OB Questions- Set 2

Following a delivery of twins a patient may be predisposed to experiencing a postpartum hemorrhage. The nurse understands that the reason for this is a) Atony of the uterus b) A secondary infection c) A laceration of the cervix d) Retained placental fragments

a) Atony of the uterus (Rationale- Atony often results from an overdistened uterus; uterine contraction does not occur readily)

A patient is admitted to the labor room in early active labor. The priority nursing intervention on admission of this laboring pt would be a) Auscultating fetal heart b) Taking an obstetric history c) Asking the pt when she ate last d) Ascertaining if the membranes are ruptured

a) Auscultating fetal heart (Rationale- Determining fetal well-being supersedes all other measures; if the fetal heart rate is absent or persistently decelerating, immediate intervention is required)

The breathing technique that the mother should be instructed to use during delivery as the fetus head is crowning is a) Blowing b) Slow chest c) Shallow breaths d) Accelerated-decelerated

a) Blowing (Blowing forcefully through the mouth controls the strong urge to push and allows for a more controlled delivery of the head.)

True labor can be differentiated from false labor because in true labor contractions will a) Bring about progressive cervical dilation b) Occur immediately after membrane rupture c) Stop when the pt is encouraged to walk around d) Be less uncomfortable if pt is in a side-lying position

a) Bring about progressive cervical dilation (Rationale- Progressive dilation of the cervix is the most accurate indication of true labor.)

A baby is delivered precipitously in the labor room. The nurse's initial action should be to a) Establish an airway for the baby b) Ascertain the condition of the funds c) Quickly tie and cut the umbilical cord d) Move mother and baby to the delivery room

a) Establish an airway for the baby (Rationale-Position the baby with head lower than chest and ub the infant's back to stimulate crying so he or she can oxygenate the lungs.)

The nurse should teach pregnant women the importance of conserving the "spurt of energy" before labor because a) Fatigue may influence need for pain medication b) Energy helps to increase the progesterone level c) Energy is needed to push during the first stage of labor d) This energy will decrease the intensity of the uterine contractions

a) Fatigue may influence need for pain medication (Rationale- Fatigue will influence other coping strategies, for instance her ability to use distraction, etc)

The management of a patient in the transition phase of labor is primarily directed toward a) Helping the patient maintain control b) Decreasing the intravenous fluid intake c) Reducing the patient's discomfort with medication d) Having the patient breathe simple breathing patterns during contractions

a) Helping the patient maintain control (Rationale- This is the most difficult part of labor and the client needs encouragement and support to cope.)

The two most important predisposing causes of postpartum infection are a) Hemorrhage and trauma during labor b) Preeclampsia and retention of placenta c) Malnutrition and anemia during pregnancy d) Organisms present in the birth canal and trauma during labor

a) Hemorrhage and trauma during labor (Rationale- Blood loss depletes the normal cellular response to infection; trauma provides an excellent avenue for bacteria to enter.)

Sheila is in active labor and begins to tremble, becomes tense with contractions and is quite irritable. She frequently states, "I cannot stand this a minute longer." This kind of behavior may be indicative of the fact that the patient a) Is entering the transition phase of labor b) Needs immediate administration of an analgesic or anesthetic c) Has been poorly prepared for labor in the parents' classes d) Is developing some abnormality in terms of uterine contractions

a) Is entering the transition phase of labor (Rationale- The contractions become stronger, last longer, and are erratic during this stage; the intervals during the contractions are shorter than the contractions themselves; much concentration and effort are needed by the mother to pace herself with each contraction.)

Eight hours after delivery the nurse notices that a patient is voiding frequently in small amounts. Intake and output are important in the early postpartum period because small amounts of output a) May indicate retention of urine with overflow b) Are commonly voided and should cause no alarm c) May be indicative of beginning glomerulonephritis d) Are common because less fluid is excreted following delivery

a) May indicate retention of urine with overflow (Rationale- Retention of urine with overflow ill be manifested in small, frequent voidings. The bladder should be palpated for distention.)

Heather is in active labor and spontaneously ruptures membranes. The nurse should first a) Monitor the FHR b) Call the physician c) Check BP and pulse d) Time the contractions

a) Monitor the FHR (Rationale- When the membranes rupture, there is always the possibility of a prolapsed cord leading to fetal distress, which would manifest itself in a slowed fetal heartbeat.)

Following the delivery of the placenta in a pt who has 6 living children, an infusion of lactated ringers with 10 units of piton is ordered. The nurse understands that this is indicated for this pt because a) Multigravidas are at increased risk for uterine atony b) Retained placental fragments must be expelled c) This was an extramural delivery d) She had a precipitate delivery

a) Multigravidas are at increased risk for uterine atony (Rationale-Multiple pregnancies and deliveries result in overstretched uterine muscles that do not contract efficiently, and bleeding may ensue.)

A laboring pt begins to experience contractions 2 to 3 minutes apart that last about 45 seconds. Between contractions the nurse records a fetal heart rate of 100 BPM. The nurse should a) Notify the physician immediately b) Continue to monitor the fetal heart c) Closely monitor the maternal vital signs d) Chart the rate as a normal response to labor

a) Notify the physician immediately (Rationale- Bradycardia indicates fetal distress and requires medical interventions.

When caring for a patient with an episiotomy during the postpartum period, the nurse encourages sits baths three times a day for 15 minutes. Sitz baths primarily aid the healing process by a) Promoting vasodilation b) Softening the incisional site c) Cleansing the perineal area d) Tightening the rectal sphincter

a) Promoting vasodilation (Rationale- Heat causes vasodilation and an increased blood supply to the area.)

When assessing patients after delivery, the nurse should be aware that postpartum hemorrhage rarely occurs as a complication of a) Retained placenta b) Overdistended bladder c) Delivery of twins or hydramnios d) Uncomplicated gestational hypertension

a) Uncomplicated gestational hypertension (rationale- Uncomplicated gestational htn does not interfere with uterine involution, return of uterine tone, or constriction of vessels at the placental site.)

A laboring patient is to have a pudental block. The nurse plans to tell the patient that once the block is working she a) Will not feel the episiotomy b) May lose the ability to push c) May lose bladder sensation d) WIll no longer feel contractions

a) Will not feel the episiotomy (Rationale- A prudential block provides anesthesia to the perineum, but does not affect muscle control, does not affect the bladder, and only anesthetizes the perineum not the cervix or body of uterus)

When caring for a pt who is having a prolonged labor, the nurse must be aware that the pt is very concerned when her labor deviates from what she sees as the norm. A response conveying acceptance of the pt's expressions of frustration and hostility would be: a) "I'll rub your back; tell me if it helps." b) "ill leave you so you can talk to your husband." c) "all women get weary and frustrated during labor." d) "Would you like to talk about what's bothering you?"

a) i'll rub your back; tell me if it helps. rationale- this response provides the pt w/a comfort measure while giving her an opportunity to verbalize her fears about having an abnormal labor. (d is wrong bc it answers yes or no and leaves no avenue for further discussion)

The nurse teaches a multipara who has just delivered a large baby what to do to maintain a contracted uterus. The nurse recognizes that teaching has been effective when the patient states a) "If I start to bleed I will call for help." b) "I will gently massage my uterus to keep it firm." c) "If I urinate frequently, my uterus will stay contracted." d) "I will call you every 15 minutes to massage my uterus."

b) "I will gently massage my uterus to keep it firm." (Rationale- The urterus responds rapidly to touch and this involves the mother in her care.)

The husband of a pt who is in the transitional phase of labor becomes very tense and nervous during this period and asks the nurse, "Do you think it is best for me to leave, since I don't seem to do my wife much good?" The most appropriate response by the nurse would be: a) "This is the time your wife needs you. Don't run out on her now." b) "This is hard for you. Let me try to help you coach her during this difficult phase." c) "I know this is hard for you. Why don't you go have a cup of coffee and relax and come back later if you feel like it?" d) "If you feel that way, you'd best go out and sit in the father's waiting room for a while because you may transmit your anxiety to your wife."

b) "This is hard for you. Let me try to help you coach her during this difficult phase." (rationale- both the father and the mother need emotional support during the transitional stage of labor)

A primigravida, 40 weeks gestation, is admitted with Q 3 to 5 min contractions, a bloody show, and intact membranes. Vaginal examination reveals that the cervix is fully effaced, 6cm dilated, and the head is +1 station. The nurse is aware that according to these data the pt is in the a) Latent phase of labor b) Active phase of labor c) Transition phase of labor d) Accelerated phase of labor

b) Active phase of labor (Rationale- Characteristics of the mid phase of labor for the primiparous pt include regular contractions 30 to 45 secs long and 3 to 5 mins apart, station of the presenting part at +1 to +2, and pink to bloody show in moderate amount.)

The nurse teaches a pregnant woman to avoid lying on her back during labor. The nurse has based this statement on the knowledge that the supine position ca a) unduly prolong labor b) Cause decreased placental perfusion c) Interfere with free movement of the coccyx d) Lead to transient episodes of hypertension

b) Cause decreased placental perfusion (Rationale- This is because of impedance of venous return by the gravid uterus, which causes hypotension and decreased systemic perfusion.)

When examining the fetal monitor strip following rupture of the membranes in a laboring patient, the nurse notes decelerations in the fetal heart rate. The nurse should a) Stop the oxytocin infusion b) Change the patient's position c) Prepare for immediate delivery d) Take the patient's blood pressure

b) Change the patient's position (Rationale- Variable decelerations are often seen as a result of cord compression; a change of position will relieve the pressure on the cord.)

During an emergency delivery, the nurse notes the baby's head crowning on the perineum. The nurse's priority action is to support head by a) Applying suprapubic pressure over it b) Distributing the fingers evenly around it c) Placing a hand firmly against the perineum d) Maintaining firm pressure against the anterior fontanel

b) Distributing the fingers evenly around it (Rationale- Distribution of the fingers around the head will prevent a rapid change in inctracranial pressure while the head is being delivered.)

A pt undergoes a cesarean delivery because of cephalopelvic disproportion. In addition to the routine care given to all postpartum patients during the first 24H, the nurse should a) Encourage early ambulation b) Maintain IV infusion of oxytocin c) Check the funds gently but firmly d) Check vital signs for evidence of shock

b) Maintain IV infusion of oxytocin (rationale- IV oxytocin is used to enhance postpartum uterine contractions after c-section delivery because massage of the fundus is difficult and painful immediately after surgery. The drug produces effective clamping down on the vessels.)

When determining the difference between cephalhematoma and kaput succedaneum, the nurse understands that with kaput succedaneum the a) Affected area will be tender b) Swelling crosses the suture line c) Swelling increases within 24 hours d) Scalp over the swelling becomes ecchymotic

b) Swelling crosses the suture line (rationale- this is the sign that differentiates between these two conditions.)

A laboring primipara should be prepared for delivery when the nurse observes a) The patient becoming irritable and not following instructions b) That the perineum is beginning to bulge with each contraction c) An increase in the amount of bloody discharge from the vagina d) The contractions are occurring every 2 to 3 minutes and lasting 60 seconds

b) That the perineum is beginning to bulge with each contraction (Rationale- The bulging perineum indicates that the fetal head is on the pelvic floor and birth is imminent)

The nurse withholds foods and limits fluids as a laboring patient approaches the second stage of labor because a) The mechanical and chemical digestive process requires energy that is needed for labor b) Undigested food and fluid may cause nausea and vomiting and limit the choice of anesthetic c) Food will further aggravate gastric peristalsis, which is already increased because of the stress of labor d) The gastric phase of digestion stimulates the release of hydrochloric acid and may cause dyspepsia

b) Undigested food and fluid may cause nausea and vomiting and limit the choice of anesthetic (Rationale-Gastric peristalsis often ceases during periods of stress. Abdominal contractions put pressure n the stomach and can cause nausea and vomiting, increasing the risk of aspiration.)

During the period of induction of labor, a patient should be observed carefully for signs of a) Severe pain b) Uterine tetany c) Hypoglycemia d) Prolapse of the umbilical cord

b) Uterine tetany (Rationale- Uterine tetany would result from the use of oxytocin to induce labor. Because oxytocin promotes powerful uterine contractions, exogenous administration of this hormone may induce uterine tetany, which does not optimize progression of labor and may restrict fetal blood flow.)

At At 38 weeks gestation a pt begins active labor and is placed on a fetal monitor. Late decelerations in the FHR begin to appear when she is 6cm dilated, with Q 4 min contractions lasting 45 seconds. Late decelerations may signify a) Imminent vaginal delivery b) Uteroplacental insufficiency c) A pattern of non progressive labor d) A reassuring response to contractions

b) Uteroplacental insufficiency (Rationale- Late decelerations are indicative of uteroplacental insufficiency and if left uncorrected leads to fetal hypoxia and/or myocardial depression)

During the taking-hold phase, the nurse would expect the new mother to a) talk about the baby b) call the baby by name c) touch the baby with her fingertips d) be passively involved with the baby

b) call the baby by name (rationale- the mother has completed the taking-in phase and has moved into the taking-hold phase when she calls baby by name because in this phase the mother has active maternal involvement with self and infant.)

A 16 yo who is 30 weeks gestation, begins to experience contractions every 5 to 7 minutes. she is admitted to the hospital with suspected preterm labor. It is determined that the pt's baby would be at severe risk if delivered because of lung immaturity. The pt is receiving terbutaline to fault labor, without adequate response. The nurse should expect the health care provider to order a) Lactated ringers b) ritodrine Hcl (yutopar) c) progest-50 (progesterone) d) theophylline (aminophylline)

b) ritodrine hcl (yutopar) (rationale- this is another tocolytic agent that stops uterine contractions and halts labor.)

A primigravida at term is admitted with contraction Q5-8 minutes and a bloody show. She and her husband attended childbirth preparation classes. Vaginal exam reveals 3cm dilation and 75% effacement, +1 station with occiput anterior, and intact membranes. The patient is cheerful and relaxed and asks the nurse if it is all right for her to walk around. Based on the observations of the patient's contractions and knowledge of the physiology and mechanism of labor, the nurse could best respond a) "I can't make a decision on that; you will have to ask the doctor." b) "please stay in bed; walking may interfere with proper uterine contractions." c) "It is quite all right for you to be up and about as long as you feel comfortable and your membranes are intact." d) "You will have to stay in bed; otherwise your contractions cannot be timed and no one can listen to the fetal heart."

c) "It is quite all right for you to be up and about as long as you feel comfortable and your membranes are intact." (Rationale- Contractions are stronger and more regular when the woman is standing; also, during walking the diameter of the pelvix inlet increases and allows for easier entrance of the head into the pelvis.)

Several hours after delivery when assessing a patient's episiotomy, the nurse finds there is edema with severe ecchymosis, and the pt is complaining of severe perineal and rectal pressure. The funds is firm and there is no lochia. The vital signs are T 99 degrees F, P 108, RR 20, BP 105/60. This assessment most likely indicates a) An urinary infection b) An uterine infeciton c) A vaginal hematoma d) A postpartal hemorrhage

c) A vaginal hematoma (Rationale- These are classic symptoms of a vaginal hematoma)

The nurse notifies the physician that a patient has been admitted in her 36 week of pregnancy. The patient is bleeding, has severed abdominal pain, a hard funds, and is demonstrating signs of shock. In addition to notifying the physician, the nurse also prepares for a) A high forceps delivery b) The insertion of a fetal monitor c) An immediate cesarean delivery d) The administration of oxytocin (Pitocin)

c) An immediate cesarean delivery (Rationale- Immediate cesarean delivery is the treatment of choice for complete placental separation. The risk of fetal death is too high to delay.)

A patient delivers a healthy baby girl. An indication to the nurse that the placenta is beginning to separate from the uterus and is about ready to be delivered would be the a) Descent of the uterus in the abdomen b) Relaxation and softening of the uterus c) Appearance of a sudden gush of blood d) Retraction of the umbilical cord into the vagina

c) Appearance of a sudden gush of blood (Rationale- When the placenta separates from the uterine wall, it tears blood vessels and results in a gush of blood from the vagina.)

A laboring patient complains of low back pain. To increase the patient's comfort the nurse should recommend that the patient's husband a) Instruct her to flex her knees b) PLace her in the supine position c) Apply back pressure during contractions d) Help her perform neuromuscular control exercises

c) Apply back pressure during contractions (Rationale- The application of back pressure combined with frequent positional changes will help alleviate the discomfort.)

A patient, 41 weeks gestation, comes to the labor suite with a bloody show and no contractions. A vaginal exam reveals that the baby's head is at +1 station. To induce labor the nurse should expect an order for a) A tap-water enema b) An IM injection of oxytocin c) Artificial rupture of membranes d) Administration of prostaglandins

c) Artificial rupture of membranes (Rationale- Transcervical amniotomy requires that the cervix be soft, partially effaced, and slightly dilated with the presenting part engaged or engaging; this pt would meet these criteria, as demonstrated by the bloody show and the head at +1 station.)

After doing Leopold's maneuvers on a laboring patient, the nurse determines the fetus is in the ROP position. TO best auscultate the fetal heart tones, the Doppler is placed a) Above the umbilicus at the midline b) Above the umbilicus on the left side c) Below the umbilicus on the right side d) Below the umbilicus near the left groin

c) Below the umbilicus on the right side (Rationale- Fetal heart tones are best auscultated through the fetal back; because the position is ROOP (RIght Occiput Presenting), the back would be below the umbilicus and on the right side.)

The nurse observes Angel's amniotic fluid and decides that it appears normal, because it is a) Clear and dark-amber colored b) Milky, greenish yellow, containing shreds of mucus c) Clear, almost colorless, containing little white specks d) Cloudy, greenish-yellow, containing little white specks

c) Clear, almost colorless, containing little white specks (Rationale- BY 36 weeks gestation, normal amniotic fluid is colorless with small particles of vernix caseosa present)

A laboring patient is placed on an external fetal monitor. The nurse notes that fetal heart decelerates in a uniform wave shape reflecting the shape of the contraction. The nurse should a) Notify the physician because there may be head compression b) Place the pt in a knee-chest position to avoid cord compression c) Continue to observe for return of fetal heart rate to baseline when contraction ends d) Put the pt in a dorsal recumbent position to prevent compression of the vena cava

c) Continue to observe for return of fetal heart rate to baseline when contraction ends (Rationale- This may occur with head compression but is perfectly normal if the FHR returns to baseline at the end of the contraction)

The membranes of a pt who is 39 weeks pregnant have ruptured spontaneously. She comes to the hospital accompanied by her husband. Her cervix is 4cm dilated and 75% effaced. The FHR is 136. The nurse should a) Place the mother in bed and attach an external fetal monitor b) Let the mother undress while the nurse takes the history from the father c) Introduce the staff nurses to the couple and try to make them feel welcome d) Have them wait in the examining room while the nurse notifies the physician they have arrived

c) Introduce the staff nurses to the couple and try to make them feel welcome (Rationale- The pt is in the first stage of labor, and the first priority of care is to establish a trusting relationship with her and her husband. This will help to allay their anxiety.)

When teaching a young primigravida about labor, the nurse should tell her to come to the hospital when a) Contractions are 10 to 15 minutes apart b) She has a bloody show and back pressure c) Membranes rupture or contractions are 5 to 8 minutes apart d) Contractions are 2 to 3 minutes apart and she cannot walk about

c) Membranes rupture or contractions are 5 to 8 minutes apart (Rationale- When the membranes rupture, the potential for infection is increased and when the contraction are 5 to 8 minutes apart, they are usually of sufficient force to warrant medical supervision. Therefore, for the safety of the mother and fetus, the mother should go to the hospital.)

A primigravida, 40 weeks gestation, arrives at the birthing center with abdominal cramping a bloody show. Her membranes ruptured 30 minutes before arrival. A vaginal exam reveals 1cm dilation and presenting part at -1 station. After obtaining the fetal heart rate and maternal vital signs the nurse should a) Teach the patient how to push b) Review Lamaze breathing techniques with the patient c) Provide the patient with comfort measures used for women in labor d) Prepare to type and cross-match the patient's blood for a possible transfusion

c) Provide the patient with comfort measures used for women in labor (Rationale- The pt is experiencing the expected discomforts of labor; the nurse should initiate measures that will promote relaxation.)

The physician asks the nurse the frequency of a laboring pt's contractions. The nurse assesses the pt's contractions by timing from t he beginning of one contraction a) Until the time it is completely over b) To the end of a second contraction c) To the beginning of the next contraction d) Until the time that the uterus becomes very firm

c) To the beginning of the next contractions (Rationale- This is the way to determine the frequency of the contractions)

Following delivery the nurse teaches a patient to cleanse her episiotomy to prevent infection. The nurse determines that the teaching was effective when the patient a) Changes her perineal pad at least twice daily b) Rinses with water after applying an analgesic spray c) Washes her hands before and after changing perineal pads d) Cleanses her perineum from anus toward symphysis pubis

c) Washes her hands before and after changing perineal pads (rationale- This action prevents the transfer of microorganisms from the hands to the genital tract or from the genital tract to the hands.)

A pt begins preterm labor and the physician order terbutaline sulfate (brethine). After its administration, the nurse assesses the pt for the therapeutic effect of a) reduction of pain in the perineal area b) decrease in BP from 120/80 to 90/60 c) decrease in frequency and duration of contractions d) dilation of the cervix from 1 to 1.5cm for every hour of labor

c) decrease in frequency and duration of contractions (rationale- Terbutaline sulfate (brethine) is a betamimetic drug that acts not he smooth muscles of the uterus to reduce contractility, which in turn inhibits dilation and contractions.)

At about 5cm,a laboring pt receives medication for pain. The nurse is aware that one of the medications given to women in labor that could cause respiratory depression of the newborn is a) scopolamine b) promazine (Sparine) c) meperidine (demerol) d) promethazine (phenergan)

c) meperidine (demerol) (rationale- Respiratory depression occurs with the use of demerol and produces significant depression of the infant at birth if circulating elves are high at delivery.)

Following delivery, while considering nursing measures to help parent-child relationships, the nurse should be aware that the most important factor at this time is the a) anesthesia during labor b) duration and difficulty of labor c) physical condition of the infant d) health status during pregnancy

c) physical condition of the infant (rationale- bonding between parent and infant is most successful when interaction is possible right after birth; if the child is ill, contact is limited.)

A pt who was admitted in active labor has only progressed from 2cm to 3cm in 8 hours. She is diagnosed as having hypotonic dystocia and is given oxytocin (Pitocin) to augment her contractions. The most important aspect of nursing at this time is a) monitoring the FHR b) checking perineum for bulging c) timing and recording length of contractions d) preparing for an emergency cesarean delivery

c) timing and recording length of contractions (rationale- the oxytocic effect of piton increases the intensity and durations of contractions. prolonged contractions will jeopardize the safety if the fetus and necessitate discontinuing the drug.)

After an 8-hour, uneventful labor a pt delivers a baby boy spontaneously under epidural block anesthesia. As the nurse places the baby in the mother's arms immediately following delivery, the mother asks, "Is he normal?" The most appropriate response by the nurse would be: a) "Most babies are normal; of course he is." b) "He must be all right, he has such a good strong cry." c) "Yes, because your pregnancy and labor were so normal." d) "Shall we unwrap him so you can look him over for yourself?"

d) "Shall we unwrap him so you can look him over for yourself?" (rationale- mothers need to explore their infants visually and tactilely to assure themselves that the infants are normal in all respects)

A birth hazard associated with breech delivery may be a) Abrupto placentae b) Cephalhematoma c) Pathologic jaundice d) Compression of cord

d) Compression of the cord (Rationale- the cord may prolapse, and pressure of the baby's head on the cord may compress the cord causing fetal hypoxia.)

A multigravida has a normal spontaneous vaginal delivery of a healthy infant. Five minutes after delivery of the infant the placenta is expressed. The nurse upon assessing the fundus at this time would expect the funds to be a) Difficult to find b) Just below the xiphoid process c) At the umbilicus in the upper right quadrant d) Halfway between the symphysis pubis and the umbilicus

d) Halfway between the symphysis pubis and the umbilicus (Rationale- Immediately following delivery the funds is found midway between the symphysis pubis and the umbilicus)

The postpartum nurse should encourage newly delivered patients to ambulate early in order to a) Promote respiration b) Increase the tone of the bladder c) Maintain tone of abdominal muscles d) Increase peripheral vasomotor activity

d) Increase peripheral vasomotor activity (Rationale- There is extensive activation of the blood clotting factor after delivery; this, together with immobility, trauma, or sepsis, encourages thromboembolization, which can be limited through activity.

During the first hour after a cesarean delivery, the nurse notes that the patient's lochia has saturated one peripad. Based on the knowledge of normal local flow, the nurse conclude that this indicates a) Scant lochial flow b) Postpartum hemorrhage c) Retained placental fragments d) Lochial flow within normal limits

d) LOchial flow within normal limits (Rationale- Up to 2 peripads can be saturated normally in the first hour)

A low Apgar score at 5 minutes after birth correlates with the occurrence of a) Cerebral palsy b) Genetic defects c) Mental retardation d) Neonatal morbidity

d) Neonatal morbidity (Rationale- This is related to neonatal morbidity and mortality; by 5 minutes the healthy neonate is relatively stable and requires minimal care.)

The expectant couple asks the nurse about the cause of low back pain in labor. The nurse replies that his pain occurs most when the position of the fetus is a) Breech b) Transverse c) Occiput anterior d) Occiput posterior

d) Occiput posterior (Rationale- A persistent occiput-posterior position causes intense back pain because of fetal compression of the sacral nerves.)

During delivery the physician performs an episiotomy. The nurse reminds the patient that this is most commonly done to a) Stretch the perineum b) Limit postpartal discomfort c) Reduce trauma to the fetus d) Prevent lacerations during birth

d) Prevent lacerations during birth (Rationale-A neat surgical incision is usually easier to repair and quicker to heal than an irregular laceration.)

A patient is admitted to the hospital in active labor. After an amniotomy the nurse would expect a) Diminished bloody show b) Increased fetal heart rate c) Less discomfort with contractions d) Progressive dilation and effacement

d) Progressive dilation and effacement (Rationale- Artificial rupture of the membranes allows for more effective pressure of the fetal head on the cervix, enhancing dilation and effacement.)

A patient is admitted in active labor; the baby's head is crowning, the patient is bearing down, and delivery appear imminent. The nurse should a) Transfer her immediately by stretcher to the delivery room b) Tell her to breathe through her mouth and not to bear down c) Instruct the patient to pant during contractions and to breathe through her mouth d) Support the perineum with the hand to prevent tearing and tell the patient to pant

d) Support the perineum with the hand to prevent tearing and tell the patient to pant (Rationale- Gentle pressure is applied against the baby's head as it emerges so it is not delivered too rapidly. The head is never held back and it should be supported as it emerges so there will be no vaginal lacerations.)

When a patient is positioned for delivery, both legs should be positioned simultaneously to prevent a) Venous stasis in the legs b) Pressure on the perineum c) Excessive pull on the fascia d) Trauma to the uterine ligaments

d) Trauma to the uterine ligaments (Rationale- As the uterus rises into the abdominal cavity, the uterine ligaments become elongated and hypertrophied; raising both legs at the same time limits the tension placed on these ligaments.)

The safest position for a woman in labor when the nurse notes a prolapsed cord is a) Prone b) Fowler's c) Lithotomy d) Trendelenburg

d) Trendelenburg (Rationale- A positioni n which the mother's head is below the level of the hips helps decrease compression of the cord and therefore maintains the blood supply to the infant.)

A patient in labor is fully dilated, totally effaced, and the head is at +2. During each contraction the nurse should encourage her to a) Push with glottis open b) Blow so as not to grunt c) Relax by closing her eyes d) Pant to prevent cervical edema

A) PUsh with glottis open (Rationale- The contractins in this phase of labor are expulsive in nature; having the pt push or bear down with the glottis open will hasten expulsion.)

The primary critical observation for Apgar scoring is the a) Heart rate b) Respiratory rate c) Presence of meconium d) Evaluation of Moro reflex

a) Heart rate (Rationale- Heart rate is vital and is the most critical observation in Apgar scoring at birth.)

A patient is being prepared for an emergency cesarean delivery because of fetal distress. The most important thing for the nurse to assess before surgery is a) A signed consent is on the chart b) A Foley catheter has been inserted c) An IV of LR has been started d) The abdomen has been shaved and prepared

a) A signed consent is on the chart (Rationale- It is imperative that a consent be obtained before anesthesia is indured.)

One of the most common causes of hypotonic uterine dystocia is a) Twin gestation b) Maternal anemia c) Pelvic contracture d) Pregnancy-induced hypertension

a) Twin gestation (Rationale- Multiple pregnancy thins the uterine wall by over-stretching; thus the efficiency of contractions is reduced.)

To promote comfort during back labor, the nurse teaches the patient to avoid the a) Sitting position b) Supine position c) Side-lying position d) Knee-Chest position

b) Supine position (Rationale-Low back pain is aggravated when the mother is in the supine position because of increased pressure from the fetus.)

Amber is gravida 1, para 0, and admitted in labor. Her cervix is 100% effaced and she is dilated 3cm. Her fetus is a 1+ station. The nurse is aware that the fetus' head is a) not yet engaged b) Entering the pelvic inlet c) Below the ischial spines d) Visible at the vaginal opening

c) Below the ischial spine (Rationale- A station of +1 indicates that the fetal head is 1cm below the ischial spines)