OB review qs

The nurse notes persistent early decelerations on the fetal monitoring strip. Which action would the nurse do next? A Administer oxygen after turning the client on her left side. B. Continue to monitor the FHR because this pattern is benign.

B. Continue to monitor the FHR because this pattern is benign. rationale: Early decelerations are not indicative of fetal distress and do not require intervention. Therefore, the nurse would continue to monitor the fetal heart rate pattern

When applying the ultrasound transducers for continuous external electronic fetal monitoring, the nurse would place the transducer to record the FHR at which location? A. between the xiphoid process and umbilicus B. between the umbilicus and the symphysis pubis

B. between the umbilicus and the symphysis pub rationale:The ultrasound transducer is positioned on the maternal abdomen in the midline between the umbilicus and the symphysis pubis. The tocotransducer is placed over the uterine fundus

Dilation follows effacement in the primiparous mother. To be fully dilated, the cervix should have a distance of what measurement? a) 8 to 10 cm b) 3 to 4 cm c) 12 to 14 cm d) 7 to 8 cm

a) 8 to 10 cm

A pregnant client requires administration of an epidural block for management of pain during labor. For which conditions should the nurse check the client before administering the epidural block? Select all that apply. a) hypovolemia b) coagulation defects c) spinal abnormality d) varicose veins e) skin rashes or bruises

a) hypovolemia b) coagulation defects c) spinal abnormality rationale: The nurse should check for any abnormality of the spine, hypovolemia, or coagulation defects in the client. An epidural is contraindicated in women with these conditions. Varicose veins and skin rashes or bruises are not contraindications for an epidural block. They are contraindications for massage used for pain relief during labor.

The nurse notes that a client's amniotic fluid is green when the membranes rupture. What finding would the nurse document? a) meconium in the amniotic sac b) umbilical cord prolapse c) infection d) amniotic fluid embolism

a) meconium in the amniotic sac

The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured based on which result? a) 5.0 b) 6.5 c) 6.0 d) 5.5

b) 6.5 rationale: Amniotic fluid is alkaline, so the membranes are probably ruptured if the pH ranges from 6.5 to 7.5.

A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing? a) Inhale and exhale through the mouth at a rate of 4 breaths every 5 seconds. b) Inhale slowly through nose and exhale through pursed lips. c) Hold breath for 5 seconds after every 3 breaths. d) Punctuated breathing by a forceful exhalation through pursed lips every few breaths.

b) Inhale slowly through nose and exhale through pursed lips.

A labor and delivery nurse knows that when assessing a woman's contraction pattern, it is important to include which of the following? (Select all that apply.) a) status of membranes b) duration c) activity of fetus d) frequency e) intensity

b) duration d) frequency e) intensity

When palpating the fundus during a contraction, the nurse notes that it feels like a chin. The nurse interprets this finding as indicating which type of contraction? a) mild b) moderate c) intense d) strong

b) moderate rationale: A contraction that feels like the chin typically represents a moderate contraction. A contraction described as feeling like the tip of the nose indicates a mild contraction

A labor and delivery nurse performs vaginal examinations to assess labor progress of patients. Which of the following is the main reason not to perform this examination too frequently? a) not very effective in predicting progress b) too time consuming c) increases the risk of infection d) painful for the patient

c) increases the risk of infection

A fetus is assessed at 2 cm above the ischial spines. How would the nurse document the fetal station? a) +4 b) 0 c) +2 d) -2

d) -2 rationale: When the presenting part is above the ischial spines, it is noted as a negative station. Since the measurement is 2 cm, the station would be -2.

When planning the care of a woman in the active phase of labor, the nurse would anticipate assessing the fetal heart rate at which interval? a) every 60 minutes b) every 4 hours c) every 15 minutes d) every 30 minutes

d) every 30 minutes

The four essential components of labor are known as the "four Ps". Which of the four Ps involves the pelvis? a) powers b) psyche c) passenger d) passageway

d) passageway

What term is used to describe the position of the fetal long axis in relation to the long axis of the mother? a) fetal presentation b) fetal attitude c) fetal lie d) fetal position

c) fetal lie rationale: Fetal lie describes the position of the long axis of the fetus in relation to the long axis of the pregnant woman.

Which type of pelvis has a roomy, round inlet and is most favorable for vaginal birth? a) android b) anthropoid c) gynecoid d) platypelloid

c) gynecoid

The initial descent of the fetus into the pelvis to zero station is which one of the cardinal movements of labor? a) expulsion b) extension c) flexion d) engagement

d) engagement rationale: The movement of the fetus into the pelvis from the upper uterus is engagement. This is the first cardinal movement of the fetus in preparation for the spontaneous vaginal delivery

The nurse is performing Leopold's maneuvers to determine fetal presentation, position, and lie. Which action would the nurse do first? a) Feel for the fetal buttocks or head while palpating the abdomen. b) Feel for the fetal back and limbs as the hands move laterally on the abdomen. c) Determine flexion by pressing downward toward the symphysis pubis. d) Palpate for the presenting part in the area just above the symphysis pubis.

a) Feel for the fetal buttocks or head while palpating the abdomen. rationale: The first maneuver involves feeling for the buttocks and head. Next the nurse palpates on which side the fetal back is located.

A pregnant woman calls her provider's office to report she thinks she is in labor. The client reports contractions have been fairly strong and at these times: 12:05, 12:10, 12:15, and 12:20. What information is gathered based on this data? a) The frequency of the contractions is every 5 minutes. b) The contractions are increasing in duration and frequency. c) The duration of the contractions is every 5 minutes. d) There is no useful information about the client's contractions.

a) The frequency of the contractions is every 5 minutes.

If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first? a) Turn her or ask her to turn to her side. b) Ask her to pant with the next contraction. c) Help the woman to sit up in a semi-Fowler's position. d) Administer oxygen at 3 to 4 L by nasal cannula.

a) Turn her or ask her to turn to her side.

A nurse is assisting a client who is in the first stage of labor. Which principle should the nurse keep in mind to help make this client's labor and birth as natural as possible? a) Women should be able to move about freely throughout labor. b) A woman should be allowed to assume a supine position. c) Routine intravenous fluid should be implemented. d) The support person's access to the client should be limited to prevent the client from becoming overwhelmed.

a) Women should be able to move about freely throughout labor.

At 37 weeks gestation a client calls the labor and birth floor and thinks she is in labor. What statement should the nurse recognize as an assessment finding for true labor? a) contraction, regular and lasting longer and stronger b) contractions, irregular, lasting 15 to 20 seconds c) scant amount of thick white vaginal discharge, no odor d) bloody mucus in the toilet once earlier in the day

a) contraction, regular and lasting longer and stronger

The nurse explains Leopold's maneuvers to a pregnant client. For which purposes are these maneuvers performed? Select all that apply. a) determining the lie of the fetus b) determining the presentation of the fetus c) determining the weight of the fetus d) determining the position of the fetus e) determining the size of the fetus

a) determining the lie of the fetus b) determining the presentation of the fetus d) determining the position of the fetus rationale: Leopold maneuvers help the nurse to determine the presentation, position, and lie of the fetus. The approximate weight and size of the fetus can be determined with ultrasound

A client is a gravida 1, in the active phase of stage 1 labor. The fetal position is LOA. When the client's membranes rupture, the nurse should expect to see a: a) moderate amount of clear to straw-colored fluid. b) small amount of greenish fluid. c) very large amount of blood. d) small segment of the umbilical cord.

a) moderate amount of clear to straw-colored fluid. rationale: The infant is in the correct position, and the client has been in labor. Expectation would be for normal amniotic fluid presentation of clear to straw-colored fluid.

While caring for woman in labor, the nurse notes that the fetal heart monitor demonstrates late decelerations. The most common cause for their occurrence is: a) uteroplacental insufficiency. b) maternal fatigue. c) maternal hypotension. d) cord compression.

a) uteroplacental insufficiency. rationale: Late decelerations are associated with uteroplacental insufficiency. They typically indicate decreased blood flow to the uterus during the contractions.

A nurse is required to obtain the fetal heart rate (FHR) for a pregnant client. If the presentation is cephalic, which maternal site should the nurse monitor to hear the FHR clearly? a) just below the maternal umbilicus b) lower quadrant of the maternal abdomen c) at the level of the maternal umbilicus d) above the level of the maternal umbilicus

b) lower quadrant of the maternal abdomen rationale: In a cephalic presentation, the FHR is best heard in the lower quadrant of the maternal abdomen. In a breech presentation, it is heard at or above the level of the maternal umbilicus

Which occurrence after birth requires immediate reporting and intervention? a) placental separation 15 minutes after birth b) maternal tachycardia and falling blood pressure c) a uterine contraction followed by a steady trickle of blood from the vagina and the lengthening of the umbilical cord d) dark red lochia

b) maternal tachycardia and falling blood pressure

While monitoring the EFM tracing the nurse notes decelerations with each contraction. The nurse knows that for a deceleration to be classified as early it has to meet three criteria. What is one of these criteria? a) The FHR begins to accelerate as the contraction begins. b) The nadir of the deceleration coincides with the acme of the contraction. c) The nadir of the deceleration falls midway between the acme of two contractions. d) The deceleration ends midway between two contractions.

b) The nadir of the deceleration coincides with the acme of the contraction. rationale: Three criteria classify the deceleration as early: (1) the FHR begins to slow as the contraction starts; (2) the lowest point of the deceleration, the nadir, coincides with the acme (highest point) of the contraction; and (3) the deceleration ends by the end of the contraction.

The nurse is aware that cord compression is not continuous when variable decelerations occur and that compression happens when which of the following takes place? a) The uterus relaxes between contractions. b) The uterus contracts and squeezes the cord against the fetus. c) prematurity d) fetal sleep

b) The uterus contracts and squeezes the cord against the fetus.

A postbirth complete blood count (CBC) has noted an elevated white blood cell (WBC) count of 22,000/mm3. Which rationale is accurate regarding the elevated WBC count? a) This might be a false result; retesting is recommended. b) This is a normal variation due to the stress of labor. c) This is an abnormal finding, and she needs antibiotics. d) This occurs in clients who have cesarean birth, from the trauma of surgery.

b) This is a normal variation due to the stress of labor. rationale: An elevation of WBC up to 30,000mm/3 can be normal variation for any woman after birth. This is related to the stress on her body from labor and birth.

The expected fetal heart rate response in an active fetus is: a) decrease in variability for 15 seconds. b) acceleration of at least 15 bpm for 15 seconds. c) deceleration followed by acceleration of 15 bpm. d) increase in variability by 15 bpm.

b) acceleration of at least 15 bpm for 15 seconds. rationale: A reassuring active fetal heart rate is a change in baseline by increase of 15 bpm for 15 seconds. This is a positive and reassuring periodic change in fetal heart rates

Which action is a priority when caring for a woman during the fourth stage of labor? a) offering fluids as indicated b) assessing the uterine fundus c) encouraging the woman to void d) assisting with perineal care

b) assessing the uterine fundus rationale: During the fourth stage of labor, a priority is to assess the woman's fundus to prevent postpartum hemorrhage.

The fetus of a nulliparous woman is in a shoulder presentation. The nurse would prepare the client for which type of birth? a) forceps-assisted b) cesarean c) vacuum extraction d) vaginal

b) cesarean rationale: The fetus is in a transverse lie with the shoulder as the presenting part, necessitating a cesarean birth.

When assessing cervical effacement of a client in labor, the nurse assesses which characteristic? a) fetal presenting part b) degree of thinning c) extent of opening to its widest diameter d) passage of the mucous plug

b) degree of thinning

The RN in labor and birth documents the fetus as ROA. To what does this documentation refer for a fetus? a) fetal size b) fetal position c) fetal station d) fetal attitude

b) fetal position rationale: relationship of the fetal position to the mother using the maternal pelvis as the point of reference

While caring for woman in labor, the nurse notes that the fetal heart monitor demonstrates late decelerations. The most common cause for their occurrence is: a) maternal hypotension. b) uteroplacental insufficiency. c) cord compression. d) maternal fatigue.

b) uteroplacental insufficiency. rationale: Late decelerations are associated with uteroplacental insufficiency. They typically indicate decreased blood flow to the uterus during the contractions.

A client is in the active phase of labor. She is a low-risk client. The nurse evaluates the fetal monitor strip at 10:00 a.m. Moderate variability is present. The FHR is in the 130s with occasional accelerations, no decelerations. At what time does the nurse need to reevaluate the FHR? a) 11:00 a.m. b) 11:15 a.m. c) 10:30 a.m. d) 10:15 a.m.

c) 10:30 a.m.

The labor and delivery nurse has responsibility for monitoring fetal heart rate patterns. Which of the following values would indicate fetal tachycardia? a) > 80 bpm b) > 120 bpm c) > 160 bpm d) > 100 bpm

c) > 160 bpm rationale: normal is 140-160 bpm

As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next? a) Ask her to bear down with the next contraction. b) Elevate her hips to prevent cord prolapse. c) Assess fetal heart rate for fetal safety. d) Test a sample of amniotic fluid for protein.

c) Assess fetal heart rate for fetal safety. rationale: Rupture of the membranes may lead to a prolapsed cord.

A 32-year-old woman presents to the labor and birth suite in active labor. She is multigravida, relaxed, and talking with her husband. When examined by the nurse, the fetus is found to be in a cephalic presentation. His occiput is facing toward the front and slightly to the right of the mother's pelvis, and he is exhibiting a flexed attitude. How does the nurse document the position of the fetus? a) ROP b) LOA c) ROA d) LOP

c) ROA

Place the following stages of labor in order from what occurs first to last. All options must be used. active stage second stage third stage transition stage latent stage

latent stage active stage transition stage second stage third stage

A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse prepares the client for this monitoring based on the understanding that which criterion must be present? a) neonatologist to insert the electrode b) floating presenting fetal part c) cervical dilation of 2 cm or more d) intact membranes

c) cervical dilation of 2 cm or more rationale: For continuous internal electronic fetal monitoring, four criteria must be met: ruptured membranes, cervical dilation of at least 2 cm, fetal presenting part low enough to allow placement of the electrode, and a skilled practitioner available to insert the electrode.

A client is ready to push. The nurse instructs her to push vigorously by taking a deep breath and pushing hard while counting to 10. What would be important to monitor on the client while she is pushing vigorously? a) perception of her pain b) perineum for lacerations c) heart rate d) oxygenation

c) heart rate rationale: recent research has revealed that vigorous pushing techniques that employ the Valsalva maneuver are associated with changes in the mother's heart rate and blood pressure

A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply. a) increase in gastric emptying and pH b) slight decrease in body temperature c) increase in blood pressure d) increase in heart rate e) increase in respiratory rate

c) increase in blood pressure d) increase in heart rate e) increase in respiratory rate rationale: When caring for a client in labor, the nurse should monitor for an increase in the heart rate by 10 to 20 bpm, an increase in BP by as much as 35 mm Hg, and an increase in respiratory rate. Slight elevation in body temperature as a result of an increase in muscle activity, also monitor for decreased gastric emptying and gastric pH, which increases the risk of vomiting with aspiration.

A nurse is caring for a client who is in the first stage of labor. The client is experiencing extreme pain due to the labor. The nurse understands that which factors are causing the extreme pain in the client? Select all that apply. a) fetus moving along the birth canal b) spontaneous placental expulsion c) lower uterine segment distention d) stretching and tearing of structures e) dilation of the cervix

c) lower uterine segment distention d) stretching and tearing of structures e) dilation of the cervix rationale: The nurse knows that lower uterine segment distention, stretching and tearing of the structures, and dilation of the cervix cause pain in the first stage.

The skull is the most important factor in relation to the labor and birth process. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps to make this passage possible? a) vertex presentation b) cephalohematoma c) molding d) caput succedaneum

c) molding rationale: The cartilage between the bones allows the bones to overlap during labor, a process called molding that elongates the fetal skull thereby reducing the diameter of the head.

Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting? a) shoulders b) brow c) occiput d) buttocks

c) occiput rationale: With a vertex presentation, a type of cephalic presentation, the fetal presenting part is the occiput. The brow or sinciput is the presenting part when a fetus is in a brow presentation. The buttocks are the presenting part when a fetus is in a breech presentation

A nurse is monitoring the FHR of a client in labor using an electronic fetal monitor. The reading shows a late deceleration. Which intervention should the nurse implement? a) Administer exogenous oxytocin. b) Place the client in the lithotomy position. c) Encourage the Valsalva maneuver. d) Change maternal position to an upright or side lying position.

d) Change maternal position to an upright or side lying position.

The laboring client is on continuous fetal monitoring when the nurse notes a decrease in the fetal heart rate with variable deceleration to 75 bpm. What is the initial nursing intervention? a) Notify the primary care provider. b) Administer oxygen. c) Increase her IV fluids. d) Change the position of the client.

d) Change the position of the client. rationale: Variable decelerations often indicate a type of cord compression. The initial response is to change the position and try to release the cord compression.

While monitoring the EFM tracing the nurse notes decelerations with each contraction. The nurse knows that for a deceleration to be classified as early it has to meet three criteria. What is one of these criteria? a) The nadir of the deceleration falls midway between the acme of two contractions. b) The FHR begins to accelerate as the contraction begins. c) The deceleration ends midway between two contractions. d) The nadir of the deceleration coincides with the acme of the contraction.

d) The nadir of the deceleration coincides with the acme of the contraction. rationale: Three criteria classify the deceleration as early: (1) the FHR begins to slow as the contraction starts; (2) the lowest point of the deceleration, the nadir, coincides with the acme (highest point) of the contraction; and (3) the deceleration ends by the end of the contraction.

During the active phase of labor, the nurse should evaluate the labor pattern how often? a) every hour b) every 15 minutes c) every 10 minutes d) every 30 minutes

d) every 30 minutes

A client is in the transitional phase of labor. Which findings would the nurse expect? Select all that apply. a) apprehension mixed with excitement b) cervical dilation of 6 cm c) contractions occurring every 3 minutes d) irritability with restlessness e) cervical effacement of 70% f) strong desire to push

d) irritability with restlessness f) strong desire to push

A client comes to the emergency department reporting strong contractions that have lasted for the past 2 hours. Which assessment will indicate to the nurse that the client is in true labor? a) increased fetal activity b) 1:5 uterine contractions c) pink show d) progressive cervical dilatation and effacement

d) progressive cervical dilatation and effacement