FFC NBC Exam 4

If nonsurgical treatment for subinvolution is ineffective, which surgical procedure is appropriate to correct the cause of this condition? a. Hysterectomy b. Laparoscopy c. Laparotomy d. Dilation and curettage (D&C)

d. Dilation and curettage (D&C) D&C allows examination of the uterine contents and removal of any retained placenta or membranes. Hysterectomy is not indicated for this condition. A hysterectomy is the removal of the uterus. Laparoscopy is not indicated for this condition. A laparoscopy is the insertion of an endoscope through the abdominal wall to examine the peritoneal cavity. Laparotomy is not indicated for this condition. A laparotomy is a surgical incision into the peritoneal cavity to explore the peritoneal cavity.

f a DVT (deep vein thrombosis) is suspected, the nurse should: a. perform a Homans sign on the affected leg. b. dorsiflex the foot of the affected leg. c. palpate the affected leg for edema and pain. d. place the client on bed rest, with the affected leg elevated.

d. place the client on bed rest, with the affected leg elevated. Initial treatment of DVT is bed rest with the leg elevated to decrease swelling and promote venous return. Performing a Homans sign, dorsiflexing the foot, and palpating the leg are contraindicated actions that may dislodge a DVT and result in a pulmonary embolism.

A client who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is: a. "You should come into the office and let the doctor check you." b. "Acetaminophen is acceptable during pregnancy. You should not take aspirin, however." c. "Back pain is common at this time during pregnancy because you tend to stand with a sway back." d. "Avoid medication because you are pregnant. Try soaking in a warm bath or using a heating pad on low before taking any medication."

a. "You should come into the office and let the doctor check you." A prolonged backache is one of the subtle symptoms of preterm labor. Early intervention may prevent preterm birth. The client needs to be assessed for preterm labor before providing pain relief.

A postpartum client would be at increased risk for postpartum hemorrhage if she delivered a(n): a. 5-lb, 2-oz infant with outlet forceps. b. 6.5-lb infant after a 2-hour labor. c. 7-lb infant after an 8-hour labor. d. 8-lb infant after a 12-hour labor.

b. 6.5-lb infant after a 2-hour labor. nfant with outlet forceps would put this client at risk for lacerations because of the forceps. A 7-lb infant after an 8-hour labor is a normal labor progression. Less than 3 hours is rapid and can produce uterine muscle exhaustion. An 8-lb infant after a 12-hour labor is a normal labor progression. Less than 3 hours is a rapid birth and can cause the uterine muscles not to contract.

Early postpartum hemorrhage is defined as a blood loss greater than: a. 500 mL within 24 hours after a vaginal birth. b. 750 mL within 24 hours after a vaginal birth. c. 1000 mL within 48 hours after a cesarean birth. d. 1500 mL within 48 hours after a cesarean birth.

b. 750 mL within 24 hours after a vaginal birth. The average amount of bleeding after a vaginal birth is 500 mL. Early postpartum hemorrhage occurs in the first 24 hours, not 48 hours. Blood loss after a cesarean averages 1000 mL. Late postpartum hemorrhage is 48 hours and later.

On vaginal exam, the client's cervix is anterior, soft, 70% effaced, dilated 2 cm, and the presenting part is at 0 station. The Bishop's score for this client is: a. 6. b. 9. c. 10. d. 12.

b. 9. On the Bishop's scoring system, an anterior cervix = 2 points, soft cervix = 2 points, 70% effaced = 2 points, 2 cm dilated = 1 point, and 0 station = 2 points, for a total score of 9.

For which client should the oxytocin (Pitocin) infusion be discontinued immediately? a. A client in transition with contractions every 2 minutes lasting 90 seconds each b. A client in early labor with contractions every 5 minutes lasting 40 seconds each c. A client in active labor with contractions every 3 minutes lasting 60 seconds each d. A client in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each

a. A client in transition with contractions every 2 minutes lasting 90 seconds each This client's contraction pattern represents hyperstimulation, and inadequate resting time occurs between contractions to allow placental perfusion. Oxytocin may assist this client's contractions to become closer and more efficient when the contractions are 5 minutes apart. There is an appropriate resting period between this client's contractions. There is an appropriate resting period between this client's contractions for her stage of labor.

Emergency measures used in the treatment of a prolapsed cord include which of the following? (Select all that apply.) a. Administration of oxygen via face mask at 8 to 10 L/min b. Maternal change of position to knee-chest c. Administration of tocolytic agent d. Administration of oxytocin (Pitocin) e. Vaginal elevation f. Insertion of cord back into vaginal area

a. Administration of oxygen via face mask at 8 to 10 L/min b. Maternal change of position to knee-chest c. Administration of tocolytic agent e. Vaginal elevation

A labor client has been diagnosed with cephalopelvic disproportion (CPD) following attempts at pushing for 2 hours with no progress. Based on this information, what birth method is available? a. Vaginal birth with vacuum extraction b. Augmentation of labor with oxytocin (Pitocin) to improve contraction pattern and strengthen contractions c. Cesarean section d. Insertion of Foley catheter into empty bladder to provide more room for fetal descent

C. Cesarean Section The presence of CPD is a contraindication for vaginal birth. To prevent further complications, the client should be prepped for a cesarean section.

After a birth complicated by a shoulder dystocia, the infant's Apgar scores were 7 at 1 minute and 9 at 5 minutes. The infant is now crying vigorously. The nurse in the birthing room should: a. palpate the infant's clavicles. b. encourage the parents to hold the infant. c. perform a complete newborn assessment. d. give supplemental oxygen with a small face mask.

a. palpate the infant's clavicles. Because of the shoulder dystocia, the infant's clavicles may have been fractured. Palpation is a simple assessment to identify crepitus or deformity that requires follow-up. The infant needs to be assessed for clavicle fractures before excessive movement. A complete newborn assessment is necessary for all newborns, but assessment of the clavicle is top priority for this infant. The Apgar indicates that no respiratory interventions are needed.

Which clinical finding indicates the use of vacuum extraction as a birth method? a. Mentum presentation of the fetus b. Presence of caput succedaneum c. Maternal exhaustion as a result of ineffective pushing during second stage of labor d. Physician preference

c. Maternal exhaustion as a result of ineffective pushing during second stage of labor Vacuum extraction is used in place of forceps as an assistive method to help with the birth of the fetus. It is not used in nonvertex presentations. Mentum presentation is where the chin is the presenting part. Vacuum extraction should not be used in the presence of caput succedaneum (swelling) or in the presence of excessive molding.

When a laboring client receiving 12 mU of pitocin for induction develops a contraction pattern of every 2 minutes lasting 80 seconds and recurring late decelerations, the nurse should immediately: a. stop oxytocin infusion. b. administer O2 at 8 TO 10 L/min. c. reposition client to left side-lying position. d. increase the rate of the primary nonadditive infusion.

a. stop the oxytocin infusion Uterine hyperstimulation can reduce placental blood flow and decrease fetal oxygenation. Late decelerations are caused by uteroplacental insufficiency. Stopping the oxytocin infusion will reduce uterine activity and increase fetal oxygenation. Administering O2, repositioning the client, and increasing the rate of the primary nonadditive infusion will not be effective until hyperstimulation is resolved.

To evaluate the desired response of methylergonovine (Methergine), the nurse would assess the client's: a. uterine tone. b. pain level. c. blood pressure. d. last voiding.

a. uterine tone. Methylergonovine (Methergine) simulates sustained contraction of the uterus as evidenced by the tone of the uterus. The pain level, blood pressure, and voiding patterns are not related to the effectiveness of the medication.

The visiting nurse must be aware that women who have had a postpartum hemorrhage are subject to a variety of complications after discharge from the hospital. These include which of the following? (Select all that apply.) a. Anemia b. Dehydration c. Exhaustion d. Postpartum infection e. Failure to attach to her infant

a. Anemia c. Exhaustion d. Postpartum infection e. Failure to attach to her infant Postpartum hemorrhage often results in anemia, and iron therapy may need to be initiated. Exhaustion is common after hemorrhage. It may take the new client weeks to feel like herself again. Fatigue may interfere with normal parent-infant bonding and the attachment processes. The client is likely to require assistance with housework and infant care. Excessive blood loss increases the risk for infection. The excessive blood loss that this client has experienced is likely to lead to risk for infection rather than dehydration. It is important that all mothers be educated about adequate fluid intake after birth.

The labor nurse is admitting a patient in active labor with a history of genital herpes. On assessment, the patient reports a recent outbreak, and the nurse verifies lesions on the perineum. What is the nurse's next action? a. Ask the patient when she last had anything to eat or drink. b. Take a culture of the lesions to verify the involved organism. c. Ask the patient if she has had unprotected sex since her outbreak. d. Use electronic fetal surveillance to determine a baseline fetal heart rate.

a. Ask the patient when she last had anything to eat or drink. A cesarean birth is recommended for women with active lesions in the genital area, whether recurrent or primary, at the time of labor. The patient's dietary intake is needed to prepare for surgery. This patient is in active labor and the fetus is at risk for infection if the membranes rupture. The health care provider needs to be notified, and a cesarean section needs to be performed as soon as possible. There is no need to validate the infection because the patient is well aware of the symptoms of an active infection. Although transmission to sexual partners is valid information, it is not necessary information in an urgent situation such as depicted in this scenario. Electronic fetal surveillance is the standard of care.

mmediately following the forceps-assisted birth of an infant, which action should the nurse implement? a. Assess the infant for signs of trauma. b. Apply a cold pack to the infant's scalp. c. Give the infant prophylactic antibiotics. d. Measure the circumference of the infant's head.

a. Assess the infant for signs of trauma. Forceps birth can result in local irritation, bruising, or lacerations of the fetal scalp. This would put the infant at risk for cold stress and would be contraindicated. Prophylactic antibiotics are not necessary with a forceps birth. Measuring the circumference of the head is part of the initial nursing assessment.

Which client data received during report should the nurse recognize as being a postpartum risk factor? a. Gravida 5, para 5 b. Labor duration of 4 hours c. Infant weight greater than 3800 g d. Epidural anesthesia for labor and birth

a. Gravida 5, para 5 Multiparity (five or more deliveries) is a risk factor for postpartum uterine atony and hemorrhage. A labor duration of 4 hours is not a risk factor because it is not a precipitate labor and birth (less than 3 hours), infant weight of 3800 g is not a risk factor because the infant is not macrosomic, and epidural anesthesia is not a risk factor because epidural anesthesia does not affect uterine contractions.

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? a. Incomplete uterine relaxation b. Maternal fatigue and exhaustion c. Maternal sedation with narcotics d. Administration of tocolytic drugs

a. Incomplete uterine relaxation A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases the fetal oxygen supply. Maternal fatigue usually does not decrease uterine blood flow. Maternal sedation will sedate the fetus but should not decrease blood flow. Tocolytic drugs decrease contractions. This will increase uterine blood flow.

Which information should the nurse recognize as contributing to mastitis in the breastfeeding mother? (Select all that apply.) a. Insufficient emptying b. Feeding every 2 hours c. Supplementing feedings d. Blisters on both nipples e. Alternating breastfeeding positions

a. Insufficient emptying c. Supplementing feedings d. Blisters on both nipples Mastitis may develop because of stasis of milk, inadequate emptying of the breast, skipped feedings, and introduction of bacteria through injured areas of the nipple. Feeding every 2 hours and alternating breastfeeding positions are both interventions that promote emptying of the breasts and support successful breastfeeding.

The nurse notes that the fundus of a postpartum patient is boggy, shifted to the left of the midline, and 2 cm above the umbilicus. What is the nurse's priority action? a. Massage the fundus of the uterus. b. Assist the patient out of bed to void. c. Increase the infusion of oxytocin (Pitocin). d. Ask another nurse to bring in a straight catheter tray.

a. Massage the fundus of the uterus.

Which adverse effects can be seen in response to administration of oxytocin (Pitocin) for induction of labor? (Select all that apply.) a. Maternal hyponatremia b. Uterine tachysystole c. Maternal hypotension d. Reassuring fetal heart pattern e. Decreased variability on fetal tracing

a. Maternal hyponatremia b. Uterine tachysystole c. Maternal hypotension

A client is using Depo-Provera as her method of birth control. Which finding warrants immediate intervention? a. Mid-cycle bleeding b. Nausea c. Temperature of 100° F d. Irregular periods

a. Mid-cycle bleeding

For which of the following infectious diseases can a woman be immunized? a. Rubella b. Toxoplasmosis c. Cytomegalovirus d. Herpesvirus type 2

a. Rubella

What data in the client's history should the nurse recognize as being pertinent to a possible diagnosis of postpartum depression? a. Teenage depression episode b. Unexpected operative birth c. Ambivalence during the first trimester d. Second pregnancy in a 3-year period

a. Teenage depression episode A personal history of depression is a risk factor for postpartum depression. An operative birth, ambivalence during the first trimester, and two pregnancies in 3 years are not risk factors for postpartum depression.

nderstands the risks of this diagnosis? a. "I know I will need to have an abortion as soon as possible." b. "Even though my test is positive, my baby might not be affected." c. "My baby is certain to have AIDS and die within the first year of life." d. "This pregnancy will probably decrease the chance that I will develop AIDS."

b. "Even though my test is positive, my baby might not be affected." The fetus is likely to test positive for HIV in the first 6 months, until the inherited immunity from the mother wears off. Many of these babies will convert to HIV-negative status. With the newer drugs, the risk for infection of the fetus has decreased. Also, the life span of an infected newborn has increased. The pregnancy will increase the chance of converting.

A pregnant patient with acquired immunodeficiency syndrome (AIDS) is reviewing infant care instructions with the prenatal nurse. Which patient statement indicates to the nurse that the teaching was effective? a. "I will bathe my baby twice a day." b. "I will use premixed formula to feed my baby." c. "I will use gloves to change my baby's diapers." d. "I will use alcohol wipes six times a day on the baby's cord until it falls off."

b. "I will use premixed formula to feed my baby." Breast milk or prechewed food from an infected person can cause infant infection, so the patient with AIDS should bottle feed her baby. The infant does not require additional bathing. The patient has AIDS and transmission from the infant's urine or stool is not an issue. Alcohol can be drying and irritating to the skin.

During the course of the birth process, the physician suspects that a shoulder dystocia is occurring and asks the nurse for assistance. Which priority action should be taken by the nurse in response to this request? a. Put pressure on the fundus. b. Ask the physician if he or she would like you to prepare for a surgical method of birth. c. Tell the client not to push until you prepare vacuum extraction device for physician. d. Reposition the client to facilitate birth.

b. Ask the physician if he or she would like you to prepare for a surgical method of birth. In the presence of a suspected shoulder dystocia, a surgical birth method is typically indicated to avoid complications from this type of abnormal presentation. Fundal pressure is no longer recommended as a treatment strategy because it can cause additional problems. Vacuum extraction will not help solve this birth issue and may lead to further complications. Repositioning of the client may not be effective to relieve this condition and facilitate birth.

ollowing a vaginal birth, a client has lost a significant amount of blood and is starting to experience signs of hypovolemic shock. Which clinical signs would be consistent with this clinical diagnosis? a. Decrease in blood pressure, with an increase in pulse pressure b. Compensatory response of tachycardia and decreased pulse pressure c. Decrease in heart rate and an increase in respiratory effort d. Flushed skin

b. Compensatory response of tachycardia and decreased pulse pressure Clinical signs consistent with the beginning of hypovolemic shock include normal blood pressure, decreased pulse pressure, compensatory tachycardia, and pale, cool skin color.

Which of the following is a potential disadvantage for a client who wishes to use an intrauterine device (IUD) as a method of birth control? a. Insertion of the device prior to coitus resulting in decreased spontaneity b. Ectopic pregnancy c. Protection against STDs d. Decrease in dysmenorrhea

b. Ectopic pregnancy

Which finding would indicate an adverse response to terbutaline (Brethine)? a. Fetal heart rate (FHR) of 134 bpm b. Heart rate of 122 bpm c. Two episodes of diarrhea d. Fasting blood glucose level of 100 mg/dL

b. Heart rate of 122 bpm Terbutaline (Brethine) stimulates beta-adrenergic receptors of the sympathetic system. This action results primarily in bronchodilation, inhibition of uterine muscle activity, increased pulse rate, and widening of pulse pressure. An FHR of 134 bpm and fasting blood glucose level of 100 mg/dL are normal findings, and diarrhea is not a side effect associated with this medication.

Which symptom in a client using oral contraceptives should be reported to the physician immediately? a. 5-lb weight gain b. Leg pain and edema c. Decrease in menstrual flow d. Increased pigmentation of the face

b. Leg pain and edema

A client presents to the Women's Health Clinic for continuation of her contraceptive method. She has been using Depo-Provera (medroxyprogesterone acetate) for 24 months. In preparation for instituting a plan of care, the nurse would consider which option as a priority? a. Schedule the client for follow-up baseline diagnostic testing to confirm that the client is not pregnant. b. Obtain information for an alternate contraception method. c. Ask the client for additional information related to her menstrual cycle. d. Inspect the skin for site selection of contraceptive method.

b. Obtain information for an alternate contraception method. According to WHO (World Health Organization) guidelines, women should not be on Depo-Provera for more than 2 years because of bone density loss. Therefore, the nurse should include assessments for other types of contraception methods for the client. Although it may prove to be important to rule out possible pregnancy, based on the provided information, discontinuation of this method is the priority intervention. Depo-Provera can cause menstrual irregularities, but this is not the priority intervention. The nurse can follow up on this issue later. Because the current method of contraception should no longer be used, this option is not necessary.

A client has had a prior history of endometriosis and comes to the clinic asking about which method of birth control might be helpful to alleviate her symptoms. Which birth control method should the client use? a. Withdrawal method b. Oral contraceptives c. Depo-Provera d. Intrauterine device (IUD)

b. Oral contraceptives

Which presentation is most likely to occur with a hypertonic labor pattern? (Select all that apply.) a. Increased risk for placenta previa b. Painful uterine contractions c. Increased resting tone d. Uterine vasodilation e. Increased uterine pressure f. Effective uterine contraction

b. Painful uterine contractions c. Increased resting tone e. Increased uterine pressure

A client with polyhydramnios was admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless, but the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next? a. Perform Leopold maneuvers. b. Perform a vaginal examination. c. Apply warm saline soaks to the vagina. d. Place the client in a high Fowler position.

b. Perform a vaginal examination. A prolapsed cord may not be visible but may be palpated on vaginal examination. The priority is to relieve pressure on the umbilical cord. Leopold maneuvers are not an appropriate action at this time. Moist towels retard cooling and drying of the prolapsed cord, but it is hoped the fetus will be delivered before this occurs. The high Fowler position will increase cord compression and decrease fetal oxygenation.

ppropriate? a. Practice respiratory isolation. b. Plan for retesting during the third trimester. c. Discuss the recommendation to bottle feed her baby. d. Anticipate administering the vaccination for hepatitis B as soon as possible.

b. Plan for retesting during the third trimester. A person who has a history of high-risk behaviors should be rescreened during the third trimester. Hepatitis B is transmitted through blood. The first trimester is too early to discuss feeding methods with a woman in the high-risk category. The vaccine may not have time to affect a person with high-risk behaviors.

Which assessment would be important for a 6-hour-old infant who has bruising over the cheeks from a forceps birth? a. Presence of newborn reflexes b. Symmetry of facial movements c. Caput and molding of the head d. Anterior and posterior fontanels

b. Symmetry of facial movements Following a forceps birth, the infant may have ecchymoses and facial nerve injury. Facial asymmetry suggests facial nerve damage. Changes in newborn reflexes, presence of caput and molding, and changes in the anterior and posterior fontanels are not risks associated with trauma to the infant's face.

A client in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for at-home continuation of the tocolytic effect? a. Buccal oxytocin (Pitocin) b. Terbutaline sulfate (Brethine) c. Calcium gluconate (Calgonate) d. Magnesium sulfate

b. Terbutaline sulfate (Brethine) The client receiving decreasing doses of magnesium sulfate is often switched to oral terbutaline to maintain tocolysis. Pitocin increases the strength of contractions and is used to augment or stimulate labor. Buccal Pitocin dosing is uncontrollable. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Magnesium sulfate is usually given intravenously or intramuscularly. The patient must be hospitalized for magnesium therapy because of the serious side effects of this drug.

he priority nursing intervention following an amniotomy is to: a. change the client's gown. b. assess the fetal heart rate. c. assess the color of the amniotic fluid. d. estimate the amount of amniotic fluid.

b. assess the fetal heart rate. The fetal heart rate must be assessed immediately after the rupture of the membranes to determine whether cord prolapse or compression has occurred. Changing the gown is important for client comfort but is not the top priority. Assessing the amount of amniotic fluid is important but is not the top priority. Estimating the amount of amniotic fluid is not a top priority for this client.

Before administering methylergonovine (Methergine), the nurse checks the: a. color of the lochia. b. blood pressure. c. location of the fundus. d. last administration of analgesics.

b. blood pressure. Methylergonovine (Methergine) elevates the blood pressure and should not be given to a woman who is hypertensive. The color of the lochia, location of the fundus, and analgesics are not related to the administration of or contraindicated to this medication.

A client has been treated with oxytocin (Pitocin) for postpartum hemorrhage. Bleeding has stabilized and slowed down considerably. The peripad in place reveals a moderate amount of bright red blood, with no clots expelled when massaging the fundus. The client now complains of having difficulty breathing. Auscultation of breath sounds reveals adventitious sounds. Based on this clinical presentation, the priority nursing action is to: a. evaluate intake and output of the past 12 hours following birth. b. initiate a rapid response intervention. c. obtain an order from the physician for type and crossmatch of 2 units packed red blood cells (PRBCs). d. reposition the client and reassess in 15 minutes. Initiate frequent vital sign assessments.

b. initiate a rapid response intervention. Oxytocin (Pitocin) can have antidiuretic effects when used in large amounts. Given the recent client history, she has received an additional Pitocin infusion relative to the direct observation of postpartum hemorrhage. Adventitious breath sounds and the client's complaints of difficulty breathing suggest that the client is progressing to pulmonary edema. An appropriate intervention is to initiate a rapid response intervention so that the client can be stabilized. Calling the physician for a type and crossmatch order is not indicated. Repositioning the client, even with the initiation of frequent vital signs, will not treat the emerging clinical condition. Evaluation of intake and output, although necessary, is not the priority nursing action at this time.

The nurse knows that late postpartum hemorrhage can be prevented by: a. manually removing the placenta. b. inspecting the placenta after birth. c. administering broad-spectrum antibiotics. d. pulling on the umbilical cord to hasten the birth of the placenta.

b. inspecting the placenta after birth. If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage. Manual removal of the placenta increases the risk of postpartum hemorrhage. Broad-spectrum antibiotics will be given if postpartum infection is suspected. The placenta is usually delivered 5 to 30 minutes after birth of the baby without pulling on the cord. That can cause uterine inversion.

A maternal indication for the use of vacuum extraction is: a. a wide pelvic outlet. b. maternal exhaustion. c. a history of rapid deliveries. d. failure to progress past 0 station.

b. maternal exhaustion. The client who is exhausted will be unable to assist with the expulsion of the fetus. With a wide pelvic outlet, vacuum extraction would not be necessary. With a rapid birth, vacuum extraction would not be necessary. A station of 0 is too high for a vacuum extraction.

Before the health care provider performs an external version, the nurse should expect an order for a: a. Foley catheter. b. tocolytic drug. c. local anesthetic. d. contraction stress test (CST).

b. tocolytic drug. A tocolytic drug will relax the uterus before and during version, making manipulation easier. The bladder should be emptied, but catheterization is not necessary. A local anesthetic is not used with external version. CST is used to determine the fetal response to stress.

The nurse is planning care for a client who just received 25 mcg of misoprostol (Cytotec) vaginally to ripen the cervix. Which interventions should the nurse plan to implement? (Select all that apply.) a. Assist the client to the bathroom. b. Position the client in a high Fowler position. c. Assess the uterus for excessive contractions. d. Monitor the fetal heart rate for at least 30 minutes.

c. Assess the uterus for excessive contractions. d. Monitor the fetal heart rate for at least 30 minutes.

Which contraceptive method should be contraindicated in a client with a history of toxic shock syndrome? a. Condom b. Spermicide c. Cervical cap d. Oral contraceptives

c. Cervical cap The cervical cap may increase the risk of toxic shock syndrome because it may be left in the vagina for a prolonged period. A condom is not contraindicated with a history of toxic shock syndrome. Spermicide is not contraindicated with a history of toxic shock syndrome. Oral contraceptives are not contraindicated with a history of toxic shock syndrome.

Which sexually transmitted disease can be cured? a. Herpes b. AIDS c. Chlamydia d. Venereal warts

c. Chlamydia

which of these situations should the nurse anticipate the use of forceps or vacuum extraction? a. Complete dilation for 2 hours at +2 station b. Complete dilation for 1 hour, transverse arrest at station +1 c. Complete dilation for 3 hours, fetus at +3 station, onset of late deceleration d. Complete dilation for 1 hour, fetal descent from 0 station to + 1 in 1 hour

c. Complete dilation for 3 hours, fetus at +3 station, onset of late deceleration Forceps or vacuum extraction is considered if the second stage should be shortened for the well-being of the woman or fetus. Onset of late decelerations is an indication for an operative birth. With the fetus at +3 station, an outlet operative birth can be performed. Complete dilation for 2 hours at +2 station, complete dilation for 1 hour with a transverse arrest at station +1, and complete dilation for 1 hour with fetal descent from 0 station to +1 in 1 hour are situations in which client pushing and position changes would be used before operative intervention is indicated.

Select the situation that describes the safest administration of oxytocin induction and cervical ripening agents. a. Concurrent use of oxytocin and dinoprostone (Cervidil) b. Misoprostol (Cytotec) 25 mcg, followed in 4 hours by oxytocin induction in vaginal birth after cesarean section (VBAC) client c. Dinoprostone (Cervidil) 10 mg in place for 12 hours followed by oxytocin induction in 1 hour d. Maximum dose of dinoprostone (Prepidil) 2 mg/24 hr followed in 4 hours by oxytocin induction

c. Dinoprostone (Cervidil) 10 mg in place for 12 hours followed by oxytocin induction in 1 hour Dinoprostone (Cervidil) in a 10-mg, time-release insert may be left in place for up to 12 hours and oxytocin induction can be safely started 1 hour after insert is removed. Oxytocin and cervical ripening agents cannot be administered at the same time. Misoprostol (Cytotec) is contraindicated in a women with previous cesarean. The maximum dose of dinoprostone (Prepidil) 1.5 mg/24 hr.

In which client situation could an amniotomy be safely performed? a. G1 P0, 38 weeks' gestation, 20% effaced, closed cervix b. G2 P1, 40 weeks' gestation, with fetus in a breech presentation c. G2 P0, 39 weeks' gestation, 70% effaced, cervix dilated 2 cm d. G3 P2, 41 weeks' gestation, early labor complicated with hydramnios

c. G2 P0, 39 weeks' gestation, 70% effaced, cervix dilated 2 cm he cervix must be partially open to allow the membranes to be ruptured. An amniotomy cannot be performed when the cervix is closed. Breech presentation would be delivered by cesarean section and membranes would be ruptured at birth. Rupturing the membranes in a client with hydramnios can result in abruptio placentae.

Which measure may prevent mastitis in a breastfeeding client? a. Wearing a tight-fitting bra b. Applying ice packs prior to feeding c. Initiating early and frequent feedings d. Nursing the infant for 5 minutes on each breast

c. Initiating early and frequent feedings Early and frequent feedings prevent stasis of milk, which contributes to engorgement and mastitis. Five minutes does not empty the breast adequately. This will produce stasis of the milk. A firm-fitting bra will support the breast, but not prevent mastitis. The breast should not be bound. Warm packs before feeding will increase the flow of milk.

Which contraceptive method provides protection against sexually transmitted diseases? a. Oral contraceptives b. Tubal ligation c. Male or female condoms d. Intrauterine device (IUD)

c. Male or female condoms

A multiparous client is admitted to the postpartum unit after a rapid labor and birth of a 4000-g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the client void and massages her fundus, but the fundus remains difficult to find and the rubra lochia remains heavy. Which action should the nurse take next? a. Recheck vital signs. b. Insert a Foley catheter. c. Notify the health care provider. d. Continue to massage the fundus.

c. Notify the health care provider. reatment of excessive bleeding requires the collaboration of the health care provider and the nurses. Do not leave the client alone. The nurse should call the clinician while a second nurse rechecks the vital signs. The client has voided successfully, so a Foley catheter is not needed at this time. The uterine muscle can be overstimulated by massage, leading to uterine atony and rebound hemorrhage.

While assisting with a vacuum extraction birth, which should the nurse immediately report to the physician? a. Maternal pulse rate of 100 bpm b. Maternal blood pressure of 120/70 mm Hg c. Persistent fetal bradycardia below 100 bpm d. Decreased intensity of uterine contractions

c. Persistent fetal bradycardia below 100 bpm Fetal bradycardia may indicate fetal distress and may require immediate intervention. Maternal pulse rate may increase due to the pushing process. Blood pressure of 120/70 mm Hg is within expected norms for this stage of labor. Decreased intensity of uterine contractions indicates the birth is imminent at this point.

Which of the following factors would lead to an increased risk for a prolapsed cord to occur during an amniotomy? a. Presenting part engaged b. Postdated pregnancy c. Preterm pregnancy d. Term pregnancy

c. Preterm pregnancy Prolapsed cord is more likely to occur when the presenting part is not engaged and the pregnancy is preterm because the fetus would be smaller and there would potentially be more amniotic fluid. If the presenting part is engaged and the pregnancy is at term or postdated, it is less likely that a prolapsed cord would occur.

A client who is receiving oxytocin (Pitocin) infusion for the augmentation of labor is experiencing a contraction pattern of more than eight contractions in a 10-minute period. Which intervention would be a priority? a. Increase rate of Pitocin infusion to help spread out contraction pattern. b. Place oxygen on client at 8 to 10 L/min via face mask and turn client to left side. c. Stop Pitocin infusion. d. Call physician to obtain an order for initiation of magnesium sulfate.

c. Stop Pitocin infusion. The client is exhibiting uterine tachysystole (uterine tetany). Priority intervention is to stop the infusion. The next course of action is to place oxygen on the client and reposition and increase the flow rate of the primary infusion. If the condition does not improve, the physician may be called for additional orders.

The major difference between the diaphragm and the cervical cap is that the diaphragm: a. is more effective. b. requires spermicide. c. applies pressure on the urethra. d. has no contribution to toxic shock syndrome.

c. applies pressure on the urethra. The diaphragm is made to fit snugly in the vaginal area and contains a hard rim that may put pressure on the urethra. The cervical cap is smaller and fits around the cervix. The cervical cap is not more effective than a diaphragm. The diaphragm does not require spermicide. Both may contribute to toxic shock syndrome.

The drug of choice to treat gonorrhea is: a. penicillin G (Pfizerpen). b. tetracycline (Achromycin). c. ceftriaxone (Rocephin). d. acyclovir (Zovirax).

c. ceftriaxone (Rocephin). Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin G is used to treat syphilis. Tetracycline is used to treat chlamydial infections. Acyclovir is used to treat herpes genitalis.

The client who has had an intrauterine device (IUD) inserted should be instructed to: a. use a vinegar douche weekly for 4 weeks. b. have the IUD replaced every 2 to 4 years. c. check the placement of the string once a week for 4 weeks. d. use another method of contraception for 2 weeks after insertion.

c. check the placement of the string once a week for 4 weeks

A client is 27 years old and delivered her first baby yesterday. She and her husband do not want to have another baby for at least 3 to 4 years. The best method of birth control to meet their needs is: a. withdrawal. b. fertility awareness method. c. combination of condoms and foam. d. vasectomy with a reversal in 3 years.

c. combination of condoms and foam.

Informed consent concerning contraceptive use is important because some of the methods: a. may not be reliable. b. require a surgical procedure to insert. c. have potentially dangerous side effects. d. are invasive procedures that require hospitalization

c. have potentially dangerous side effects.

When using the basal body temperature method of family planning, the woman should know that: a. she will remain fertile for 5 days after ovulation. b. she should take her temperature each night before going to bed. c. her temperature will increase about 0.4° to 0.8° F after ovulation. d. her temperature is normally lower during the second half of her cycle.

c. her temperature will increase about 0.4° to 0.8° F after ovulation. The basal body temperature will increase about 0.4° to 0.8° F when ovulation occurs. The woman is fertile for up to 18 days. She should take her temperature on rising in the morning. A woman's temperature is usually higher in the second half of her cycle.

The priority nursing care associated with an oxytocin infusion is: a. measuring urinary output. b. evaluating cervical dilation. c. monitoring uterine response. d. increasing infusion rate every 30 minutes.

c. monitoring uterine response. Because of the risk of hyperstimulation, which could result in decreased placental perfusion and uterine rupture, the nurse's priority intervention is monitoring uterine response. Monitoring urinary output is important with Pitocin but not the top priority. Monitoring labor progression is important but not the top priority. The infusion rate may be increased but only after proper assessment that it is appropriate.

ou are assessing a client in the clinic setting who has been taking oral contraceptives for several years, without side effects. Vital signs are stable and the client denies any pain or tenderness. On examination, you note a small erythematous area of approximately 2 cm on her right lower leg. She denies any traumatic injury and says this is a recent onset of a few days. Based on this information you would: a. instruct the client to use warm compresses for several days and keep the leg elevated as much as possible. b. have the client wear flats rather than heels to modify her gait and help alleviate this issue. c. refer the client to the health care provider for additional diagnostic work up. d. have the client take an over-the-counter (OTC) nonsteroidal antiinflammatory drug (NSAID) and return to the clinic if the problem persists.

c. refer the client to the health care provider for additional diagnostic work up. Because the client has a history of taking oral contraceptives, the nurse must assess and evaluate findings relative to ACHES (warning signs of oral contraceptives). Thus, the client should be worked up for the possibility of a superficial or deep vein thrombosis (DVT). Warm compresses and elevation of the leg, wearing flats, and taking an OTC NSAID may lead to further problems if there is an underlying clot that is not addressed promptly.

Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? a. A primigravida who is 17 years old b. A 22-year-old multiparous client with ruptured membranes c. A primigravida who has requested no analgesia during her labor d. A multiparous client at 39 weeks of gestation who is expecting twins

d. A multiparous client at 39 weeks of gestation who is expecting twins Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that this client's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.

Which response by the nurse is most appropriate when a client asks, "What contraceptive do you think I should use?" a. "Ask your doctor. She will know what is best for you." b. "The male condom is probably the easiest for you to use." c. "Because you are younger than 40, you should use oral contraceptives." d. "I can discuss the various methods with you so you can decide what is best."

d. "I can discuss the various methods with you so you can decide what is best." The nurse should provide the woman with all the necessary information to make an informed decision but should not make the decision for her. The nurse can educate the woman about contraception; she does not have to ask the doctor. The nurse should provide information about contraception, not tell her which one to choose. The nurse should educate the woman about different types of contraception, not make the choice for her.

A laboring client in the latent phase is experiencing uncoordinated irregular contractions of low intensity. How should the nurse respond to complaints of constant cramping pain? a. "You are only 2 cm dilated, so you should rest and save your energy for when the contractions get stronger." b. "Let me take off the monitor belts and help you get into a more comfortable position." c. "You must breathe more slowly and deeply so there is greater oxygen supply for your uterus. That will decrease the pain." d. "I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps."

d. "I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps." Intervention is needed to manage the dysfunctional pattern. Offering support and comfort is important to help the client cope with the situation, no matter at what stage. It is important to get her into a more comfortable position, but fetal monitoring should continue. Breathing will not decrease the pain.

Which statement by a postpartum client indicates that further teaching is not needed regarding thrombus formation? a. "I'll keep my legs elevated with pillows." b. "I'll sit in my rocking chair most of the time." c. "I'll stay in bed for the first 3 days after my baby is born." d. "I'll put my support stockings on every morning before rising."

d. "I'll put my support stockings on every morning before rising." Venous congestion begins as soon as the client stands up. The stockings should be applied before she rises from the bed in the morning. The client should avoid knee pillows because they increase pressure on the popliteal space. Sitting in a chair with legs in a dependent position causes pooling of blood in the lower extremities. As soon as possible, the client should ambulate frequently.

Which temperature indicates the presence of postpartum infection? a. 99.6° F in the first 48 hours b. 100° F for 2 days postpartum c. 100.4° F in the first 24 hours d. 100.8° F on the second and third postpartum days

d. 100.8° F on the second and third postpartum days A temperature elevation to greater than 100.4° F on two postpartum days, not including the first 24 hours, indicates infection. 99.6° F in the first 48 hours is an expected finding because of dehydration. To be classified as an infection, the temperature needs to be greater than 100.4° F. It is anticipated that women have an elevated temperature the first 24 hours.

Which client is a safe candidate for the use of oral contraceptives? a. 39-year-old with a history of thrombophlebitis b. 16-year-old with a benign liver tumor c. 20-year-old who suspects she may be pregnant d. 43-year-old who does not smoke cigarettes

d. 43-year-old who does not smoke cigarettes Heavy cigarette smoking is a contraindication. Oral contraceptives are contraindicated with a history of thrombophlebitis. Liver tumors, benign or malignant, preclude the use of oral contraceptives. Pregnancy is a contraindication.

Which is (are) the priority nursing assessment(s) for the client having tocolytic therapy with terbutaline (Brethine)? a. Intake and output b. Maternal blood glucose level c. Internal temperature and odor of amniotic fluid d. Fetal heart rate, maternal pulse, and blood pressure

d. Fetal heart rate, maternal pulse, and blood pressure All assessments are important, but those most relevant to the medication include the fetal heart rate and maternal pulse, which tend to increase, and the maternal blood pressure, which tends to exhibit a wide pulse pressure. Intake and output and glucose are not important assessments to monitor for side effects of terbutaline. Internal temperature and odor of amniotic fluid are important if the membranes have ruptured, but these are not relevant to the medication

Which assessment finding is indicative of a major complication 1 hour following a forceps birth? a. Uterine fundus displaced at U + 1 b. Complaints of vaginal and uterine pain c. Peripads showing moderate lochia rubra d. Increase in pulse rate from 90 to 110 bpm

d. Increase in pulse rate from 90 to 110 bpm Trauma to the vaginal area from a forceps birth may result in significant blood loss from hematomas or lacerations. Tachycardia is an early sign of compensation for excessive blood loss. A displaced uterine fundus is mostly likely indicative of a full bladder. Vaginal pain may be present even when the vaginal mucosa is intact. Moderate lochia rubra is a common finding early in the postpartum period.

A nurse is leading a discussion regarding birth control measures. Which method is considered the most reliable method? a. Coitus interruptus b. Breastfeeding c. Natural family planning d. Intrauterine device

d. Intrauterine device

Which instruction should be included in the discharge teaching plan to assist the client in recognizing early signs of complications? a. Palpate the fundus daily to ensure that it is soft. b. Report any decrease in the amount of brownish red lochia. c. The passage of clots as large as an orange can be expected. d. Notify the health care provider of any increase in the amount of lochia or a return to bright red bleeding.

d. Notify the health care provider of any increase in the amount of lochia or a return to bright red bleeding. An increase in lochia or a return to bright red bleeding after the lochia has become pink indicates a complication. The fundus should stay firm. The lochia should decrease in amount. Large clots after discharge are a sign of complications and should be reported.

Which client status is an acceptable indication for serial oxytocin induction of labor? a. Multiple fetuses b. Polyhydramnios c. History of long labors d. Past 42 weeks of gestation

d. Past 42 weeks of gestation Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses overdistend the uterus, making induction of labor high risk. Polyhydramnios overdistends the uterus, making induction of labor high risk. A history of rapid labors is a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances

Which intervention should be incorporated in a plan of care for a labor client who is experiencing hypertonic labor? Vaginal exam is unchanged from prior exam—3 cm, 80% effaced, and 0 station presenting part vertex. a. Augmentation of labor with oxytocin (Pitocin) b. AROM c. Performing a vaginal exam to denote progress d. Preparing the client for epidural administration as ordered by the physician

d. Preparing the client for epidural administration as ordered by the physician The administration of an epidural may help relieve increased uterine resting tone by decreasing maternal pain sensation. Hypertonic labor pattern indicates increased uterine resting tone; therefore, augmentation would not be advised as this time because it would cause further uterine irritation in the form of contractions. Rupture of membranes would not be warranted at this time because the critical issue is to resolve the increased uterine resting tone. There is no indication that a vaginal exam is required at this time based on the information provided.

An obstetric client has been identified as being high risk and so has had activities restrictions (placed on bed rest) placed on her until the end of the pregnancy. Currently, she is at 32 weeks' gestation and has two other children at home, ages 3 and 6. The client's husband works at home. A nursing diagnosis of Impaired home maintenance is noted. Which statement potentially identifies a long-term goal? a. The client and husband will be able to adapt their schedules accordingly to meet activities of daily living until the client's next scheduled antepartum visit the following week. b. The client and husband will hire a nanny to act as an additional caregiver for the next month. c. The client will continue to take care of her children at home, taking frequent rest periods. d. The client and husband will make arrangements for child care routine activity assistance for the rest of the pregnancy.

d. The client and husband will make arrangements for child care routine activity assistance for the rest of the pregnancy. A long-term goal is based on acknowledgment of prescribed clinical treatment conditions for the specified time frame. Planning for caregiving for the next week or month provide evidence of short-term goals. It is not realistic for the client to take care of her children at home with rest period because the client will not be maintaining the prescribed therapy regimen and thus may be at risk to further develop complications.

o determine an adverse response to carboprost tromethamine (Hemabate), the nurse should frequently assess: a. temperature. b. lochial flow. c. fundal height. d. breath sounds.

d. breath sounds. Pulmonary edema is a potential adverse effect of carboprost tromethamine (Hemabate). Auscultation of breath sounds will identify pulmonary edema; temperature, lochial flow and fundal height are not affected by this medication. HEMABATE ALSO CONTRAINDICATED W/ ASTHMA

The role of the nurse in family planning is to: a. refer the couple to a reliable physician. b. decide on the best method for the couple. c. advise couples on which contraceptive to use. d. educate couples on the various methods of contraception.

d. educate couples on the various methods of contraception.

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests: a. uterine atony. b. perineal hematoma. c. infection of the uterus. d. lacerations of the genital tract.

d. lacerations of the genital tract. Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction. The fundus would not be firm with uterine atony. A hematoma would be internal. Swelling and discoloration would be noticed, but bright bleeding would not be. With an infection of the uterus, there would be an odor to the lochia and systemic symptoms such as fever and malaise.