sherpath questions - wk 6

Which risk factor identified by the nurse places the patient at risk for preterm labor (PTL)? Family history of cervical cancer Homelessness Hypertension History of birth of a child at 37 weeks

Homelessness

A patient with prolonged labor has amniotic fluid with a greenish-yellow color and foul-smelling odor. Which initial nursing intervention is most appropriate? Monitor the patient's temperature. Initiate an amnioinfusion. Prepare the patient for cesarean delivery. Reassure the patient that this is a normal finding.

Monitor the patient's temperature.

A patient is a G2/P0 at 32 weeks pregnant and experiencing regular contractions. She has a multifetal gestation pregnancy, a history of preterm birth, and has had recurrent bacterial vaginosis throughout the pregnancy. Her BMI is 22, she is 30 years' old, and she is a former smoker who quit two years ago. Of the data provided, which are risk factors for preterm labor? Select all that apply. Age Multifetal gestaation Recurrent bacterial vaginosis Former smoker status BMI 22

Multifetal gestaation Recurrent bacterial vaginosis

The nurse is caring for a patient who has just been prescribed intravenous (IV) oxytocin for the induction of labor. The nurse's subsequent assessments should address the risk for which complication of oxytocin use? Tachysystole Shoulder dystocia Fluid volume deficit Maternal hypertensive crisis

Tachysystole

A protein-to-creatinine ratio of _____ or greater confirms the diagnosis of preeclampsia. (Record your answer to the nearest tenth.)

0.3

The nurse administered magnesium sulfate to a woman experiencing preterm labor, following a health care provider prescription. Which assessment would concern the nurse? Urine output of 50 mL Oxygen saturation of 95% 10 respirations per minute Bronchial sounds heard over the body of the sternum

10 respirations per minute

The nurse understands that the definition of preeclampsia includes diagnostic criteria of a blood pressure of ______ mm Hg on two or more occasions at least 4 hours apart.

140/90

Preterm labor is labor that begins after week ______ but before the end of the 37th week of pregnancy.

20

Match the medications to their contraindications. 33 weeks' pregnancy Urine output 10 mL/hr Blood pressure 96/42 mm Hg Type 1 diabetes

33 weeks' pregnancy - indomethacin Urine output 10 mL/hr - magnesium sulfate Blood pressure 96/42 mm Hg - nifedipine Type 1 diabetes - betamethasone

Which Bishop score has a positive predictive value of a vaginal delivery? 3 5 7 9

9

The nurse is caring for a patient whose delivery was assisted by forceps. Which assessment finding would the nurse report to the health care provider immediately? Pain with defecation Fundus that is firm on palpation A hard, turgid area on the labia minora Episiotomy incision flush with the surrounding skin

A hard, turgid area on the labia minora

Which patient would the nurse anticipate needing an assisted delivery? A patient with a history of perineal laceration A patient who rates her pain at 10 out of 10 A patient whose bladder is distended and who is unable to void A patient who has been pushing for 3 hours with minimal fetal progress

A patient who has been pushing for 3 hours with minimal fetal progress

The nurse is caring for a patient in the second stage of labor. Which patient condition is most likely to result in the need for an episiotomy? A patient with a history of perineal laceration A patient receiving oxytocin for induction of labor A patient whose fetus is experiencing shoulder dystocia A patient who had an episiotomy during a previous delivery

A patient whose fetus is experiencing shoulder dystocia

For which patient does the nurse know that cesarean delivery is relatively contraindicated? A patient with preeclampsia A patient with cephalopelvic disproportion A patient with a confirmed absence of fetal heartbeat A patient with premature rupture of membranes (PROM)

A patient with a confirmed absence of fetal heartbeat

Which medication would the nurse anticipate administering to promote fetal lung maturity? Magnesium sulfate Betamethasone Nifedipine Indomethacin

Betamethasone

Which pregnant women are at risk for preterm premature rupture of membranes (PPROM)? Select all that apply. A woman who is bearing twins A woman who sits eight hours a day at her job A woman who eats spicy foods at each meal A woman who is depressed over losing her job A woman with a Gardnerella vaginalis infection

A woman who is bearing twins A woman who is depressed over losing her job A woman with a Gardnerella vaginalis infection

Which order during labor augmentation would cause the nurse to question the health care provider? Administer oxytocin in lactated Ringer solution per protocol. Administer oxytocin in normal saline per protocol. Administer oxytocin in dextrose 10% per protocol. Administer oxytocin in water per protocol.

Administer oxytocin in dextrose 10% per protocol.

A patient on a magnesium sulfate infusion for seizure prophylaxis reports sudden shortness of breath and lethargy, and she is minimally responsive. Which intervention by the nurse is the most immediate? Increase the rate of the magnesium sulfate infusion. Administer the emergency dose of calcium gluconate. Prepare for an emergency cesarean section. Administer a 500-mL intravenous bolus of lactated Ringer's solution.

Administer the emergency dose of calcium gluconate.

During an emergency cesarean section, which interventions can help minimize maternal risk? Select all that apply. Eliminating surgical instrument counts to expedite the procedure Administering antibiotics before skin incision Performing the Foley catheter insertion using clean technique to expedite the procedure Performing an interdisciplinary time-out before skin incision Having a prewarmed isolette available for the birth

Administering antibiotics before skin incision Performing an interdisciplinary time-out before skin incision

Which measures should the nurse ensure are available and ready before a multiple gestation twin delivery? Select all that apply. An operating room set up for vaginal and cesarean delivery Neonatal health care providers capable of advanced resuscitation for each baby A single infant warmer with supplies for each infant Two separate infant warmers with separate supplies for each baby A fetal monitor with the capacity to monitor two babies at the same time

An operating room set up for vaginal and cesarean delivery Neonatal health care providers capable of advanced resuscitation for each baby Two separate infant warmers with separate supplies for each baby A fetal monitor with the capacity to monitor two babies at the same time

A patient who experienced umbilical cord prolapse asks the nurse why it happened. Which patient cue and obstetric intervention would the nurse say can contribute to umbilical cord prolapse? Select all that apply. Cervical dilation greater than 5 cm Upright maternal positioning in labor Artificial rupture of membranes Epidural anesthesia Hydramnios High fetal station

Artificial rupture of membranes Hydramnios High fetal station

Which initial nursing intervention would a nurse perform for a patient laboring without an epidural and experiencing prolonged labor and suspected maternal soft tissue dystocia? Asking the woman when her last bowel movement was Encouraging the woman to void frequently Administering a soap suds enema Straight catheterization

Encouraging the woman to void frequently

A laboring patient who ate breakfast 2 hours ago is undergoing an emergency cesarean section for umbilical cord prolapse. The nurse recognizes these cues and forms a hypothesis that the patient is at risk for which serious surgical complication? Anaphylaxis Venous thromboembolism Septic shock Aspiration pneumonia

Aspiration pneumonia

Which intervention by the health care team will decrease the risk of infection for a patient with preterm premature rupture of membranes during labor, delivery, and the postpartum period? Avoiding frequent vaginal examinations to check for cervical dilation Inserting an indwelling urinary catheter to measure urinary output Checking maternal temperature every 12 hours Using clean technique when performing speculum examinations

Avoiding frequent vaginal examinations to check for cervical dilation

When caring for an unstable pregnant patient with preeclampsia with severe features, which data are relevant to the health care team? Select all that apply. Absence of clonus bilaterally Blood pressure 178/114 Headache that is not relieved with acetaminophen 2+ patellar reflexes Platelet count 160 (X 109 /L) Proteinuria

Blood pressure 178/114 Headache that is not relieved with acetaminophen Proteinuria

The health care provider announces that the patient is experiencing shoulder dystocia. Which nursing actions are appropriate? Select all that apply. Call additional qualified health care providers to the bedside for assistance. Note the times the baby's head and body are delivered. Notify the neonatal intensive care unit (NICU) team to evaluate the baby at birth. Place the baby skin-to-skin immediately and initiate breastfeeding. Assist with the McRoberts maneuver and suprapubic pressure as needed. Place the patient in a side-lying position to push.

Call additional qualified health care providers to the bedside for assistance. Note the times the baby's head and body are delivered. Notify the neonatal intensive care unit (NICU) team to evaluate the baby at birth. Assist with the McRoberts maneuver and suprapubic pressure as needed.

When caring for an infant after vacuum-assisted delivery, which would the nurse monitor for? Select all that apply. Chignon Ecchymosis Intracranial hemorrhage Cephalohematoma Exaggerated grasp and Moro reflexes bilaterally Facial nerve damage

Chignon Ecchymosis Intracranial hemorrhage Cephalohematoma Facial nerve damage

Which patient cue would lead the nurse to suspect preterm labor in a patient rather than Braxton Hicks contractions? Contractions that occur during the evening Contractions that go away with ambulation Contractions that are irregular and vary in intensity Contractions that are perceived in the back and are intermittent

Contractions that are perceived in the back and are intermittent

The nurse understands there are both maternal and fetal consequences of hypertensive disorders that affect pregnancy. Which consequences of hypertensive disorders can affect the fetus? Select all that apply. Death Intrauterine growth restriction Pulmonary edema Preterm birth Myocardial infarction Seizure

Death Intrauterine growth restriction Preterm birth

Which change is associated with preeclampsia? Decreased renal perfusion Large-for-gestational-age fetus Increased colloid oncotic pressure Increased liver circulation

Decreased renal perfusion

A G1/P0 patient arrives for elective induction of labor at 39 weeks and is 1 to 2 cm dilated and 50% effaced. The fetal station is −3 with a posterior and firm cervix. Which order is most appropriate based on this patient's Bishop score? Discharge to home with follow-up in 1 week at the office. Administer oxytocin and titrate per protocol. Assist with amniotomy and initiate oxytocin as prescribed. Initiate electronic fetal monitoring and insert peripheral intravenous device.

Discharge to home with follow-up in 1 week at the office.

While monitoring a patient receiving oxytocin for augmentation of labor, the nurse notes tachysystole with recurrent late decelerations and minimal variability on the electronic fetal monitor. Which actions are appropriate? Select all that apply. Discontinue the oxytocin infusion. Reposition the patient on her side. Administer an intravenous bolus of fluid per protocol. Administer 100% oxygen via tight face mask. Notify the health care provider. Place the patient in semi-Fowler position and continue to monitor.

Discontinue the oxytocin infusion. Reposition the patient on her side. Administer an intravenous bolus of fluid per protocol. Administer 100% oxygen via tight face mask. Notify the health care provider.

Which assessment can the nurse initiate to determine fetal well-being in utero? Amniotic sac assessment Cervical length Fern test Electronic fetal monitoring

Electronic fetal monitoring

A G4/P3 patient experiencing precipitate labor presents to the labor wing fully dilated and at +1 station stating that she feels a strong, involuntary urge to push. Which immediate intervention would the nurse take? Encourage the patient to push in a side-lying position. Initiate an oxytocin infusion to prevent postpartum hemorrhage. Assess for umbilical cord prolapse. Allow the fetus to rest and descend until birth is imminent.

Encourage the patient to push in a side-lying position.

A nurse caring for a patient experiencing maternal exhaustion who desires a natural labor would implement which intervention to promote normal labor progress and decrease fatigue? Limit intravenous fluids (IV) to prevent overhydration. Encourage the patient to take a warm shower or bath. Insert an indwelling urinary catheter so the patient does not have to ambulate as frequently. Restrict visitation to given time intervals to allow for sleep.

Encourage the patient to take a warm shower or bath.

Worsening preeclampsia may lead to HELLP syndrome. Which symptom of HELLP syndrome would the nurse recognize as the most common? Epigastric pain Pedal edema Visual disturbances Hypertension

Epigastric pain

When a preterm patient presents with a complaint of "feeling wet," which intervention would the nurse anticipate the obstetric provider performing? Select all that apply. Intermittent fetal monitoring A prescription to discharge to home with complete bedrest Fern and pH tests Vaginal exams every hour to check for advancing cervical dilation An ultrasound A sterile speculum examination

Fern and pH tests An ultrasound A sterile speculum examination

Which factors are included in patient evaluation when considering induction of labor using the Bishop score? Select all that apply. Fetal station Cervical effacement Cervical dilation Cervical consistency Cervical position Fetal size

Fetal station Cervical effacement Cervical dilation Cervical consistency Cervical position

Which maternal and fetal risks would the nurse discuss with a patient who is experiencing prolonged labor? Select all that apply. Preeclampsia Infection Maternal exhaustion Exposure to thick meconium Increased risk for delivering outside of a birth center Neonatal heart murmur

Infection Maternal exhaustion Exposure to thick meconium

A woman in labor has been having regular contractions but has remained 5 cm dilated for 5 hours, with a reassuring fetal heart rate. Which intervention may be necessary for this patient? Labor augmentation Cesarean delivery Vacuum-assisted delivery Intrauterine resuscitation

Labor augmentation

The nurse suspects cord prolapse after rupture of membranes and palpates a pulse with internal examination. Which nursing action is most appropriate? Manually elevate the presenting part vaginally to relieve pressure on the cord. Turn the patient to her left side. Attempt to manually place the umbilical cord back into the uterus to relieve pressure on the cord. Continue electronic fetal monitoring and alert the health care provider if decelerations are noted.

Manually elevate the presenting part vaginally to relieve pressure on the cord.

A woman who is at 36 weeks' gestation thinks she is experiencing labor. Which signs or symptoms would support the woman's suspicion? Select all that apply. Headache Menstrual-like cramps Reports of constipation Reports of pelvic pressure Reports that "something is wrong"

Menstrual-like cramps Reports of pelvic pressure Reports that "something is wrong"

Which drugs would the nurse anticipate administering for tocolysis during preterm labor? Select all that apply. Nifedipine Indomethacin Magnesium sulfate Labetalol Betamethasone

Nifedipine Indomethacin

The nurse is providing care for a patient in labor, and the health care provider has just stated the patient's need for a forceps-assisted delivery. Which actions would the nurse's preparation include? Select all that apply. Obtaining a urinary catheter Establishing intravenous (IV) access Performing a head-to-toe assessment Educating the patient about the risk for lacerations Preparing the forceps using aseptic technique Monitoring the fetal heart rate for signs of distress

Obtaining a urinary catheter Establishing intravenous (IV) access Preparing the forceps using aseptic technique Monitoring the fetal heart rate for signs of distress

When evaluating a patient with suspected preterm premature rupture of membranes and preterm labor, the nurse recognizes which cues as signs of preterm labor? Select all that apply. Dysuria and urinary frequency Pain and discomfort in the upper inner thighs Intermittent or constant lower back pain A sensation that the fetus is frequently "balling up" The perception of decreased fetal movements Diarrhea

Pain and discomfort in the upper inner thighs Intermittent or constant lower back pain A sensation that the fetus is frequently "balling up" Diarrhea

Which conditions are contraindications to induction of labor? Select all that apply. Posterior placenta Placenta previa Previous classical cesarean delivery Transverse fetal lie History of dilation and curettage (D&C) Longitudinal fetal lie

Placenta previa Previous classical cesarean delivery Transverse fetal lie

Which common cause of inaccurate blood pressure readings would the nurse recognize when taking a patient's blood pressure? Placing the cuff below the level of the right atrium Waiting 5 quiet minutes before obtaining a reading Applying the cuff directly to the patient's bare arm Requiring the patient to uncross his or her legs before assessment

Placing the cuff below the level of the right atrium

A G1/P0 gestational diabetic mother is undergoing induction of labor. She is in her 39th week of gestation, and she has been diagnosed with polyhydramnios. The nurse recognizes which patient cue as a risk factor for umbilical cord prolapse? Polyhydramnios Being a primigravida Gestational diabetes Term gestation

Polyhydramnios

When preterm premature rupture of membranes is confirmed, which actions would the nurse implement? Select all that apply. Educate the patient on the need for a cesarean section delivery. Prepare the patient for admission to labor and delivery. Collect a group B streptococcus swab, if not done previously. Initiate continuous fetal monitoring. Anticipate the administration of corticosteroids. Alert the neonatal care provider of the patient status.

Prepare the patient for admission to labor and delivery. Collect a group B streptococcus swab, if not done previously. Initiate continuous fetal monitoring. Anticipate the administration of corticosteroids. Alert the neonatal care provider of the patient status.

A 36-week gestation patient presents with membranes grossly ruptured and is not contracting. Which diagnosis does the nurse anticipate? Preterm premature rupture of membranes (PPROM) Preterm labor (PTL) Premature rupture of membranes (PROM) AROM

Preterm premature rupture of membranes (PPROM)

The nurse is caring for a patient who had a forceps delivery that caused a perineal hematoma. Which nursing intervention is most appropriate? Administer topical analgesic ointment as prescribed. Provide the patient with an ice pack and educate her about its use. Encourage the patient to lie on her side as much as possible until the injury heals. Educate the patient about the fact that the hematoma was caused by the introduction of forceps.

Provide the patient with an ice pack and educate her about its use.

Which conditions are possible causes of dysfunctional labor? Select all that apply. Psychological dysfunction and fear Absence of a void in 6 hours Rapid descent of the fetal head and small parts An abnormally shaped maternal pelvis Meconium-stained amniotic fluid Use of oxytocin to augment labor

Psychological dysfunction and fear Absence of a void in 6 hours An abnormally shaped maternal pelvis

When administering nifedipine for tocolysis, it is important for the nurse to monitor for which serious side effect? Reflex tachycardia Hyperglycemia Change in fundal height Bradypnea

Reflex tachycardia

The nurse is manually elevating the presenting fetal part, after an umbilical cord prolapse, as the patient is transferred to the operating room. Which action would the nurse avoid to minimize patient risk? Assisting the mother into the hands-knees position Discontinuing the oxytocin infusion Removing the hand to allow the fetal head to descend in the maternal pelvis Administering oxygen to the mother via a tight face mask

Removing the hand to allow the fetal head to descend in the maternal pelvis

A nurse caring for a patient immediately postpartum after a precipitate labor would monitor the patient for which possible postpartum complication related to her precipitate labor? Retained placenta Infection Low Apgar scores Postpartum depression

Retained placenta

Match the maternal body part to the preeclampsia sign or symptoms experienced. Scotoma Subtle or pitting edema Hyperreflexia Nausea/vomiting

Scotoma - Head Subtle or pitting edema - Hands Hyperreflexia - Knees Nausea/vomiting - Abdomen

Which fetal factor can contribute to dysfunctional labor? Cardiac arrhythmia Sex Chromosomal abnormalities Size

Size

When administering corticosteroids to a patient in preterm labor, which information is relevant to the nurse regarding the patient's history? The patient is 33 weeks' gestation. The patient suffers from chronic hypertension. The patient's membranes are ruptured. The patient has type 1 diabetes.

The patient has type 1 diabetes.

Which sign indicates that a preeclamptic patient in the third trimester of pregnancy is experiencing a decline in her condition? The patient reports epigastric pain. The patient's platelet count is 200 (x 109/L). The patient's reflexes are 2+. The patient has bilateral nonpitting edema in the lower extremities.

The patient reports epigastric pain.

Which statement describes an umbilical cord prolapse? The umbilical cord ruptures, causing fetal hemorrhage. The umbilical cord passes between the fetal presenting part and the pelvis before birth. The umbilical cord has only two vessels instead of three. The umbilical cord is shorter than normal, causing decelerations.

The umbilical cord passes between the fetal presenting part and the pelvis before birth.

In which situation is there an increased likelihood for prolonged labor? The woman is a teen mother. The woman is nulliparous. The woman has been diagnosed with an incompetent cervix. The woman has a history of postpartum hemorrhage.

The woman is nulliparous.

Match the hypertensive disorder of pregnancy to the correct statement. Traditionally characterized by hypertension and proteinuria Involves seizure onset May be diagnosed during pregnancy or before Occurs after 20 weeks gestation/returns to normal by 6 weeks postpartum

Traditionally characterized by hypertension and proteinuria - Preeclampsia Involves seizure onset - Eclampsia May be diagnosed during pregnancy or before - Chronic HTN Occurs after 20 weeks gestation/returns to normal by 6 weeks postpartum - Gestational HTN

A G5/P4 laboring patient with suspected fetal intrauterine growth restriction has just experienced spontaneous rupture of membranes. On examination, the nurse notes that the cervix is dilated 3 cm and is 70% effaced and that the fetal station is 0. Fetal heart tracing shows recurrent and severe variable decelerations. Which explanation is the most likely cause for this change in fetal heart rate? High fetal station Umbilical cord prolapse Fetal intrauterine growth restriction Grand multiparity

Umbilical cord prolapse