Maternity 3

1) The nurse is admitting a patient to the labor and delivery unit. Which aspect of the patient's history requires notifying the physician? 1. Blood pressure 120/88 2. Father is a carrier of sickle-cell trait 3. Dark red vaginal bleeding 4. History of domestic abuse

3. Dark red vaginal bleeding

13) The baseline fetal heart rate is 135 beats per minute. Following contractions, the fetus develops late decelerations. Which nursing intervention should be implemented first? 1. Alert the physician/CNM of the fetal status. 2. Administer oxygen to the patient at 4 liters per minute via nasal cannula. 3. Decrease the rate of infusion of intravenous fluids. 4. Facilitate a maternal left lateral position.

4. Facilitate a maternal left lateral position.

9) The anesthesia provider has just administered an epidural anesthetic in a laboring client and local anesthesia is continuously infusing via the epidural catheter. Suddenly, the client asks, "Why are my ears ringing?" What is the most likely cause of the client's complaint? 1. Hypotension 2. Allergic reaction 3. Dehydration 4. Local anesthetic toxicity

4. Local anesthetic toxicity

3) The laboring client and her partner have arrived at the birthing unit. Which step of the admission process should be undertaken first? 1. The sterile vaginal exam 2. Welcoming the couple 3. Auscultation of the fetal heart rate 4. Checking for ruptured membranes

2. Welcoming the couple

11) During admission, a laboring client tells the nurse, "I'm so afraid I'll need a cesarean section. I don't want to be asleep for surgery when my baby is born!" Which of the following nursing responses is most appropriate? 1. "If a cesarean section is needed, that doesn't necessarily mean you'll need to go to sleep for surgery." 2. "Your anesthesia provider will require that you go to sleep for surgery." 3. "We'll do our best to make sure you deliver vaginally, so you don't need to have a cesarean section." 4. "If you need a cesarean section, the anesthesia provider will awaken you as soon as possible after delivery so that you can see your baby quickly."

1. "If a cesarean section is needed, that doesn't necessarily mean you'll need to go to sleep for surgery."

9) The neonatal nurse specialist is presenting a class to nursing students. When describing a proper method for preventing heat loss in the neonate, which statement should the neonatal nurse specialist include in his presentation? 1. "If the newborn is under a radiant-heated unit, he or she is dried, placed on a dry blanket, and left uncovered under the radiant heat." 2. "After delivery, the newborn is immediately placed in skin-to-skin contact with the mother." 3. "If a radiant-heated unit is used to keep the neonate warm, he or she is dried, wrapped in a dry blanket, and placed under the radiant heat." 4. "Immediately after delivery, the newborn is wrapped in a blanket and placed on the mother's chest."

1. "If the newborn is under a radiant-heated unit, he or she is dried, placed on a dry blanket, and left uncovered under the radiant heat."

8) During her hospital admission, the laboring client explicitly refused all pain medications and a labor epidural. Once dilated to 5 cm, the client complains of intolerable discomfort and asks the nurse, "If I have an epidural, how will you make sure it doesn't hurt my baby?" The best response by the nurse is: 1. "We'll monitor your baby continuously so we can recognize and treat any changes that may be related to the epidural." 2. "Epidural anesthesia is very safe and there are no potential side effects that can affect your baby." 3. "We'll assess your blood pressure every 15 minutes to make sure the epidural is not having any negative effects on your baby." 4. Before your epidural is placed, we'll administer IV fluid to you in order to prevent the epidural from causing you problems."

1. "We'll monitor your baby continuously so we can recognize and treat any changes that may be related to the epidural."

3) The primiparous patient has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of contractions occurring every 5 minutes. The best response by the nurse is: 1. "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress." 2. "When your perineal body thins out, your cervix will begin to dilate much faster than it is now." 3. "What did you expect? You've only had contractions for a few hours. Labor takes time." 4. "The hormones that cause labor to begin are just getting to be at levels that will change your cervix."

1. "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress."

1) The laboring client has rated her pain at 9 on a scale of 1 to 10, and she requests IV pain medication. She has refused epidural anesthesia, but her certified nurse-midwife (CNM) has ordered butorphanol tartrate (Stadol) for administration to the client. Which action should the nurse complete next? 1. Advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication. 2. Offer the woman epidural anesthesia once more and describe the effectiveness of this method of labor pain control. 3. Obtain maternal vital signs and assess the fetal heart rate (FHR). 4. Administer oxygen via face mask at 6 to 10 liters per minute.

1. Advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.

15) The clinical coordinator is observing a nursing student as he provides care to a client who is in early labor. Which of the student's actions should be addressed for correction during the student's daily clinical evaluation? 1. Application of a fetal heart monitor followed by an explanation of the reason for its use 2. Upon entering the client's room, speaking with the client prior to looking at the fetal heart monitor 3. Using layman's terms to provide the client with an explanation of the rationale for electronic fetal monitoring 4. Incorporating cues that arise from intuition or from observations of the client and family as opposed to focusing on the fetal heart monitor

1. Application of a fetal heart monitor followed by an explanation of the reason for its use

10) The fetal heart rate baseline is 140 beats per minute. When contractions begin, the fetal heart rate drops suddenly to 120 and rapidly returns to 140 before the end of the contraction. Which nursing intervention is best? 1. Assist the patient to change from Fowler's to left lateral position. 2. Apply oxygen to the patient at 2 liters per nasal cannula. 3. Notify the operating room of the need for a cesarean birth. 4. Determine the color of the leaking amniotic fluid.

1. Assist the patient to change from Fowler's to left lateral position.

7) The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor most likely will include which of the following? Select all that apply. 1. Contractions that do not intensify while walking 2. An increase in the intensity and frequency of contractions 3. Progressive cervical effacement and dilatation 4. Pain in the abdomen that does not radiate 5. Increased thin vaginal secretions

1. Contractions that do not intensify while walking 4. Pain in the abdomen that does not radiate

19) The nurse is caring for a G3P2 woman that is in transition. Which signs/symptoms would indicate that the woman is progressing to the next stage? Select all that apply. 1. Feels the urge to push 2. Perineum bulges 3. Bag of water ruptures 4. Cervix dilated fully 5. Increased bloody show

1. Feels the urge to push 2. Perineum bulges 4. Cervix dilated fully 5. Increased bloody show

2) The client presents to labor and delivery stating that her water broke 2 hours ago. Indicators of normal labor include (select all that apply): 1. Fetal heart rate of 130 with average variability. 2. Blood pressure of 130/80. 3. Maternal pulse of 160. 4. Protein of +1 in urine. 5. Odorless, clear fluid on underwear.

1. Fetal heart rate of 130 with average variability. 2. Blood pressure of 130/80. 5. Odorless, clear fluid on underwear.

10) The nurse is caring for a laboring client who is receiving continuous epidural anesthesia via infusion. The maternal blood pressure decreases from 132/78 to 78/42. Which intervention should the nurse implement first? 1. Increase the flow rate of infusion of intravenous crystalloid solution. 2. Verify the patient is positioned to promote left uterine displacement. 3. Administer oxygen. 4. Administer ephedrine 5 to 10 mg intravenously.

1. Increase the flow rate of infusion of intravenous crystalloid solution.

17) A primigravida is admitted to the labor unit with contractions every 7 to 8 minutes. She is 3 cm dilated, 70 percent effaced, and at 0 station. She is very anxious, is having difficulty coping with contractions, and states that she did not attend prenatal classes. Which of the following would be the most effective nursing intervention? Select all that apply. 1. Instruct the client in abdominal breathing and progressive relaxation. 2. Instruct the client in patterned, paced breathing and touch relaxation. 3. Instruct the client in pelvic tilt and pelvic rock exercises. 4. Call the physician and request a sedative.

1. Instruct the client in abdominal breathing and progressive relaxation. 3. Instruct the client in pelvic tilt and pelvic rock exercises.

7) The charge nurse is looking at the charts of laboring clients. Which patient most requires further intervention? 1. Multipara at 7 cm, fetal heart tones auscultated every 90 minutes 2. Primipara at 10 cm and pushing, external fetal monitor applied 3. Multipara with meconium-stained fluid, internal fetal scalp electrode in use 4. Primipara in preterm labor, external monitor in place

1. Multipara at 7 cm, fetal heart tones auscultated every 90 minutes

14) A healthy 18-year-old client who is 40 weeks' gestation presents at the clinic complaining of vaginal expulsion of stringy mucus followed by blood-tinged secretions. She denies any discomfort or any other changes. Based upon the client's complaints, what is most likely to occur within the next 24 to 48 hours? 1. Onset of labor 2. Spontaneous abortion 3. Cesarean section 4. Chorioamnionitis

1. Onset of labor

4) The nurse is preparing to assess the fetus of a laboring client. Which assessment should the nurse perform first? 1. Perform Leopold's maneuver to determine fetal position. 2. Count the fetal heart rate for 30 seconds and multiply by two. 3. Dry the maternal abdomen before using the Doppler. 4. Place the patient into a left lateral position.

1. Perform Leopold's maneuver to determine fetal position.

5) Which of the following nursing actions can prevent or detect common side effects of epidural anesthesia? Select all that apply. 1. Preloading the client with a rapid infusion of IV fluids 2. Continuing the client on p.o. fluids only to prevent hypotension 3. Monitoring the FHR for late deceleration and decrease in rate 4. Use of intermittent FHR monitoring so the client can use the birthing ball

1. Preloading the client with a rapid infusion of IV fluids 3. Monitoring the FHR for late deceleration and decrease in rate

1) The nurse is caring for laboring patients. Which women are experiencing problems related to a critical factor of labor? Select all that apply. 1. Primipara at 7 cm, fetus in military attitude 2. Multipara at 3 cm, fetus in longitudinal lie 3. Primipara at 4 cm, fetus with macrocephaly due to hydrocephalus 4. Multipara at 6 cm, fetus at −2 station, mild contractions 5. Primipara at 5 cm, fetal presenting part is right shoulder

1. Primipara at 7 cm, fetus in military attitude 3. Primipara at 4 cm, fetus with macrocephaly due to hydrocephalus 4. Multipara at 6 cm, fetus at −2 station, mild contractions 5. Primipara at 5 cm, fetal presenting part is right shoulder

10) A 32-year-old laboring client demonstrates cervical dilatation of 9 cm. Her contractions are 2 minutes apart and 60 to 90 seconds in duration. She complains of excruciating rectal pressure. How should the nurse interpret this complaint? 1. The client's complaint is congruent with her current stage of labor. 2. The client's complaint may indicate the need for delivery via cesarean section. 3. Based upon the client's complaint, she is experiencing the active phase of labor. 4. The client's complaint is consistent with placental separation, which is normal for her current stage of labor.

1. The client's complaint is congruent with her current stage of labor.

16) The nurse is caring for five laboring clients. Which clients will the nurse prepare for cesarean section? Select all that apply. 1. The fetus is in transverse position. 2. The lecithin/sphingomyelin ratio is 1:1. 3. The mother has active herpes simplex II lesions. 4. The fetus is in LOP position. 5. Evidence of umbilical cord in vagina

1. The fetus is in transverse position. 3. The mother has active herpes simplex II lesions. 5. Evidence of umbilical cord in vagina

15) The G2P1 is in the active stage of labor. What maternal and fetal assessments would the nurse evaluate? Select all that apply. 1. Uterine contractions palpated every 15 to 30 min. 2. Uterine contractions every 30 min. 3. FHR every 15 min for low-risk women and every 5 min for high-risk women. 4. FHR every 30 min for low-risk women and every 15 min for high-risk women if normal characteristics are present. 5. Temperature every 4 hours unless over 37.5°C (99.6°F) or membranes ruptured, then every 2 hours.

1. Uterine contractions palpated every 15 to 30 min. 4. FHR every 30 min for low-risk women and every 15 min for high-risk women if normal characteristics are present.

3) The nurse is working with a pregnant adolescent. The client asks the nurse how the baby's condition is determined during labor. Which statement indicates the client education was successful? "During labor, the nurse will: 1. "Check your cervix by doing a pelvic exam every two hours." 2. "Assess the baby's heart rate with an electronic fetal monitor." 3. "Look at the color and amount of bloody show that you have." 4. "Verify that your contractions are strong but not too close together."

2. "Assess the baby's heart rate with an electronic fetal monitor."

3) The nurse has presented a teaching session on pain relief options to a prenatal class. Which client statement indicates that additional teaching is needed? 1. "An epidural can be continuous or one dose." 2. "General anesthesia is usually recommended for a client who delivers by way of cesarean section." 3. "Narcotics can be given through a client's epidural infusion catheter." 4. "A pudendal block usually works well to control pain during episiotomy repair."

2. "General anesthesia is usually recommended for a client who delivers by way of cesarean section."

11) The primigravida in labor asks the nurse to explain the electronic fetal heart rate monitor strip. The fetal heart rate baseline is 150, with accelerations to 165, variable decelerations to 140, and moderate long-term variability. Which statement indicates that the patient understands the nurse's teaching? "The most important part of fetal heart monitoring is the: 1. "Absence of variable decelerations." 2. "Presence of variability." 3. "Fetal heart rate baseline." 4. "Depth of decelerations."

2. "Presence of variability."

4) The primiparous patient at 40 weeks' gestation reports to the nurse that she has had increased pelvic pressure and increased urinary frequency. Which response by the nurse is best? 1. "Unless you have pain with urination, we don't need to worry about it." 2. "These symptoms usually mean the baby's head has descended further." 3. "Come in for an appointment today and we'll check everything out." 4. "This might indicate that the baby is no longer in a head down position."

2. "These symptoms usually mean the baby's head has descended further."

6) A healthy woman who is scheduled for elective cesarean birth is being admitted to the hospital. Her surgery is scheduled to begin in 4 hours. The woman asks for a sip of coffee with creamer. How should the nurse respond? 1. "Since you're having surgery today, you're not allowed to have anything to eat or drink." 2. "You can drink black coffee." 3. "You may have coffee with creamer." 4. "You're only allowed to drink water right now."

2. "You can drink black coffee."

10) One minute after delivery, the neonate's heart rate is 120 beats per minute. She demonstrates a vigorous cry and is actively moving. The infant resists the nurse's attempts to straighten her arm. When the nurse flicks the soles of her feet, the infant grimaces. Her body is pink and her extremities are blue. What APGAR score should the nurse assign to this infant? 1. 9 2. 8 3. 7 4. 6

2. 8

7) Breathing techniques used in labor provide which of the following? Select all that apply. 1. A form of anesthesia 2. A source of relaxation 3. An increased ability to cope with contractions 4. A source of distraction

2. A source of relaxation 3. An increased ability to cope with contractions 4. A source of distraction

18) The nurse knows what pelvic types are adequate for vaginal birth? Select all that apply. 1. Midpelvis 2. Anthropoid 3. Gynecoid 4. Platypelloid 5. Android

2. Anthropoid 3. Gynecoid

5) The laboring client has been found to be having moderately strong contractions lasting 60 seconds every 3 minutes. The fetal head is presenting at a −2 station. The cervix is 6 cm and 100 percent effaced. The membranes spontaneously ruptured prior to admission, and clear fluid is leaking. Fetal heart tones are in the 140s with accelerations to 150. Which nursing action has the highest priority? 1. Encourage the husband to remain in the room. 2. Keep the client on bed rest at this time. 3. Apply an internal fetal scalp electrode. 4. Obtain a clean-catch urine specimen.

2. Keep the client on bed rest at this time.

16) The nurse performs Leopold maneuvers. A hard round area is felt in the fundal region, a flat area is felt on the right side and a soft round area is noted above the symphysis area. Which position is congruent with these findings? 1. RSP 2. LSA 3. LOA 4. ROP

2. LSA

17) The client is crying and complains of "terrible back pain" with each contraction. The nurse realizes that the fetus is possibly in which position? 1. Sacrum posterior 2. Occiput posterior 3. Occiput anterior 4. Scapula anterior

2. Occiput posterior

11) Upon delivery of the newborn, the nursing intervention that most promotes parental attachment is: 1. Placing the newborn under the radiant warmer. 2. Placing the newborn on the maternal abdomen. 3. Allowing the mother a chance to rest immediately after delivery. 4. Taking the newborn to the nursery for the initial assessment.

2. Placing the newborn on the maternal abdomen.

12) Which client requires immediate intervention by the labor and delivery nurse? 1. Multipara at 8 cm, systolic blood pressure has increased 35 mmHg 2. Primipara that delivered one hour ago with WBC of 50,000 3. Multipara at 5 cm with a respiratory rate of 22 between contractions 4. Primipara in active labor with urine output of 100 mL/hour

2. Primipara that delivered one hour ago with WBC of 50,000

11) The labor and delivery nurse is reviewing charts. Of which client should the nurse inform the supervisor? 1. Multipara at 5 cm requesting labor epidural analgesia 2. Primipara whose cervix remains at 6 cm for four hours 3. Multipara who has developed nausea and vomiting 4. Primipara requesting her partner to stay with her

2. Primipara whose cervix remains at 6 cm for four hours

12) A laboring client has received an order for epidural anesthesia. In order to prevent the most common complication associated with this procedure, the nurse would expect to do which of the following? 1. Observe fetal heart rate variability. 2. Rapidly infuse 500 to 1,000 mL of intravenous fluids. 3. Place the client in the semi-Fowler's position. 4. Teach the client appropriate breathing techniques.

2. Rapidly infuse 500 to 1,000 mL of intravenous fluids.

6) The nurse is explaining to a student nurse how to determine fetal presentation and position by performing Leopold's maneuver. The nurse should explain that the second maneuver in this procedure is used to determine: 1. Whether the fetal head or buttocks occupies the uterine fundus. 2. The location of the fetal back. 3. Whether the pelvic inlet contains the head or buttocks. 4. The descent of the presenting part into the pelvis.

2. The location of the fetal back.

14) The laboring primiparous client with meconium-stained amniotic fluid asks the nurse why the fetal monitor is necessary, as she finds the belt uncomfortable. Which response by the nurse is most important? 1. "The monitor is necessary so we can see how your labor is progressing." 2. "The monitor will prevent complications from the meconium in your fluid." 3. "The monitor helps us to see how the baby is tolerating labor." 4. "The monitor can be removed, and oxygen can be given instead."

3. "The monitor helps us to see how the baby is tolerating labor."

5) The primiparous client at 39 weeks' gestation calls the clinic and reports increased bladder pressure but easier breathing and irregular, mild contractions. She also states that she just cleaned the entire house. Which statement should the nurse make? 1. "You shouldn't work so much at this point in pregnancy." 2. "What you are describing is not commonly experienced in the last weeks." 3. "Your body may be telling you it is going into labor soon." 4. "If the bladder pressure continues, come in to the clinic tomorrow."

3. "Your body may be telling you it is going into labor soon."

4) The charge nurse is reviewing the plans of care for four laboring clients. Which care plan requires immediate reconsideration for revision? 1. Administration of epidural anesthesia to a woman who is in the first stage of labor and has a shellfish allergy 2. Administration of a spinal anesthetic to a woman who is scheduled for vaginal delivery of her baby 3. Administration of epidural anesthesia to a woman with a history of vomiting secondary to hyperemesis gravidarum 4. Administration of a spinal anesthetic to a woman with a history of irritable bowel syndrome (IBS)

3. Administration of epidural anesthesia to a woman with a history of vomiting secondary to hyperemesis gravidarum

5) The student nurse is to perform Leopold's maneuver on a laboring patient. Which assessment requires intervention by the staff nurse? 1. The patient is assisted into supine position, and the position of the fetus is assessed. 2. The upper portion of the uterus is palpated, and then the middle section. 3. After determining where the back is located, the cervix is assessed. 4. Following voiding, the patient's abdomen is palpated from top to bottom.

3. After determining where the back is located, the cervix is assessed.

12) A young adolescent is transferred to the labor and delivery unit from the emergency department. The client is in active labor but did not know that she was pregnant. The most important nursing action is to: 1. Determine who might be the father of the baby for paternity testing. 2. Ask the client what kind of birthing experience she would like to have. 3. Assess blood pressure and check for proteinuria. 4. Obtain a social services referral to discuss adoption.

3. Assess blood pressure and check for proteinuria.

13) The labor and delivery nurse is preparing a prenatal class about facilitating the progress of labor. Which of the following frequent responses to pain should the nurse indicate is most likely to impede progress in labor? 1. Increased pulse 2. Elevated blood pressure 3. Muscle tension 4. Increased respirations

3. Muscle tension

13) After receiving nalbuphine hydrochloride (Nubain), a woman's labor progresses rapidly, and the baby is born less than one hour later. The baby exhibits signs of respiratory depression. Which medication should the nurse be prepared to administer to the newborn? 1. Fentanyl (Sublimaze) 2. Butorphanol tartrate (Stadol) 3. Naloxone (Narcan) 4. Pentobarbital (Nembutal)

3. Naloxone (Narcan)

4) An expectant father has been at the bedside of his laboring partner for more than 12 hours. An appropriate nursing intervention would be to: 1. Insist that he leave the room for at least the next hour. 2. Tell him he is not being as effective as he was and that he needs to let someone else take over. 3. Offer to remain with his partner while he takes a break. 4. Suggest that the client's mother might be of more help.

3. Offer to remain with his partner while he takes a break.

14) The nurse encounters a woman giving birth at the local mall. What should the nurse do first? 1. Apply counter pressure to the perineum. 2. Ask a bystander for a dry piece of clothing. 3. Visualize the perineum. 4. Determine if the membranes have ruptured.

3. Visualize the perineum.

1) The nurse is orienting a new graduate nurse to the labor and birth unit. Which statement indicates that teaching has been effective? "When a patient arrives in labor: 1. "A urine specimen is obtained by catheter to check for protein and ketones." 2. "She will be positioned supine to facilitate a normal blood pressure." 3. "Her prenatal record is reviewed for indications of domestic abuse." 4. "A vaginal exam is performed if delivery appears to be imminent."

4. "A vaginal exam is performed if delivery appears to be imminent."

2) The nurse is preparing to assess a laboring primiparous client who has just arrived in the labor and birth unit. Which statement indicates that additional education is needed? 1. "You are going to do a vaginal exam to see how far dilated my cervix is." 2. "The reason for a pelvic exam is to determine how low in the pelvis my baby is." 3. "When you check my cervix, you will find out how thinned out it is." 4. "After you assess my pelvis, you will be able to tell when I will deliver."

4. "After you assess my pelvis, you will be able to tell when I will deliver."

6) A 25-year-old woman is 38 weeks' gestation with her first pregnancy. For the third time in one week, she presents to the hospital with complaints that are determined to be suggestive of false labor. Prior to discharge, the client states, "I'm so embarrassed for thinking I was in labor. I feel like a fool." What is the nurse's best response? 1. "We'll discuss the differences between true labor and false labor so this doesn't happen again." 2. "It's impossible to distinguish between false labor and true labor." 3. "Don't feel bad. Everyone makes mistakes sometimes." 4. "It's very difficult to tell the difference between true and false labor. Please know we're here to take care of you whenever you need us."

4. "It's very difficult to tell the difference between true and false labor. Please know we're here to take care of you whenever you need us."

8) While orienting a new nurse to the obstetrics unit the RN preceptor is describing how to determine the baseline (BL) fetal heart rate (FHR). Which statement should the RN preceptor include in order to accurately describe the BL FHR? 1. "The baseline rate is the mean FHR during a 5-minute period rounded to increments of 5 beats per minute is the baseline rate." 2. "The baseline FHR should include periodic or episodic changes in FHR." 3. "Normal baseline FHR ranges from 100 to 180 beats per minute." 4. "The baseline FHR excludes periods of marked variability."

4. "The baseline FHR excludes periods of marked variability."

16) A client in active labor is demonstrating intense contractions and demonstrates cervical dilatation of 3 cm without rupture of amniotic membranes. The attending physician requests an amnihook. What procedure does the nurse anticipate that the physician will perform? 1. Cesarean section 2. Placental separation 3. Cervical dilatation 4. Artificial rupture of membranes (AROM)

4. Artificial rupture of membranes (AROM)

12) A woman is in labor. The fetus is in vertex position. When the client's membranes rupture, the nurse sees that the amniotic fluid is meconium-stained. The nurse should immediately: 1. Change the client's position in bed. 2. Notify the physician that birth is imminent. 3. Administer oxygen at 2 liters per minute. 4. Begin continuous fetal heart rate monitoring.

4. Begin continuous fetal heart rate monitoring.

9) During the fourth stage of labor, your client's assessment includes a BP of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. The priority action of the nurse should be to: 1. Turn the client onto her left side. 2. Place the bed in Trendelenburg position. 3. Massage the fundus. 4. Continue to monitor.

4. Continue to monitor.

13) As compared with admission considerations for an adult woman in labor, the nurse's priority for an adolescent in labor would be: 1. Cultural background. 2. Plans for keeping the infant. 3. Support persons. 4. Developmental level.

4. Developmental level.

15) While caring for a labor client, the nurse determines during a vaginal exam that the baby's head has internally rotated. This information is given to the family. The labor support person asks the nurse, "What other position changes will the baby undertake during labor and birth?" How should the nurse describe the rest of the cardinal movements for a baby in a vertex presentation? 1. Flexion, extension, restitution, external rotation, and expulsion 2. Expulsion, external rotation, and restitution 3. Restitution, flexion, external rotation, and expulsion 4. Extension, restitution, external rotation, and expulsion

4. Extension, restitution, external rotation, and expulsion

2) A client has just been admitted for labor and delivery. She is having mild contractions every 15 minutes lasting 30 seconds. The client wants to have a medication-free birth. When discussing medication alternatives, the nurse should be sure the client understands that: 1. In order to respect her wishes, no medication will be given. 2. Pain relief will allow a more enjoyable birth experience. 3. The use of medications allows the patient to rest and be less fatigued. 4. Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

4. Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

8) Five minutes after delivery, the neonate's body is pink with blue extremities. The heart rate is 150. The infant demonstrates a vigorous cry and good respiratory effort, and is actively moving. His elbows and hips are flexed, with his knees positioned up toward his abdomen. When the nurse flicks the soles of his feet, the neonate withdraws his leg. Which nursing interventions are appropriate? 1. Stimulation and resuscitative efforts 2. Oxygen via face mask and endotracheal suctioning 3. Rescue breathing and stimulation 4. Nasopharyngeal suctioning and blow-by oxygen

4. Nasopharyngeal suctioning and blow-by oxygen

2) The charge nurse has received a shift change report. Which patient requires immediate intervention? 1. Multipara at 6 cm undergoing induction of labor, strong contractions every three minutes 2. Primipara at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation 3. Multipara at 10 cm and fetus at +2 station experiencing a strong expulsion urge 4. Primipara at 3 cm screaming in fear because her mother died during childbirth

4. Primipara at 3 cm screaming in fear because her mother died during childbirth

7) The laboring client requests pain medication. Her contractions are lasting 20 to 30 seconds and are occurring every 8 to 20 minutes. The nurse would explain that analgesics given at this time would likely cause: 1. Fetal respiratory depression. 2. Decreased analgesic effectiveness at the end of labor. 3. Maternal hypotension. 4. Prolonged labor.

4. Prolonged labor.

8) The nurse is caring for a laboring client. A cervical exam indicates 8 cm dilation. The client is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important? 1. Leave the client alone so she can rest. 2. Ask the family to take a coffee and snack break. 3. Encourage the client to have an epidural for pain. 4. Reassure the client that she will not be left alone.

4. Reassure the client that she will not be left alone.

6) Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring client in which of the following positions? 1. On her right side in the center of the bed with her back curved 2. Lying prone with a pillow under her chest 3. On her left side with the bottom leg straight and the top leg slightly flexed 4. Sitting on the edge of the bed with her back slightly curved and her feet on a stool

4. Sitting on the edge of the bed with her back slightly curved and her feet on a stool

9) Which of the following, if seen on an electronic fetal monitoring strip, would the nurse explain to a laboring client as a change in the baseline fetal heart rate? 1. Acceleration 2. Late deceleration 3. Sinusoidal pattern 4. Tachycardia

4. Tachycardia