boop 1

The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders?

drop in estrogen and progesterone levels after birth

A 19-year-old woman presents to the emergency department in the late stages of active labor. Assessment reveals she received no prenatal care. As part of her examination, a rapid HIV screen indicates she is HIV positive. To reduce the perinatal transmission to her infant, which intravenous medication would the nurse anticipate administering?

Antiretroviral

Which would the nurse expect to include in the plan of care for a woman with mastitis who is receiving antibiotic therapy?

Apply warm or cold compresses and administer analgesics

When assessing the following women, who would the nurse identify as being at the greatest risk for preterm labor?

Client with history of previous preterm birth

A woman gave birth vaginally approximately 12 hours ago, and her temperature is now 100° F (37.8° C). Which action would be most appropriate?

Continue to monitor the woman's temperature every 4 hours; this finding is normal.

When implementing the plan of care for a multigravida postpartum woman who gave birth just a few hours ago, the nurse vigilantly monitors the client for which complication?

Postpartum hemorrhage

The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus?

caput succedaneum

When explaining to a class of pregnant women why labor begins, the nurse will include the fact that there are several theories that have been proposed to explain why labor begins, although none have been proven scientifically. Which idea is one of those theories?

change in estrogen-to-progesterone ratio

After a class for expectant parents on the various forms of birth control after the birth of their infant, the nurse realizes more training is needed when a participant makes which comment?

"I'm going to be breastfeeding occasionally, so we won't need to use any other birth control for at least six months."

During a home visit with new parents, the nurse also assesses the new father's adaptation to his new role. Which statement would indicate that he is in the expectation stage?

"It'll be fun to have a baby in the house, but things shouldn't change too much."

The nurse is instructing the postpartum client who plans to bottle-feed her newborn about measures to prevent breast engorgement when she is discharged. Which measure should the nurse include in the teaching plan?

Wearing a tight-fitting supportive bra 24 hours daily

The nurse is reviewing the medical record of a woman for whom induction of labor is being considered. The nurse notes the following: •Cervical dilation 4 cm •Effacement 60% •0 Station •Soft cervix •Anterior cervical position Based on this information, which Bishop score would the nurse assign?

10

When caring for a client during the active phase of labor without continuous electronic fetal monitoring, the nurse would intermittently assess FHR every

15 to 30 minutes

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition?

Macrosomia

A client has come to the office for her first postpartum visit. On evaluating her blood work, the nurse would be concerned if the hematocrit is noted to have:

acutely decreased.

A new dad is alarmed at the shape of his newborn's head. Assessment reveals swelling at the area of the presenting part. The swelling crosses the suture lines. The nurse suspects which condition?

Molding

The nurse is developing a plan of care for a woman experiencing dystocia. Which nursing intervention would be the nurse's highest priority?

Monitoring the fetal heart rate patterns

When assessing a postpartum woman, which finding would lead the nurse to suspect postpartum blues?

Periodic crying and insomnia

A woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropriate?

Stop the infusion immediately.

When managing a client's pain during labor, nurses should

Support the client's decisions and requests

Which finding would lead the nurse to suspect that a postpartum woman was developing a complication?

Swollen, tender, hot area on the breast

A new mother gave birth 12 hours ago. Because this is her first child, which goal planned by the nurse is most appropriate?

Effective education of both parents before discharge

The nurse reviews the history of a postpartum woman, G3, P3 and notes it is positive for obesity and smoking. The nurse would be especially alert for the development of signs and symptoms of which complication in this client?

deep venous thrombosis

A client calls the clinic asking to come in to be evaluated. She states that when she went to bed last night the fetus was high in the abdomen, but this morning the fetus feels like it has dropped down. After asking several questions, the nurse explains this is probably due to:

lightening.

A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer?

magnesium sulfate

A primary care provider prescribes oral tocolytic therapy for a woman with preterm labor. The nurse explains to the client about the drugs that may be used. The nurse determines that the client needs additional teaching when she states which drug might be used for oral therapy?

magnesium sulfate

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem?

prolonged decelerations

The nurse plays a major role in assessing the progress of labor. The nurse integrates understanding of the typical rule for monitoring labor progress. Which finding would the nurse correlate with this rule?

Cervix dilates 1 cm per hour.

Which assessment would indicate that a woman is in true labor?

Cervix is 4cm dilated, 90% effaced

A client has arrived to the birthing center in labor, requesting a VBAC. After reading the client's previous history, the nurse anticipates that the client would be a good candidate based on which finding?

has previous lower abdominal incision

A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility?

increased risk of infection

Which findings would lead the nurse to suspect that a postpartum woman has developed endometritis? Select all that apply.

pain on both sides of the abdomen, foul-smelling lochia, leukocytosis

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?

less anxiety

Immediately after childbirth in the recovery area, the nurse observes the mother's partner's fascination and interest in the new child. This behavior is often termed

Engrossment

A postpartum client with a history of deep vein thrombosis is being discharged on anticoagulant therapy. The nurse teaches the client about the therapy and measures to reduce her risk for bleeding. Which statement by the client indicates the need for additional teaching?

"I should brush my teeth vigorously to stimulate the gums."

A postpartum client has decided to bottle feed her newborn. After teaching the woman about it, the nurse determines that the teaching was successful based on which client statement(s)? Select all that apply.

"I will get my newborn to suck by touching the nipple to the lips.", "I will make sure the nipple and neck of the bottle are filled with formula during a feeding.", "I will be sure not to use the microwave to warm the formula."

A pregnant client in labor experiences a problem with the passenger related to shoulder dystocia. The health care provider is planning to relieve it with McRobert maneuver. The client asks the nurse, "What is going to happen when they try this?" Which response by the nurse would be appropriate?

"Your thighs will be flexed and moved away from the center of your body to open things up."

The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction?

Acme

What would the nurse use to monitor the effectiveness of intravenous anticoagulant therapy for a postpartum woman with deep vein thrombosis?

Activated partial thromboplastin time

The most intense time during labor is during the

Active phase

A woman at 38 weeks' gestation is in labor and oxytocin is prescribed to augment her labor. When preparing to administer this medication, what action by the nurse would be appropriate?

Administer the medication piggybacked into a primary IV line using a pump.

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical?

Amniotomy

The client wants to avoid an episiotomy. What other technique would the nurse suggest the client try?

Apply warm compresses to the perineum.

A nurse is providing care to a couple who have experienced intrauterine fetal demise. Which action would be least effective in assisting a couple at this time?

Avoid any discussion of the situation with the couple.

Which suggestion would be most appropriate to include in the teaching plan for a postpartum woman who needs to lose weight?

Avoid empty-calorie foods, breastfeed, and increase exercise

Methergine has been ordered for a postpartum woman because of excessive bleeding. The nurse should question this order if which is present?

BP of 158/96 mm Hg (Methergine can cause hypertension)

In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman's behavior to be characterized in what way?

Being passive and dependent

Which finding would lead the nurse to suspect that a woman is developing a postpartum complication?

Chest pain experienced when ambulating

A nurse is caring for woman in labor. The woman's membranes just ruptured. The nurse assesses the characteristics of the fluid. Which finding would the nurse identify as normal?

Clear

The nurse is preparing a young couple for the upcoming birth of their child, and the mother expresses concern for needing pain medications and the effects on the fetus. When counseling the couple about pain relief, the nurse would incorporate which information in the teaching about measures to help to decrease the requests for pain medication?

Continuous support through the labor process helps decrease the need for pain medication.

The nurse is explaining to a postpartum woman 48 hours after childbirth that the afterpains she is experiencing can be the result of which factor?

Contractions of the uterus after birth

The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which process?

Crowning

A nurse is reading a journal article about cervical ripening agents, based on the understanding that certain pharmaceuticals can be used to attain cervical ripening in women who need assistance in this area. They have also often continued into labor without further agents to stimulate uterine contractions. Which agent would the nurse anticipate reading about as an FDA-approved agent for cervical ripening?

Dinoprostone

A nurse is developing a plan of care for a postpartum woman, newborn, and partner to facilitate the attachment process. Which intervention would be appropriate for the nurse to include in the plan?

Ensure early and frequent parent-newborn interactions.

The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse expect the culture to reveal?

Escherichia coli

A pregnant client is experiencing dystocia resulting from persistent occiput posterior position. The client, in the first stage of labor, is reporting significant back pain. The nurse encourages the client to change positions frequently for comfort and to help promote rotation of the fetal head. Which position(s) would be appropriate for the nurse to suggest? Select all that apply.

Hands and knees, Squatting, Side-lying

A nurse is preparing for a class to teach pregnant women and their partners about postpartum complications. Which measure would be most important for the nurse to emphasize as helping to prevent postpartum infection?

Handwashing

After a vaginal examination, the nurse determines that the client's fetus is in an occiput posterior position. The nurse would anticipate that the client will have

Intense back pain

A laboring woman is admitted to the labor and birth suite at 4-cm dilation. She would be in which phase of labor?

Latent

Which fetal lie is most conducive to a spontaneous vaginal birth?

Longitudinal

Which interventions are underutilized in promoting a normal birth? Select all that apply.

Oral nutrition and fluids in laborOpen-glottis pushing in the second stage of laborSkin-to-skin contact after birth for infant bonding

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?

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

A nurse is providing care to a postpartum woman and is completing the assessment. Which finding would indicate to the nurse that a postpartum woman is experiencing bladder distention?

Percussion reveals dullness.

Which activity would the nurse include in the teaching plan for parents with a newborn and an older child to reduce sibling rivalry when the newborn is brought home?

Planning a daily "special time" for the older sibling

A postpartum woman reports hearing voices and says, "The voices are telling me to do bad things to my baby." The clinic nurse interprets these findings as suggesting postpartum

Psychosis

While providing care to a postpartum client on her first day at home, the nurse observes which behavior that would indicate the new mother is in the taking-hold phase?

Showing increased confidence when caring for the newborn

A G3, P2 woman arrives at the birthing center stating that she has been in labor for the past 18 hours. The nurse suspects a protracted labor pattern disorder based on which finding?

Slower than usual cervical dilation

The rationale for using a prostaglandin gel for a client prior to the induction of labor is to

Soften and efface the cervix

When determining the frequency of contractions, the nurse would measure which period of time?

Start of one contraction to the start of the next contraction

A pregnant client at 28 weeks' gestation in preterm labor has received a dose of betamethasone IM today at 1400. The client is scheduled to receive a second dose. At which time would the nurse expect to administer that dose?

Tomorrow at 1400

During the fourth stage of labor, the nurse assesses the woman at frequent intervals after giving childbirth. What assessment data would cause the nurse the most concern?

Uterine fundus palpated to the right of the umbilicus

Which observation would suggest that placental separation is occurring?

Uterine shape changes to globular

A postpartum woman has been unable to urinate since giving birth. When the nurse is assessing the woman, which finding would indicate that this client is experiencing bladder distention?

Uterus is boggy.

A 25-year-old nulliparous client presents in active labor. She has had no prenatal care, and her coagulation status is determined. Which result would the nurse identify as placing the client at risk for postpartum hemorrhage?

activated partial thromboplastin time 60 seconds

The nurse realizes that accommodating for the various cultural differences in her clients is an important aspect in providing their care. When caring for a Japanese-American postpartum woman, which action would be a priority?

ensuring that the newborn receives a daily bath

A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency?

every 15 minutes

The nurse is caring for a client who is considered low-risk and in active labor. During the second stage, the nurse would evaluate the client's FHR by Doppler at which frequency?

every 15 minutes

During the assessment of a woman in labor, the nurse explains that certain landmarks are used to determine the progress of the birth. The nurse identifies which area as one of these landmarks?

ischial spine

A client at 33 weeks' gestation is calling the office with various reports and is very concerned. The nurse recognizes which report(s) as indicating the client is potentially going into preterm labor? Select all that apply.

low, dull backache, general sense of discomfort, achiness in the thighs, GI upset (nausea, vomiting, diarrhea)

A nurse is conducting a class for nurses working in the postpartum unit about ways to reduce the risk of postpartum infections. The nurse determines that the teaching was effective when the group identifies which preventive measure as essential?

meticulous handwashing

After conducting a review class on the labor and birth process for a group of nurses working in the community clinic, the nurse determines that the teaching was successful when the group identifies which factors as affecting the labor process? Select all that apply.

patience, passenger, powers

A nurse is providing care to a postpartum woman during the immediate postpartum period. The nurse recognizes that the mother will need assistance with meeting her basic needs based on the understanding that the mother is most likely in which phase?

taking-in phase

Quickly determining the cause of postpartum hemorrhaging enables effective treatment. A nurse using the 5 Ts tool will recognize which as a potential causes of postpartum hemorrhage? Select all that apply.

tissue, thrombin, tone

Review of a woman's labor and birth record reveals a laceration that extends through the anal sphincter muscle. The nurse identifies this laceration as which type?

third-degree laceration

During a routine home visit, the couple asks the nurse when it will be safe to resume full sexual relations. Which answer would be the best?

Generally within 3 to 6 weeks

A client who is in active labor and whose cervix had dilated to 6 cm experiences a weakening in the intensity and frequency of her contractions and exhibits no further progress in labor. The nurse interprets this as a sign of

Hypotonic labor

The major purpose of the first postpartum home care visit is to

Identify complications that require interventions

When teaching a group of soon-to-be parents about the structures of the fetal skull, the nurse describes the anterior fontanel (fontanelle). Which description would the nurse include?

approximately 2 to 3 cm in size

Which instruction would the nurse include in the teaching plan for a postpartum woman with mastitis?

"Try applying warm compresses to your breasts to encourage the milk to be released."

The nurse is providing care to a client in labor. On examination, the nurse determines the fetus is at -1 station. The nurse interprets this as indicating that the fetus is:

1 cm above the ischial spines.

The new mother has decided to feed her infant formula. When teaching her about the different types of formula, the nurse should stress the infant should receive how many calories each day?

650 calories

A postpartum woman is experiencing subinvolution. When reviewing the client's history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply.

prolonged labor, hydramnios, uterine infection

A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse initiate?

providing a comfortable environment with dim lighting

The nurse encourages a woman in labor to ambulate based on the understanding that ambulating does what? Select all that apply.

Enhances the effectiveness of contractions, Enlists the aid of gravity to move the fetus, helps the fetus line up with the angle of the pelvis., Increases the urge to push during the second stage., Encourages rotation of the fetus

When describing the hormonal changes that occur after birth of a newborn, the nurse would identify a decrease in which hormone as being associated with breast engorgement?

Estrogen

When reviewing the medical record of a client, the nurse notes that the woman has a condition in which the fetus cannot physically pass through the maternal pelvis. The nurse interprets this as:

Fetopelvic disproportion

The nurse would anticipate a cesarean birth for a client who has which active infection present at the onset of labor?

Herpes simplex virus

As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is

Progressive cervical changes occur in true labor

A nurse is teaching a postpartum woman about breastfeeding. When explaining the influence of hormones on breast-feeding, the nurse would identify which hormone that is responsible for milk production?

Prolactin

The nurse would expect a postpartum woman to experience lochia in which sequence?

Rubra, serosa, alba

When a client in labor is fully dilated, which instruction would be most effective to assist her in encouraging effective pushing?

Wait until you feel the urge to push

During a routine assessment the nurse notes the postpartum client is tachycardic. What is a possible cause of tachycardia?

delayed hemorrhage

A nurse is caring for a woman in labor and understands that as the fetus travels through the birth canal, the fetus makes positional changes that occur concurrently. Based on the nurse's conceptualization of their sequential occurrence, list the cardinal movements of labor in the correct order that the nurse would expect the fetus to move. All options must be used.

engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.

Massage is an effective nonpharmacologic technique that can help to decrease pain during labor. The nurse explains that massage achieves its effect by which mechanism?

increasing the release of endorphins

A pregnant woman at 37 weeks gestation calls the clinic to say she thinks that she is in labor. The nurse instructs the woman to go to the health care facility based on the client's report of contractions that are:

occurring about every 5 minutes.

A nurse practitioner is conducting an in-service education program for a group of nurses working in the labor and birth unit. The program is focusing on interpreting FHR patterns. The nurse practitioner determines that the teaching was successful when the group identifies which patterns as indicating abnormal fetal acid-base status? Select all that apply.

recurrent late decelerations, sinusoidal pattern, fetal bradycardia

Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions? Select all that apply.

severe preeclampsia, septicemia, abruptio placenta

On examination, the nurse determines the client is at 50% effacement. This means:

the cervical canal is 1 cm long.

The health care provider is evaluating a high-risk woman for a continuous internal monitoring. Which criterion would need to be met for this type of monitoring?

rupture of membranes

During a postpartum home visit, a woman tells the nurse that her hip joints are sore, just like they were when she was pregnant. Which information would the nurse likely include when teaching the woman about this condition? Select all that apply.

"Let me show you how to use good body mechanics to lessen the problem.", "This soreness should go away in about 6 to 8 weeks."

A pregnant client's labor has been progressing slower than normal. The client is visibly anxious and tense, telling the nurse, "I am so worried about what is going to happen. And I am so tired and feel so helpless." Other underlying issues that may be contributing to the client's slow labor progress have been ruled out. Which response(s) by the nurse would be appropriate? Select all that apply.

"Maybe dimming the lights or some soft music will help you relax a bit.", "Things are moving along but sometimes it can take a little longer.", "I will keep you updated often on how you and your baby are doing."

A young mother is at the office for her 6-week visit. She is still experiencing mild loch alba and is concerned that she has an infection. Which finding would the nurse interpret as supporting this suspicion?

foul odor

A nurse is describing a technique developed in the 1940s by Dr. Arnold Kegel to assist postpartum women with a common issue. The nurse explains that the purpose of this technique is to:

strengthen the pelvic floor muscles to reduce urinary incontinence.

It has been 2 hours since a woman gave birth vaginally to a healthy newborn. When assessing the woman's uterine fundus, the nurse would expect to find it at:

the level of the umbilicus.

The client, who has just been walking around her room, sits down and reports leg tightness and achiness. After resting, she states she is feeling much better. The nurse recognizes that this discomfort could be due to which cause?

thromboembolic disorder of the lower extremities

During an assessment, the nurse notes that the client has been unable to urinate properly since giving birth and is bleeding more than expected. The nurse suspects which condition?

uterine atony

The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem?

uterus 1 cm below umbilicus

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

1)-4 station2)-2 station3)0 station4)+2 station5)+4 station

In a class for expectant parents, the nurse discusses the various benefits of breastfeeding. However, the nurse also describes that there are situations involving certain women who should not breastfeed. Which examples would the nurse cite? Select all that apply.

women using street drugs, women on antithyroid medications, women on antineoplastic medications

A nurse is providing care to a woman who is 6 hours postpartum. The nurse suspects urinary retention based on which finding?

50 to 70 mL urine per void every hour

On a routine home visit, the nurse is asking the new mother about her breastfeeding and personal eating habits. How many additional calories should the nurse encourage the new mother to eat daily?

500 additional calories per day

During a home visit, the client mentions she is still having significant of joint pain. The nurse explains that the changes that softened the pelvic joints to allow for the birth were due to the hormone relaxin. The nurse informs the client that it takes approximately how long for the joints to return to prepregnancy status?

6 to 8 weeks after pregnancy

The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured based on which result?

6.5

Various medications are available to help control hemorrhage in the postpartum client. When reviewing the client's history, the nurse notes she has a history of asthma. Which medication if prescribed would the nurse question?

Carboprost

A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn?

Corticosteroids

The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction. The nurse would document this as which finding?

Duration

The nurse is determining how often contractions occur measuring from the beginning of the one contraction to the beginning of the next contraction. The nurse documents this finding as:

frequency.

Which factor in a postpartum woman's history would lead the nurse to monitor the woman closely for an infection?

Manually extracted placenta

While assessing a postpartum multiparous woman, the nurse detects a boggy uterus midline 2 cm above the umbilicus. Which intervention would be the priority?

Massaging her fundus

A nurse provides care to pregnant women and their families from a wide range of cultural backgrounds and considers their culture and traditions when providing care. As the nurse communicates with the families, the nurse integrates understanding of communication as being more than just speaking and listening. Which aspect must the nurse also consider?

Touching

A nurse is conducting a in-service education program for a group of nurses working in the postpartum unit about postpartal infection. The nurse determines that the teaching was successful when the group identifies which factor as contributing to the risk for infection postpartally?

placenta removed via manual extraction

A nurse is reviewing a postpartum woman's history and labor and birth record. The nurse determines the need to closely monitor this client for infection based on which factor?

placenta removed via manual extraction

After teaching a class of pregnant women on ways to decrease the postpartum complication of thrombotic conditions, the nurse recognizes more teaching is needed when one of the participants states:

"At least I don't have to give up smoking for this one."

A nurse is making a follow up visit to a new parent and 3-month-old infant. The nurse is talking with the client about her role as a mother and caring for her infant. Which statement by the client would lead the nurse to immediately call the health care provider?

"I am so angry with myself, I just want to give up my life right now."

The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as:

baseline FHR.

After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, the nurse understands there is a need for additional teaching when one of the women makes which statement?

"I can't wait for these stretch marks to disappear after I give birth."

When assessing a new father's adaptation to his new role, which statement would indicate that he is in the reality stage?

"I didn't realize all that went into being a dad. I wasn't prepared for this."

A nurse is conducting a class on various issues that might develop after going home with a new infant. After discussing how to care for hemorrhoids, the nurse understands that which statement by the class would indicate the need for more information?

"I only eat a low-fiber diet."

A new mother comes in for her first visit and reports pain and tenderness in her breast just before feeding. Based on her description, the nurse determines she is experiencing breast engorgement. Which instruction should the nurse provide to her?

"Take a warm shower just before feeding your infant."

A nurse is teaching a woman in her third trimester about Braxton Hicks contractions. When describing these contractions, which information would the nurse likely include? Select all that apply.

"They go away when you walk around or change position.", "They often spread downward before they go away.", "They usually feel like a tightening across the top of your uterus."

Effective nursing management involves many aspects and being aware of subtle changes in the client. Which finding should alert the nurse to a potential infection in the client?

temperature of 38° C or higher after the first 24 hours after birth

A 19-year-old female presents in advanced labor. Examination reveals the fetus is in frank breech position. The nurse interprets this finding as indicating:

the buttocks are presenting first with both legs extended up toward the face.

It has been 8 hours since a woman gave birth vaginally to a healthy newborn. When assessing the woman's fundus, the nurse would expect to find it at:

the level of the umbilicus.

During the examination, the health care provider mentions the fetus has a good attitude. The nurse explains to the parents that this means:

the posture of the fetus is with all joints flexed for birth.

A nurse is discussing the advantages and disadvantages of intermittent and continuous fetal heart rate monitoring with a colleague. What would the nurse cite as being able to be detected when using continuous monitoring but not intermittent monitoring? Select all that apply.

types of decelerations, variability

A postpartum woman tells the home care nurse, "My hemorrhoids are really uncomfortable. Is there anything I can do?" Which suggestion(s) by the nurse would be appropriate? Select all that apply.

"I will show you how to use a sitz bath.", "Witch hazel pads can have a cooling effect.", "Applying ice to the area can help."

The client is anxious about her prolonged pregnancy. She informs the nurse she has been doing research on the Internet and has read about certain herbs that can help to induce labor. Which response from the nurse would be appropriate?

"Please talk to your primary care provider first to ensure it is safe."

After the nurse teaches a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful?

"Postpartum depression develops gradually, appearing within the first 6 weeks."

A woman who is breastfeeding her newborn says, "He doesn't seem to want to nurse. I must be doing something wrong." After teaching the woman about breastfeeding and offering suggestions, which statement by the mother indicates the need for additional teaching?

"Some women just can't breastfeed. Maybe I'm one of these women."

A nurse is providing care to a postpartum woman who is breastfeeding her 1-day old neonate. While observing the interaction, the woman says to the nurse, "I have noticed some tingling in both of my breasts just before my baby starts to feed and then for a bit during the feeding. What is happening?" Which response by the nurse would be appropriate?

"What you are feeling is the normal let-down reflex when milk is released."

The client is preparing to go home after a cesarean birth. The nurse giving discharge instructions stresses to the family that the client should be seen by her primary care provider within what time interval?

2 weeks

Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement?

An increase in blood and lymph supply to the breasts

A postpartum mother appears very pale and states she is bleeding heavily. The nurse should first

Assess the fundus and ask about her voiding status

A nurse is caring for a postpartum woman who is Muslim. When developing the woman's plan of care, the nurse would make which action a priority?

Assign a female nurse to care for her.

The nurse is assisting a young mother who has decided not to breastfeed her infant. The nurse should make which suggestions to the client to ease discomfort and prevent breast engorgement? Select all that apply.

Avoid sexual stimulation., Apply ice to the breast for approximately 15 to 20 minutes every other hour., Wear tight supportive bra 24 hours each day.

The nurse is teaching a class to a group of pregnant women in their second trimester. Which information about the effects of maternal position on labor will the nurse include?

Being upright promotes a sense of control for the mother.

A nurse is monitoring a woman in labor. When interpreting the assessment findings, an increase in which finding would the nurse identify as a deviation from the expected body response?

Blood glucose levels

Physiologic preparation for labor would be demonstrated by

Lightening, when the fetus drops into true pelvis

A nurse is teaching a 42-week nulliparous pregnant woman about labor induction which is being recommended by her health care provider. The nurse determines that the woman needs additional teaching when she identifies which assessment as being done before induction?

Maneuvers for fetal positioning

A new dad is alarmed at the shape of his newborn's head. When responding to the dad, the nurse reminds him this is due to:

cranial bones overlapping at the suture lines.

After teaching a group of breastfeeding women about nutritional needs, the nurse determines that the teaching was successful when the women state that they need to increase their intake of which nutrients?

Calories and protein

What is the Bishop score used to assess?

Cervical readiness for induction

Evidence-based practice applied to the clinical setting improves

Client care and overall better outcomes

A nurse is describing the many changes that will occur during the early postpartum period with a group of young parents. The nurse reviews common reports experienced as the woman's body returns to her prepregnancy state. The nurse determines that the teaching was successful when the participants identify which report as being most common during the first week that will indicate their fluid volume is returning to normal?

Diaphoresis

The nurse notes the presence of transient fetal accelerations on the fetal monitoring strip. Which intervention would be most appropriate?

Document this as indicating a normal pattern

A client has asked that an opioid be kept on standby in case she needs it for pain control. As a precaution, the nurse will also have which of medication readily available to reverse the effects of that opioid?

Naloxone

A woman gave birth vaginally approximately 12 hours ago, and her temperature is now 100.8° F (38.2° C). Which action would be most appropriate for the nurse to take?

Notify the health care provider about this elevation; this finding reflects possible infection.

The nurse is caring for a woman experiencing hypertonic uterine dystocia. The woman's contractions are erratic in their frequency, duration, and of high intensity. The priority nursing intervention would be to:

Provide pain relief measures

The nurse has been asked to present information to a group of civic leaders concerning women's health issues. In preparing the information, the nurse includes what goal from Healthy People 2030 related to women in labor?

Reduce the rate of cesarean births among low-risk women

A nurse is explaining to a pregnant client about the changes occurring in the body in preparation for labor. Which hormone would the nurse include in the explanation as being responsible for causing the pelvic connective tissue to become more relaxed and elastic?

Relaxin

A nurse is making a postpartum home visit to a woman who gave birth vaginally about 12 days ago. The woman's partner is present during the visit. When assessing the woman and the family, which finding related to the partner would lead the nurse to suspect that the partner may be experiencing postpartum depression? Select all that apply.

Reports of frequent headaches, Statements that woman is getting all the attention, Reports of feeling highly stressed

During the discharge planning for new parents, what would the case manager do to help provide the positive reinforcement and ensure multiple assessments are conducted?

Schedule home visits for high-risk families.

Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects?

Seizures

Assessment of a woman in labor reveals that the scapula of the fetus is the presenting part. The nurse interprets this finding as indicating which fetal presentation?

Shoulder

By the end of the second stage of labor, the nurse would expect which of the following events?

The fetus is born and on mother's chest

The nurse who is working with parents and their newborn encourages which action to assist the bonding and attachment between them?

Touching

A nurse is administering oxytocin to a woman in labor. The nurse monitors the infusion closely and notifies the health care provider if signs and symptoms of which condition occurs?

Water intoxication

A woman comes to the clinic for her first postpartum visit. She gave birth to a healthy term neonate 2 weeks ago. As part of this visit, the woman has a complete blood count drawn. Which result would the nurse identify as a potential problem?

White blood cell count 14,000/mm3 (14 ×109/L)

A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out. Which intervention would the nurse expect to include in the plan of care for this client?

administering oxytocin

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?

allowing the woman time to be alone

A client who is 12 hours postbirth is reporting perineal pain. After the assessment reveals no signs of an infection, which measure could the nurse offer the client?

an ice pack applied to the perineum

A nurse works at a facility that provides care to clients holding various cultural beliefs. The nurse integrates understanding of the areas recognized by other cultures that are not necessarily acknowledged by the Western culture. Which area would the nurse need to incorporate into the plans of care?

balance of hot and cold

When assessing the effectiveness of the obstetrical regional analgesia received by a client, the nurse recognizes it is successful by the complete loss of pain sensation at which level of the spinal cord?

below T8 level

As part of a review class for perinatal nurses, the nurse is explaining the laboratory and diagnostic tests that can be conducted to evaluate a woman's risk for preterm labor. The nurse determines that additional teaching is needed when the group identifies which test as being used?

blood chemistry levels

A 17-year-old nulliparous client presents in active labor. It is discovered that she received no prenatal care. Which information would be important to collect first?

coagulation studies

A woman received morphine during labor to help with pain control. Which finding would the nurse need to monitor the newborn for after birth?

decreased alertness

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as:

effleurage.

The nurse is conducting a review class for a group of perinatal nurses about factors that place a pregnant woman at risk for infection in the postpartum period. The nurse determines that additional teaching is needed when the group identifies which factor?

increased vaginal acidity leading to growth of bacteria

Prior to discharge is an appropriate time to evaluate the client's status for preventative measures such as immunizations and Rh status. Which test would the nurse ensure has been conducted to evaluate the Rh negative mother?

indirect Coombs' test

A client presents to her postpartum appointment with vague reports. The nurse suspects postpartum depression based on which assessment finding?

lack of pleasure

A woman presents to her first postpartum visit reporting she does not feel well. Which findings would lead the nurse to suspect that she has developed endometritis? Select all that apply.

leukocytosis, pain on both sides of the abdomen

A nurse is conducting a presentation for a group of pregnant women about labor and the importance of being well prepared and having good labor support. The nurse determines that additional discussion is needed when the group identifies which possible outcome as the result of being prepared?

need for someone to control the situation

The client is requesting information on the various pain medication management techniques that are available so she can decide which option she would like to choose for her impending birth. While gathering together the information, the nurse would indicate which technique as becoming very popular and effective?

neuraxial analgesia/anesthesia

The nurse has been asked to conduct a class to teach new mothers how to avoid developing stress incontinence. Which action would the nurse include in the discussion as possible strategies for the new mothers to do? Select all that apply.

performing Kegel exercises, losing weight if obese, avoiding smoking

During the birth, the primary care provider performed an episiotomy. The client is now reporting discomfort. To reduce this discomfort and increase hygiene to the perineum, the nurse would encourage the client to use which intervention?

peribottle and warm water

The birth center recognizes that attachment is very important in the early stages after birth. Which policy would be inappropriate for the birth center to implement when assisting new parents in this process?

policies that discourage unwrapping and exploring the infant

While discussing labor with a client and her partner, the nurse is asked what the best position is for giving birth to the baby. The nurse provides them with information that indicates research has shown which position as the best?

position of comfort for the mother

A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring?

preterm labor

A nurse is reviewing the FHR and notes it to be in the range of 100 to 106 bpm over the past 10 minutes. Which conditions might the nurse suspect as the cause? Select all that apply.

prolonged umbilical cord compression, effect of maternal analgesia, fetal hypoxia

The nurse is concerned that the parents are having difficulties relating to their newborn. In an effort to assist with and encourage attachment, which activity should the nurse suggest?

promoting skin-to-skin contact on the chest

When assessing a postpartum woman, the nurse would find which factor to be most significant in identifying possible postpartum hemorrhage?

pulse rate

After assessing a client's progress of labor, the nurse suspects the fetus is in a persistent occiput posterior position. Which finding would lead the nurse to suspect this condition?

reports of severe back pain

A nurse is preparing a class for a group of new parents on the psychological adaptations that occur after the birth. The nurse should include which signs and symptoms that might suggest postpartum depression? Select all that apply.

restlessness, feeling overwhelmed, feelings of worthlessness

A young couple are anxious for the birth of their first child. The nurse discusses the options, including elective induction of labor for nulliparas. The nurse determines that additional teaching is necessary when the couple identifies which condition as being associated with this procedure?

shorter hospitalizations

Every postpartum client has the potential of hemorrhage. While assessing a client's status, which finding would be of little benefit in identifying the possibility of hemorrhage?

signs of shock

A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition?

uterine atony

A nurse is working with the parents of a newborn girl. The parents have a 2-year-old boy at home. Which statement would the nurse include when teaching these parents?

"Ask your 2-year-old to pick out a special toy for his sister."

A client calls the prenatal clinic and tells the nurse, "I think I am in labor." The nurse determines that the client is in true labor based on which client statement?

"I feel pressure in my vagina when I have the contraction."

After teaching a postpartum client about postpartum blues, the nurse determines that the teaching was effective when the client makes which statement?

"I might feel like laughing one minute and crying the next."

After the nurse provides instructions to a postpartum woman about postpartum blues, which statement indicates understanding?

"I will feel like laughing one minute and crying the next minute."

A woman comes to the clinic. She gave birth about 2 months ago to a healthy term male newborn. During the visit, the woman tells the nurse, "I've noticed that I'm a bit uncomfortable now when we have sexual intercourse. Is there anything that I can do?" The woman's menstrual period has not yet resumed. Which suggestion by the nurse would be most appropriate?

"You might try using a water-soluble lubricant to ease the discomfort."

A client in her third trimester comes to the clinic for an evaluation. Assessment reveals that the cervix is thinning. The client says, "I know my cervix needs to dilate, but why does it get thinner?" Which response by the nurse would be appropriate?

"You need the cervix to thin so it can stretch more easily."

The nurse will be performing the Leopold's maneuver to determine the position of the fetus. List in order the steps that the nurse would take. All options must be used.

1)Determine presentation.2)Determine position.3)Confirm presentation.4)Determine attitude.

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount?

1000 mL

A postpartum woman is being treated for hemorrhage and is to receive a blood transfusion. The nurse understands that this treatment is being instituted based on which amount of estimated blood loss?

1,500 mL

The nurse is teaching a postpartum woman and her spouse about postpartum blues. The nurse would instruct the couple to seek further care if the client's symptoms persist beyond which time frame?

2 weeks

A client arrives in the emergency department accompanied by her husband and new 10-week-old infant, crying, confused, and with possible hallucinations. The nurse recognizes this could possibly be postpartum psychosis as it can appear within which time frame after birth?

3 months

The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh:

4,000 g to 4500 g

A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is:

5

Following the birth, the nurse is responsible for assessing the cord pH. The nurse recognizes that which value would be considered a normal pH?

7.2

A nurse is assessing the perineum of several postpartum clients using the REEDA score. The nurse initiates interventions to minimize the risk for postpartum infection for the client with which score?

9

Which practice would not be included in a physiologic birth?

Early induction of labor before 39 weeks' gestation

The nurse is providing care to a postpartum woman who has given birth vaginally to a healthy term neonate about 4 hours ago. While assessing the client, the client tells the nurse, "I've really been urinating a lot in the past hour." The nurse interprets this finding as suggestive of a decrease in which hormone?

Estrogen

A client presents to the birthing center in labor. The client's membranes have just ruptured. Which assessment is the nurse's priority?

FHR

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents?

FHR fluctuates from 6 to 25 beats per minute.

Which assessment finding indicates positive bonding between the parents and their newborn?

Holding the infant close to the body

Prioritize the postpartum mother's needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need.

Interaction time (first 30 minutes) with the infant to facilitate bonding.Sleep and rest without being disturbed for a few hours. Learn how to hold and cuddle the infant.Watch a baby bath demonstration given by the nurse.

When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action?

Keeping the communication lines open.

While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect?

Laceration

Assessment of a pregnant woman in labor reveals that the fetal attitude is normal. The nurse interprets this as indicating which information? Select all that apply.

Legs are flexed at the knees., Chin is on the chest.

The nurse is performing a routine assessment of the client after birth. Inspection of a woman's perineal pad reveals a 3-in (7.5-cm) lochia stain. This amount should be documented as which type?

Light

The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings would the nurse expect?

Light pink or brown lochia; uterus four to five fingerbreadths below umbilicus

The nurse is assessing a client who has given birth within the past hour. The nurse would expect to find the woman's fundus at which location?

at the level of the umbilicus

A nurse is reviewing the history of a postpartum woman. The nurse determines that the woman is at low risk for uterine subinvolution based on which findings? Select all that apply.

early ambulation, breastfeeding

The mental health clinical nurse specialist is teaching a postpartum nurse how to use the Postpartum Depression Predictor Scale (PDSS) to assess for postpartum depression. The nurse specialist determines the need for additional teaching when the nurse identifies which component as being screened with the scale?

family and social support system

A 19-year-old nulliparous is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication?

reduced oxygen to the fetus