OB
A) Umbilical cord compression.
41. The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by: A) Umbilical cord compression. B) Altered fetal cerebral blood flow C) Fetal hypoxemia. D) Uteroplacental insufficiency
D) Pressure.
30. The factors that affect the process of labor and birth, known commonly as the five Ps, include all EXCEPT: A) Passageway. B) Powers. C) Passenger. D) Pressure.
A) LOA
1. Choose the abbreviation that represents the fetal presentation and position that is most favorable for vaginal birth. A) LOA B) RMP C)LST D) ROP
B) Variability
10. The single most important assessment when monitoring the fetal heart is: A) Rate B) Variability C) Tachycardia D) Bradycardia
D) Altitude
20. When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal: A) Lie. B) Position. C) Presentation. D) Attitude.
A) First
21. To adequately care for a laboring woman, the nurse knows that which stage of labor varies the most in length? A) First B) Fourth C) Third D) Second
C) Naloxone (Narcan)
49.A laboring woman received meperidine (Demerol) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate? A) Fentanyl (Sublimaze) B) Promethazine (Phenergan) C) Naloxone (Narcan) D) Nalbuphine (Nubain)
D) Fetal presenting part is 1cm below the mother's ischial spines.
5. A station of +1 means that the: A) Maternal cervix is open 1cm. B) Mother's ischial spines project into her pelvis by 1 cm. C) Fetal presenting part is 1cm above the mother's ischial spines. D) Fetal presenting part is 1cm below the mother's ischial spines.
D) Absent FHR Variability
42.Which of the following is NOT a reassuring component of the fetal heart rate A) FHR of 114 B) Accelerations of the FHR C) Moderate Variability D) Absent FHR Variability
C) Active phase
11. A sterile vaginal exam reveals that the woman is 5cm dilated, 80% effaced, and at 0 station. Based on this exam, this woman is in: A) Transition phase B) Latent phase C) Active phase D) Placental phase
Braxton Hicks, false
12. _______ are intermittent, physiological uterine contractions that may occur during the second and third trimester and do not cause cervical change. They are associated with _____ labor.
D) Variable decelerations
13. A nurse is observing the electronic fetal heart rate monitor for a client who is at 40 weeks of gestation and is in labor. The nurse should suspect cord compression when she observes which of the following patterns? A) Early decelerations B) Accelerations C) Late decelerations D) Variable decelerations
C) An excessive amount of amniotic fluid is present.
14. A client is admitted to the maternity unit who is 38 weeks gestation and experiencing polyhydramnios. The nurse understands that this diagnosis means that: A) There is the normal amount of amniotic fluid , thinner is volume. B) A less-than normal amount of amniotic fluid is present. C) An excessive amount of amniotic fluid is present. D) A leak is causing fluid to accumulate outside the amniotic sac.
B,C,D
15. What information do Leopold maneuvers provide? ( Select all that apply). A) Fetal weight B) Fetal lie C) Position of fetal back D) Presenting part of fetus E) Fetal gender
C) ROP
16. A laboring client station is complaining of severe back pain. The nurse knows that which of the following positions is associated with lower back pain in laboring women. A) RSA B) LOA C) ROP D) ROA
A) The fetus has an intact central nervous system
17. A fetus heart rate tracing indicates moderate variability with accelerations. What is the significance of this tracing? A) The fetus has an intact central nervous system B) The fetus is awake C) The fetus is ready for delivery D) The fetus heart has 4 chambers
D) The cervix is 4 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines
18. The nurse has received a report about a woman in labor. The woman's last vaginal examination was recorded as 4, 80%, and -2. The nurse's interpretation of this assessment is that: A) The cervix is dilated 4 cm, it is effaced 80%, and the presenting part is 2 cm below the ischial spines B) The cervix is effaced 4 cm, it is dilated 80%, and the presenting part is 2 cm below the ischial spines. C) The cervix is effaced 4 cm, it is dilated 80%, and the presenting part is 2 cm above the ischial spines D) The cervix is 4 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines
A) D, B, A, E, C
19. What is the correct order of the cardinal movements? A.Extension B.Internal Rotation C.Expulsion D.Engagement, Flexion Descent E.External Rotation A) D, B, A, E, C B) D, A, B, E, C C) B, D, A, C, E D) D, B, A, C. E
C) Reduce time for oxygen exchange across the placenta
2. Firm contractions that occur every 2.5 minutes and last 100 seconds (I minute 40 seconds) may educe fetal oxygen supply because they: A) Cause fetal bradycardia and reduce oxygen concentration B)Activate the normal variability of the fetal heart C) Reduce time for oxygen exchange across the placenta D) Suppress the normal variability of the fetal heart.
B) Squatting
22. Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? A) Sitting B) Squatting C) Side-lying D) Semirecumbent
D) LOA
23. When assessing the fetus using Leopold maneuvers, the nurse feels a round, hard, movable fetal part just above the symphysis and a long, smooth surface in the mother's left side close to midline. In the fundus, there is a prominence- when pushed the whole body seems to follow. What is the likely position of the fetus? A) RSA B) ROA C) LSP D) LOA
A) Birth is imminent when the presenting part is at +4 to +5 cm, below the spine.
24. With regard to fetal positioning during labor, nurses should be aware that: A) Birth is imminent when the presenting part is at +4 to +5 cm, below the spine. B) Engagement is the term used to describe the beginning of labor. C) The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter. D) Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal.
A) Cephalic: occiput; at least 95%
25. Which presentation is described accurately in terms of both presenting part and frequency of occurrence? A) Cephalic: occiput; at least 95% B) Cephalic: cranial; 80% to 85% C) Shoulder: scapula; 10% to 15% D) Breech: sacrum; 10% to 15%
B) Active Phase of First Stage
26.A client is admitted to the labor and delivery unit with contractions that are 3-5 minutes apart, lasting 60-70 seconds. She reports that she is leaking fluid. A vaginal exam reveals that her cervix is 80 percent effaced and 4 cm dilated and a -1 station. The nurse knows that the client is in which phase and stage of labor? A) Latent phase, First Stage B) Active Phase of First Stage C) Latent phase of Second Stage D) Transition
D) Assess duration from beginning to end of each contraction., frequency by measuring the time between the beginnings of contractions, and palpate the fundus of the uterus for strength.
27. To assess uterine contractions the nurse would A) Asses duration from the beginning of the contraction to the peak of the same contraction, frequency by measuring the time between the beginning of one contraction to the beginning of the next contraction. B) Assess frequency as the time between the end of one contraction and the beginning of the next contraction, duration as the length of time from the beginning to the end of contractions, and palpate the uterus for strength C) Assess duration from beginning to end of each contraction. Assess the strength of the contraction by the external fetal monitor reading. Measure frequency by measuring the beginning of one contraction to another. D) Assess duration from beginning to end of each contraction., frequency by measuring the time between the beginnings of contractions, and palpate the fundus of the uterus for strength.
A) Platypelloid: flattened, wide, shallow; 3%
28. Which basic type of pelvis includes the correct description and percentage of occurrence in women? A) Platypelloid: flattened, wide, shallow; 3% B) Anthropoid: resembling the ape; narrower; 10% C) Android: resembling the male; wider oval; 15% D) Gynecoid: classic female; heart shaped; 75%
A) Lithotomy
29. What position would be least effective when gravity is desired to assist in fetal descent? A) Lithotomy B) Walking C) Kneeling D) Sitting
B) Acceleration of 15 or more beats per minute for 15 seconds.
3. The expected response of the fetal heart rate of a term fetus to movement is: A) Suppression of normal variability for at least 15 seconds. B) Acceleration of 15 or more beats per minute for 15 seconds. C) Increase in variability by 15 beats per minute for 10 minutes. D) Accelerations followed by decelerations of the fetal heart.
C) Change the woman's position
31. While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to: A) Notify the care provider. B) Assist with amnioinfusion C) Change the woman's position D) Insert a scalp electrode.
D) Tachycardia.
32. During labor a fetus with an average heart rate of 175 beats/min over a 15-minute period would be considered to have: A) A normal baseline heart rate. B) Bradycardia. C) Hypoxia. D) Tachycardia.
C) Hypoxemia/acidemia
33. As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations with loss of variability is nonreassuring and is associated with A) Cord compression B) Hypotension C) Hypoxemia/acidemia D) Maternal drug use.
C) Variable decelerations
34. The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat: A) Fetal tachycardia. B) Fetal bradycardia. C) Variable decelerations D) Late decelerations.
B) Fetal sleep cycles
35. The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is: A) Fetal hypoxemia B) Fetal sleep cycles C) Altered cerebral blood flow. D) Umbilical cord compression.
B) Document the finding in the client's record.
36. While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate in a slow curve at the onset of several contractions and returns to baseline before each contraction ends. The nurse should: A) Insert an internal monitor B) Document the finding in the client's record. C) Discontinue the oxytocin infusion D) Change the woman's position
A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.
37. What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. B) Perform a vaginal examination, reposition the mother, and provide oxygen via face mask. C) Administer oxygen to the mother, increase IV fluid, and notify the care provider. D) Call the provider, reposition the mother, and perform a vaginal examination
B) The examiner's hand should be placed over the fundus before, during, and after contractions.
38. When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: A) The resting tone between contractions is described as either placid or turbulent B) The examiner's hand should be placed over the fundus before, during, and after contractions. C) The frequency and duration of contractions is measured in seconds for consistency D) Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. B) The examiner's hand should be placed over the fundus before, during, and after contractions. p. 424
B) Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes.
39. Perinatal nurses are legally responsible for: A) Applying the external fetal monitor and notifying the care provider. B) Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes. C) Greeting the client on arrival, assessing her, and starting an intravenous line. D) Making sure that the woman is comfortable.
A,B,C
4. The nurse caring for a client in the 3rd stage of labor. Which of the following indicates that the client is in the 3rd stage? (Select all that apply). A) Firm fundus B) Lengthening of the umbilical cord C) Dark gush of blood from the vagina D) Gush of clear amniotic fluid
C) Uteroplacental insufficiency
40. The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are caused by: A) Altered cerebral blood flow B) Spontaneous rupture of membranes C) Uteroplacental insufficiency D) Umbilical cord compression
A) Call for help and Notify the care provider immediately
43. You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? A) Call for help and Notify the care provider immediately B) Start pitocin C) Have her empty her bladder D) Insert a Foley catheter
C) The external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring.
44. What is an advantage of external electronic fetal monitoring? A) Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions. B) The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs). C) The external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring. D) The external EFM can accurately record FHR all the time.
C) Fetal pulse oximetry.
45. A number of methods to assist in the assessment of fetal well-being have been developed for use in conjunction with electronic fetal monitoring. These various technologies assist in supporting interventions for a nonreassuring fetal heart rate pattern when necessary. The labor and delivery nurse should be aware that one of these modalities, fetal oxygen saturation monitoring, includes the use of: A) Fetal blood sampling B) Umbilical cord acid-base determination C) Fetal pulse oximetry. D) A fetal acoustic stimulator.
A) Uteroplacental insufficiency.
46.The nurse caring for the woman in labor should understand that maternal hypotension can result in: A) Uteroplacental insufficiency. B) Spontaneous rupture of membranes C) Fetal dysrhythmias. D) Early decelerations.
D) Are reassuring.
47.The nurse providing care for the laboring woman should understand that accelerations with fetal movement: A) Are caused by umbilical cord compression B) Are caused by uteroplacental insufficiency C) Warrant close observation D) Are reassuring.
A) Meperidine (Demerol)
48.A woman in active labor receives an analgesic, an opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease? A) Meperidine (Demerol) B) Promethazine (Phenergan) C) Butorphanol tartrate (Stadol) D) Nalbuphine (Nubain)
C) Monitor the maternal blood pressure for possible hypotension.
50.A woman in labor has just received an epidural block. The most important nursing intervention is to: A) Limit parenteral fluids. B) Monitor the fetus for possible tachycardia C) Monitor the maternal blood pressure for possible hypotension. D) Monitor the maternal pulse for possible bradycardia
B) Changes in the cervix
6. The nurse is caring for a client who is primigravida, at term, and having contractions but stating that she is "not really sure if she is in labor or not." The nurse should recognize that which of the following is an indication of true labor? A) Rupture of membranes B) Changes in the cervix C) Station of the presenting part D) Pattern of contractions
A) Assess the fetal heart rate.
7. A woman's membranes rupture during a contraction. The priority nursing actions is to: A) Assess the fetal heart rate. B) Note the color of the discharge. C) Check the woman's vital signs. D) Determine if the fluid has a foul odor.
D) Continue to observe and record the normal pattern.
8. The nurse notices a pattern of decelerations on the fetal monitor that begins when the contraction begins and returns to baseline just before the contraction is over. The correct nursing response is to: A) Give the woman Oxygen by face mask at 8-10L/min. B) Position the woman on her opposite side. C) Increase the rate of IV fluid. D) Continue to observe and record the normal pattern.
C) Check blood glucose
9. A 34 week pregnant client with Type 1 diabetes presents to the client with polydipsia, polyphagia, and polyuria. Which of the following should the nurse do first? A) Administer insulin B) Give oral glucose C) Check blood glucose D) Schedule 3 hour glucose challenge test
