OB II (Davis Question)
A client requests to keep the placenta following delivery. How would the nurse respond to this request? 1. "We do not allow that in this hospital. It is against all regulations." 2. "Can you tell me what you plan to do with the placenta? We only allow this if you plan to bury the placenta." 3. "Why would you want to take that home? It will begin to smell and can attract insects." 4. "I understand that this is very important to you, and I will see what I can do to honor this request."
"I understand that this is very important to you, and I will see what I can do to honor this request."
Following cesarean delivery, a stable female infant weighing 3,126 grams is placed skin-to-skin with the mother. The client's partner asks why the infant is placed with the mother during the remainder of the surgery. What is the best response from the nurse? "Placing the infant with the mother reduces the need to have another nurse in the crowded operating room." "We can discuss this later, I need to help the surgeon right now." "Infants are less likely to need NICU care when placed skin-to-skin with the mother." "It is important to get a picture immediately after delivery of the infant."
"Infants are less likely to need NICU care when placed skin-to-skin with the mother."
Following a cesarean section a few hours ago, the partner of a client comes out to the nurses' station to report severe itchiness the client is experiencing. The partner voices concern that the client is experiencing an allergic reaction to the morphine given during surgery. How does the nurse respond to the client when entering to the room to assess the itching? "Itchiness, also known as pruritis, is a common reaction to morphine and is not considered an allergy." "Here is some medication to stop the itching." "I will note in your medical record that you have an allergy to morphine." "Let me call the provider and report the itching."
"Itchiness, also known as pruritis, is a common reaction to morphine and is not considered an allergy."
While the nurse is preparing a client for an emergency cesarean section, the family voices concern that the client is extremely nervous about the procedure. How does the nurse respond to the client? "Tell me about how you are feeling right now." "We do many c-sections every day, you will be fine." "I am going to insert the foley catheter now." "It is important that you try to calm down for the baby."
"Tell me about how you are feeling right now."
The nurse is caring for a client who has been dilated to 10 cm for about one hour. When assessing the client, her mother asks why the nurse has not started telling her daughter to push. Which is the appropriate response from the nurse? 1."Times are different now, we do not make women push if they do not want to." 2."The baby does better at birth if the mother waits to push once she feels the urge." 3."It is best to start pushing one hour after reaching full dilation. It will start soon." 4."The provider is not here yet, so pushing must be delayed."
"The baby does better at birth if the mother waits to push once she feels the urge."
A woman in the second stage of labor has been pushing for 3 hours. The provider is preparing for a vacuum-assisted delivery. Which anticipatory guidance should the nurse give to the patient? 1. "The blades of the forceps will be applied to the fetal head." 2. "The baby may have some bruising and edema of the head." 3. "You will need to push between contractions." 4. "An episiotomy is required for a vacuum delivery."
"The baby may have some bruising and edema of the head."
The grandmother of a newly-delivered infant was in the room for the delivery. The newborn is placed skin-to-skin with the mother and covered with a warm blanket while waiting for the placenta to deliver. The grandmother expresses concern that the newborn is too cold with no clothes on. Which is the best response by the nurse? "I will check the temperature when I have time." ."Skin-to-skin contact helps newborns to regulate temperature." "Please just stand out of the way of the provider." "The warm blanket will stop all cold air from reaching the baby."
."Skin-to-skin contact helps newborns to regulate temperature."
The Labor and Delivery (L&D) educator has explained to a group of nurses how the utero-placental unit functions. Which components are necessary for the fetus to receive appropriate oxygenation? Select all that apply. 1. Adequate oxygenation of the mother 2. Adequate uteroplacental circulation 3. Adequate umbilical circulation 4. Adequate fetal blood volume 5. Adequate blood flow to the placenta
1. Adequate oxygenation of the mother 2. Adequate uteroplacental circulation 3. Adequate umbilical circulation 5. Adequate blood flow to the placenta
The nurse is describing baseline fetal heart rate (FHR) to a practicum student. which would the nurse mention when teaching about the definition and assessment criteria related to baseline FHR? Select all that apply. 1. "Periodic changes in baseline of FHR occur in relation to uterine contractions." 2. "Recurrent changes in baseline of FHR occur in less than 50% of the contractions in 20 minutes." 3. "Intermittent changes in baseline of FHR occur in greater than 50% of the contractions in 20 minutes." 4. "Episodic changes in baseline of FHR occur independent of uterine contractions." 5. "FHR is rounded to increments of 5 beats per minute during a 10-minute window. This must be at least 2 minutes of identifiable baseline segment."
1. "Periodic changes in baseline of FHR occur in relation to uterine 4. "Episodic changes in baseline of FHR occur independent of uterine contractions." 5. "FHR is rounded to increments of 5 beats per minute during a 10-minute window. This must be at least 2 minutes of identifiable baseline segment."
While assessing a pregnant patient, the nurse notes the fetal heart rate (FHR) is 125 with moderate variability, no accelerations and no decelerations. Using the National Institute of Child Health and Human Development (NICHD) Criteria, which would the nurse record as the appropriate category related to the assessment findings? 1. Category I: Strongly predictive of a well- oxygenated, non-acidotic fetus. No action required. 2. Category II: Indeterminate. Requires continued surveillance and reevaluation. 3. Category III: Abnormal requiring prompt evaluation and intervention. 4. Category IV: Fetal Demise.
1. -Category I: Strongly predictive of a well- oxygenated, non-acidotic fetus. No action required.
The labor nurse is caring for a patient at risk for intraamniotic infection. Which assessment findings would alert the nurse of intraamniotic infection? Select all that apply. 1. Baseline fetal heart rate 170 2. Maternal fever 3. Meconium stained amniotic fluid 4. Severe headache 5. Foul-smelling vaginal discharge
1. Baseline fetal heart rate 170 2. Maternal fever 5. Foul-smelling vaginal discharge
The nurse is caring for a patient whose fetus has been diagnosed with Intrauterine Growth Restriction (IUGR). The patient asks the nurse how this could have happened. Which does the nurse recognize as a possible cause? 1. The fetus has a lower oxygen tension then an adult. 2. Available oxygen chronically falls below 50% of normal levels and there is a redistribution of blood to vital organs. 3. The amount of lactic acid exceeds fetal buffering capacity. 4. Oxygenated blood from the mother is delivered to the intervillous space in the placenta.
2. Available oxygen chronically falls below 50% of normal levels and there is a redistribution of blood to vital organs.
The nursing instructor has just completed a lecture on fetal surveillance and the use of structured intermittent auscultation (SIA). The instructor knows that teaching was effective when the students recognize which contradiction to the use of SIA? 32-year-old G1, P0 patient at 40 weeks who is 6 cm dilated with a Category I tracing Presence of nurses and providers experienced in SIA Institutional policy addressing technique and frequency of SIA 26-year-old G4P3 at 39 weeks who is 3 cm dilated with a Category I tracing, being induced for gestational diabetes mellitus (GDM)
26-year-old G4P3 at 39 weeks who is 3 cm dilated with a Category I tracing, being induced for gestational diabetes mellitus (GDM)
The nurse is caring for an obese patient and having difficulty maintaining the fetal heart rate (FHR) and contractions on an external fetal monitor (EFM). Which is the best action by the nurse in this situation? 1. Notify the provider and document. 2. Insert intrauterine pressure catheter (IUPC) and fetal spiral/scalp electrode (FSE). 3. Reposition patient, adjust tocodynamometer and ultrasound transducer. 4. Discontinue EFM and notify provider.
3. Reposition patient, adjust tocodynamometer and ultrasound transducer.
The nurse is assessing a pregnant patient who is externally monitored and contracting every 3 to 4 minutes with each contraction lasting 40 to 60 seconds. The peak of the contraction reads 90 on the graph paper with a resting tone of 20. The patient rates her contractions as 10/10 and is crying. Which can the nurse document, based on these findings? 1. The contractions are very strong, and the patient will probably deliver soon. 2. The contractions are not adequate to make cervical changes. 3. The resting tone is too high. 4. The frequency and duration of contractions.
4. The frequency and duration of contractions.
While presenting an educational session on childbirth the nurse was asked to discuss risk factors requiring a cesarean section. What should the nurse include in her response? Select all that apply. Advanced maternal age Spontaneous labor onset Breech position Maternal request Multiparity
AMA Breech Position
The obstetric nurse is preparing a client for an epidural. What is the priority nursing intervention prior to this procedure? Monitor fetal heart tones Obtain maternal blood pressure Administer IV fluid bolus Assess for prior epidural anesthesia
Administer IV fluid bolusv
A gravid patient in labor suddenly has dyspnea, hypotension, frothy sputum, and loss of consciousness. The nurse knows these are signs and symptoms of which obstetrical emergency? 1. Placental abruption 2. Uterine rupture 3. Uterine inversion 4. Amniotic fluid embolism
Amniotic fluid embolism
A nurse is caring for a client following a cesarean section four hours ago that occurred due to arrest of labor. Initially, the client was admitted to the hospital two days ago after experiencing spontaneous rupture of membranes. Which medication order does the nurse anticipate for this client? Bisacodyl Ampicillin Methergine Dexamethasone
Ampicillin
While assessing a post-operative cesarean section client, the nurse notes a temperature of 102.1?. Prior to calling the provider, what other assessment should the nurse complete to include when reporting the concern? Identify the time of last pain medication Assess the c-section incision Assess lung sounds and incentive spirometry Assess uterine fundus and lochia
Assess the c-section incision
In addition to assessing bowel sounds, what other priority gastrointestinal assessment should be completed on a client following a cesarean section delivery? Assessing for nausea Last bowel movement before surgery Assessing for flatulence Tolerance of a full liquid diet
Assessing for flatulence
The OB nurse is assessing a patient utilizing structured intermittent auscultation (SIA). Which intervention assists the nurse in identifying fetal heart tones (FHT)? Perform a 20-minute Non-Stress Test (NST). Auscultate fetal heart tones (FHT) for at least 20 minutes. Auscultate FHT's during and after contractions for 30 seconds. Auscultate FHT's between contractions for at least 30 to 60 seconds.
Auscultate FHT's between contractions for at least 30 to 60 seconds.
The nurse notes a fetal heart rate (FHR) deceleration that begins after the peak of the contraction and ends once the contraction is over. Which is the priority nursing action for this patient? 1. Administer oxygen at 10L/min via nonrebreather face mask. 2. Give an IV bolus. 3. Discontinue oxytocin. 4. Change the maternal position.
Change the maternal position
The nurse is caring for a patient that is being induced with oxytocin. Upon assessment of the oxytocin infusion and patient status, the nurse would determine effectiveness with which clinical finding? 1. The patient reports a pain level of 4 on the numeric pain scale with bloody show noted on the peripad. 2. Contractions last 40 to 60 seconds every 2 to 3 minutes with cervical change. 3. Contractions are 4 to 5 minutes apart lasting 30 to 40 seconds with no cervical change. 4. Intensity of contractions is at least 75 to 100 mm/Hg with IUPC.
Contractions last 40 to 60 seconds every 2 to 3 minutes with cervical change.
The nurse is assessing a laboring client. Which signs and symptoms does the nurse recognize that indicate movement into the transition phase of labor? Select all that apply. Contractions every 3 to 4 minutes Contractions lasting 60 to 90 seconds Cervix dilated to 8 cm Noted trembling of client Increase in client anxiety
Contractions lasting 60 to 90 seconds Cervix dilated to 8 cm Noted trembling of client Increase in client anxiety
A mother-baby nurse just received report on four mother baby couplets and is preparing to start the first assessments of the shift. All are recovering from cesarean section deliveries. Which couplet will need to be seen first? Couplet #1: the infant and mother have been doing well since delivery 3 days ago and would like to be discharged in the next couple hours. Couplet #2: the infant has been breastfeeding successfully and the mother has required the uterine fundus to be massaged to firm. Couplet #3: the mother has chosen to bottle feed the infant, and the infant has lost 89 grams of the 3200-gram birth weight at 2 days of age Couplet #4: the infant has been experiencing difficulties latching on to breastfeed and last nursed successfully an hour and a half ago.
Couplet #2: the infant has been breastfeeding successfully and the mother has required the uterine fundus to be massaged to firm.
A laboring patient is experiencing labor dystocia. Which statement correctly describes labor dystocia? 1. Difficult labor characterized by abnormally slow labor progress 2. Fetal shoulder impacted under the maternal symphysis pubis 3. Fetal head larger than maternal pelvis 4. Uterine contractions >25 mm Hg with intrauterine pressure catheter
Difficult labor characterized by abnormally slow labor progress
A patient in labor is noted to have an occiput posterior presentation. Which complications would the nurse anticipate? 1. Prolapsed cord 2. Facial bruising in neonate 3. Dystocia 4. Shortened second stage
Dystocia
The nurse caring for a multiparous patient in active labor suspects cephalopelvic disproportion (CPD). Which assessment finding supports this? 1. Fetal station descending 2. Large maternal stature 3. Tachysystole 4. Fetus not engaged in the pelvis
Fetus not engaged in the pelvis
Which assessments of uterine activity are obtained by the nurse when the patient has an intrauterine pressure catheter (IUPC) placed? Select all that apply. 1. Frequency 2. Intensity 3. Duration 4. Fetal Heart Rate 5. Resting Tone
Frequency Intensity Duration Resting Tone
While caring for a client, which interventions would the nurse include in the nursing care plan to provide culturally competent care? Select all that apply. Describe hospital protocols that will be followed during deliv. Provide teaching on non-pharm pain management options as they are preferred by women of the client's culture Identify who the woman prefers to care for her during labor and delivery. Provide the client's preferred foods as appropriate or encourage the client's family to bring foods from home. Determine who is the client's support person(s) and how they will participate in her care.
Identify who the woman prefers to care for her during labor and delivery. Provide the client's preferred foods as appropriate or encourage the client's family to bring foods from home. Determine who is the client's support person(s) and how they will participate in her care.
The Labor and Delivery (L&D) unit educator discusses the prioritization of fetal monitoring goals, creating a plan of care, and setting goals for implementation with a group of nurses. Which goals are correct? Select all that apply. Interpretation of ongoing assessment of fetal oxygenation Prevention of significant fetal academia Minimize unnecessary interventions Promote a satisfying family-centered birth experience Use of EFM for all laboring women in the US is required
Interpretation of ongoing assessment of fetal oxygenation Prevention of significant fetal academia Minimize unnecessary interventions Promote a satisfying family-centered birth experience
The nurse is caring for a patient who is undergoing a term gestation pregnancy induction. Which is the nurse aware of regarding the induction of labor? 1. It is achieved by external and internal version techniques. 2. It is always done for medical indications. 3. It is rated for probability of success by a Bishop score. 4. It is only achieved through oxytocin infusion.
It is rated for probability of success by a Bishop score.
The nurse is in the room with a laboring patient who was found to have a prolapsed umbilical cord. The nurse will place the patient in which positions to help relieve pressure on the cord? Select all that apply. 1. High-Fowlers 2. Left lateral 3. Knee-chest 4. Squatting 5. Trendelenburg
Knee-chest Trendelenburg
While caring for a pregnant client, which can the nurse provide to decrease fear and anxiety throughout labor and delivery? Ambulation Confidence Pain Medication Labor Support
Labor Support
The nurse is preparing a group session for childbirth preparation. The topic will include signs of impending labor. The nurse will include which topics? Select all that apply. 1. Lightening 2. Decreased fetal movement 3. Nesting 4. Bloody show 5. Weight gain
Lightening Nesting Bloody show
The nurse is instructing a woman and her partner on non-pharmacological pain relief interventions such as effleurage and using heat/cold. The client asks how these techniques work to manage pain. Which is the best statement by the nurse? a. Slow abdominal breathing b. Guided relaxation c. Listening to music d. Massage
Massage
When palpating the patient's fundus during a contraction, the nurse notes that it feels like a 'chin.' The nurse documents this finding as which contraction intensity? 1. Mild 2. Moderate 3. Strong 4. Firm
Moderate
Upon admission, the nurse instructed a 39-week gestation client to lie on her back in bed for assessment and placement of the fetal monitor. After going through the medical history, the nurse assesses the client's blood pressure at 76/42. Which is the appropriate intervention? Retake BP with a manual cuff Move client onto her L. side Call Provider to obtain an order for IV fluids Continue to monitor BP every 30 minutes
Move the client onto her Left side
The nurse has just completed a fetal monitoring course and is explaining the normal findings of structured intermittent auscultation (SIA) with a handheld Doppler. Which would the nurse identify as a normal finding of SIA? Select all that apply. Moderate variability Normal baseline between 110-160bpm Regular rhythm Presence of FHR increases from baseline Absence of FHR decreases from baseline
Normal baseline between 110-160bpm Regular rhythm Presence of FHR increases from baseline Absence of FHR decreases from baseline
A client was recently admitted to the labor and delivery unit in active labor. The nurse performs Leopold's maneuvers during the assessment. During the third maneuver, the nurse notes a firm and fixed fetal part. Which position correlates with this assessment finding? 1.Occiput 2.Acromion 3.Sacrum 4.Transverse
Occiput
A term laboring patient is reporting severe lower back pain and has been pushing for two hours. The nurse would anticipate that the fetus is in which position? 1. Frank breech 2. Occiput posterior 3. Occiput anterior 4. Shoulder presentation
Occiput posterior
The nurse is preparing a client for a cesarean section. Following the epidural anesthesia, the nurse is ready to show the partner where to stay during the surgery. Where does the nurse show the partner to go? On a stool next to the client's head. On a stool next to the infant warmer. In a waiting room next to the operating room. In the recovery room, to await completion of the surgery.
On a stool next to the client's head.
The instructor is teaching the modes of fetal heart rate and contraction assessment to a class of nursing students. What are the modes of uterine monitoring? Select all that apply. 1. Auscultation 2. Palpation 3. Fetal spiral electrode 4. Intrauterine pressure catheter 5. Tocodynamometer
Palpation Intrauterine pressure catheter Tocodynamometer
A client is admitted to the labor and delivery unit in active labor. There has been no prenatal care for the current pregnancy, and the on-call provider estimates the pregnancy to be around 35 weeks' gestation. Which medication will the nurse anticipate being ordered for on this client? Oxytocin Penicillin Magnesium Sulfate Metoclopramide
Penicillin
Following a cesarean section, the nurse caring for the client notes the following assessment data: Temperature 99.1?, Heart rate 136, Respirations 20, Blood pressure 82/48, and skin pale and clammy to the touch. The nurse reports concern of what postpartum complication to the provider? Respiratory depression Renal failure Wound infection Postpartum hemorrhage
Postpartum hemorrhage
The nurse is caring for a patient following a precipitous delivery. Which complication would the nurse watch for? 1. Retained placenta 2. Postpartum hemorrhage 3. Hemorrhoids 4. Uterine rupture
Postpartum hemorrhage
The nurse is teaching a childbirth education class. Which statements regarding induction of labor would be included in the teaching? Select all that apply. 1. Labor induction is used only for medical reasons. 2. Prior to using oxytocin for labor induction, the cervix should be favorable. 3. As long as you are over 37 weeks gestation, your doctor may induce you for convenience. 4. The risks of labor induction are the same as the risks with spontaneous labor. 5. You should not have a labor induction if you have active herpes.
Prior to using oxytocin for labor induction, the cervix should be favorable. You should not have a labor induction if you have active herpes.
The nurse is caring for a term gestation laboring patient who just had a sudden onset of hypoxia and hypotension shortly after spontaneous rupture of membranes. Which is the nurse's priority action? 1. Assist the patient into High-Fowler's position. 2. Call the provider and prepare for imminent delivery. 3. Draw a blood panel and prepare to administer blood products. 4. Provide supplemental oxygen and left uterine displacement.
Provide supplemental oxygen and left uterine displacement.
The nurse instructs the client on second stage positioning and pushing techniques. The nurse recognizes that the client understands the teaching when the client states: Holding my breath helps increase pressure and push the baby out. Having my legs in stirrups reduces the risk that I will tear Pushing on my side can increase blood flow to the baby I should begin pushing as soon as I am completely dilated.
Pushing on my side can increase blood flow to the baby
A nurse is preparing to assist a new mother with breastfeeding following a cesarean section delivery. Which positions will the nurse recommend to maximize patient comfort while breastfeeding? Select all that apply. Side-lying position Cradle hold C-cup positioning Using a breast pump Football hold
Side-lying position Football hold
Regarding oxytocin for labor induction, what is the most concerning side effect of oxytocin? 1. Fetal heart rate baseline change from 140 to 130 beats per minute 2. Increased blood pressure 3. Oliguria 4. Tachysystole
Tachysystole
A provider has determined a client needs a cesarean section for cephalopelvic disproportion. The client asks the nurse to explain what cephalopelvic disproportion means. What is the best response by the nurse? "You are needing a c-section due to the baby experiencing stress from labor." "Let's focus on preparing for the surgery." "The baby is too large for your pelvis." "Have you had a recent ultrasound to estimate the baby's weight?"
The baby is too large for the pelvis
The nurse is assessing client 12 hours post cesarean section delivery, of a healthy male infant weighing 9 pounds 3 ounces. The client's Foley catheter was removed three hours ago. Which subjective assessment data requires immediate intervention? The client reports pain at a level of four and can tolerate a five. The client reports the infant nursed for about 20 minutes one and a half hours ago. The client has a blood pressure of 92/48. The client reports no voiding since the catheter was removed.
The client reports no voiding since the catheter was removed.
The charge nurse is observing a new nurse on the labor and delivery floor caring for a client in active labor and recognizes the need for additional training. Which care provided by the new nurse demonstrates a need for further orientation? Select all that apply. The new nurse encourages client to use the restroom every hour. The new nurse recommends client stay in bed and rests until it is time to push. The new nurse explains all procedures to the client throughout the shift. The new nurse suggests that all family members leave the room. The new nurse assists client with breathing techniques to help with relaxation.
The new nurse recommends client stay in bed and rests until it is time to push. The new nurse suggests that all family members leave the room.
The process of labor is multifactorial. The five primary factors include powers, passage, passenger, psyche, and: a-Pressure b-Patience c-Position d-Pelvis
c-Position
A gravid patient is having a trial of labor after cesarean (TOLAC). The nurse knows to watch for which obstetrical emergency? 1. Dystocia 2. Shoulder dystocia 3. Amniotic fluid embolism 4. Uterine rupture
Uterine rupture
A client is pregnant with her second child following a cesarean section delivery with the first pregnancy for a breech fetal position. The couple plans to have three children total. What option does the nurse discuss as the best one for this couple? Vaginal birth Repeat c-section External cephalic version Only having two children
Vaginal Birth
A nursing instructor explains to a group of students that an amnioinfusion is a procedure used most commonly in the first stage of labor to treat which type of decelerations? Variable Late Early Prolonged
Variable
Which nursing interventions would support a normal, physiologic birth? Select all that apply. Waiting until 40 weeks gestation to induce labor Assisting the mother to change positions freq Collaborating with a doula or other support person to manage discomfort Encouraging the mother to lie on her back and place her feet in stirrups for delivery Allowing the bag of waters to rupture spontaneously
Waiting until 40 weeks gestation to induce labor Assisting the mother to change positions freq Collaborating with a doula or other support person to manage discomfort Allowing the bag of waters to rupture spontaneously