OB Finals

Massage the woman's back.

Which nursing intervention offered in labor would probably be the most effective in applying the gate control theory for relief of labor pain?

Cephalic presentation using preprinted materials in her language

he nurse is teaching a non-English speaking primigravida about the most common type of fetal presentation. Which presentation will the nurse prepare?

The patient is not requesting for pain medication.

During labor, a pregnant patient's doula uses therapeutic touch and massage. Which outcome indicates that these approaches have been effective?

Episiotomy

A new mother calls the clinic on her fourth day after delivery and reports difficulty urinating and defecating because of the perineal pain. What does the nurse suspect is causing these problems?

allowing the woman time to be alone

A nurse is conducting an in-service program for staff nurses working in the labor and birth unit. The nurse is discussing ways to promote a positive birth outcome for the woman in labor. The nurse determines that additional teaching is necessary when the group identifies which measure?

Radiates from the back to the front

A pregnant woman comes to the emergency department stating she thinks she is in labor. Which assessment finding concerning the pain will the nurse interpret as confirmation that this client is in true labor?

Presence of an indwelling catheter

A primigravida whose baby is presenting breech is scheduled to have a cesarean birth. Which of the following would you prepare her for postoperatively

Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area.

Which statement is true regarding analgesia versus anesthesia?

Fetal malpresentation Non-reassuring fetal status Labor dystocia

The nursing instructor is teaching about cesarean birth and informs the students that the main reasons for this procedure include which of the following? Select all that apply.

Fetal heart rate in relation to contractions

Which consideration is a priority when caring for a mother with strong contractions 1 minute apart?

Bishop score of 42 weeks

A client at 42 weeks' gestation presents for induction of labor. Which assessment should the nurse prioritize as the best indicator for the induction to proceed

Assess vital signs

A client has just received combined spinal epidural. Which nursing assessment should be performed first?

Transverse

The nurse is caring for a client whose fetus is noted to be in the position shown. For which fetal lie would the nurse provide client teaching?

The characteristics of labor pain follow a pattern.

When planning a labor experience for a primigravida, understanding which characteristic of labor pain is most helpful?

The client will practice breathing techniques during contractions.

Which client outcome during active and transitional labor is best?

Call for help and prepare the patient for an emergency cesarean delivery

A 21-year-old has been in labor for 4 hours; her examination 2 hours ago revealed 6 cm/100%/-3. During a contraction, she spontaneously ruptures her membranes. The doctor checks the patient, finds her to be 9 cm/100%/-3, and states that the cord is palpable. What should the nurse do?

Support the client's decision and call the obstetrician. It might be too late for an epidural, but other options could be discussed.

A client and her husband have prepared for a natural birth; however, as the client progresses to 8 cm dilation, she can no longer endure the pain and begs the nurse for an epidural. What is the nurse's best response?

Urinary Output Maintaining IV access

A client is being prepared for a scheduled cesarean delivery by the medical team. Which interventions will be most critical for the team to monitor in the first 24 hours post cesarean delivery? Select all that apply:

Midline episiotomy

A nursing student correctly identifies that an episiotomy that extends straight down into the true perineum is which of the following

"It is rounded in shape and allows ample room for the neonate to fit through the passageway

A student observes during an initial prenatal visit. The student states, "I heard the primary care provider say that the client has a gynecoid pelvis. What does that mean?" The best response by the nurse is

artificial rupture of membranes

A student observing in labor and delivery watches a physician introduce a hard plastic instrument with a hook on the end into the vagina during a digital examination. The physician proceeds to guide the hook to snag a hole into the membranes. This process causes the body to release prostaglandins, which induces labor and is known as which of the following?

moderately strong contractions every 4 minutes, lasting about 1 minute

A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which symptom?

latent phase of the first stage

Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in:

occiput

Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting?

At the time of placental delivery

During which time is the nurse correct to document the end of the third stage of labor

Postpartum hemorrhage

Eight hours after a cesarean section, a postpartum woman is having heavy lochia. She informs the nurse, who suspects which of the following causes?

Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication.

Erin, a 19-year-old first-time mother in the second stage of labor who has been given an epidural, reports severe, unrelenting abdominal pain and rates it as 10 on a scale of 0 to 10. What should the nurse do?

When bowel sounds return

Following a cesarean birth, a patient is prescribed to receive intravenous fluids. At which time should the nurse anticipate that this patient will be able to resume an oral intake?

A nurse is providing care to a pregnant client in labor. Assessment of a fetus identifies the buttocks as the presenting part, with the legs extended upward. The nurse identifies this as which type of breech presentation?

Frank

False

General anesthesia is a preferred method of pain management in childbirth. True or False

True

If the patient receives opioid medications in labor, the nurse should have Narcan available for the baby. True or False

The nurse is assessing a neonate after a cesarean delivery. Which most common complication should the nurse be prepared for

Respiratory distress

The nurse identifies from a client's prenatal record that she has a documented gynecoid pelvis. Upon the client entering the labor and delivery department, which nursing action is best

Take no extra measures; prepare for a standard labor.

Fetal position

The client in active labor overhears the nurse state the fetus is ROA. The nurse should explain this refers to which component when the client becomes concerned?

counterpressure against the sacrum

The client is experiencing back labor and reporting intense pain in the lower back. The nurse should point out which intervention will be effective at this point?

"The analgesia will reduce the sensation of pain for a limited period of time."

The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best?

"The cervix needs to be soft and thinning to be induced for labor; this helps soften the cervix."

The health care provider has determined a client should be admitted for induction of labor and begins the process with cervical ripening overnight. Which teaching should the nurse prioritize for the client and her partner when describing this procedure?

Assess the fetal heart rate

The nurse assists while a pregnant patient has an amniotomy. Which action should the nurse take immediately at the conclusion of the procedure

PT will not develop manifestations of thrombophlebitis.

The nurse encourages a patient recovering from a cesarean birth to begin early ambulation. For which outcome would this action be indicated?

Acute pain related to uterine contractions

The nurse is assessing a laboring client and notes: 5 cm dilated, 80% effaced, zero station, contractions every 2 to 3 minutes, lasting 50 seconds, becoming increasingly uncomfortable, and apprehensive but appropriate and focused on breathing and relaxation. The nurse determines which nursing diagnosis is most appropriate for this client?

Engagement

The nurse is assessing a pregnant client at 37 weeks' gestation and notes the fetus is at zero station. When questioned by the client as to what has happened, the nurse should point out which event has occurred?

degree of thinning

When assessing cervical effacement of a client in labor, the nurse assesses which characteristic?

"Tell me how you handled labor pain in your past deliveries."

When collecting data to devise a labor plan for a multiparous woman, which question best allows the nurse to develop individualized strategies?

The client will direct her pain management techniques.

When developing a labor plan with the client, which outcome is the priority?

Vaginal rugae stretch and smooth out The cervix dilates to 10cm The cervix softens

Which changes in the female body occur to allow the passage of the fetus down the birth canal? Select all that apply.

"I have no pain now."

Which client statement is anticipated after immediately receiving an intrathecal injection of pain medication?

The client's contractions are 5 minutes apart and last 45 seconds

Which description is best when documenting an accurate client contraction?

Bleeding

Which is the most important nursing assessment of the mother during the fourth stage of labor?

Giving a fluid bolus of 500mL

Which nursing action is required before a client in labor receives an epidural?

Anxiety can slow down labor & decrease oxygen to the fetus.

A primigravida client has just arrived in early labor and is showing signs of extreme anxiety over the birthing process. Why should the nurse prioritize helping the client relax?

Patient uses breathing techniques to control anxiety and pain during labor.

A pregnant patient nearing her due date expresses anxiety over the labor and delivery process. Which outcome should the nurse select as appropriate for the patient during the delivery process?

Ask the woman to describe why she believes that she is in labor

A primigravida client at 39 weeks' gestation calls the OB unit questioning the nurse about being in labor. Which response should the nurse prioritize?

Prepare for an emergency cesarean delivery

A 24-year-old primigravida has been laboring longer than 24 hours. She has entered the second stage of labor, and the baby is at +2 station. The fetal heart rate has been 90 bpm for the last 2 minutes. The physician applies a Kiwi vacuum; after 3 attempts (pop-offs), the baby is not delivered, and the fetal heart rate is still 90 bpm. What should the nurse do next? Choose the best answer

maternal hypotension and fetal bradycardia

A client in labor has administered an epidural anesthesia. Which assessment findings should the nurse prioritize?

Maternal blood pressure decreases from 130/70 to 98/50 mm Hg

A client in labor has been given an epidural anesthetic. Which nursing assessment finding is most important immediately following the administration of epidural anesthesia?

Possible headache following anesthesia

A client is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia?

instruct the client or her partner to perform light fingertip repetitive abdominal massage.

A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will

"Based on your history, a vaginal delivery is not recommended, it might cause your uterus to rupture."

A client with limited prenatal care presents in labor and is requesting a VBAC. What is the nurse's response after verifying the client had a classical incision with the last cesarean delivery?

Passageway

A group of nursing students are preparing a presentation which will illustrate various components of the birthing process. When presenting the pelvis, the students should point out that it is often referred to as which term?

cervical dilation

A nurse is providing care to a pregnant woman in labor. The woman is in the first stage of labor. When describing this stage to the client, which event would the nurse identify as the major change occurring during this stage?

"rip" cervix

A nursing student has learned that cervical readiness is generally a prerequisite for successful labor induction. The student correctly uses which of the following terms to describe a cervix favorable for induction?

Bishop score

A nursing student is asking the instructor how to assess whether a cervix is ready and favorable for labor induction. The nurse informs the student that a score is used known as which of the following?

The frequency of the contractions is every 5 minutes

A pregnant client arrives to the clinic for a prenatal visit appearing uncomfortable. During the assessment, the nurse determines the client is experiencing fairly strong contractions at 12:05 p.m., 12:10 p.m., 12:15 p.m., and 12:20 p.m. What can the nurse conclude from these findings?

Simple breathing exercises Effleurage Walking & then using a birthing ball

A primigravida is 1 cm dilated, in early latent labor, and interested in avoiding epidural anesthesia. After asking about which nonpharmacologic options for pain relief she can use at this time, which option(s) should the nurse point out to the client? Select all that apply.

"A cesarean birth involves major surgery, which puts you and your baby at higher risk for complications. Your physician will discuss the options with you."

A primigravida is tired of being pregnant. She asks the nurse, "Why can't my doctor just schedule a cesarean delivery? My friend had a cesarean and everything went very well." What is the nurse's best reply?

"The baby has dropped into the pelvis; your body and baby are getting ready for labor in the next few weeks."

A primigravidia client at 38 weeks' gestation calls the clinic and reports, "My baby is lower and it is more difficult to walk." Which response should the nurse prioritize?

Infection

A woman is about to go for her first cesarean delivery and asks the nurse what complications can come from this type of delivery. The nurse correctly identifies which of the following as the number one complication of cesarean delivery?

False

A woman who has a low segment or low transverse incision cesarean birth will not be able to have a vaginal birth with future pregnancies.

Prepare to assist the RN as scrub nurse.

A woman who has already had one successful vaginal birth after prior cesarean (VBAC) has elected to deliver her third child vaginally. She reports a sudden sensation of "something snapping inside," followed by chest pain. What should the nurse do?

"Although there are some exceptions, surgical techniques allow for vaginal birth after cesarean birth."

A woman who has had a cesarean birth asks you if she will always need to have cesarean births in the future. Which of the following would be your best response?

"Babies born by cesarean section have more respiratory complications because they do not have the benefit of having the mucus in their lungs removed by the pressure experienced in the birth canal."

A woman who underwent a primary cesarean section for a breech presentation states that her neonate seems to have so much more mucus than her first baby. Concerned, she asks why this has happened. How should the nurse respond?

"The presenting part is at the true pelvis and is engaged."

The community health nurse is conducting a presentation on labor and delivery. When illustrating the birth process, the nurse should point out zero station refers to which sign?

Briefly describe what will be experienced, explain each procedure, and encourage the partner to participate.

The health care provider has ordered a cesarean delivery for an exhausted client who has been in labor for many hours with the fetus now showing increasing signs of distress. As the client and partner express disappointment in not having a natural birth (and anxiety in not knowing what will now happen), which response will the nurse prioritize?

8 to 10

The nurse has been monitoring a multipara client for several hours. She cries out that her contractions are getting harder and that she cannot do this. The nurse notes the client is very irritable, nauseated, annoyed, and doesn't want to be left alone. Based on the assessment the nurse predicts the cervix to be dilated how many centimeters?

Assess return of sensory and motor functions to the lower extremities.

The nurse has just applied a sterile pressure dressing to an epidural site after removing the epidural catheter in a client who is now recovering from a standard delivery. Which action should the nurse now prioritize?

Placenta previa Active vaginal or cervical herpes lesions A classical uterine scar

The nurse has received the beginning-of-shift report for five clients. With which conditions will the nurse anticipate a cesarean delivery? Select all that apply

These methods are a technique to prevent the painful stimuli from entering the brain.

The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?

"You're doing a great job"

The nurse is caring for a client who is a primagravida. Which statement is best to improve the client's psyche?

Complete cervical dilation and time of fetal birth

The nurse is documenting the length of time in the second stage of labor. Which data will the nurse use to complete the documentation?

"My sister had a cesarean section with the first and then needs it for all subsequent pregnancies."

The nurse is instructing a primip who has concerns about the need for a cesearan section due to her sister's obstetrical history. Which statement by the client needs further instruction?

Ambulate only with assistance from the nurse or caregiver.

The nurse is monitoring a client who just received IV sedation. Which instruction should the nurse prioritize with the client and her partner?

A cephalohematoma

The nurse is noting a collection of blood under the scalp on a newborn being discharged to home. The nurse is correct to prepare teaching instructions of which topic?

Client priorities and preferences are incorporated into the plan.

The nurse is preparing a birthing care plan for a pregnant client. Which factor should the nurse prioritize to achieve adequate pain relief during the birthing process?

Signed informed consent

The nurse is preparing a client for an emergent cesarean delivery. Which action should the nurse prioritize?

Just before birth

The nurse is preparing to assist with a pudendal block. The nurse predicts the client is at which point in the labor process

Assess for fetal heart rate.

The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering?

increase even if relaxing and taking a shower

The nurse is teaching a prenatal class on the difference between true and false labor contractions. The nurse determines the session is successful when the class correctly chooses which factor as an indication of true labor contraction?

Operative vaginal delivery

The nursing instructor is leading a group discussion on the various types of delivery. The instructor determines the session is successful when the students correctly categorize forceps or vacuum-assisted delivery as what type?

Fear of pain during labor.

The nursing instructor is teaching a group of nursing students about the uniqueness of pain involved with the birthing process. The instructor determines the session is successful when the students correctly choose which pain factor to be related to psychosocial influences?

Shoulder dystocia

The nursing instructor is teaching a group of student nurses about the current use of episiotomies during the labor process. The instructor determines the session is successful when the students correctly choose which situation that may require the health care provider to perform an episiotomy?

Head flexed forward so much that the chin touches the sternum

The obstetrician is examining a woman who is in early labor to determine the positioning of the fetus. The nurse knows that which of the following fetal attitudes would be the most advantageous for birth?

A nurse is caring for a pregnant client with rhythmic uterine contractions. Which feature should the nurse identify as associated with true labor?

increase in frequency of the contractions

The nurse is reviewing the laboratory test results of a client in labor. Which finding would the nurse consider normal?

increased WBC count