prep-U questions OB exam #3
The nursing instructor is conducting a class discussion on the various agents used during labor and delivery to assist the client. The instructor determines the class is successful after the students correctly choose which factor as true about the use of systemic analgesia? A. Barbiturates are used primarily in active labor and during transition. B. Ataractics are used for pain relief but may cause nausea and vomiting. C. Benzodiazepines enhance pain relief attained with opioids and cause sedation. D. Opioids are more effective if given PO.
C. Benzodiazepines enhance pain relief attained with opioids and cause sedation.
A nurse is providing care to a woman in labor. When reviewing the woman's medical record, the nurse notes that fetal position is documented as LSA. The nurse interprets this to mean that which part of the fetus is presenting? A. chin B. occiput C. buttocks D. acromion process
C. buttocks
A nurse performs an initial assessment of a laboring woman and reports the following findings to the primary care provider: fetal heart rate is 152 bpm, cervix is 100% effaced and 5 cm dilated, membranes are intact, and presenting part is well applied to the cervix and at -1 station. The nurse recognizes that the client is in which stage of labor? A. second B. third C. first, active D. first, latent
C. first, active
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: A. 9. B. 6. C. 7. D. 5.
D. 5.
The nurse in a busy L & D unit is caring for a woman beginning induction via oxytocin drip. Which prescription should the nurse question with regard to titrating the infusion upward for adequate contractions? A. After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate. B. Start oxytocin drip, piggyback to main IV line to port closest to client. C. Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each. D. Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min.
D. Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min.
A 19-year-old nulliparous woman is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication? A. cephalopelvic disproportion B. reduced oxygen to the fetus C. ruptured uterus D. precipitate labor
B. reduced oxygen to the fetus
A new dad is alarmed at the shape of his newborn's head. When responding to the dad, the nurse reminds him this is due to: A. cranial bones overlapping at the suture lines. B. extreme pressure in the vaginal vault. C. a congenital defect. D. prolonged labor.
A. cranial bones overlapping at the suture lines.
A multigravid client has been in labor for several hours and is becoming anxious and distressed with the intensity of her frequent contractions. The nurse observes moderate bloody show and performs a vaginal examination to assess the progress of labor. The cervix is 9 cm dilated. The nurse knows that the client is in which phase of labor? A. transition phase B. active phase C. latent phase D. early phase
A. transition phase
The nurse is caring for a client who is late in her pregnancy. What assessment finding should the nurse attribute to the role of prostaglandins? A. The cervix is dilating B. The cervix is softening C. The perineum is relaxing D. The uterus is relaxing
B. The cervix is softening
The nurse is reviewing a pregnant client's birth plan. The client asks the nurse about the use of opioids during the labor process. How will the nurse respond? A. "You may require urinary catheterization during the laboring process." B. "You will feel less pain during the contractions, but will still feel some of the pain." C. "Using an opioid during labor may cause the baby to have seizures immediately after birth." D. "Sometimes opioids cause high blood pressure so we closely monitor your blood pressure."
B. "You will feel less pain during the contractions, but will still feel some of the pain."
A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanel (fontanelle). The client is anxious to know when the posterior fontanel (fontanelle) will close. Which time span is the normal duration for the closure of the posterior fontanel (fontanelle)? A. 12 to 14 weeks B. 8 to 12 weeks C. 14 to 18 weeks D. 4 to 6 weeks
B. 8 to 12 weeks
A pregnant client in labor has to undergo a sonogram to confirm the fetal position of a shoulder presentation. For which condition associated with shoulder presentation during a vaginal birth should the nurse assess? A. congenital anomalies B. uterine abnormalities C. birth after due date D. fetal anomalies
D. fetal anomalies
The nurse is monitoring a laboring client with continuous fetal monitoring and notes a decrease in FHR with variable deceleration to 75 bpm. Which intervention should the nurse prioritize? A. Change the position of the client. B. Notify the primary care provider. C. Increase her IV fluids. D. Administer oxygen.
A. Change the position of the client.
Which nursing action is essential if the laboring client has the urge to push but she is not fully dilated? A. Have the client pant and blow through the contraction. B. Have the client divert the energy to squeezing a hand. C. Have the client lightly push to meet the need. D. Assist the client to a Fowler position.
A. Have the client pant and blow through the contraction.
When teaching possible differences in labor between the first labor experience and all other labors, which statement is most beneficial to assist a woman's psyche? A. "You had a successful labor and vaginal delivery with your first pregnancy." B. "The labor process is typically shorter for subsequent pregnancies." C. "You can have input into the labor plan as you know what to expect." D. "The intensity of contractions are much greater throughout the labor."
A. "You had a successful labor and vaginal delivery with your first pregnancy."
During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor? A. Assess the amount of cervical dilation (dilatation). B. Monitor vital signs. C. Obtain urine specimen for urinalysis. D. Monitor hydration status.
A. Assess the amount of cervical dilation (dilatation).
A 24-year-old primigravida client at 39 weeks' gestation presents to the OB unit concerned she is in labor. Which assessment findings will lead the nurse to determine the client is in true labor? A. The client reports back pain, and the cervix is effacing and dilating. B. The contraction pains are 2 minutes apart and 1 minute in duration. C. The contraction pains have been present for 5 hours, and the patterns are regular. D. After walking for an hour, the contractions have not fully subsided.
A. The client reports back pain, and the cervix is effacing and dilating.
The client is progressing into the second stage of labor and coping well with the natural birth method. Which instructions should the nurse prioritize at this point in the process? A. Ask for privacy, and have just the partner present. B. Use a birthing ball and find a position of comfort. C. Stay low on her back to ease the back pain. D. Use the Valsalva maneuver for effective pushing.
B. Use a birthing ball and find a position of comfort.
A multigravid client has been in labor for several hours and is becoming anxious and distressed with the intensity of her frequent contractions. The nurse observes moderate bloody show and performs a vaginal examination to assess the progress of labor. The cervix is 9 cm dilated. The nurse knows that the client is in which phase of labor? A. active phase B. transition phase C. early phase D. latent phase
B. transition phase
A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? A. 2 to 7 days B. 6 to 10 days C. 4 to 8 days D. 1 to 5 days
A. 2 to 7 days
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: A. 5. B. 9. C. 6. D. 7.
A. 5. A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.
A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first? A. Assess for labor progression. B. Instruct the client to do slow-paced breathing. C. Assist the client in ambulating to the bathroom. D. Prepare the client for an epidural.
A. Assess for labor progression.
The nurse is monitoring a client who is in the second stage of labor, at +2 station, and anticipating birth within the hour. The client is now reporting the epidural has stopped working and is begging for something for pain. Which action should the nurse prioritize? A. Encourage her through the contractions, explaining why she cannot receive any pain medication. B. Call the anesthetist from the nurse's station to retry the epidural. C. Call the primary care provider, and obtain a reduced dose of meperidine. D. Give the meperidine because she needs pain relief now.
A. Encourage her through the contractions, explaining why she cannot receive any pain medication.
The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus? A. caput succedaneum B. cervical lacerations C. infection of episiotomy D. perineal hematoma
A. caput succedaneum
When explaining to a class of pregnant women why labor begins, the nurse will include the fact that there are several theories that have been proposed to explain why labor begins, although none have been proven scientifically. Which idea is one of those theories? A. change in estrogen-to-progesterone ratio B. decrease in number of oxytocin receptors C. decrease in the level of estrogen D. decrease in prostaglandins, leading to myometrium contractions
A. change in estrogen-to-progesterone ratio
A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? A. corticosteroids B. nifedipine C. magnesium sulfate D. indomethacin
A. corticosteroids
A woman received morphine during labor to help with pain control. Which finding would the nurse need to monitor the newborn for after birth? A. decreased alertness B. increased agitation C. low Apgar D. increased crying
A. decreased alertness
The student nurse is learning about normal labor. The teacher reviews the cardinal movements of labor and determines the instruction has been effective when the student correctly states the order of the cardinal movements as follows: A. descent, flexion, internal rotation, extension, external rotation, expulsion B. internal rotation, flexion, descent, extension, external rotation, expulsion C. internal rotation, descent, extension, flexion, external rotation, expulsion D. descent, flexion, external rotation, extension, internal rotation, expulsion
A. descent, flexion, internal rotation, extension, external rotation, expulsion
A client has arrived to the birthing center in labor, requesting a VBAC. After reading the client's previous history, the nurse anticipates that the client would be a good candidate based on which finding? A. had previous lower abdominal incision B. had prior transfundal uterine surgery C. has a contracted pelvis D. had prior classic uterine incision
A. had previous lower abdominal incision
A client received IV nalbuphine in labor. The labor progressed rapidly and the nurse is preparing for the birth of the neonate less than 1 hour later. What medication will the nurse ensure is available immediately after birth of the neonate? A. naloxone B. vitamin K C. vitamin D D. morphine sulfate
A. naloxone
The nurse is providing care to a client in labor. On examination, the nurse determines the fetus is at -1 station. The nurse interprets this as indicating that the fetus is: A. 1 cm below the pubic bone. B. 1 cm above the ischial spines. C. 1 cm below the ischial spines. D. 1 cm above the pubic bone.
B. 1 cm above the ischial spines.
The nursing student demonstrates an understanding of dystocia with which statement? A. "Dystocia is diagnosed at the start of labor." B. "Dystocia is diagnosed after labor has progressed for a time." C. "Dystocia cannot be diagnosed until just before birth." D. "Dystocia is not diagnosed until after the birth."
B. "Dystocia is diagnosed after labor has progressed for a time."
The nurse determines a client is 7 cm dilated. What is the best response when asked by the client's partner how long will she be in labor? A. "She is still in early latent labor and has much too long to go to tell when she will give birth." B. "She is in active labor; she is progressing at this point and we will keep you posted." C. "She is in the transition phase of labor, and it will be within 2 to 3 hours, though it might be sooner." D. "She is doing well and is in the second stage; it could be anytime now."
B. "She is in active labor; she is progressing at this point and we will keep you posted."
A pregnant client in labor experiences a problem with the passenger related to shoulder dystocia. The health care provider is planning to relieve it with McRoberts maneuver. The client asks the nurse, "What is going to happen when they try this?" Which response by the nurse would be appropriate? A. "You will get a medicine to increase the strength and frequency of your contractions to move things along." B. "Your thighs will be flexed and moved away from the center of your body to open things up." C. "The provider will place firm pressure on the area just above your pubic bone to unstick the shoulder." D. "A gel will be placed in your vagina to soften the cervix and allow the baby to move."
B. "Your thighs will be flexed and moved away from the center of your body to open things up."
Which documentation in the health record is most correct for the third stage of labor? A. Begins with the time of placental delivery and ends when the health care provider is satisfied that there are no placental fragments. B. Begins with the time of delivery of the fetus and ends with the time of the delivery of the placenta. C. Begins with the time of placental delivery and ends 48 hours later. D. Begins with the time of full cervical dilation (dilatation) and ends with the delivery of the fetus.
B. Begins with the time of delivery of the fetus and ends with the time of the delivery of the placenta.
A client arrives in the labor and delivery unit in the beginning early phase with the contractions 5 to 8 minutes apart and dilated 1 cm. Thirty minutes later the nurse finds the client in hard, active labor and 8 cm dilated. The nurse calls for assistance, prepares for a precipitate birth, and monitors the client for which priority assessment caused by a rapid birth? A. Assess bladder for fullness. B. Check perineal area frequently for bleeding. C. Assess the client's breathing and intervene if necessary. D. Assess and administer pain medication as needed.
B. Check perineal area frequently for bleeding.
A pregnant client is admitted to a maternity clinic for birth. The client wishes to adopt the kneeling position during labor. The nurse knows that which of the following is an advantage of adopting a kneeling position during labor? A. It facilitates vaginal examinations. B. It helps to rotate the fetus in a posterior position. C. It facilitates external belt adjustment. D. It helps the woman in labor to save energy.
B. It helps to rotate the fetus in a posterior position.
The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true? A. Variable decelerations B. Late decelerations C. Mild decelerations D. Early decelerations
B. Late decelerations
Which statement describes why hypertonic contractions tend to become very painful? A. More than one contraction may begin at the same time, as receptor points in the myometrium act independently of each other. B. The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells. C. The number of uterine contractions is very low or infrequent. D. There is an increase in the length of labor because so many contractions are needed to achieve cervical dilation (dilatation).
B. The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells.
The laboring client who is at 3 cm dilation (dilatation) and 25% effaced is asking for a narcotic for pain relief. The nurse explains this usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice? A. This can lead to maternal hypertension. B. This may prolong labor and increase complications. C. This would cause fetal depression in utero. D. The effects would wear off before birth.
B. This may prolong labor and increase complications.
A 28-year-old primigravida client presents to the unit in early labor. The record reveals the client is 5 ft (1.5 m) tall, 95 lb (43 kg), and has gained 25 lb (11.3 kg) over a normal, uneventful pregnancy. The nurse predicts this client will have which type of pelvis upon assessment? A. android B. cannot be determined C. platypelloid D. gynecoid
B. cannot be determined
A pregnant client at 32 weeks' gestation has been admitted to a health care center reporting decreased fetal movement. Which fetal structure should the nurse determine first before auscultating the fetal heart sounds? A. fetal shoulders B. fetal back C. fetal buttocks D. fetal head
B. fetal back
A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will: A. press down firmly with her index finger and forefinger on key trigger points on the client's ankle or wrist. B. instruct the client or her partner to perform light fingertip repetitive abdominal massage. C. instruct the client to perform controlled chest breathing with a slow inhale and a quick exhale. D. lead the client through a series of visualizations to aid in relaxation.
B. instruct the client or her partner to perform light fingertip repetitive abdominal massage.
The student nurse is preparing to assess the fetal heart rate (FHR) and has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's: A. right lower quadrant. B.left lower quadrant. C. left upper quadrant. D. right upper quadrant.
B.left lower quadrant.
A woman refuses to have an epidural block because she does not want to have a postdural puncture (spinal) headache after birth. What would be the nurse's best response? A. "The anesthesiologist will do her best to avoid this." B. "The pain relief offered will compensate for the discomfort afterward." C. "Spinal headache is not a usual complication of epidural blocks." D. "Your health care provider knows what is best for you."
C. "Spinal headache is not a usual complication of epidural blocks."
The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? A. The fetus is descending too slowly B. To lessen the mother's pain C. Abnormal position of the fetal head D. Reduce risk of complications
C. Abnormal position of the fetal head
A laboring woman is receiving oxytocin IV to augment her labor and 2 hours later begins having contractions every 2 minutes lasting 60 to 90 seconds each with little, if any, rest time in between the contractions. At this time, which interventions would be the priority for the nurse caring for this client? Select all that apply. A. Administer betamethasone to mature the fetal lungs. B. Ask the woman to drink 32 ounces (1 L) of water. C. Discontinue the oxytocin infusion. D. Administer an IV bolus of fluids. E. Apply oxygen to the woman via mask at 8 to 10 L/min.
C. Discontinue the oxytocin infusion. D. Administer an IV bolus of fluids. E. Apply oxygen to the woman via mask at 8 to 10 L/min.
A pregnant client is being discharged from the labor and birth suite because of false labor. The client asks the nurse how to tell whether the contractions are true contractions or Braxton Hicks contractions. Which description(s) will the nurse mention as characteristic of true contractions? Select all that apply. A. begin and remain irregular B. felt first abdominally and remain confined to the abdomen and groin C. begin irregularly but become regular and predictable D. felt first in lower back and sweep around to the abdomen in a wave E. often disappear with ambulation or sleep F. increase in duration, frequency, and intensity
C. begin irregularly but become regular and predictable D. felt first in lower back and sweep around to the abdomen in a wave F. increase in duration, frequency, and intensity
A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response? A. hypoxia of the contracting uterine muscles B. distention of the vagina and perineum C. pain from the dilation (dilatation) or stretching of the cervix D. pressure on the lower back, buttocks, and thighs
C. pain from the dilation (dilatation) or stretching of the cervix
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. 5.5 B. 6.0 C. 5.0 D. 6.5
D. 6.5
A shoulder dystocia situation is called in room 4. The nurse enters the room to help and the health care provider says to the nurse, "McRoberts maneuver." What does the nurse do next? A. Push the fetal head back into the uterus and prepare the client for cesarean birth B. Apply downward pressure above the pubic bone of the client, in an attempt to rotate the anterior shoulder C. Move the client into a hands-and-knees position, to straighten the sacral curve and release the posterior shoulder D. Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis
D. Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis
Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? A. Assess vital signs every 30 minutes. B. Make sure the epidural medication is turned down. C. Make sure the client is lying on her left side. D. Check for a full bladder.
D. Check for a full bladder.
The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in the abdomen and shoulder. What should the nurse prepare to do? A. Bolus the client with another dose of medication through the epidural. B. Place the client in a knee-chest position. C. Turn the client on their left side. D. Prepare the client for a cesarean birth.
D. Prepare the client for a cesarean birth.
The client is progressing into the second stage of labor and coping well with the natural birth method. Which instructions should the nurse prioritize at this point in the process? A. Stay low on her back to ease the back pain. B. Use the Valsalva maneuver for effective pushing. C. Ask for privacy, and have just the partner present. D. Use a birthing ball and find a position of comfort.
D. Use a birthing ball and find a position of comfort.
A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds that can prolong labor. The nurse is referring to which compounds? A. oxytocin B. prostaglandins C. relaxin D. catecholamines
D. catecholamines Fear and anxiety cause the release of catecholamines, such as norepinephrine and epinephrine, which stimulate the adrenergic receptors of the myometrium.
A pregnant woman comes to the birthing center, stating she is in labor and does not know far along her pregnancy is because she has not had prenatal care. A primary care provider performs an ultrasound that indicates oligohydramnios. When the client's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this client? A. placental abruption (abruptio placentae) B. complications of placenta previa C. complications of preterm labor D. complications of a post-term pregnancy
D. complications of a post-term pregnancy
A pregnant client with a history of spinal injury is being prepared for a cesarean birth. Which method of anesthesia is to be administered to the client? A. local infiltration B. epidural block C. regional anesthesia D. general anesthesia
D. general anesthesia
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? A. nifedipine B. indomethacin C. betamethasone D. magnesium sulfate
D. magnesium sulfate
A pregnant woman at 37 weeks' gestation calls the clinic to say she thinks that she is in labor. The nurse instructs the woman to go to the health care facility based on the client's report of contractions that are: A. lasting about 30 seconds. B. relieved by walking. C. occurring in the abdomen and groin. D. occurring about every 5 minutes.
D. occurring about every 5 minutes.
