Maternity test 3
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What are the appropriate nursing interventions when a fetus is found to be in a transverse (perpendicular) lie during labor or antenatal assessment?

  • Contact Provider (correct)
  • Encourage walking
  • Administer medication
  • Perform a vaginal examination

    • How does labor progress when the fetus is in a face presentation?

  • Because Fetal neck is extended - labor may progress slower than anticipated (correct)
  • Because Fetal neck is flexed - labor usually progresses normally
  • Fetal position does not affect labor progression
  • Labor is expedited in face presentation

    • While assessing a laboring patient, the nurse reviews the factors influencing labor progression. What are the P's of labor? (Select all that apply)

  • Passenger - Directly relates to fetus (correct)
  • Passage - Refers to the maternal pelvis and surrounding soft tissue (correct)
  • Powers - Maternal efforts during labor including pushing (correct)
  • Position - Maternal position (correct)
  • Psyche - Emotional state of the client (correct)
  • Presentation- How the fetus is positioned

    • During fetal heart rate (FHR) monitoring, the nurse observes a sinusoidal pattern on the tracing. What are the appropriate nursing actions when a sinusoidal FHR pattern is detected?

    <p>Intrauterine resuscitation (Increase of fetal oxygenation) (A)</p> Signup and view all the answers

    A nurse is monitoring a patient in labor and notes a Category II FHR tracing on the fetal monitor. What are the characteristics of a Category II FHR tracing? (Select all that apply)

    <p>Bradycardia (A), Minimal baseline variability - Prolonged deceleration (B), Variable or late deceleration with minimal or moderate baseline variability (C)</p> Signup and view all the answers

    The nurse is applying external fetal monitoring and places the tocodynamometer on the patient’s abdomen. What is the purpose of the tocodynamometer (TOCO) transducer?

    <p>External sensor that provides information related to the duration and frequency of contractions (A)</p> Signup and view all the answers

    While monitoring a laboring client, the nurse evaluates uterine contractions to assess fetal well-being. What are the key characteristics of uterine contractions that influence fetal oxygenation?

    <p>Uterine relaxation between contractions is essential to ensure fetal oxygenation (A)</p> Signup and view all the answers

    What smooth muscle adaptations occur during labor to promote the expulsion of the fetus? (Select all that apply)

    <p>Stretching of pelvic smooth muscle (A), Facilitates cervical dilation (B)</p> Signup and view all the answers

    What immediate nursing actions should be taken when an umbilical cord prolapse is detected during a vaginal examination? (Select all that apply)

    <p>Repositioning - Client in a knee-chest position (A), Oxygen - IV Fluids - Discontinue uterotonic meds (B), If persistent after interventions - notify provider - facilitate emergent birth (C)</p> Signup and view all the answers

    A laboring client reports a sudden gush of fluid before contractions begin. When does rupture of membranes typically occur in relation to labor contractions?

    <p>Rupture of membranes usually occurs before contractions start (A)</p> Signup and view all the answers

    What maternal physiological adaptations occur during labor to promote fetal oxygenation? (Select all that apply)

    <p>Increased cardiac output - promotes fetal oxygenation (A), Increased uterine contractions - assists in fetal positioning (D)</p> Signup and view all the answers

    A nurse is reviewing a laboring client's lab results which show an elevated white blood cell (WBC) count. What should the nurse do next?

    <p>Monitor temperature (A)</p> Signup and view all the answers

    A client in active labor expresses concern about losing control of their bladder. What nursing interventions should be implemented for a client experiencing incontinence during labor?

    <p>Provide absorbent pads for the client (A)</p> Signup and view all the answers

    A new parent asks the nurse why their newborn’s head appears elongated after delivery. How should the nurse explain the causes of an elongated head in a newborn?

    <p>Due to molding, which are spaces between the fetal skull bones that allow the fetal head to change shape. (A)</p> Signup and view all the answers

    How do dilation, effacement, and fetal station describe the progress of labor in the first stage? (Select all that apply)

    <p>Dilation: widening or opening of the cervix (A), Effacement: thinning and shortening of the cervix (B), Station: (Fetal station) Is the fetal position within the maternal pelvis related to the maternal ischial spine, bony prominences within the pelvis (C)</p> Signup and view all the answers

    The nurse notices that the tocodynamometer is not displaying contractions accurately on the monitor. What steps should the nurse take to troubleshoot and correct issues with an inaccurate tocodynamometer reading?

    <p>Alert the provider that it may not be producing satisfactory recordings (A)</p> Signup and view all the answers

    During fetal monitoring, the nurse observes late decelerations on the fetal heart tracing. What nursing actions should be taken when late decelerations are recorded, and what do they indicate about fetal well-being? (Select all that apply)

    <p>Reposition client to left lateral position (A), If no recovery to baseline, emergent birth is necessary (B)</p> Signup and view all the answers

    The fetal monitor shows persistent bradycardia below 110 bpm. What are the priority nursing interventions when persistent fetal bradycardia is detected?

    <p>If persistent after intervention, notify provider (A)</p> Signup and view all the answers

    The nurse notes a sustained fetal heart rate above 160 bpm. What are the potential causes of fetal tachycardia, and how should the nurse assess and respond to this finding? (select all that apply)

    <p>Maternal Fever (A), Maternal dehydration (B)</p> Signup and view all the answers

    What is visceral pain, and how does it present during the different stages of labor?

    <p>Uterine contraction. (A), Cervical dilation. (B), First stage of labor – lower abdomen, back, legs (C)</p> Signup and view all the answers

    As labor progresses, a client describes sharp, localized pain in the perineal area. What is somatic pain, and how does it differ from visceral pain during labor?

    <p>Fetal head pressure in perineum. (A), Stretching of pelvic muscles. (B), Perineal tissue stretching. (C)</p> Signup and view all the answers

    What should a nurse recognize about how cultural practices influence pain perception? (Select all that apply)

    <p>Beliefs and practices (A), Culturally-specific pain relief practices that are safe (B)</p> Signup and view all the answers

    A client in labor expresses extreme anxiety, which appears to be worsening their perception of pain. What interventions can help reduce anxiety and its impact on labor pain?

    <p>Support from care partner is vital (A)</p> Signup and view all the answers

    A maternal client experiencing high levels of anxiety is showing signs of distress during labor. What are the potential physiological outcomes of excessive anxiety during labor?

    <p>Arrest of labor (A)</p> Signup and view all the answers

    What signs indicate that a laboring client is coping well with pain? (Select all that apply)

    <p>Moaning (A), Rhythmic movements and breathing (B), Relaxed between contractions (C)</p> Signup and view all the answers

    A client in labor is experiencing severe back pain and requests alternatives to pain medication. What non-pharmacological techniques can be used to manage back pain during labor?

    <p>Counter-Pressure - Most helpful for pain in back (A)</p> Signup and view all the answers

    A client with a history of anxiety and psychosis is in labor and expresses distress about pain management options. What non-pharmacological techniques are appropriate for pain relief in a laboring client with a history of anxiety and psychosis?

    <p>Support- Can decrease pain and anxiety (A), Deep breathing exercises - Can help reduce anxiety (B), Hypnosis (C)</p> Signup and view all the answers

    A client receiving opioid pain medication experiences respiratory depression. What is the opioid antagonist used to reverse opioid effects?

    <p>Naloxone (A)</p> Signup and view all the answers

    A client sustains a second-degree perineal laceration during delivery. What is the best management option for repairing perineal lacerations?

    <p>Prudential Nerve Block (A)</p> Signup and view all the answers

    A laboring client who received an epidural reports dizziness and hypotension. What are the potential complications of an epidural? (Select all that apply)

    <p>Infection-Severe headache (A), Epidural Hematoma (B), Respiratory depression in the newborn (C)</p> Signup and view all the answers

    A client who received opioid analgesia for labor pain complains of nausea. What nursing interventions can help manage nausea caused by opioid administration during labor?

    <p>Anti emetics - Ondansetron (A)</p> Signup and view all the answers

    What pain management methods are commonly used for a cesarean section? (Select all that apply)

    <p>Spinal or intrathecal block (A), Opioid, local, or combination (B), Fentanyl, morphine, lidocaine, bupivacaine (C)</p> Signup and view all the answers

    A client undergoing an emergency C-section requires general anesthesia. What are the potential complications of general anesthesia?

    <p>Postpartum hemorrhage due to decreased uterine tone (A)</p> Signup and view all the answers

    What are the contraindications for an epidural? (Select all that apply)

    <p>Spinal anomalies (spina bifida, scoliosis) (A), Coagulopathy (excess bleeding) or hypovolemia that has not been addressed (B), Spine that is not stable or limitations in spinal positioning (C), Anomalies with CNS (multiple sclerosis, syringomyelia) - Cardiac anomalies (aortic stenosis) (D), Allergy to opioids/sepsis or infection around the site where catheter will be placed (@), Increase in intracranial pressure (@)</p> Signup and view all the answers

    What nursing assessments and interventions are required when removing an epidural catheter postpartum? (Select all that apply)

    <p>Turn off infusion and waste the remaining medication with another nurse (A), Check for pain and bleeding at the site (B), Monitor for signs and symptoms of infection (C), Ensure the tip of the catheter is intact (D)</p> Signup and view all the answers

    What labor positions can help reduce pain and promote comfort during contractions? (Select all that apply)

    <p>Ambulation (A), High-fowler's position (B), Squatting (C)</p> Signup and view all the answers

    What are the contraindications for a client having a home birth, and when is a hospital birth recommended? (Select all that apply)

    <p>High Risk Pregnancy (A), Needs to be Safety and quick access to a hospital (B)</p> Signup and view all the answers

    What is the purpose of an episiotomy, and under what circumstances is it typically performed? (Select all that apply)

    <p>Should only be performed for clients who have an increased risk of perineal tear greater than a second degree. (A), Birth needs to happen in a timelier fashion due to fetal distress. (B)</p> Signup and view all the answers

    What interventions can help reduce the risk of hypothermia in newborns? (Select all that apply)

    <p>Body temperature / place infant in warmer (A), Skin-to-skin to prevent hypothermia (B), Dry with a towel and stimulate / Put on a hat (C)</p> Signup and view all the answers

    A postpartum nurse is assessing a client’s vaginal bleeding. How should the nurse accurately measure and document lochia? (Select all that apply)

    <p>From birth to 24 hours, should not exceed 1000 mL (A), Use gram scale to weigh pads (B)</p> Signup and view all the answers

    What are the signs of respiratory distress in a newborn? (Select all that apply)

    <p>Grunting and nasal flaring (A)</p> Signup and view all the answers

    A client presents with moderate vaginal bleeding and abdominal pain. What are the priority nursing actions for a client experiencing moderate acute placental abruption? (select all that apply)

    <p>Prep for emergent birth (A), Treat blood loss (B), Nursing: NPO, Informed consent, IV access, FHR patterns and maternal VS and indwelling catheter (C)</p> Signup and view all the answers

    What nursing interventions are required to manage chorioamnionitis in a client diagnosed during labor? (Select all that apply)

    <p>Educate client on treatment for chorioamnionitis (A), Notify neonatology provider to attend birth (B), Monitor maternal temperature, administer IV antibiotics, and assure pain control (C)</p> Signup and view all the answers

    A nurse is caring for a client receiving magnesium sulfate for preeclampsia. What assessments and monitoring are essential for a client receiving magnesium sulfate? ( select all that apply)

    <p>Fetal HR and Maternal Respiratory Rate (A), Fetal HR Patterns and Uterine activity (B), Urine output (C)</p> Signup and view all the answers

    A client undergoes an external cephalic version for breech presentation. What nursing interventions should be performed before, during, and after the procedure? (Select all that apply)

    <p>Determine client's understanding of procedure / provide illustration (A), Prescription for Tocolytic (B), Verify blood type and RH Factor - Prep for emergency C-section if indicated (C)</p> Signup and view all the answers

    A client asks about risk factors for placental abruption. What factors increase the risk of placental abruption? (Select all that apply)

    <p>Preclampsia/Eclampsia (A), Gestational Diabetes - Low Hemoglobin (B), Artificial ROM - Multiples (C)</p> Signup and view all the answers

    The nurse is assessing the uterine fundus after birth. How is the postpartum fundus measured, and what are the expected findings? (Select all that apply)

    <p>12 hours postpartum - the fundus rises to at or below the umbilicus (B), Should be firm, nontender, globular, and located between symphysis pubic and umbilicus (A), The uterus decreases in size by about 1 cm per day to go back to between symphysis pubis and the umbilicus - end of first week postpartum (C)</p> Signup and view all the answers

    What changes in lab values and blood volume are expected after vaginal birth? (Select all that apply)

    <p>Hemoglobin and hematocrit decrease first and then gradually increase; clotting factors and fibrinogen also increase. (A), WBCs can increase to about 25,000. (B)</p> Signup and view all the answers

    A nurse assesses a postpartum client’s cervix. What cervical changes occur after birth? (Select all that apply)

    <p>External os becomes a transverse slit (A), Heals within a few weeks postpartum (B)</p> Signup and view all the answers

    How should the nurse describe lochia characteristics on a perineal pad during a postpartum assessment? (Select all that apply)

    <p>Scant (less than 2.5 cm on pad) (A), Light (less than 10 cm on the pad) (B), Moderate (15 cm on the pad) (C), Heavy (pad saturated in 1 hour) (D)</p> Signup and view all the answers

    A postpartum client's uterus feels boggy during assessment. What nursing interventions should be performed for a boggy uterus? (Select all that apply)

    <p>Perform fundal massage (A), Assist client to empty bladder (B)</p> Signup and view all the answers

    A client is at high risk for postpartum hemorrhage. What factors increase the risk for postpartum hemorrhage? (Select all that apply)

    <p>Uterine Atony (boggy uterus) (A), Retained placenta (B), Lacerations (C)</p> Signup and view all the answers

    A postpartum client experiences heavy vaginal bleeding. What medications are commonly prescribed for excessive postpartum vaginal bleeding?

    <p>Uterotonics- Oxytocin, misoprostol, Tranexamic, Methylergonovine (A), Tocolytics- for uterine relaxation during surgical procedures (B)</p> Signup and view all the answers

    What are the potential complications of applying traction to the umbilical cord during placental delivery?

    <p>Incomplete, complete, prolapsed, total (A), Sensation of bearing down and lower abdominal pain (B)</p> Signup and view all the answers

    A provider suspects a client may have placenta accreta. What risk factors contribute to placenta accreta?(select all that apply)

    <p>Primigravida- Maternal age &gt; 35 (A), History of endometriosis (B), Uterine Atony - Uterine Fibroids-smoking (C)</p> Signup and view all the answers

    What are the risk factors for postpartum hemorrhage that can lead to maternal shock? (Select all that apply)

    <p>History of PPH (A), BMI&gt;40 (B)</p> Signup and view all the answers

    What are the risk factors for deep vein thrombosis in the postpartum period? (Select all that apply)

    <p>BMI &gt; 35 (A), Pre-existing Diabetes (B)</p> Signup and view all the answers

    What diagnostic tests are used to confirm deep vein thrombosis in the postpartum period? (Select all that apply)

    <p>D-Dimer (A), Ultrasound (B)</p> Signup and view all the answers

    A postpartum client with an infection begins to exhibit worsening symptoms. What are the signs that a postpartum infection is progressing to sepsis?

    <p>Hypotension, Hypoxia, Hypothermia, Tachycardia (A)</p> Signup and view all the answers

    A breastfeeding client with mastitis seeks pain relief options. What nonpharmacological therapies can help manage mastitis-related breast pain?

    <p>Cold compresses (A)</p> Signup and view all the answers

    Which hereditary bleeding disorder increases the risk for postpartum hemorrhage?

    <p>Von Willebrand Disease (B)</p> Signup and view all the answers

    A postpartum client experiences excessive bleeding and hypotension. What physician orders should the nurse anticipate for managing postpartum hemorrhage and hypotension?

    <p>Active Management strategies and shock index monitoring (A), Laboratory and diagnostic testing: fibrinogen, hemoglobin, platelet count (B), Infusion of fibrinogen concentrate, packed red blood cells, or platelets as needed (C)</p> Signup and view all the answers

    What are the priority medications used to manage immune thrombocytopenic purpura (ITP) in postpartum clients experiencing bleeding complications? (Select all that apply)

    <p>Oral corticosteroids (A), Tranexamic acid (bleeding) (B)</p> Signup and view all the answers

    What medication is used for newborn eye prophylaxis, and what is its purpose?

    <p>Erythromycin 0.9% ophthalmic ointment - within 1 hour to prevent Neonatal Ophthalmia (A)</p> Signup and view all the answers

    During labor, the nurse notices the umbilical cord protruding from the vaginal canal before the fetal head. What is an overt prolapse?

    <p>Cord slips through dilated cervix and becomes compressed by the fetal presenting part (A)</p> Signup and view all the answers

    What is an occult umbilical cord prolapse? ( select all that apply)

    <p>Can occur with intact membranes (A), Cord is compressed between cervix and presenting part, preventing presenting part from being observed or felt (B)</p> Signup and view all the answers

    What happens during a uterine rupture, and what are the priority nursing interventions?

    <p>Obstetric emergency - Three layers of uterus tear apart (A)</p> Signup and view all the answers

    A nurse is performing Leopold's maneuvers to assess fetal positioning. How can they help determine if a fetus is in a breech presentation?

    <p>Clinical presentation - Soft mass above symphysis pubic (A)</p> Signup and view all the answers

    During delivery, the fetal head delivers, but the shoulders fail to emerge. What are the clinical signs of shoulder dystocia?

    <p>&quot;Turtle sign&quot; - Fetal head emerges and then retracts (A)</p> Signup and view all the answers

    Match the following fetal positions with their corresponding abbreviations:

    <p>Right Occiput Anterior = ROA Right Occiput Posterior = ROP Right Occiput Transverse = ROT</p> Signup and view all the answers

    Match the following left fetal positions with their abbreviations:

    <p>Left Occiput Anterior = LOA Left Occiput Posterior = LOP Left Occiput Transverse = LOT</p> Signup and view all the answers

    Match the following fetal positions for mentum with their abbreviations:

    <p>Right Mentum Posterior = RMP Left Mentum Anterior = LMA Right Mentum Anterior = RMA</p> Signup and view all the answers

    What are the fetal positions for the Sacrum? (Select all that apply)

    <p>Left Sacrum Anterior (L.S.A) (A), Left Sacrum Posterior (L.S.P) (B)</p> Signup and view all the answers

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