Exam 2 for OB/PEDS PDF

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This is for OB/PEDS in 7th semester...

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1. A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply 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. Your best response is: “The top line graphs the baby’s heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor.” 2. Fetal well-being during labor is assessed by: The response of the fetal heart rate (FHR) to uterine contractions (UCs). 3. Signs that precede labor include (Select all that apply): Lightening Bloody show Rupture of membranes 4. A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor? Active phase 5. In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information would the nurse include? “Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures.” 6.

A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following antepartum complications should the nurse understand is a risk factor for the condition? Preeclampsia

7. The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are the result of: Uteroplacental insufficiency. 8. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman? Lochia Serosa 9. In evaluating the effectiveness of oxytocin induction, the nurse would expect: Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. 10. A maternal indication for the use of vacuum extraction is: Maternal exhaustion

11. As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with: Hypoxemia 12. After giving birth to a stillborn infant, the woman turns to the nurse and says, “I just finished painting the baby’s room. Do you think that caused my baby to die?” The nurse’s best response to this woman is: “I can understand your need to find an answer to what caused this. What else are you thinking about?” 13. After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to: Stimulate the uterus to contract 14. When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman’s risk for _________________________ has increased. Intrauterine infection 15. Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as: First stage; active phase 16. The nurse providing care for the laboring woman realizes that variable fetal heart rate (FHR) decelerations are caused by: Umbilical cord compression 17. The hormone necessary for milk production is: Prolactin 18. The primary difference between the labor of a nullipara and that of a multipara is the: Total duration of labor 19.

The nerve block used in labor that provides anesthesia to the lower vagina and perineum is called: Pudendal

20. A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by: Apply ice to the breasts for comfort

21. The laboring woman who imagines her body opening to let the baby out is using a mental technique called: Imagery 22. A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: Counterpressure against the sacrum 23. 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 woman’s intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the woman’s 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 the woman? She has thrombocytopenia 24. A woman in labor has just received an epidural block. The most important nursing intervention is to: Monitor the maternal blood pressure for possible hypotension 25. To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features: May include bipolar disorder (formerly called “manic depression”). 26. The maternity nurse understands that as the uterus contracts during labor, maternal-fetal exchange of oxygen and waste products: Diminishes as the spiral arteries are compressed. 27. Women who have participated in childbirth education classes often bring a “birth bag” or “Lamaze bag” with them to the hospital. These items often assist in reducing stress and providing comfort measures. The nurse caring for women in labor should be aware of common items that a client may bring, including (Select all that apply): Rolling pin Tennnis balls Pillow Stuff animal or photo 28. A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following factors should the nurse include in the teaching? (select all that apply.) Retained Placental Fragments Precipitous Delivry Inversion of the Uterus

29. The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is: Respiratory depression 30. While providing care to a patient in active labor, the nurse should instruct the woman that: Frequent changes in position will help relieve her fatigue and increase her comfort. 31. The factors that affect the process of labor and birth, known commonly as the five Ps, include all except: Pressure 32. A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15minute assessment, she tells you that she “feels all wet underneath.” You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action? Assess the fundus for firmness 33. The nurse is caring for a client whose labor is being augmented with oxytocin. He or she recognizes that the oxytocin should be discontinued immediately if there is evidence of: A fetal heart rate (FHR) of 180 with absence of variability. 34. What is an essential part of nursing care for the laboring woman? Helping the women manage her pain 35. A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman’s fundus? 1 cm above the umbilicus 36. A normal uterine activity pattern in labor is characterized by: Contractions every 2-5 minutes 37. To initiate the milk ejection reflex (MER), the mother should be advised to: Place infant to the breast 38. A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse’s initial response would be to: assess fetal heart rate and pattern 39. The slight overlapping of cranial bones or shaping of the fetal head during labor is called: Molding

40. The obstetric nurse is preparing the patient for an emergency cesarean birth, with no time to administer spinal anesthesia. The nurse is aware and prepared for the greatest risk of administering general anesthesia to the patient. This risk is: Aspiration of stomach contents. 41. The most critical nursing action in caring for the newborn immediately after birth is: Keeping the newborn’s airway clear 42. During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have: Normal baseline heart rate 43. Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory? Massaging the woman’s back 44. While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (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. The nurse’s first priority is to: Change the woman’s position 45. Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? The vulva bulges and encircles the fetal head. 46. Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? Early decelerations 47. Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium? Headaches 48. To teach patients about the process of labor adequately, the nurse knows that which event is the best indicator of true labor? Cervical dilation and effacement 49. Which fetal heart rate (FHR) finding would concern the nurse during labor? Late decelerations 50. Perinatal nurses are legally responsible for:

Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes. 51. Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman? Prolactin 52. The nurse has received report regarding her patient in labor. The woman’s last vaginal examination was recorded as 3 cm, 30%, and -2. The nurse’s interpretation of this assessment is that: The cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines. 53. The nurse expects to administer an oxytocic (e.g., Pitocin, Methergine) to a woman after expulsion of her placenta to: Stimulate uterine contraction 54. Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client’s blood pressure (Select all that apply)? Place the woman in a lateral position. Administer oxygen. Increase intravenous (IV) fluids. 55. Why is continuous electronic fetal monitoring usually used when oxytocin is administered? Uteroplacental exchange may be compromised. 56. To assist the woman after delivery of the infant, the nurse knows that the blood patch is used after spinal anesthesia to relieve: Headache 57. With regard to spinal and epidural (block) anesthesia, nurses should know that: A high incidence of after-birth headache is seen with spinal blocks. 58. The priority nursing intervention after an amniotomy should be to: Assess the fetal heart rate 59. The nurse knows that the second stage of labor, the descent phase, has begun when: The woman experiences a strong urge to bear down.

60. A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: Stimulate fetal surfactant production 61. It is important for the nurse to develop a realistic birth plan with the pregnant woman in her care. The nurse can explain that a major advantage of nonpharmacologic pain management is: No side effects or risks to the fetus are involved. 62. What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. 63. In assessing a woman for pain and discomfort management during labor, a nurse most likely would: Have the woman use a visual analog scale (VAS) to determine her level of pain. 64. A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse’s best response is: “It’s normal to be anxious about labor. Let’s discuss what makes you afraid.” 65. The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate may be caused by: Methamphetamines. 66. To care for a laboring woman adequately, the nurse understands that the __________ stage of labor varies the most in length? First 67. Which maternal condition is considered a contraindication for the application of internal monitoring devices? Unruptured membranes 68. A pregnant woman’s amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? Placing the woman in the knee-chest position 69. As relates to fetal positioning during labor, nurses should be aware that: Birth is imminent when the presenting part is at +4 to +5 cm below the spine. 70. With regard to nerve block analgesia and anesthesia, nurses should be aware that:

Most local agents are related chemically to cocaine and end in the suffix -caine. 71. The role of the nurse with regard to informed consent is to: Witness the signing of the inform consent 72. A nurse is caring for a client who is postpartum. The nurse should identify which of the following findings as an early indicator of hypovolemia caused by hemorrhage? Increasing pulse and decreasing blood pressure 73. Fetal bradycardia is most common during: Prolonged umbilical cord compression 74. A laboring woman is lying in the supine position. The most appropriate nursing action at this time is to: Ask her to turn to one side 75. You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? Notify health care provider immediately 76. What is an expected characteristic of amniotic fluid? Pale, straw color with small white particles 77. The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates the woman’s understanding of the instructions when she states, “True labor contractions will: Continue and get stronger even if I relax and take a shower.” 78. The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located: Over the uterine fundus 79. A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should: help her breath in a paper bag 80. If the patient’s white blood cell (WBC) count is 25,000/mm on her second postpartum day, the nurse should:

Recognize that this is an acceptable range at this point postpartum. 81. A laboring woman received an opioid agonist (meperidine) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate? Naloxone (Narcan) 82. One of the first symptoms of puerperal infection to assess for in the postpartum woman is: Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth. 83. For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. The woman may fight the labor process and react with pain or anger. Alternately, she may become a passive player and emotionally absent herself from the process. The nurse is in a unique position of being able to assist the client to associate the sensations of labor with the process of childbirth and not the past abuse. The nurse can implement a number of care measures to help the client view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care? Limiting the number of procedures that invade her body 84. A first-time mother is concerned about the type of medications she will receive during labor. She is in a fair amount of pain and is nauseous. In addition, she appears to be very anxious. You explain that opioid analgesics often are used with sedatives because: Sedatives help the opioid work better, and they also will assist you to relax and relieve your nausea.” 85. When 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. The nurse concludes that: The placenta has separated 86. A woman in active labor receives an analgesic opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease? Meperidine (Demerol) 87. With regard to a pregnant woman’s anxiety and pain experience, nurses should be aware that:

Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on. 88. Which statement is the best rationale for assessing maternal vital signs between contractions? Maternal circulating blood volume increases temporarily during contractions. 89. The nurse caring for the woman in labor should understand that maternal hypotension can result in: Uteroplacental insufficiency. 90. In the current practice of childbirth preparation, emphasis is placed on: Having expectant parents attend childbirth preparation in any or no specific method....