Question 1

Which is (are) the priority nursing assessment(s) for the client having tocolytic therapy with terbutaline (Brethine)?

Accepted Answer

A)  Intake and output 
B)  Maternal blood glucose level 
C)  Internal temperature and odor of amniotic fluid 
D)  Fetal heart rate, maternal pulse, and blood pressure 
A)  Intake and output 
B)  Maternal blood glucose level 
C)  Internal temperature and odor of amniotic fluid 
D)  Fetal heart rate, maternal pulse, and blood pressure

Question 2

A client who has had two previous cesarean births is in active labor when she suddenly complains of pain between her scapulae. Which should be the nurse's priority action?

Accepted Answer

A)  Notify the health care provider promptly. 
B)  Observe for abnormally high uterine resting tone. 
C)  Decrease the rate of nonadditive intravenous fluid. 
D)  Reposition the client with her hips slightly elevated. 
A)  Notify the health care provider promptly. 
B)  Observe for abnormally high uterine resting tone. 
C)  Decrease the rate of nonadditive intravenous fluid. 
D)  Reposition the client with her hips slightly elevated.

Question 3

Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?

Accepted Answer

A)  A primigravida who is 17 years old 
B)  A 22-year-old multiparous client with ruptured membranes 
C)  A primigravida who has requested no analgesia during her labor 
D)  A multiparous client at 39 weeks of gestation who is expecting twins 
A)  A primigravida who is 17 years old 
B)  A 22-year-old multiparous client with ruptured membranes 
C)  A primigravida who has requested no analgesia during her labor 
D)  A multiparous client at 39 weeks of gestation who is expecting twins

Question 4

A pregnant client who has had a prior obstetric history of preterm labors is pregnant with her third child. The physician has ordered an fFN (fetal fibronectin) test. Which instructions should be given to the client related to this clinical test?

Accepted Answer

A)  Client must be NPO prior to testing. 
B)  Blood work will be drawn every week to help confirm the start of preterm labor. 
C)  Client should refrain from sexual activity prior to testing. 
D)  A urine specimen will be collected for testing. 
A)  Client must be NPO prior to testing. 
B)  Blood work will be drawn every week to help confirm the start of preterm labor. 
C)  Client should refrain from sexual activity prior to testing. 
D)  A urine specimen will be collected for testing.

Question 5

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor?

Accepted Answer

A)  Incomplete uterine relaxation 
B)  Maternal fatigue and exhaustion 
C)  Maternal sedation with narcotics 
D)  Administration of tocolytic drugs 
A)  Incomplete uterine relaxation 
B)  Maternal fatigue and exhaustion 
C)  Maternal sedation with narcotics 
D)  Administration of tocolytic drugs

Question 6

Which action by the nurse prevents infection in the labor and birth area?

Accepted Answer

A)  Using clean techniques for all procedures 
B)  Keeping underpads and linens as dry as possible 
C)  Cleaning secretions from the vaginal area by using a back to front motion 
D)  Performing vaginal examinations every hour while the client is in active labor 
A)  Using clean techniques for all procedures 
B)  Keeping underpads and linens as dry as possible 
C)  Cleaning secretions from the vaginal area by using a back to front motion 
D)  Performing vaginal examinations every hour while the client is in active labor

Question 7

A dose of dexamethasone 12 mg was administered to a client in preterm labor at 8:30 AM on March 12. The nurse knows that the next dose must be scheduled for:

Accepted Answer

A)  2:30 PM on March 12. 
B)  8:30 PM on March 12. 
C)  8:30 AM on March 13. 
D)  2:30 PM on March 13. 
A)  2:30 PM on March 12. 
B)  8:30 PM on March 12. 
C)  8:30 AM on March 13. 
D)  2:30 PM on March 13.

Question 8

The fetus in a breech presentation is often born by cesarean birth because:

Accepted Answer

A)  the buttocks are much larger than the head. 
B)  compression of the umbilical cord is more likely. 
C)  internal rotation cannot occur if the fetus is breech. 
D)  postpartum hemorrhage is more likely if the client delivers vaginally. 
A)  the buttocks are much larger than the head. 
B)  compression of the umbilical cord is more likely. 
C)  internal rotation cannot occur if the fetus is breech. 
D)  postpartum hemorrhage is more likely if the client delivers vaginally.

Question 9

When reviewing the prenatal record of a client at 42 weeks' gestation, the nurse recognizes that induction of labor is indicated based on the finding of:

Accepted Answer

A)  reduced amniotic fluid volume. 
B)  cervix 2 cm at last prenatal visit. 
C)  fundal height measured at the xyphoid process. 
D)  1-pound weight gain at each of the last two weekly visits. 
A)  reduced amniotic fluid volume. 
B)  cervix 2 cm at last prenatal visit. 
C)  fundal height measured at the xyphoid process. 
D)  1-pound weight gain at each of the last two weekly visits.

Question 10

Emergency measures used in the treatment of a prolapsed cord include which of the following? (Select all that apply.)

Accepted Answer

A)  Administration of oxygen via face mask at 8 to 10 L/min 
B)  Maternal change of position to knee-chest 
C)  Administration of tocolytic agent 
D)  Administration of oxytocin (Pitocin) 
E)  Vaginal elevation
F) Insertion of cord back into vaginal area 
A)  Administration of oxygen via face mask at 8 to 10 L/min 
B)  Maternal change of position to knee-chest 
C)  Administration of tocolytic agent 
D)  Administration of oxytocin (Pitocin) 
E)  Vaginal elevation
F) Insertion of cord back into vaginal area

Question 11

A client who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is:

Accepted Answer

A)  "You should come into the office and let the doctor check you." 
B)  "Acetaminophen is acceptable during pregnancy. You should not take aspirin, however." 
C)  "Back pain is common at this time during pregnancy because you tend to stand with a sway back." 
D)  "Avoid medication because you are pregnant. Try soaking in a warm bath or using a heating pad on low before taking any medication." 
A)  "You should come into the office and let the doctor check you." 
B)  "Acetaminophen is acceptable during pregnancy. You should not take aspirin, however." 
C)  "Back pain is common at this time during pregnancy because you tend to stand with a sway back." 
D)  "Avoid medication because you are pregnant. Try soaking in a warm bath or using a heating pad on low before taking any medication."

Question 12

Which technique is least effective for the client with persistent occiput posterior position?

Accepted Answer

A)  Squatting 
B)  Lying supine and relaxing 
C)  Sitting or kneeling, leaning forward with support 
D)  Rocking the pelvis back and forth while on hands and knees 
A)  Squatting 
B)  Lying supine and relaxing 
C)  Sitting or kneeling, leaning forward with support 
D)  Rocking the pelvis back and forth while on hands and knees

Question 13

A client with polyhydramnios was admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless, but the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next?

Accepted Answer

A)  Perform Leopold maneuvers. 
B)  Perform a vaginal examination. 
C)  Apply warm saline soaks to the vagina. 
D)  Place the client in a high Fowler position. 
A)  Perform Leopold maneuvers. 
B)  Perform a vaginal examination. 
C)  Apply warm saline soaks to the vagina. 
D)  Place the client in a high Fowler position.

Question 14

Which presentation is most likely to occur with a hypertonic labor pattern? (Select all that apply.)

Accepted Answer

A)  Increased risk for placenta previa 
B)  Painful uterine contractions 
C)  Increased resting tone 
D)  Uterine vasodilation 
E)  Increased uterine pressure
F) Effective uterine contraction 
A)  Increased risk for placenta previa 
B)  Painful uterine contractions 
C)  Increased resting tone 
D)  Uterine vasodilation 
E)  Increased uterine pressure
F) Effective uterine contraction

Question 15

During the course of the birth process, the physician suspects that a shoulder dystocia is occurring and asks the nurse for assistance. Which priority action should be taken by the nurse in response to this request?

Accepted Answer

A)  Put pressure on the fundus. 
B)  Ask the physician if he or she would like you to prepare for a surgical method of birth. 
C)  Tell the client not to push until you prepare vacuum extraction device for physician. 
D)  Reposition the client to facilitate birth. 
A)  Put pressure on the fundus. 
B)  Ask the physician if he or she would like you to prepare for a surgical method of birth. 
C)  Tell the client not to push until you prepare vacuum extraction device for physician. 
D)  Reposition the client to facilitate birth.

Question 16

A client in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for at-home continuation of the tocolytic effect?

Accepted Answer

A)  Buccal oxytocin (Pitocin) 
B)  Terbutaline sulfate (Brethine) 
C)  Calcium gluconate (Calgonate) 
D)  Magnesium sulfate 
A)  Buccal oxytocin (Pitocin) 
B)  Terbutaline sulfate (Brethine) 
C)  Calcium gluconate (Calgonate) 
D)  Magnesium sulfate

Question 17

A 20-year-old gravida 1, para 0, is determined to be at 42 weeks' gestation on admission to the labor and birth unit. The client is not in labor at the current time but has been sent over by her physician to be admitted for the induction of labor. The client indicates to you that she would rather go home and wait for natural labor to start. How should the nurse respond to the client's request?

Accepted Answer

A)  There is no way to tell if any complications would arise. Because the client is not presenting with any problems, the nurse should call the health care provider and inform her or him of the client's decision to go home and wait. 
B)  Inform the client that there are a number of serious concerns related to a postdate pregnancy and that she would be better off to be monitored in a clinical setting. 
C)  Tell the client that an assessment will be done and if there are no findings indicating that an induction of labor would be favorable, the client will be sent home. 
D)  Tell the client that confirmation of a due date can be off by 2 weeks and possibly be even later than 42 weeks, so it is better to follow the physician's directions. 
A)  There is no way to tell if any complications would arise. Because the client is not presenting with any problems, the nurse should call the health care provider and inform her or him of the client's decision to go home and wait. 
B)  Inform the client that there are a number of serious concerns related to a postdate pregnancy and that she would be better off to be monitored in a clinical setting. 
C)  Tell the client that an assessment will be done and if there are no findings indicating that an induction of labor would be favorable, the client will be sent home. 
D)  Tell the client that confirmation of a due date can be off by 2 weeks and possibly be even later than 42 weeks, so it is better to follow the physician's directions.

Exam 27: Intrapartum Complications

Which is (are) the priority nursing assessment(s) for the client having tocolytic therapy with terbutaline (Brethine)?

A client who has had two previous cesarean births is in active labor when she suddenly complains of pain between her scapulae. Which should be the nurse's priority action?

Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?

A pregnant client who has had a prior obstetric history of preterm labors is pregnant with her third child. The physician has ordered an fFN (fetal fibronectin) test. Which instructions should be given to the client related to this clinical test?

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor?

Which action by the nurse prevents infection in the labor and birth area?

A dose of dexamethasone 12 mg was administered to a client in preterm labor at 8:30 AM on March 12. The nurse knows that the next dose must be scheduled for:

The fetus in a breech presentation is often born by cesarean birth because:

When reviewing the prenatal record of a client at 42 weeks' gestation, the nurse recognizes that induction of labor is indicated based on the finding of:

Emergency measures used in the treatment of a prolapsed cord include which of the following? (Select all that apply.)

A client who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is:

Which technique is least effective for the client with persistent occiput posterior position?

A client with polyhydramnios was admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless, but the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next?

Which presentation is most likely to occur with a hypertonic labor pattern? (Select all that apply.)

During the course of the birth process, the physician suspects that a shoulder dystocia is occurring and asks the nurse for assistance. Which priority action should be taken by the nurse in response to this request?

A client in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for at-home continuation of the tocolytic effect?

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