Women's Health Exam I

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A laboring woman is reclining in the supine position. What is the most appropriate nursing action at this time? A.) Ask her to turn to one side B.) Elevate her feet and legs C.) Take her blood pressure D.) Determine whether fetal tachycardia is present

A nurse in the labor and delivery unit is caring for a client in labor and applies an external fetal monitor and tocotransducer. The FHR is around 140/min. Contractions are occurring every 8 min and 30-40 sec in duration. The nurse performs a vaginal exam and finds the cervix is 2 cm dilated, 50% effaced and the fetus is at -2 station. Which of the following stages and phases of labor is the client experiencing? A.) First stage, latent phase B.) First stage, active phase C.) First stage, transition phase D.) Second stage of labor

A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A.) Assist the client into the left-lateral position B.) Apply a fetal scalp electrode C.) Insert an IV catheter D.) Perform a vaginal exam

A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and she is expected to deliver vaginally in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthesia blocks should be administered? A.) Pudendal B.) Epidural C.) Spinal D.) Paracervical

As the United States and Canada continue to become more culturally diverse, recognizing a wide range of varying cultural beliefs and practices is increasingly important for the nursing staff. A client is from which country if she requests to have the baby's father in attendance? A.) Mexico B.) China C.) Iran D.) India

Breathing patterns are taught to laboring women. Which breathing pattern should the nurse support for the woman and her coach during the latent phase of the first stage of labor if the couple has attended childbirth preparation classes? A.) Slow-paced breathing B.) Deep abdominal breathing C.) Modified-paced breathing D.)Patterned-paced breathing

In recovery, if a woman is asked to either raise her legs (knees extended) off the bed or flex her knees, and then place her feet flat on the bed and raise her buttocks well off the bed, the purpose of this exercise is to assess what? A.) Recovery from epidural or spinal anesthesia B.) Hidden bleeding underneath her C.) Flexibility D.) Whether the woman is a candidate to go home after 6 hours

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects the application of the gate-control theory? A.) Massage the woman's back B.) Change the woman's position C.) Give the prescribed medication D.) Encourage the woman to rest between contractions

The nurse expects which maternal cardiovascular finding during labor? A.) Increased cardiac output B.) Decreased pulse rate C.) Decreased white blood cell (WBC) count D.) Decreased blood pressure

The nurse is caring for a client in early labor. Membranes ruptured approximately 2 hours earlier. This client is at increased risk for which complication? A.) Intrauterine infection B.) Hemorrhage C.) Precipitous labor D.) Supine hypotension

The nurse should be aware of which information related to a woman's intake and output during labor? A.) Traditionally, restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia B.) Intravenous (IV) fluids are usually necessary to ensure that the laboring woman stays hydrated C.) Routine use of an enema empties the rectum and is very helpful for producing a clean, clear delivery D.) When a nulliparous woman experiences the urge to defecate, it often means birth will quickly follow

Under which circumstance should the nurse assist the laboring woman into a hands-and-knees position? A.) Occiput of the fetus is in a posterior position B.) Fetus is at or above the ischial spines C.) Fetus is in a vertex presentation D.) Membranes have ruptured

What is the most critical nursing action in caring for the newborn immediately after the birth? A.) Keeping the airway clear B.) Fostering parent-newborn attachment C.) Drying the newborn and wrapping the infant in a blanket D.) Administering eye drops and vitamin K

What is the nurses understanding of the appropriate role of primary and secondary powers? A.) Primary powers are responsible for the effacement and dilation of the cervix B.) Effacement is generally well ahead of dilation in women giving birth for the first time; they are closer together in subsequent pregnancies C.) Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation D.) Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. What is the nurse's assessment of the situation? A.) The placenta has separated B.) A cervical tear occurred during the birth C.) The woman is beginning to hemorrhage D.) Clots have formed in the upper uterine segment

When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective? A.) Dilation of the cervix B.) Descent of the fetus to 2 station C.) Rupture of the amniotic membranes D.) Increase in bloody show

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. Which instruction best describes these measures? A.) Encouraging the woman to try various upright positions, including squatting and standing B.) Telling the woman to start pushing as soon as her cervix is fully dilated C.) Continuing an epidural anesthetic so pain is reduced and the woman can relax D.) Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction

Which component of the physical examination are Leopold maneuvers unable to determine? A.) Gender of the fetus B.) Number of fetuses C.) Fetal lie and attitude D.) Degree of the presenting parts descent into the pelvis

Which description of the four stages of labor is correct for both the definition and the duration? A.) First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours B.) Second stage: full effacement to 4 to 5 cm; visible presenting part; 1 to 2 hours C.) Third stage: active pushing to birth; 20 minutes (multiparous woman), 50 minutes (nulliparous woman) D.) Fourth stage: delivery of the placenta to recovery; 30 minutes to 1 hour

Which information regarding the procedures and criteria for admitting a woman to the hospital labor unit is important for the nurse to understand? A.) Client is considered to be in active labor when she arrives at the facility with contractions B.) Client can have only her male partner or predesignated doula with her at assessment C.) Children are not allowed on the labor unit. D.) NonEnglish speaking client must bring someone to translate

Which presentation is accurately described in terms of both the presenting part and the frequency of occurrence? A.) Cephalic: occiput, at least 96% B.) Breech: sacrum, 10% to 15% C.) Shoulder: scapula, 10% to 15% D.) Cephalic: cranial, 80% to 85%

Which technique is an adequate means of controlling the birth of the fetal head during delivery in a vertex presentation? A.) Ritgen maneuver B.) Fundal pressure C.) Lithotomy position D.) De Lee apparatus

Women who have participated in childbirth education classes often bring a birth plan with them to the hospital. Which items might this plan include (select all that apply): A.) Presence of companions B.) Clothing to be worn C.) Care and handling of the newborn D.) Medical interventions E.) Date of delivery

A, B, C, D

At least five factors affect the process of labor and birth. These are easily remembered as the five Ps. Which factors are included in this process (select all that apply): A.) Passenger B.) Passageway C.) Powers D.) Pressure E.) Psychologic response

A, B, C, E

Emergency conditions during labor that would require immediate nursing intervention can arise with startling speed. Which situations are examples of such an emergency (select all that apply): A.) Nonreassuring or abnormal FHR pattern B.) Inadequate uterine relaxation C.) Vaginal bleeding D.) Prolonged second stage E.) Prolapse of the cord

A, B, C, E

A nurse is providing care for a client who is in active labor. Her cervix is dilated to 5 cm, and her membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a FHR of 115 to 125/min with occasional increases up to 150 to 155/min that last for 25 seconds, and have beat-to-beat variability of 20/min. There is no slowing of FHR from the baseline. The nurse should recognize that this client is exhibiting signs of which of the following (select all that apply): A.) Moderate variability B.) FHR accelerations C.) FHR decelerations D.) Normal baseline FHR E.) Fetal tachycardia

A, B, D

Which factors influence cervical dilation (select all that apply): A.) Strong uterine contractions B.) Force of the presenting fetal part against the cervix C.) Size of the woman D.) Pressure applied by the amniotic sac E.) Scarring of the cervix

A, B, D, E

A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 90% effaced and -1 station. The client asks for pain medication. Which of the following actions should the nurse take (select all that apply): A.) Encourage use of patterned breathing techniques B.) Insert in indwelling urinary catheter C.) Administer opioid analgesic medication D.) Suggest application of cold E.) Provide ice chips

A, C, D

Which changes take place in the woman's reproductive system, days or even weeks before the commencement of labor (select all that apply): A.) Lightening B.) Exhaustion C.) Bloody show D.) Rupture of membranes E.) Decreased fetal movement

A, C, D

A nurse is caring for a client in the third stage of labor. Which of the following findings indicate that placental separation has occurred (Select all that apply): A.) Lengthening of the umbilical cord B.) Swift gush of clear amniotic fluid C.) Softening of the lower uterine segment D.) Appearance of dark blood from the vagina E.) Fundus firm upon palpation

A, D, E

A client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. Which of the following actions should the nurse take first? A.) Check the amniotic fluid for meconium B.) Monitor FHR for distress C.) Dry the client and make her comfortable D.) Monitor uterine contractions

A first-time mother is concerned about the type of medications she will receive during labor. The client is in a fair amount of pain and is nauseated. In addition, she appears to be very anxious. The nurse explains that opioid analgesics are often used along with sedatives. How should the nurse phrase the rationale for this medication combination? A.) The two medications, together, reduce complications B.) Sedatives enhance the effect of the pain medication C.) The two medications work better together, enabling you to sleep until you have the baby D.) This is what your physician has ordered for you

A nurse in labor and delivery unit is completing an admission assessment for a client who is at 39 weeks of gestation. The client reports that she has been leaking fluid from her vagina for 2 days. Which of the following conditions is the client at risk for developing? A.) Cord prolapse B.) Infection C.) Postpartum hemorrhage D.) Hydramnios

A nurse is caring for a client who is in active labor. The client reports lower-back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client? A.) Abdominal effleurage B.) Sacral counterpressure C.) Showering if not contraindicated D.) Back rub and massage

A nurse is caring for a client who is in the transition phase of labor and reports that she needs to have a bowel movement with the peak of contractions. Which of the following actions should the nurse make? A.) Assist the client to the bathroom B.) Prepare for an impending delivery C.) Prepare to remove a fecal impaction D.) Encourage the client to take deep, cleansing breaths

A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify fetal lie? A.) Apply palms of both hands to sides of uterus B.) Palpate the fundus of the uterus C.) Grasp lower uterine segment between thumb and fingers D.) Stand facing client's feet with fingertips outlining cephalic prominence

A woman who has a history of sexual abuse may have a number of traumatic memories triggered during labor. She may fight the labor process and react with pain or anger. The nurse can implement a number of care measures to help her client view the childbirth experience in a positive manner. Which intervention is key for the nurse to use while providing care? A.) Tell the client to relax and that it won't hurt much B.) Limit the number of procedures that invade her body C.) Reassure the client that, as the nurse, you know what is best D.) Allow unlimited care providers to be with the client

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. What is the nurses ideal response? A.) Dont worry about it. You'll do fine B.) It's normal to be anxious about labor. Let's discuss what makes you afraid C.) Labor is scary to think about, but the actual experience isn't D.) You can have an epidural. You wont feel anything

A woman who is gravida 3 para 2 arrives on the intrapartum unit. What is the most important nursing assessment at this time? A.) Contraction pattern, amount of discomfort, and pregnancy history B.) FHR, maternal vital signs, and the woman's nearness to birth C.) Identification of ruptured membranes, woman's gravida and para, and her support person D.) Last food intake, when labor began, and cultural practices the couple desires

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. What is the primary purpose of this activity? A.) To facilitate maternal-newborn interaction B.) To stimulate the uterus to contract C.) To prevent neonatal hypoglycemia D.) To initiate the lactation cycle

Nurses can help their clients by keeping them informed about the distinctive stages of labor. Which description of the phases of the first stage of labor is accurate? A.) Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours B.) Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours C.) Lull: No contractions; dilation stable; duration of 20 to 60 minutes D.) Transition: Very strong but irregular contractions; 8- to 10-cm dilation; duration of 1 to 2 hours

The nurse has received a report regarding a client in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and 2. What is the nurses interpretation of this assessment? A.) Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines B.) Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines C.) Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines D.) Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines

Through a vaginal examination, the nurse determines that a woman is 4 cm dilated. The external fetal monitor shows uterine contractions every to 4 minutes. The nurse reports this as what stage of labor? A.) First stage, latent phase B.) First stage, active phase C.) First stage, transition phase D.) Second stage, latent phase

Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination? A.) Admission to the hospital at the start of labor B.) When accelerations of the FHR are noted C.) On maternal perception of perineal pressure or the urge to bear down D.) When membranes rupture

What is the correct term describing the slight overlapping of cranial bones or shaping of the fetal head during labor? A.) Lightening B.) Molding C.) Ferguson reflex D.) Valsalva maneuver

What is the primary difference between the labor of a nullipara and that of a multipara? A.) Amount of cervical dilation B.) Total duration of labor C.) Level of pain experienced D.) Sequence of labor mechanisms

What is the rationale for the administration of an oxytocic (e.g., Pitocin, Methergine) after expulsion of the placenta? A.) To relieve pain B.) To stimulate uterine contraction C.) To prevent infection D.) To facilitate rest and relaxation

What is the role of the nurse as it applies to informed consent? A.) Inform the client about the procedure, and ask her to sign the consent form B.) Act as a client advocate, and help clarify the procedure and the options C.) Call the physician to see the client D.) Witness the signing of the consent form

What should the laboring client who receives an opioid antagonist be told to expect? A.) Her pain will decrease B.) Her pain will return C.) She will feel less anxious D.) She will no longer feel the urge to push

Which description of the phases of the first stage of labor is most accurate? A.) Latent: mild, regular contractions; no dilation; bloody show B.) Active: moderate, regular contractions; 4 to 7 cm dilation C.) Lull: no contractions; dilation stable D.) Transition: very strong but irregular contractions; 8 to 10 cm dilation

Which statement concerning the third stage of labor is correct? A.) The placenta eventually detaches itself from a flaccid uterus B.) An expectant or active approach to managing this stage of labor reduces the risk of complications C.) It is important that the dark, roughened maternal surface of the placenta appears before the shiny fetal surface D.) The major risk for women during the third stage is a rapid heart rate

Which statement is the best rationale for assessing the maternal vital signs between uterine contractions? A.) During a contraction, assessing the fetal heart rate is the priority B.) Maternal circulating blood volume temporarily increases during contractions C.) Maternal blood flow to the heart is reduced during contractions D.) Vital signs taken during contractions are not accurate

Which statement related to fetal positioning during labor is correct and important for the nurse to understand? A.) Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal B.) Birth is imminent when the presenting part is at +4 to +5 cm below the spine C.) The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter D.) Engagement is the term used to describe the beginning of labor

A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following should statements the nurse include in the teaching (select all that apply): A.) "It is considered a noninvasive procedure." B.) "It can detect abnormal fetal heart tones early." C.) "It can determine the amount of amniotic fluid you have." D.) "It allows for accurate readings with maternal movement." E.) "It can measure uterine contraction intensity."

B, D, E

A 25-year-old gravida 3, para 2 client gave birth to a 9-pound, 7-ounce boy, 4 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light, and asks for her nurse right away, stating Im bleeding a lot. What is the most likely cause of postpartum hemorrhaging in this client? A.) Retained placental fragments B.) Unrepaired vaginal lacerations C.) Uterine atony D.) Puerperal infection

A labor and delivery nurse should be cognizant of which information regarding how the fetus moves through the birth canal? A.) Fetal attitude describes the angle at which the fetus exits the uterus B.) Of the two primary fetal lies, the horizontal lie is that in which the long axis of the fetus is parallel to the long axis of the mother C.) Normal attitude of the fetus is called general flexion D.) Transverse lie is preferred for vaginal birth

A laboring woman has received meperidine (Demerol) intravenously (IV), 90 minutes before giving birth. Which medication should be available to reduce the postnatal effects of meperidine on the neonate? A.) Fentanyl (Sublimaze) B.) Promethazine (Phenergan) C.) Naloxone (Narcan) D.) Nalbuphine (Nubain)

A nulliparous woman has just begun the latent phase of the second stage of her labor. The nurse should anticipate which behavior? A.) A nulliparous woman will experience a strong urge to bear down B.) Perineal bulging will show C.) A nulliparous woman will remain quiet with her eyes closed between contractions D.) The amount of bright red bloody show will increase

A nurse is caring for a client and her partner during the second stage of labor. The client's partner asks the nurse to explain how he will know when crowning occurs. Which of the following responses should the nurse make? A.) "The placenta will protrude from the vagina." B.) "Your partner will report a decrease in the intensity of contractions." C.) "The vaginal area will bulge as the baby's head appears." D.) "Your partner will report less rectal pressure."

A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response for the nurse to make? A.) "It is needed to promise increased urinary output." B.) "It is needed to counteract respiratory depression." C.) "It is needed to counteract hypotension." D.) "It is needed to prevent oligohydramnios."

A nurse is caring for a client who is in active labor and becomes nauseous and vomits. The client is very irritable and feels the urge to have a bowel movement. She states, "I've had enough. I can't do this anymore. I want to go home right now." Which of the following stages of labor is the client experiencing? A.) Second stage B.) Fourth stage C.) Transition stage D.) Latent phase

A woman's position is an important component of the labor progress. Which guidance is important for the nurse to provide to the laboring client? A.) The supine position, which is commonly used in the United States, increases blood flow B.) The laboring client positioned on her hands and knees (all fours position) is hard on the womans back C.) Frequent changes in position help relieve fatigue and increase the comfort of the laboring client D.) In a sitting or squatting position, abdominal muscles of the laboring client will have to work harder

Nurses should be cognizant of what regarding the mechanism of labor? A.) Seven critical movements must progress in a more or less orderly sequence B.) Asynclitism is sometimes achieved by means of the Leopold maneuvers C.) Effects of the forces determining descent are modified by the shape of the woman's pelvis and the size of the fetal head D.) At birth, the baby is said to achieve restitution; that is, a return to the C-shape of the womb

The first 1 to 2 hours after birth is sometimes referred to as what? A.) Bonding period B.) Third stage of labor C.) Fourth stage of labor D.) Early postpartum period

The labs of a woman in labor are as follows: Blood Type 0+ Hgb 11.2 Hct 33 HIV Positive Platelets 63,000 Her VS are: BP 165/92; P 84; RR 18; T 98.6°F Which of these would contraindicate placement of an epidural? A.) Her positive HIV status B.) Her Vital signs C.) Her Platelet Count D.) Her Hgb & Hct

The nurse is performing an initial assessment of a client in labor. What is the appropriate terminology for the relationship of the fetal body parts to one another? A.) Lie B.) Presentation C.) Attitude D.) Position

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. They are becoming more regular and are moderate to strong. Based on this information, what would a prudent nurse do next? A.) Immediately notify the woman's primary health care provider B.) Prepare to administer an oxytocic to stimulate uterine activity C.) Document the findings because they reflect the expected contraction pattern for the active phase of labor D.) Prepare the woman for the onset of the second stage of labor

What is the primary rationale for the thorough drying of the infant immediately after birth? A.) Stimulates crying and lung expansion B.) Removes maternal blood from the skin surface C.) Reduces heat loss from evaporation D.) Increases blood supply to the hands and feet

When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, and movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the position of the fetus? A.) ROA B.) LSP C.) RSA D.) LOA

Where is the point of maximal intensity (PMI) of the FHR located? A.) Usually directly over the fetal abdomen B.) In a vertex position, heard above the mothers umbilicus C.) Heard lower and closer to the midline of the mother's abdomen as the fetus descends and internally rotates D.) In a breech position, heard below the mothers umbilicus

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions? A.) Placing the hand on the abdomen below the umbilicus and palpating uterine tone with the fingertips B.) Determining the frequency by timing from the end of one contraction to the end of the next contraction C.) Evaluating the intensity by pressing the fingertips into the uterine fundus D.) Assessing uterine contractions every 30 minutes throughout the first stage of labor

Which adaptation of the maternal-fetal exchange of oxygen occurs in response to uterine contraction? A.) The maternal-fetal exchange of oxygen and waste products continues except when placental functions are reduced B.) This maternal-fetal exchange increases as the blood pressure decreases C.) It diminishes as the spiral arteries are compressed D.) This exchange of oxygen and waste products is not significantly affected by contractions

Which clinical finding indicates that the client has reached the second stage of labor? A.) Amniotic membranes rupture B.) Cervix cannot be felt during a vaginal examination C.) Woman experiences a strong urge to bear down D.) Presenting part of the fetus is below the ischial spines

Which description of the phases of the second stage of labor is most accurate? A.) Latent phase: Feeling sleepy; fetal station 2+ to 4+; duration of 30 to 45 minutes B.) Active phase: Overwhelmingly strong contractions; Ferguson reflux activated; duration of 5 to 15 minutes C.) Descent phase: Significant increase in contractions; Ferguson reflux activated; average duration varies D.) Transitional phase: Woman laboring down; fetal station 0; duration of 15 minutes

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? A.) Fetal head is felt at 0 station during the vaginal examination B.) Bloody mucous discharge increases C.) Vulva bulges and encircles the fetal head D.) Membranes rupture during a contraction

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? A.) Fetal head is felt at 0 station during vaginal examination B.) Bloody mucous discharge increases C.) Vulva bulges and encircles the fetal head D.) Membranes rupture during a contraction.

Which statement by the client will assist the nurse in determining whether she is in true labor as opposed to false labor? A.) I passed some thick, pink mucus when I urinated this morning B.) My bag of waters just broke C.) The contractions in my uterus are getting stronger and closer together D.) My baby dropped, and I have to urinate more frequently now

Which statement by the client would lead the nurse to believe that labor has been established? A.) I passed some thick, pink mucus when I urinated this morning B.) My bag of waters just broke C.) The contractions in my uterus are getting stronger and closer together D.) My baby dropped, and I have to urinate more frequently now

A client is in early labor, and her nurse is discussing the pain relief options she is considering. The client states that she wants an epidural no matter what! What is the nurse's best response? A.) I'll make sure you get your epidural B.) You may only have an epidural if your physician allows it C.) You may only have an epidural if you are going to deliver vaginally D.) The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. What is the nurses highest priority in this situation? A.) Prepare the woman for imminent birth B.) Notify the woman's primary health care provider C.) Document the characteristics of the fluid D.) Assess the fetal heart rate (FHR) and pattern

A new mother asks the nurse when the soft spot on her sons head will go away. What is the nurse's best response, based upon her understanding of when the anterior frontal closes? A.) 2 months B.) 8 months C.) 12 months D.) 18 months

A nurse in labor and delivery is planning care for a newly admitted client who reports she is in labor and has been having vaginal bleeding for 2 weeks. Which of the following should the nurse include in the plan of care? A.) Inspect the introitus for a prolapsed cord B.) Perform a test to identify the ferning pattern C.) Monitor station of the presenting part D.) Defer vaginal examinations

A nurse in the labor and delivery unit receives a phone call from a client who reports that her contractions started about 2 hours ago, did not go away when she had two glasses of water and rested, and became stronger since she started walking. Her contractions occur every 10 min and last about 30 seconds. She hasn't had any fluid leak from her vagina. However, she saw some blood when she wiped after voiding. Based on this report, which of the following should the nurse recognize that the client is experiencing? A.) Braxton Hicks contractions B.) Rupture of membranes C.) Fetal descent D.) True contractions

A nurse is caring for a client who is in the first stage of labor and is encouraging the client to void every 2 hr. Which of the following statements should the nurse make? A.) "A full bladder increases the risk for fetal trauma." B.) "A full bladder increases the risk for bladder infections." C.) "A distended bladder will be traumatized by frequent pelvic exams." D.) "A distended bladder reduces pelvic space needed for birth."

A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A.) Administer oxygen via nasal cannula at 2 L/min B.) Apply a warm blanket C. Assist the client to a side-lying position D.) Place an oxygen mask over the client's nose and mouth

A nurse is reviewing the electronic monitor tracing of a client who is in active labor. The nurse should know that a fetus receives more oxygen when which of the following appears on the tracing? A.) Peak of the uterine contraction B.) Moderate variability C.) FHR acceleration D.) Relaxation between uterine contractions

A pregnant woman is at 38 weeks of gestation. She wants to know whether there are any signs that labor is getting close to starting. Which finding is an indication that labor may begin soon? A.) Weight gain of 1.5 to 2 kg (3 to 4 lb) B.) Increase in fundal height C.) Urinary retention D.) Surge of energy

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The FHR has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. What disposition would the nurse anticipate? A.) Admitted and prepared for a cesarean birth B.) Admitted for extended observation C.) Discharged home with a sedative D.) Discharged home to await the onset of true labor

A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth classes. What is the optimal intervention for the nurse to provide at this time? A.) Notify the woman's health care provider B.) Administer the prescribed narcotic analgesic C.) Assure her that her labor will be over soon D.) Assist her with simple breathing and relaxation instructions

An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The client states, My contractions are so strong, I don't know what to do. Before making a plan of care, what should the nurses first action be? A.) Assess for fetal well-being B.) Encourage the woman to lie on her side C.) Disturb the woman as little as possible D.) Recognize that pain is personalized for each individual

Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth. Which change in fetal physiologic activity is not part of this process? A.) Fetal lung fluid is cleared from the air passages during labor and vaginal birth B.) Fetal partial pressure of oxygen (PO2) decreases C.) Fetal partial pressure of carbon dioxide in arterial blood (PaCO2) increases D.) Fetal respiratory movements increase during labor

The Valsalva maneuver can be described as the process of making a forceful bearing-down attempt while holding one's breath with a closed glottis and a tightening of the abdominal muscles. When is it appropriate to instruct the client to use this maneuver? A.) During the second stage to enhance the movement of the fetus B.) During the third stage to help expel the placenta C.) During the fourth stage to expel blood clots D.) Not at all

The nurse performs a vaginal examination to assess a client's labor progress. Which action should the nurse take next? A.) Perform an examination at least once every hour during the active phase of labor B.) Perform the examination with the woman in the supine position C.) Wear two clean gloves for each examination D.) Discuss the findings with the woman and her partner

When a nulliparous woman telephones the hospital to report that she is in labor, what guidance should the nurse provide or information should the nurse obtain? A.) Tell the woman to stay home until her membranes rupture B.) Emphasize that food and fluid intake should stop C.) Arrange for the woman to come to the hospital for labor evaluation. D.) Ask the woman to describe why she believes she is in labor

Which basic type of pelvis includes the correct description and percentage of occurrence in women? A.) Gynecoid: classic female pelvis; heart shaped; 75% B.) Android: resembling the male pelvis; wide oval; 15% C.) Anthropoid: resembling the pelvis of the ape; narrow; 10% D.) Platypelloid: flattened, wide, and shallow pelvis; 3%

Which characteristic of a uterine contraction is not routinely documented? A.) Frequency: how often contractions occur B.) Intensity: strength of the contraction at its peak C.) Resting tone: tension in the uterine muscle D.) Appearance: shape and height

Which collection of risk factors will most likely result in damaging lacerations, including episiotomies? A.) Dark-skinned woman who has had more than one pregnancy, who is going through prolonged second-stage labor, and who is attended by a midwife B.) Reddish-haired mother of two who is going through a breech birth C.) Dark-skinned first-time mother who is going through a long labor D.) First-time mother with reddish hair whose rapid labor was overseen by an obstetrician

A client is experiencing back labor and complains of intense pain in her lower back. Which measure would best support this woman in labor? A.) Counterpressure against the sacrum B.) Pant-blow (breaths and puffs) breathing techniques C.) Effleurage D.) Conscious relaxation or guided imagery

A client who gave birth 4 days ago reports that her vaginal discharge has an offensive odor. Which client condition would the nurse infer from this report? A.) Infection B.) High oxytocin levels C.) Postpartum hemorrhage D.) Normal lochial discharge

A client who is at 32 weeks of gestation asks the nurse when she will start menstruating after delivery. Which question would the nurse ask before responding to the client's question? A.) "Will you be breastfeeding your child after delivery" B.) "Do you plan to opt for elective cesarean delivery" C.) "Do you plan to conceive again immediately after delivery" D.) "What form of contraception do you plan to use after delivery"

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. What goal is the nurse attempting to achieve by performing this practice? A.) To improve the accuracy of blood loss estimation, which usually is a subjective assessment B.) To determine which pad is best C.) To demonstrate that other nurses usually underestimate blood loss D.) To reveal to the nurse supervisor that one of them needs some time off

A nurse caring for a woman in labor should understand that absent or minimal variability is classified as either abnormal or indeterminate. Which condition related to decreased variability is considered benign? A.) Periodic fetal sleep state B.) Extreme prematurity C.) Fetal hypoxemia D.) Preexisting neurologic injury

A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the client is experiencing profuse bleeding. What is the most likely cause for this bleeding? A.) Uterine atony B.) Uterine inversion C.) Vaginal hematoma D.) Vaginal laceration

A primiparous woman is to be discharged from the hospital the following day with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged? A.) The woman is disinterested in learning about infant care B.) The woman continues to hold and cuddle her infant after she has fed her C.) The woman reads a magazine while her infant sleeps D.) The woman changes her infants diaper and then shows the nurse the contents of the diaper.

A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500 ml. When evaluating the woman's vital signs, which finding would be of greatest concern to the nurse? A.) Temperature 37.9 C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg B.) Temperature 37.4 C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg C.) Temperature 38 C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg D.) Temperature 36.8 C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg

A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate this woman's fundus? A.) 1 centimeter above the umbilicus B.) 2 centimeters below the umbilicus C.) Midway between the umbilicus and the symphysis pubis D.) Nonpalpable abdominally

After delivery, excess hypertrophied tissue in the uterus undergoes a period of self-destruction. What is the correct term for this process? A.) Autolysis B.) Subinvolution C.) Afterpains D.) Diastasis

Conscious relaxation is associated with which method of childbirth preparation? A.) Grantly Dick-Read childbirth method B.) Lamaze method C.) Bradley method D.) Psychoprophylactic method

During which period would the health care provider perform an episiotomy for a client who is expected to deliver a newborn who is large for gestational age (LGA)? A.) During crowning B.) Before pushing C.) During dearing of the perineum D.) During delivery of the shoulders

In many hospitals, new mothers are routinely presented with gift bags containing samples of infant formula. This practice is inconsistent with what? A.) Baby Friendly Hospital Initiative B.) Promotion of longer periods of breastfeeding C.) Perception of being supportive to both bottle feeding and breastfeeding mothers D.) Association with earlier cessation of breastfeeding

Part of the nurses role is assisting with pushing and positioning. Which guidance should the nurse provide to her client in active labor? A.) Encourage the woman's cooperation in avoiding the supine position B.) Advise the woman to avoid the semi-Fowler position C.) Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response D.) Instruct the woman to open her mouth and close her glottis, letting air escape after the push

Rho immune globulin will be ordered postpartum if which situation occurs? A.) Mother Rh, baby Rh+ B.) Mother Rh, baby Rh C.) Mother Rh+, baby Rh+ D.) Mother Rh+, baby Rh

Several delivery changes in the integumentary system that appear during pregnancy disappear after birth, although not always completely. What change is almost certain to be completely reversed? A.) Nail brittleness B.) Darker pigmentation of the areolae and linea nigra C.) Striae gravidarum on the breasts, abdomen, and thighs D.) Spider nevi

The client has delivered by urgent caesarean birth for fetal compromise. Umbilical cord gases were obtained for acid-base determination. The pH is 6.9, partial pressure of carbon dioxide (PCO2) is elevated, and the base deficit is 11 mmol/L. What type of acidemia is displayed by the infant? A.) Respiratory B.) Metabolic C.) Mixed D.) Turbulent

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (enzyme immunoassay [EIA] 0.8); hematocrit, 30%. How should the nurse best interpret these data? A.) Rubella vaccine should be administered B.) Blood transfusion is necessary C.) Rh immune globulin is necessary within 72 hours of childbirth D.) Kleihauer-Betke test should be performed

The nurse assesses fetal wellbeing during labor by monitoring which factor? A.) Response of the fetal heart rate (FHR) to uterine contractions B.) Maternal pain control to uterine contractions C.) Accelerations in FHR D.) FHR greater than 110 bpm

The nurse caring for a laboring client is aware that maternal cardiac output can be increased by which factor? A.) Change in position B.) Oxytocin administration C.) Regional anesthesia D.) Intravenous analgesic

The nurse is monitoring the fetal heart rate (FHR) of a full-term client in labor. Which measure would the nurse take to obtain the most accurate baseline FHR? A.) Record or monitor a 10-minute segment of tracing B.) Include periods of marked variability in the segment C.) Include episodic changes in the segment of tracing D.) Obtain at least 5 minutes of interpretable data in the segment

The nurse palpates the fontanels and sutures to determine the fetal presentation. Which is the characteristic of the anterior fontanel? A.) It is diamond-shaped in appearance B.) It measures about 1 cm by 2 cm C.) It closes after 6 to 8 weeks of birth D.) It lies near the occipital bone

The nurse should be cognizant of which important information regarding nerve block analgesia and anesthesia? A.) Most local agents are chemically related to cocaine and end in the suffix caine B.) Local perineal infiltration anesthesia is effective when epinephrine is added, but it can be injected only once C.) Pudendal nerve block is designed to relieve the pain from uterine contractions D.) Pudendal nerve block, if performed correctly, does not significantly lessen the bearing-down reflex

The nurse should be cognizant of which physiologic effect of pain? A.) Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen B.) Referred pain is the extreme discomfort experienced between contractions C.) Somatic pain of the second stage of labor is more generalized and related to fatigue D.) Pain during the third stage is a somewhat milder version of the pain experienced during the second stage

What are the legal responsibilities of the perinatal nurses? A.) Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes B.) Greeting the client on arrival, assessing her status, and starting an IV line C.) Applying the external fetal monitor and notifying the health care provider D.) Ensuring that the woman is comfortable

What fundal height is appropriate on the second postpartum day for a client whose fundal height one day postpartum was U+1, midline and firm? A.) U/U B.) U+2 C.) U-2 D.) U-3

What is the correct placement of the tocotransducer for effective EFM? A.) Over the uterine fundus B.) On the fetal scalp C.) Inside the uterus D.) Over the mothers lower abdomen

What is the most common reason for late postpartum hemorrhage (PPH)? A.) Subinvolution of the uterus B.) Defective vascularity of the decidua C.) Cervical lacerations D.) Coagulation disorders

What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern? A.) Altered fetal cerebral blood flow B.) Umbilical cord compression C.) Uteroplacental insufficiency D.) Spontaneous rupture of membranes

When assessing a postpartum client, the nurse finds that the client has excessive foul-smelling lochia. Which medication would helpful in treating this condition? A.) A broad-spectrum antibiotic B.) A diuretic to induce urination C.) An intravenous oxytocin agent D.) Intravenous fluids

When is the appropriate time to place elastic compression stockings on the legs of a client who is being treated with intravenous (IV) heparin for deep vein thrombosis (DVT)? A.) Before ambulating B.) During treatment with IV heparin C.) Throughout the client's time on bedrest D.) While the client's leg is elevated

When should discharge instruction, or the teaching plan that tells the woman what she needs to know to care for herself and her newborn, officially begin? A.) At the time of admission to the nurses unit B.) When the infant is presented to the mother at birth C.) During the first visit with the physician in the unit D.) When the take-home information packet is given to the couple

Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion? A.) Variable decelerations B.) Late decelerations C.) Fetal bradycardia D.) Fetal tachycardia

Which alterations in the perception of pain by a laboring client should the nurse understand? A.) Sensory pain for nulliparous women is often greater than for multiparous women during early labor B.) Affective pain for nulliparous women is usually less than for multiparous women throughout the first stage of labor C.) Women with a history of substance abuse experience more pain during labor D.) Multiparous women have more fatigue from labor and therefore experience more pain

Which client would not be a suitable candidate for internal EFM? A.) Client who still has intact membranes B.) Woman whose fetus is well engaged in the pelvis C.) Pregnant woman who has a comorbidity of obesity D.) Client whose cervix is dilated to 4 to 5 cm

Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur? A.) Maternal fever B.) Umbilical cord prolapse C.) Regional anesthesia D.) Magnesium sulfate administration

Which condition is considered a medical emergency that requires immediate treatment? A.) Inversion of the uterus B.) Hypotonic uterus C.) ITP D.) Uterine atony

Which condition places the pregnant client at a higher risk for a cesarean delivery? A.) A client with the fetus in a transverse lie B.) A client with the fetus in a cephalic presentation C.) A client with a fetal biparietal diameter of 9.25 cm at term D.) A client in whom the presenting part is 4 cm below the spines

Which food is appropriate to suggest to the postpartum client to increase docosahexaenoic acid (DHA) in breast milk? A.) Fish B.) Eggs C.) Sugar D.) Citrus fruits

Which initial treatment would the nurse anticipate when teaching an obstetric client who is newly diagnosed with idiopathic thrombocytopenic purpura (ITP)? A.) Prednisone B.) Splenectomy C.) Platelet transfusion D.) Coagulation studies

Which is an effective nursing intervention for a laboring client who is experiencing back labor and complains of intense pain in her lower back? A.) Counterpressure against the sacrum B.) Pant-blow (breaths and puffs) breathing techniques C.) Effleurage D.) Biofeedback

Which is the most appropriate time to determine the station of the presenting part in a pregnant client? A.) When the labor begins B.) One week before the labor C.) During the fourth stage of labor D.) At the end of the third stage of labor

Which laboring client would the nurse expect to be a likely candidate for amnioinfusion? A.) A client with heavily meconium-stained amniotic fluid or a low amniotic fluid index (AFI) B.) A client with an increase in uterine activity (or a high amniotic fluid index) C.) A client with hypertension and diabetes during the third trimester D.) A client with an overdistended uterine cavity during the second stage of labor

Which medication is contraindicated in a client who is on anticoagulant therapy? A.) Aspirin B.) Clindamycin C.) Midoprostol D.) Ergovine

Which nursing instruction is appropriate to give a postpartum client to prevent infection? A.) "Wipe from front to back after using the toilet" B.) "Use cold water to cleanse the perineal area" C.) "Change the perineal pad from back to front" D.) "Avoid the use of slippers while in the hospital"

Which nursing intervention reduces postpartum fatigue (PPF) in the breastfeeding client? A.) Encourages relatives and friends to bring meals and help with housework B.) Ask the client to postpone hospital discharge for a few days C.) Encourage the client to avoid ambulation and increase rest D.) Ask the client to assume the side-lying position for breastfeeding

Which nursing intervention would result in an increase in maternal cardiac output? A.) Change in position B.) Oxytocin administration C.) Regional anesthesia D.) IV analgesic

Which parameter is closely monitored in a client during the latent phase of the first stage of labor? A.) Fetal heart rate B.) Cervical dilation C.) Maternal temperature D.) External cephalic version

Which physiologic change is appropriate to discuss with a client who is concerned about the resolution of her carpal tunnel syndrome? A.) Diuresis B.) Joint relaxation C.) Hormonal changes D.) Hypermobility of the joints

Which postpartum conditions are considered medical emergencies that require immediate treatment? A. Inversion of the uterus and hypovolemic shock B. Hypotonic uterus and coagulopathies C. Subinvolution of the uterus and idiopathic thrombocytopenic purpura (ITP) D. Uterine atony and disseminated intravascular coagulation (DIC)

Which stage of labor varies the most in length? A.) First B.) Second C.) Third D.) Fourth

Which statement best describes a normal uterine activity pattern in labor? A.) Contractions every 2 to 5 minutes B.) Contractions lasting approximately 2 minutes C.) Contractions approximately 1 minute apart D.) Contraction intensity of approximately 500 mm Hg with relaxation at 50 mm Hg

Which statement is accurate regarding the difference experience can make in labor pain? A.) Pain for nulliparous women often is greater than the multiparous women during early labor B.) Pain for nulliparous woman usually is less than the multiparous women throughout the first stage of labor C.) Women with a history of substance abuse experience more pain during labor D.) Multiparous women have more fatigue from labor and therefore experience more pain

Which testing for ruptured membranes is appropriate for a client at 39 weeks gestation who presents to labor and delivery concerned that she has ruptured amniotic membranes? A.) Ferning B.) Nitrazine pH C.) Nitrazine pH and farning D.) Ultrasound measurement of the amniotic fluid index

Which type of laceration is expected in a client who has suffered perineal tears? A.) Vaginal B.) Cervical C.) Urethral D.) Vaginal vault

Which type of medication is used to decrease excessive bleeding and uterine atony in the postpartum client? A.) Oxytocic B.) Anesthetic C.) Antiinflammatory D.) Selective serotonin reuptake inhibitors

Which type of vaginal discharge is more common during the transition phase of the first stage of labor? A.) Bloody mucus B.) Pale pink mucus C.) Brownish discharge D.) Pink-to-bloody mucus

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the FHR for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. What is the nurse's first priority? A.) Change the woman's position B.) Notify the health care provider C.) Assist with amnioinfusion D.) Insert a scalp electrode

Which nursing interventions are appropriate for a client with a fluid imbalance resulting from postpartum hemorrhage (select all that apply): A.) Weighing peri pads B.) Monitoring vital signs C.) Assessing capillary refill D.) Assessing arterial blood gas E.) Providing oxygen supplementation

A, B

In assessing the immediate condition of the newborn after birth, a sample of cord blood may be a useful adjunct to the Apgar score. Cord blood is then tested for pH, carbon dioxide, oxygen, and base deficit or excess. Which clinical situation warrants this additional testing (select all that apply): A.) Low 5-minute Apgar score B.) Intrauterine growth restriction (IUGR) C.) Maternal thyroid disease D.) Intrapartum fever E.) Vacuum extraction

A, B, C, D

Which risk factors are associated with an increased risk for postpartum infection (select all that apply): A.) Hematoma B.) Prolonged labor C.) Cesarean delivery D.) Postpartum hemorrhage E.) Prolonged rupture of membranes

A, B, C, D, E

Which alternative approaches to relaxation have proven successful when working with the client in labor (select all that apply): A.) Aromatherapy B.) Massage C.) Hypnosis D.) Cesarean birth E.) Biofeedback

A, B, C, E

Which components of a cultural assessment aid in planning effective interventions for a postpartum client (select all that apply): A.) Primary language B.) Dietary preferences C.) Folk medicine practices D.) Client's pharmacologic knowledge E.) Ability to read and write English

A, B, C, E

While developing an intrapartum care plan for the client in early labor, which psychosocial factors would the nurse recognize upon the client's pain experience (select all that apply): A.) Culture B.) Anxiety and fear C.) Previous experiences with pain D.) Intervention of caregivers E.) Support systems

A, B, C, E

A woman has requested an epidural block for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's IV fluid for a preprocedural bolus. Before the initiation of the epidural, the woman should be informed regarding the disadvantages of an epidural block. Which concerns should the nurse share with this client (select all that apply): A.) Ability to move freely is limited B.) Orthostatic hypotension and dizziness may occur C.) Gastric emptying is not delayed D.) Higher body temperature may occur E.) Blood loss is not excessive

A, B, D

Because of its size and rigidity, the fetal head has a major effect on the birth process. Which bones comprise the structure of the fetal skull (select all that apply): A.) Parietal B.) Temporal C.) Fontanel D.) Occipital E.) Femoral

A, B, D

If a woman is at risk for thrombus and is not ready to ambulate, which nursing intervention would the nurse use (select all that apply): A.) Putting her in antiembolic stockings (thromboembolic deterrent [TED] hose) and/or sequential compression device (SCD) boots B.) Having her flex, extend, and rotate her feet, ankles, and legs C.) Having her sit in a chair D.) Immediately notifying the physician if a positive Homans sign occurs E.) Promoting bed rest

A, B, D

Which medications are used to manage PPH (select all that apply): A.) Oxytocin B.) Methergine C.) Terbutaline D.) Hemabate E.) Magnesium sulfate

A, B, D

Which physiologic factors are reliable indicators of impending shock from postpartum hemorrhage (select all that apply): A.) Respirations B.) Skin condition C.) Blood pressure D.) Level of consciousness E.) Urinary output

A, B, D, E

The nurse is aware of which symptoms of carpal tunnel syndrome when performing a prenatal assessment (select all that apply): A.) Tingling of fingers B.) Increased urination C.) Increased sweating D.) Numbness of fingers E.) Yellow-colored sputum

A, C, D

Which circumstances would warrant the nurse to perform a vaginal examination (select all that apply): A.) On admission to the hospital at the start of labor B.) When accelerations in fetal heart rate (FHR) are noted C.) On maternal perception of perineal pressure or the urge to bear down D.) When rupture of membranes (ROM) occurs E.) When bright red bleeding is observed

A, C, D

Which practices contribute to the prevention of postpartum infection (select all that apply): A.) Not allowing the mother to walk barefoot at the hospital B.) Educating the client to wipe from back to front after voiding C.) Having staff members with conditions such as strep throat, conjunctivitis, and diarrhea stay home D.) Instructing the mother to change her perineal pad from front to back each time she voids or defecates E.) Not permitting visitors with cough or colds to enter the postpartum unit

A, C, D

Lacerations of the cervix, vagina, or perineum are also causes of PPH. Which factors influence the causes and incidence of obstetric lacerations of the lower genital tract (select all that apply): A.) Operative and precipitate births B.) Adherent retained placenta C.) Abnormal presentation of the fetus D.) Congenital abnormalities of the maternal soft tissue E.) Previous scarring from infection

A, C, D, E

Many new mothers experience some type of nipple pain during the first weeks of initiating breastfeeding. Should this pain be severe or persistent, it may discourage or inhibit breastfeeding altogether. Which factors might contribute to this pain (select all that apply): A.) Improper feeding position B.) Large-for-gestational age infant C.) Fair skin D.) Progesterone deficiency E.) Flat or retracted nipples

A, C, E

The class of drugs known as opioid analgesics (butorphanol, nalbuphine) is not suitable for administration to women with known opioid dependence. The antagonistic activity could precipitate withdrawal symptoms (abstinence syndrome) in both mothers and newborns. Which signs would indicate opioid or narcotic withdrawal in the mother (select all that apply): A.) Yawning, runny nose B.) Increase in appetite C.) Chills or hot flashes D.) Constipation E.) Irritability, restlessness

A, C, E

Which are factors that accelerate dilation of the cervix (select all that apply): A.) Strong uterine contractions B.) Scarring of the cervix C.) Pressure by amniotic fluid D.) Prior infection of the cervix E.) Force by fetal presenting part

A, C, E

Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security (select all that apply): A.) The mother should check the photo identification (ID) of any person who comes to her room B.) The baby should be carried in the parents arms from the room to the nursery C.) Because of infant security systems, the baby can be left unattended in the clients room D.) Parents should use caution when posting photographs of their infant on the Internet E.) The mom should request that a second staff member verify the identity of any questionable person

A, D, E

A client becomes anxious during the transition phase of the first stage of labor, develops a rapid and deep respiratory pattern and complains of feeling dizzy and lightheaded. Which action would the nurse's immediate response? A.) Encourage the woman to breathe more slowly B.) Help the woman breathe into a paper bag C.) Turn the woman on her side D.) Administer a sedative

A new client and her partner arrive on the labor, delivery, recovery, and postpartum (LDRP) unit for the birth of their first child. The nurse applies the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. What is the nurse's best response? A.) Don't worry about that machine; that's my job B.) The baby's heart rate will fluctuate in response to what is happening during labor C.) The top line graphs the baby's heart rate, and the bottom line lets me know how strong the contractions are D.) Your physician will explain all of that later

A nurse is making rounds on a client who had a vaginal delivery, and suspects that the client is having excessive postpartum bleeding. Which would be the priority intervention at this time? A.) Call the primary health care provider B.) Massage the uterine fundus C.) Increase the rate of intravenous fluids D.) Monitor pad count, and perform catheterization

A postpartum client reports severe headaches. When reviewing the client's medical record, the nurse finds that the client's blood pressure was 150/100 mmHg and 160/90 mmHg on the second and third postpartum days, respectively. Which condition may be responsible for these alterations in blood pressure? A.) Bradycardia B.) Preeclampsia C.) Hypovolemia D.) Hyponatremia

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle feed. During the assessment, the nurse notices that both breasts are swollen, warm, and tender on palpation. Which guidance should the nurse provide to the client at this time? A.) Run warm water on her breasts during a shower B.) Apply ice to the breasts for comfort C.) Express small amounts of milk from the breasts to relieve the pressure D.) Wearing a loose-fitting bra to prevent nipple irritation

According to professional standards (the Association of Women's Health, Obstetric and Neonatal Nurses [AWHONN], 2007), which action cannot be performed by the nonanesthetist registered nurse who is caring for a woman with epidural anesthesia? A.) Monitoring the status of the woman and fetus B.) Initiating epidural anesthesia C.) Replacing empty infusion bags with the same medication and concentrate D.) Stopping the infusion, and initiating emergency measures

After massaging the boggy fundus of a client who delivered a large baby after a prolonged labor with a forceps-assisted birth, the nurse is unable to obtain a firm fundus. Which nursing action is indicated at this time? A.) Increase the rate of the intravenous infusion B.) Massage the fundus while another nurse notifies the primary health care provider C.) Change the peripad, replacing it with a double pad D.) Administer a half-dose of a uterine-contracting medication

Anxiety is commonly associated with pain during labor. Which statement regarding anxiety is correct? A.) Even mild anxiety must be treated B.) Severe anxiety increases tension, increases pain, and then, in turn, increases fear and anxiety, and so on C.) Anxiety may increase the perception of pain, but it does not affect the mechanism of labor D.) Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity

Developing a realistic birth plan with the pregnant woman regarding her care is important for the nurse. How would the nurse explain the major advantage of nonpharmacologic pain management? A.) Greater and more complete pain relief is possible B.) No side effects or risks to the fetus are involved C.) The woman will remain fully alert at all times D.) Labor will likely be more rapid

During labor a fetus displays an average FHR of 135 beats per minute over a 10-minute period. Which statement best describes the status of this fetus? A.) Bradycardia B.) Normal baseline heart rate C.) Tachycardia D.) Hypoxia

In assessing a postpartum client, the nurse is aware that which factor is the primary cause of thromboembolic disease? A.) Viral infection B.) Hypercoagulation C.) Corticosteroid therapy D.) Deficient clotting factors

In providing care for a laboring client, the nurse is aware that the client's prior experience with labor may have which effect? A.) Nulliparous women often have greater coping skills than multiparous women during early labor B.) Pain perception for a multiparous women can be increased if the previous birth experience was difficult C.) Women with a history of substance abuse experience more pain during labor D.) Multiparous women have more fatigue from labor and therefore experience more pain

The health care team is administering naloxone hydrochloride to a pregnant client in labor to counter the adverse effects of opioids. Which teaching regarding Narcan would the nurse provide to the client? A.) "Naloxone will cause a more rapid birth" B.) Naloxone will reverse the pain relief provided by the opioid" C.) "Naloxone is likely to cause nausea and vomiting" D.) "Naloxone may cause prolonged neonatal sedation"

The nurse assuming care of a multiparous client in labor who is complaining of pain that radiates to her abdominal wall, lower back, buttocks and down her thighs. Which term would the nurse use in documenting the client's pain? A.) Visceral B.) Referred C.) Somatic D.) Afterpain

The nurse instructor is teaching a group of students about the structure of the fetal head during labor and birth. Which statement by the student indicates effective learning? A.) "The fetal skull bones are firmly united during labor" B.) "The fetal skull bones are united by membranous sutures" C.) "The two important fontanels are the parietal and temporal" D.) "The sutures and fontanels restrict brain growth after delivery"

The nurse is monitoring the client's fetal heart rate (FHR) and notices late decelerations associated with uterine contractions, including a gradual decrease in and return to baseline. To which condition would the nurse attribute this pattern? A.) Fundal pressure B.) Uteroplacental insuffiency C.) Vaginal examination D.) Fetal scalp stimulation

The nurse is providing care during labor for a client with twins and instructs the client to avoid lying flat on the back. Which condition would the nurse aim to prevent in the client during labor? A.) Valsalva maneuver B.) Supine hypotension C.) Respiratory alkalosis D.) Painful uterine contractions

The nurse should be aware of what important information regarding systemic analgesics administered during labor? A.) Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier B.) Effects on the fetus and newborn can include decreased alertness and delayed sucking C.) Intramuscular (IM) administration is preferred over IV administration D.) IV patient-controlled analgesia (PCA) results in increased use of an analgesic

The nurse should be cognizant of which postpartum physiologic alteration? A.) Cardiac output, pulse rate, and stroke volume all return to prepregnancy normal values within a few hours of childbirth B.) Respiratory function returns to nonpregnant levels by 6 to 8 weeks after childbirth C.) Lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections D.) Hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth

What information should the nurse understand fully regarding rubella and Rh status? A.) Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus B.) Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination C.) Rh immunoglobulin is safely administered intravenously because it cannot harm a nursing infant D.) Rh immunoglobulin boosts the immune system and thereby enhances the effectiveness of vaccinations

What is the correct terminology for the nerve block that provides anesthesia to the lower vagina and perineum? A.) Epidural B.) Pudendal C.) Local D.) Spinal block

What is the most likely cause for variable FHR decelerations? A.) Altered fetal cerebral blood flow B.) Umbilical cord compression C.) Uteroplacental insufficiency D.) Fetal hypoxemia

What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony? A.) Establishing venous access B.) Performing fundal massage C.) Preparing the woman for surgical intervention D.) Catheterizing the bladder

What is the rationale for the use of a blood patch after spinal anesthesia? A.) Hypotension B.) Headache C.) Neonatal respiratory depression D.) Loss of movement

What three measures should the nurse implement to provide intrauterine resuscitation? A.) Call the provider, reposition the mother, and perform a vaginal examination B.) Turn the client onto her side, provide oxygen (O2) via face mask, and increase intravenous (IV) fluids C.) Administer O2 to the mother, increase IV fluids, and notify the health care provider D.) Perform a vaginal examination, reposition the mother, and provide O2 via face mask

What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse? A.) Uterine atony B.) Lacerations of the genital tract C.) Perineal hematoma D.) Infection of the uterus

When caring for a newly delivered woman, what is the best measure to prevent abdominal distention after a cesarean birth? A.) Rectal suppositories B.) Early and frequent ambulation C.) Tightening and relaxing abdominal muscles D.) Carbonated beverages

When performing a health history with a pregnant client, the nurse knows that which hematologic disorder is transferred genetically from parents to offspring? A.) Deep vein thrombosis B.) von Willebrand disease C.) Superficial vein thrombosis D.) Idiopathic thrombocytopenia

Which characteristic correctly matches the type of deceleration with its likely cause? A.) Early deceleration umbilical cord compression B.) Late deceleration uteroplacental insufficiency C.) Variable deceleration head compression D.) Prolonged deceleration unknown cause

Which client finding indicates a potential risk for complications during the labor process? A.) Maternal temperature of 99.7 F B.) Persistent dark red vaginal bleeding C.) Intrauterine pressure of 50 mmHg D.) Contractions lasting for 70 seconds

Which client is at greatest risk for early PPH? A.) Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress B.) Woman with severe preeclampsia on magnesium sulfate whose labor is being induced C.) Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor D.) Primigravida in spontaneous labor with preterm twins

Which client is most likely to experience strong and uncomfortable afterpains? A.) A woman who experienced oligohydramnios B.) A woman who is a gravida 4, para 4-0-0-4 C.) A woman who is bottle-feeding her infant D.) A woman whose infant weighed 5 pounds, 3 ounces

Which description of postpartum restoration or healing times is accurate? A.) The cervix shortens, becomes firm, and returns to form within a month postpartum B.) Vaginal rugae reappear by 3 weeks postpartum C.) Most episiotomies heal within a week D.) Hemorrhoids usually decrease in size within 2 weeks of childbirth

Which fetal heart rate tracing characteristics are considered reassuring or normal (Category I)? A.) Bradycardia not accompanied by baseline variability B.) Early decelerations, either present or absent C.) Sinusoidal pattern, either present or absent D.) Tachycardia not accompanied by baseline variability

Which medication is appropriate for the postpartum client with fourth-degree perineal lacerations who has been prescribed opioid analgesics but is now experiencing constipation? A.) Enemas B.) Laxatives C.) Prostaglandins D.) Rectal suppositories

Which nursing action would be taken immediately following the vaginal birth of a healthy term newborn? A.) Placing a hat on the infant before drying the infant B.) Drying the infant on the mother's chest and then placing a hat on the infant C.) Drying the infant in the warmer and then initiating skin-to-skin contact D.) Removing wet blankets from the delivery and placing a hat on the infant

Which nursing explanation is appropriate for a client who is 6 hours postpartum and asks when she will receive a RhoGAM injection? A.) "It is too early to administer the RhoGAM" B.) "The baby's blood type has not come back yet" C.) "You will receive the RhoGAM before discharge" D.) "The RhoGAM will be administered on your first postpartum visit"

Which pelvic shape is ideal for vaginal birth? A.) Android B.) Gynecoid C.) Platypelloid D.) Anthropoid

Which statement by a newly delivered woman indicates that she knows what to expect regarding her menstrual activity after childbirth? A.) My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter B.) My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles C.) I will not have a menstrual cycle for 6 months after childbirth D.) My first menstrual cycle will be heavier than normal and then will be light for several months after.

Which statement by the client who just gave birth and is not breastfeeding indicates effective learning about menstrual activity after childbirth? A.) "My first menstrual cycle will be lighter than normal and then will get heavier each month thereafter" B.) "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles" C.) "I will not have a menstrual cycle for 6 months after childbirth" D.) "My first menstrual cycle will be heavier than normal and then will be light for several months after"

Which statement is accurate regarding caring for a client in the third stage of labor? A.) The placenta eventually detaches itself from a flaccid uterus B.) The duration of the third stage may be short and lasts from the birth of the fetus until the placenta is delivered C.) it is important that the dark, roughened materna; surface of the placenta appear before the shiny fetal surface D.) The major risk for women during the third stage of labor is rapid heart rate

Which statement regarding the postpartum uterus is correct? A.) At the end of the third stage of labor, the postpartum uterus weighs approximately 500 g B.) After 2 weeks postpartum, it should be abdominally nonpalpable C.) After 2 weeks postpartum, it weighs 100 g D.) Postpartum uterus returns to its original (prepregnancy) size by 6 weeks postpartum

Which factors place a client at risk for postpartum infection (select all that apply): A.) Asthma B.) Obesity C.) Preeclampsia D.) Hypothyroidism E.) History of blood transfusion

B, C

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could the nurse use to increase the client's blood pressure (select all that apply): A.) Place the woman in a supine position B.) Place the woman in a lateral position C.) Increase IV fluids D.) Administer oxygen E.) Perform a vaginal examination

B, C, D

The breast-feeding mother should be taught to expect which changes to the condition of the breasts (select all that apply): A.) Breast tenderness is likely to persist for approximately 1 week after the start of lactation B.) As lactation is established, a mass may form that can be distinguished from cancer by its positional shift from day to day C.) In nonlactating mothers, colostrum is present for the first few days after childbirth D.) If suckling is never begun or is discontinued, then lactation ceases within a few days to a week E.) Little change occurs to the breasts in the first 48 hours

B, C, D

What psychosocial factors are appropriate to assess when understanding a client's behavior during the postpartum period (select all that apply): A.) Current illnesses B.) Family size C.) Cultural beliefs D.) Previous birth experiences E.) Delivery process

B, C, D

Which objective data provides understanding about a client's health status in the immediate postpartum period (select all that apply): A.) HIV test B.) Urinalysis C.) Hematocrit D.) Hemoglobin E.) Rh factor test

B, C, D

A tiered system of categorizing FHR has been recommended by professional organizations. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category. What is the correct nomenclature for these categories (select all that apply): A.) Reassuring B.) Category I C.) Category II D.) Nonreassuring E.) Category III

B, C, E

Which FHR decelerations would require the nurse to change the maternal position (select all that apply): A.) Early decelerations B.) Late decelerations C.) Variable decelerations D.) Moderate decelerations E.) Prolonged decelerations

B, C, E

Which clinical findings are expected during the first 48 to 72 hours postpartum (select all that apply): A.) Diarrhea B.) Glycosuria C.) Diaphoresis D.) Proteinuria E.) Increased urinary output

B, C, E

Which statement by the nurse describes the type of questions that help distinguish if a client is experiencing true labor (select all that apply): A.) "Have you noticed any bloody show" B.) "Where are you feeling your contractions" C.) "Have your contractions become closer together" D.) "Do you think you have been leaking amniotic fluid" E.) "Do your contractions feel the same when you are lying down"

B, C, E

Postpartum fatigue (PPF) is more than just feeling tired. It is a complex phenomenon affected by physiologic, psychologic, and situational variables. Which factors contribute to this phenomenon (select all that apply): A.) Precipitous labor B.) Hospital routines C.) Bottle feeding D.) Anemia E.) Excitement

B, D, E

Which is a part of the role of doula care for a laboring client (select all that apply): A.) Administering analgesics B.) Providing comfort measures C.) Interpreting the fetal heart rate pattern D.) Providing support to the client's partner E.) Providing coaching during the second stage of labor

B, D, E

According to the National Institute of Child Health and Human Development (NICHD) Three-Tier System of FHR Classification, category III tracings include all FHR tracings not categorized as category I or II. Which characteristics of the FHR belong in category III (select all that apply): A.) Baseline rate of 110 to 160 beats per minute B.) Tachycardia C.) Absent baseline variability not accompanied by recurrent decelerations D.) Variable decelerations with other characteristics such as shoulders or overshoots E.) Absent baseline variability with recurrent variable decelerations F.) Bradycardia

B, D, E, F

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. Which response by the client alerts the nurse that psychosocial outcomes have not been met? A.) The woman excessively discusses her labor and birth experience B.) The woman feels that her baby is more attractive and clever than any others C.) The woman has not given the baby a name D.) The woman has a partner or family members who react very positively about the baby

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the womans IV fluid for a preprocedural bolus. The nurse reviews her laboratory values and notes that the womans hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for this woman? A.) She is too far dilated B.) She is anemic C.) She has thrombocytopenia D.) She is septic

A woman in labor has just received an epidural block. What is the most important nursing intervention at this time? A.) Limit parenteral fluids B.) Monitor the fetus for possible tachycardia C.) Monitor the maternal blood pressure for possible hypotension D.) Monitor the maternal pulse for possible bradycardia.

A woman in labor is breathing into a mouthpiece just before the start of her regular contractions. As she inhales, a valve opens and gas is released. She continues to inhale the gas slowly and deeply until the contraction starts to subside. When the inhalation stops, the valve closes. Which statement regarding this procedure is correct? A.) The application of nitrous oxide gas is not often used anymore B.) An inhalation of gas is likely to be used in the second stage of labor, not during the first stage C.) An application of nitrous oxide gas is administered for pain relief D.) The application of gas is a prelude to a cesarean birth

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which nursing action is appropriate in this case? A.) Encourage the client to empty her bladder B.) Decrease her intravenous (IV) rate to keep-vein-open rate C.) Turn the client to the left lateral position or place a pillow under her hip D.) No action is necessary because a decrease in the woman's blood pressure is expected

A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed? A.) Disseminated intravascular coagulation (DIC); asking for laboratory tests B.) von Willebrand disease (vWD); noting whether bleeding times have been extended C.) Thrombophlebitis; using real-time and color Doppler ultrasound D.) Idiopathic or immune thrombocytopenic purpura (ITP); drawing blood for laboratory analysis

During the second phase of labor, the client initiates pattern-paced breathing. Which adverse symptom would the nurse watch for when the client initiates this breathing method? A.) Pallor B.) Nausea C.) Dizziness D.) Diaphoresis

In which clinical situation would the nurse most likely anticipate a fetal bradycardia? A.) Intraamniotic infection B.) Fetal anemia C.) Prolonged umbilical cord compression D.) Tocolytic treatment using terbutaline

In which stage of labor would the nurse expect the placenta to be expelled? A.) First B.) Second C.) Third D.) Fourth

In which stage of labor would the nurse expect the placental to be expelled? A.) First B.) Second C.) Third D.) Fourth

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help their clients. Which clients may initially appear very stoic but then become quite vocal as labor progresses until late in labor, when they become more vocal and request pain relief? A.) Chinese B.) Arab or Middle Eastern C.) Hispanic D.) African-American

Postpartum overdistention of the bladder and urinary retention can lead to which complications? A.) Postpartum hemorrhage and eclampsia B.) Fever and increased blood pressure C.) Postpartum hemorrhage and urinary tract infection D.) Urinary tract infection and uterine rupture

The most effective and least expensive treatment of puerperal infection is prevention. What is the most important strategy for the nurse to adopt? A.) Large doses of vitamin C during pregnancy B.) Prophylactic antibiotics C.) Strict aseptic technique, including hand washing, by all healthcare personnel D.) Limited protein and fat intake

The nurse assisting a laboring client recognizes the Ferguson reflex in a client. Which is the most accurate description of the Ferguson reflex? A.) Release of endogenous oxytocin B.) Involuntary uterine contractions C.) Maternal urge to bear down D.) Mechanical stretching of the cervix

The nurse is aware of which factor regarding the conditioning and reconditioning of the urinary system after childbirth? A.) Kidney function returns to normal a few days after birth B.) Diastasis recti abdominis is a common condition that alters the voiding reflex C.) Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium D.) With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth

The nurse observes a sudden increase in variability on the ERM tracing. Which class of medications may cause this finding? A.) Narcotics B.) Barbiturates C.) Methamphetamines D.) Tranquilizers

The nurse observes profuse bleeding in a postpartum client. Which is the priority intervention in this case? A.) Call the client's primary health care provider B.) Administer the standing prescription for an oxytocic C.) Palpate the uterus, and massage it if it is boggy D.) Assess maternal blood pressure and pulse for signs of hypovolemic shock

The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations. Which clinical finding might be the cause for these late decelerations? A.) Altered cerebral blood flow B.) Umbilical cord compression C.) Uteroplacental insufficiency D.) Meconium fluid

The nurse who provides care to clients in labor must have a thorough understanding of the physiologic processes of maternal hypotension. Which outcome might occur if the interventions for maternal hypotension are inadequate? A.) Early FHR decelerations B.) Fetal arrhythmias C.) Uteroplacental insufficiency D.) Spontaneous rupture of membranes

The nurse would anticipate which client condition in the second stage of labor? A.) The amniotic membranes rupture B.) The cervix cannot be felt during a vaginal examination C.) The client experiences a strong urge to bear down D.) The presenting part is below the ischial spines

The nurse would assess for which complication before planning care for a client who has undergone a forceps-assisted delivery? A.) Decreased vaginal secretions B.) Decreased urinary frequency C.) Presence of vaginal lacerations D.) Increased pelvic muscles tone

Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. Which physiologic alteration is the cause for the diaphoresis and diuresis that this client is experiencing? A.) Elevated temperature caused by postpartum infection B.) Increased basal metabolic rate after giving birth C.) Loss of increased blood volume associated with pregnancy D.) Increased venous pressure in the lower extremities

Under the Newborns and Mothers Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth. What is the correct interpretation of this legislation? A.) 24; 72 B.) 24; 96 C.) 48; 96 D.) 48; 120

What is a distinct advantage of external EFM? A.) The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the FHR B.) The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions C.) The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor D.) Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions

What should the nurses next action be if the clients white blood cell (WBC) count is 25,000/mm3 on her second postpartum day? A.) Immediately inform the physician B.) Have the laboratory draw blood for reanalysis C.) Recognize that this count is an acceptable range at this point postpartum D.) Immediately begin antibiotic therapy

When assessing the fetal heart rate (FHR) of a client in labor, which would the nurse identify as normal variability of the FHR? A.) Absent variability B.) Minimal variability C.) Moderate variability D.) Marked variability

When monitoring the client in labor, the nurse knows that the likely cause of variable fetal heart rate (FHR) decelerations in which factor? A.) Uterine tachysystole B.) Maternal hypertension C.) Umbilical cord compression D.) Epidural or spinal anesthesia

Which caloric intake is appropriate for the lactating client who gave birth to twins one month earlier? A.) Less than 1800 kcal/day B.) Less than 2200 kcal/day C.) More than 2700 kcal/day D.) 1800 to 2200 kcal/day

Which client behavior is expected during the transition phase of the first stage of labor? A.) Remains calm and silent B.) Doubts her ability to control pain C.) Vomits D.) Attention is directed inward

Which condition would the nurse assess in a postpartum client who does not breastfeed her newborn infant? A.) Sore nipples B.) Low estrogen levels C.) Breast engorgement D.) Postpartum depression

Which documentation on a woman's chart on postpartum day 14 indicates a normal involution process? A.) Moderate bright red lochial flow B.) Breasts firm and tender C.) Fundus below the symphysis and nonpalpable D.) Episiotomy slightly red and puffy

Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman? A.) Estrogen B.) Progesterone C.) Prolactin D.) Human placental lactogen

Which information related to a prolonged deceleration is important for the labor nurse to understand? A.) Prolonged decelerations present a continuing pattern of benign decelerations that do not require intervention B.) Prolonged decelerations constitute a baseline change when they last longer than 5 minutes C.) A disruption to the fetal oxygen supply causes prolonged decelerations D.) Prolonged decelerations require the customary fetal monitoring by the nurse

Which intervention would the nurse perform to provide a relaxed environment for a laboring client? A.) Stand at the bedside B.) Encourage a rapid birth C.) Control sensory stimuli D.) Demonstrate excitement

Which is the initial treatment for the client with vWD who experiences a PPH? A.) Cryoprecipitate B.) Factor VIII and von Willebrand factor (vWf) C.) Desmopressin D.) Hemabate

Which nursing information is appropriate for the postpartum client who is taking analgesics for pain relief and is anxious that the medication may pass into her breast milk and adversely affect the infant? A.) "Medications do not pass into the breast milk" B.) "Take the medication just before bedtime" C.) "Take the medication immediately after breastfeeding" D.) "You need to avoid breastfeeding and use infant formula"

Which nursing information is appropriate to include in the postpartum client's teaching to help her adjust to her role as a mother? A.) Knowledge of pediatric terminology B.) The importance of Western medicine C.) Probable family issues and coping strategies D.) Use of the Internet to learn about parenting

Which physiologic change(s) would the nurse expect to see in the client during labor pain and discomfort? A.) Reduced heart rate B.) Respiratory acidosis C.) Pallor and diaphoresis D.) Reduced blood pressure

Which position facilitates the pelvic outlet to increase in the second stage of labor? A.) Semirecumbent B.) Sitting C.) Squatting D.) Side-lying

Which postpartum infection is most often contracted by mothers who are breastfeeding? A.) Endometritis B.) Wound infections C.) Mastitis D.) Urinary tract infections (UTIs)

Which statement indicates effective learning regarding the manifestations of true labor? A.) "The fetus is usually not engaged in the pelvis" B.) "The cervix is often soft and is felt in the posterior position" C.) "Contractions become more intense with walking" D.) "Contractions are felt above the navel"

Which statement is not an expected outcome for the client who attends a reputable childbirth preparation program? A.) Childbirth preparation programs increase the woman's sense of control B.) Childbirth preparation programs prepare a support person to help during labor C.) Childbirth preparation programs guarantee a pain-free childbirth D.) Childbirth preparation programs teach distraction techniques

Which statement, related to the reconditioning of the urinary system after childbirth, should the nurse understand? A.) Kidney function returns to normal a few days after birth B.) Diastasis recti abdominis is a common condition that alters the voiding reflex C.) Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium D.) With adequate emptying of the bladder, bladder tone is usually restored 2 to 3 weeks after childbirth

Which symptom occurs for the postpartum client who has splanchnic engorgement? A.) Inability to perform Kegel exercises B.) Late ambulation C.) Orthostatic hypotension D.) Venous thromboembolism

Changes in blood volume after childbirth depend on several factors such as blood loss during childbirth and the amount of extravascular water (physiologic edema) mobilized and excreted. What amount of blood loss does the postpartum nurse anticipate (select all that apply): A.) 100 ml B.) 250 ml or less C.) 300 to 500 ml D.) 500 to 1000 ml E.) 1500 ml or greater

C, D

Which clinical findings are associated with the early phase of labor for a nulliparous client who is 2 cm dilated (select all that apply): A.) Zero station B.) Bloody mucus C.) Client takes direction easily D.) Scant amount of vaginal discharge E.) Presence of mild to moderate contractions

C, D, E

The baseline FHR is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the client's most recent 10-minute segment on the monitor strip and notes a late deceleration. Which is likely to have caused this change (select all that apply): A.) Spontaneous fetal movement B.) Compression of the fetal head C.) Placental abruption D.) Cord around the baby's neck E.) Maternal supine hypotension

C, E

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. What is the nurses most appropriate response? A.) Didn't you like your lunch? B.) Does your physician know that you are planning to eat that? C.) What is that anyway? D.) I'll warm the soup in the microwave for you

A client asks the nurse when her ovaries will begin working again. Which explanation by the nurse is most accurate? A.) Almost 75% of women who do not breastfeed resume menstruating within 1 month after birth B.) Ovulation occurs slightly earlier for breastfeeding women C.) Because of menstruation and ovulation schedules, contraception considerations can be postponed until after the puerperium D.) The first menstrual flow after childbirth usually is heavier than normal

A client is concerned that her breasts are engorged and uncomfortable. What is the nurse's explanation for this physiologic change? A.) Overproduction of colostrum B.) Accumulation of milk in the lactiferous ducts and glands C.) Hyperplasia of mammary tissue D.) Congestion of veins and lymphatic vessels

A postpartum client who had a cesarean delivery reports fever, loss of appetite, pelvic pain and foul-smelling lochia. On assessment, the nurse finds that the client has an increased pulse rate and uterine tenderness. Laboratory reports indicate significant leukocytosis. Which clinical condition would the nurse suspect based on these findings? A.) Cystocele B.) Rectocele C.) Hematoma D.) Endometritis

A woman gave birth to a healthy infant boy 5 days ago. What type of lochia does the nurse expect to find when evaluating this client? A.) Lochia rubra B.) Lochia sangra C.) Lochia alba D.) Lochia serosa

A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath three times daily, and a stool softener. Which information regarding the client's condition is most closely correlated with these orders? A.) Woman is a gravida 2, para 2 B.) Woman had a vacuum-assisted birth C.) Woman received epidural anesthesia D.) Woman has an episiotomy

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is approximately twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. Which intervention should the nurse immediately initiate? A.) Contact the woman's physician B.) Tell the woman to slow her pace of her breathing C.) Administer oxygen via a mask or nasal cannula D.) Help her breathe into a paper bag

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use? A.) Pouring water from a squeeze bottle over the woman's perineum B.) Placing oil of peppermint in a bedpan under the woman C.) Asking the physician to prescribe analgesic agents D.) Inserting a sterile catheter

During a prenatal evaluation, the nurse notes that the client has a flat pelvis. Which term would the nurse use in documenting the findings? A.) Gynecoid B.) Android C.) Anthropoid D.) Platypelloid

During the vaginal examination of a client in labor, the nurse identifies the presenting part as the scapula. Which fetal presentation would the nurse recognize? A.) Cephalic B.) Frank breech C.) Complete breech D.) Shoulder

If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition? A.) Hysterectomy B.) Laparoscopy C.) Laparotomy D.) Dilation and curettage (D&C)

In which situation would the nurse be called on to stimulate the fetal scalp? A.) As part of fetal scalp blood sampling B.) In response to tocolysis C.) In preparation for fetal oxygen saturation monitoring D.) To elicit an acceleration in the FHR

Maternity nurses often have to answer questions about the many, sometimes unusual, ways people have tried to make the birthing experience more comfortable. Which information regarding nonpharmacologic pain relief is accurate? A.) Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine B.) Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time C.) Effleurage is permissible, but counterpressure is almost always counterproductive D.) Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins

Nurses need to understand the basic definitions and incidence data regarding PPH. Which statement regarding this condition is most accurate? A.) PPH is easy to recognize early; after all, the woman is bleeding B.) Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH C.) If anything, nurses and physicians tend to overestimate the amount of blood loss D.) Traditionally, PPH has been classified as early PPH or late PPH with respect to birth

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurses highest priority at this time? A.) Beginning an intravenous (IV) infusion of Ringer's lactate solution B.) Assessing the woman's vital signs C.) Calling the woman's primary health care provider D.) Massaging the woman's fundus

Parents who have not already done so need to make time for newborn follow-up of the discharge. According to the American Academy of Pediatrics (AAP), when should a breastfeeding infant first need to be seen for a follow-up examination? A.) 2 weeks of age B.) 7 to 10 days after childbirth C.) 4 to 5 days after hospital discharge D.) 48 to 72 hours after hospital discharge

Pelvic floor exercises, also known as Kegel exercises, will help to strengthen the perineal muscles and encourage healing after childbirth. The nurse requests the client to repeat back instructions for this exercise. Which response by the client indicates successful learning? A.) I contract my thighs, buttocks, and abdomen B.) I perform 10 of these exercises every day C.) I stand while practicing this new exercise routine D.) I pretend that I am trying to stop the flow of urine in midstream

The nurse is caring for a client in the first stage of labor and notes that the client has scarring on her cervix as a result of a past STI. Which complication would the nurse predict in the client during labor? A.) Ferguson reflex B.) Slow fetal descent C.) Supine hypotension D.) Slow cervical dilation

The nurse is evaluating the EFM tracing of the client who is in active labor. Suddenly, the FHR drops from its baseline of 125 down to 80 beats per minute. The mother is repositioned, and the nurse provides oxygen, increased IV fluids, and performs a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should the nurse take next? A.) Call for help B.) Insert a Foley catheter C.) Start administering Pitocin D.) Immediately notify the care provider

The nurse is evaluating the fetal monitor tracing of a client who is in active labor and notes a sudden drop in fetal heart rate (FHR) from its baseline of 125 down to 80. The nurse repositions the client, provides oxygen, increases intravenous (IV) fluid, and performs a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. Which additional measure would the nurse take? A.) Care for help B.) Insert a Foley catheter C.) Start oxytocin D.) Immediately notify the primary health care provider

The nurse is providing instruction to the newly delivered client regarding postbirth uterine and vaginal discharge, called lochia. Which statement is the most appropriate? A.) Lochia is similar to a light menstrual period for the first 6 to 12 hours B.) It is usually greater after cesarean births C.) Lochia will usually decrease with ambulation and breastfeeding D.) It should smell like normal menstrual flow unless an infection is present

The nurse is teaching a group of student nurses about fetal oxygenation. The nurse asks a student. "What happens when oxytocin levels are elevated in the client?" Which statement by the student nurse indicates effective learning related to the client's condition? A.) "Hemoglobin levels will decrease" B.) "Blood glucose levels will increase" C.) "There is a lower blood supply to the placenta" D.) "Uterine contractions will increase"

The nurse is using intermittent auscultation (IA) to locate the fetal heartbeat. Which statement regarding this method of surveillance is accurate? A.) The nurse can be expected to cover only two or three clients when IA is the primary method of fetal assessment B.) The best course is to use the descriptive terms associated with EFM when documenting results C.) If the heartbeat cannot be immediately found, then a shift must be made to EFM D.) Ultrasound can be used to find the FHR and to reassure the mother if the initial difficulty is a factor

The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis? A.) Absence of cyanosis in the buccal mucosa B.) Cool, dry skin C.) Calm mental status D.) Urinary output of at least 30 ml/hr

The obstetric nurse is preparing the client for an emergency cesarean birth, with no time to administer spinal anesthesia. The nurse is aware of and prepared for the greatest risk of administering general anesthesia to the client. What is this risk? A.) Respiratory depression B.) Uterine relaxation C.) Inadequate muscle relaxation D.) Aspiration of stomach contents

The perinatal nurse realizes that an FHR that is tachycardic, bradycardic, has late decelerations, or loss of variability is nonreassuring and is associated with which condition? A.) Hypotension B.) Cord compression C.) Maternal drug use D.) Hypoxemia

The trend in the United States is for women to remain hospitalized no longer than 1 or 2 days after giving birth. Which scenario is not a contributor to this model of care? A.) Wellness orientation model of care rather than a sick-care model B.) Desire to reduce health care costs C.) Consumer demand for fewer medical interventions and more family-focused experiences D.) Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information

What are the most common causes for subinvolution of the uterus? A.) Postpartum hemorrhage and infection B.) Multiple gestation and postpartum hemorrhage C.) Uterine tetany and overproduction of oxytocin D.) Retained placental fragments and infection

What is one of the initial signs and symptoms of puerperal infection in the postpartum client? A.) Fatigue continuing for longer than 1 week B.) Pain with voiding C.) Profuse vaginal lochia with ambulation D.) Temperature of 38 C (100.4 F) or higher on 2 successive days

What physiologic change occurs as the result of increasing the infusion rate of nonadditive IV fluids? A.) Maintaining normal maternal temperature B.) Preventing normal maternal hypoglycemia C.) Increasing the oxygen-carrying capacity of the maternal blood D.) Expanding maternal blood volume

When caring for a client in labor, which instruction would the nurse provide in the second stage of labor? A.) "Point your toes to prevent pain" B.) "Avoid fluids until the infant is delivered" C.) "Lie still and avoid movement to prevent fatigue" D.) "Avoid holding your breath or tightening the abdominal muscles"

Which FHR finding is the most concerning to the nurse who is providing care to a laboring client? A.) Accelerations with fetal movement B.) Early decelerations C.) Average FHR of 126 beats per minute D.) Late decelerations

Which action would the nurse take before administering meperidine hydrochloride to a client to relieve labor pain? A.) Administer 1000 mL of normal saline solution B.) Ask the client to use relaxation techniques C.) Ask the client to assume an upright position D.) Monitor maternal vital signs and fetal heart rate

Which assessment regarding the effects of fear and anxiety during labor would the nurse observe in caring for a client in the last trimester of pregnancy? A.) Increased blood flow B.) Increase in the progression of labor C.) Increased contractions D.) Increase in muscle tension

Which classification of placental separation is not recognized as an abnormal adherence pattern? A.) Placenta accreta B.) Placenta increta C.) Placenta percreta D.) Placenta abruptio

Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium? A.) Varicosities of the legs B.) Carpal tunnel syndrome C.) Periodic numbness and tingling of the fingers D.) Headaches

Which definition of an acceleration in the fetal heart rate (FHR) is accurate? A.) FHR accelerations are indications of fetal well-being when they are periodic B.) FHR accelerations are greater and longer in preterm gestations C.) FHR accelerations are usually observed with breech presentations when they are episodic D.) An acceleration in the FHR presents a visually apparent and abrupt peak

Which degree of severity is indicated for a client's perineal laceration involving the anterior rectal wall during childbirth? A.) First degree B.) Second degree C.) Third degree D.) Fourth degree

Which device would the nurse use for monitoring the intensity of uterine contractions in a pregnant client? A.) Tocotransducer B.) Spiral electrode C.) Ultrasound transducer D.) Intrauterine pressure catheter (IUPC)

Which is an early sign of hemorrhagic shock? A.) Hypotension B.) Altered mental status C.) Cool, clammy, pale skin D.) Capillary refill time of 4 seconds

Which is the best response by the nurse to a client who complains of the urge to have a bowel movement during each contraction? A.) "There is a possibility of an infection" B.) "I will have to evaluate your urine reports" C.) "There is a complication with the delivery" D.) "This is a normal occurrence at the onset of labor"

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus? A.) Notify the physician of an impending hemorrhage B.) Assess the blood pressure and pulse C.) Evaluate the lochia D.) Assist the client in emptying her bladder

Which nursing intervention would suppress lactation in the client who had a stillbirth? A.) Run warm water over the client's breasts B.) Administer strong analgesics C.) Administer oral and intravenous fluids D.) Advise the client to wear a breast binder for the first 72 hours after giving birth

Which position would the nurse identify as effective in facilitating the rotation of a fetus from a posterior occipital to an anterior occiput presentation? A.) Squatting B.) Ambulation C.) Birthing ball D.) Hands and knees

Which postpartum complication is indicated for the client who has lost 600 mL of blood within 24 hours and has a soft and relaxed uterus? A.) Mastitis B.) Puerperal infectuion C.) Venous thromboembolism D.) Postpartum hemorrhage

Which statement correctly describes the effects of various pain factors? A.) Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth B.) Upright positions in labor increase the pain factor because they cause greater fatigue C.) Women who move around trying different positions experience more pain D.) Levels of pain-mitigating beta-endorphins are higher during a spontaneous, natural childbirth

Which statement regarding the care of a client in labor is correct and important to the nurse as he or she formulates the plan of care? A.) The woman's blood pressure will increase during contractions and fall back to prelabor normal levels between contractions B.) The use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. C.) Having the woman point her toes will reduce leg cramps D.) Endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.

Which term best describes the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state? A.) Involutionary period because of what happens to the uterus B.) Lochia period because of the nature of the vaginal discharge C.) Mini-tri period because it lasts only 3 to 6 weeks D.) Puerperium, or fourth trimester of pregnancy

Which nursing instruction is appropriate to give the postpartum client before administering the varicella vaccine of the day of discharge from the hospital (select all that apply): A.) "Stop breastfeeding after receiving the vaccine" B.) "You need not return to the hospital because one dose is enough for you" C.) "Stop taking all medications before returning home" D.) "You must return for a second dose in 4 to 8 weeks" E.) "Use contraception for 1 month to avoid pregnancy"

Women's Health Exam I

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