Maternity Final Pt. 2

During an antenatal visit at 24-weeks, the nurse weighs the client as part of the physical assessment. Which finding would be of most concern?

A weight gain of more than 3 pounds in a week

The nurse has presented a session on pain relief options to a prenatal class. Which statement indicates that additional teaching is needed?

"An epidural before 3cm dilation is recommended to promote physiologic (vaginal) birth."

A patient at 16 weeks' gestation has a hematocrit of 32% and a hemoglobin level of 9.9 g/dL. Her baseline (prepregnant) hematocrit was 40% and hemoglobin 13.4 g/dL. Which statement by the nurse best explains this change?

"Because your blood volume has increased, your hematocrit and hemoglobin counts are lower."

Your patient is 34 weeks pregnant and during a regular prenatal visit tells you she does not understand how to do "kick counts." The best response by the nurse would be to explain:

"Fetal movements are an indicator of fetal well-being. You should count twice a day, and you should feel ten fetal movements in 2 hours."

The client has been pushing for two hours and is now exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the birth. Which statement indicates that the client needs additional information about vacuum extraction assistance? ( Select all that apply)

"It doesn't matter how many times the vacuum pops off." "I can stop pushing and just rest if the vacuum extractor is used."

A nurse is teaching a pregnant woman with preterm premature rupture of membranes who is about to be discharged home about caring for herself. Which statement by the woman indicates a need for additional teaching?

"It's okay for my husband and me to have sexual intercourse."

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective?

"Purse-string sutures are placed in the cervix to prevent it from dilating."

When performing a vaginal examination during labor, the nurse feels the presenting part at 1 centimeter below the woman's ischial spines. The nurse should chart the station as:

+1.

In performing a physical assessment on a primigravida who is 20-weeks pregnant, which of the following findings would necessitate referral for further evaluation?

3+ ankle swelling

Induction of labor is planned for a 31-year-old primiparous at 39 weeks due to insulin-dependent diabetes. The plan for induction includes "stripping the membranes" followed by a cervical ripening agent. Which of the following would the nurse include in his teaching to the birthing patient? Select ALL that apply

50 mcg of misoprostol (Cytotec) will be administered orally after fetal monitoring is appropriate. The healthcare provider will insert a gloved finger into the cervical os and rotate the finger 360 degrees. Uterine contractions, cramping, and a bloody discharge can occur after the procedure.

During a nonstress test, when monitoring the fetal heart rate of a term fetus, the nurse notes that when the expectant mother reports fetal movement, the heart rate increases 15 beats or more above the baseline for longer than 15 seconds twice times during a twenty minutes tracing. The nurse interprets this as

A Reactive NST (non-stress test).

Why is it important for the nurse to assess the bladder regularly and encourage the laboring patient to void every 2 hours?

A full bladder can impede fetal descent.

A woman is scheduled to have an external cephalic version (ECV) for a breech presentation. The nurse carefully reviews the patient's chart for contraindications to this procedure, such as:

Previous cesarean section

The nurse is caring for a 25-week patient who was diagnosed with preterm premature rupture of membranes (PPROM) 8 days ago. After completing a change of shift assessment, which finding should the nurse be most concerned about?

Abdominal tenderness when adjusting external monitors.

The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4/70/-1 station. She tells you she has fluid running down her leg. Your first priority nursing intervention is to:

Assess the color, odor, and amount of fluid.

A nurse is preparing to monitor a patient who is to receive an amnioinfusion. Which of the following actions should the nurse make at this time?

Assist in insertion of an internal uterine pressure catheter.

The nurse uses the external fetal heart monitor to evaluate fetal status. The fetal heart tracing shows accelerations. Accelerations in the fetal heart are:

Associated with fetal well-being and oxygenation

The cardinal movements of labor are the positional changes that the fetus goes through to best navigate the birth process. The order of the cardinal movements are:

Engagement, Descent, Flexion, Internal rotation, Extension, Restitiution, External rotation, Expulsion

Any infant born before the 36 6/7 weeks of gestation, regardless of birth weight is considered:

Preterm

When describing the stages of labor to a pregnant woman, which of the following would the nurse identify as the major change occurring during the first stage?

Cervical dilation

On examination of the prenatal patient, the nurse is aware that he will assess for a bluish pigmentation of the vaginal mucosa and cervix. This objective (probable) sign of pregnancy is also known as:

Chadwick's sign.

A nurse needs to evaluate the progress of a woman's labor. The nurse obtains the following data: cervical dilatation 7 cm; contractions, mild in intensity, occurring every 20-30 minutes, with a duration of 60-90 seconds. Which clue in this data does not fit the pattern suggested by the rest of the clues?

Contractions frequency every 20-30 minutes

A woman has just entered the second stage of labor. The nurse would focus care on which of the following? Select ALL that apply:

Encouraging the woman to push when she has a strong desire to do so. Palpating the woman's fundus to ensure the patient with epidural anesthesia is pushing during contractions.

The client in her first trimester of pregnancy is experiencing nausea. To promote self-care, the nurse should help the pregnant client understand that the nausea may be relieved by:

Eating small, frequent meals.

A primigravida dilated to 5 cm has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was 120/80 before the procedure and is now 80/52. In addition to the bolus of IV fluid she has been given, which medication is preferred to increase her BP?

Ephedrine

Bishop's scoring system for cervical readiness includes cervical dilatation, cervical consistency, cervical position, cervical effacement, and:

Fetal station

A woman came to her first prenatal visit, she stated that she delivered three children at 40 weeks' gestation, delivered twins at 36.5 weeks' gestation and one at 39 weeks. She also had 1 miscarriage between her 2nd and 3rd child. Express her obstetrical history using the GTPAL system.

G7 T4 P1 A1 L6

A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shape should the nurse describe as the most favorable for a successful vaginal birth?

Gynecoid

The primiparous patient is at 42 weeks' gestation. Which order should the nurse question?

Have the patient return to the clinic in 1 week.

On examination of a prenatal client, the health care provider notes the isthmus of the uterus is soft. Which probable sign of pregnancy would be documented?

Hegar's sign

The nurse is assessing a new patient in the clinic. The nurse knows that the subjective (presumptive) signs and symptoms of pregnancy include:

Increase in urination, amenorrhea, fatigue, breast enlargement, and quickening.

A nurse is teaching a prenatal client about cardiovascular changes during the second stage of pregnancy. The client asks the nurse why she becomes dizzy when getting out of a chair or out of bed. What is the best explanation?

Increased blood volume and low blood pressure

Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in:

Latent phase of the first stage of labor

A 30 year old primigravida patient presents for a routine prenatal appointment. She verbalizes great concern regarding the possibility of preterm labor and delivering a preterm newborn with complications. As her nurse, you explain risk factors of delivery preterm include all of the following except:

Maternal age greater than 30.

A woman calls the health care facility stating that she is in labor at 39 weeks gestation. The nurse would advise the client to come to the facility if the client reports which of the following?

Moderately strong contractions every 4 minutes, lasting about 1 minute

A woman states that the first day of her last normal menstrual period was February 16. Using Nagele's rule, the nurse would calculate her expected date of birth to be:

November 23.

The patient presents to the labor and delivery unit stating that her water broke two hours ago. Indicators of normal labor include each of the following, EXCEPT:

Odorless, green fluid on underwear.

The nurse is developing a plan of care for a woman who is pregnant with twins. The nurse anticipates interventions and assessments focusing on which of the following because of recommendations related to increased risks of multiple gestation?

Oligohydramnios.

A client's maternal serum alpha-fetoprotein (MSAFP) level was unusually elevated at 17 weeks. The nurse understands that an elevated MSAFP level is associated with which of the following?

Open spinal defects

A woman has been 3cm dilated and having contractions since 4:00 am. At 11:00 am, her cervix is now dilated to 4 cm and she is complaining of exhaustion. Contractions are frequent, and mild to moderate in intensity and the fetal heart tracing has been Category I. Cephalopelvic disproportion (CPD) has been ruled out. After giving the mother some sedation so she can rest, the nurse should anticipate preparing for:

Oxytocin (Pitocin) augmentation of labor.

Blood volume expansion during pregnancy leads to

Physiological anemia of pregnancy

The clinic nurse talks with Kathy about her possible pregnancy. Kathy has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. These symptoms are best described as:

Presumptive signs of pregnancy

The student has read that the placenta produces hormones that are vital to the function of the fetus. It is evident that that the student understands the function of the placenta when he states, "The hormone primarily responsible for the maintenance of pregnancy past the 11th week is:

Progesterone.

The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor most likely will include all of the following, EXCEPT:

Progressive cervical effacement and dilatation

The nurse administers vitamin K intramuscularly to the newborn based on which of the following rationales?

Promote blood clotting.

A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, terbutaline will be administered to:

Relax the uterus.

A 25-year-old primigravida is 20 weeks pregnant. At the clinic, her nurse begins a prenatal assessment and obtains the following vital signs. Which finding would require the nurse to contact the physician?

Respirations 30/min

A nurse is assessing a woman in labor. Which finding would the nurse identify as a cause for concern during a contraction?

Respiratory rate of 10 breaths /minute

During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to:

Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension.

The nursing instructor is preparing an illustration which will emphasize the various functions of the placenta during pregnancy. The instructor points out that each of the following hormones are secreted by the placenta during pregnancy EXCEPT:

Testosterone

A woman is experiencing preterm labor. The client asks why she is on betamethasone (Celestone). The best response by the nurse would be:

This medication has been found to be effective in stimulating lung maturity in the preterm infant.

The nurse is caring for a laboring client. To identify the duration of a contraction, the nurse should:

Time from the beginning of one contraction to the completion of the same contraction.

A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined?

Transverse fetal lie

When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is:

True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

The nurse teaches a primigravida client that lightening occurs about 2-weeks before the onset of labor. Which of the following would the client also likely experience at that time?

Urinary frequency

An ultrasound indicates that the arms and legs of the baby are flexed onto the chest and thighs, and the head is bent down towards the chest. This describes fetal:

attitude.

A nurse is assessing a pregnant woman on a routine first trimester checkup. When assessing the woman's gastrointestinal tract, the nurse would expect to find all of the following EXCEPT:

increased peristalsis

A woman in active labor is to have an epidural line inserted for continuous analgesia. In order to prevent the most common complication of this procedure, the nurse should:

rapidly infuse (bolus) 500-1000 mL of intravenous fluids.

A 32-year-old multigravida presents to the clinic with the following musculoskeletal concerns. Upon assessment, the nurse contacts the physician for which of the following?

unilateral ankle swelling and tenderness