N215 Exam 2 Practice Questions
A 38-year-old G5 P4 woman at 40 weeks gestation presents to the maternity ward in active labor. Initial pelvic exam reveals that her cervix has dilated to 10 cm and the fetal head is fully engaged. Within 20 minutes of presentation, she delivers a 4000 g baby girl. After delivery, a severe vaginal tear is noted (4th degree); it requires repair. What method of analgesia would be most appropriate for this procedure? A. pudendal nerve block B. epidural block C. paracervical plexus block D. subarachnoid block E. combined spinal/epidural block
A
Clarissa's partner remained with her throughout labor. Current research demonstrates that A. one-to-one care or presence during labor improves outcomes B. clarissa would get more relief from a doula C. Susan will have to leave the labor room if Clarissa desires an epidural D. She increases Clarissa's risk of Covid transmission with her presence
A
During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. The nurse's priority action is to: A. use position change and the vaginal hand to relieve compression on the cord B. Facilitate dilation of the cervix w/ prostaglandin gel C. prevent head compression D. help the fetal head descend faster
A
In a labor record, the findings of your patient's vaginal examination were recorded as 3 cm, 50%, and vertex -2. This means: A. The cervix is dilated 3 cm and effaced 50%, and the head is 2 cm above the ischial spines B. The cervix is dilated 3 cm and effaced 50%, and the head is 2 cm below the ischial spines C. The cervix is effaced 3 cm and dilated 50%, and the head is 2 cm below the ischial spines D. The cervix is effaced 3 cm and dilated 50%, and the head is 2 cm above the ischial spines
A
Janine has been receiving oxytocin to augment her labor. The nurse notes that contractions are lasting 100 seconds. Which immediate action should the nurse take? A. stop the oxytocin infusion B. monitor Fetal heart tones as usual C. turn the client on her L side D. notify the provider
A
Mary is 1 hour post-delivery and is experiencing a PPH. She has a history of chronic hypertension. Which uterotonic agent should she not receive to treat her pph A. methergine B. oxytocin C. Prostaglandin F2
A
Mary is 1 hour post-delivery and is experiencing a postpartum hemorrhage. She has a history of chronic hypertension. Which uterotonic agent should she not receive to treat her postpartum hemorrhage? A. methergine B. oxytocin C. misoprostol
A
Meredith is admitted to the L&D unit at 36 week's gestation. She has a history of cesarean birth and reports severe abdominal pain that started less than one hour ago. When the nurse palpates tetanic contractions, Meredith again reports severe pain and begins to vomit. After Meredith vomits, she states "The pain is better." Meredith then loses consciousness. The FHR is 100. What is your priority intervention? A. Prepare the client for immediate surgery B. assess the client's level of pain C. place the client in a L lateral position D. administer IV antibiotics
A
PP depression typically has all of the following symptoms except: A. delusional thinking B. lack of interest in baby care C. feelings of worthlessness D. crying and sadness
A
The nurse is preparing to assess the fetus of a laboring client. Which assessment should the nurse perform first? A. perform Leopold maneuvers to determine fetal position. B. the diaphragm should be cooled before using the Doppler C. Count the fetal heart rate between, during, and for 30 seconds following a uterine contraction. D. Dry the maternal abdomen before using the Doppler.
A
Upon the client's admission to the birthing unit, the nurse performs a careful assessment to determine whether the client has a history of physical dependence on narcotics. For which complication related to analgesic administration is the nurse preparing? A. resp. depression B. urinary retention C. fetal depression D. pruritis
A
Which client activity would indicate that a nurse's teaching about postpartum perineal care has been effective? A. the uses a spray bottle to cleanse the perineum after urination and bowel movements. B. the client wipes the perineum from back to front after urinating or a bowel movement C. the client douches after urination or a bowel movement D. the client changes perineal pads three times a day
A
The healthcare provider is caring for a woman whose labor is being augmented with an IV oxytocin infusion. For which of the following adverse effects of this medication will the nurse monitor? SELECT ALL THAT APPLY A. uterine tetany B. uterine rupture C. fluid overload D. fetal hypoxia
A, B, C, D
After receiving an epidural, your patient begins to develop hypotension. ID the actions you will take as a nurse when managing this patient. SELECT ALL THAT APPLY A. turn the patient to their L side B. Add an antihypertensive med to the patient's IV C. increase the patient's IV fluids D. Administer oxygen the patient
A, C, D
For what common side effects of epidural anesthesia should the nurse watch? SELECT ALL THAT APPLY A. elevated maternal temp B. long-term back pain C. nausea D. local itching E. urinary retention
A, C, D, E
A nurse suspects that a new postpartum patient has developed pulmonary embolism (PE). Which symptoms would confirm this suspicion? SELECT ALL THAT APPLY A. sudden dyspnea B. chills, fever C. diaphoresis D. bradycardia E. confusion
A, C, E
A nurse suspects that a client may have developed a pulmonary embolism. Which symptoms would validate the nurse's suspicion? SELECT ALL THAT APPLY A. sudden breathlessness B. chills and fever C. bradycardia and hypertension D. cough w/ bloody sputum E. sudden chest pain
A, D, E
A 30-year old multiparous client in active labor is admitted to the labor and delivery unit. She has received no prenatal care for this pregnancy. Which data would the nurse obtain FIRST? A. family history of sexually transmitted infection (STIs) B. Date of last menstrual period (LMP) C. name of insurance provider D. number of and ages of previous children
B
A nurse is assisting in monitoring a client in labor. Which monitoring data are indicative of fetal well-being? A. FHR of 110 - 120 bpm with variable deceleration to 90 B. FHR of 145-155 bpm w/ 15-second accelerations to 160 C. FHR of 165-175 bpm w/ late decelerations to 140 D. FHR of 130-140 bpm w/ late decelerations to 110
B
A nurse is performing an assessment on a postpartum client. The assessment reveals that the fundus is firm. The nurse interprets this as: A. a firm tumor at the top of the uterus B. contraction of the uterus C. a uterus filled with blood D. bladder distention
B
A nurse treating a postpartum client a few days after birth? Which verbalization should be cause for concern? A. the client states that she is nervous about taking the baby home B. the client tells the nurse that she feels empty since she delivered the baby C. the client asks if she can watch the nurse give her baby the first bath D. the client says that she would like the nurse to take her baby to the nursery so she can sleep
B
Epidural anesthesia involves placing an anesthetic medication: A. into the thoracic vertebral disk of the spine B. next to the membrane covering the spinal column C. into the fluid surrounding the spinal column D. into the tissues next to the pudendal nerve
B
The nurse has just palpated contraction and compares the consistency to that of the forehead in order to estimate the firmness of the funds. What would be the intensity of these contraction be identified as? A. weak B. strong C. moderate D. mild
B
Thomas is in the active phase of labor. She has an epidural, which is working well. She last voided 3 hours ago. She has received 2000 cc of IV fluid. Contractions are occurring every 3 minutes with a duration of 60 seconds and moderate intensity. The presenting part is at -2 station. Of the actions below, which is most likely to help the presenting part to descend in the pelvis? A. Give oxygen to enhance uterine muscle oxygenation B. assist her to empty her bladder or catheterize her C. Teach relaxation exercises to reduce muscle tension D> give oxytocin to encourage stronger contractions
B
Which finding would the nurse consider to be a normal physiologic response in the early postpartum period? A. urinary urgency and dysuria B. rapid diuresis C. decrease in BP D. increased motility of the gastrointestinal system
B
The healthcare provider is caring for a woman during the birth of her baby. As the fetal head is delivered, the healthcare provider notes that the head retracts against the mother's perineum ("turtle sign"). What actions will the healthcare provider implement? SELECT ALL THAT APPLY A. ask the woman to begin pushing B. flex the woman's thighs against her abdomen toward her armpits C. empty the woman's bladder D. Attempt delivery w/ forceps E. apply fundal pressure
B, C
The nurse is prioritizing care of a client in the immediate postpartum period (1st hour). What is the nurse's priority assessment? SELECT ALL THAT APPLY A. blood glucose level B. height of fundus C. BP D. rectal temp
B, C
You are teaching a prenatal birthing class at your local hospital. One of the attendees asks you about the advantages of using inhaled nitrous oxide for pain management during labor. Your education will include: SELECT ALL THAT APPLY A. pain relief can last 1-2 hours after discontinuing inhaled nitrous oxide B. Patients using inhaled nitrous oxide remain in control of the pain medication C. Patients using inhaled nitrous oxide do not need additional monitoring during labor D. Patients using inhaled nitrous oxide in labor can be mobile
B, C, D
Upon assessing the FHR tracing, the nurse determines that there is fetal tachycardia. The fetal tachycardia would be caused by which of the following? SELECT ALL THAT APPLY A. fetal sleep cycle B. early fetal hypoxia C. infection D. prolonged fetal stimulation E. fetal anemia
B, C, D, E
When general anesthesia is necessary for a cesarean delivery, what should the nurse be prepared to do? SELECT ALL THAT APPLY A. place a wedge under the client's thigh B. administer an antacid to the client C. place a foley catheter in the client's bladder D. apply cricoid pressure to the client during anesthesia intubation E. preoxygenate the client for 3-5 minutes before anesthesia
B, C, D, E
A c/s is ordered for the laboring client w/ whom the nurse has worked all shift. The nurse knows that potential complications of general anesthesia include which of the following? SELECT ALL THAT APPLY A. itching of the face and neck B. fetal depression that is directly proportional to the depth and duration of the anesthesia C. poor fetal metabolism of anesthesia, which inhibits use w/ preterm infants D. increased gastric motility E. uterine relaxation
B, C, E
A client is 5 days PP following a vaginal birth of a 7 lb. 10 oz infant. She calls the clinic to inquire about her pp care. What information should the nurse share w/ this client? SELECT ALL THAT APPLY A. douche daily to cleanse the vagina B. use only sanitary pads and avoid tampons C. call your provider if you have any gushes of blood when standing up D. Call your provider immediately if the bleeding increases, or if you are soaking a pad in one hour
B, D
The nurse is caring for a client who has experiences premature rupture of membranes. For which maternal implication(s) should the nurse monitor? SELECT ALL THAT APPLY A. discomfort B. infection C. uterine distention D. dyspnea E. preterm labor
B, E
A RN receives the following report on Ms. Johnson, who delivered 1 hour ago: She is a G1 P2 who had a normal pregnancy and first stage of labor. She delivered a 9 lb. 6 oz. baby via forceps after a 3-hour second stage. The third stage of labor lasted 12 minutes. Her BP is 94/60, pulse 96. Her lochia is heavy and red. This patient is at risk for several types of PPH. Which of the following types is LEAST likely for this patient? A. uterine atony B. vaginal hematoma C. clotting disorder D. cervical laceration
C
A client is receiving magnesium sulfate therapy. The nurse recognizes that this client must be monitored for: A. hypotension B. postpartum depression C. postpartum hemorrhage
C
A client states she needs to void 3 hours after a vaginal birth. Which risk factor would require the nurse to assist the client while getting out of bed? A. afterpains B. breast engorgement C. orthostatic hypotension D. painful episiotomy incision
C
A nurse is assessing a client with T1 DM. The client's birth was complicated by polyhydramnios and macrosomia. The nurse is aware that this client is at risk for: A. postpartum mastitis B. increased insulin needs C. PPH D. gestational hypertension
C
A postpartum client was diagnosed w/ a deep vein thrombophlebitis (DVT). What is the most important information for the nurse to include in discharge teaching? A. avoid heat compresses B. keep legs crossed when sitting C. avoid rubbing or massaging the legs D. you should experience numbness, tingling, or muscle weakness (esp. in your legs and feet)
C
A woman who is 10 days pp calls the nurse to say that she having repetitive thoughts about harming her baby and can't get rid of the thoughts. The nurse's next actions would be to: A. schedule her an appointment to see her ob/gyn doctor the next day B. tell her this is just pp blues and nothing to worry about C. assist in getting her to a mental health crisis center immediately D. suggest she call her mother
C
After delivery, as the midwife is doing a perineal repair and Clarissa starts to bleed heavily. Your first nursing action is to: A. call for help B. take her vital signs C. massage her fundus D. catheterize clarissa
C
An amniotomy is performed on a client in labor. What is the priority nursing intervention following this procedure? A. Assist the client to ambulate to promote labor B. position the client on her L side C. assess fetal heart tones D. encourage the client to use breathing exercises as contractions increase
C
As Ms. Olveira's nurse, you apply the external fetal monitor. You will determine the intensity of contractions from: A. the amplitude of the curve registered by the tocodynamometer B. The beginning of one contraction to the beginning of the next contraction C. The firmness of the uterus when palpated during contractions D. The measurement of intrauterine pressure in millimeters of mercury
C
Ms. Kota, a G2P1 has just been admitted to L&D. She is already in the transition phase, although her labor only started 1 hour ago. Her baby is estimated to weigh 9.5 lbs. She is extremely frightened as the staff hurries to prepare for the birth. Based on her labor so far, she is at increased risk for: A. vaginal lacerations B. postpartum dperession C. eclampsia D. hypotonic labor
C
The first stage of labor: A. Begins with complete dilatation of the cervix and ends with the birth of the baby B. begins with rupture of the membranes and ends with complete dilatation of the cervix C. begins with onset of regular contractions and ends with complete dilatation of the cervix D. begins with onset of regular contractions and ends with the birth of the baby
C
The nurse knows that contraindications to the induction of labor include: A. premature rupture of membranes B. diabetes mellitus C. placenta previa D. isoimmunizations
C
Two hours after an epidural infusion has begun, a client complains of itching on her face and neck. What should the nurse do? A. remove the epidural catheter and apply a band-aid to the injection site B. offer the client a cool cloth and let her know the itching is temporary C. recognize that this is a common side effect and follow protocol for administration of Benadryl D. Call the anesthesia care provider to re-dose the epidural catheter
C
A 17-year-old primigravida w/ severe hypertension of pregnancy has been receiving magnesium sulfate IV for 3 hr. The latest assessment reveals deep tendon reflexes of +1, flushing, BP of 150/100 mmHg, a pulse of 92 beats/min, a respiratory rate of 10 breaths/min, and urine output of 20 mL/hr. Which action would be most important? A. decrease the infusion rate by 5 gtts/min B. Increase the infusion rate by 5 gtts/min C. Continue monitoring per standards of care D. stop the magnesium sulfate infusion
D
A 20-year-old primigravida presents at 30 weeks gestation with a 2-day history of a headache, decreased urine output, and facial puffiness. On examination, vitals are as follows: pulse 90/min, BP 164/116 mm Hg and 166/114 mm Hg (taken 6 hrs apart), RR 20/min. There is generalized edema and exaggerated deep tendon reflexes with the presence of clonus. Abdominal examination reveals a fundal height corresponding to 30 weeks gestation and the presence of good fetal heart sounds. Urine dipstick for protein reveals 3+ proteinuria (300 mg/dL) on 2 occasions. What will likely be the next step in the management of this patient? A. immediate induction of labor B. immediate c/s C. strict bed rest at home D. injection of betamethasone
D
A nurse is caring for a client exhibiting mild contractions and cervical dilation of 4 cm. Using an external fetal monitor, the nurse observes variable decelerations. Which action should the nurse take first? A. increase the IV rate B. Administer oxygen by face mask C. prepare for imminent birth D. Place the client on her left side
D
Clarissa is a 25 year old G2P1 who arrives at the hospital, with her partner Susan, in labor. She is unable to talk through her contractions, is experiencing nausea and vomiting, and says "I can't do this. Based on maternal behavior alone, what stage/phase of labor is she demonstrating? A. active labor B. 3rd stage, placenta delivery C. Early/latent labor D. Transition, the end of the first stage
D
Ms. Chu had a forceps delivery of a 9 lb. baby girl 48 hours ago. She complains of severe fatigue but says she feels too nervous to sleep. Your best initial action is: A. tell her you will keep out all visitors and leave her to rest B. reassure her that she can get plenty of rest when she is discharged C. Provide a med that she has been ordered PRN for sleep D. spend quiet time w/ her, asking about her fears and concerns
D
Ms. Howard is admitted w/ sudden vaginal bleeding at 35 weeks' gestation. US reveals a complete placenta previa. In planning your care and monitoring of this patient, which of the following nursing diagnoses is MOST likely to apply? A. risk of fluid volume excess related to sodium retention B. pain related to uterine tissue hypoxia C. fear related to planned induction of labor D. risk of fluid volume deficit related to hemorrhage
D
The nurse describes the cardinal mechanisms of labor while teaching an antepartum client about the passage of the fetus through the birth canal during labor. Place these events in the proper sequence as they would occur. A. descent, flexion, external rotation, internal rotation, expulsion B. descent, flexion, external rotation, expulsion, internal rotation, extension C. flexion, external rotation, descent, expulsion, internal rotation, extension D. descent, flexion, internal rotation, extension, external rotation, expulsion
D
The nurse is assessing the baseline FHR for a client in labor. What action should the nurse take first? A. Exclude periods of marked variation B. calculate the mean (avg.) heart rate C. round the HR to increments of 5 beats/min. D. measure the FHR for 10 min.
D
The nurse is caring for a woman who is in active labor at 40 weeks gestation. Which of the following best describes the correct placement of the external tocotransducer to monitor uterine activity? A. just above the symphysis pubis B. midline on the lower abdomen C. over the umbilicus D. near the uterine fundus
D
The nurse is performing a postpartum assessment on a new patient. When checking the fundus, there is a gush of blood. The patient asks why that is happening. What is the nurse's best response? A. we see this from time to time. It's not a big deal B. The gush is an indication that your fundus isn't contracting C. don't worry. I'll make sure everything is fine D. blood pooled in the vagina while you were in bed
D
The patient has delivered a 4200 g fetus. The physician performed a midline episiotomy, which extended into a third-degree laceration. The patient asks the nurse where she tore. Which response is best? "The episiotomy extended and tore: A. through your urethra B. up near your urethra C. into the muscle layer D> through your rectal sphincter
D
Thom is a 38-year-old G4P3 who presents to the emergency room at 29 weeks gestation reporting painless vaginal bleeding over the last 3 hours. The physician suspects placenta previa. Diagnosis of placenta previa will be confirmed by: A. digital examination of the cervix and vaginal canal for fetal tissue B. Sterile speculum examination C. chorionic villus sampling D. abdominal ultrasound
D
While performing the morning postpartum assessment, the nurse notices that client's perineal pad is completely saturated with lochia rubra. What action should the nurse take first? A. vigorously massage the fundus B. call the health care provider immediately C. heave the charge nurse review the assessment D. ask the client when she last changed her perineal pad
D
Which of the following is NOT a risk factor for postpartum uterine atony? A. oxytocin induction B. uterine infection C. primiparity D. triplet pregnancy
C
4 clients each gave birth 12 hours ago. Based upon report and assessment, which client should the nurse see first? A. gravida 2 Para 2002, c/s, incisional site intact, hemoglobin level 8.8 g/dl with dizziness B. Gravida 2 Para 1011, c/s, incisional site intact, pulse 84 bpm C. gravida 1 para 1001, vaginal birth, midline episiotomy, temp. 99 D. Gravida 1 para 1001, vaginal birth, ruptured membranes 10 hours before birth
A
A nurse is performing an assessment of a postpartum client two hours after birth and notes heavy bleeding with large clots. What should be the nurse's initial action? A. massaging the fundus firmly B. perfomring bi-manual uterine compressions C. administering ergonovine D. Notifying the health care provider
A
Which finding in a postpartum client requires further nursing assessment? A. fundus at the umbilicus one hour postpartum B. fundus 3 cm below the umbilicus on postpartum day 3 C. fundus not palpable in the abdomen at 2 weeks postpartum D. fundus slightly to the right, and two cm above the umbilicus on postpartum day 2
D
Which one of the following fetal positions is also a breech presentation A. RMA B. ROP C. LOA D. RSP
D
While performing the morning postpartum assessment, the nurse notices that a client's perineal pad is completely saturated with lochia rubra. What action should the nurse take first? A. vigorously massage the fundus B. call the health care provider immediately C. have the charge nurse review the assessment D. ask the client when she last changed her perineal pad
D
A nurse is reviewing laboratory data on a client admitted to the labor and delivery unit. What is the most important laboratory value for the nurse to obtain? A. blood type B. calcium C. iron D. oxygen saturation
A
After administration of an epidural anesthetic to a patient in active labor, it is most important to assess the mother immediately for: A. hypotension B. bradycardia C. headache D. urinary retention
A
Carmen is admitted to the labor and delivery unit in labor with blood flowing down her legs. What would be the priority nursing intervention? A. monitor the fetal heart tones B. place an indwelling catheter C. perform a cervical exam D. prepare the client for c/s
A
A multiparous client who has been in labor for two hours states that she feels the intense urge to move her bowels. What would the nurse do first? A. allow the client to use a bedpan B. check the fetal heart heart (FHR) C. assist the client to get up to use the toilet D. Perform a pelvic examination
D
