Ch 21 OB
The nurse provides education to a postterm pregnant client. What information will the nurse include to assist in early identification of potential problems? a. "Be sure to measure 24-hour urine output daily." b. "Monitor your bowel movements for constipation." c. "Continue to monitor fetal movements daily." d. "Increase your fluid intake to prevent dehydration."
"Continue to monitor fetal movements daily."
A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies because the woman just experienced preterm labor with her most recent pregnancy. The nurse determines that the teaching was successful based on which statement by the woman? a. "Stress isn't a problem that is related to preterm labor." b. "Separating pregnancies by about a year should be helpful." c. "I'll make sure to limit the amount of long distance traveling I do." d. "I'll need extra iron in my diet so
"I'll make sure to limit the amount of long distance traveling I do."
A nurse is teaching a pregnant woman with preterm premature rupture of membranes (PPROM) about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching? a. "I need to call my doctor if my temperature increases." b. "It's okay for my husband and I to have sexual intercourse." c. "I can shower, but I shouldn't take a tub bath." d. "I need to keep a close eye on how active my baby is each
"It's okay for my husband and I to have sexual intercourse."
The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? a. "I need a cesarean section if I develop this problem." b. "Since I am over 30, I run a much higher risk of developing this problem." c. "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal
"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
A client at 42 weeks' gestation receives a vaginal insert of time-released dinoprostone at 0900 hours for cervical ripening. At which time does the nurse anticipate the client to receive oxytocin? a. 1220 hours b. 1590 hours c. 2120 hours d. 0950 hours
0950 hours
The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? a. 7 b. 5 c. 3 d. 11
11
A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? a. 2 to 7 days b. 4 to 8 days c. 6 to 10 days d. 1 to 5 days
2 to 7 days
The nurse is caring for a client after experiencing a placental abruption (abruptio placentae). Which finding is the priority to report to the health care provider? a. 45 ml urine output in 2 hours b. hematocrit of 36% (0.36) c. hemoglobin of 13 g/dl (130 g/L) d. platelet count of 150,000 mm3
45 ml urine output in 2 hours
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: a. 5. b. 7. c. 9. d. 6.
5
A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? a. Administer oxygen at 10 L/min by face mask. b. Administer amnioinfusion. c. Place the woman in Trendelenburg position. d. Assess fetal heart sounds.
Assess fetal heart sounds.
The nurse in a busy L & D unit is caring for a woman beginning induction via oxytocin drip. Which prescription should the nurse question with regard to titrating the infusion upward for adequate contractions? a. Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. b. Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each. c. After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate. d. Start o
Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min.
Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? a. Check for a full bladder. b. Assess vital signs every 30 minutes. c. Make sure the epidural medication is turned down. d. Make sure the client is lying on her left side.
Check for a full bladder.
A pregnant client late in the second trimester comes to the emergency department with a report of painless, bright red vaginal bleeding. The client states, "It started all of a sudden and now it seems to have stopped." Placenta previa is suspected. Which action should the nurse implement immediately for this client? a. Prepare the client for an immediate cesarean birth. b. Determine fetal heart sounds using an external monitor. c. Assist with insertion of internal monitoring to assess uterine pr
Determine fetal heart sounds using an external monitor.
A client at 35 weeks' gestation has been admitted due to concerns that the fetal blood vessels are too close to the cervix. Which action will the nurse prioritize when a nonstress test (NST) reveals a minor nonreassuring fetal heart pattern? a. Place the client in the Trendelenburg position. b. Notify the health care provider immediately. c. Repeat the NST in one hour. d. Ask the client to empty their bladder.
Notify the health care provider immediately.
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? a. Placenta previa is an abnormally implanted placenta that is too close to the cervix. b. Placenta previa causes painful, dark red vaginal bleeding during pregnancy. c. Placental abruption results in painless, bright red vaginal bleeding during labor. d. Placental abruption requi
Placenta previa is an abnormally implanted placenta that is too close to the cervix.
A laboring woman is receiving oxytocin IV to augment her labor and 2 hours later begins having contractions every 2 minutes lasting 60 to 90 seconds each with little, if any, rest time in between the contractions. At this time, which interventions would be the priority for the nurse caring for this client? Select all that apply. a. Apply oxygen to the woman via mask at 8 to 10 L/min. b. Administer betamethasone to mature the fetal lungs. c. Discontinue the oxytocin infusion. d. Administer an IV
a. Apply oxygen to the woman via mask at 8 to 10 L/min. c. Discontinue the oxytocin infusion. d. Administer an IV bolus of fluids.
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? a. amniotomy b. prostaglandin c. breast stimulation d. laminaria
amniotomy
After an hour of oxytocin therapy, a woman in labor states she feels dizzy and nauseated. The nurse's best action would be to: a. assess the rate of flow of the oxytocin infusion. b. administer oral orange juice for added potassium. c. instruct her to breathe in and out rapidly. d. assess her vaginally for full dilation (dilatation).
assess the rate of flow of the oxytocin infusion.
During a prenatal ultrasound, the client is discovered to have a succenturiate placenta. Following delivery of the fetus and placenta, which nursing assessment is most important? a. assessment for hemorrhage b. assessment for a thrombus c. assessment for shortness of breath d. assessment for pain
assessment for hemorrhage
A client has been in labor for several hours, but the membranes have not yet ruptured. Oxytocin is started intravenously. Which assessment finding(s) supports the decision to perform the artificial rupture of membranes? Select all that apply. a. vertex presentation of the fetus b. cervical dilation (dilatation) of 4 cm c. cervical effacement at 50% d. uterine contractions every 2 minutes e. fetal head at -2 station
b. cervical dilation (dilatation) of 4 cm e. fetal head at -2 station
A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. a. dinoprostone b. magnesium sulfate c. nifedipine d. misoprostol e. indomethacin
b. magnesium sulfate c. nifedipine e. indomethacin
A pregnant client mentions to the nurse that a friend has given her a variety of herbs to use during her upcoming labor to help manage pain. Specifically, she gave her chamomile tea, raspberry leaf tea, skullcap, catnip, jasmine, lavender, and black cohosh. Which of these should the nurse encourage the client not to take because of the risk of acute toxic effects such as cerebrovascular accident? a. skullcap b. jasmine c. black cohosh d. catnip
black cohosh
When planning the care of a client scheduled for induction of labor with exogenous oxytocin, the nurse should make which assessment? a. fetal heart rate b. vaginal discharge c. fundal height d. cervical ripening
cervical ripening
A pregnant woman comes to the birthing center, stating she is in labor and does not know far along her pregnancy is because she has not had prenatal care. A primary care provider performs an ultrasound that indicates oligohydramnios. When the client's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this client? a. complications of a post-term pregnancy b. complications of preterm labor c. placental abruption (abruptio placentae) d. complica
complications of a post-term pregnancy
A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth? a. fetal hydrocephalus b. macrosomia c. cord compression d. shoulder dystocia
cord compression
A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? a. fetal heart tones b. signs of shock c. infection d. uterine stabilization
fetal heart tones
A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? a. gradual onset of symptoms b. absence of pain c. fetal heart rate within normal range d. firm, rigid uterus on palpation
firm, rigid uterus on palpation
Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor? a. gestational diabetes b. gestational hypertension c. low parity d. macrosomia
gestational hypertension
A client has been admitted with placental abruption (abruptio placentae). She has lost 1,200 ml of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? a. grade 4 b. grade 2 c. grade 3 d. grade 1
grade 2
A nurse is describing the risks associated with post-term pregnancies as part of an in-service presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems concerning the fetus? a. meconium aspiration b. increased amniotic fluid volume c. aging of the placenta d. cord compression
increased amniotic fluid volume
A nurse is reviewing the medical record of a pregnant client. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which condition? a. low-lying placenta b. placenta increta c. placenta accreta d. placenta percreta
low-lying placenta
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? a. dystocia b. hemorrhage c. infection d. macrosomia
macrosomia
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? a. magnesium sulfate b. nifedipine c. betamethasone d. indomethacin
magnesium sulfate
A client at 29 weeks' gestation is seen in obstetric triage with reports of heavy vaginal bleeding noted upon waking. The client denies abdominal pain or uterine contractions. Continuous fetal monitoring shows a normal fetal heart rate with no signs of fetal distress. Which is the likely cause of the client's condition? a. disseminated intravascular coagulation (DIC) b. placenta previa c. vasa previa d. placental abruption
placenta previa
A client has arrived at the labor and delivery suite for a scheduled induction of labor. Which nursing intervention will the nurse implement before starting the oxytocin infusion? a. assessing the client's lung sounds b. obtaining a urine specimen c. placing on a tocodynamometer d. completing an ultrasound
placing on a tocodynamometer
A antepartum client at 35 weeks' gestation arrives at the clinic stating bright, red vaginal spotting occurred in the morning but has seemed to have stopped. An ultrasound indicates that the placenta is partially covering the cervical os. Which nursing intervention is intiated first? a. nonstress test to track fetal movement b. obtaining a urine specimen to assess for ketones c. positioning client on bed rest in a side-lying position d. vaginal examination to assess for cervical dilation (dilata
positioning client on bed rest in a side-lying position
A client at 7 months' gestation presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This client is showing clinical signs of which of the following? a. precipitous labor b. premature rupture of membranes c. dystocia d. all of the above
premature rupture of membranes
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? a. precipitate labor b. preterm labor c. normal labor d. dystocia
preterm labor
A woman having contractions comes to the emergency department. She tells the nurse that she is at 34 weeks' gestation. The nurse examines her and finds that she is already effaced and dilated 2 cm. What is this woman demonstrating? a. normal labor b. dystocia c. macrosomia d. preterm labor
preterm labor
The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? a. posterior position b. shortened c. closed d. firm
shortened
A nurse is providing care to a postpartum client who had a placental abruption and has now become tachycardic with a thready pulse. The client also has moderate to heavy vaginal bleeding. Laboratory testing reveals anemia, thrombocytopenia, and altered liver function tests. The health care team suspects the client is developing disseminated intravascular coagulation (DIC). Which assessment finding is most indicative of DIC? a. vaginal bleeding b. tachycardia c. thrombocytopenia d. altered liver
thrombocytopenia
A young woman experiencing contractions arrives at the emergency department. After examining her, the nurse learns that the client is at 33 weeks' gestation. What treatment can the nurse expect this client to be prescribed? a. bronchodilators b. anti-anxiety therapy c. muscle relaxants d. tocolytic therapy
tocolytic therapy
A pregnant woman at the emergency department informs staff that she is at least 2 weeks past her due date. The physician begins to perform several tests to determine fetal age. The nurse anticipates that the woman's amniotic fluid volume will be decreased. How would the nurse measure the amniotic fluid in this situation? a. aspiration b. palpation c. ultrasound d. x-ray
ultrasound
A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. The nurse should immediately check the client for: a. placental abruption (abruptio placentae). b. amniotic fluid infection. c. amniotic fluid embolus. d. umbilical cord prolapse.
umbilical cord prolapse.
A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? a. urine output of 20 mL/hour b. uterine resting tone of 14 mm Hg c. contractions every 2 minutes, lasting 45 seconds d. fetal heart rate of 150 beats/minute
urine output of 20 mL/hour
A nurse is preparing an in-service program about labor and the hormones involved with the initiation of labor. Which information would the nurse include as believing to play a role in the onset of labor? a. suppression of oxytocin b. withdrawal of progesterone c. suppression of prostaglandin release d. decrease in fetal cortisol levels
withdrawal of progesterone
