OB Exam 2

The nurse is monitoring a patient when the EFM strip conveys fetal bradycardia. Which action would be the most urgent for the nurse to take?

Check the mother for vaginal bleeding and severe abdominal pain.

A patient who is expecting her first baby tells the nurse, "I am afraid of the whole birth experience and plan to ask the doctor for a cesarean delivery." Which response by the nurse is most appropriate?

"Cesarean will cause you issues with additional pregnancies."

The patient is having an unmedicated childbirth and has begun to bear down. She vocalizes, "The baby is coming!" Which action should the nurse take?

Have the patient assume a comfortable and upright position.

The obstetric nurse is managing her patients while covering for another nurse who is on a break. Which patient is the lowest priority?

A patient with Category I FHR tracings

Following a cesarean birth, intrathecal morphine is administered to the patient for postoperative pain management. Of which fact about intrathecal morphine therapy is the nurse aware? Select all that apply.

An anesthesiologist or CRNA administers it intrathecally. The nurse needs to closely monitor for common side effects. The drug produces generalized CNS depression. The drug alters perception of and response to painful stimuli.

The nurse is caring for a 34-year-old woman who is G2P1001 at 39 weeks and 1 day. The patient is an observant Muslim and is in active labor. Which outcome would be the most effective form of applying culturally sensitive communication?

Assuring the patient that her baby is less than 9 lbs

The nurse is caring for a 24-year-old woman who is G1P0 at 40 weeks, 1 day gestation and in active labor. She has just received an epidural and now complains of "an itchy feeling all over." Her vitals are as follows: HR 120, RR 12, BP 130/74, T 98.8, and O2 sat 98%. Which action should the nurse take first?

Call the health care provider regarding the patient's pruritus to order an antipruritic medication.

The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with SROM clear fluid 2 hours ago. What action should the nurse take?

Help the patient change her position from side to side every 30 minutes

The nurse in labor and delivery notices an increase in the number of women requesting cesarean births. Which are the parameters and criteria used when making the decision to perform a cesarean delivery on maternal request (CDMR)? Select all that apply.

Patient is aware of possible neonatal complications. Procedure is performed after 39 weeks gestation.

While providing care for a patient, the nurse notices an erratic FHR recording. What action should the nurse take next?

Place the transducer in a different position.

A patient is interested in a pain relief option that she can control during labor. The nurse explains to the patient what pain relief options are available that would meet her needs, and they mutually decide on nitrous oxide. Which of the following does the nurse describe to the patient about the use of nitrous oxide in labor? Select all that apply.

"The gas takes effect in about 50 seconds after the first breath, and the patient will feel calm." "There is no effect on the labor progress from active labor to delivery, and therefore you do not need to worry about longer labors with the medication."

The nurse is caring for a pregnant patient who expresses concern about the effects of electronic fetal monitoring (EFM) on her labor and delivery. Which responses by the nurse would be appropriate in this situation? Select all that apply.

"There is a reduced rate of seizures if a patient has EFM during labor." "There is a link between the rate of cesarean sections and continuous EFM." "There is an increase in operative vaginal births and the use of continuous EFM."

The nurse is counseling a 15-year-old pregnant patient at her first prenatal appointment. Which patient teaching by the nurse is appropriate?

"Your response to pregnancy, labor, and delivery will differ from that of an adult because your cognitive development is not yet complete."

The nurse is speaking with a pregnant patient who is asking what processes start labor. Which responses by the nurse are appropriate? Select all that apply.

1. There is more pressure on the cervix, which causes the start of contractions by releasing oxytocin. 2. Oxytocin stimulates uterine muscles to contract. 4. The placenta begins to age and deteriorate and this triggers the start of contractions. 5. The fetus releases a stress hormone, cortisol, and this starts contractions.

The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing with a baseline of 120, moderate variability, with absence of decelerations and accelerations. According to the National Institute of Child Health and Human Development tier system, what category tracing does the patient's fall into?

A Category I tracing

The nurse is helping the patient assume a position for placement of an epidural. Which of the following positions are appropriate for placing an epidural?

Lateral position with head flexed toward chest Trendelenburg position

The nurse is providing care for a primip patient in active labor. Cervical dilation has progressed 0.5 cm in 2 hours. Intrauterine pressure catheter reading is 20 mm Hg. Which action does the nurse anticipate next?

Augmentation of labor with oxytocin per health care provider's order

The nurse is providing care to a patient who is diagnosed with dystocia related to hypertonic uterine dysfunction. Which medical intervention does the nurse implement for this patient?

Administer morphine to decrease contractions and promote uterine rest.

The nursing preceptor is teaching the nursing student about fetal bradycardia. Which is true of the maternal reasons for fetal bradycardia? Select all that apply.

Administering terbutaline to the mother for uterine tachysystole; this is self-limiting to when the drug is affecting the mother. A urine toxicology screen may reveal recent cocaine use; the nurse should also monitor for placental abruption. Check the chart for a history of maternal mental illness, particularly maternal anxiety; speak with the patient regarding her anxiety and take steps to ease her anxieties. Check the maternal blood pressure, as hypertension is linked to fetal tachycardia; identify the on-call provider and correct with lisinopril as necessary.

In preparation for a cesarean birth, the nurse expects which medical-based preoperative interventions? Select all that apply.

Administration of narrow-spectrum prophylactic antibiotics Assessment for risk of venous thromboembolism (VTE) Prescription for sequential compression devices prior to surgery

The nurse is providing care to a patient who is in labor. The patient's membranes rupture spontaneously, and the nurse notices meconium-stained amniotic fluid. Which actions does the nurse immediately perform? Select all that apply.

Alert the neonatal team of a possible meconium aspiration neonate. Notify the primary care provider about the presence of meconium.

The nurse is caring for a baby who is experiencing fetal tachycardia. Which action should the nurse take next?

Check maternal allergies in the patient chart.

A patient arrives at labor and delivery for the induction labor for her first child. The patient tells the nurse, "I can't believe how easy this is just to pick a day, sign a paper, and have a baby." Which action does the nurse take before the induction process?

Call the health care provider to validate patient understanding.

A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (CVAC) screening. The nurse is aware that which patient information will likely disqualify the patient for CVAC?

Cesarean due to pelvic abnormalities

A nurse-preceptor is explaining to a new nurse about the tocodynamometer. The new nurse is looking at the EFM paper and sees that, of the two tracked heart rates, the one on the bottom is in the 80s; she is concerned that the fetal heart rate is bradycardic. Which of the following should the nurse do first?

Check to make sure that the maternal radial pulse is being recorded correctly.

The nurse is caring for a 30-year-old woman who is G4P2012 at 38 weeks and 5 days gestation. The nurse is watching her EFM strip and notices that for the past 10 minutes the fetus has shown minimal variability. Which actions should the nurse perform? Select all that apply.

Check to see if the patients' membranes have been ruptured, as there could be potential cord compression. Look to see what the patient's position is and is she supine; change her to left side lying. Continue to watch the strip, but know that this could be due to fetal sleep.

The nurse educator is teaching the nursing student the basic principles of using analgesia by using a patient, Christa, as an example. Which of the following demonstrates the basic principles of analgesia during Christa's labor and delivery? Select all that apply.

Christa has been in labor for 4 hours. She has been having contractions every 3 minutes. Contractions last a minute and are intense. She has had cervical change from 3 to 5 cm over the past 4 hours. The medication Christa wants is an epidural. After she receives the epidural, the FHR tracing is within normal limits.

The nurse is making a plan of care for a patient who is in the first 24-hour period past a cesarean delivery. Which interventions will the nurse include in regards to medications? Select all that apply.

Continue a daily stool softener. Manage pain with morphine. Ensure the availability of naloxone. Administer Rhogam if needed.

The nurse is attending to a patient who just delivered a term fetus who was stillborn. Which nursing interventions will the nurse use to provide emotional support to the couple? Select all that apply.

Cut a lock of the neonate's hair and get foot and hand prints. Allow parents unlimited time to hold and touch the neonate.

The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor?

Dystocia is associated with extreme fear.

A patient at 34 weeks gestation is in labor with twins. The primary care provider decides the fetuses need to be delivered by cesarean. Which medical and nursing interventions will be in place for this delivery? Select all that apply.

Delivery is attended by two medical personnel. The placement of a large-bore IV access is ensured. A hospital with a Level II or III nursery is selected. The FHR for the two fetuses is monitored alternately.

An internal fetal monitor has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1 day gestation. Her medical history is significant for a history of pregnancy-induced hypertension. Her laboratory values are as follows: H/H 11/30, O negative, RPR negative, GBS positive. Based on Chrissy's history and presentation, what action should the nurse take next?

Discuss with the health care provider that Chrissy is GBS positive and therefore should not receive an internal monitor.

The nurse educator is in a childbirth education class discussing nonpharmacological ways nurses can assist to enhance labor and spontaneous vaginal delivery. Which of the following facts regarding nonpharmacologic approaches will the nurse use to help illustrate its benefits?

Effleurage is performed in rhythm with breathing during a contraction.

The nurse educator is teaching about regional and local anesthesia in a childbirth education class. The nurse should teach that regional anesthesia is used for which of the following? Select all that apply.

Epidural with lidocaine for pain in labor Spinal block with lidocaine for a cesarean delivery Lidocaine without epinephrine for forceps use

Which actions indicate the is assessing uterine activity? Select all that apply.

Feeling the maternal abdomen in between contractions Checking the EFM strip to determine if contractions are either 2 or 3 minutes apart Evaluating that the EFM strip shows 200 MVU every 10 minutes. Evaluating that the EFM strip shows that each contraction lasts 1 minute

The nurse is providing care to a patient who is at 41 weeks gestation. Which factor about the patient does the nurse consider as an indication of late-term or post-term pregnancy?

Fetus is identified as a male

The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the facility. Which reasons contribute to the high rates of cesarean births? Select all that apply.

Fetuses in breech position unable to deliver vaginally Increased number of elective or maternal request cesareans Incidences of women of older maternal age getting pregnant

An emergency cesarean is being implemented. The patient describes tingling in her ears and a metallic taste with the administration of regional anesthesia. The nurse is aware that which incidence has occurred?

Inadvertent injection of the anesthetic agent into the maternal bloodstream

The patient is a 26-year-old G1P0 at 38 weeks, 2 days of gestation. She is at her provider's office for a visit and complains to the nurse of wrist pain, fatigue, increased discharge, and "feeling heavy." Which complaint could be a sign of impending labor?

Increased discharge

The obstetric nurse is assessing the laboring patient for pain. Which of the following should the nurse identify in a pain assessment? Select all that apply.

Intensity of contractions Presence of pain in the neck or back Frequency and duration of contractions Signs of anxiety

The nurse-educator is preparing a presentation on fetal heart monitoring. Which of the following should be included? Select all that apply

Intermittent auscultation should be performed every hour in the latent phase. For Category I situations, intermittent electronic fetal monitoring (EFM) should be performed for 10 to 30 minutes every 1 to 2.5 hours. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.

A patient in labor receives high-level regional anesthesia, which inhibits her ability to push during the second state of labor. The primary care provider will use forceps to aid in the delivery of the fetus. Which fetal complications is the nurse aware of being related to a forceps birth? Select all that apply.

Intracranial hemorrhage Cephalohematoma Nerve injuries Skin lacerations Skull fracture

A patient is being prepared for an unplanned cesarean section. Which pre-procedure information is most important for the nurse to report before the administration of regional anesthesia?

Laboratory value indicating a low platelet count

The nurse in the post-delivery unit is encouraging skin-to-skin contact for a mother and neonate after cesarean delivery. Which action, if noticed by the nurse, requires immediate intervention by the nurse?

Mother is supine with the neonate prone on her chest.

The nurse is providing care for a patient in the second phase of labor. After more than 4 hours of pushing, the nurse suspects fetal dystocia. Which is the greatest risk related to the nurse's suspected complication?

Neonatal asphyxia related to prolonged labor

The nurse is assisting with the preparation of a patient admitted for a planned cesarean birth. The patient has signed the consent form and discussed the elected regional anesthesia with the nurse anesthetist. Which is the most important action for the nurse related to anesthesia?

Obtain a baseline fetal heart rate monitor strip.

The EFM tracing shows the following: FHR baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the five-tier FHR interpretation system, how should the nurse interpret this tracing?

Orange: acceptable low risk of acidemia, prepare for possible urgent delivery

The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring strip. How would the nurse assess this?

Palpate the maternal abdomen during a contraction.

The nursing is caring for a 31-year-old female patient who is pregnant at 37 weeks and 5 days gestation. The patient is having contractions every 3 minutes and was found to have a platypelloid pelvis upon examination. The fetus has an estimated fetal weight of 7 lbs and is in the LOA position. This patient is laboring on the birth ball, and her mother-in-law is helping her labor. The nurse is concerned about the five Ps and their effect on the patient's labor. Which P is the nurse most likely concerned about based on the patient's history?

Passage

The nurses in a labor and delivery unit are concerned about the high incidence of cesarean deliveries at their facility and initiate an internal study. Which is the most likely condition the nurses will recognize as a contributor to the rate of cesarean births?

Policies and parameters for cesarean need to be reviewed and refined.

The nurse is providing care in PACU for a patient who just delivered a neonate via cesarean section. The patient reports tightness in her chest. Assessment findings include tachypnea, hypotension, and decreasing oxygen saturation levels. Which complication does the nurse report to the health care provider?

Pulmonary embolism

When assisting with a vacuum-assisted vaginal delivery, the nurse is aware that adherence to which guidelines for the vacuum device will minimize the nurse's liability in vacuum-assisted vaginal births? Select all that apply.

Pump up the vacuum manually to the pressure indicated on the pump. Recognize that cup detachment (pop off) is a warning sign. Understand that pressure should be released between contractions. The procedure is timed from insertion of the cup into the vagina until the birth.

The nurse is monitoring a patient who has been in prolonged labor. Which assessment finding will result in the nurse notifying the health care provider about the development of an emergent situation requiring a cesarean delivery?

Recognition of a Category II fetal heart rate pattern

During a vaginal delivery, the primary care provider notices greenish yellow coloration on the fetal head during crowning. Intrapartum suctioning is performed as soon as the fetus's head is delivered. The nurse understands the aspiration of meconium will have which effects on the neonate's respiratory function? Select all that apply.

Result in airway obstruction Contribute to pulmonary hypertension Result in chemical pneumonitis Cause surfactant dysfunction

A nurse has recently transferred to a labor and delivery unit. During a scheduled cesarean, the nurse notices a prescription for the administration of 1,000 mL of prewarmed IV fluid. For which reason does the health care provider prescribe the fluid in this manner?

Results in an increased maternal core temperature Results in improved neonatal umbilical arterial pH Results in improved Apgar scores

The nurse is providing care for a patient who delivered via cesarean 24 hours ago. Which teaching does the nurse provide for the patient and family? Select all that apply.

Signs and symptoms to report to health care provider Comfortable positions for feeding the newborn

The nurse is providing care for a patient who is at 42 weeks gestation. The patient's primary care provider is suggesting induction, but the patient is resistant. Which facts can the nurse provide if the patient asks about allowing labor to start spontaneously? Select all that apply.

Stillbirth or newborn death increases in pregnancies beyond 42 weeks. There is a greater chance of developing complications because of larger fetal size. Postmature fetuses have decreased subcutaneous fat and lack vernix and lanugo.

The nurse in labor and delivery is preparing to initiate labor induction with the administration of oxytocin. After research about oxytocin, the nurse is aware of which fact about the drug?

Synthetic oxytocin is identical to endogenous oxytocin.

While reviewing the birth plan of an uncomplicated and healthy patient in active labor, the nurse notices that she would like to have a natural labor and potentially experience hydrotherapy. Which option should the nurse suggest for the patient?

Telemetry to allow for the patient to accomplish her birth plan

The nurse is assisting the primary care provider with a vacuum-assisted delivery because of a prolonged second stage of labor. The nurse will inform the primary care provider when which guideline of the procedure is met?

The "three-pull rule" has been achieved.

The nurse is obtaining a baseline fetal heart rate (FHR). At 1:00 pm the baseline FHR was 130, at 1:20 pm FHR baseline was 166, and at 1:40 pm the baseline FHR was 204. What should the nurse assess from this trend of fetal baselines? Select all that apply.

The 1:00 pm FHR baseline warranted no further action. The 1:40 pm FHR baseline should be corrected immediately.

The nurse is teaching the patient about the trends and risks of epidural anesthesia. Which of the following should the nurse relay about the risks of epidural anesthesia?

When using an epidural, women are less likely to sweat with a fever. Labor may be longer with an epidural. There is a higher rate of fever and sepsis.

The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient?

Wider outlet

The nurse is looking at an EFM strip and sees that the patient is having contractions that are measuring 150 MVU every 10 minutes for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps?

The patients' contractions are inadequate; the provider could consider an amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective.

The nurse-educator is instructing on the physiology of fetal heart rate (FHR) patterns. He is showing the students an EFM strip, and there is a tracing that is classified as baseline 140 bpm, moderate variability, accelerations, and 2 decelerations. A half hour later the baseline is 150 bpm, there is minimal variability, accelerations, and 3 decelerations. Which of these findings would the nurse attribute to the parasympathetic nervous system?

The presence of 2 and then 3 decelerations.

A 40-year-old G5P1031 is attending a childbirth education class. During the class, the woman says, "The worst part of contractions with my last labor was when they were at the peak of intensity." The nurse educator correctly explains that the woman is identifying which part of a contraction?

The shortest part of the contraction

The nurse is providing care for a prenatal patient who is told she will require a cesarean delivery because of cephalopelvic disproportion. Which explanation of the condition will the nurse provide to the patient?

The size and/or shape of either the fetal head or patient pelvis is an issue.

The nurse is aware that there are multiple classifications for cesarean deliveries. Which situations does the nurse classify as an unscheduled cesarean birth? Select all that apply.

There is evidence of a prolapsed cord with membrane rupture. The cervix fails to fully dilate after prolonged labor. Patient has a preexisting cardiac health condition. There is recognition of placenta previa with mild bleeding.

The nurse is explaining telemetry to the patient, who has just begun active labor. The patient would like to have a labor in which she is mobile, able to change positions, and use hydrotherapy. Which response by the nurse is most appropriate?

We can start using telemetry now, and if there are no problems with the signal, we can continue it throughout your labor until delivery.

The nursing is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacologic methods of pain relief. The nurse thinks that sterile water injections may help with her pain management. Which of the following explanations should the nurse explain to the patient?

We will inject 0.5 mL of sterile water subcutaneously, and it will last for an hour to 90 minutes."

A patient who is at 39 weeks gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure?

The fetal head is currently engaged in the maternal pelvis

The nurse is providing care for a patient who is admitted for cervical ripening. The health care provider has prescribed the use of a hygroscopic dilator. Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening?

The method may be indicative of fetal demise.

The nurse encourages the patient to bring loved ones to be with her during labor because the nurse knows that their presence does which of the following? Select all that apply.

shortens the length of labor Reduces the likelihood that a patient will require an epidural Increases patients' happiness and satisfaction with the outcome of their birth

The nurse preceptor is teaching a nursing student about the physiology of the fetal heart rate (FHR) pattern. Which statement by the student indicates successful teaching about this concept?

the sympathetic nervous system is responsible for heart rate variability