Question 1

While assisting with a vacuum extraction birth, which should the nurse immediately report to the physician?

Accepted Answer

A)  Maternal pulse rate of 100 bpm 
B)  Maternal blood pressure of 120/70 mm Hg 
C)  Persistent fetal bradycardia below 100 bpm 
D)  Decreased intensity of uterine contractions

Question 2

Which adverse effects can be seen in response to administration of oxytocin (Pitocin) for induction of labor? (Select all that apply.)

Accepted Answer

A)  Maternal hyponatremia 
B)  Uterine tachysystole 
C)  Maternal hypotension 
D)  Reassuring fetal heart pattern 
E)  Decreased variability on fetal tracing

Question 3

Following an external cephalic version, which assessment finding indicates a complication?

Accepted Answer

A)  Onset of irregular contractions 
B)  Maternal blood pressure of 110/70 mm Hg 
C)  Deceleration of FHR to 88 bpm 
D)  Maternal pulse rate of 100 bpm

Question 4

A patient who is a 2-1-0-0-1 at 34 weeks' gestation is interested in a vaginal birth after cesarean section (VBAC) and asks the nurse about this possibility. Which reason for her primary cesarean section would indicate to the nurse that the patient should be discouraged from pursuing this option?

Accepted Answer

A)  Transverse lie 
B)  Prolapsed cord 
C)  Placenta previa 
D)  Cephalopelvic disproportion (CP
D)

Question 5

Which client is most at risk for a uterine rupture?

Accepted Answer

A)  A gravida 4 who had a classic cesarean incision 
B)  A gravida 5 who had two vaginal births and one cesarean birth 
C)  A gravida 3 who has had two low-segment transverse cesarean births 
D)  A gravida 2 who had a low-segment vertical incision for birth of a 10-lb infant

Question 6

The priority nursing care associated with an oxytocin infusion is:

Accepted Answer

A)  measuring urinary output. 
B)  evaluating cervical dilation. 
C)  monitoring uterine response. 
D)  increasing infusion rate every 30 minutes.

Question 7

Which client status is an acceptable indication for serial oxytocin induction of labor?

Accepted Answer

A)  Multiple fetuses 
B)  Polyhydramnios 
C)  History of long labors 
D)  Past 42 weeks of gestation

Question 8

The pregnant client is admitted to the labor and birth unit for induction of labor. Which finding would allow the induction to continue as planned?

Accepted Answer

A)  Abruptio placentae 
B)  Cephalopelvic disproportion 
C)  Ripening of the cervix 
D)  Umbilical cord prolapse

Question 9

Which of the following factors would lead to an increased risk for a prolapsed cord to occur during an amniotomy?

Accepted Answer

A)  Presenting part engaged 
B)  Postdated pregnancy 
C)  Preterm pregnancy 
D)  Term pregnancy

Question 10

When the client receiving an oxytocin (Pitocin) drip at 16 mU/min develops hypertonic stimulation, FHR 138 bpm with accelerations, and no decelerations, the nurse's best response would be to:

Accepted Answer

A)  stop the drip immediately. 
B)  decrease the dose to 14 mU/min. 
C)  reassess the patient at 5 minute intervals. 
D)  reposition the patient to the left side-lying position.

Question 11

A maternal indication for the use of vacuum extraction is:

Accepted Answer

A)  a wide pelvic outlet. 
B)  maternal exhaustion. 
C)  a history of rapid deliveries. 
D)  failure to progress past 0 station.

Question 12

A client who is receiving oxytocin (Pitocin) infusion for the augmentation of labor is experiencing a contraction pattern of more than eight contractions in a 10-minute period. Which intervention would be a priority?

Accepted Answer

A)  Increase rate of Pitocin infusion to help spread out contraction pattern. 
B)  Place oxygen on client at 8 to 10 L/min via face mask and turn client to left side. 
C)  Stop Pitocin infusion. 
D)  Call physician to obtain an order for initiation of magnesium sulfate.

Question 13

The labor nurse is developing a plan of care for a patient admitted in active labor with spontaneous rupture of the membranes 6 hours prior to admission with clear fluid. On admission, vital signs were as follows: maternal heart rate (HR) 92 bpm; fetal rate (FHR) baseline, 150 to 160 bpm; blood pressure, 124/76 mm Hg; temperature 99° F [37.2° C]. What is the priority nursing action for this patient?

Accepted Answer

A)  Fetal acoustic stimulation 
B)  Assess temperature every 2 hours 
C)  Change absorption pads under her hips every 2 hours 
D)  Review white blood cell count (WB
C)  drawn at admission

Question 14

Which assessment finding is indicative of a major complication 1 hour following a forceps birth?

Accepted Answer

A)  Uterine fundus displaced at U + 1 
B)  Complaints of vaginal and uterine pain 
C)  Peripads showing moderate lochia rubra 
D)  Increase in pulse rate from 90 to 110 bpm

Question 15

A gravida 2, para 1 client is admitted to the labor and birth unit in labor. She states that she had a cesarean birth with her first pregnancy. The most critical information the nurse must obtain at this point is:

Accepted Answer

A)  the onset of contractions. 
B)  her estimated date of birth. 
C)  when the client ate last and what she consumed. 
D)  the type of uterine incision with the first pregnancy.

Question 16

The health care provider has prescribed an initial rate of 6 mU/min of diluted Pitocin to be started to augment labor for a client having arrested labor. At which setting will the nurse set the infusion pump (in mL/hr) if the dilution of the Pitocin is 10 U of Pitocin in 1000 mL of 0.25 normal saline? Record your answer as a whole number.
_______ mL/hr

Accepted Answer

The answer of The health care provider has prescribed an...

Question 17

To monitor for potential hemorrhage in the client who has just had a cesarean birth, which action should the recovery room nurse implement?

Accepted Answer

A)  Monitor her urinary output. 
B)  Maintain an intravenous infusion at 1 mL/hr. 
C)  Assess the abdominal dressings for drainage. 
D)  Assess the uterus for firmness every 15 minutes.

Question 18

The nurse is preparing to administer a vaginal prostaglandin preparation to ripen the cervix of a client. With which client should the nurse question the use of vaginal prostaglandin as a cervical ripening agent?

Accepted Answer

A)  The client who has a Bishop's score of 5 
B)  The client who is at 42 weeks of gestation 
C)  The client who had a previous low transverse cesarean birth 
D)  The client who had previous surgery in the upper uterus

Question 19

The pregnant client expresses a desire to schedule birth during the baby's father's furlough from the Army. The nurse explains that prior to induction of labor, it is essential to determine which condition?

Accepted Answer

A)  Dilated cervix 
B)  Fetal lung maturity 
C)  Rupture of membranes 
D)  Uterine hypertonia

Question 20

Which clinical finding indicates the use of vacuum extraction as a birth method?

Accepted Answer

A)  Mentum presentation of the fetus 
B)  Presence of caput succedaneum 
C)  Maternal exhaustion as a result of ineffective pushing during second stage of labor 
D)  Physician preference

Exam 16: Nursing Care During Obstetric Procedures