F2
a primigravida in active labor complains to the nurse of continuous back pain. The nurse determines that the client's fetus is most likely in which position? A) double footing breech B) mentum anterior C) transverse lie D) occipritoposterior
D
A nurse is teaching a client about potential adverse effects of implantable progestins. Which of the following adverse effects should the nurse include? (select all that apply) A) tinnitus B) irregular vaginal bleeding C) weight gain D) breast changes E) gingival hyperplasia
B, C, D
A nurse is providing care for a client who is diagnosed with a marginal abrupt placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? (select all that apply) A) fetal position B) blunt abdominal trauma C) cocaine use D) maternal age E) cigarette smoking
B, C, E
A 35 year old client, who is now 1 week past her due date, presents to a labor and birth unit. She had an ultrasound at 6 weeks for vaginal bleeding and another scan at 20 weeks. She believes that, according to her last menstrual period, she should be 3 days before her due date; however, she has a history of irregular periods. The estimated date of confinement is off by 11 days on the second sonogram. Her fundal height is 43 centimeters. Based on this information, the nurse determines that which method would be the most accurate for dating this pregnancy? A) the crown rump length on the 6 week sonogram B) her las menstrual period C) head circumference on a second trimester sonogram D) her fundal height measurement obtained today
A
A woman in labor is 5cm. She is complaining of severe back pain, 8/10, with each contraction. Using Leopold's Maneuvers, the nurse palpates fetal small parts of the fundus and along the maternal midline and find a cephalic presentation. What position is the fetus? A) occiput posterior B) occiput anterior C) occiput oblique D) occiput transverse
A
A woman presents with vaginal bleeding at 7 weeks. What is the primary nursing intervention for a woman who is bleeding during the first trimester? A) monitor vital signs B) prepare equipment for examination C) have oxygen available D) assess family's response to the situation
A
Preterm birth in Oklahoma A) increased from 2007 to 2010 B) occurs in over 20% of births to women over 40 C) is highest among African American women D) decreased from 2007 to 2010
A, B, C
A nurse in an infertility clinic is providing care to a couple who has been unable to conceive for 18 months. Which of the following data should be included in the assessment? (select all that apply) A) occupation B) menstrual history C) childhood infectious diseases D) history of falls E) recent blood transfusions
A, B, C (occupational hazards include exposure to teratogenic substances in the workplace, such as radiation, chemicals, herbicides, and pesticides; menstrual history can identify hormone-related patterns, such as an ovulation, pituitary disorders, and endometriosis; childhood infectious diseases can identify the male pattern having had the mumps)
Which of the following maternal health indicators in OK have actually gotten worse in the past several years? A) obesity B) access to vaginal birth after c-section services C) access to clean water D) smoking
A, B, D
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 125/min with occasional increases up to 150-155/min that last for 25 seconds and have beat to beat variability of 20/min. There is no slowing of FHR from the baseline. The nurse 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, B, D (there is a moderate variability of 20/min: 6-25/min is expected reference range)
A nurse is caring for a client who is at 42 weeks of gestation and is admitted to the labor and delivery unit. During an ultrasound, it is noted that the fetus is large for gestational age. The nurse reviews the prescription from the provider to begin an amnioinfusion. Which of the following conditions should the nurse plan to prepare an amnioinfusion? (select all that apply) A) oligohydramnios B) hydramnios C) fetal cord compression D) hydration E) fetal immaturity
A, C (oligohydramnios is an indication for an amnioinfusion because inadequate amniotic fluid can contribute to intrauterine growth restriction of the fuels, restrict fetal movement, and cause fetal distress during labor; oligohydramnios results in fetal cord compression, which decreases fetal oxygenation, amnioinfusion prevents cord compression)
A mother is 1 day postpartum. She is very dependent, asking for help with each of her baby's diaper changes, and wants to discuss her birth with each caregiver. An appropriate action for the nurse is: A) show the mother videos n diaper changes. Ask her to tell her brith story to her family. The nurse recognizes this as the maternal "taking-hold" phase B)Educate the mother and encourage her to participation to diaper changes when she asks and listen to her birth story. The nurse recognizes this as the maternal "taking-in" phase C) educate the mother and encourage the woman to focus on the infant's care rather than the birth experience. The nurse recognizes this as the maternal "letting-go" phase D) encourage the mother to participate in the diaper changes and listen to her birth story. The nurse recognizes this as the maternal "taking-hold" phase
B
A nurse admits a woman with a diagnosis of placenta previa. Which symptom is the nurse most likely to assess in a woman with this diagnosis? A) painful vaginal bleeding B) painless vaginal bleeding C) contractions D) absence of fetal movement
B
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? A) prolonged labor B) reduced fetal oxygen supply C) delated cervical dilation D) increased maternal stress
B
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 non pharmacological nursing interventions should the nurse recommend to the client? A) abdominal effleurage B) sacral counter pressure 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 primigravida client has been pushing for 2 hours when the head emerges. The fetus fails to deliver, and the physician notes that the turtle sign has occurred. Which should be a nurse's interpretation of this information? A) cephalopelvic disproportion B) shoulder dystocia C) persistent occiput posterior position D) cord prolapse
B (shoulder dystocia is a significant complication when the head is born but the fetal shoulders are unable to deliver)
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 the rupture of membranes. The first action by the nurse is to monitor the FHR for clinical findings of distress)
A nurse in a clinic is caring for a group of female clients who are being evaluated for infertility. Which of the following clients should the nurse anticipate the provider will refer to a genetic counselor? A) a client whose sister has alopecia B) a client whose partner has von Willebrand disease C) a client who has an allergy to sulfa D) a client who had rubella 3 months ago
B (von Willebrand disease is a genetic bleeding disorder and warrants a client being referred to a genetic counselor)
A 39 year old client presents in active labor. The client is breathing rapidly and having difficulty coping with the contractions. Based on this assessment, what would a nurse predict should occur if interventions are not initiated immediately? A) respiratory acidosis B) respiratory alkalosis C) metabolic acidosis D) metabolic alkalosis
B (women who are hyperventilating have a decrease in the PaCO2 levels, which leads to respiratory alkalosis)
A 42 year old woman who had a partial hydatidiform molar pregnancy 3 months ago, asks a nurse whether she and her husband can try conceiving again. Which response by the nurse is incorrect and warrants follow up action by an observing nurse manager? A) "You will need serial beta human chorionic gonadotropin (BHCG) levels every 1 to 2 weeks until negative, and then every 1 to 2 months for 6 to 12 months" B) "you cannot conceive again because of the risk of choriocarcinoma" C) "you should not become pregnant for 6 to 12 months D) "your risk of hydatidiform molar pregnancy reoccurrence is low"
B (women who have had a molar pregnancy can conceive again once their BHCG levels are normal and remain normal for a certain period, usually 6 to 12 months)
A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following statements should the nurse include in the teaching? (select all that apply) A) "it is considered a noninvasive 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 accurate readings with maternal movement" E) "it can measure uterine contraction intensity"
B, D, E
a nurse is at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? A) hyperemesis gravidarum B) threatened abortion C) hydatidiform mole D) preterm labor
C (a client who has a hydatidiform mole exhibits increased fundal height that is inconsistent with the week of gestation, and excessive n/v due to elevated hCG levels. Scant, dark discharge occurs in the second trimester)
A nurse is caring for a couple who is being evaluated for infertility. Which of the following statements by the nurse indicates understanding of the infertility assessment process? A) "you will need to see a genetic counselor as part of the assessment" B) "it is usually the woman who is having trouble, so the man doesn't have to be involved" C) "the man is the easiest to assess, and the provider will usually begin there" D) "think about adopting first because there are many babies that need good homes"
C (a sperm analysis is one of the first steps in the infertility assessment process and can identify a cause of infertility in a less invasive and costly manner)
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 pattern 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 increased during output" B) "it is needed to counteract respirator depression" C) "it is needed to counteract hypotension" D) "it is needed to prevent oligohydramnios"
C (maternal hypotension can occur following an epidural black and can be offset by administering an IV fluid bolus)
A client who is 39 weeks pregnant presents to the birthing facility with a complaint of uterine contractions. Her contractions are mild, infrequent, and every 9 to 12 minutes; however she is having variable decelerations. A physician orders a sonogram to determine if her amniotic fluid index (AFI) is adequate. The nurse interprets that which AFI is normal at 39 weeks? A) 4.75 cm B) 5.0 cm C) 10.5 cm D) 26 cm
C (normal AFI for a term pregnancy is greater than 5 and less than 25 cm)
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 is at risk for developing? A) intrauterine growth restriction B) hyperglycemia C) meconium aspiration D) polyhydramnios
C (postterm neonates are at risk for aspiration of meconium)
A nurse is caring for a client who wants minimal intervention in terms of pain relief. A physician recommends a procedure of injecting perineal anesthesia into the pudendal plexus for pain relief for the second stage of labor, birth, and episiotomy repair. Which type of anesthesia should the nurse anticipate that the HCP will likely request? A) epidural anesthesia B) systemic analgesia C) pudendal bloc D) local infiltration anesthesia
C (pudendal anesthesia involves injecting perineal anesthesia into the pudendal plexus for pain relief of the second stage of labor, birth, and episiotomy repair)
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 to the need to have a bowel movement, and can become nauseous with emesis)
A nurse is caring for a client and her partner during the second stage 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 will bulge as the baby's head appears" D) "your partner will report less rectal pressure"
C
A nurse is caring for a woman who is being evaluated for a suspected malpresentation. The fetus's long axis is lying across the maternal abdomen, and the contour of the abdomen is elongated. Which should be the nurse's documentation of the lie of the fetus? A) vertex B) breech C) transverse D) brow
C
A nurse is screening prenatal clients who may be carriers for potential genetic abnormalities. Which ethnic group should the nurse identify as having the lowest risk for hemoglobinopathies, such as sickle cell disease and thalassemia? A) African descent B) Southeast Asian descent C) Scandinavian descent D) Mediterranean descent
C
A nurse is providing emotional support for a woman who experienced a recent miscarriage during her second trimester. The nurse's care of the woman should be based on knowing which cause of spontaneous abortions is most common in the second trimester? A) maternal factors B) chromosomal abnormalities C) fetal death D) alcoholism
A (most common causes of second trimester losses are maternal factors, such as incompetent cervix)
A client presents with moderate vaginal bleeding and intense abdominal pain at 38 weeks gestation. The fetal heart rate is 90 beats per minute with no variability. A sonogram completed at 20 weeks reveals no evidence of a previa and an anterior placenta. The nurse determines that the most likely cause of her bleeding and pain is A) class 0 placenta abruption B) class 2 placenta abruption C) late-onset placenta previa D) spontaneous abortion
B (a class 2 placenta abruption is characterized by moderate vaginal bleeding with non reassuring fetal status)
A nurse caring for multiple clients determines that which woman would be a candidate for intermittent monitoring during labor? A) a woman with a previous cesarean birth B) a 41 week primigravida C) a woman with preeclampsia D) a woman with gestational diabetes
B (a woman who is overdue by 7 days, but has a reassuring fetal heart rate pattern, is able to have intermittent fetal monitoring)
The nurse assesses a client's funds and find it firm, 2 centimeters above the umbilicus and displaced to the right. What is the most appropriate intervention? A) have the client void and reassess the fundus B) massage the fundus vigorously C) observe for signs of increase in lochia flow D) notify the physician immediately
A
A nurse is about to obtain a fetal heart rate on a client in triage for evaluation of possible labor. When preparing to auscultate the FHR, what information is needed to determine where to find the correct placement? A) fetal position B) position of the placenta C) presence of contractions D) whether ultrasonic gel should be used
A ( the nurse should first perform Leopold's maneuvers to determine the fetal position, which will enable proper placement of the Doppler device over the location of the FHR)
A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and she is expected to deliver vaginally 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? A) pudendal B) epidural C) spinal D) paracervical
A (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 providing care for a client who is at 32 weeks of gestation and who has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following medications should the nurse anticipate the provider will provide? A) betamethasone B) indomethacin C) nifedipine D) methylergonovine
A (betamethasone is given to promote lung maturity if delivery is anticipated)
A nurse educator in the labor and delivery unit is reviewing the use of chemical agents to promote cervica ripening with a group of newly hired nurses. Which of the following statements by a nurse indicates understanding of the teaching? A) "they are administered in an oral form" B) "they act by absorbing fluid from tissues" C) "they promote dilation of the os" D) "they include an amniotomy"
A (chemical agents that promote cervical ripening include medications administered in oral form)
A nurse in a health clinic is reviewing contraceptive use with a group of adolescent clients. Which of the following statements by an adolescent reflects an understanding of the teaching? A) "a water-soluble lubricant should be used with condoms" B) "a diaphragm should be removed 2 hours after intercourse" C) "Oral contraceptives can worsen a case of acne" D) "a contraceptive patch is replaced once a month"
A (condoms are used with water-soluble lubricants)
A client presents with regular contractions that she describes as strong in intensity. Her cervical exam indicates that she is dilated to 3 cm. This information should suggest to a nurse that the client is experiencing A) early labor B) false labor C) cervical ripening D) lightening
A (early labor is a pattern of labor that occurs when contractions become regular and the cervix dilates to 3cm)
A nurse's client has requested an epidural for pain management during delivery. Which factors associated with epidural anesthesia? A) need for medications to stimulate contractions B) decrease in incidence of vaginal operative deliveries C) decrease in second stage of labor D) increase in cesarean births
A (epidural anesthesia is associated with less pain during the intrapartum period. Women who receive epidural anesthesia are more likely to require stimulation of uterine contractions)
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? A) hands and knees B) lithotomy C) Trendelenburg D) supine with a rolled towel under one hip
A (having the client assume a position on her hands and knees can help the fetus rotate from a posterior to an anterior position)
A nurse in the labor and delivery unit is caring for a client in labor and applies an external fetal monitor and tocotransducre. 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 2 cm dilated, 50% effaced, and the fetus is at a 2-station. Which of the following stages and phases of labor is this 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 0-3cm, and contraction duration ranges from 30-45 seconds)
A nurse is caring for a client who has been in labor for 12 hr, and her membranes are intact. The provider has decided to perform an amniotomy in an effort to facilitate the progress of labor. The nurse performs a vaginal examination to ensure which of the following prior to the performance of the amniotomy? A) fetal engagement B) fetal lie C) fetal attitude D) fetal position
A (prior to the performance of an amniotomy, the amniotic membranes should have ruptured. It is also imperative that the fetus is engaged at 0 station and at the level of the maternal ischial spines to prevent prolapse of the umbilical cord)
A nurse is in the room during a physician's examination of a client who thinks she may be pregnant. Which findings during the examination support a possibility of pregnancy? A) increased hyperplasia and hypertrophy in the breasts B) vaginal atrophy C) decrease in respiratory tidal volume D) increase in hemoglobin
A (the breasts increase in size and weight because of hyperplasia and hypertrophy of the breast tissue in preparation for lactation. Vaginal hypertrophy occurs from the increase in estrogen levels. Tidal volume increases throughout pregnancy because of a small degree of hyperventilation that occurs during pregnancy. Hemoglobin typically decreases as the pregnancy progresses, with some women developing pregnancy-induced anemia)
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 left-lateral position B) apply a fetal scalp electrode 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 a pregnant woman who states she smokes two packs per day of cigarettes. She states she has smoked in other pregnancies and has never had any problems. What is the nurse's best response? A) "I am glad to hear your other pregnancies went well. Smoking can cause a variety of problems in pregnancies and it would be best if you could quit smoking with this pregnancy" B) "You need to stop smoking for the baby's sake" C) "Smoking can lead to having a large baby which can make it difficult for delivery. You may even need a cesarean section" D) "Smoking less would eliminate the risk for your baby"
A (the mother should be advised that there are adverse effects associated with smoking, including small for gestational size, smaller fetal head, spontaneous abortion, placental abruption, neural tube defects, and increase risk of sudden infant death syndrome. Second hand smoke is also associated with adverse health effects for the fetus, including a risk for neural tube defects)
A nurse in a clinic is caring for a client who is to be seen by the provider for a postoperative appointment following a salpingectomy due to an ectopic pregnancy. Which of the following statements by the client requires clarification? A) "it is good to know that I won't have a tubal pregnant in the future" B) "the doctor said that this surgery can affect my ability to get pregnant again" C) I understand that one of my fallopian tubes had to be removed" D) "ovulation can still occur because my ovaries were not affected"
A (the risk of recurrence of an ectopic pregnancy is increased following an ectopic pregnancy)
A 22 year old woman tells a clinic nurse that her last menstrual period was 3 months ago, which began on 11/21. She has a positive urine pregnancy test. Using Nagele's rule, which date should the nurse calculate to be the woman's estimated date of confinement (EDC)? A) 8/28 B) 1/28 C) 8/15 4) 1/15
A (to calculate the EDC using Nagele's rule, subtract 3 months and add 7 days)
A laboring client is experiencing dyspnea, diaphoresis, tachycardia, and hypotension. A nurse suspects aortocaval compression. Which intervention should the nurse implement immediately? A) turning the client onto her left side B) turning the client onto her right side C) positioning the bed in reverse Trendelenburg's position D) positioning the client in a supine position
A (when a laboring woman lies flat on her back, the gravid uterus completely occludes the inferior vena cava and laterally displaces the sub renal aorta. This aortocabal compression reduces maternal cardiac output, producing dyspnea, diaphoresis, tachycardia, and hypotension)
A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3-5 minutes 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 all that apply) A) encourage use 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, C, D
A nurse is taking the health history of a new, pregnant client. Which medical conditions are most likely to be risk factors for complications during pregnancy? (select all that apply) A) diabetes B) previous pregnancy C) controlled chronic hypertension D) anemia E) hemorrhage with a previous pregnancy
A, C, D, E
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) 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) fundus firm upon palpation
A, D, E (the umbilical cord lengthens as the placenta is being expulsed, a gush of dark blood from the introits is an indication of placental separation; the uterus contracts firmly with placental separation)
A nurse is caring for a client who just gave birth vaginally. The nurse indicates that the presenting part was vertex and a hand. What should the proper documentation read in this woman's chart? A) "client gave birth via vertex presentation with a second degree perineal laceration: B) "client gave birth via compound presentation of vertex and hand with a second degree perineal laceration C) "client gave birth via breech presentation" D) "client gave birth via cesarean section with a hand presentation and breech part presenting"
B
In addition to breathing with contractions, which of the following actions can help a woman in labor to work with the pain of the first stage of labor? A) lying in the lithotomy position B) performing massage C) pushing with each contraction D) practicing Kegel exercises
B
The nurse examines a woman one hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her loch flow is profuse. The nurse's immediate action would be to A) assess the blood pressure B) massage her fundus C) administer 10 units PItocin IM D) increase IV fluid rate
B
The nurse is assessing the midline episiotomy on a postpartum client. Which of the following findings should the nurse expect to see? A) ecchymotic area distal to the episiotomy B) well-approximated edges C) moderate serousanguinous drainage D) an area of redness adjacent to the incision
B
The postpartum nurse plans nursing care based on the knowledge that in the immediate postpartum period, the most serious consequence likely to occur from bladder distention is? A) a urinary tract infection B) excessive uterine bleeding C) afterpains D) bladder wall atrophy
B
When performing Leopold's maneuvers, the nurse notes that the fetus is in the left occiput anterior (LOA) position. The nurse places the doppler on fetal back to best hear the heartbeat. Where is the fetal back located on the maternal abdomen? A) right lower quadrant B) left lower quadrant C) right upper quadrant D) left upper quadrant
B
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 reviewing the health record of a client who is to undergo hysterosalpingography. Which of the following data alert the nurse that the client is at risk for a complication related to this procedure? Vital signs: temp 37.2C(98.9F) BMI 40.3 - History and Physical: employed as a radiology tech, allergy to shrimp, tonsillectomy at age 18 - lab findings: glucose 103 mg/dL, Hgb 13.1 g/dL, total cholesterol 265 mg/dL - meds: rosuvastatin, magnesium oxide, mafenide acetate A) vital signs B) history and physical C) lab findings D) meds
B (an allergy to seafood is a contraindication to the dye used in a hysterosalpingography)
A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot be pregnant because she has an intrauterine device. The nurse should suspect which of the following? A) missed abortion B) ectopic pregnancy C) severe preeclampsia D) hydatidiform mole
B (manifestations of an ectopic pregnancy include unilateral lower quadrant pain with or without bleeding. Use of an IUD is a risk factor associated with this condition)
A nurse is caring for a client who is Rh negative at 13 weeks gestation. The client is having cramping and has moderate vaginal bleeding. Which physician order should the nurse question? A) administer Rho(D) immune globulin B) obtain beta human chorionic gonadotropin level (BHCG) C) schedule an ultrasound D) assess for fetal heart tones
B (obtaining the BHCG level is not indicated at this late stage in pregnancy. BHCG levels are followed in early pregnancy before a fetal heart can be confirmed)
A nurse is caring for a client who is receiving oxytocin for induction of labor and has an intrauterine pressure catheter (IUPC) placed to monitor uterine contractions. For which of the following contraction patterns should the nurse discontinue the infusion of oxytocin? A) frequency of every 2 min\ B) duration of 90-120 seconds C) intensity of 60-90 mmHg D) resting tone of 15 mm Hg
B (oxytocin is discontinued if uterine hyper stimulation occurs with contraction duration longer than 90 seconds)
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 uterus B) palpate the fundus of the uterus C) grasp lower uterine segment between thumb and fingers D) stand facing client's feet with fingertips outlining cephalic prominence
B (palpating the fundus of the uterus identifies the fetal part that is present, indicating the fetal lie; longitudinal or transverse)
A nurse in labor and delivery unit is completing an admission assessment for a client who is at 39 weeks of 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 membranes for longer than 24hr prior to delivery increases the risk that infectious organisms will enter the vagina and eventually into the uterus)
A 22 year old client, who is experiencing vaginal bleeding in the first trimester of pregnancy, fears that she has lost her baby at 8 weeks. Which definitive test results should indicate to a nurse that the client's fetus has been lost? A) falling beta human chorionic gonadotropin (BHCG) B) low progesterone measurement C) ultrasound demonstrating lack of fetal cardiac activity D) ultrasound determining crown-rump
C
A nurse is caring for a client who had no prenatal care, is Rh-negative, and will undergo an external version at 37 weeks of gestation. Which of the following medications should the nurse plan to administer prior to the version? A) prostaglandin gel B) magnesium sulfate C) Rho(D) immune globulin D) oxytocin
C (Rho immune globulin is administered to an Rh-negative client at 28 weeks of gestation. because this client had no prenatal care, it should be given prior to the version to prevent isoimmunization)
A nurse is instructing a client who is taking an oral contraceptive about danger signs tor report to her provider. The nurse determines the client understands the teaching when the client states the need to report which of the following?" A) reduced menstrual flow B) breast tenderness C) shortness of breath D) headaches
C (shortness of breath can indicate a pulmonary embolus or myocardial infarction and should be reported to the provider immediately)
A nurse in a clinic is teaching a client about her new prescription for medroxyprogesterone. Which of the following information should the nurse include in the teaching? (select all that apply) A) "weight loss can occur" B) "you are protected against STIs" C) "you should increase your intake of calcium" D) "you should avoid taking antibiotics" E) "irregular vaginal spotting can occur"
C, E (clients should take calcium and vitamin D to prevent loss of bone density, which can occur when taking medroxyprogesterone; medroxyprogesterone can cause irregular vaginal bleeding)
A nurse is caring for a client who is admitted to the labor and delivery unit. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which f the following possible complications should the nurse observe? A) precipitous labor B) premature rupture of membranes C) post maturity syndrome D) prolapsed umbilical cord
D
A woman in labor is 5 cm. She is complaining of severe back pain 8/10, with each contraction. Using Leopold's Maneuvers, the nurse placates fetal small parts at the fundus and along the maternal midline and finds a cephalic presentation. What position should the nurse assist the mother to? A) semirecumbent B) Semi-Fowlers D) left lateral E) hands and knees
D
A nurse is monitoring a laboring client, who has ruptured membranes and is 4 cm dilated. The client has been having intermittent decelerations for the last hour There is a decrease in variability, although the fetal heart rate remains in the 140s. The decelerations are now becoming more regular. What is the most accurate means to monitor the FHR in this client? A) fetal electrocardiography B) continuous external fetal monitoring C) cardiotocography D) fetal electrocardiography and cardiotocography
D (EBP indicates that the combination of fetal electrocardiography and cardiotocography provides the most accurate assessment, results in less surgical intervention, and ensures better oxygen levels)
A nurse in an obstetrical clinic a teaching a client about using an IUD for contraception. Which of the following statements by the client indicates an understanding of the teaching? A) "an IUD should be replaced annually during a pelvic exam" B) "I cannot get an IUD until after I've had a child" C) "I should expect intermittent abdominal pain while the IUD is in place: D) "a change in the string length of my IUD is expected"
D (a change in the length of the string can indicate explosion and should be reported to the provider)
A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? A) no alteration in menses B) transvaginal ultrasound indicating a fetus in the uterus C) serum progesterone greater than the expected reference range D) report of severe shoulder pain
D (a clients report of severe shoulder pain is a finding associated with a ruptured ectopic pregnancy due to the presence of blood in the abdominal cavity which irritates the diaphragm and phrenic nerve)
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? 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 monitor 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 intervilious spaces are compressed resulting in a decrease in fetal circulation and oxygenation)
A nurse is caring for a client in active labor. When last examined 2 hr ago, the client's cervix was 3cm 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 80-85/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? A) place the client in the Trendelenburg position B) apply pressure to the presenting part with her fingers C) administer oxygen at 10 L/min via a face mask D) call for assistance
D (according to EBP, the nurse should first call for assistance)
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? A) administer O2 via nasal cannula at 2 L/min B) apply a warm blanket C) assist the client to a side-lying position D) place an O2 mask over the client's nose and mouth
D (the client is experiencing hyperventilation caused by low serum levels of PCO2. Placing an O2 mask over the client's nose and mouth or having the client breath into a paper bag will reduce the intake of O2, allowing the PCO2 to rise and alleviate the numbness and tingling)
A nurse's client, who is in labor, is waiting for laboratory results to come back so epidural anesthesia can be administered. Which result is abnormal and should be reported to a physician? A) WBC 24000/mm3 B) glucose 78 gm/dL C) hemoglobin 13.2 g/dL D) platelets 112000/mm3
D (the normal platelet count is 150000 to 450000/mm3. Counts less than 150000 should be evaluated because they can contribute to bleeding. Counts less than 100000 may interfere with the woman's choice to receive epidural anesthesia)
A nurse in the labor and delivery unit receives a phone call from a client who reports that her contractions started about 2 hr 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 min 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 client 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 previa or abrupt placentae has been ruled out as the cause of vaginal bleeding)
