Final
Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? "I will make handprints and footprints of the baby for you to keep." "I know you are hurting, but you can have another baby in the future." "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" "Have you named your baby yet? I would like to know your baby's name."
"I know you are hurting, but you can have another baby in the future."
The nurse is working with several clients who have recently delivered healthy newborns. Which statement by a mother would alert the nurse to further assess the mother for postpartum depression? "The first few days I was home, I was overwhelmed." "I seem to cry more each and every day that goes by." "I am hearing voices and sometimes want to harm myself and my newborn." "Life sure has changed since I had the newborn....I am so tired but it is worth it."
"I seem to cry more each and every day that goes by."
A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman makes which statement? "I'll sit down to rest for 30 minutes." "I'll try to move my bowels." "I'll lie down with my legs raised." "I'll drink several glasses of water."
"I'll drink several glasses of water."
The laboring mother is 8 cm dilated and continues to want to push with every contraction. The mother asks the nurse why she can't push. What is the nurse's best response? "If you push against the cervix it will cause it to swell." "You have to wait until you are fully dilated to push." "Pushing before it's time won't get the baby her any sooner." "The baby is not down far enough for you to push."
"If you push against the cervix it will cause it to swell."
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? "I need to keep a close eye on how active my baby is each day." "I need to call my doctor if my temperature increases." "It's okay for my husband and I to have sexual intercourse." "I can shower, but I shouldn't take a tub bath."
"It's okay for my husband and I to have sexual intercourse."
The nurse is teaching an antepartum class to first-time mothers. A mother asks the nurse if she should stay in bed when her contractions start. How should the nurse respond? "No, walking actually shortens the first stage of labor." "No, but you need to only walk for 15-minute intervals." "Yes, you don't want to risk having your water break while you are walking." "Yes, it is important so monitoring can be done for you and the baby."
"No, walking actually shortens the first stage of labor."
The diabetic mother has been in active labor for 9 hours and has only reached 3 cm dilation (dilatation). It has been determined by ultrasound the fetus is very large. The decision has been made to deliver the fetus via cesarean. How much time does the nurse have to prepare the client before the surgery begins? 15 minutes 30 minutes 45 minutes 60 minutes
30 minutes
The nurse instructs the pregnant mother that it will necessary to collect swabs for group B streptococcus at which prenatal visit? 32 weeks' gestation 34 weeks' gestation 36 weeks' gestation 38 weeks' gestation
36 weeks' gestation
The postpartum mother who delivered via cesarean birth is preparing for discharge from the hospital. As part of the discharge teaching, the nurse instructs the mother to make an appointment with her physician to have the staples removed in: 3 days. 6 days. 11 days. 14 days.
6 days
A pregnant woman with type 2 diabetes is scheduled for a laboratory test of glycosylated hemoglobin (HbA1C). What does the nurse tell the client is a normal level for this test? 8% 6% 14% 12%
6%
A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result? 3.3 mEq/L 6.1 mEq/L 8.4 mEq/L 10.8 mEq/L
6.1 mEq/L
A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize? A systolic blood pressure increase of 10 mm Hg Weight gain of 1.2 lb (0.54 kg) during the past 1 week A dipstick value of 2+ for protein Pedal edema
A dipstick value of 2+ for protein
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? Prepare the client for an immediate cesarean birth. Assist with insertion of internal monitoring to assess uterine pressure. Determine fetal heart sounds using an external monitor. Prepare the client for a pelvic examination to assess rupture of membranes.
Determine fetal heart sounds using an external monitor.
The nurse is caring for an intrapartum mother whose fetus has asymmetrical intrauterine growth restriction (IUGR) after the 24th week of gestation. Which nursing action is best? Provide emotional support to the mother and support person as the neonate has anomalies. Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. Anticipate a precipitous delivery since the neonate is small-for-gestational-age. Use regular assessment techniques as an uncomplicated delivery is anticipated.
Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. --> The fetus with asymmetrical intrauterine growth restriction is compromised in some manner; thus, regular assessment of the fetal monitor tracings can indicate if the fetus is in distress (a common occurrence). If the fetus is in distress due to the work of birth, be prepared for a cesarean section. Neither a congenital anomaly nor a precipitous delivery is always present with IUGR. Since there is a complication causing IUGR, a complicated delivery is anticipated.
A client in labor has a spinal cord injury and is unable to effectively push with contractions. Forceps will be used. What should the nurse do to prepare the client for this type of delivery? Select all that apply. Provide oxygen 2 L via face mask. Validate that the cervix is fully dilated. Determine that the client's bladder is empty. Begin an intravenous infusion of replacement fluid. Ensure that the client's membranes have ruptured.
Validate that the cervix is fully dilated. Determine that the client's bladder is empty. Ensure that the client's membranes have ruptured.
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? breast stimulation amniotomy laminaria prostaglandin
amniotomy
A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum? limiting sodium intake inspecting the extremities for edema ensuring that the client consumes a high fiber diet assessing for cardiac decompensation
assessing for cardiac decompensation
A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: birth is unlikely within the 2 next weeks. birth is likely within the next 2 weeks. no infection is present. infection is present.
birth is unlikely within the 2 next weeks. Fetal fibronectin is a protein that helps the placenta and fetal membranes adhere to the uterus during pregnancy. A negative result (absence of fetal fibronectin) is a reliable indicator that birth is unlikely within 2 weeks following the test. It does not diagnose infection.
A client with severe preeclampsia is receiving magnesium sulfate as part of the treatment plan. To ensure the client's safety, which compound would the nurse have readily available? potassium chloride ferrous sulfate calcium gluconate calcium carbonate
calcium gluconate
A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds that can prolong labor. The nurse is referring to which compounds? prostaglandins catecholamines oxytocin relaxin
catecholamines
In preparing a class for a group of pregnant couples, the nurse includes information about possible newborn complications associated with smoking during pregnancy. Which complications will the nurse include? Select all that apply. trisomy 21 cerebral palsy low birth weight cleft lip and palate sudden infant death syndrome
cerebral palsy low birth weight cleft lip and palate sudden infant death syndrome
A 16-year-old client has been in the active phase of labor for 14 hours. An ultrasound reveals that the likely cause of delay in dilation (dilatation) is cephalopelvic disproportion. Which intervention should the nurse most expect in this case? cesarean birth administration of oxytocin administration of morphine sulfate darkening room lights and decreasing noise and stimulation
cesarean birth If the cause of the delay in dilation (dilatation) is fetal malposition or cephalopelvic disproportion (CPD), cesarean birth may be necessary. Oxytocin would be administered to augment labor only if CPD were ruled out. Administration of morphine sulfate (an analgesic) and darkening room lights and decreasing noise and stimulation are used in the management of a prolonged latent phase caused by hypertonic contractions. These measures would not help in the case of CPD.
A woman with cardiac disease has come to the office for prenatal counseling. Assessment supports the decision to caution the woman against pregnancy. The woman most likely fits the criteria for which functional risk classification? class IV class I class II class III
class IV
A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome? congenital anomalies incompetent cervix placenta previa placental abruption (abruptio placentae)
congenital anomalies
Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? lack of cervical dilation past 2 cm fetal buttocks as the presenting part reports of severe back pain contractions most forceful in the middle of uterus rather than the fundus
contractions most forceful in the middle of uterus rather than the fundus
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? fetal hydrocephalus macrosomia cord compression shoulder dystocia
cord compression
A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position? cord prolapse uterine atony placental abruption (abruptio placentae) brachial plexus injury
cord prolapse
A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding? urinary output of 20 mL per hour respiratory rate of 10 breaths/minute deep tendons reflexes 2+ difficulty in arousing
deep tendons reflexes 2+
A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the client is likely to increase the risk for shoulder dystocia? diabetes preterm birth nullipara pendulous abdomen
diabetes
It is necessary for the mother to have a forceps delivery. To reduce complications from this procedure, the nurse should: empty the mother's bladder. provide pain medication. have anesthesia provider present. call the neonatologist.
empty the mother's bladder.
The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding? well coordinated. poor in quality. brief. erratic.
erratic
A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion (miscarriage). The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first-trimester miscarriage? maternal disease cervical insufficiency fetal genetic abnormalities uterine fibroids (uterine myomas)
fetal genetic abnormalities
A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? a low-lying placenta fetopelvic disproportion contraction ring uterine bleeding
fetopelvic disproportion
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? firm, rigid uterus on palpation gradual onset of symptoms fetal heart rate within normal range absence of pain
firm, rigid uterus on palpation
A client is admitted with a diagnosis of ruptured ectopic pregnancy. For what should the nurse anticipate preparing the client? immediate surgery internal uterine monitoring bed rest for the next 4 weeks intravenous administration of a tocolytic
immediate surgery
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? aging of the placenta increased amniotic fluid volume meconium aspiration cord compression
increased amniotic fluid volume
The nurse reviews the medication therapy regimen of a pregnant woman with chronic hypertension. Which medication would the nurse most likely expect to find? labetalol atenolol carvedilol metoprolol
labetalol --> think "labe-" sounds like "labor" = safe for pregnant moms
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? hemorrhage macrosomia infection dystocia
macrosomia
The nurse is caring for a woman at 32 weeks' gestation who expresses deep concern because her previous pregnancy ended in a stillbirth. The nurse would encourage the mother to have what screening test? contraction stress test nonstress test (NST) vaginal ultrasound doppler ultrasound
nonstress test (NST) Women with a history of previous stillbirth begin antepartum fetal testing 1 to 2 weeks prior to the gestational age at which the intrauterine demise occurred, or no later than 32 to 34 weeks' gestation. One method to assess the well-being of the fetus is the biophysical profile. Included in this is the nonstress test. Other regular screening methods are having the mother keep a record of kicks (fetal movement counts/kick counts) and monitoring for hypertensive disorders and diabetes. An abdominal ultrasound could screen for fetal growth restriction. A Doppler ultrasound measures the blood flow of the fetus but it is not part of the regular screening unless fetal problems have been identified.
A client is experiencing dysfunctional labor that is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this client? oxytocin therapy fluid replacement pain management increasing activity
oxytocin therapy
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? labor less than 3 hours hemoglobin of 11.5 mg/dl (115 g/L) placenta removed via manual extraction multiparity
placenta removed via manual extraction
A client with a multiple gestation has come to a health care facility for a regular antenatal check-up. When educating the client on pregnancy, about which complication should the nurse inform the client? hypotension fetal macrosomia frequent diarrhea placental dysfunction
placental dysfunction
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? precipitous labor premature rupture of membranes dystocia all of the above
premature rupture of membranes
The nurse is caring for a client with preeclampsia and understands the need to auscultate this client's lung sounds every 2 hours to detect which condition? pulmonary hypertension pulmonary edema pulmonary emboli pulmonary atelectasis
pulmonary edema --> In the hospital, monitor blood pressure at least every 4 hours for mild preeclampsia and more frequently for severe disease. In addition, it is important to auscultate the lungs every 2 hours. Adventitious sounds may indicate developing pulmonary edema.
A nurse is reviewing a client's history and physical examination findings. Which information would the nurse identify as contributing to the client's risk for an ectopic pregnancy? use of oral contraceptives for 5 years ovarian cyst 2 years ago recurrent pelvic infections heavy, irregular menses
recurrent pelvic infections --> In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease. Oral contraceptives, ovarian cysts, and heavy, irregular menses are not considered risk factors for ectopic pregnancy.
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? "I need a cesarean section if I develop this problem." "If I develop this complication, I will have bright red vaginal bleeding," "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." "Since I am over 30, I run a much higher risk of developing this problem."
"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
The nurse is teaching a pregnant client with type 2 diabetes about diet during pregnancy. Which client statement indicates that the nurse's teaching was successful? "I'll basically follow the same diet that I was following before I became pregnant." "Because I need extra protein, I will have to increase my intake of milk and meat." "Pregnancy affects insulin production, so I will need to make adjustments in my diet." "I will adjust my diet and insulin based on the results of my urine tests for glucose."
"Pregnancy affects insulin production, so I will need to make adjustments in my diet."
The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging? Use Zavanelli maneuver. Apply pressure to the fundus. Attempt to push in one of the fetus's shoulders. Use McRoberts maneuver.
Use McRoberts maneuver. McRoberts maneuver intervention is used with a large baby who may have shoulder dystocia and requires assistance. The legs are sharply flexed by a support person or nurse, and the movement will help to open the pelvis to the widest diameter possible. Zavanelli maneuver is performed when the practitioner pushes the fetal head back in the birth canal and performs an emergency cesarean birth. Fundal pressure is contraindicated with shoulder dystocia. It is outside the scope of practice for the LPN to attempt birth of the fetus by pushing one of the fetus' shoulders in a clockwise or counterclockwise motion.
A nurse is assessing pregnant clients for the risk of placenta previa. Which client faces the greatest risk for this condition? a 23-year-old multigravida client a client with a history of alcohol use disorder a client with a structurally defective cervix a client who had a myomectomy to remove fibroids
a client who had a myomectomy to remove fibroids A previous myomectomy to remove fibroids can be associated with the cause of placenta previa. Risk factors also include maternal age greater than 30 years. A structurally defective cervix cannot be associated with the cause of placenta previa. However, it can be associated with the cause of cervical insufficiency. Alcohol ingestion is not a risk factor for developing placenta previa but is associated with placental abruption (abruptio placentae).
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? black cohosh skullcap catnip jasmine
black cohosh
A woman has been diagnosed as having gestational hypertension. Which symptom for this condition is the most typical? increased perspiration blood pressure elevation weight loss susceptibility to infection
blood pressure elevation
A high-risk pregnant client is determined to have gestational hypertension. The nurse suspects that the client has developed preeclampsia with severe features based on which finding? blurred vision blood pressure of 150/100 mm Hg mild facial edema proteinuria of 300 mg per 24 hours
blurred vision
A client in the active phase of labor is diagnosed as having a protracted labor pattern. Which pattern would the nurse assess as indicative of a protracted labor pattern? arrest of the descent of the fetal head prolonged deceleration phase secondary arrest of cervical dilation (dilatation) delayed descent of the fetal head
delayed descent of the fetal head
A woman who is 42 weeks' pregnant comes to the clinic. During the visit, which assessment should the nurse prioritize? determining an accurate gestational age asking her about the occurrence of contractions checking for spontaneous rupture of membranes measuring the height of the fundus
determining an accurate gestational age
A pregnant client with deep vein thrombosis has been diagnosed as having systemic lupus erythematosus (SLE). The nurse would monitor the client closely for the development of which complication? increased placental weight postterm birth of infant fetal macrosomia fetal malnutrition
fetal malnutrition
The nurse is caring for a client at 26 weeks' gestation who experiences periodic bleeding from the vagina. Which additional finding indicates to the nurse that the client should be evaluated for chronic placental abruption? elevated blood pressure elevated blood glucose level fundus below expected height periodic right upper quadrant pain
fundus below expected height
Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also reports significant pelvic pain and is experiencing problems with voiding. The nurse suspects which condition? hematoma laceration bladder distention uterine atony
hematoma
TORCH is an acronym for maternal infections associated with congenital malformations and disorders. Which disorder does the H represent? hemophilia hepatitis B virus herpes simplex virus human immunodeficiency virus (HIV)
herpes simplex virus
A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? hypotonic contractions hypertonic contractions uncoordinated contractions Braxton Hicks contractions
hypotonic contractions
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. nifedipine magnesium sulfate dinoprostone misoprostol indomethacin
nifedipine magnesium sulfate indomethacin Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), indomethacin (a prostaglandin synthetase inhibitor), and nifedipine (a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix.
A woman with an artificial mitral valve develops heart failure at the 20th week of pregnancy. Which measure would the nurse stress with her during the remainder of the pregnancy? obtaining enough rest maintaining a high fluid intake beginning a low-impact aerobics program discontinuing her prepregnancy anticoagulant
obtaining enough rest
A 19-year-old nulliparous woman 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 ruptured uterus cephalopelvic disproportion precipitate labor
reduced oxygen to the fetus
A woman has presented to the emergency department with symptoms that suggest an ectopic pregnancy. Which finding would lead the nurse to suspect that the fallopian tube has ruptured? referred shoulder pain vaginal spotting nausea breast tenderness
referred shoulder pain
The nurse is assisting with a vaginal birth. The client is fully dilated, 100% effaced, and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus? shoulder dystocia umbilical cord prolapse nuchal cord breech position
shoulder dystocia The "turtle sign" is the classic sign that alerts the practitioner to the probability of shoulder dystocia. The fetal head delivers, but then retracts similar to a turtle. The fetal head may wiggle from side to side and fail to rotate.
A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do? "Maintain bed rest, and count the number of perineal pads used." "Come to the health care facility if uterine contractions begin." "Continue normal activity, but take the pulse every hour." "Come to the health facility with any vaginal material passed."
"Come to the health facility with any vaginal material passed."
A pregnant client has been diagnosed with hydramnios and has been referred for further testing. To obtain family history information needed for the testing, which question(s) should the nurse ask the client? Select all that apply. "Has anyone in your family been born with a problem with the intestines?" "Do you have a family history of children with heart defects?" "Do you have anyone in the family who has been born with a spine problem?" "Do you have anyone in the family born with Down syndrome?" "Has anyone in the family been born with kidney problems?"
"Has anyone in your family been born with a problem with the intestines?" "Do you have anyone in the family who has been born with a spine problem?" "Do you have anyone in the family born with Down syndrome?"
During active labor, the nurse notes a decrease in the baby's fetal heart rate and consults with the health care provider. The provider concurs and prescribes application of oxygen via mask, increase in IV fluids, and repositioning. The nurse should communicate which piece of information to the woman when she protests about being "tied down" in bed with IVs? "An IV line will assist the staff if your baby shows signs of distress." "Increasing your oxygen level will also increase the infant's oxygen level." "Changing your position to side lying can prevent hypotension from inferior vena cava compression." "Remember, the goal is to increase the FHR so a healthy infant can be born."
"Remember, the goal is to increase the FHR so a healthy infant can be born."
The mother asks the nurse when an episiotomy is performed. How should the nurse respond? "The episiotomy is done after the baby is crowning." "The episiotomy is done before crowning to allow more room for the baby." "The episiotomy is done when the baby reaches the perineum." "The episiotomy is only done if the perineum begins to tear."
"The episiotomy is done after the baby is crowning."
A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage (D&C). The client looks frightened and confused and states that she does not believe in induced abortion (medical abortion). Which statement by the nurse is best? "I know that it is sad but the pregnancy must be terminated to save your life." "The choice is up to you but the health care provider is recommending an induced abortion (medical abortion). "You have experienced an incomplete abortion (miscarriage) and must have the placenta and any other tissues cleaned out." "Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."
"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications."
A nurse is caring for a 45-year-old pregnant client with a cardiac disorder who has been instructed by her primary care provider to follow class I functional activity recommendations. The nurse correctly instructs the client to follow which limitations? "You will need to be on bedrest for the remainder of your pregnancy." "It is important for you to rest after any physical activity in order to prevent any cardiac complications." "It will be beneficial if you plan rest periods throughout your day." "You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath."
"You do not need to limit your physical activity unless you experience any problems such as fatigue, chest pain, or shortness of breath."
A client with asthma is confused by her primary care provider continuing her medication while she is pregnant, since she read online the medications can cause birth defects. What is the nurse's best response? "Your primary care provider will order safe doses of your medication." "It's OK to not use them if you would feel more comfortable." "They won't cause any major defects." "I'll let your primary care provider know how you feel about it."
"Your primary care provider will order safe doses of your medication."
The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? To lessen the mother's pain The fetus is descending too slowly Abnormal position of the fetal head Reduce risk of complications
Abnormal position of the fetal head
A nurse is preparing a nursing care plan for a client who is admitted at 22 weeks' gestation with advanced cervical dilation (dilatation) to 5 cm, cervical insufficiency, and a visible amniotic sac at the cervical opening. Which primary goal should the nurse prioritize at this point? Give birth vaginally Bed rest to maintain pregnancy as long as possible Notification of social support for loss of pregnancy Education on causes of cervical insufficiency for the future
Bed rest to maintain pregnancy as long as possible
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? Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate. Start oxytocin drip, piggyback to main IV line to port closest to client. Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each.
Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. Hyperstimulation is usually defined as five or more contractions in a 10-minute period or contractions lasting more than 2 minutes in duration or occurring within 60 seconds of each other. The surest method to relieve hyperstimulation is to immediately discontinue the oxytocin infusion. The rate should not be increased by more than 2 milliunits at a time. When the infusion is administered, the oxytocin solution should be "piggybacked" to a maintenance IV solution such as Ringer's lactate and the piggyback added to the main infusion at the port closest to the woman. Infusions are usually begun at a rate of 1 to 2 milliunits/min. If there is no response, the infusion is gradually increased every 30 to 60 minutes by small increments of 1 to 2 milliunits/min until contractions begin.
After conducting a refresher class on possible congenital infections with a group of perinatal nurses, the nurse recognizes the class was successful when the group identifies which congenital viral infection as the most common? CMV HIV HPV RSV
CMV
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? Make sure the epidural medication is turned down. Check for a full bladder. Make sure the client is lying on her left side. Assess vital signs every 30 minutes.
Check for a full bladder.
The nurse notes that a client's uterus, which was firm after the fundal massage, has become boggy again. Which intervention would the nurse do next? Perform vigorous fundal massage for the client. Check for bladder distention, while encouraging the client to void. Use semi-Fowler position to encourage uterine drainage. Offer analgesics prescribed by health care provider.
Check for bladder distention, while encouraging the client to void.
The nurse is monitoring a primipara who has been receiving oxytocin and is now in hypertonic labor. If the nurse notes the fetal heart rate has suddenly dropped, which action should the nurse prioritize? Decrease the oxytocin drip rate. Turn the client on the left side. Administer a tocolytic medication. Assist with McRoberts maneuver.
Decrease the oxytocin drip rate.
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? Determine fetal heart sounds using an external monitor. Prepare the client for an immediate cesarean birth. Assist with insertion of internal monitoring to assess uterine pressure. Prepare the client for a pelvic examination to assess rupture of membranes.
Determine fetal heart sounds using an external monitor.
Which response is most appropriate for a client with diabetes who wants to breastfeed but is concerned about the effects of breastfeeding on her health? Diabetic clients who breastfeed have a hard time controlling their insulin needs. Diabetic clients shouldn't breastfeed because of potential complications. Diabetic clients shouldn't breastfeed; insulin requirements are doubled. Diabetic clients may breastfeed; insulin requirements may decrease from breastfeeding
Diabetic clients may breastfeed; insulin requirements may decrease from breastfeeding
A pregnant client receiving intravenous oxytocin for 1 hour has contractions lasting 85 seconds. What should the nurse do first for this client? Discontinue the oxytocin infusion. Slow the infusion to below 10 gtt/minute. Increase the flow rate of the main line infusion. Continue to monitor contraction duration every 2 hours.
Discontinue the oxytocin infusion. Contractions should last no longer than 70 seconds. If contractions become longer in duration, stop the IV infusion and seek help immediately. The infusion needs to be discontinued and not slowed. Increasing the flow rate could cause fetal distress. The client needs to be assessed more frequently than every 2 hours.
When preparing a mother for a trial of labor after cesarean (TOLAC), what information should the nurse include in the teaching plan? There may be a longer active phase of first stage of labor. There may be a shorter active phase of first stage of labor. There may be a longer latent phase of labor. There may be a shorter latent phase of labor.
There may be a longer active phase of first stage of labor.
The nurse notifies the obstetrical team immediately because the nurse suspects that the pregnant woman may be exhibiting signs and symptoms of amniotic fluid embolism. When reporting this suspicion, which finding(s) would the nurse include in the report? Select all that apply. significant difficulty breathing hypertension tachycardia pulmonary edema bleeding with bruising
significant difficulty breathing tachycardia pulmonary edema bleeding with bruising
A woman who delivered her infant by cesarean section 1 week ago called her physician's office to report chills, fever of 101.6℉ (38.7℃) and a poor appetite. She also tells the nurse that she is having strong afterbirth pains and her lochia has increased in volume and has an odor. Lab work shows an elevated WBC count. Which of these reported findings is the most significant finding related to the suspected diagnosis of endometritis? Fever Lochia odor Strong afterpains Elevated WBC count
Fever
Many women develop iron-deficient anemia during pregnancy. What diagnostic criteria would the nurse monitor for to determine anemia in the pregnant woman? Hemoglobin of 13 g/dl (130 g/L) or lower Hematocrit of 32% or less Blood pressure of 100/68 mm Hg Heart rate of 84 beats/min
Hematocrit of 32% or less
A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position? Lie flat on her back. Stay in high Fowler position. Lie in a semi-recumbent position. Use pillows and wedges to stay in a fully recumbent position.
Lie in a semi-recumbent position.
A client at 38 weeks' gestation is admitted to the labor and delivery unit in early labor and with the membranes intact. The nurse completes an assessment and determines by the Leopold maneuver that the fetus is in a malposition. What action(s) will the nurse take? Select all that apply. Notify the health care provider. Connect the external fetal heart monitor. Conduct a sterile vaginal examination. Bring the ultrasound machine to the bedside. Perform a nitrazine test.
Notify the health care provider. Connect the external fetal heart monitor. Bring the ultrasound machine to the bedside.
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? Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placental abruption results in painless, bright red vaginal bleeding during labor. Placental abruption requires "watchful waiting" during labor and birth.
Placenta previa is an abnormally implanted placenta that is too close to the cervix.
A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? Premature separation of the placenta Preterm labor that was undiagnosed Placenta previa obstructing the cervix Possible fetal death or injury
Premature separation of the placenta
The nurse is admitting a client in labor. The nurse determines that the fetus is in a transverse lie by performing Leopold maneuvers. What intervention should the nurse provide for the client? Administer an analgesic to the client. Prepare the client for a cesarean birth. Prepare for a precipitous vaginal birth. Prepare to assist the care provider with an amniotomy.
Prepare the client for a cesarean birth. If a transverse lie persists, the fetus cannot be born vaginally. Thus, the nurse will prepare the client for a caesarean birth. There is no indication the client will have precipitous labor. Amniotomy, artificial rupture of the membranes, is not indicated when preparing from a caesarean birth. The nurse would not administer analgesic before surgery unless prescribed by the health care provider.
A nurse is reviewing the medical record of a postpartum woman in preparation for assessment. Which factor would the nurse identify as increasing the woman's risk for infection? Select all that apply. urinary stasis denuded endometrial arteries episiotomy white blood cell count 25,000/mm³ hemoglobin 11.0 g/100 mL
urinary stasis denuded endometrial arteries episiotomy
The nurse is caring for a pregnant client admitted for abdominal trauma following an assault. The nurse will monitor the client for which potential complications? Select all that apply. Spontaneous abortion (miscarriage) Placental abruption (abruptio placentae) Uterine rupture Gestational hypertension Preterm labor
Spontaneous abortion (miscarriage) Placental abruption (abruptio placentae) Uterine rupture Preterm labor
A pregnant woman asks the nurse how the uterine arteries will be able to supply blood to the uterus after the uterus increases to four times its prepregnant size. The nurse would explain that this will happen easily because of which of the following? More arteries form during pregnancy. The muscle of the uterus decreases during pregnancy. Venous congestion causes stasis of arterial blood. The normally twisted and coiled uterine vessels uncoil and elongate.
The normally twisted and coiled uterine vessels uncoil and elongate.
Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? hemoglobin level of 12 g/dl (120 g/L) uterine atony thrombophlebitis moderate amount of lochia rubra
uterine atony
A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to: administer oxygen by mask. increase her intravenous fluid infusion rate. put firm pressure on the fundus of her uterus. tell the woman to take short, catchy breaths.
administer oxygen by mask.
A client at 36 weeks' gestation presents to the OB unit reporting continuous, heavy vaginal discharge and pelvic pressure. Assessment reveals no signs of labor and positive nitrazine test. The nurse prepares for which nursing intervention after admitting the client? administering erythromycin IV performing daily pelvic exams administering IM corticosteroids administering oxytocin
administering erythromycin IV
A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment? uterine hypertonicity active genital herpes infection blood pressure of 130/88 mm Hg decreased urine output TAKE ANOTHER QUIZ
uterine hypertonicity --> The nurse should ensure that the client does not have uterine hypertonicity to confirm that amnioinfusion is not contraindicated. Other factors that enforce contraindication of amnioinfusion include vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, and severe fetal distress. Active genital herpes infection is a condition that enforces contraindication of labor induction rather than amnioinfusion. Urine output and blood pressure do not determine a client's ability to receive an amnioinfusion.
A woman in labor is experiencing dysfunctional labor (hypotonic uterine dysfunction). Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer? sedatives tocolytics uterine stimulants corticosteroids
uterine stimulants
A woman in active labor has just had her membranes ruptured to speed up labor. The nurse is concerned the woman is experiencing a prolapse of the umbilical cord when the nurse notices which pattern on the fetal heart monitor? variable deceleration pattern fetal heart rate (FHR) increase to 200 beats/min early deceleration with each contraction late deceleration with late recovery following contraction
variable deceleration pattern
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? suppression of prostaglandin release withdrawal of progesterone decrease in fetal cortisol levels suppression of oxytocin
withdrawal of progesterone
