Maternal Newborn (Ch6,8,9)

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Progesterone is secreted by which structure? 1. Corpus luteum 2. Graafian follicle 3. Ovum 4. Endometrium

The nurse is caring for a client being augmented with oxytocin. What potential complications should the nurse observe the client for? Select all that apply. 1. Tachysystole 2. Late decelerations on the fetal monitor 3. Episodic accelerations 4. Uterine rupture 5. Maternal edema

1, 2, 4, 5 oxytocin has an antidiuretic effect which can cause water retention and new onset or worsening edema

The nurse is preparing a group session for childbirth preparation. The topic will include signs of impending labor. The nurse will include which topics? Select all that apply. 1. Lightening 2. Decreased fetal movement 3. Nesting 4. Bloody show 5. Weight gain

1, 3, 4

Following the delivery of a term newborn, the mother experiences a moderate urge to push and a gush of blood emerges from the vagina. The nurse recognizes this as: 1. Indicating the placenta is about to deliver 2. The formation of a vaginal hematoma 3. Perform a cervical exam 4. Signs of a postpartum hemorrhage

1. Indicating the placenta is about to deliver

A client was recently admitted to the labor and delivery unit in active labor. The nurse performs Leopold's maneuvers during the assessment. During the third maneuver, the nurse notes a firm and fixed fetal part. Which position correlates with this assessment finding? 1. Occiput 2. Acromion 3. Sacrum 4. Transverse

1. Occiput the acromion would not be fixed the sacrum would palpate as soft

The process of labor is multifactorial. What are the five P's of labor?

1. Power 2. Passage 3. Passenger 4. Psyche 5. Position

What happens under the influence of progesterone? Select all that apply. 1. Vaginal epithelium proliferates 2. Cervix secretes a thick viscous mucous 3. Breast glandular tissue increase in size and complexity and breasts prepare for lactation 4. The basal body temperature drop 0.3 to 0.6 degrees celcius (0.5 to 1.0 degrees Fahrenheit)

1., 2., 3., 4 is incorrect because the body temperature increases not decreases.

Which phase of the menstrual cycle is estrogen the greatest? 1. Menstrual phase 2. Proliferative phase 3. Secretory phase 4. Ischemic phase

What day does the follicular cycle end and the luteal cycle begin? 1. Day 8 2. Day 15 3. Day 25 4. Day 28

What is the part of the vagina called that allows for the pooling of semen? 1. Vaginal orifice 2. Vaginal fornix 3. Hymen 4. Cervix

A client is admitted to the labor and delivery unit in active labor. There has been no prenatal care for the current pregnancy, and the on-call provider estimates the pregnancy to be around 35 weeks' gestation. Which medication will the nurse anticipate being ordered for on this client? 1. Oxytocin 2. Penicillin term-182 3. Magnesium sulfate 4. Metoclopramide

2 with no prenatal care the Group B strep status is unknown. Penicillin is the drug of choice to use during labor to prevent GBS infection in the neonate.

The nurse is rapidly determining the need for resuscitation immediately following delivery of a 36-week infant. The nurse must answer yes to which questions to determine that skin-to-skin contact is appropriate? Select all that apply. 1. How long was the mother in labor? 2. Is the infant a term gestation? 3. Does the newborn have good muscle tone? 4. Is the baby crying and breathing?5. Were medications given during labor?

2, 3, 4

The nurse is assessing a laboring client. Which signs and symptoms does the nurse recognize that indicate movement into the transition phase of labor? Select all that apply. 1. Contractions every 3 to 4 minutes 2. Contractions lasting 60 to 90 seconds 3. Cervix dilated to 8 cm 4. Noted trembling of client 5. Increase in client anxiety

2, 3, 4, 5

What parts of the pelvis are considered the false pelvis?1. Sacrum 2. Ilium 3. Ischium 4. Pubis 5. Coccyx

2,3

Which structures are responsible for progesterone production? Select all that apply 1. Ovum 2. Corpus luteum 3. Placenta 4. Anterior pituitary

2,3

True or false: Once the ovaries mature following puberty they slowly begin to decrease in size until menopause where they are finally ejected with the women's final menstrual cycle. 1. True2. False

2. False. Ovaries become larger after puberty and then decrease in size following menopause. They are not ejected with the women's final menstrual cycle.

Which function of the fallopian tube is false? 1. Provide transport for the ovum from the ovary to uterus 2. Produce FSH and LH for ovum maturation 3. Provide a site for fertilization 4. Serve as a warm, moist nourishing environment for the ovum or zygote

2. The anterior pituitary produces these hormones

Which is not a function of the bony pelvis? 1. Support and protect the pelvic contents. 2. Form a relatively fluid axis of the birth passage.

2. The bony pelvis forms a relatively fixed acid of the birth passage

True or false: The myometrium is continuous with the musculature of the ovaries, fallopian tubes, and vagina. 1. True2. False

2. The myometrium is not continuous with the ovaries.

Which ligaments maintain the ovaries location? Select all that apply. 1. Round ligament 2. Broad ligament 3. Uterosacral ligament 4. Ovarian ligament 5. Cardinal ligament 6. Infundibulopelvic ligament

2., 4., and 6.

Progesterone is greatest during which phase of the menstrual cycle? 1. Menstrual phase 2. Proliferative phase 3. Secretory phase 4. Ischemic phase

What event signals the end of the follicular cycle? 1. Oogenesis 2. Luteinization of the follicle into the corpus luteum 3. Ovulation 4. Shedding of the endometrial layer

What is the cyclical process that prepares the uterine lining for implantation called? 1. Prodation 2. Inundation 3. Nidation 4. Predation

What is the pH of the vagina before ovulation? 1. 2.0-3.0 2. 7.0-7.5 3. 4.0-5.0 4. 3.5-4.0

What part of the uterus do the fallopian tubes enter? 1. Isthmus 2. Ampulla 3. Cornua 4. Fimbriae

The nursery nurse is caring for a neonate who requires resuscitation. Place the resuscitation interventions given in the sequence in which the nurse will administer them. 1. Provide positive pressure ventilation by CPAP. 2. Administer epinephrine to the neonate. 3. Reposition mouth and clear secretions from airway. 4. Perform coordinated chest compressions.

3, 1, 4, 2

The nurse is caring for a term gestation client in active labor when her membranes rupture spontaneously. Prioritize the following nursing interventions. 1. Document the assessment findings along with time of rupture. 2. Assess the color, odor, and amount of fluid. 3. Assess the fetal heart rate. 4. Update the physician on spontaneous rupture of membranes and labor progress.

3, 2, 1, 4

While caring for a client, which interventions would the nurse include in the nursing care plan to provide culturally competent care? Select all that apply. 1. Describe hospital protocols that will be followed during the delivery. 2. Provide teaching on non-pharmacological pain management options as they are preferred by women of the client's culture. 3. Identify who the woman prefers to care for her during labor and delivery. 4. Provide the client's preferred foods as appropriate or encourage the client's family to bring foods from home. 5. Determine who is the client's support person(s) and how they will participate in her care.

3, 4, 5

A new mother is refusing all medications for her newborn infant. The obstetrician has asked the nurse to explain the purpose of the Vitamin K injection to the parent. How would the nurse explain the need for this medication? 1. "This medication will help prevent infections in the eyes due to bacteria in the birth canal." 2. "All medications are required in our state, so you will not be able to refuse this medication." 3. "This medication is given because the infant does not yet have good bacteria in the gut to help with clotting." 4. "This medication is the first of several that will prevent viral liver disease."

3. "This medication is given because the infant does not yet have good bacteria in the gut to help with clotting." vitamin K is givent to help with synthesis of clotting factors

Immediately following the delivery of the placenta, the nurse prepares to administer IV oxytocin. The client states, "What is this medication for?" which is the nurse's best response? 1. "To augment labor contractions" 2. "To improve the let-down reflex for your breastmilk." 3. "To prevent hemorrhage after delivery." 4. "To prevent uterine cramping and pain following delivery.

3. "To prevent hemorrhage after delivery." WHO and AWHONN recommend oxytocin use during the third stage of labor to prevent postpartum hemorrhage

Which sentence about the ovaries is incorrect? 1. There is no peritoneal covering for the ovaries. This allows easier spread of malignant cells from cancer of the ovaries. 2. The lack of a peritoneal covering for the ovaries assists the mature ovum to erupt. 3. The ovaries are the primary source of two important hormones: Estrogen and Prostaglandin 4. The ovarian cortex is the main functional part of the ovary.

3. Th ovaries are the primary source of Estrogen and Progesterone

Which are the two parts of the uterus called? 1. Ampulla and isthmus 2. Cornua and cervix 3. Corpus and isthmus 4. Corpus and cervix

Which hormone allows for proliferation of the endometrial lining? 1. Follicle stimulating hormone 2. Luteinizing hormone 3. Gonadotropin Releasing hormone 4. Estrogen

Which is not considered a layer of the uterus? 1. Endometrium 2. Perimetrium 3. Myometrium 4. Submetrium

Which ovarian ligament can alter the position of the ovary in order to help the fimbriae catch the ovum? 1. Broad ligament 2. Infundibulopelvic ligament 3. Cardinal ligament 4. Ovarian ligament

Why does the relationship between the fallopian tubes, the uterus/vagina, and the peritoneal cavity increase a women's vulnerability to pelvic infection? 1. The fallopian tubes have a close proximity to the pelvis and lack a membrane to contain infections 2. The ciliary action of the fallopian tubes carry pathological bacterial to the pelvis 3. The fallopian tubes lack the production of an immmunodefensive mucous capable of phagocytosis 4. The fallopian tube links the peritoneal cavity with the uterus and vagina

During the transition phase, the client states that she feels a strong urge to push. The nurse explains that which reflex triggers this urge? 1. Deep tendon reflex 2. Moro reflex 3. Naegele's reflex 4. Ferguson's reflex

4. Ferguson's reflex

Which statement about pregnancy is accurate? A) A normal pregnancy lasts about 10 lunar months. B) A trimester is one third of a year. C) The prenatal period extends from fertilization to conception. D) The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth.

A) A normal pregnancy lasts about 10 lunar months.

The multiple marker test is used to assess the fetus for which condition? A) Down syndrome B) Diaphragmatic hernia C) Congenital cardiac abnormality D) Anencephaly

A) Down syndrome

Which behavior indicates that a woman is seeking safe passage for herself and her infant? A) She keeps all prenatal appointments B) She eats for two C) She drives her car slowly D) She wears only low-heeled shoes

A) She keeps all prenatal appointments

An Eastern European Jewish couple had two children who died from Tay-Sachs disease. The couple is currently pregnant and have asked for genetic confirmation about this fetus with the intention of early termination if the fetus tests positively. For which reason does the nurse expect chorionic villa sampling to be prescribed? 1. The test is performed as early as 10 weeks gestation. 2. Risks to the fetus and mother are less than other tests. 3. A positive result allows termination during the test. 4. This is the only testing that is disease specific.

ANS: 1 This is correct. Chorionic villa testing can be performed as early as 10 weeks gestation. Given the reproductive history of the couple and their expectations, this is the test the nurse should expect to be prescribed

A patient is scheduled for transvaginal ultrasound testing. Which preparation by the nurse is appropriate?1. Place the patient supine with a pillow beneath her head. 2. Explain that pain at 4 or less on a 0 to10 scale is expected. 3. Ascertain whether the patient has a latex or banana allergy. 4. Request that the patient's partner leave the testing room.

ANS: 3 This is correct. Because the transvaginal ultrasound probe is covered by a latex sheath, the nurse needs to ascertain whether the patient has a latex allergy or has exhibited an allergic response to specific foods such as bananas.

A patient who is at 20 weeks gestation is being prepared for an MRI after a nonconclusive ultrasound testing for suspected brain abnormality related to possible zika virus exposure. Which nursing actions are appropriate for this patient? Select all that apply. 1. Provide information regarding the test. 2. Allow patient to express feelings about her high-risk pregnancy. 3. Promote open communication with her primary health care providers. 4. Encourage patient to think about resolutions for negative testing. 5. Provide psychological support to the patient and her partner.

ANS: 1, 2, 3, 5 1 This is correct. A nursing responsibility related to antenatal testing is to inform the patient of what to expect during the testing. 2 This is correct. A nursing responsibility related to antenatal testing because of a high-risk pregnancy is to provide the patient and her partner with psychological support. The patient is likely to be anxious and should be allowed to express feelings. 3 This is correct. A nursing responsibility related to antenatal testing is always to promote open communication with the patient's primary health care providers. This nursing action is especially important in the event of a high-risk pregnancy. 4 This is incorrect. In this scenario, the nurse needs to refrain from encouraging the patient from thinking of resolutions if the MRI test results indicate manifestations of zika virus. The nurse needs to encourage the patient to make informed decisions when all factors are available. 5 This is correct. All antenatal testing related to high-risk factors causes anxiety and distress; the nurse needs to provide psychological support.

A patient in the third trimester of pregnancy is instructed on how to perform daily fetal movement count. The nurse needs to inform the patient what to do if fetal movement is decreased. Which patient actions are appropriately recommended by the nurse? Select all that apply. 1. Eat something. 2. Recount movements the next morning. 3. Arrange for a period of rest. 4. Focus on movement for 1 hour. 5. Exercise or take a walk.

ANS: 1, 3, 4 Feedback 1 This is correct. If the fetal movement is decreased from previous counts, the nurse should instruct the patient to eat something, which may stimulate the fetus. 2 This is incorrect. Fetal movement is an indicator of fetal well-being. If the patient notices a decrease in fetal movement, measures need to be taken to stimulate and/or reassess movement. Persistent decreased movement or lack of movement needs to be reported immediately to the HCP. 3 This is correct. If the fetal movement is decreased from previous counts the nurse should instruct the patient to arrange for a period of rest. If the patient is busy or distracted, the fetal movements may not be noticed. 4 This is correct. If the fetal movement is decreased from previous counts the nurse should instruct the patient to focus on fetal movement for a period of 1 hour. Four movements in an hour is reassuring

A patient who is at 30 weeks gestation is involved in a car crash. The nurse recognizes that which initial testing will be used to assess fetal well-being? 1. Ultrasonography 2. Nonstress testing 3. Contraction stress test 4. Fetal movement counting

ANS: 2 This is correct. Initially, nonstress testing is used to monitor fetal heart rate patterns and accelerations as an indication of fetal well-being. The heart rate of a physiologically normal fetus with adequate oxygenation and an intact autonomic nervous system accelerates in response to movement. This test is the most widely accepted method to assess fetal well-being after maternal trauma, among other conditions.

An adolescent patient who is 15 weeks pregnant refuses to have an alpha-fetoprotein test performed because, "I don't like needles." Which initial approach does the nurse take to achieve the testing? 1. Insist that testing will be done with or without her cooperation. 2. Explain the testing is important in detecting serious birth defects. 3. Ask an accompanying parent to help persuade the patient. 4. Notify the health care provider of the patient's refusal

ANS: 2 This is correct. The initial approach for the nurse to take is to appeal to the patient about the importance of ensuring that her baby is healthy.

A patient is scheduled for a contraction stress test (CST) at 36 weeks gestation. The nurse is aware that a successful testing is dependent on which factor?1. Whether Braxton-Hicks contractions are occurring 2. Whether uterine contractions can be stimulated 3. If the mother is not overly tired or anxious 4. If the fetus is in an awake cycle and active

ANS: 2 This is correct. The success of a CST is dependent on the ability to stimulate uterine contractions. Contractions can be stimulated with careful administration of IV oxytocin or by having the mother brush her nipples for 10 minutes.

A patient in the second trimester of pregnancy is scheduled for a Doppler flow study because the health care provider (HCP) is concerned about an assessment finding during a routine prenatal visit. Which finding of concern does the nurse suspect? 1. Fetal movement count is less than 8 per hour. 2. Patient shows no weight gain in 2 weeks. 3. Patient exhibits mild lower extremity edema. 4. Fetal growth is below expectation for gestational age.

ANS: 2 This is correct. There are many variables that can cause a patient not to gain weight in a 2-week period: preexisting obesity or patient actions to maintain anormal weight gain. This finding would not cause the HCP to order a Doppler flow study.

The nurse is providing pre-amniocentesis teaching for a patient who is at 18 weeks gestation. Which information does the nurse provide? Select all that apply. 1. Positioning on the left side will avoid injury to the fetus. 2. A full bladder will assist in ultrasound visualization. 3. Discomfort will be minimized with a local anesthetic. 4. Avoid lifting heavy objects for a period of 2 weeks. 5. Abdominal cramping and bleeding is normal for 24 hours

ANS: 2, 3 2 This is correct. Because the patient is less than 20 weeks gestation, a full bladder will assist with ultrasound visualization. 3 This is correct. To minimize discomfort as the needle is inserted, the patient will receive local anesthesia.

Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae? a. Increasing abdominal girth measurements b. Profuse vaginal bleeding c. Bradycardia with an aortic thrill d. Hypothermia with chills

ANS: a The nurse would expect to see increasing abdominal girth measurements.

A patient in the second trimester of pregnancy becomes upset when the health care provider (HCP) schedules several screening tests. The patient voices concern that something is wrong with her baby. Which statement by the nurse will reduce the patient's anxiety?1. "Multiple screening tests are ordered for every pregnancy." 2. "It is better to identify problems before birth than afterward." 3. "Screening tests are primarily to identify those without disease or abnormality." 4. "Diagnostic testing is a reason for worry because they indicate fetal problems."

ANS: 3 This is correct. The truthful statement that screening tests are primarily to identify those without disease or abnormality will alleviate the patient's anxiety

A woman at 32 weeks' gestation is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will identify which of the following as a positive patient care outcome? a. Rise in serum creatinine b. Drop in serum protein c. Resolution of thrombocytopenia d. Resolution of polycythemia

ANS: c Resolution of thrombocytopenia is a positive sign. It indicates that the platelet count is returning to normal.

The nurse is assessing a patient who just received confirmation of pregnancy. While collecting information about the patient's medical history, which information alerts the nurse to biophysical risk factors? Select all that apply. 1. The patient is primip who is 38 years of age. 2. The patient smokes two packs of cigarettes weekly. 3. The patient has been a strict vegetarian for 25 years. 4. The patient works as a nuclear medicine technician. 5. The patient is medically treated for rheumatoid arthritis.

ANS: 3, 5 3 This is correct. A nursing responsibility related to antenatal testing is always to promote open communication with the patient's primary health care providers. This nursing action is especially important in the event of a high-risk pregnancy. 4 This is incorrect. In this scenario, the nurse needs to refrain from encouraging the patient from thinking of resolutions if the MRI test results indicate manifestations of zika virus. The nurse needs to encourage the patient to make informed decisions when all factors are available. 5 This is correct. All antenatal testing related to high-risk factors causes anxiety and distress; the nurse needs to provide psychological support.

A patient has experienced an uneventful pregnancy but begins to have vaginal spotting at 38 weeks gestation. The health care provider (HCP) suspects placenta previa initiated by cervical thinning. Which testing does the nurse expect the HCP to schedule? 1. Doppler flow studies 2. Nonstress testing 3. Magnetic resonance imaging 4. Ultrasonography studies

ANS: 4 This is incorrect. Ultrasonography studies are appropriate in determining placental placement and possible abnormalities

For the patient with which of the following medical problems should the nurse question a physician's order for beta agonist tocolytics?a. Type 1 diabetes mellitus b. Cerebral palsy c. Myelomeningocele d. Positive group B streptococci culture

ANS: a Beta agonists often elevate serum glucose levels. The nurse should question the order.

A laboratory report indicates the L/S ratio (lecithin/sphingomyelin) results from an amniocentesis of a gravid patient with preeclampsia are 2:1. The nurse interprets the result as which of the following? a. The baby's lung fields are mature. b. The mother is high risk for hemorrhage. c. The baby's kidneys are functioning poorly. d. The mother is high risk for eclampsia.

ANS: a Feedbacka. An L/S ratio of 2:1 usually indicates that the fetal lungs are mature. b. L/S ratios are unrelated to maternal blood loss. c. L/S ratios are unrelated to fetal renal function. d. L/S ratios are unrelated to maternal risk for becoming eclamptic.

After an education class, the nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that additional teaching about sexually transmitted infection (STI) control issues is needed? a. "I could get an STI even if I just have oral sex." b. "Girls over 16 are less likely to get STDs than younger girls." c. "The best way to prevent an STI is to use a diaphragm." d. "Girls get human immunodeficiency virus (HIV) easier than boys do."

ANS: c This statement is untrue. The young woman needs further teaching. Condoms protect against STDs and pregnancy. In addition, condoms can be kept in readiness for whenever sex may occur spontaneously. Using condoms does not require the teen to plan to have sex. A diaphragm is not an effective infection-control method. Plus, it would require the teen to plan for intercourse.

The nurse is aware that some ____________________ tests, such as multiple marker screening and ultrasound, are offered to all pregnant women.

ANS: screening The nurse is aware that some screening tests are offered to all pregnant women. Screening tests such as multiple marker screening and ultrasound are performed to identify those who are not affected by a disease or abnormality, and can be referred to as a "rule out" process. Abnormal results on a screening test will warrant diagnostic testing.

Immediately after a newborn has been delivered, the nurse draws blood from the umbilical vein and one of the umbilical arteries. Which of the following is the proper rationale for this intervention? a. To determine blood glucose level in the newborn b. To determine the acid-base balance in the newborn c. To determine blood cholesterol levels in the newborn d. To determine white blood cell count in the newborn

What type of cultural concern is the most likely deterrent to many women seeking prenatal care? A) Religion B) Modesty C) Ignorance D) Belief that physicians are evil

B) Modesty

What BPP score would indicate the need for immediate delivery of the fetus? A. 6 B. 2 C. 12 D. 4

B. 2

Which finding is a positive sign of pregnancy? A: amenorrhea B: breast changes C: fetal movement felt by the woman D: visualization of fetus by ultrasound

D: visualization of fetus by ultrasound The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner. Amenorrhea is a presumptive sign of pregnancy. Breast changes are a presumptive sign of pregnancy. Fetal movement is a presumptive sign of pregnancy.

A nurse is assisting a patient in the fourth stage of labor. The nurse recognizes that which of the following is the primary means by which bleeding is stopped and hemostasis achieved during this stage? a. Application of an ice pack to the perineum b. Administration of a coagulant c. Compression with a large bandage d. Vasoconstriction produced by a well-contracted myometrium

A nurse is helping a woman in labor manage her pain. Which of the following pain relief measures would best indicate the nurse's understanding of the gate control theory of pain? a. Gently stroking the woman's abdomen b. Assisting with the administration of an epidural c. Dispensing an analgesic ordered by the primary care provider d. Encouraging the patient to meditate

A woman in active labor is experiencing excessive uterine activity or tachysystole. Which of the following nursing actions would be effective in reducing uterine activity? (Select all that apply.) a. Administering oxytocin b. Changing maternal position c. Providing hydration d. Reducing maternal anxiety or pain e. Administering a tocolytic

b,c,d,e

A patient who is near full term has just gone into labor, and an ultrasound shows that the fetus' buttocks are presenting, with thighs and legs completely flexed. The nurse recognizes that this fetal presentation is which of the following? a. Cephalic vertex b. Cephalic brow c. Complete breech d. Frank breech

Which of the following fetal heart rate (FHR) patterns is represented in the recording in Figure 9-12 (Indicates an amplitude range of greater than 25 bpm)? a. Absent variability b. Minima variability c. Moderate variability d. Marked variablility

Chapter 9- Fetal Heart Rate Assessment

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Within which part of the fallopian tube does fertilization take place? 1. Isthmus 2. Fimbriae 3. Ampulla 4. Pouch of douglas

Variable decelerations are typically related to: A. Cord compression B. Head compression C. Uteroplacental insufficiency D. Uterine hyper-stimulation due to hypovolemia

A. Cord compression

For what reason would breastfeeding be contraindicated? A) Hepatitis B B) Everted nipples C) History of breast cancer 3 years ago D) Human immunodeficiency virus (HIV) positive

D) Human immunodeficiency virus (HIV) positive

A nurse is explaining to a patient the maternal factors that trigger labor. Which of the following should the nurse mention? (Select all that apply.) a. Stretching of uterine muscles b. Desire of the mother c. Pressure on the cervix d. Release of oxytocine. Increase in estrogen

a,c,d,e

Which is not a function of the vagina? 1. serves as a passage way for the primary oocyte. 2. serve as a passage way for sperm during coitus and the fetus during birth. 3. To provide passage for the menstrual flow . 4. To protect the uterus from pathological bacteria.

Amniocentesis done after 15 weeks is associated with a fetal death rate of: A. Less than 1% B. Less than 5% C. Greater than 1% D. Approximately 5%

A. Less than 1%

Specialized ultrasounds are involved in all the following except: A. Maternal assays B. BPP C. Assessment of amniotic fluid D. Measurement of fetal structures

A. Maternal Assays

The goal of maternal position changes for a prolonged deceleration is: A. Maximizing uterine blood flow B. Increasing uterine contractions C. Maximizing maternal oxygenation D. Increasing maternal movement

A. Maximizing uterine blood flow

What are the walls of the vagina covered with? 1. Rugae 2. Endometrial tissue 3. Wharton's Jelly 4. Streptococci

What part of the uterus is the site for lower-segment cesarean births? 1. Isthmus 2. Corpus 3. Cervix 4. Cornua

Which hormone causes the anterior pituitary to release FSH and LH? 1. Gonadotropin-releasing hormone 2. Progesterone 3. Human chorionic gonadotropin 4. Estrogen

Which hormone is responsible for maturation of the follicle? 1. Follicle stimulating hormone 2. Luteinizing hormone 3. Gonadotropin-releasing hormone 4. Human chorionic gonadotropin

Chapter 8- Intrapartum Assessment and Intervention

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What lamellar body count value is highly indicative of fetal lung maturity? A. 20,000 B. 35,000 C. 55,000 D. 40,000

C. 55,000

A nurse is caring for a client who is pregnant and reviewing manifestations of complications the client should promptly report to the provider. Which of the following complications should the nurse include? A: vaginal bleeding B: swelling of the ankles C: heartburn after eating D: lightheadedness when lying on back

A: vaginal bleeding Vaginal bleeding indicates a potential complication of the placenta such as placenta prevue. Instruct the client to notify the provider immediately.

Which layer of the uterine corpus undergoes monthly renew from menarche to menopause in the absence of pregnancy? 1. Endometrium 2. Myometrium 3. Perimetrium 4. All layers

In explaining to a patient factors that help the fetal head to mold during labor and birth and thus fit through the maternal pelvis, which of the following should the nurse mention? a. The presence of membranous spaces between the bones (sutures) and fontanels of the fetal skull b. The action of estrogen to soften cartilage and increase elasticity of the ligaments c. The action of relaxin to soften cartilage and increase elasticity of the ligaments d. The gender of the fetus

A nurse is caring for a patient who is in the active phase of the first stage of labor. How often should the nurse monitor fetal heart rate and contractions during this phase? a. Every 5 to 10 minutes b. Every 15 to 20 minutes c. Every 30 to 40 minutes d. Every 45 to 60 minutes

A nurse is monitoring a woman's progress during active labor. The nurse observes that the woman's cervix has thinned and shortened dramatically in the past 15 minutes. The nurse recognizes that this phenomenon is known as which of the following? a. Dilation b. Effacement c. Bearing down d. Lightening

As the nurse explains the purpose of the tocotransducer (Toco), which she places on the abdomen, she states that this monitoring device provides an accurate evaluation of which of the following? a. Uterine hypertonus b. Frequency of contractions c. Intensity of contractions d. Progress of labor

b (Feedback a. Uterine tone is palpated or measured with an intrauterine pressure catheter (IUPC). b. A tocotransducer measures frequency and duration of uterine contractions. c. Contraction strength is palpated or measured with an intrauterine pressure catheter (IUPC). d. Progress of labor is evaluated with a sterile vaginal examination (SVE).)

A patient who is in labor has just experienced rupture of membranes. Which of the following should be priority actions for the nurse to take at this time? (Select all that apply.) a. Assist the patient into the lithotomy position b. Assess the fetal heart rate c. Assess the amniotic fluid for color, amount, and odor d. Instruct the woman to bear down with the urge to push e. Document the date and time of rupture of membranes

b,c,e

A woman with her first pregnancy believes she is in labor and calls her she is in labor and calls her obstetrician's office. Which of the following criteria for going to the birthing facility should the nurse mention to the woman? (Select all that apply.) a. Contractions are 10 minutes apart b. Rupture of membranes occurs c. Contractions last at least 30 seconds d. She experiences intense paine. Increase in bloody show

b,d,e

A nurse is assisting a patient who has finished delivering her baby vaginally and is now delivering the placenta. The nurse recognizes that the woman is in which stage of labor? a. First b. Second c. Third d. Fourth

A nurse is evaluating fetal heart rate (FHR) monitor results and notes that the baseline FHR is 170 beats per minute. The nurse should recognize this FHR pattern as which of the following? a. Early deceleration b. Late deceleration c. Tachycardia d. Bradycardia

A patient has just entered the third stage of labor, and the nurse is awaiting delivery of the placenta. Which of the following should the nurse expect as a sign that delivery of the placenta is imminent? a. The further descent of the uterus b. shortening of the umbilical cord at the introitus c. A sudden gush of blood from the vagina d. Rupture of membranes

About a few weeks before her due date, a patient who is in her first pregnancy calls her obstetrician's office and says that it feels like the baby has moved down in her abdomen and that she can breathe more easily, although she feels like she needs to urinate all the time now. She wonders whether this means that she is about to go into labor. Which of the following should the nurse tell her?a. "That is called a Braxton-Hicks contraction. It is harmless and not a sign of true labor." b. "That is called nesting. It means that you will likely begin labor within 24 hours." c. "That is called lightening. It means that you are probably just a couple of weeks away from labor." d. "That is called a true contraction. It means that you are in labor. Get to the hospital as soon as possible."

A patient needs continuous electronic fetal monitoring while at the same time the freedom to walk about the birth center and have a bath. Which form of monitoring should the nurse expect to arrange for this patient? a. Palpation b. Auscultation c. Portable electroencephalogram (EEG) d. Telemetry

Which of the fetal heart rate (FHR) is represented in the recording in Figure 9-7(The FHR here is about 180 bpm)?a. Normal FHR b. Fetal tachycardia c. Fetal bradycardia d. Marked variability

Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider? A) Nausea with occasional vomiting B) Fatigue C) Urinary frequency D) Vaginal bleeding

D) Vaginal bleeding

Potential causes of late decelerations include: A. Maternal fever B. Umbilical cord compression C. Uteroplacental insufficiency D. Fetal activity

C. Uteroplacental insufficiency

The nurse is preparing the client for epidural anesthesia. Which assessments or interventions would the nurse perform prior to administration? Select all that apply. 1. Check the platelet level. 2. Perform the procedure time-out. 3. Determine that the client is dilated to at least 5cm. 4. Ensure the consent has been signed. 5. Administer IV fluid bolus of normal saline or lactated ringers.

1, 2, 4, 5 lab values for bleeding and clotting should be checkedtime-out verification procedures ensure safety by identifying client, procedure, allergiestime of epidural is based on client preference

Which is not a function of the breast? 1. To provide nourishment to the newborn and infant 2. To provide antibodies to the newborn and infant 3. To provide steroid hormones to the infant 4. To be a source of pleasurable sexual sensation

Which function of the cervix is false? 1. To provide lubrication for the vaginal canal 2. To act as a bacteriostatic agent 3. To provide an acidic environment to shelter deposited sperm from vaginal secretions 4. To secrete a clear, thin, and alkaline mucous during ovulation

3. The cervix provides an alkaline environment

Signs and symptoms that a woman should report immediately to her health care provider include (Select all that apply): A) Vaginal bleeding. B) Rupture of membranes. C) Heartburn accompanied by severe headache. D) Decreased libido. E) Urinary frequency.

A) Vaginal bleeding. B) Rupture of membranes. C) Heartburn accompanied by severe headache.

Increased information provided by assessment of uterine contractions with an IUPC includes: A. Frequency, duration, intensity and resting tone B. Frequency, duration and intensity C. Intensity only D. Labor progress

A. Frequency, duration, intensity and resting tone

A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old daughter is expecting her first child. Which is a major factor in determining how this woman will respond to becoming a grandmother? A: her age B: her career C: being divorced D: age of the daughter

A: her age Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. Career responsibilities may have demands that make the grandparents not as accessible but are not a major factor in determining the woman's response to becoming a grandmother. Being divorced is not a major factor that determines the adaptation of grandparents. The age of the daughter is not a major factor that determines the adaptation of grandparents. The age of the grandparent is a major factor.

Which findings are presumptive signs of pregnancy? (Select all that apply.) A: quickening B: amenorrhea C: ballottement D: goodell's signE: chadwick's sign

A: quickening B: amenorrhea E: chadwick's sign Quickening, amenorrhea, and Chadwick's sign are presumptive signs of pregnancy. Ballottement and Goodell's sign are probable signs of pregnancy.

Screening tests are designed to A. Be offered to all pregnant women B. Identify those not affected by a disease. C. Identify a particular disease D. Make a specific diagnosis

B. Identify those not affected by a disease

With regard to a womans reordering of personal relationships during pregnancy, the maternity nurse should understand that: A) Because of the special motherhood bond, a woman's relationship with her mother is even more important than with the father of the child. B) Nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other. C) Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father. D) The woman's sexual desire is likely to be highest in the first trimester because of the excitementand because intercourse is physically easier.

C) Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father.=

The nurses role in antepartal testing includes: A. Interpreting results B. Obtaining consent C. Explaining how and why test is performed D. Referring the woman's question to a physician

C. Explaining how and why a test is performed

While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?A) Have the patient stand up and retake her blood pressure. B) Have the patient sit down and hold her arm in a dependent position. C) Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. D) Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

D) Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she doesn't know what ishappening; one minute shes happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate? A) Don't worry about it; you'll feel better in a month or so. B) Have you talked to your husband about how you feel? C) Perhaps you really don't want to be pregnant. D) Hormonal changes during pregnancy commonly result in mood swings.

D) Hormonal changes during pregnancy commonly result in mood swings.

In her work with pregnant women of various cultures, a nurse practitioner has observed various practicesthat seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose? A) To promote family unity B) To ward off the evil eye C) To appease the gods of fertility D) To protect the mother and fetus during pregnancy

D) To protect the mother and fetus during pregnancy

The nurse knows that a FHR monitor printout indicates a Category III abnormal fetal heart rate pattern when: a. Baseline variability is minimal or absent with decelerations. b. FHR mirrors the uterine contractions. c. Occasional periodic accelerations occur. d. Baseline variability is 6 to 25 bpm with decelerations

a (Feedback a. Minimal or absent baseline variability may be an indication of fetal hypoxia. b. This answer describes early decelerations that are not an indication of fetal intolerance of labor. c. Periodic accelerations are a sign of fetal well-being. d. A baseline variability of 6 to 25 bpm is normal.)

A patient who is near term has called the obstetrician's office saying that she's nervous that she may be in labor. The nurse should tell the patient that true labor is characterized by which of the following? a. Lightening and contractions that vary in frequency, duration, and intensity b. Contractions that occur at regular intervals and increase in frequency, duration, and intensity c. Occurrence on or within a day or two of the estimated due date d. Rupture of membranes

As a nurse is monitoring a fetal heart rate (FHR), the nurse observes a sudden increase in FHR. Which of the following factors could account for this change? a. Stimulation of the parasympathetic nervous system b. Stimulation of the sympathetic nervous system c. Stimulation of a vagal response due to increased pressure applied to the baroreceptors in the aortic arch d. Stimulation of chemoreceptors in the aortic arch due to a decreases in O2 and increase in CO2

Early in labor, a patient tells the nurse that she would like an unmedicated birth, in general, but would like some pain relief that is fast-acting, that she can administer herself, and that will not interfere with the normal physiology and progress of labor. Which of the following should the nurse suggest to the patient? a. Parenteral opioids b. Nitrous oxide c. Epidural anesthesia d. General anesthesia

Which of the following fetal heart rate (FHR) patterns is represented in the recording in Figure 9-14 (visually apparent, usually symmetrical, with a gradual decrease and return of FHR associated with a uterine contraction, with the nadir occuring at the same time as the peak of the contraction)? a. Accelerations b. Early decelerations c. Variable decelerations d. Late decelerations

A nurse is preparing to monitor a patient who is to receive an amnioinfusion. Which of the following actions should the nurse make at this time? a. Attach the patient to an electronic blood pressure cuff. b. Assist in insertion of an internal uterine pressure catheter. c. Attach the patient to an oxygen saturation monitor. d. Perform an amniotic fluid Nitrazine test.

b (Feedback a. The patient's blood pressure will need to be monitored, but a manual cuff is sufficient. b. There is a possibility of uterine rupture during an amnioinfusion. An internal pressure transducer, therefore, must be inserted to monitor the patient's intrauterine pressures. c. The woman's oxygen saturation levels need not be monitored during the amnioinfusion. d. Because the woman's membranes are already ruptured, there is no need for a Nitrazine test to be performed.)

Early in labor, a patient tells the nurse that she had an awful experience with pain in her last pregnancy and would like strongest pain relief option available for a vaginal birth. Which of the following should the nurse suggest to the patient? a. parenteral opioids b. Nitrous oxide c. Epidural anesthesia d. General anesthesia

Early decelerations are probably caused by: a. Decreased maternal-fetal exchange b. Umbilical cord occlusion c. Momentary increase in intracranial pressure due to head compression d. Compression of umbilical cord

c (Feedback a. Decreased maternal-fetal exchange results in late decelerations. b. Umbilical cord occlusion results in variable deceleration or bradycardia. c. Early decelerations are related to increased intracranial pressure due to head compression. d. Compression of the umbilical cord results in variable decelerations.)

A nurse is evaluating fetal heart rate (FHR) monitor results and notes a gradual decrease in FHR below the baseline, with the nadir (lowest point) occurring at the same time as the peak of the uterine contraction (UC). The onset, nadir, and recovery of this decrease mirror those of the UC of the mother. The nurse should recognize this FHR pattern as which of the following? a. Early deceleration b. Late deceleration c. Tachycardia d. Bradycardia

With regard to medications, herbs, shots, and other substances normally encountered by pregnant women, the maternity nurse should be aware that: A) Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. B) The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. C) Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. D) No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

A) Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy (Select all that apply)? A) Tetanus B) Diphtheria C) Chickenpox D) Rubella E) Hepatitis B

A) Tetanus B) Diphtheria E) Hepatitis B

The nurse is providing care for a 45-year-old patient who has just learned she is in the second trimester of pregnancy. The patient thought she was experiencing manifestations of menopause until she recognized fetal movement. Which diagnostic test does the nurse expect to be prescribed for this patient? 1. Amniocentesis 2. Ultrasonography 3. Daily fetal movement count 4. Chorionic villi sampling

ANS: 1 This is correct. Due to the age of the patient and the period of gestation, the nurse expects amniocentesis to be performed. The test is appropriate between 15 and 20 weeks of gestation and for detection of genetic disorders in mothers older than age 35 years.

A patient is in her first trimester of her second pregnancy. The patient's first child was born with a trisomy 21 defect. The patient is requesting testing to determine whether the current fetus has the same defect. Which initial testing does the nurse expect the HCP to prescribe? 1. Fetal ultrasound 2. Magnetic resonance imaging 3. Chorionic villa sampling 4. Amniocentesis

ANS: 1 This is correct. Fetal ultrasound in the first trimester of pregnancy can be performed for nuchal translucency, which measures the midsagittal plane with the neck of the fetus to assess the amount of fluid behind the neck. An elevated measurement is associated with trisomy 21. This is the initial test the nurse can expect; results may require further diagnostic testing.

A woman who is admitted to labor and delivery at 30 weeks' gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour? a. Temperature b. Pulse c. Respiratory rate d. Blood pressure

ANS: c The respiratory rate is the most important vital sign. Respiratory depression is a sign of magnesium toxicity.

The nurse is reviewing the purpose of a modified BPP for a patient at 38 weeks gestation. The nurse recognizes which determinations can be made through a modified BPP regarding fetal well-being? Select all that apply. 1. The NST is an indicator of short-term fetal well-being. 2. The test is normal if NST is considered to be nonreactive. 3. The test is considered most predictive for perinatal outcomes. 4. The AFI is an indicator of long-term placental function. 5. An AFI of 5 cm is indicative of fetal asphyxia

ANS: 1, 3, 4, 5 1 This is correct. The nurse recognizes the NST indicates short-term fetal well-being. 2 This is incorrect. The nurse recognizes that modified BPP is considered normal if the NST is noted to be reactive, not nonreactive. 3 This is correct. The nurse recognizes a modified BPP is considered to be the most predictive testing for perinatal outcomes; the test measures the two most sensitive indicators (NST and AFI) for fetal well-being. 4 This is correct. The nurse is aware a modified BPP uses the AFI to determine the long-term functionality of the placenta. 5 This is correct. The nurse understands oligohydramnios is associated with increased perinatal mortality, and decreased amniotic fluid may reflect acute or chronic fetal asphyxia. The finding is related to a decrease in renal output as blood is shifted away from the kidneys to other more vital organs in response to asphyxia. Normal AFI is greater than 5 cm.

The nurse is performing an NST along with a biophysical profile scoring (BPP) on a patient at 39 weeks gestation. The nurse determines the fetus has a nonreactive NST. The fetus has trunk or limb movement two times; is noted to be opening and closing hands; has a 45-second breathing episode; and has two 2-cm pockets of amniotic fluid. The nurse should assign a BPP score of ____________________/10

ANS: 6 The nurse assigns 2 points for tone, breathing, and amniotic fluid. Zero points are assigned for motion and NST results. The total score is 6/10

A woman you are caring for in labor requests an epidural for pain relief in labor. Included in your preparation for epidural placement is a baseline set of vital signs. The most common vital sign to change after epidural placement: a. Blood pressure, hypotension b. Blood pressure, hypertension c. Pulse, tachycardia d. Pulse, bradycardia

ANS: a Blood pressure, hypotension, as up to 40% of women may experience hypotension. Hypotension is defined as systolic BP <100 mm Hg or 20% decrease in BP from preanesthesia levels. Intravenous bolus is typically given to decrease the incidence of hypotension.

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that: A) Nonacceptance of the pregnancy very often equates to rejection of the child. B) Mood swings most likely are the result of worries about finances and a changed lifestyle as well as profound hormonal changes. C) Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers. D) Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth.

B) Mood swings most likely are the result of worries about finances and a changed lifestyle as well as profound hormonal changes.

A 3-year-old girls mother is 6 months pregnant. What concern is this child likely to verbalize? A) How the baby will get out B) What the baby will eat C) Whether her mother will die D) What color eyes the baby has

B) What the baby will eat

An expected change during pregnancy is a darkly pigmented vertical mid abdominal line. The nurse recognizes this alterations as: A: epulis B: linea nigra C: melasma D: striae gravidarum

B: linea nigra The linea nigra is a dark pigmented line from the fundus to the symphysis pubis. Epulis refers to gingival hypertrophy. Melasma is a different kind of dark pigmentation that occurs on the face. Striae gravidarum (stretch marks) are lines caused by lineal tears that occur in connective tissue during periods of rapid growth.

A nurse is determining the Apgar score of a newborn. The nurse observes that the newborn has slow, irregular respiratory effort, a heart rate of 90 beats per minute, some flexion of extremities, a grimace, and a pink body with blue extremities. Which Apgar score should the nurse report? a. 1 b. 3 c. 5 d. 7

While assisting a patient who is in active labor, the nurse assesses her uterine contractions and observes the following: the time from one contraction starting to the time the next one starts is about 4 minutes; the time from the beginning of a contraction to the end of the same contraction is about 40 seconds; and the uterine wall is resistant to indentation when the nurse presses on it with her thumb . How would the nurse sum up these observations? a. Frequency; 4 minutes; duration 40 seconds; intensity; moderate b. Frequency; 40 seconds; duration: 4 minutes: intensity: mild c. Frequency: 4 minutes; duration: 40 seconds; intensity: strong d. Frequency: 40 seconds; duration: 4 minutes; intensity: strong

A nurse monitoring fetal heart rate (FHR) finds the results to be Category I, normal. Which of the following should be true of the FHR tracings in such a finding? (Select all that apply.) a. Baseline rate of 110 to 160 beats per minute b. Baseline variability moderate c. Late or variable deceleration absent d. Early decelerations presente. Sinusoidal pattern

a,b,c,d

A nurse is using a fetoscope to externally listen to fetal heart rate (FHR) without the use of a paper recorder. The nurse is using which of the following types of fetal and uterine monitoring? a. Auscultation b. Palpation c. External electronic fetal and uterine monitoring d. Internal electronic fetal and uterine monitoring

a. Auscultation

A nurse is placing her fingertips on the fundus of the uterus of a patient who is in labor and assessing the degree of tension as the contractions occur. The nurse is using which of the following types of fetal and uterine monitoring? a. Auscultation b. Palpation c. External electronic fetal and uterine monitoring d. Internal electronic fetal and uterine monitoring

A nurse is working with a patient from Pakistan who is in her third trimester and is experiencing a high-risk pregnancy. Which of the following approaches should the nurse take in caring for this patient? a. Take precisely the same approach the nurse would take with any other client b. Use the beliefs, values, customs, and expectations of the woman to shape her plan of care c. Avoid using nonverbal communication d. Base care on the understanding that the woman's needs are the same as those of other Pakistani women the nurse has worked with

Prenatal testing for human immunodeficiency virus (HIV) is recommended for: A) All women, regardless of risk factors. B) A woman who has had more than one sexual partner. C) A woman who has had a sexually transmitted infection. D) A woman who is monogamous with her partner.

A) All women, regardless of risk factors.

While teaching the expectant mother about personal hygiene during pregnancy, maternity nurses should be aware that: A) Tub bathing is permitted even in late pregnancy unless membranes have ruptured. B) The perineum should be wiped from back to front. C) Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath. D) Expectant mothers should use specially treated soap to cleanse the nipples.

A) Tub bathing is permitted even in late pregnancy unless membranes have ruptured.

The nurse is assisting a patient who is pregnant to prepare for an MRI scheduled to assess fetal brain development. Which situation causes the nurse to notify the radiology department personnel? 1. The patient had breakfast before the test. 2. The patient reports having an iodine allergy. 3. The patient expresses concern about pain. 4. The patient has a permanent body piercing.

ANS: 4 This is correct. Part of the preparation for an MRI is to have the patient remove all metallic objects before the testing. The fact that the patient has a permanent body piercing will present a problem. The nurse needs to notify the radiology department for the situation.

A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following? a. High leukocyte count b. Explosive diarrhea c. Fractured pelvis d. Low platelet count

ANS: d Low platelet count is one of the signs associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

Which of the following fetal heart rate (FHR) patterns is represented in the recording in Figure 9-8(The FHR here is about 90 bpm)? a. Normal FHR b. Fetal tachycardia c. Fetal bradycardia d. Marked variability

The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the: A) Mother of the pregnant woman B) Couple's teenage daughter C) Sister of the pregnant woman D) Expectant father

D) Expectant father

True or false: The uterine nervous system allows for use of epidural anesthesia without inhibiting motor function because motor function is derived from the 7th and 8th thoracic vertebrae nerves whereas pain signals are sent along the 11th and 12 thoracic nerve1 1. True2. False

True

____________________ stimulation may be effective in eliciting a change in fetal behavior, fetal startle movements, and increased FHR variability

Vibroacoustic Vibroacoustic stimulation (VAS) is a screening tool that uses auditory stimulation (with an artificial larynx) to assess fetal well-being with EFM when NST is nonreactive. VAS is only used when the baseline rate is determined to be within normal limits. When deceleration or bradycardia is present, VAS is not an appropriate intervention

Nursing interventions related to late decelerations include all of the following except: A. Initiate pitocin induction B. Initiate IV bolus C. Change maternal position D. Initiate oxygen therap

A. Initiate pitocin induction

Chapter 6- Antepartal Tests

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In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the __________ of labor. a. Passenger b. Passage c. Powers d. Psyche

ANS: c Powers refer to the contractions.

During labor and delivery, the fetus passes through the birth canal and must make several movements to allow for successful delivery. Place the following cardinal movements for birth into the correct order. 1. Descent 2. Expulsion 3. Extension 4. Flexion 5. External rotation 6. Engagement 7. Internal rotation

6, 1, 4, 7, 3, 5, 2

A nurse performs effleurage on a laboring patient to help distract her from her pain. This intervention is an example of which type of pain management? a. Cutaneous stimulation b. Thermal stimulation c. Mental stimulation d. Social stimulation

Assessment for risk factors includes: A. Cultural Factors B. Medical and Obstetrical issues C. Religion D. Sexual Preference

B. Medical and Obstetrical issues

A patient is in the first stage of labor. Which position should the nurse encourage the patient to assume to increase the pelvic outlet and aid the descent of the fetus? a. Lithotomy b. Upright c. Supine d. Prone

As relates to the fathers acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that: A) The father goes through three phases of acceptance of his own. B) The fathers attachment to the fetus cannot be as strong as that of the mother because it does notstart until after birth. C) In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of theirestablished lifestyle and resist making changes to the home. D) Typically men remain ambivalent about fatherhood right up to the birth of their child.

A) The father goes through three phases of acceptance of his own.

You are in the process of admitting a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 4/70/0. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to: a. Reassure the patient and rapidly complete the admission. b. Assist your patient to the bathroom to have a bowel movement. c. Assess the fetal heart rate and uterine contractions. d. Perform a vaginal exam.

ANS: d Perform a vaginal exam to assess the progress of labor. The urge to have a bowel movement and feeling like pushing indicate that birth may be imminent.

A FHR that increases 15 beats above baseline for 15 seconds twice in 20 minutes is considered: A. Category III B. Reactive C. Nonreactive D. Negative

B. Reactive

You are caring for a woman in labor who is 6 cm dilated with a reassuring FHT pattern and regular strong UCs. The fetal heart rate (FHR) should be: a. Monitored continuously b. Monitored every 15 minutes c. Monitored every 30 minutes d. Monitored every 60 minutes

ANS: c Assessment of fetal heart rate (FHR) during the active phase of labor with a reassuring FHR is indicated every 30 minutes.

A primiparous woman has been admitted at 35 weeks' gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis? a. Hematocrit dropped to 28%. b. Platelets increased to 300,000 cells/mm3. c. Red blood cells increased to 5.1 million cells/mm3. d. Sodium dropped to 132 mEq/dL.

ANS: a The nurse would expect to see a drop in the hematocrit: The H in HELLP stands for hemolysis.

A woman entering the second stage of labor reports that she feels the urge to bear down. The nurse recognizes that this phenomenon is known as which of the following? a. Ferguson's reflex b. Valsalva technique c. Lightening d. Braxton-Hicks contraction

A woman in labor is dilated 2 cm, effaced 30%, and has contractions that occur every 7 minutes and last 35 seconds. She describes the contractions as feeling like "bad cramps" but is still talkative and able to relax. The nurse recognizes that this woman is in which phase of the first stage of labor? a. Latent phase b. Active phase c. Transitional phase d. Expulsive phase

Which of the following fetal heart rate (FHR) patterns is represented in the recording in Figure 9-13(visually abrupt, transient increases-onset to peak less than 30 seconds-in the FHR above the baseline)? a. Accelerations b. Early decelerations c. Variable decelerations d. Late decelerations

The nurse should be aware that the partners main role in pregnancy is to: A) Provide financial support. B) Protect the pregnant woman from old wives tales. C) Support and nurture the pregnant woman. D) Make sure the pregnant woman keeps prenatal appointments.

C) Support and nurture the pregnant woman.

What is the uppermost portion of the uterus called?1. Cornua 2. Fundus 3. Isthmus 4. Cervix

Which hormone allows for the maintenance of the uterine lining and the continuation of pregnancy?1. Luteinizing hormone 2. Progesterone 3. Estrogen 4. Human chorionic gonadotropin

Which hormone is responsible for the increase of progesterone, and the release of the mature follicle? 1. Human chorionic gonadotropin 2. Luteinizing hormone 3. Prostaglandin 4. Estrogen

Umbilical artery doppler flow can replace which antepartal test? A. Amniocentesis B. Chorionic villus sampling C. Multiple marker screen D. Delta OD 450

D. Delta OD 450

A woman in labor is dilated 9 cm, effaced 100%, and has contractions that occur almost every minute and last 90 seconds. She is exhausted and has trouble concentrating. The nurse recognizes that this woman is in which phase of the first stage of labor? a. Latent phase b. Active phase c. Transitional phase d. Expulsive phase

A low-risk patient calls the labor unit and says "I need to come in to be checked right now, there were pink streaks on the toilet paper when I went to the bathroom. I think I'm bleeding." What response should the nurse say first? a. "How much blood is there?" b. "You sound concerned, what other labor symptoms do you have? c. "Don't worry that sounds like a mucus plug." d. "Does it burn when you urinate?"

ANS: b The nurse is using reflection to acknowledge the woman's concerns and asks for further assessment. The woman's fear must first be acknowledged and then other questions or comments can be made.

Fetal heart rate should be assess in a low risk woman in active labor: A. Every 5 minutes B. Every 10 minutes C. Every 15 minutes D. Every 30 minutes

D. Every 30 minutes

A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following findings? a. Patellar and biceps reflexes of +4 b. Urinary output of 50 mL/hr c. Respiratory rate of 10 rpm d. Serum magnesium level of 5 mg/dL

ANS: c The drop in respiratory rate may indicate that the patient is suffering from magnesium toxicity. The nurse should report the finding to the physician.

A woman who has had no prenatal care was assessed and found to have hydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings? a. Pyelonephritis b. Pregnancy-induced hypertension c. Gestational diabetes d. Abruptio placentae

ANS: c Untreated gestational diabetics often have hydramnios and often deliver macrosomic babies.

Which of the following indicates a Category I fetal heart rate? A. Baseline rate of 170bpm, decreased variability, no fetal heart rate decelerations. B. Baseline rate of 150bpm, moderate variability, accelerations to 170bpm for 20 seconds. C. Baseline rate of 150bmp, decreased variability, no fetal heart rate deceleration. D. Baseline rate of 130bpm, average variability, decreases after uterine contractions.

B. Baseline rate of 150bpm (within 110-160), moderate variability (normal), and accelerations show well-oxygenation.

A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner? a. Presence of chloasma b. Presence of severe heartburn c. 10-pound weight gain in a month d. Patellar reflexes +1

ANS: c The weight gain may be due to fluid retention. Fluid retention may occur in patients with pregnancy-induced hypertension and in patients with congestive heart failure. The physician should be notified.

A woman is considered in active labor when: a. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. b. Cervical dilation progresses to 3 cm with effacement of 30, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. c. Cervical dilation progresses to 8 cm with effacement of 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds. d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds

ANS: a Characteristics of this phase are the cervix dilates, on an average, 1.2 cm/hr for primiparous women and 1.5 cm/hr for multiparous women. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%. Fetal descent continues and contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds, and discomfort increases.

The clinic nurse meets with Rebecca, a 30-year-old woman who is experiencing her first pregnancy. Rebecca's quadruple marker screen result is positive at 17 weeks' gestation. The nurse explains that Rebecca needs a referral to: a. A genetics counselor/specialist b. An obstetrician c. A gynecologist d. A social worker

ANS: a Feedback a. All women should be offered screening with maternal serum markers. The Triple Marker screen and the Quadruple Marker screen test for the presence of alpha-fetoprotein (AFP), estradiol, human chorionic gonadotropin (hCG), and other markers. These tests screen for potential neural tube defects, Down syndrome, and Trisomy 18. If the screen is positive, the woman should be referred to a genetics specialist for counseling, and further testing, such as chorionic villus sampling (CVS) or amniocentesis, should be performed. b. If genetic screening is positive, the woman should be referred to a genetics specialist for counseling, and further testing, such as chorionic villus sampling (CVS) or amniocentesis, should be performed. c. If genetic screening is positive, the woman should be referred to a genetics specialist for counseling, and further testing, such as chorionic villus sampling (CVS) or amniocentesis, should be performed. d. If genetic screening is positive, the woman should be referred to a genetics specialist for counseling, and further testing, such as chorionic villus sampling (CVS) or amniocentesis, should be performed.

Mrs. H is telling you she feels the urge to push. This is most likely caused by what?a. Low fetal station triggering the Ferguson reflex b. A fetal position of occiput posterior (OP) c. The second stage of labor d. Transition phase

ANS: a Once the cervix is fully dilated and the vertex is low in the pelvis and the woman feels the urge to push, she will involuntarily bear down. This is activated when the presenting part as it descends stretches the pelvic floor muscles and triggers the Ferguson reflex.

The provision of support during labor has demonstrated that women experience a decrease in anxiety and a feeling of being in more control. In clinical situations, this has resulted in:a. A decrease in interventions b. Increased epidural rates c. Earlier admission to the hospital d. Improved gestational age

ANS: a Studies have shown that with a support person, be it a family member, friend, or professional such as a Doula or nurse, the patient experiences a decrease in anxiety and has a feeling of being in more control. This, in turn, results in a decrease in interventions, a significantly lower level of pain, and an enhanced overall maternal satisfaction.

The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include (select all that apply): a. Cocaine use b. Tobacco use c. Previous caesarean birth d. Previous use of medroxyprogesterone (Depo-Provera)

ANS: a, b, c Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years.Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years.Placenta previa may be associated with conditions that cause scarring of the uterus such as a prior cesarean section, multiparity, or increased maternal age.

The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes (select all that apply): a. Encouraging regular, ongoing prenatal care b. Reporting symptoms of urinary frequency and burning to the health-care provider c. Coming to the labor triage unit if back pain or cramping persist or become regular d. Lying on the right side, withholding fluids, and counting fetal movements if contractions occur every 5 minutes

ANS: a, b, c The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur.Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur.Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider if symptoms of preterm labor occur.

The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes. These risks include (select all that apply): a. Chorioamnionitis b. Abruptio placentae c. Operative birth d. Cord prolapse

ANS: a, b, d Even though maintaining the pregnancy to gain further fetal maturity can be beneficial, prolonged PPROM has been correlated with an increased risk of chorioamnionitis, placental abruption, and cord prolapse.

Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks' gestation. An appropriate nursing action would be to (select all that apply): a. Assess the fetal heart rate b. Obtain urine for culture and sensitivity c. Assess Kerry's blood pressure and pulse d. Palpate Kerry's abdomen for contractions

ANS: a, b, d Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patient's abdomen should be palpated to assess for contractions, and the fetus's heart rate should be monitored.Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. A urinalysis and urine culture and sensitivity (C & S) should be obtained on all patients who present with signs of preterm labor, and the nurse must remember that signs of UTI often mimic normal pregnancy complaints (i.e., urgency, frequency). The patient's abdomen should be palpated to assess for contractions, and the fetus's heart rate should be monitored.Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patient's abdomen should be palpated to assess for contractions, and the fetus's heart rate should be monitored.

The ____________________ in conjunction with NST is a strong indicator of fetal status, as it is accurate in detecting fetal hypoxia

ANS: amniotic fluid index The amniotic fluid level is based on fetal urine production, which is the predominate source of amniotic fluid and is directly dependent on renal perfusion. In prolonged fetal hypoxemia, blood is shunted away from fetal kidneys to other vital organs. Persistent decreased blood flow to the fetal kidneys results in reduction of amniotic fluid production and oligohydramnios. The volume of amniotic fluid is measured using ultrasound.

The mechanism of labor known as cardinal movements of labor are the positional changes that the fetus goes through to best navigate the birth process. These cardinal movements are: a. Engagement, Descent, Flexion, Extension, Internal rotation, External rotation, Expulsion b. Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion c. Engagement, Flexion, Internal rotation, Extension, External rotation, Descent, Expulsion d. Engagement, Flexion, Internal rotation, Extension, External rotation, Flexion, Expulsion

ANS: b Engagement occurs when the greatest diameter of the fetal head passes through the pelvic inlet. Engagement can occur late in pregnancy or early in labor. Descent is the movement of the fetus through the birth canal during the first and second stages of labor. Flexion is when the chin of the fetus moves toward the fetal chest. Flexion occurs when the descending head meets resistance from maternal tissues. This movement results in the smallest fetal diameter to the maternal pelvic dimensions. It typically occurs early in labor. Internal rotation is the movement, the rotation of the fetal head, that aligns the long axis of the fetal head with the long axis of the maternal pelvis. It occurs mainly during the second stage of labor. Extension is the movement facilitated by resistance of the pelvic floor, causing the presenting part to pivot beneath the pubic symphysis and the head to be delivered. This occurs during the second stage of labor. External rotation is when the sagittal suture moves to a transverse diameter and the shoulders align in the anteroposterior diameter. The sagittal suture maintains alignment with the fetal trunk as the trunk navigates through the pelvis. Expulsion is the movement that occurs when the shoulders and remainder of the body are delivered.

Your pregnant patient is having maternal alpha-fetoprotein (AFP) screening. She does not understand how a test on her blood can indicate a birth defect in the fetus. The best reply by the nurse is: a. "We have done this test for a long time." b. "If babies have a neural tube defect, alpha-fetoprotein leaks out of the fetus and is absorbed into your blood, causing your level to rise. This serum blood test detects that rise." c. "Neural tube defects are a genetic anomaly, and we examine the amount of alpha-fetoprotein in your DNA." d. "If babies have a neural tube defect, this results in a decrease in your level of alpha-fetoprotein."

ANS: b Feedback a. This response does not explain AFP screening. b. When a neural tube defect is present, AFP is absorbed in the maternal circulation, resulting in a rise in the maternal AFP level. c. AFP testing is not related to DNA. d. Fetal neural tube defects result in an increase in maternal AFP.

A woman at 10 weeks' gestation is diagnosed with gestational trophoblastic disease (hydatidiform mole). Which of the following findings would the nurse expect to see? a. Platelet count of 550,000/mm3 b. Dark brown vaginal bleeding c. White blood cell count 17,000/mm3 d. Macular papular rash

ANS: b The nurse would expect to see dark brown vaginal discharge.

A labor nurse is caring for a patient, 39 weeks' gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question? a. Type and cross-match her blood. b. Insert an internal fetal monitor electrode. c. Administer an oral stool softener. d. Assess her complete blood count.

ANS: b This action is inappropriate. When a patient has a placenta previa, nothing should be inserted into the vagina.

Ms. M is 38 weeks' gestation and is a G1 P0. At 10 pm Ms. M has just been informed by the nurse that she is 3 to 4 cm dilated, cervix is 100% effaced, and contractions are every 4 to 5 minutes. When the nurse tells her the findings from the SVE, Ms. M states that she had been contracting since early that morning and she becomes extremely frustrated stating "I should have had this baby by now." What is the best response by the nurse? a. Remind her that length of labor for the first child can be 18 to 24 hours b. Promote relaxation techniques c. Discuss various analgesic options d. Tell Ms. M that the provider will be contacted immediately about the slow progress of labor

ANS: b Women in the latent phase of labor may be frustrated with lack of progress or slow progress of labor and desire companionship and encouragement. The other responses are inappropriate. The nurse should first encourage breathing and relaxation methods as well as provide reassurance, and then contact the provider.

Your pregnant patient is in her first trimester and is scheduled for an abdominal ultrasouterm-8nd. When explaining the rationale for early pregnancy ultrasound, the best response is: a. "The test will help to determine the baby's position." b. "The test will help to determine how many weeks you are pregnant." c. "The test will help to determine if your baby is growing appropriately." d. "The test will help to determine if you have a boy or girl."

ANS: b a. Fetal position during pregnancy changes, and position in the first trimester is not indicative of position later in pregnancy. b. Fetal growth and size are fairly consistent during the first trimester and are a reliable indicator of the weeks of gestation. c. Fetal growth is best assessed later in pregnancy. d. The primary rationale for ultrasounds is not to determine gender.

t would be most important for a nurse caring for a mother and the infant in the fourth stage of labor to do which of the following? a. Assess and massage the fundus every 15 minutes or more often if needed b. Massage the uterus continuously c. Administer oxytocin per protocol d. Assess the patient for a distended bladder a.A, c b.A, c, d c.C, d d.all of the above

ANS: b A, C, D The fourth stage of labor immediately follows the delivery of the placenta. The nurse should be assessing the fundus every 15 minutes for position, tone, and location. The provider may order oxytocin at this stage, and the nurse should assist the woman to the bathroom if she has a distended bladder which could interfere with the contraction of the uterus.

The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4/70/-1 station. She tells you she has fluid running down her leg. Your priority nursing intervention is to: a. Assess the color, odor, and amount of fluid. b. Assist your patient to the bathroom. c. Assess the fetal heart rate. d. Call the care provider.

ANS: c Assessing the fetal heart rate is the first priority because of the risk of umbilical cord prolapse with rupture of membranes.

The perinatal nurse knows that tocolytic agents are most often used to (select all that apply): a. Prevent maternal infection b. Prolong pregnancy to 40 weeks' gestation c. Prolong pregnancy to facilitate administration of antenatal corticosteroids d. Allow for transport of the woman to a tertiary care facility

ANS: c, d Presently, it is believed that the best reason to use tocolytic drugs is to allow an opportunity to begin the administration of antenatal corticosteroids to accelerate fetal lung maturity.Delaying the birth provides time for maternal transport to a facility equipped with a neonatal intensive care unit.

The nurse is caring for a woman at 28 weeks' gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis? a. Human relaxin levels b. Amniotic fluid levels c. Alpha-fetoprotein levels d. Fetal fibronectin levels

ANS: d A rise in the fetal fibronectin levels in cervical secretions has been associated with preterm labor.

The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: a. Preterm labor b. Term labor c. Back labor d. Braxton-Hicks contractions

ANS: d Braxton-Hicks contractions are regular contractions occurring after the third month of pregnancy. They may be mistaken for regular labor, but unlike true labor, the contractions do not grow consistently longer, stronger, and closer together, and the cervix is not dilated. Some patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor.

A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? a. Serum potassium level increases b. Diarrhea c. Urticaria d. Complaints of nervousness

ANS: d Complaints of nervousness are commonly made by women receiving subcutaneous beta agonists.

Ms. P has delivered her first baby 30 minutes ago and the placenta delivered 15 minutes ago. She is attempting to breastfeed her newborn daughter for the first time. Which action by the nurse would NOT be appropriate? a. The nurse is checking the BP every 15 minutes b. The nurse is massaging the fundus vigorously c. The nurse is auscultating the infant's heart and lungs while on the mother's chest d. The nurse is leaving the patient unattended for 30 minutes to bond with her newborn

ANS: d During the fourth stage of labor the mothers should not be left unattended as maternal bleeding needs to be closely monitored.

The primary complications of amniocentesis are: a. Damage to fetal organs b. Puncture of umbilical cord c. Maternal pain d. Infection

ANS: d Feedback a. Amniocentesis is done under ultrasound guidance, and damage to fetal organs is very rare. b. Amniocentesis is done under ultrasound guidance, and damage to the umbilical cord is very rare. c. Amniocentesis is done under local anesthesia, and maternal pain is generally minimal. d. Amniocentesis involves insertion of a needle into the amniotic sac, and infection is the primary complication.

A 37-year-old woman who is 17 weeks pregnant has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences which of the following side effects? a. Pain at the puncture site b. Macular rash on the abdomen c. Decrease in urinary output d. Cramping of the uterus

ANS: d Feedback a. It is normal for the patient to experience pain at the puncture site. b. A rash is not an expected complication. c. Oliguria is not an expected complication. d. The woman should report any uterine cramping. Although rare, amniocentesis could stimulate preterm labor.

Your patient is 34 weeks pregnant and during a regular prenatal visit tells you she does not understand how to do "kick counts." The best response by the nurse would be to explain: a. "Here is an information sheet on how to do kick counts." b. "It is not important to do kick counts because you have a low-risk pregnancy." c. "Fetal kick counts are not a reliable indicator of fetal well-being in the third trimester." d. "Fetal movements are an indicator of fetal well-being. You should count twice a day, and you should feel 10 fetal movements in 2 hours."

ANS: d Feedback a. Providing written information may not be enough, and the patient may need a verbal explanation. b. Kick counts are indicated for all pregnancies. c. Kick counts are a reliable indicator of fetal well-being after 32 to 34 weeks' gestation. d. This response provides the patient with information on how to do kick counts and the rationale for doing kick counts and criteria for normal fetal movement.

Your patient is a 37-year-old pregnant woman who is 5 weeks pregnant and is considering genetic testing. During your discussion, the woman asks the nurse what the advantages of chorionic villus sampling (CVS) are over amniocentesis. The best response is: a. "You will need anesthesia for amniocentesis, but not for CVS." b. "CVS is a faster procedure." c. "CVS provides more detailed information than amniocentesis." d. "CVS can be done earlier in your pregnancy, and the results are available more quickly."

ANS: d Feedbacka. Anesthesia is not done for either procedure. b. The length of time for either procedure is similar. c. Both amniocentesis and CVS provide the same information. d. CVS can be done earlier in gestation.

Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa? a. "During the second stage of labor you will need to bear down." b. "You should ambulate in the halls at least twice each day." c. "The doctor will likely induce your labor with oxytocin." d. "Please promptly report if you experience any bleeding or feel any back discomfort."

ANS: d Labor often begins with back pain. Labor is contraindicated for a patient with complete placenta

The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? a. The patient with placenta previa b. The patient whose vagina is colonized with group B streptococci c. The patient who is hepatitis B surface antigen positive d. The patient with eclampsia

ANS: d Patients with eclampsia are high risk for placental abruption.

The Apgar score consists of a rapid assessment of five physiological signs that indicate the physiological status of the newborn and includes: a. Apical pulse strength, respiratory rate, muscle flexion, reflex irritability, and color b. Heart rate, clarity of lungs, muscle tone, reflexes, and color c. Apical pulse strength, respiratory rate, muscle tone, reflex irritability, and color of extremities d. Heart rate, respiratory rate, muscle tone, reflex irritability, and color

ANS: d The Apgar score includes assessment of heart rate based on auscultation, respiratory rate based on observed movement of chest, muscle tone based on degree of flexion and movement of extremities, reflex irritability based on response to tactile stimulation, and color based on observation.

The perinatal nurse knows that the term to describe a woman at 26 weeks' gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is: a. Preeclampsia b. Chronic hypertension c. Gestational hypertension d. Chronic hypertension with superimposed preeclampsia

ANS: d The following criteria are necessary to establish a diagnosis of superimposed preeclampsia: hypertension and no proteinuria early in pregnancy (prior to 20 weeks' gestation) and new-onset proteinuria, a sudden increase in protein—urinary excretion of 0.3 g protein or more in a 24-hour specimen, or two dipstick test results of 2+ (100 mg/dL), with the values recorded at least 4 hours apart, with no evidence of urinary tract infection; a sudden increase in blood pressure in a woman whose blood pressure has been well controlled; thrombocytopenia (platelet count lower than 100,000/mmC); and an increase in the liver enzymes alanine transaminase (ALT) or aspartate transaminase (AST) to abnormal levels.

According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia: a. Take the patient's blood pressure every 6 hours b. Encourage the patient to rest on her back c. Notify the physician of urine output greater than 30 mL/hr d. Administer magnesium sulfate according to agency policy

ANS: d The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion.

When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is: a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact. b. True labor contractions result in increasing anxiety and discomfort, and false labor does not. c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

ANS: d True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see? a. Postpartum hemorrhage b. Neonatal hyperglycemia c. Postpartum oliguria d. Neonatal macrosomia

ANS: d The nurse would expect to see neonatal macrosomia.

The perinatal nurse assists the nursing student who is preparing the patient with oligohydramnios for a fluid infusion into the uterine cavity. This procedure is described as a(n) __________.

Amnioinfusion (Pregnancy outcome in patients experiencing variable fetal heart rate decelerations caused by cord compression is improved through the use of amnioinfusion, which is the instillation of normal saline or lactated Ringer's solution into the uterine cavity.)

During the first trimester, a woman can expect which of the following changes in her sexual desire? A) An increase, because of enlarging breasts B) A decrease, because of nausea and fatigue C) No change D) An increase, because of increased levels of female hormones

B) A decrease, because of nausea and fatigue

The nurse caring for a newly pregnant woman would advise her that ideally prenatal care should begin: A) Before the first missed menstrual period. B) After the first missed menstrual period. C) After the second missed menstrual period. D) After the third missed menstrual period.

B) After the first missed menstrual period.

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: A) Constipation. B) Alteration in the pattern of fetal movement. C) Heart palpitations. D) Edema in the ankles and feet at the end of the day.

B) Alteration in the pattern of fetal movement.

The nurse should have knowledge of the purpose of the pinch test. It is used to: A) Check the sensitivity of the nipples. B) Determine whether the nipple is everted or inverted. C) Calculate the adipose buildup in the abdomen. D) See whether the fetus has become inactive.

B) Determine whether the nipple is everted or inverted.

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she: A) Do Kegel exercises B) Do pelvic rock exercises C) Use a softer mattress D) Stay in bed for 24 hours

B) Do pelvic rock exercises

With regard to the initial physical examination of a woman beginning prenatal care, maternity nursesshould be cognizant of: A) Only women who show physical signs or meet the sociologic profile should be assessed forphysical abuse. B) The woman should empty her bladder before the pelvic examination is performed. C) The distribution, amount, and quality of body hair are of no particular importance. D) The size of the uterus is discounted in the initial examination.

B) The woman should empty her bladder before the pelvic examination is performed.

Which statement about multifetal pregnancy is inaccurate? A) The expectant mother often develops anemia because the fetuses have a greater demand for iron. B) Twin pregnancies come to term with the same frequency as single pregnancies. C) The mother should be counseled to increase her nutritional intake and gain more weight. D) Backache and varicose veins often are more pronounced.

B) Twin pregnancies come to term with the same frequency as single pregnancies.

A client who is at 8 weeks of gestation tells the nurse "I am not sure I am happy about being pregnant." Which of the following responses should the nurse make? A: "I will inform the provider that you are having these feelings" B: "It is normal to have these feelings during the first few months of pregnancy" C: "You should be happy that you are going to bring new life into the world" D: "I am going to make an appointment with the counselor for you to discuss these thoughts"

B: "It is normal to have these feelings during the first few months of pregnancy" Feelings of ambivalence about pregnancy are normal during the first trimester.

A patient in her first trimester complains of nausea and vomiting. The patient asks, "Why is this happening?" What is the nurse's best response? A: "It is due to an increase in gastric motility." B: "It may be due to changes in hormones." C: "It is related to an increase in glucose levels." D: "It is caused by a decrease in gastric secretions."

B: "It may be due to changes in hormones." Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Gastric secretions decrease, but this is not the main cause of nausea and vomiting.

A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." Which is the nurse's best response? A: "Your baby is doing fine." B: "Tell me about your concerns." C: "There is nothing to worry about." D: "The doctor is taking good care of you and your baby."

B: "Tell me about your concerns." Encouraging the patient to discuss her feelings is the best approach. The nurse should not disregard or belittle the patient's feelings. Responding that your baby is doing fine disregards the patient's feelings and treats them as unimportant. Responding that there is nothing to worry about does not answer the patient's concerns. Saying that the doctor is taking good care of you and your baby is belittling the patient's concerns.

Which physiologic finding is consistent with normal pregnancy? A: systemic vascular resistance increases as blood pressure decreases B: cardiac output increases during pregnancy C: blood pressure remains consistent independent of position changes D: maternal vasoconstriction occurs in response to increased metabolism

B: cardiac output increases during pregnancy Cardiac output increases during pregnancy as a result of increased stroke volume and heart rate. Systemic vascular resistance decreases while blood pressure remains the same. Maternal blood pressure changes in response to patient positioning. In response to increased metabolism, maternal vasodilation is seen during pregnancy.

A patient with a fever is in the active phase of the first stage of labor. According to the Association of women's Health Obstetric and Neonatal Nurses (AWHONN), standards for frequency of assessment of fetal heart rate (FHR), the nurse should perform FHR monitoring in which of the following ways for this patient? a. Intermittent auscultation every hour b. Intermittent auscultation every 5 to 30 minutes c. Continuous electronic fetal monitoring d. Intermittent electronic monitoring every 30 minutes

With regard to follow-up visits for women receiving prenatal care, nurses should be aware that: A) The interview portions become more intensive as the visits become more frequent over the courseof the pregnancy. B) Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, andweekly for the third trimester. C) During the abdominal examination, the nurse should be alert for supine hypotension. D) For pregnant women, a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient tobe considered hypertensive.

C) During the abdominal examination, the nurse should be alert for supine hypotension.

In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement would accurately apply to the centering model of care? A) Group sessions begin with the first prenatal visit. B) At each visit, blood pressure, weight, and urine dipsticks are obtained by the nurse. C) Eight to 12 women are placed in gestational-age cohort groups. D) Outcomes are similar to those of traditional prenatal care.

C) Eight to 12 women are placed in gestational-age cohort groups.

To provide the patient with accurate information about dental care during pregnancy, maternity nurses should be aware that: A) Dental care can be dropped from the priority list because the woman has enough to worry aboutand is getting a lot of calcium anyway. B) Dental surgery, in particular, is contraindicated because of the psychologic stress it engenders. C) If dental treatment is necessary, the woman will be most comfortable with it in the second trimester. D) Dental care interferes with the expectant mothers need to practice conscious relaxation.

C) If dental treatment is necessary, the woman will be most comfortable with it in the second trimester.

With regard to the initial visit with a client who is beginning prenatal care, nurses should be aware that: A) The first interview is a relaxed, get-acquainted affair in which nurses gather some generalimpressions. B) If nurses observe handicapping conditions, they should be sensitive and not inquire about thembecause the client will do that in her own time. C) Nurses should be alert to the appearance of potential parenting problems, such as depression or lack of family support. D) Because of legal complications, nurses should not ask about illegal drug use; that is left to physicians.

C) Nurses should be alert to the appearance of potential parenting problems, such as depression or lack of family support.

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: A) You don't need to modify your exercising any time during your pregnancy. B) Stop exercising because it will harm the fetus. C) You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month. D) Jogging is too hard on your joints; switch to walking now.

C) You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.

A pregnant woman complains of frequent heartburn. The patient states that she has never had these symptoms before and wonders why this is happening now. The most appropriate response by the nurse is to: A: examine her dietary intake pattern and tell her to avoid certain foods B: tell her that this is a normal finding during early pregnancy and will resolve as she gets closer to term C: explain to the patient that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms D: refer her to her health care provider for additional testing because this is an abnormal finding

C: explain to the patient that physiologic changes caused by the pregnancy make her more likely to experience these types of symptoms The presentation of heartburn is a normal abnormal finding that can occur in pregnant woman because of relaxation of the lower esophageal sphincter as a result of the physiologic effects of pregnancy. Although foods may contribute to the heartburn, the patient is asking why this presentation is occurring, so the nurse should address the cause first. It is independent of gestation. There is no need to refer to the physician at this time because this is a normal abnormal finding. There is no evidence of complications ensuing from this presentation.

During vital sign assessment of a pregnant patient in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is most appropriate? A: have the patient stand up and retake her blood pressure B: have the patient sit down and hold her arm in a dependent position C: have the patient turn to her left side and recheck her blood pressure in 5 minutes D: have the patient lie supine for 5 minutes and recheck her blood pressure on botharms

C: have the patient turn to her left side and recheck her blood pressure in 5 minutes Blood pressure is affected by positioning during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the patient is standing. This would cause an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her: A) Since you're in your second trimester, there's no problem with having one drink with dinner. B) One drink every night is too much. One drink three times a week should be fine. C) Since you're in your second trimester, you can drink as much as you like. D) Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.

D) Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.

What represents a typical progression through the phases of a woman's establishing a relationship with the fetus? A) Accepts the fetus as distinct from herself accepts the biologic fact of pregnancy has a feeling ofcaring and responsibility B) Fantasizes about the child's gender and personality views the child as part of herself becomes introspective C) Views the child as part of herself has feelings of well-being accepts the biologic fact of pregnancy D) I am pregnant.I am going to have a baby.I am going to be a mother.

D) I am pregnant.I am going to have a baby.I am going to be a mother.

When discussing work and travel during pregnancy with a pregnant patient, nurses should instruct themthat: A) Women should sit for as long as possible and cross their legs at the knees from time to time for exercise. B) Women should avoid seat belts and shoulder restraints in the car because they press on the fetus. C) Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. D) While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so.

D) While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so.

Daily fetal movement counts are done" A. only in high-risk pregnancies B. By care providers during prenatal visits C. As soon as the pregnancy is confirmed D. To identify potentially hypoxic fetuses

D. To identify potentially hypoxic fetuses

The patient has just learned that she is pregnant and overhears the gynecologist saying that she has a positive Chadwick's sign. When the patient asks the nurse what this means, how would the nurse respond? A: "Chadwick's sign signifies an increased risk of blood clots in pregnant women because of a congestion of blood." B: "That sign means the cervix has softened as the result of tissue changes that naturally occur with pregnancy." C: "This means that a mucus plug has formed in the cervical canal to help protect you from uterine infection." D: "This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix."

D: "This sign occurs normally in pregnancy, when estrogen causes increased blood flow in the area of the cervix." Increasing levels of estrogen cause hyperemia (congestion with blood) of the cervix, resulting in the characteristic bluish purple color that extends to include the vagina and labia. This discoloration, referred to as Chadwick's sign, is one of the earliest signs of pregnancy. Although Chadwick's sign occurs with hyperemia (congestion with blood), the sign does notsignify an increased risk of blood clots. The softening of the cervix is called Goodell's sign, not Chadwick's sign. Although the formation of a mucus plug protects from infection, it is not called Chadwick's sign.

Which physiologic adaptation of pregnancy may lead to increased constipation during the pregnancy? A: increased emptying time in the intestines B: abdominal distention and bloating C: decreased absorption of water D: decreased motility in the intestines

D: decreased motility in the intestines Decreased motility in the intestines leading to increased water absorption would cause constipation. Increased emptying time in the intestines leads to increased nutrient absorption. Abdominal distention and bloating are a result of increased emptying time in the intestines. Decreased absorption of water would not cause constipation.

A patient reports to the clinic nurse that she has not had a period in over 12 weeks, she is tired, and her breasts are sore all of the time. The patient's urine test is positive for hCG. What is the correct nursing action related to this information?A: ask the patient if she has had any nausea or vomiting in the morning B: schedule the patient to be seen by a health care provider within the next 4 weeks C: Send the patient to the maternity screening area of the clinic for a routine ultrasound D: determine if there are any factors that might prohibit her from seeking medical care

D: determine if there are any factors that might prohibit her from seeking medical care The patient has presumptive and probable indications of pregnancy. However, she has not sought out health care until late in the first or early in the second trimester. The nurse must assess for barriers to seeking health care, physical or emotional, because regular prenatal care is key to a positive pregnancy outcome. Asking if the patient has nausea or vomiting will only add to the list of presumptive signs of pregnancy, and this information will not add to the assessment data to determine whether the patient is pregnant. The patient needs to see a health care provider before the next 4 weeks because she is late in seeking early prenatal care. Ultrasound testing must be prescribed by a health care provider.

An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. What information should the nurse provide? A: intercourse is safe until the third trimester B: safer sex practices should be used once the membranes rupture C: intercourse should be avoided if any spotting from the vagina occurs afterward D: intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present

D: intercourse and orgasm are often contraindicated if a history of or signs of preterm labor are present Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman is at risk for or has a history of preterm labor. Intercourse can continue as long as the pregnancy is progressing normally. Rupture of the membranes may require abstaining from intercourse. Safer sex practices are always recommended. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy.

A pregnant woman notices that she is beginning to develop dark skin patches on her face. She denies using any different type of facial products as a cleansing solution or makeup. What would the priority nursing intervention be in response to this situation? A: refer the patient to a dermatologist for further examination B: ask the patient if she has been eating different types of foods C: take a culture swab and send to the lab for culture and sensitivity (C&S) D: let the patient know that this is a common finding that occurs during pregnancy

D: let the patient know that this is a common finding that occurs during pregnancy This condition is known as chloasma or melasma (mask of pregnancy) and is a result of pigmentation changes relative to hormones. It can be exacerbated by exposure to the sun. There is no need to refer to a dermatologist. Intake of foods is not associated with exacerbation of this process. There is no need for a C&S to be taken. The patient should be assured that this is a normal finding of pregnancy.

While providing education to a primiparous patient regarding the normal changes of pregnancy, what is an important information for the nurse to share regarding Braxton Hicks contractions? A: these contractions may indicate preterm labor B: these are contractions that never cause any discomfort C: Braxton hicks contractions only start during the third trimester D: these occur throughout pregnancy, but you may not feel them until the 3rd trimester

D: these occur throughout pregnancy, but you may not feel them until the 3rd trimester Throughout pregnancy, the uterus undergoes irregular contractions called Braxton Hicks contractions. During the first two trimesters, the contractions are infrequent and usually not felt by the woman until the third trimester. Braxton Hicks contractions do not indicate preterm labor. Braxton Hicks contractions can cause some discomfort, especially in the third trimester. Braxton Hicks contractions occur throughout the whole pregnancy.

While a patient is early in labor, she explains to her nurse that she and her husband have taken childbirth classes that that focus on birth without fear by education and environmental control and relaxation. The nurse recognizes that this couple most likely attended which type of classes? a. Dick-Read method b. Lamaze c. Bradley d. Aromatherapy

The nurse uses the external electronic fetal heart monitor to evaluate fetal status. The fetal heart tracing shows accelerations. Accelerations in the fetal heart are: select all a. Associated with fetal well-being and oxygenation b. An indication of potential fetal intolerance to labor c. Never associated with the uterine contraction pattern d. A reason to notify the care provider

a (Feedback a. Accelerations are a sign of fetal well-being. b. Accelerations are a sign of fetal well-being and are reassuring. c. Accelerations may or may not be associated with uterine contractions. d. Accelerations are reassuring, and there is no need to notify the care provider.)

The perinatal nurse providing care to a laboring woman recognizes a category II, fetal heart rate tracing. The most appropriate initial action is to: a. Assist the laboring woman to a left lateral position b. Decrease the intravenous solution c. Request that the physician/certified nurse-midwife come to the hospital STAT d. Document the fetal heart rate and variability

a (Feedback a. Because Category II fetal heart rate patterns could deteriorate, they constitute a risk indicator for fetal hypoxia, the nurse should change the woman's position to her side to increase oxygen flow to the baby. b. Because Category II fetal heart rate patterns could deteriorate, they constitute a risk indicator for fetal hypoxia, the nurse should increase, not decrease, the IV infusion to increase perfusion through the placenta. c. The scenario described does not require STAT intervention but continued assessment after intrauterine resuscitation interventions. d. Documentation of the FHR is important but not the most important action in this scenario.)

Which statement correctly describes the nurse's responsibility related to electronic fetal monitoring?a. Teach the woman and her family about the monitoring equipment and discuss any questions they have. b. Report abnormal findings to the care provider before initiating corrective actions. c. Inform the support person that the nurse will be responsible for all comfort measures when the electronic equipment is in place. d. Document the frequency, duration, and intensity of contractions measured by the external device.

a (Feedback a. Teaching is an essential part of the nurse's role. b. Corrective measures for a non-reassuring fetal heart rate are done before notifying a provider. c. The support person can help to provide comfort measures for women in labor. d. Only an IUPC will measure the intensity of uterine contractions.)

After assessing the FHR tracing shown below, which of the following interventions should the nurse perform? a. Turn the woman on her side. b. Administer oxygen by nasal cannula. c. Encourage the patient to push with each contraction. d. Provide the patient with caring labor support.

a (Feedback a. The woman's position should be changed. The side-lying position is the best. b. If a laboring patient needs oxygen, it should be administered via face mask. c. There is no indication in the scenario that the patient is fully dilated. d. The nurse should not wait to intervene. He or she should intervene as quickly as possible in order to reverse the problem.)

The nurse is caring for a woman, G2 P1001, 40 weeks' gestation, in labor.A 12 P.M. assessment revealed: cervix 4 cm, 80% effaced, -3 station, and fetal heart 124 with moderate variability.5 p.m. assessment: cervix 6 cm, 90% effaced, -3 station, and fetal heart 120 with minimal variability.10 a.m. assessment: cervix 8 cm, 100% effaced, -3 station, and fetal heart 124 with absent variability.Based on the assessments, which of the following should the nurse conclude? a. Descent is progressing well. b. Woman is carrying a small-for-gestational age fetus. c. Baby is potentially acidotic. d. Woman should begin to push with the next contraction.

c (Feedback a. The baby has not descended since admission. The station is still -3. b. The baby may be macrosomic. Because the baby is not descending, the baby may be too large to traverse through the pelvis. c. The variability is decreasing. This is an indication that the fetus is in distress. d. The woman is only 8 cm dilated. She should not begin to push until she has reached 10 cm dilation. Plus, the fetal station is still -3.)

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