OB QUIZ 5 CH 13/15/16 (ATI 5/11/12/13/14) [EXAM 2]

a nurse is reviewing a new prescription for iron supplements with a client who is in the 8th week of gestation and has iron deficiency anemia. which of the following beverages should the nurse instruct the client to take the iron supplements with? a. ice water b. low fat or whole milk c. tea or coffee d. orange juice

d. orange juice contains vitamin c, which aids in the absorption of iron

The nurse is assisting a woman through labor, monitoring her closely now that she has received an epidural. The nurse would report which finding to the anesthesiologist? a. Dry, cracked lips b. Urinary retention c. Rapid progress of labor d. Inability to push

D. Inability to push Rationale: If she is not able to push, her epidural dose may be adjusted to decrease the impact on the sensory system.

A patient you care for in labor asks you what causes labor to begin. Which of the following statements is a possible explanation? a. Progesterone levels rise at term to initiate contractions. b. The ovary releases additional estrogen at term. c. Prostaglandins may be the causative factor of labor. d. Calcium is drawn from bones to block relaxation fibers.

C. Prostaglandins may be the causative factor of labor. Rationale: The cause of labor is unknown, but prostaglandin release is one of the possible causes.

a nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. the clients partner asks about the purpose of the IV fluids. which of the following is an appropriate response for the nurse to make? a. it is needed to promote urine output b. it is needed to counteract respiratory depression c. it is needed to counteract hypotension d. it is needed to prevent oligohydramnios

3. maternal hypotension can occur following an epidural block and can be offset by administering an IV fluid bolus

Although the time frame for labor differs with individual women, which time period would you find excessive for a nullipara woman? a. A latent phase of labor of 24 hours b. A deceleration phase of 2 hours c. A phase of maximum slope of 1.5 cm per hour d. A fetal descent slope of 1 cm per hour

A. A latent phase of labor of 24 hours Rationale: A latent phase typically does not last more than 6 hours in a woman having her first child.

A woman has just received IV sedation. What must the nurse tell the woman to do? a. Ambulate only with assistance from the nurse or caregiver. b. Ambulate within 15 minutes to prevent spinal headache. c. Sit on the edge of the bed with her feet dangling before ambulating. d. Remain in bed for at least 30 minutes.

A. Ambulate only with assistance from the nurse or caregiver. Rationale: The patient may have decreased sensory reactions from the medication. She needs assistance to ambulate for safety.

What calorie intake is recommended during pregnancy? a. An additional 300 calories per day b. An average of 1,500 calories, except for obese patients c. An increase of 30 g of protein per day above the normal 44 to 46 g d. Individualization by multiplying 60 calories per kg of ideal body weight, then subtracting 300 calories

A. An additional 300 calories per day Rationale: An additional 300 calories per day will provide for healthy fetal growth.

If a fetus is in an ROA position during labor, how would the nurse understand the fetus to be positioned? a. In a longitudinal lie facing the left posterior b. Facing the right anterior abdominal quadrant c. In a common breech delivery position d. Presenting with the face as the presenting part

A. In a longitudinal lie facing the left posterior Rationale: ROA (right occiput anterior) means the occiput of the fetal head points toward the mother's right anterior pelvis; the head is the presenting part.

Which would be appropriate teaching about the force that propels the fetus through the vagina during labor? a. It is a combination of fundal and abdominal pressure. b. It is mainly gravitational from the superior fetal lie. c. It is cervical contractions beginning with full dilation. d. It is abdominal and perineal muscle contractions.

A. It is a combination of fundal and abdominal pressure. Rationale: "Bearing down" using abdominal muscles plus fundal contractions provide the power that moves the fetus forward.

Why might fat-soluble vitamins be harmful if taken in large quantities during pregnancy? a. They can be stored in the body, leading to toxic effects. b. A low hemoglobin may develop. c. They are not absorbed from the gastrointestinal tract. d. They may render an oral contraceptive ineffective.

A. They can be stored in the body, leading to toxic effects. Rationale: Excessive fat-soluble vitamins are stored by the body and can accumulate into toxic amounts.

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. As the nurse, what should you do? a. Proceed with standard care; the nurse knows that this is typical in the second stage of labor and that younger women and those who are first-time mothers are more likely to report severe pain. b. Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication. c. Call the anesthetist, who is responsible for managing the epidural and should be monitoring the woman's pain. d. Discuss with the woman the additional pain medication options available to her at this stage in her labor so that she can choose which option she prefers.

B. Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication. Rationale: After an epidural is in place, if the women reports unrelenting pain, the provider must be contacted for a complication.

Protein is found in large quantities in meat. How many meat servings per day are recommended for women during pregnancy? a. 1 b. 3 c. 6 d. 8

C. 6 Rationale: Meat is a prime source of protein, which is necessary for fetal growth, so six servings are recommended daily.

a nurse is caring for a client who is in the second stages of labor. the client's labor has been progressing and she is expected to deliver vaginally in 20 min. the provider is preparing to administerlidocaine for pain relief and perform and episiotomy. the nurse should know that which of the following types of regional anesthetic block to be administered. a. pudendal b. epidural c. spinal d. paracervical

a. a pudenal block is a transvaginal of local anesthetizes the perineal for the episiotomy and repair and the expulsion of the fetus

a nurse in prenatal clinic is providing education to a client who is in the 8thweek of gestation. the client states that she does not like milk. which of the following foods should the nurse recommend as a good source of calcium a. dark green leafy vegetables b. deep red or orange vegetables c. white breads and rice d. meat, poultry and fish

a. good sources of calcium for bone and teeth formation include low-oxalate, dark green leafy vegetables, such as kale, artichokes, turnip greens.

a nurse in the labor and deliver unit is caring for a client in labor and applies an external fetal monitor and tocotransducer. the FHR is around 140/min. contractions are occurring every 8 minutes and 30-40 seconds in duration. the nurse performs a vaginal exam and finds the cervix is 2cm dilated, 50% faced, and the fetus is at a -2 station. which of the following stages and phases of labor is the client experiencing? a. first stage, latent phase b. first stage, active phase c. first stage, transition phase d. second stage of labor

a. in stage 1, latent phase, the cervix dilates from 0 to 3 cm and contraction duration ranges from 30-45 seconds

a nurse is providing care for a client who is in active labor. her cervix is dilated to 5cm, and her membranes are intact. based on the use of external electronic fetal monitoring. the nurse notes a FHR of 115 to up to 150-155/min the last for 25 seconds, they last for 25 seconds, and have beat to beat variability of 20/min. there is no slowing of FHR from the baseline. the client should recognize that this client is exhibiting signs of which of the following? (select all that apply) a. moderate variability b. FHR accelerations c. FHR decelerations d. normal baseline FHR e. fetal tachycardia

a. moderate variability of 20/min (6-25/min is expected reference rang) b. FHR accelerations are present with increase up to 150-155/min lasting for 35 seconds d. there is a normal baseline the FHR does not slow down. falls within the expected references range of 110-160/min

a nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. which of the following is the first action the nurse should take ? a assist the client into the the left-lateral position b. apply a fetal scalp electrodes c. insert an IV catheter d. perform a vaginal exam

a. the greatest risk to the fetus during late decelerations is uteroplacental insufficiency. the initial nursing action should be to place the client into the left-lateral position to increase uteroplacental perfusion.

a nurse is caring for client in the third stage of labor. which of the following findings indicate that placental separation? (select all that apply) a. lengthening of the umbilical cord b. swift gush of clear amniotic fluid c. softening of the lower uterine segment d. appearance of dark blood from the vagina e. funds firm upon palpation

a. the umbilical cord lengthens as the placenta is being expulsed d. a gush of dark blood from the introits is an indication of placental separation e. the uterus contracts firmly with placental separation

a nurse in a clinic is teaching a client of childbearing age about recommended folic acid supplements. which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency? a. iron deficiency anemia b. poor bone formation c. macrocosmic fetus d. neural tube defects

d. neural tube defects are caused by folic acid deficiency. food sources of folic acid include fresh green leafy vegetables, liver, peanuts, cereals, and whole-grain breads

a nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3-5 min and becoming stronger. a vaginal exam reveals that the clients cervix is 3cm dilated 80% effaced and -1 station. the client asks for pain medication. which of the following actions should the nurse take? (select all that apply) a. encourages of patterned breathing techniques b. insert an indwelling urinary catheter c. administer opioid analgesic medication d. suggest application of cold e. provide ice chips

a. the use of patterned breathing techniques can assist with pain management at this time c. an opioid analgesic can be safely administered at this time d. the use of a non pharmacological approach, such as the application of cold, is an appropriate intervention at this time.

a nurse is teaching a client about the benefits of internal fetal heart rate monitoring. which of the following statements should the nurse include in the teaching? (select all that apply) a. it is considered a non invasive procedure b. it can detect abnormal fetal heart tones early c. it can determine the amount of amniotic fluid you have d. it allows for the accurate readings with maternal movement e. it can measure uterine contraction intensity

b. a benefit of internal fetal monitoring is that it can detect abnormal fetal heart rate tones early. d. a benefit of internal fetal monitoring is that it allows for accurate readings with maternal movement which external monitoring needs adjusting when the client moves e. a benefit of internal fetal monitoring is that it can measure uterine contraction intensity which external monitoring cannot

a nurse is performing leopold maneuvers on a client who is in labor. which of the following techniques should the nurse use to identify the fetal lie? a. apply palms of both hands to sides of the uterus b. palpate on the funds of the uterus c. grasp lower uterine segment between thumb and fingers d. stand facing clients feet with fingertips outlining cephalic prominence.

b. palpating the funds of the uterus identifies the fetal part that is present, indicating the fetal lie (longitudinal or transverse)

4. a nurse in labor and delivery unit is completing an admission assessment for a client who is at 39 weeks gestation. the client reports that she has been leaking fluid from her vagina for 2 days. which of the following conditions is the client at risk for developing? a. cord prolapse b. infection c. postpartum hemorrhage d. hydramnios

b. rupture of the membranes for longer than 24 hours prior to delivery increases the risk that infectious organisms will enter the vagina and then eventually into the uterus

a nurse is caring for a client who is in active labor. the client reports lower back pain. the nurse suspects that this pain is related to the persistent occiput posterior fetal position. which of the following non pharmacological nursing interventions should the nurses recommend to the client? a. abdominal effleurage b. sacral counterpresusure c. showering if not contraindicated d. back rub and massage

b. sacral counter pressure to the lower back relieves the pressure exerted on the pelvis and spinal nerves by the fetus

a client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. which of the following actions should the nurse take first? a. check the amniotic fluid for meconium b. monitor FHR for distress c. dry the client and make her comfortable d. monitor uterine contractions

b. the greatest risk to the client and fetus is umbilical cord prolapse, leading to fetal distress following rupture of membranes. the first action by the nurse is to monitor the FHR for clinical findings of distress

a nurse in a prenatal clinic is caring for four clients. which of the following clients weight gain should the nurse report to the provider? a. 1.8 kg (4lb) weight gain and is in her first trimester b. 3.6 (8lb) weight gain and is in her first trimester c. 6.8kg (15b) weight gain and is in her second trimester d. 11.3kg (25lb) weight gain and is in her third trimester

b. the nurse should be concerned about this client because she has exceeded the expected 3 to 4lb weight gain of a client in the first trimester

a nurse is caring for a client who is in the transition phase of labor and reports that she needs to have a bowel movement with the peak of contractions. which of the following actions should the nurse make? a. assist the client to the bathroom b. prepare for an impending delivery c. prepare to remove a fecal impaction d. encourage the client to take deep, cleansing breaths

b. the urge to have a bowel movement indicates fetal descent and complete dilation. preparing for an imminent delivery is appropriate

a nurse is caring for a client and her partner during the second stages of labor the client's partner asks the nurse to explain how he will know when crowning occurs. which of the following responses should the nurse make a. the placenta will protrude from the vagina b. your partner will report a decrease in the intensity of contractions c. the vaginal area that bulge as the baby's head appears d. your partner will report less rectal pressure

c. crowning si bulging of the perineum and the appearance of the fetal head

a nurse is caring for a client who is in active labor and becomes nauseous and vomits. the client is very irritable and feels the urge to have a bowel movement. she states I've had enough. i can't do this anymore. i want to go home right now. which of the following stages of labor is the client experiencing? a. second stage b. fourth stage c. transition phase d. latent phase

c. the transition phase of labor occurs when the client becomes irritable, feels rectal pressure similar the need to have a bowel movement, and can become nauseous with emesis

a nurse is caring for a client who is in the first stage of labor and encouraging the client to void every 2 hours. which of the following statements should the nurse make? a. a full bladder increases the risk for fetal trauma b. a full bladder increases the risk for bladder infections c. a distended bladder will be traumatized by frequent pelvic exams d. a distended bladder reduces pelvic space needed for birth.

d. a distended bladder reduces pelvic space, impedes fetal descent, and places the bladder at risk for trauma during the labor process

a nurse is reviewing the electronic monitoring tracing of a client who is in active labor. the nurse should know that a fetus receives more oxygen when which of the following appears on the tracing? a. peak of the uterine contraction b. moderate variability c. FHR acceleration d. relaxation between uterine contractions

d. a fetus is most oxygenated during the relaxation period between contractions. during contractions, the arteries to the uteroplacental intervillous spaces are compressed, resulting in a decrease in fetal circulation and oxygen

a nurse is reviewing postpartum nutrition needs with a group of new mothers who are breastfeeding their newborns. which of the following statements by a member of the group indicates an understanding of the teaching? a. i am glad i can have my morning coffee b. i should take folic acid to increase my milk supply c. i will continue adding 330 calories per day to my diet d. i will continue my calcium supplements because i don't like milk

d. postpartum women who are at risk for inadequate dietary calcium should continue taking calcium supplements during lactation

a nurse is caring for a client who is using a patterned breathing during labor. the client reports numbness and tingling of the fingers. which of the following actions should the nurse take? a. administer o2 via nasal cannula at 2L/min b. apply a warm blanket c. assist the client to a side lying position d. place an o2 mask over the clients nose and mouth

d. the client is experiencing hyperventilation caused by low serum levels of PCO2. placing an O2 mask over the clients nose and mouth or having the client breathe into a paper bag and will reduce the intake of O2, allowing the PCO2 to rise and alleviate the numbness and tingling

a nurse in the labor and delivery unit receives a phone call from a diet who reports that her contractions started about 2 hours ago, did not go away when she had two glasses of water and rested, and became stronger since she started walking. Her contractions occur every 10 minutes and last about 30 seconds. she hasn't had any fluid leak from her vagina. however she saw some blood when she wiped after voiding. based on this report, which of the following clinical findings should the nurse recognize that the client is experiencing? a. braxton hicks contractions b. rupture of membranes c. fetal descent d. true contractions

d. true contractions do not go away with hydration or walking. they are regular in frequency, duration, and intensity and become stronger with walking

a nurse in labor and delivery is planning care for a newly admitted clients who reports she is in labor and has been having vaginal bleeding for 2 weeks. which of the following should the nurse include in the plan of care? a. inspect the introits for a prolapsed cord b. perform a test to identify the ferning pattern c. monitor station of the presenting part d. defer vaginal examinations

d. vaginal examinations should not be performed until placenta prevue or abrupt placentae has been ruled out as the cause of vaginal bleeding