OB PrepU Chapter 14

The nurse is analyzing the readout on the EFM and determines the FHR pattern is normal based on which recording? a. Acceleration of at least 15 bpm for 15 seconds b. Deceleration followed by acceleration of 15 bpm c. Decrease in variability for 15 seconds d. Increase in variability by 27 bpm

a. Acceleration of at least 15 bpm for 15 seconds

A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication? a. indomethacin b. ampicillin c. naloxone d. epinephrine

c. naloxone

If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first? a. Help the woman to sit up in a semi-Fowler's position. b. Ask her to pant with the next contraction. c. Administer oxygen at 3 to 4 L by nasal cannula. d. Turn her or ask her to turn to her side.

d. Turn her or ask her to turn to her side.

The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy? a. acupuncture b. acupressure c. biofeedback d. effleurage

b. acupressure

The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is: a. 7.20. b. 7.25 or more. c. 7.21. d. 7.15 or less.

d. 7.15 or less.

The nurse has just administered morphine 2 mg IV to a laboring client. Which change in the fetal heart rate pattern would the nurse prioritize? a. increased variability b. late decelerations c. early decelerations d. decreased variability

d. decreased variability

Which possible outcome would be a major disadvantage of any pain relief method that also affects awareness of the mother? a. The mother may have difficulty working effectively with contractions. b. The infant may show increased drowsiness. c. The mother may have continued memory loss postpartum. d. The father's coaching role may be disrupted at times.

a. The mother may have difficulty working effectively with contractions.

A client at 41 weeks' gestation has been in labor for 18 hours and the fetus is now showing signs of distress. Due to prior back surgery, the client is to receive general anesthesia instead of an epidural. Which medication will the nurse prepare to give the client first? a. Nonsteroidal anti-inflammatory (NSAID) b. Pain medication c. Sedative d. Antacid

d. Antacid

A client is in active labor. Checking the EFM tracing, the nurse notes variables that are abnormal. What would be the nurse's first nursing intervention? a. Help the woman change positions. b. Prepare the woman for an emergency cesarean birth. c. Obtain assistance to check for a compressed umbilical cord. d. Document the finding.

a. Help the woman change positions.

The nurse assesses the client and tells her the baby is at +1 station. Which is the best response by the nurse when asked by the client what this means concerning the location of the baby? a. 1 cm above the ischial spine. b. 1 cm below the ischial spine. c. 1 cm below the symphysis pubis. d. 1 cm above the symphysis pubis.

b. 1 cm below the ischial spine.

The client wants to avoid an episiotomy. What other technique would the nurse suggest the client try? a. Massage the perineum daily during the last trimester. b. Apply warm compresses to the perineum. c. Practice Kegel exercises during pregnancy. d. Give birth to the infant while lying on her back.

b. Apply warm compresses to the perineum.

As a woman enters the second stage of labor, which would the nurse expect to assess? a. expressions of satisfaction with her labor progress b. feelings of being frightened by the change in contractions c. reports of feeling hungry and unsatisfied d. falling asleep from exhaustion

b. feelings of being frightened by the change in contractions

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: a. instruct the client to perform controlled chest breathing with a slow inhale and a quick exhale. b. lead the client through a series of visualizations to aid in relaxation. c. press down firmly with her index finger and forefinger on key trigger points on the client's ankle or wrist. d. instruct the client or her partner to perform light fingertip repetitive abdominal massage.

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

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem? a. prolonged decelerations b. early decelerations c. variable decelerations d. accelerations

a. prolonged decelerations

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? a. "The analgesia will limit your ability to be out of bed without assistance." b. "The analgesia will block pain sensation and limit your ability to push." c. "The analgesia will reduce the sensation of pain for a limited period of time." d. "The analgesia will allow for a pain-free birth experience."

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

At what time is the laboring client encouraged to push? a. When the nurse wants the client to push b. When the health care provider has arrived c. When the cervix is fully dilated d. When the fetal head can be seen

c. When the cervix is fully dilated

When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching? a. "Epidural anesthesia is more effective than opioid analgesia in providing pain relief." b. "You have no trouble walking around and using the bathroom after you receive the epidural." c. "You can continuously receive epidural anesthesia until you have the baby, and even afterward if you need it." d. "If you end up having a cesarean, the epidural can be used for anesthesia during surgery."

b. "You have no trouble walking around and using the bathroom after you receive the epidural."

In the labor and delivery unit, which is the best way to prevent the spread of infection? a. Provide clean gloves in the room b. Complete hand hygiene c. Use sterile gloves d. Limit vaginal examinations

b. Complete hand hygiene

A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using? a. abdominal imagery b. pain pathway blockage c. massage d. effleurage

d. effleurage

A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse? a. "The injection is given at the third or fourth thoracic vertebrae so paralysis is not a problem." b. "The injection is given in the space outside the spinal cord." c. "An injury is unlikely because of expert professional care given." d. "I have never read or heard of this happening."

b. "The injection is given in the space outside the spinal cord."

During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor? a. Obtain urine specimen for urinalysis. b. Assess amount of cervical dilation. c. Monitor vital signs. d. Monitor hydration status.

b. Assess amount of cervical dilation.

A client in labor has requested the administration of narcotics to reduce pain. At 2 cm cervical dilation (dilatation), she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do? a. Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. b. Agree with the client, and administer the drug immediately to keep the pain manageable. c. Refuse to administer narcotics because they can develop dependency in the client and the fetus. d. Explain to the client that narcotics should only be administered an hour or less before birth.

a. Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor.

The pain of labor is influenced by many factors. What is one of these factors? a. The woman is prepared for labor and birth. b. The woman has lots of visitors during labor. c. The woman has a high threshold for pain. d. The woman has a high tolerance for pain.

a. The woman is prepared for labor and birth.

The nursing instructor is teaching the students the basics of the labor and delivery process. The instructor determines the session is successful when the students correctly choose which action will best help to prevent infections in their clients? a. Thoroughly wash the hands before and after client contact. b. Strictly follow universal precautions. c. Replace soiled drapes and linen as needed. d. Clean the woman's perineum with a Betadine scrub.

a. Thoroughly wash the hands before and after client contact.

A nurse is preparing a client for rhythm strip testing. She places the woman into a semi-Fowler position. What is the appropriate rationale for this measure? a. To prevent supine hypotension syndrome b. To aid the woman as she pushes during labor c. To prevent the woman from falling out of bed d. To decrease the heart rate of the fetus

a. To prevent supine hypotension syndrome

The nurse is monitoring a client's uterine contractions. Which factors should the nurse assess to monitor uterine contraction? Select all that apply. a. frequency of contractions b. uterine resting tone c. change in blood pressure d. intensity of contractions e. change in temperature

a. frequency of contractions b. uterine resting tone d. intensity of contractions

A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia? a. headache following anesthesia b. passage of the drug to the fetus c. excessive contractions of the uterus d. increased frequency of micturition

a. headache following anesthesia

The licensed practical nurse is evaluating the tracings on the fetal heart monitor. The nurse is concerned that there is a change in the tracings. What should the LPN do first? a. Notify the registered nurse. b. Assess and reposition the woman. c. Notify the health care provider. d. Wait 2 minutes to review another tracing.

b. Assess and reposition the woman.

A nurse places an external fetal monitor on a woman in labor. Which instruction would be best to give her? a. Lie supine so the tracing does not show a shadow. b. Lie on her side so she is comfortable. c. Avoid using her call bell to reduce interference. c. Avoid flexing her knees so her abdomen is not tense.

b. Lie on her side so she is comfortable.

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? a. Assess maternal blood pressure. b. Assess for constipation. c. Assess fetal heart rate. d. Assess for dry mouth.

c. Assess fetal heart rate.

The nurse is admitting a client who is in early labor. After determining that the birth is not imminent, which assessment should the nurse perform next? a. Maternal obstetrical history b. Risk factors c. Fetal status d. Maternal status

c. Fetal status

The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next? a. tactile stimulation b. fetal scalp stimulation c. administration of oxygen by mask d. application of vibroacoustic stimulation

c. administration of oxygen by mask

A woman in labor who is receiving an opioid for pain relief is to receive promethazine. The nurse determines that this drug is effective when the woman demonstrates which finding? a. decreased sedation b. increased cervical dilation (dilatation) c. less anxiety d. increased feelings of control

c. less anxiety

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? a. The health care provider decides the best pain relief for the mother and family. b. The nurse suggests alternative methods of pain relief. c. The client has the baby without any analgesic or anesthetic. d. Client priorities and preferences are incorporated into the plan.

d. Client priorities and preferences are incorporated into the plan.

A low-risk client is in the active phase of labor. The nurse evaluates the fetal monitor strip at 10:00 a.m. and notes the following: moderate variability, FHR in the 130s, occasional accelerations, and no decelerations. At what time should the nurse reevaluate the FHR? a. 10:30 a.m. b. 11:15 a.m. c. 11:30 a.m. d. 10:05 a.m.

a. 10:30 a.m.

A nurse is auscultating the fetal heart rate of a woman in labor. To ensure that the nurse is assessing the FHR and not the mother's heart rate, which action would be most appropriate for the nurse to do? a. Palpate the mother's radial pulse at the same time. b. Instruct the woman to bend her knees and flex her hips. c. Have the woman lie completely flat on her back while auscultating. d. Ask the woman to hold her breath while assessing the FHR.

a. Palpate the mother's radial pulse at the same time.

A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage? a. Immersing the client in warm water in a pool or hot tub b. Administering a sedative such as secobarbital or pentobarbital c. Administering an opioid such as meperidine or fentanyl d. Practicing effleurage on the abdomen

d. Practicing effleurage on the abdomen

During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used. -----

-4 station -2 station 0 station +2 station +4 station

The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client? a. Prenatal classes b. Continuous labor support c. Massage therapy d. Pharmacologic pain management

b. Continuous labor support

The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding? a. Rupture of amniotic membranes b. Dilation (dilatation) of cervix c. Bloody show d. Engagement of fetus

b. Dilation (dilatation) of cervix

The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor? a. Pain is focal in nature. b. Pain originates from the cervix and lower uterine segment. c. It is reported as the worst pain a woman will ever feel. d. Diffuse abdominal pain signals a complication with progression of labor.

b. Pain originates from the cervix and lower uterine segment.

Which nursing action prevents a complication associated with the lithotomy position for the birth of the fetus? a. Massaging the client's lower back b. Placing a wedge under the hips c. Providing a paper bag d. Rubbing the client's legs

b. Placing a wedge under the hips

A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next? a. temperature b. respiratory rate c. pulse d. uterine contractions

b. respiratory rate

As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next? a. Elevate her hips to prevent cord prolapse. b. Assess fetal heart rate for fetal safety. c. Test a sample of amniotic fluid for protein. d. Ask her to bear down with the next contraction.

b. Assess fetal heart rate for fetal safety.