TEST-TAKING TIP: Clavicle breaks are a fairly common injury seen after a delivery. They usually result from a disproportion between the sizes of the maternal pelvis and the fetal body. Because shoulder dystocia is an obstetric emergency, threatening the life of the baby, obstetricians may purposefully break a baby's clavicle to enable the baby to be birthed as rapidly as possible.

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, and 5 are correct 1. When a baby is in the breech presentation, there is increased risk of prolapsed cord. 2. The presenting part is floating, which increases the risk of prolapsed cord. 3. With decreased quantity of amniotic fluid there is no increased risk of prolapsed cord. 4. 2-cm dilation is not a situation that is at high risk for prolapsed cord. 5. When a baby is in the transverse lie, there is increased risk for prolapsed cord. TEST-TAKING TIP: Once the membranes have ruptured, there are several situations that can increase the possibility of the cord prolapsing; that is, when the cord slips past the baby and becomes the presenting part. The baby then compresses the cord, preventing the baby from being oxygenated. The situations include malpresentations, such as breech and shoulder presentations. A shoulder presentation is the same as a transverse lie. Additional situations that are at high risk for cord prolapse are hydramnios, premature rupture of membranes, and negative fetal station

The nurse in the obstetrician's office is caring for four 25-week-gestation prenatal clients who are carrying singleton pregnancies. With which of the following clients should the nurse carefully review the signs and symptoms of preterm labor (PTL)? Select all that apply. 1. 38-year-old in an abusive relationship. 2. 34-year-old whose first child was born at 32 weeks' gestation. 3. 30-year-old whose baby has a two-vessel cord. 4. 26-year-old with a history of long menstrual periods. 5. 22-year-old who smokes 2 packs of cigarettes every day.

1, 2, and 5 are correct. 1. This client is at high risk for PTL because she is over 35 years of age and in an abusive relationship. 2. A previous preterm delivery places a client at increased risk of preterm labor. 3. The presence of a two-vessel cord does not place a client at increased risk of preterm labor. 4. A history of long menstrual periods does not place a client at increased risk of preterm labor. 5. A woman who smokes cigarettes is at high risk for preterm labor. TEST-TAKING TIP: Even though medical and psychosocial histories are not absolute predictors of preterm labor, there are a number of factors that have been shown to place clients at risk, including pregnancy history of multiple gestations; previous preterm deliveries; cigarette smoking and/or illicit drug use; a number of medical histories like diabetes and hypertension; and social issues like adolescent pregnancy and domestic violence.

The nurse is caring for a 30-week-gestation client whose fetal fibronectin (fFN) levels are positive. It is essential that she be taught about which of the following? 1. How to use a blood glucose monitor. 2. Signs of preterm labor. 3. Signs of pre-eclampsia. 4. How to do fetal kick count assessments.

2 1. Fetal fibronectin is not related to glucose metabolism. 2. Positive fetal fibronectin levels are seen in clients who deliver preterm. 3. Fetal fibronectin is not related to hypertensive conditions. 4. Fetal fibronectin is not related to fetal distress. TEST-TAKING TIP: Fetal fibronectin (fFN) is a substance that is metabolized by the chorion. Although positive during the first half of pregnancy, it is very rare to see positive results between 24 and 34 weeks' gestation unless the client's cervix begins to efface and dilate. It is an excellent predictor of preterm labor (PTL); therefore, many practitioners assess the cervical and vaginal secretions of women at high risk for PTL for the presence of fFN.

A client is seen at 8 weeks' gestation for her first prenatal visit. During her last gynecological visit, the client's blood pressure was 100/60. Her blood pressure is now 150/90. For which of the following pregnancy-related illnesses should this client be assessed? 1. Hyperemesis gravidarum. 2. Hydatidiform mole. 3. Pre-eclampsia. 4. Gestational diabetes.

2 1. Hyperemesis gravidarum (HG) is characterized by excessive vomiting during pregnancy. Hypertension is not a common symptom of HG. 2. Unless the pregnant client developed chronic hypertension during her pregnancy, hydatidiform mole is the most likely cause of her high blood pressure. 3. The hypertension seen in pre-eclamptic patients rarely appears before 20 weeks' gestation. This client is exhibiting signs much earlier in her pregnancy. 4. Although hypertensive patients are at high risk for gestational diabetes, this client was normotensive until her pregnancy. In addition, clients who do exhibit diabetic symptoms early in pregnancy are diagnosed with type 2 diabetes, not gestational diabetes. TEST- TAKING TIP: There is no viable fetus in a pregnancy complicated by hydatidiform mole. Rather, the trophoblastic layer, that is, the portion of the fertilized ovum that should become the fetal portion of the placenta, proliferates. The hyperproliferation of the placental tissue often results in the pregnant client developing pre-eclamptic symptoms during the fi rst trimester.

The birth of a baby, weight 4,500 grams, was complicated by shoulder dystocia. Which of the following neonatal complications should the nursery nurse observe for? 1. Leg deformities. 2. Brachial palsy. 3. Fractured radius. 4. Buccal abrasions.

2 1. Limb deformities develop during pregnancy. They are not related to dystocia. 2. During a difficult delivery with shoulder dystocia, the brachial nerve can become stretched and may even be severed. The nurse should, therefore, observe the baby for signs of palsy. 3. A fracture of the radius is an unlikely injury to occur even during a shoulder dystocia. 4. Buccal surfaces lie inside the cheeks. Buccal abrasions are highly unlikely injuries for the baby to sustain during a shoulder dystocia. TEST-TAKING TIP: The key to answering this question is understanding the terminology. A shoulder dystocia is a diffi cult delivery when the shoulder fails to pass easily through the pelvis. Deformities are disfi gurements or malformations. Although the arm and shoulder may be injured, the baby is not disfi gured. A buccal abrasion would occur on the inside of the cheek.

A neonate in the nursery whose mother had no prenatal care has been diagnosed with macrosomia. For which of the following signs/symptoms should the nurse carefully monitor this baby? 1. Jaundice. 2. Jitters. 3. Blepharitis. 4. Strabismus.

2 1. Macrosomic babies are no more at high risk for jaundice than babies of average weight. 2. Macrosomic babies are at high risk for jitters. 3. Macrosomic babies are no more at high risk for blepharitis, inflammation of the eyelash follicles, than babies of average weight. 4. All babies are born with a pseudostrabismus. The muscles of the eyes usually mature by 6 months when the strabismus ceases. TEST- TAKING TIP: To answer this question correctly, the test taker must fully understand the physiology of pregnancy and the pathophysiology of a major cause of macrosomia—namely, maternal gestational diabetes. The high glucose levels in the maternal bloodstream easily cross the placenta, resulting in high glucose levels in the fetus. The babies metabolize the glucose, resulting in a proportionate increase in body weight. When the babies deliver, their bodies continue to excrete high levels of insulin but the high levels of glucose are no longer available. Hypoglycemia and jitters (a symptom of hypoglycemia) result. Because the mother in this scenario had had no prenatal care, it is very possible that she had undiagnosed gestational diabetes

A baby has been admitted to the neonatal intensive care unit with a diagnosis of symmetrical intrauterine growth restriction (IUGR). Which of the following pregnancy complications would be consistent with this diagnosis? 1. Severe pre-eclampsia. 2. Fetal chromosomal defect. 3. Infarcts in an aging placenta. 4. Preterm premature rupture of the membranes.

2 1. Severe pre-eclampsia is associated with asymmetrical IUGR. 2. Chromosomal abnormalities are associated with symmetrical IUGR. 3. An aging placenta is associated with asymmetrical IUGR. 4. Preterm premature rupture of the membranes (PPROM) is unrelated to fetal growth. TEST-TAKING TIP: There is a distinct difference between symmetrical and asymmetrical IUGR. Babies with chromosomal defects often grow poorly from the time of conception. Their entire bodies, therefore, will grow poorly and will be small. Babies who are exposed to complications like pre-eclampsia or an aging placenta during the pregnancy will grow normally during the beginning of the pregnancy but start to grow poorly at the time of the insult. Their growth, therefore, will be disproportionally affected. Although PPROM is unrelated to fetal growth, the premature rupture of the membranes can result in a preterm delivery

A client, G8 P3406, 14 weeks' gestation, is being seen in the prenatal clinic. During the nurse's prenatal teaching session, the nurse will emphasize that the woman should notify the obstetric office immediately if she notes which of the following? 1. Change in fetal movement. 2. Signs and symptoms of labor. 3. Swelling of feet and ankles. 4. Appearance of spider veins.

2 1. The obstetric history is high risk for preterm delivery, not of fetal death. 2. The nurse should emphasize the need for the client to notify the office of signs of preterm labor. 3. Dependent edema is a normal complication of pregnancy. 4. The appearance of spider veins is a normal complication of pregnancy. TEST-TAKING TIP: The test taker must be able to interpret a client's gravidity and parity. The letter "G" stands for gravid, or the number of pregnancies. The letter "P" stands for para, or the number of deliveries. The delivery information is further distinguished by 4 separate numbers: The first refers to the number of full-term pregnancies the client has had, the second refers to the number of preterm pregnancies the client has had, the third refers to the number of abortions the client has had (any pregnancy loss before 20 weeks' gestation), and the fourth refers to the number of living children that the client currently has. The client in the scenario, therefore, has had 8 pregnancies (she is currently pregnant) with 3 full-term deliveries, 4 preterm deliveries, and no abortions, and she currently has 6 living children.

The nurse in the obstetrician's office is caring for four 25-week-gestation prenatal clients who are carrying singleton pregnancies. With which of the following clients should the nurse carefully review the signs and symptoms of preterm labor? 1. African American, 15 years old, with newly diagnosed gestational diabetes. 2. Asian American, 23 years old, with five-year-old twins who were born at term. 3. Jewish, 25 years old, working as a certified public accountant. 4. Mormon, 33 years old, who recently moved into a new apartment.

2 1. This client is high risk for preterm labor because she is African American, under 17 years of age, and has been diagnosed with gestational diabetes, a vascular disease. 2. Although twin pregnancies are at high risk for preterm labor, this client currently is carrying a single fetus. Plus, Asian American women are not at high risk for preterm labor. 3. Neither Jewish clients nor clients who work as certified public accountants are at high risk for preterm labor. 4. Clients who follow the Mormon religion are not at high risk for preterm labor. Simply because a client has had a recent move does not place her at high risk for preterm labor. TEST-TAKING TIP: It has been shown that there are many risk factors for preterm labor, including non-white race, age over 35 or under 17, and maternal medical disease

A woman, 26 weeks' gestation, calls the triage nurse stating, "I'm really scared. I tried not to but I had an orgasm when we were making love. I just know that I will go into preterm labor now." Which of the following responses by the nurse is appropriate? 1. "Lie down and drink a quart of water. If you feel any back pressure at all call me back right away." 2. "Although oxytocin was responsible for your orgasm, it is very unlikely that it will stimulate preterm labor." 3. "I will inform the doctor for you. What I want you to do is to come to the hospital right now to be checked." 4. "The best thing for you to do right now is to take a warm shower and then do a fetal kick count assessment."

2 1. Unless a woman is at high risk for preterm labor, there is no reason to refrain from making love during pregnancy. Therefore, this is an inappropriate statement. 2. This is an accurate statement. 3. Unless a woman is at high risk for preterm labor, this is an inappropriate statement. 4. This is an inappropriate statement. TEST-TAKING TIP: There is no contraindication to intercourse or to orgasm during pregnancy, unless it has been determined that a client is at high risk for preterm labor. Until late in pregnancy, there are very few oxytocin receptor sites on the uterine body. The woman will, therefore, not go into labor as a result of an orgasm during sexual relations.

Which of the following findings would the nurse expect to see when assessing a first-trimester gravida suspected of having gestational trophoblastic disease (hydatidiform mole) that the nurse would not expect to see when assessing a first-trimester gravida with a normal pregnancy? Select all that apply. 1. Hematocrit 39%. 2. Grape-like clusters passed from the vagina. 3. Markedly elevated blood pressure. 4. White blood cell count 8,000/mm 3 . 5. Hypertrophied breast tissue.

2 and 3 are correct. 1. A hematocrit of 39% is well within normal limits. 2. Women with hydatidiform mole often expel grape-like clusters from the vagina. 3. Although signs and symptoms of preeclampsia usually appear only after a pregnancy has reached 20 weeks or later, pre-eclampsia is seen in the first trimester of pregnancy in women with hydatidiform mole. 4. A white blood cell count of 8,000/mm 3 is well within normal limits. 5. Hypertrophied breast tissue is expected early in pregnancy. TEST-TAKING TIP: It is very important that the test taker know the normal values of common laboratory values, especially the complete blood count, and that the test taker be familiar with deviations from normal diagnostic signs and symptoms.

The nurse working in an outpatient obstetric offi ce assesses four primigravid clients. Which of the client findings should the nurse highlight for the physician? Select all that apply. 1. 17 weeks' gestation; denies feeling fetal movement. 2. 24 weeks' gestation; fundal height at the umbilicus. 3. 27 weeks' gestation; salivates excessively. 4. 34 weeks' gestation; experiences uterine cramping. 5. 37 weeks' gestation; complains of hemorrhoidal pain.

2 and 4 are correct. 1. It is common for primigravid women not to feel fetal movement until 19 to 20 weeks' gestation. 2. The fundal height at 24 weeks should be 4 cm above the umbilicus. The fundal height at the level of the umbilicus is expected at 20 weeks' gestation. 3. Excessive salivation, called ptyalism, is an expected finding in pregnancy. 4. The woman may be going into preterm labor. 5. Hemorrhoids are commonly seen in pregnant women. TEST-TAKING TIP: It is important for the test taker to know the timing of key pregnancy changes as well as abnormal prenatal fi ndings. The mother should feel fetal movement by 20 weeks' gestation. Primigravidas often feel fetal movement later than multigravidas. Specifi c fundal height measurements are also expected at key times in the pregnancy. A baby delivered at 34 weeks' gestation is at high risk for many neonatal complications

When preparing a multigravid client who has undergone evacuation of a hydatidiform mole for discharge, the nurse explains the need for follow-up care. The nurse determines that the client understands the instruction when she says that she is at risk for developing which of the following? 1.Ectopic pregnancy. 2.Choriocarcinoma. 3.Multifetal pregnancies. 4.Infertility.

2. A client who has had a hydatidiform mole removed should have regular checkups to rule out the presence of choriocarcinoma, which may complicate the client's clinical picture. The client's human chorionic gonadotropin (hCG) levels are monitored for 1 year. During this time, she should be advised not to become pregnant because this would be reflected in rising hCG levels. Ectopic or multifetal pregnancy is not associated with hydatidiform mole. Women who have molar pregnancies have fertility rates similar to the general population

After a dilatation and curettage (D&C) to evacuate a molar pregnancy, assessing the client for signs and symptoms of which of the following would be most important? 1.Urinary tract infection. 2.Hemorrhage. 3.Abdominal distention. 4.Chorioamnionitis

2. After D&C to evacuate a molar pregnancy, the nurse should assess the client's vital signs and monitor for signs of hemorrhage, because the surgical procedure may have traumatized the uterine lining, leading to hemorrhage. Urinary tract infections, not common after evacuation of a molar pregnancy, are most commonly related to urinary catheterization. Typically, urinary catheters are not used during evacuation of a molar pregnancy. The client should not experience abdominal distention, because the contents of the uterus have been removed. Chorioamnionitis is an inflammation of the amniotic fluid membranes. With complete mole, no embryonic or fetal tissue or membranes are present

Which statement by the client indicates an understanding of the teaching regarding the use of magnesium sulfate and corticosteroids for preterm labor? 1."I will be on magnesium sulfate and corticosteroids until my baby's due date, so he has the best chance of doing well." 2."The magnesium sulfate is to stop contractions while the corticosteroids increase lung surfactant in my baby so he can breathe better if he is born early." 3."The goal of the magnesium sulfate and the corticosteroids is to stop contractions and help me get to my due date." 4."If I take this magnesium sulfate and the corticosteroids, my baby won't have to spend any time in the neonatal intensive care unit if he is born."

2. Corticosteroids given IM have been shown to increase fetal lung surfactant and reduce the risk of respiratory distress syndrome in premature infants. It is not a guarantee that a premature newborn would not have problems at birth that would require time in the neonatal intensive care unit. The administration of the corticosteroids is normally completed within 24 to 48 hours. Magnesium sulfate is currently given IV to women in preterm labor to stop contractions and therefore prolong gestation long enough for the corticosteroids to be most effective for the fetus. Magnesium sulfate is not always effective at stopping preterm labor

After suction and evacuation of a complete hydatidiform mole, the 28-year-old multigravid client asks the nurse when she can become pregnant again. The nurse would advise the client not to become pregnant again for at least which of the following time spans? 1.6 months. 2.12 months. 3.18 months. 4.24 months

2. A client who has experienced a molar pregnancy is at risk for development of choriocarcinoma and requires close monitoring of human chorionic gonadotropin (hCG) levels. Pregnancy would interfere with monitoring these levels. High hCG titers are common for up to 7 weeks after the evacuation of the mole, but then these levels gradually begin to decline. Clients should have a pelvic examination and a blood test for hCG titers every month for 6 months and then every 2 months for 1 year. Gradually declining hCG levels suggest no complications. Increasing levels are indicative of a malignancy and should be treated with methotrexate. If after 1 year the hCG levels are negative, the client is theoretically free of the risk of a malignancy developing and could plan another pregnancy

A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis? 1. Dark brown rectal bleeding. 2. Severe nausea and vomiting. 3. Sharp unilateral pain. 4. Marked hyperthermia.

3 1. After the embryo dies, the nurse would expect to see vaginal bleeding. Rectal bleeding would not be expected. 2. Nausea and vomiting are not characteristic of a ruptured ectopic. 3. Sharp unilateral pain is a common symptom of a ruptured ectopic. 4. Hyperthermia is not characteristic of a ruptured ectopic. TEST-TAKING TIP: The most common location for an ectopic pregnancy to implant is in a fallopian tube. Because the tubes are nonelastic, when the pregnancy becomes too big, the tube ruptures. Unilateral pain can develop because only one tube is being affected by the condition, but some women complain of generalized abdominal pain.

There are four clients in the labor suite. Each client's labor is being augmented with oxytocin (Pitocin). Which of the women should the nurse monitor carefully for the potential of uterine rupture? 1. Age 15, G3 P0020, in active labor. 2. Age 22, G1 P0000, eclampsia. 3. Age 25, G4 P3003, last delivery by cesarean section. 4. Age 32, G2 P0100, first baby died during labor.

3 1. Although this teenager has had two abortions, she is not markedly at high risk for uterine rupture. 2. A primigravida with eclampsia is not markedly at high risk for uterine rupture. 3. A woman, no matter what her age, who has had a previous cesarean section and whose labor is being augmented with oxytocin, is at risk for uterine rupture. 4. A woman who has a history of fetal death is not markedly at high risk for uterine rupture. TEST-TAKING TIP: When babies are birthed via cesarean section, the surgeon must create an incision through the uterine body. The muscles of the uterus have, therefore, been ligated and a scar has formed at the incision site. Scars are not elastic and do not contract and relax the way muscle tissue does. A vaginal birth after cesarean (VBAC) section can be performed only if the woman had a low flap (Pfannenstiel) incision in the uterus during her previous cesarean section.

Which of the following findings should the nurse expect when assessing a client, 8 weeks' gestation, with gestational trophoblastic disease (hydatidiform mole)? 1. Protracted pain. 2. Variable fetal heart decelerations. 3. Dark brown vaginal bleeding. 4. Suicidal ideations.

3 1. Pain is not associated with this condition. 2. There is no fetus; therefore, there will be no fetal heart. 3. The condition is usually diagnosed after a client complains of brown vaginal discharge early in the "pregnancy." 4. Suicidal ideations are not associated with this condition. TEST-TAKING TIP: The most important thing to remember when answering questions about hydatidiform mole is the fact that, even though a positive pregnancy test has been reported, there is no "pregnancy." The normal conceptus develops into two portions—a blastocyst, which includes the fetus and amnion, and a trophoblast, which includes the fetal portion of the placenta and the chorion. In gestational trophoblastic disease (hydatidiform mole), only the trophoblastic layer develops; no fetus develops. With the proliferation of the chorionic layer, the client is at high risk for gynecological cancer.

During a vaginal delivery of a macrosomic baby, the nurse midwife requests nursing assistance. Which of the following actions by the nurse would be appropriate? 1. Estimate fetal length and weight. 2. Assess intensity of contractions. 3. Provide suprapubic pressure. 4. Assist woman with breathing.

3 1. This action will not assist the midwife with the delivery of the baby. 2. This action will not assist the midwife with the delivery of the baby. 3. Suprapubic pressure can help to dislodge the shoulders of a macrosomic baby and facilitate the delivery. 4. This action will not assist the midwife with the delivery of the baby. TEST-TAKING TIP: Macrosomia can lead to shoulder dystocia during a delivery. Suprapubic pressure helps to dislodge the shoulders and enable the baby to be delivered. Nurses must not apply fundal pressure in this situation. Rather than facilitating delivery of the shoulders, fundal pressure can actually worsen the dystocia.

The nurse discusses sexual intimacy with a pregnant couple. Which of the following should be included in the teaching plan? 1. Vaginal intercourse should cease by the beginning of the third trimester. 2. Breast fondling should be discouraged because of the potential for preterm labor. 3. The couple may find it necessary to experiment with alternate positions. 4. Vaginal lubricant should be used sparingly throughout the pregnancy.

3 1. Unless a woman is at high risk for preterm labor, has been diagnosed with placenta previa, or has preterm rupture of the membranes, sexual intercourse is not contraindicated. 2. Breast fondling should be discouraged only if the client is at high risk for preterm labor. 3. With increasing size of the uterine body, the couple may need counseling regarding alternate options for sexual intimacy. 4. There is no contraindication for vaginal lubricant use in pregnancy. As a matter of fact, with the increased discharge experienced by many mothers, lubricants are often not needed. TEST-TAKING TIP: Pregnancy lasts 10 lunar months. It is essential that the nurse counsel clients on ways to maintain health and well-being in the many facets of their lives. Sexual intimacy is one of the important aspects of a married couple's life together. The couple can be counseled to use alternate positions, engage in mutual masturbation, or discover other means to satisfy their needs for sexual exp

A pregnant woman, G3 P2002, had her two other children by cesarean section. Which of the following situations would mandate that this delivery also be by cesarean? 1. The woman refuses to have a regional anesthesia. 2. The woman is postdates with intact membranes. 3. The baby is in the occiput posterior position. 4. The previous uterine incisions were vertical.

4 1. A vaginal delivery can be performed with no anesthesia. 2. A postdates pregnancy is not an absolute indication for a cesarean delivery. 3. An occiput posterior position is not an indication for a cesarean delivery. 4. The presence of vertical incisions in the uterine wall is an absolute indication for a cesarean delivery. TEST-TAKING TIP: The muscle tissue that contracts during labor is located in the fundal region of the uterus. A vertical incision into the uterus ligates fundal tissue. The scar that forms from the incision is nonelastic, putting the client at risk of uterine rupture. Having had a previous vertical uterine incision, therefore, is an absolute indicator for future cesarean delivery. Albeit not an absolute indicator, some physicians also encourage clients who have had low-fl ap (Pfannenstiel) incisions into the uterus to have all subsequent children delivered via cesarean section. (It is important to note that the type of incision that the surgeon used to open the skin is not necessarily the type of incision used to open the uterus.)

A newborn in the well-baby nursery is noted to have a chignon. The nurse concludes that the baby was born via which of the following methods? 1. Cesarean section. 2. High forceps delivery. 3. Low forceps delivery. 4. Vacuum extraction.

4 1. Babies born via cesarean section usually have round, unmolded heads. 2. High forceps are not used in obstetrics today. High forceps, applied to babies' heads that are not well descended, are no longer used because of the high incidence of fetal damage that results. Instead, babies who fail to descend are now delivered via cesarean section. 3. Low forceps are applied when engagement is +2 or greater. The baby may develop forceps marks but would not develop a chignon. 4. Babies born via vacuum extraction often do develop chignons. TEST-TAKING TIP: In common language, a chignon is a hairstyle that is characterized by a bun or knot of hair worn on the back of the head or nape of the neck. In obstetrics, a chignon is a round, bruised caput seen on the crown of the baby's head. It results from the pressure exerted on the scalp during a vacuum-assisted delivery

Which of the following situations should the nurse conclude is a vaginal delivery emergency? 1. Third stage of labor lasting 20 minutes. 2. Fetal heart dropping during contractions. 3. Three-vessel cord. 4. Shoulder dystocia.

4 1. The normal time frame for the third stage of labor is between 5 and 30 minutes. 2. This is a description of an early deceleration. Early decelerations are expected during the late first stage and the second stage of labor. 3. A three-vessel umbilical cord is normal. 4. Shoulder dystocia is an obstetric emergency. TEST-TAKING TIP: "Dystocia" means "difficult delivery." A shoulder dystocia, therefore, refers to difficulty in delivering a baby's shoulders. This is an obstetric emergency because the dystocia occurs in the middle of the delivery when the head has been delivered but the shoulders remain wedged in the pelvis. In addition, the baby's life is threatened because the baby is unable to breathe and umbilical cord fl ow is often dramatically reduced during this phase of the delivery. If the baby is delivered successfully, the baby should be assessed for nerve palsies from traction placed on the baby's head during the delivery of the shoulders.

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following laboratory values would be consistent with this diagnosis? 1. PO2 90, PCO2 35, HCO 3 19 mEq/L, pH 7.3. 2. PO2 100, PCO2 30, HCO 3 21 mEq/L, pH 7.5. 3. PO2 60, PCO2 50, HCO 3 28 mEq/L, pH 7.3. 4. PO2 90, PCO2 45, HCO 3 30 mEq/L, pH 7.5.

4 1. This client is in metabolic acidosis. This is consistent with a diagnosis of diarrhea. 2. This client is in respiratory alkalosis. This is consistent with a diagnosis of hyperventilation. 3. This client is in respiratory acidosis. This is consistent with a diagnosis of respiratory distress. 4. This client is in metabolic alkalosis. This is consistent with a diagnosis of hyperemesis gravidarum. TEST-TAKING TIP: The test taker must not panic when confronted with blood gas data. If assessed methodically, the test taker should have little trouble determining the correct answer. The fi rst action is to determine what the results should show. If a woman is vomiting repeatedly, one would expect her to have lost acid from the stomach. She would, therefore, be in metabolic alkalosis. The test taker should then look at the pH levels—they should be elevated—and the O 2 levels—they should be normal—to begin to determine which response is correct.

A baby born by vacuum extraction has been admitted to the well-baby nursery. The nurse should assess this baby for which of the following? 1. Pedal abrasions. 2. Hypobilirubinemia. 3. Hyperglycemia. 4. Cephalhematoma.

4 1. Vacuum-assisted deliveries result in injuries to the head and scalp, not to the feet. 2. The babies are at high risk for hyperbilirubinemia, not hypobilirubinemia. 3. Babies born via vacuum are not at high risk for hyperglycemia. 4. Babies born via vacuum are at high risk for cephalhematoma. TEST-TAKING TIP: Babies born either via vacuum or via forceps are at high risk for cephalhematoma as well as subdural hematoma. During mechanically assisted births, there often is trauma to the neonate's head and scalp. A cephalhematoma develops as a result of injury to superfi cial blood vessels. The blood loss accumulates in the subcutaneous space above the periosteum. The test taker should remember that babies born with cephalhematomas are at high risk for hyperbilirubinemia.

A client is receiving terbutaline (Brethine) for preterm labor. Which of the following findings would warrant stopping the infusion? Select all that apply. 1. Change in contraction pattern from q 2 min × 90 sec to q 3 min × 30 sec. 2. Change in fetal heart pattern from no decelerations to early decelerations. 3. Change in beat-to-beat variability from minimal to moderate. 4. Change in fetal heart rate from 160 bpm to 210 bpm. 5. Change in the amniotic sac from intact to ruptured.

4 and 5 are correct. 1. A lengthening of the frequency and a decrease in the duration of the contractions are the expected, therapeutic responses. The changes do not warrant stopping the medication. 2. A change in fetal heart rate pattern from no decelerations to early decelerations is a benign change. This change does not warrant stopping the medication. 3. Minimal variability is a sign of poor fetal oxygenation, whereas moderate variability is a sign of good fetal oxygenation. This change does not warrant stopping the medication. 4. When the fetal heart rate pattern is greater than 200 bpm, the medication should be stopped. 5. Terbutaline is contraindicated when the membranes have ruptured prematurely. TEST- TAKING TIP: Terbutaline, a beta agonist, stimulates the "fi ght-or-fl ight" response in the mother and in the fetus. The fetal heart rate, therefore, increases in response to the medication. When the rate is too high, however, there is insuffi cient time for the blood to enter the heart, which leads to a drop in cardiac output.

A client at 15 weeks' gestation is admitted with dark brown vaginal bleeding and continuous nausea and vomiting. Her blood pressure is 142/98 and fundal height is 19 cm. The nurse should prepare to do which of the following? 1.Transfer the client to the antenatal unit. 2.Keep the client NPO for 24 hours. 3.Administer magnesium sulfate. 4.Obtain an ultrasound

4. The nurse should prepare the client for an ultrasound to determine the cause of the symptoms. Elevated blood pressure at this point in the pregnancy could indicate chronic hypertension as well as hydatidiform mole. The fundal height of 19 cm is higher than is typically found at 15 weeks' gestation and is indicative of a molar pregnancy (hydatidiform mole). The dark brown vaginal bleeding in isolation could indicate an abortion but when placed in context of the other symptoms is likely related to a hydatidiform mole. The continuous nausea and vomiting is abnormal at this point in the pregnancy and can be a result of the high levels of progesterone from a molar pregnancy. There is no fetus involved; the blood pressure elevation and the continuous nausea and vomiting will resolve with evacuation of the mole, negating the need for magnesium sulfate therapy and placing the client on NPO status

A multigravid client at 34 weeks' gestation is being treated with indomethacin (Indocin) to halt preterm labor. If the client gives birth to a preterm infant, the nurse should notify the nursery personnel about this therapy because of the possibility for which of the following? 1.Pulmonary hypertension. 2.Respiratory distress syndrome (RDS). 3.Hyperbilirubinemia. 4.Cardiomyopathy"

"1. Indomethacin (Indocin) has been successfully used to halt preterm labor. However, if the client should give birth to a preterm infant, the nurse would notify the nursery personnel about the tocolytic therapy because this drug can lead to premature closure of the fetal ductus arteriosus, resulting in pulmonary hypertension. Prematurity is associated with RDS because of the immaturity of the fetal lungs. RDS is not a result of indomethacin. Hyperbilirubinemia is more common in preterm infants. Use of indomethacin to halt preterm labor is not associated with cardiomyopathy in the infant

The nurse is assisting in the delivery of a baby via vacuum extraction. Which of the following nursing diagnoses for the gravida is appropriate at this time? 1. Risk for impaired skin integrity. 2. Risk for body image disturbance. 3. Risk for impaired parenting. 4. Risk for ineffective sexuality pattern.

1 1. The woman is at risk of impaired skin integrity. 2. Risk for impaired body image is not appropriate at this time. 3. Risk for impaired parenting is not appropriate at this time. 4. Risk for ineffective sexuality pattern is not appropriate at this time. TEST-TAKING TIP: Clients who are delivered by vacuum extraction are at high risk for lacerations. Their skin integrity, therefore, is at risk. The other nursing diagnoses are not applicable.

A client, G2 P1001, telephones the gynecology office complaining of left-sided pain. Which of the following questions by the triage nurse would help to determine whether the one-sided pain is due to an ectopic pregnancy? 1. "When did you have your pregnancy test done?" 2. "When was the first day of your last menstrual period?" 3. "Did you have any complications with your first pregnancy?" 4. "How old were you when you first got your period?"

1. The timing of the pregnancy test is irrelevant. 2. The date of the last menstrual period will assist the nurse in determining how many weeks pregnant the client is. 3. The woman's previous complications are irrelevant at this time. 4. The age of the woman's menarche is irrelevant. TEST-TAKING TIP: The date of the last menstrual period is important for the nurse to know. Ectopic pregnancies are usually diagnosed between the 8th and the 9th week of gestation because, at that gestational age, the conceptus has reached a size that is too large for the fallopian tube to hold.

A woman, G5 P0311, is in the post-anesthesia care unit (PACU) after a cervical cerclage procedure. During the immediate postprocedure period, what should the nurse carefully monitor this client for? 1. Hyperthermia. 2. Hypotension. 3. Uterine contractions. 4. Fetal heart dysrhythmias.

3 1. Clients who have cerclages placed are not at high risk for hyperthermia in the immediate postprocedure period. 2. Hypotension is not a major complication of clients who have had a cerclage placed. 3. Preterm labor is a complication in the immediate postprocedure period. 4. A fetal heart dysrhythmia is not a complication related to the placement of the cerclage. TEST-TAKING TIP: Cerclages are inserted when clients have a history of recurring pregnancy loss related to a cervical insuffi ciency. Losses typically occur between 14 and 26 weeks' gestation. This client has had 5 pregnancies but only one living child. Unfortunately, with the manipulation of the cervix at the time of the cerclage, the clients may develop preterm labor. The clients should be monitored carefully with a tocometer to assess for labor contractions.

A 28-week-gestation client with intact membranes is admitted with the following findings: Contractions every 5 min × 60 sec, 3 cm dilated, 80% effaced. Which of the following medications will the obstetrician likely order? 1. Oxytocin (Pitocin). 2. Ergonovine (Methergine). 3. Magnesium sulfate. 4. Morphine sulfate.

3 1. Oxytocin will increase the client's contractions. The administration of this medication is inappropriate at this time. 2. Methergine should never be administered unless the placenta is already delivered. 3. Magnesium sulfate is a tocolytic agent. It would be appropriate for this medication to be administered at this time. 4. Morphine sulfate is an opioid. There is no rationale for its administration in the scenario. TEST-TAKING TIP: The client in the scenario is exhibiting signs that meet the criteria for preterm labor. The test taker should deduce, therefore, that a tocolytic agent may be ordered in this situation. The only tocolytic agent included in the choices is magnesium sulfate.

Immediately prior to an amniotomy, the external fetal heart monitor tracing shows 145 bpm with early decelerations. Immediately following the procedure, an internal tracing shows a fetal heart rate of 90 bpm with variable decelerations. A moderate amount of clear, amniotic fluid is seen on the bed linens. The nurse concludes that which of the following has occurred? 1. Placental abruption. 2. Eclampsia. 3. Prolapsed cord. 4. Succenturiate placenta.

3 1. There are no signs of placenta abruption in this scenario. 2. The woman has not seized. She is not eclamptic. 3. The drop in fetal heart rate with variable decelerations indicates that the cord has likely prolapsed. 4. There are no signs that this client has a succenturiate placenta. TEST-TAKING TIP: Variable decelerations are caused by cord compression. Variable decelerations and a precipitous drop in the fetal heart baseline are indirect indications that the cord is being compressed, resulting in decreased oxygenation to the fetus

A mother, G6 P6006, is 15 minutes postpartum. Her baby weighed 4,595 grams at birth. For which of the following complications should the nurse monitor this client? 1. Seizures. 2. Hemorrhage. 3. Infection. 4. Thrombosis.

3 1. This client is not especially at high risk for seizures. 2. The client should be monitored carefully for signs of postpartum hemorrhage. 3. This client is not especially at high risk for infection. 4. This client is not especially at high risk for thrombosis. TEST-TAKING TIP: An average size baby weighs 2,500 to 4,000 grams. The baby in the scenario is macrosomic. As a result, the mother's uterus has been stretched beyond its expected capacity. In addition, this client is a "grand multipara" or a woman who has delivered 5 or more babies. The client is at high risk for uterine atony, which could result in a postpartum hemorrhage.

The health care provider has determined that a preterm labor client at 34 weeks' gestation has no fetal fibronectin present. Based on this finding, the nurse would anticipate that within the next week: 1.The client will develop preeclampsia. 2.The fetus will develop mature lungs. 3.The client will not develop preterm labor. 4.The fetus will not develop gestational diabetes.

3. The absence of fetal fibronectin in a vaginal swab between 22 and 37 weeks' gestation indicates there is less than 1% risk of developing preterm labor in the next week. Fetal fibronectin is an extra cellular protein normally found in fetal membranes and deciduas and has no correlation with preeclampsia, fetal lung maturation, or gestational diabetes.

A multigravid client is admitted to the hospital with a diagnosis of ectopic pregnancy. The nurse anticipates that, because the client's fallopian tube has not yet ruptured, which of the following may be prescribed? 1.Progestin contraceptives. 2.Medroxyprogesterone. 3.Methotrexate. 4.Dyphylline.

3. Because the fallopian tube has not yet ruptured, methotrexate may be given, followed by leucovorin. This chemotherapeutic agent attacks the fast-growing zygote and trophoblast cells. RU-486 is also effective. A hysterosalpingogram is usually performed after chemotherapy to determine whether the tube is still patent. Progestin-only contraceptives and medroxyprogesterone are ineffective in clearing the fallopian tube. Dyphylline is a bronchodilator and is not used." Excerpt From: Diane Billings

A client who is 8 weeks' gestation has been diagnosed with a hydatidiform mole (gestational trophoblastic disease). In addition to vaginal loss, which of the following signs/symptoms would the nurse expect to see? 1. Hyperemesis and hypertension. 2. Diarrhea and hyperthermia. 3. Polycythemia. 4. Polydipsia.

1 1. Hyperemesis and hypertension are often seen in clients with hydatidiform mole. 2. Neither diarrhea nor hyperthermia is associated with hydatidiform mole. 3. Polycythemia is not associated with hydatidiform mole. 4. Polydipsia is not associated with hydatidiform mole. TEST-TAKING TIP: Because the levels of human chorionic gonadotropin are markedly elevated with hydatidiform mole, women often experience excessive vomiting. In addition, signs of preeclampsia, such as hypertension, appear before 20 weeks' gestation in clients with molar pregnancies.

Which of the following long-term goals is appropriate for a client, 10 weeks' gestation, who is diagnosed with gestational trophoblastic disease (hydatidiform mole)? 1. Client will be cancer-free 1 year from diagnosis. 2. Client will deliver her baby at full term without complications. 3. Client will be pain-free 3 months after diagnosis. 4. Client will have normal hemoglobin and hematocrit at delivery.

1 1. This long-term goal is appropriate. 2. This client is not pregnant. She will not deliver a baby. 3. This client is not in intense pain. This long-term goal is not appropriate. 4. This client is not pregnant. She will not deliver a baby. TEST-TAKING TIP: When nurses plan care, they have in mind short-term and longterm goals that their clients will achieve. Short-term goals usually have a time frame of a week or two and often are specifi c to the client's current hospitalization. Long-term goals are expectations of client achievement over extended periods of time. It is important for nurses to develop goals to implement appropriate nursing interventions.

Thirty seconds after birth, a baby who appears preterm has exhibited no effort to breathe even after being stimulated. The heart rate is assessed at 70 bpm. Which of the following actions should the nurse perform first? ' 1. Perform a gestational age assessment. 2. Inflate the lungs with positive pressure. 3. Provide external chest compressions. 4. Assess the oxygen saturation level.

2 1. The gestational age assessment should be performed only after resuscitation efforts have been performed. 2. The baby's airway should be established by inflating the lungs with an ambu bag. 3. Chest compressions are begun after an airway is established and the heart rate has been assessed. 4. Immediately after positive pressure ventilation (PPV) has been started, an oxygen saturation electrode should be placed on the baby's foot and the values should be monitored continuously. TEST-TAKING TIP: The steps of a neonatal resuscitation are slightly different from those for an older baby, a child, or an adult. Because the baby's survival is contingent upon the establishment of respiratory function, respiratory resuscitation must be instituted in a timely manner. If there is no spontaneous breathing and the heart rate is less than 100 bpm after birth, PPV should be begun followed immediately by continuous O 2 saturation assessments and, if available, direct ECG. Cardiac compressions and intubation, if not already performed, are started if the heart rate falls below 60 bpm

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 healthcare 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 and 4 are correct. 1. The presence of contractions without cervical change is not diagnostic of preterm labor. 2. Preterm labor is defi ned as cervical effacement of greater than 80%. Although the client has effaced slightly, a diagnosis of preterm labor cannot as yet be made. 3. The dilation of 3 cm is indicative of preterm labor. 4. A cervical length of 2 cm is indicative of preterm labor. 5. The presence of 30-second-duration contractions is not diagnostic of preterm labor.

A 36-year-old multigravid client is admitted to the hospital with possible ruptured ectopic pregnancy. When obtaining the client's history, which of the following would be most important to identify as a predisposing factor? 1.Urinary tract infection. 2.Marijuana use during pregnancy. 3.Episodes of pelvic inflammatory disease. 4.Use of estrogen-progestin contraceptives

3. Anything that causes a narrowing or constriction in the fallopian tubes so that a fertilized ovum cannot be properly transported to the uterus for implantation predisposes an ectopic pregnancy. Pelvic inflammatory disease is the most common cause of constricted or narrow tubes. Developmental defects are other possible causes. Ectopic pregnancy is not related to urinary tract infections. Use of marijuana during pregnancy is not associated with ectopic pregnancy, but its use can result in cognitive reduction if the mother's use during pregnancy is extensive. Progestin-only contraceptives and intrauterine devices have been associated with ectopic pregnancy

When preparing a multigravid client at 34 weeks' gestation experiencing preterm labor for the shake test performed on amniotic fluid, the nurse would instruct the client that this test is done to evaluate the maturity of which of the following fetal systems? 1.Urinary. 2.Gastrointestinal. 3.Cardiovascular. 4.Pulmonary.

4. The shake test helps determine the maturity of the fetal pulmonary system. The test is based on the fact that surfactant foams when mixed with ethanol. The more stable the foam, the more mature the fetal pulmonary system. Although the shake test is inexpensive and provides rapid results, problems have been noted with its reliability. Therefore, the lecithin-sphingomyelin ratio is usually determined in conjunction with the shake test.

A type 1 diabetic gravida has developed polyhydramnios. The client should be taught to report which of the following? 1. Uterine contractions. 2. Reduced urinary output. 3. Marked fatigue. 4. Puerperal rash

1 1. The client should be taught to observe for signs of preterm labor. 2. The client is not at high risk for decreased urinary output. 3. The client is not at high risk for marked fatigue. 4. Puerperal complications occur postpartum. TEST-TAKING TIP: Clients with polyhydramnios (also called hydramnios) have excessive quantities of amniotic fluid in their uterine cavities. The excessive quantities likely result from increased fetal urine production, caused by the mother's having periods of hyperglycemia. When the uterus is overextended from the large quantities of fluid, these women are at high risk for preterm labor.

A primiparous client has just given birth. The primary health care provider has informed the labor nurse that he believes the uterus has inverted. Which of the following would help to confirm this diagnosis? Select all that apply. 1.Hypotension. 2.Gush of blood from the vagina. 3.Intense, severe, tearing type of abdominal pain. 4.Uterus is hard and in a constant state of contraction. 5.Inability to palpate the uterus. 6.Diaphoresis

1,2,5,6. Uterine inversion is indicated by a sudden gush of blood from the vagina leading to decreased blood pressure, and an inability to palpate the uterus since it may be in or protruding from the vagina and any signs of blood loss such as diaphoresis, paleness, or dizziness could be observed at this time. Intense pain and a hard contracting uterus are not associated with uterine inversion

The nurse enters a laboring client's room. The client is complaining of intense back pain with each contraction. The nurse concludes that the fetus is likely in which of the following positions? 1. Mentum anterior. 2. Sacrum posterior. 3. Occiput posterior. 4. Scapula anterior.

3 1. A fetus in the mentum anterior position is unlikely to elicit severe back pain in the mother. 2. A fetus in the sacral posterior position is unlikely to elicit severe back pain in the mother. 3. When a fetus is in the occiput posterior position, mothers frequently complain of severe back pain. 4. A fetus in the scapula anterior position is unlikely to elicit severe back pain in the mother. TEST-TAKING TIP: If the test taker were to view a picture of a baby in the occiput posterior position, he or she would note that the occiput of the baby lies adjacent to the coccyx of the mother. During each contraction, the occiput, therefore, is forced backward into the coccyx. This action is very painful.

A gravid woman has just been admitted to the emergency department subsequent to a head-on automobile accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which of the following complications of pregnancy? Select all that apply. 1. Placenta previa. 2. Transverse fetal lie. 3. Placental abruption. 4. Severe pre-eclampsia. 5. Preterm labor.

3 and 5 are correct. 1. Placenta previa is not an acute problem. It is related to the site of placental implantation. 2. Transverse fetal lie is a malpresentation. It would not be related to the auto accident. 3. Placental abruption may develop as a result of the auto accident. 4. Pre-eclampsia does not occur as a result of an auto accident. 5. The woman may go into preterm labor after an auto accident. TEST-TAKING TIP: The fetus is well protected within the uterine body. The musculature of the uterus and the amniotic fluid provide the baby with enough cushioning to withstand minor bumps and falls. A major automobile accident, however, can cause anything from preterm premature rupture of the membranes, to preterm labor, to a ruptured uterus, to placental abruption. The nurse should especially monitor the fetal heartbeat for any variations.

The fetus of a 38-week-gestation client has been diagnosed with intrauterine growth restriction (IUGR). The nurse would expect that which of the following diagnostic assessments would be appropriate for the primary healthcare practitioner to order at this time? Select all that apply. 1. Biophysical profile. 2. Nonstress test. 3. Umbilical arterial Doppler assessment. 4. Chorionic villus sampling. 5. Human chorionic gonadotropin test.

1, 2, and 3 are correct. 1. It would be appropriate to perform a biophysical profile (BPP). 2. It would be appropriate to perform a nonstress test (NST). 3. It would be appropriate to perform an umbilical arterial Doppler assessment (UA). 4. Chorionic villus sampling is performed during the first trimester. The results provide fetal genetic information. 5. Human chorionic gonadotropin testing is performed during the first trimester. The hormone is produced by the trophoblastic layer until approximately 13 weeks' gestation. TEST-TAKING TIP: A fetus with IUGR is growing more slowly than expected. The restricted growth may be caused by poor placental blood fl ow. The UA is performed to assess the blood fl ow. The NST and BPP are performed to provide additional information regarding the health and well-being of the fetus.

A 38-year-old client at about 14 weeks' gestation is admitted to the hospital with a diagnosis of complete hydatidiform mole. Soon after admission, the nurse would assess the client for signs and symptoms of which of the following? 1.Pregnancy-induced hypertension. 2.Gestational diabetes. 3.Hypothyroidism. 4.Polycythemia

1. Hydatidiform mole is suspected when the following are present: pregnancy-induced hypertension before the 24th week of gestation, brownish or prune-colored vaginal bleeding, anemia, absence of fetal heart tones, passage of hydropic vessels, uterine enlargement greater than expected for gestational age, and increased human chorionic gonadotropin levels. Gestational diabetes is related to an increased risk of preeclampsia and urinary tract infections, but it is not associated with hydatidiform mole. Hyperthyroidism, not hypothyroidism, occurs occasionally with hydatidiform mole. If it does occur, it can be a serious complication, possibly life-threatening to the mother and fetus from cardiac problems. Polycythemia is not associated with hydatidiform mole. Rather, anemia from blood loss is associated with molar pregnancies

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary healthcare provider is highest priority for the nurse to complete? 1. Obtain complete blood count. 2. Start intravenous with multivitamins. 3. Check admission weight. 4. Obtain urine for urinalysis

2 1. The blood count is important but it is not highest priority. 2. Starting an intravenous with multivitamins takes priority. 3. An admission weight is important but is not highest priority. 4. The urinalysis is important but is not highest priority. TEST-TAKING TIP: Clients who are vomiting repeatedly are energy depleted, vitamin depleted, electrolyte depleted, and often dehydrated. It is essential that the client receive her IV therapy as quickly as possible. The other orders should be completed soon after the IV is started.

Intravenous magnesium sulfate has been ordered for a 31 weeks' gestation client in preterm labor. The client's vital signs are: TPR 98.6°F /37°C, 92, 22; BP 110/70. The nurse knows that, in addition to its tocolytic action, the rationale for its administration is to prevent which of the following neonatal complications? 1. Hypoxemia. 2. Cerebral palsy. 3. Cold stress syndrome. 4. Necrotizing enterocolitis.

2 1. The goal of administering IV magnesium sulfate to the mother is not to prevent hypoxemia in the neonate. 2. The goal of administering IV magnesium sulfate to the mother is to prevent cerebral palsy in the neonate. 3. The goal of administering IV magnesium sulfate to the mother is not to prevent cold stress syndrome in the neonate. 4. The goal of administering IV magnesium sulfate to the mother is not to prevent necrotizing enterocolitis in the neonate. TEST-TAKING TIP: Preterm babies birthed to mothers who have received at least 48 hours of intravenous magnesium sulfate prior to the birth are at reduced risk of developing cerebral palsy. Cerebral palsy is one of the most common sequalae to prematurity. Whether during pregnancy, labor and delivery, or postdelivery, premature babies are at risk of developing cerebral palsy secondary to cerebral hypoxemia. When the motor centers of the brain are deprived of oxygen, the chronic illness— cerebral palsy—can result. Other neurodevelopmental complications can also result.

During a nurse's shift, the fetal heartbeat patterns on five fully dilated clients showed minimal variability and late decelerations. The primary healthcare practitioners all requested forceps to speed the deliveries. In which of the situations should the nurse have refused to provide the delivery forceps? Select all that apply. 1. Maternal history of asthma. 2. Right occiput posterior position at +4 station. 3. Transverse fetal lie. 4. Mentum presentation and -1 station. 5. Maternal history of cerebral palsy.

3 and 4 are correct. 1. Asthmatic clients, although needing careful monitoring, are able to deliver via forceps. 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 the baby who is at -1 station with forceps. The baby has yet to engage. 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 suffi cient 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 baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis? Select all that apply. 1. Hyperopia. 2. Gestational diabetes. 3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age.

3, 4, and 5 are correct. 1. Hyperopia, another name for farsightedness, is unrelated to placental function. 2. If the mother had gestational diabetes, the nurse would expect the baby to be macrosomic, not to have IUGR. 3. Placental function is affected by the vasoconstrictive properties of many illicit drugs as well as by cigarette smoke. 4. Placental function is diminished in women who have chronic hypertension. 5. Placental function has been found to be diminished in women of advanced maternal age. TEST-TAKING TIP: Any condition that inhibits the fl ow of blood, including illicit drug use, hypertension, cigarette smoking, and the like, can lead to fetal IUGR—that is, a fetus smaller than expected for the gestational period.

A mother, 39 weeks' gestation, is admitted to the labor suite with rupture of membranes 15 minutes earlier and contractions q 8 minutes × 30 seconds. On vaginal exam, the cervix is 4 cm dilated and 80% effaced and the station is −2. The baby is found to be in the LSP position. The fetal heart rate is 144 with average variability and variable decelerations. Which of the following complications of labor must the nurse assess this client for at this time? 1. Precipitous delivery. 2. Chorioamnionitis. 3. Uteroplacental insufficiency. 4. Prolapsed cord.

4 1. The baby is not yet engaged. It is very unlikely that the client will experience a precipitous delivery. 2. The membranes have been ruptured a very short time. The client is not at high risk for infection at this time. 3. The fetal heart rate is showing variable decelerations, the baby is not postdates, and there is no evidence of other placental issues. The client is not at high risk for uteroplacental insufficiency. 4. The membranes are ruptured, the baby is not engaged, the baby is in the sacral position, and the fetal heart rate is showing variable decelerations. The nurse should assess this client carefully for prolapsed cord. TEST-TAKING TIP: The test taker must methodically consider the many factors in the scenario before determining the correct answer to this question. The key items that must be considered are fetal heart rate, time since rupture of membranes, fetal position, fetal station, and gestational age

A woman is to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects of the therapy? Select all that apply. 1. Nausea and vomiting. 2. Abdominal pain. 3. Fatigue. 4. Light-headedness. 5. Breast tenderness.

1, 2, 3, and 4 are correct. 1. Nausea and vomiting are common side effects. 2. Abdominal pain is a common side effect. The pain associated with the medication needs to be carefully monitored to differentiate it from the pain caused by the ectopic pregnancy itself. 3. Fatigue is a common side effect. 4. Light-headedness is a common side effect. 5. Breast tenderness is not seen with this medication. TEST-TAKING TIP: Because methotrexate is an antineoplastic agent, the nurse would expect to see the same types of complaints that he or she would see in a patient receiving chemotherapy for cancer. It is very important that the abdominal pain seen with the medication not be dismissed because a common complaint of women with ectopic pregnancies is pain. The source of the pain, therefore, must be clearly identifi ed.

The nurse is assessing a multigravid client at 12 weeks' gestation who has been admitted to the emergency department with sharp right-sided abdominal pain and vaginal spotting. Which of the following should the nurse obtain about the client's history? Select all that apply. 1.History of sexually transmitted infections. 2.Number of sexual partners. 3.Last menstrual period. 4.Cesarean section. 5.Contraceptive use

1,2,3,5. The client may be experiencing an ectopic pregnancy. Contributing factors to an ectopic pregnancy include a prior history of sexually transmitted infection that can scar the fallopian tubes. Multiple sex partners increase the risk of sexually transmitted infections. Knowledge of the client's last menstrual period and contraceptive use may support or rule out the possibility of an ectopic pregnancy. The client's history of cesarean sections would not contribute information valuable to the client's current situation or potential diagnosis of ectopic pregnancy

The nurse is monitoring a woman, G2 P1001, 41 weeks' gestation, in labor. A 12 p.m. assessment revealed: cervix, 4 cm; 80% effaced; -3 station; and FH 124 with moderate variability. A 5 p.m. assessment: cervix, 6 cm; 90% effaced; −3 station; and FH 120 with moderate variability. A 10 p.m. assessment: cervix, 8 cm; 100% effaced; −3 station; and FH 124 with moderate variability. Based on the assessments, which of the following should the nurse conclude? 1. Labor is progressing well. 2. The woman is likely carrying a macrosomic fetus. 3. The baby is in fetal distress. 4. The woman will be in second stage in about fi ve hours.

2 1. Although dilation is progressing, the station is unchanged. The baby, therefore, is not descending into the birth canal. The nurse cannot conclude that the labor is progressing well. 2. Because the presenting part is not descending into the birth canal, the nurse can logically conclude that the baby may be macrosomic. 3. There is no sign of fetal distress in this scenario. 4. This woman is a multigravida. The average length of the transition phase of labor for multiparas is 10 minutes. TEST-TAKING TIP: The test taker must carefully analyze the results of the three vaginal examinations. The fetal heart rate is virtually unchanged: The rate is within normal limits and the variability is normal. There is no sign of fetal distress. The dilation and effacement are changing, but the lack of progressive descent of the presenting part is unexpected. When babies are too big to fit through a client's pelvis, they fail to descend. That is the conclusion that the nurse should make from the findings.

A multigravid client thought to be at 14 weeks' gestation reports that she is experiencing such severe morning sickness that she "has not been able to keep anything down for a week." The nurse should assess for signs and symptoms of which of the following? 1.Hypercalcemia. 2.Hypobilirubinemia. 3.Hypokalemia. 4.Hyperglycemia.

3. Gastrointestinal secretion losses from excessive vomiting, diarrhea, and excessive perspiration can result in hypokalemia, hyponatremia, decreased chloride levels, metabolic alkalosis, and eventual acidosis if precautionary measures are not taken. Ketones may be present in the urine. Dehydration can lead to poor maternal and fetal outcomes. Persistent vomiting can lead to hypocalcemia, not hypercalcemia. Hyperbilirubinemia, not hypobilirubinemia, is typical in clients with hyperemesis. Persistent vomiting may affect liver function and subsequently the excretion of bilirubin from the body. Hypoglycemia, not hyperglycemia, may occur as a result of decreased intake of food and fluids, decreased metabolism of nutrients, and excessive vomiting

A primigravid client with diabetes at 39 weeks' gestation is seen in the high-risk clinic. The primary health care provider estimates that the fetus weighs at least 4,500 g (10 lb). The client asks, "What causes the baby to be so large?" The nurse's response is based on the understanding that fetal macrosomia is usually related to which of the following? 1.Family history of large infants. 2.Fetal anomalies. 3.Maternal hyperglycemia. 4.Maternal hypertension

3. Maternal hyperglycemia and poor control of the mother's diabetes mellitus have been implicated in fetal macrosomia. When the mother is hyperglycemic, large amounts of amino acids, free fatty acids, and glucose are transferred to the fetus. Although maternal insulin does not cross the placenta, the fetal pancreas responds by hypertrophy of the islet cells of the pancreas. The islet cells produce large amounts of insulin, which acts as a growth hormone. A family history of large infants usually is not the reason for large-for-gestational-age fetuses in diabetic mothers. Maternal hypertension is associated with small-for-gestational-age fetuses because of vasoconstriction of the maternal and placental blood vessels

A nurse is discussing preterm labor in a prenatal class. After class, a client and her partner ask the nurse to identify again the nursing strategies to prevent preterm labor. The clients need further instruction when they state which of the following? 1."I need to stay hydrated all the time." 2."I need to avoid any infections." 3."I should include frequent rest breaks if we travel." 4."Changing to filter cigarettes is helpful

4. Smoking in any form is contraindicated in pregnancy, regardless of the type of filtering system used. Smoking is a major risk factor for preterm labor and decreased fetal weight. Dehydration is a risk factor for preterm labor as is prolonged standing and remaining in one position. Infection is thought to be a primary cause of preterm labor and the client would need to avoid contracting any type of infection. While taking trips, frequent emptying of the bladder prevents infection and ambulates the woman