Practice questions

What do late decelerations usually indicate? 1) Non-reassuring pattern, head compression 2) Cord compression, hypertension 3) Non-reassuring pattern, utero-placental insufficiency 4) Utero-placental insufficiency, cord compression

3

A client who has been in latent labor for 24 hours has been ordered Morphine for pain control and to help her rest. The order is for Morphine 15mg IM q 4 hours prn. The concentration you have available is 25mg/ml. How much will you give? 1) 0.6 ml 2) 0.006 ml 3) 1.6 ml 4) 0.06 ml

1

A nurse educator in the labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly licensed nurses. Which of the following statements by a nurse indicates understanding of the teaching? 1) "They are tablets administered vaginally." 2) "They act by absorbing fluid from tissues." 3) "They promote dilation of the os." 4) "They include an amniotomy."

1

A nurse is caring for a client having contractions every 8 min that are 30 to 40 seconds in duration. The client's cervix is 2 cm dilated, 50% effaced, and the fetus is at a -2 station with a FHR around 140/min. Which of the following stages and phases of labor is this client experiencing? 1) first stage, latent phase 2) first stage, active phase 3) first stage, transition phase 4) second stage

1

A nurse is caring for a client who has been in labor for 12 hr with intact membranes. The nurse performs a vaginal examination to ensure which of the following prior to the performance of the amniotomy? 1) Fetal engagement 2) Fetal lie 3) Fetal attitude 4) Fetal position

1

A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to facilitate normal labor progress? 1) Hands and knees 2) Lithotomy 3) Trendelenburg 4) Supine with a rolled towel under one hip

1

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? 1) Assist the client into the left-lateral position. 2) Apply a fetal scalp electrode. 3) Insert an IV catheter. 4) Perform a vaginal exam

1

Mrs. S. is a 23 year old G3P2002 at 37 weeks pregnant who presents to labor and delivery complaining of contractions. The patient's contractions are moderate on palpation. She is 4/70/-1. She states that she has been leaking a small amount of fluid for the past "couple of days" but has not had any vaginal bleeding. The nurse observes the fetal heart rate is 165-175. Appropriate nursing interventions would include: 1) Assess maternal temperature, test any vaginal discharge for ph, plan to gather equipment and supplies before the birth that might be necessary for neonatal resuscitation, and limit number of vaginal exams 2) Repeat the vaginal exam, assess maternal temperature, and anticipate assisting with an amniotomy 3) Repeat the vaginal exam, test any vaginal discharge for ph, assess maternal temperature, anticipate assisting with an amniotomy, and plan to gather equipment and supplies before the birth that might be necessary for neonatal resuscitation 4) Plan to gather equipment and supplies before the birth that might be necessary for neonatal resuscitation, anticipate assisting with an amniotomy, and recognize she is in preterm labor

1

The nurse is caring for a patient in labor whose fetus is in an occiput posterior position. Which intervention should the nurse use to reduce this patient's discomfort? 1) Provide counterpressure to her lower back 2) Place her in the Trendelenberg position 3) Apply ice packs to the perineum 4) Place her in a prone position

1

The nurse providing care for the laboring woman should understand that accelerations with fetal movement: 1) Are reassuring 2) Warrant close observation 3) Are caused by uteroplacental insufficiency 4) Are caused by umbilical cord compression

1

There are many indications in the days or weeks prior to the onset of labor that indicate the body is preparing for the labor process. Which symptom is NOT one of these signs? 1) Decreased fetal movement 2) Braxton Hicks contractions 3) Bloody show 4) Lightening

1

What is the most likely reason for the physician to place a fetal scalp electrode (FSE) and Intrauterine Pressure Catheter (IUPC)? 1) Improved fetal and maternal assessment 2) Improved fetal well being 3) Improved blood pressure monitoring 4) Improved maternal well being

1

With regard to primary and secondary powers, the maternity nurse should know that: 1) Primary powers are primarily responsible for effacement and dilation of the cervix. 2) Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation. 3) Pushing in the first stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs. 4) Effacement always occurs after dilation.

1

Your actively laboring patient has requested pain medication for her labor pains and the physician has ordered Fentanyl to be given IV push. As you are administering the medication, your patient wants to know how soon it will start working. Your best response is: 1) 3-5 minutes 2) 15-20 minutes 3) 25-30 minutes 4) 10-15 minutes

1

A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and a vaginal delivery is expected in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic block is to be administered? 1) Pudendal 2) Epidural 3) Spinal 4) Paracervical

1 - A pudendal block is a transvaginal injection of local anesthetic that anesthetizes the perineal area for the episiotomy and repair, and the expulsion of the fetus.

A nurse is caring for a client who is in active labor. The cervix is dilated to 5 cm, and the membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a HR of 115 to 125/min with occasional increases up to 150 to 155/min that last for 25 seconds and have moderate variability. There is no slowing of the FHR from the baseline. This dient is exhibiting, manifestations of which of the following? (Select all that apply.) 1) Moderate variability 2) FHR accelerations 3) FHR decelerations 4) Normal baseline FHR 5) Fetal tachycardia

1,2,4

A nurse is caring for a client who is 42 weeks of gestation and is having an ultrasound. For which of the following conditions should the nurse plan for an amnioinfusion? (Select all that apply.) 1) Oligohydramnios 2) Hydramnios 3) Fetal cord compression 4) Hydration 5) Fetal immaturity

1,3

Reassuring fetal heart rate is characterized by which of the following? 1) Baseline FHR between 110-160 beats/min 2) Baseline FHR between 100-170 beats/min 3) Accelerations with fetal movement 4) Minimal variability 5) No late or prolonged decelerations 6) Moderate variability

1,3,5,6

A nurse is caring for a client in the third stage of labor. Which of the following findings indicate placental separation? (Select all that apply.) 1) Lengthening of the umbilical cord 2) Swift gush of clear amniotic fluid 3) Softening of the lower uterine segment 4) Appearance of dark blood from the vagina 5) Fundus firm upon palpation

1,4,5

A nurse is caring for a client in active labor. When last examined 2 hr ago, the client's cervix was 3 cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states, "My water broke." The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vaginal examination, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. Which of the following actions should the nurse perform first? 1) Place the client in the Trendelenburg position. 2) Apply pressure to the presenting part with the fingers. 3) Administer oxygen at 10 L/min via a face mask. 4) Initiate IV fluids.

2

A nurse is caring for a client who is 40 weeks of gestation and reports having large gush of fluid from the vagina while walking from the bathroom. Which of the following actions should the nurse take first? 1) Examine the amniotic fluid for meconium. 2) Check the FHR. 3) Dry the client and make them comfortable. 4) Apply a tocotransducer.

2

A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions. The nurse should identify that this contraction pattern increases the risk for which of the following complications? 1) Prolonged labor 2) Reduced fetal oxygen supply 3) Delayed cervical dilation 4) Increased maternal stress

2

A nurse is caring for a client who is in the transition phase of labor and reports that they need to have a bowel movement with the peak of contractions. Which of the following actions should the nurse make? 1) Assist the client to the bathroom. 2) Prepare for an impending delivery. 3) Prepare to remove a fecal impaction 4) Encourage the client to take deep, cleansing breaths.

2

A nurse is completing an admission assessment for a client who is 39 weeks of gestation and reports fluid leaking from the vagina for 2 days. Which of the following conditions is the client at risk for developing? 1) Cord prolapse 2) Infection 3) Postpartum hemorrhage 4) Hydramnios

2

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? 1) Apply palms of both hands to sides of uterus. 2) Palpate the fundus of the uterus. 3) Grasp lower uterine segment between thumb and fingers. 4) Stand facing client's feet with fingertips outlining cephalic prominence.

2

The nurse has received a report about a woman in labor. The woman's last vaginal examination was recorded as 3/30/-2. The nurse's interpretation of this assessment is that the cervix is: 1) effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm above the ischial spines. 2) 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines. 3) effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm below the ischial spines. 4) dilated 3 cm, it is effaced 30%, and the presenting part is 2 cm below the ischial spines.

2

The nurse performs Leopold's maneuvers in order to: 1) Relieve pressure on the umbilical cord. 2) Assess fetal presentation, lie, and position. 3) Determine if the bladder is distended. 4) Place the internal monitor correctly.

2

When assessing a woman in labor, the nurse is aware that the relationship of the presenting part to the four quadrants of the mother's pelvis is called the fetal: 1) Lie 2) Position 3) Attitude 4) Presentation

2

A nurse is caring for a client who is receiving oxytocin for induction of labor and has an intrauterine pressure catheter (UPC) placed to monitor uterine contractions. For which of the following contraction patterns should the nurse discontinue the infusion of oxytocin? 1) Frequency of every 2 min 2) Duration of 90 to 120 seconds 3) Intensity of 60 to 90 mm Hg 4) Resting tone of 15 mm Hg

2 - Oxytocin is discontinued if uterine tachysystole occurs with contraction duration longer than 90 seconds.

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 a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client? 1) Abdominal effleurage 2) Sacral counter-pressure 3) Showering if not contraindicated 4) Back rub and massage

2 - Sacral counterpressure to the lower back relieves the pressure exerted on the pelvis and spinal nerves by the fetus.

A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following statements should the nurse include? (Select all that applies) 1) "It is considered a noninvasive procedure." 2) "It can detect abnormal fetal heart tones early." 3) "It can determine the amount of amniotic fluid you have." 4) "It allows for accurate readings with maternal movement." 5) "It can measure uterine contraction intensity."

2,4,5

A nurse is caring for a client and partner during the second stage of labor. The client's partner asks the nurse to explain how to know when crowning occurs. Which of the following responses should the nurse make? 1) "The placenta will protrude from the vagina." 2) "Your partner will report a decrease in the intensity of contractions." 3) "The vaginal area will bulge as the baby's head appears." 4) "Your partner will report less rectal pressure."

3

A nurse is caring for a client who had no prenatal care, is Rh-negative, and will undergo an external version at 38 weeks of gestation. Which of the following medications should the nurse plan to administer prior to the version? 1) Prostaglandin gel 2) Magnesium sulfate 3) Rho(D) immune globulin 4) Oxytocin

3

A nurse is caring for a client who is at 42 weeks of gestation and in active labor. Which of the following findings is the fetus at risk for developing? 1) Intrauterine growth restriction 2) Hyperglycemia 3) Meconium aspiration 4) Polyhydramnios

3

About one hour after receiving a narcotic analgesic, the laboring client tells the nurse that she feels like pushing. A vaginal examination reveals a cervix that is completely dilated and the fetal head is at the perineum. Which of the following medications does the nurse need to have available in the room? 1) Hydroxyzine (Vistaril) 2) Promethazine (Phenergan) 3) Naloxone (Narcan) 4) Nalbuphine (Nubain)

3

In labor and delivery it is of utmost importance for the labor and delivery nurse to be able to interpret fetal monitoring strips. Minimal variability is probably best initially interpreted as: 1) A sign that the baby has low blood sugar 2) A sign that the baby is active 3) A sign that the baby may have hypoxia 4) A sign that the baby is well oxygenated

3

Upon placement on the external fetal monitor the nurse observes that the fetal heart rate is 170 with minimal variability in the baseline and no obvious accelerations or decelerations. The nurse understands that the fetal heart rate is considered to be which of the following? 1) Irregular 2) Normal 3) Tachycardia 4) Bradycardia

3

nurse is caring for a client who is in active labor, irritable, and reports the urge to have a bowe novement. The client vomits and states, "I've had enough. I can't do this anymore." Which of the ollowing stages of labor is the client experiencing? 1) 1st stage 2) 2nd stage 3) transition stage 4) latent phase

3

A nurse is caring for a client following the administration of an epidural block and is preparing, to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following statements should the nurse make? 1) It is needed to promote increased urine output 2) "It is needed to counteract respiratory depression." 3) "It is needed to counteract hypotension." 4) "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.

A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station, The client asks for pain medication, Which of the following actions should the nurse take? (Select that apply.) 1) Encourage use of patterned breathing techniques. 2) Insert an indwelling urinary catheter. 3) Administer opioid analgesic medication. 4) Suggest application of cold. 5) Provide ice chips.

3,4

A nurse is caring for a client who is in labor. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe? 1) Precipitous labor 2) Premature rupture of membranes 3) Postmaturity syndrome 4) Prolapsed umbilical cord

4

A nurse is caring for a client who is in the first stage of labor and is encouraging the client to void every 2 hr. Which of the following statements should the nurse make? 1) "A full bladder increases the risk for fetal trauma." 2) "A full bladder increases the risk for bladder infections." 3) "A distended bladder will be traumatized by frequent pelvic exams." 4) "A distended bladder reduces pelvic space needed for birth."

4

A nurse is planning care for a newly admitted client who reports, "I am in labor and I have been having vaginal bleeding for 2 weeks." Which of the following should the nurse include in the plan of care? 1) Inspect the introitus for a prolapsed cord. 2) Perform a test to identify the ferning pattern. 3) Monitor station of the presenting part. 4) Defer vaginal examinations.

4

Which description of the four stages of labor is correct? 1) Third stage: 7 to 10 cm dilation, increased fetal descent 2) Fourth stage: active pushing to birth 3) Second stage: full effacement to 4 to 5 cm with visible presenting part 4) First stage: onset of regular uterine contractions to full dilation

4

Which of the following nursing actions is required before a client in labor receives an epidural? 1) Assess maternal reflexes 2) Check for maternal pupil dilation 3) Assess maternal gait 4) Give a fluid bolus of 500-1000 ml

4

While caring for a laboring woman who is being induced, the nurse notices a pattern of variable decelerations in fetal heart rate with uterine contractions. What is the nurse's first action? 1) Stop the oxytocin administration 2) Notify the provider 3) Increase the IV fluid rate 4) Reposition the woman on her side

4

A nurse is reviewing the electronic monitor tracing of a client who is in active labor. A fetus receives more oxygen when which of the following appears on the tracing? 1) Peak of the uterine contraction 2) Moderate variability 3) FHR acceleration 4) Relaxation between uterine contractions

4 - A fetus is most oxygenated during the relaxation period between contractions.

A client calls a provider's office and reports having contractions for 2 hr that inc with activity and didn't decrease with rest & hydration. Client denies leaking of vaginal fluids but did notice blood when wiping after voiding. Which of the following manifestations is the client experiencing? 1) Braxton Hicks 2) Rupture of membranes 3) Fetal descent 4) True contractions

4 - true contractions don't go away w/ hydration or walking, it becomes more stronger with walking

A nurse is caring, for a client who is using, patterned breathing during, labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? 1) Administer orgen via nasal cannula at 2 L/min 2) Apply a warm blanket. 3) Assist the client to a side-lying position. 4) Place an oxygen mask over the client's nose and mouth.

4 - The client is experiencing hyperventilation caused by low blood levels of PCO2. Placing an oxygen mask over the client's nose and mouth or having the client breathe into a paper bag will reduce the intake of oxygen, allowing the PCO2 to rise and alleviate the numbness and tingling.