Labor and Delivery

A nurse is reinforcing teaching with a client who is in labor about why epidural anesthesia is not initiated until a good labor pattern has been established. Which of the following explanations should the nurse include?

"Given too soon, epidural anesthesia can prolong labor."

A nurse is caring for a client who has unrelieved episiotomy pain 8 hr following delivery. Which of the following actions should the nurse take?

Apply an ice pack to the perineum.

A nurse is reinforcing teaching with a client who is in the first trimester of pregnancy and has a new prescription for ferrous sulfate. The nurse should encourage the client to avoid taking the medication with which of the following liquids?

​Coffee

A nurse is assisting in the care of a client who is in active labor. The nurse notes late decelerations on the fetal monitor tracing. Which of the following actions should the nurse take first?

​Position the client on her side.

A nurse is caring for a client who is pregnant and undergoing a nonstress test. The nurse records the FHR as 130 to 150/min, with no fetal movement for 15 min. Which of the following actions should the nurse take?

Apply vibroacoustic stimulation to the woman's abdomen.

A nurse is caring for a group of clients on an intrapartum unit. Which of the following findings should be reported to the RN immediately?

​A client who has preeclampsia and reports epigastric pain and unresolved headache

A nurse is assisting in the care of a client following an amniotomy who is now in the active phase of the first stage of labor. Which of the following actions should the nurse take?

​Encourage the client to empty the bladder every 2 hr.

A nurse is collecting data from a client who is at 11 weeks of gestation and reports slight, occasional vaginal bleeding over the past 2 weeks. The provider determines that the fetus has died and that the placenta, fetus, and tissues remain in the uterus. How should the nurse document these findings?

​Missed miscarriage

A nurse is reinforcing discharge teaching with a client who is 3 days following a cesarean birth. Which of the following client statements indicates that the teaching was effective? (Select all that apply.)

"My partner and I will use a condom until I can get an intrauterine device." "I will call my provider if I have discharge from my incision." "I should not have unrelieved pain in my abdomen."

A nurse is caring for a client who is at 32 weeks of gestation and is in labor. Which of the following medications is contraindicated for this client?

Misoprostol

A nurse is reinforcing teaching with a client who is scheduled for a nonstress test. Which of the following information should the nurse include?

An external fetal monitor will be used to monitor the FHR.

A nurse is caring for a client who is pregnant and reports constipation. Which of the following recommendations should the nurse make?

Increased cellulose and fluid in the diet

A nurse is assisting a client out of bed for the first time since delivery. The client becomes frightened when she passes a large amount of lochia. Which of the following responses should the nurse make?

"Lochia can pool in the vagina while you lie in bed."

A nurse is caring for a client in the prenatal clinic who is at 7 weeks of gestation. The client reports urinary frequency and asks the nurse if this will continue throughout her pregnancy. Which of the following responses by the nurse is appropriate?

"No, it should only last until about your 12th week, but it will return near the end of the pregnancy."

A nurse is caring for a client who wants to know if it is possible to have a vaginal birth after a cesarean birth (VBAC). Which of the following statements by the nurse is appropriate?

"The primary consideration is what type of incision you had."

A nurse is assisting with the admission of a client who is in preterm labor at 30 weeks of gestation and has a new prescription for betamethasone. Which of the following statements should the nurse make?

"The purpose of this medication is to boost fetal lung maturity."

A nurse is speaking on the phone to a client on the phone who is pregnant and taking iron supplements for iron-deficiency anemia. The client reports that her stools are black but she has no abdominal pain or cramping. Which of the following responses by the nurse is appropriate?

"This is expected because of the way iron is broken down during digestion."

A nurse is assisting with the care of a client who is at 32 weeks of gestation and in labor. The client asks the nurse, "Will my baby be okay?" Which of the following responses should the nurse make?

"You must be feeling very scared."

A nurse is reinforcing teaching about signs preceding the onset of labor with a client who is at 39 weeks of gestation. Which of the following statements should the nurse include?

"You will experience a surge of energy."

A nurse is reinforcing teaching with a client who is pregnant and whose routine diagnostic testing reveals a negative rubella titer. Which of the following statements should the nurse tell the client?

"You will need an immunization following delivery."

A nurse is caring for a client who is 2 hr postpartum. The client has an IV of lactated Ringer's with 25 units of oxytocin infusing and large rubra lochia with a hypotonic uterus. Vital signs include blood pressure 146/94 mm Hg, pulse 80/min, and respirations 18/min. Which of the following prescriptions should the nurse clarify with the provider?

Administer methylergonovine 0.2 mg IM now.

A nurse is collecting data from a client who is in her second trimester of pregnancy. The nurse should recognize which of the following findings as an expected physiologic change during pregnancy?

An increase in lordosis

A nurse is collecting data from a client who gave birth 12 hr ago. The nurse notes the fundus is deviated to the right, boggy, and 2 cm above the umbilicus. Which of the following actions should the nurse take first?

Assist the client to void.

A nurse is caring for a client who is at 38 weeks of gestation and has a score of 10 on her biophysical profile. Which of the following actions should the nurse take?

Assure the client that the score is within the expected range.

A nurse is caring for a client following a cesarean birth. The client tells the nurse that she is hungry. Which of the following actions should the nurse take first?

Auscultate the client's abdomen.

A nurse is reinforcing teaching about reducing the risk of perineal infection with a client who had a vaginal birth. Which of the following information should the nurse include in the teaching? (Select all that apply.)

Blot the perineal area dry after voiding. Clean the perineal area from front to back. Perform hand hygiene before and after voiding.

A nurse is collecting data from a client who is at 35 weeks of gestation. Which of the following findings should the nurse report to the provider?

Blurred vision

A nurse is reinforcing teaching with a client at her first prenatal visit about expected changes during gestation. (Move the steps into the box on the right, placing them in the selected order of occurrence from earliest to latest in gestation. Use all the steps.)

Breast tenderness Nausea and vomiting Goodell's sign Quickening Striae gravidarum Lightening

A nurse is performing Leopold maneuvers on a client who is in labor and determines the fetus is in an RSA position. Which of the following fetal presentations should the nurse document in the client's medical record?

Breech

A nurse is assisting with monitoring a client who has preeclampsia and is receiving magnesium sulfate. The client's respiratory rate is 8/min. Which of the following should the nurse administer?

Calcium gluconate

A nurse is caring for a client who is 4 hr postpartum. The nurse finds a small amount of lochia rubra on the client's perineal pad. The fundus is midline and firm at the umbilicus. Which of the following actions should the nurse take?

Check for blood under the client's buttock.

A nurse is collecting data from a postpartum client and finds a large amount of lochia rubra with several clots on the client's perineal pad. Which of the following actions should the nurse take first?

Check the client's fundus.

A nurse is caring for a client who is experiencing shaking chills during the immediate postpartum period. Which of the following actions should the nurse take?

Cover the client with warm blankets.

A nurse is assisting with the admission of a client who is Hispanic to the labor and delivery unit. Which of the following practices should the nurse anticipate while caring for this client?

Desire to delay breastfeeding for several days

A nurse is preparing to administer dinoprostone gel to a client who is pregnant. The client asks the nurse about the purpose of the medication. Which of the following responses should the nurse make?

Dinoprostone promotes softening of the cervix.

A nurse is collecting data from a client who is 1 day postpartum. Which of the following findings requires immediate intervention by the nurse?

Displaced fundus from the midline

A nurse is reinforcing teaching with a client about how to reduce the risk of giving birth to a newborn who has a neural tube defect. Which of the following instructions should the nurse include in the teaching?

Eat foods fortified with folic acid.

A nurse is caring for a client who is requesting to go to the bathroom immediately after a vaginal birth. Which of the following actions should the nurse to take?

Evaluate the side effects of analgesia used during labor.

A nurse is caring for a client who might have a hydatidiform mole. The nurse should monitor the client for which of the following findings?

Excessive uterine enlargement

A nurse is caring for a client who is 12 hr postpartum. The nurse recognizes the client is in the dependent, taking-in phase of maternal postpartum adjustment. Which of the following is an expected finding during this period?

Expressions of excitement

A nurse is caring for a client who has just learned that she is pregnant. The nurse should reinforce with the client to call her provider if she experiences which of the following manifestations?

Facial edema

A nurse is assisting with the admission of a client who is at 38 weeks of gestation and has severe preeclampsia. When collecting data from the client, the nurse should expect which of the following findings?

Headache

A charge nurse observes a newly licensed nurse checking fetal heart tones (FHT) for a client who is at 12 weeks of gestation. Which of the following actions by the nurse indicates a need for intervention by the charge nurse?

Listens with a fetoscope

A nurse in a prenatal client is caring for a client who is at 38 weeks of gestation and has heavy, red vaginal bleeding, without contractions, that started spontaneously. She is in no distress and states that she can "feel the baby moving." The client should undergo an ultrasound to determine which of the following findings?

Location of the placenta

A nurse is assisting with the care of a client who is experiencing preterm labor and is scheduled to undergo amniocentesis. The client needs an amniocentesis to determine which of the following findings?

Maturity of lungs

A nurse is reinforcing teaching with a client who is pregnant and has a new prescription for ferrous sulfate due to iron-deficiency anemia. The nurse should instruct the client to take this medication with which of the following?

Orange juice

A nurse is caring for a client who is 36 hr postpartum and has a distended bladder. The client reports saturating four perineal pads in the past hour. Which of the following actions should the nurse take? (Select all that apply.)

Palpate the fundus for location and tone. Check the client's blood pressure and pulse. Administer intravenous infusion of 0.9% sodium chloride. Look under the client's buttocks.

A nurse is caring for a client in the prenatal clinic who has a possible ectopic pregnancy at 8 weeks of gestation. Which of the following findings should the nurse expect?

Pelvic pain

A nurse in a provider's office is reinforcing teaching about home care with a client who has mild preeclampsia. Which of the following information should the nurse include in the teaching?

Perform daily fetal movement counts.

A nurse is assisting with the care of a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse take first?

Place the client in a knee-chest or Trendelenburg position.

A nurse is reviewing the medical record of a client who experienced a vaginal birth 2 hr ago. The nurse should identify that which of the following findings places the client at risk for a postpartum hemorrhage?

Precipitous birth

A nurse is reinforcing teaching about immunizations with a woman in her first trimester of pregnancy whose diagnostic testing indicates she does not have an immunity to rubella. The nurse should recommend that the client receive a measles, mumps, rubella (MMR) vaccine at which of the following times?

Prior to discharge from the hospital after giving birth

A nurse is assisting with the care of a client who is at 37 weeks of gestation and has placenta previa. Which of the following risks is the primary reason the nurse should avoid performing a pelvic examination?

Profound bleeding

A nurse on the postpartum unit is planning to delegate client care to an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum.

A nurse is reinforcing teaching about quickening with a client who is at 6 weeks of gestation. Which of the following information should the nurse include?

Quickening occurs between the fourth and fifth months of pregnancy.

A nurse is reviewing laboratory results from a client who is at 28 weeks of gestation and has gestational diabetes. The nurse notes that blood glucose levels taken 1 hr following a meal range from 145 mg/dL to 162 mg/dL over the past week. Which of the following actions should the nurse take?

Reinforce instruction about insulin administration.

A nurse is assisting in the plan of care for a client who is pregnant and has phenylketonuria (PKU). Which of the following actions should the nurse include in the plan of care?

Reinforce teaching about a protein-free diet.

​A nurse is assisting with the care of a newborn immediately following a cesarean delivery. The nurse's highest priority is to monitor the newborn for which of the following?

Respiratory distress

A nurse is assisting with the care of a client who presents to a labor and delivery unit with rapidly progressing labor. Which of the following actions is the priority for the nurse to take?

Supporting the infant during the birth

A nurse is caring for a client in the immediate postoperative period following removal of an ectopic pregnancy via salpingostomy. For which of the following indications should the nurse administer Rho(D) immune globulin?

The client is Rh-negative.

A nurse is reinforcing teaching with a newly licensed nurse about a biophysical profile. Which of the following information should the nurse include in the teaching?

The test predicts fetal well-being in the third trimester

A nurse is reinforcing teaching with a client who is pregnant and has a prescription for Rho(D) immune globulin. Which of the following information should the nurse include?

This medication prevents the formation of Rh antibodies by a woman who is Rh-negative.

A nurse is reinforcing teaching with a client who is at 17 weeks of gestation and is scheduled to have a maternal serum alpha-fetoprotein (MSAFP) determination. Which of the following information should the nurse include?

This test will screen for neural tube defects.

A nurse is reinforcing teaching about common discomforts of pregnancy during the first trimester with a client who is pregnant. Which of the following manifestations should the nurse include in the teaching?

Urinary urgency

A nurse is caring for a client who is at 28 weeks of gestation and has received terbutaline. Which of the following findings should the nurse expect?

Weakened uterine contractions

A nurse is reinforcing nutrition teaching with a client during the first prenatal visit. Which of the following statements by the client indicates an understanding of the teaching?

"I can eat 12 to 18 ounces of albacore tuna weekly."

A nurse in a provider's office is collecting data from a female client in her third trimester of pregnancy. The client describes actions she took to obtain relief from a headache which lasted all day. Which of the following client statements should the nurse identify as the priority?

"I took 400 mg of ibuprofen with a diet soda."

A nurse is reinforcing teaching about appropriate exercises during pregnancy with a client who is at 24 weeks of gestation. Which of the following statements indicates a need for additional teaching?

"I will participate in a game of racquetball once a week."

A nurse is reinforcing teaching with a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which of the following statements by the client indicates a need for further teaching?

"I will reduce my exercise schedule to 3 days a week."

A nurse is reinforcing discharging teaching with a client who is 2 days postpartum. Which of the following statements should the nurse include in the teaching?

"If you breastfeed your newborn, expect two to three stools per day."

A nurse is assisting with the care of a client who is in labor. Immediately after delivery of a newborn, which of the following actions should the nurse take first?

Dry the newborn.

A nurse is assisting with the care of a client who is receiving oxytocin via IV infusion following a vaginal delivery. Which of the following findings should the nurse monitor to evaluate effectiveness of this medication?

Fundal consistency

A nurse is reinforcing teaching about bottle-feeding with a client who is postpartum. Which of the following statements by the client indicates a need for further teaching?

"Each feeding should last about 15 minutes."

A nurse is caring for a client who has gestational diabetes and reports feeling shaky, sweaty, and having blurred vision. The client's blood glucose level is 48 mg/dL. Which of the following foods should the nurse give to the client? (Select all that apply).

120 mL unsweetened fruit juice 1 tbsp honey 5 hard candies

A nurse is caring for a client who is at 36 weeks of gestation and has suspected placenta previa. For which of the following findings should the nurse monitor the client?

A large amount of bright red vaginal bleeding without pain