Deck 19: Nursing Care during Obstetric Procedures

Question 1

What is an appropriate response to a woman's comment that she is worried about having a cesarean birth?

A) "Don't worry. Everything will be okay."
B) "What are your feelings about having a cesarean birth?"
C) "I know you're worried, but this is a routine procedure."
D) "Patients commonly worry about surgery."

Answer 1

"What are your feelings about having a cesarean birth?"

Question 2

An indication for an episiotomy would be a woman who

A) has a routine vaginal birth.
B) has fetal shoulder dystocia.
C) is delivering a preterm infant.
D) has a history of rapid deliveries.

Answer 2

has fetal shoulder dystocia.

Question 3

The nurse knows that a urinary catheter is added to the instrument table if a forceps-assisted birth is anticipated.What is the correct rationale for this intervention?

A) Spontaneous release of urine might contaminate the sterile field.
B) An empty bladder provides more room in the pelvis.
C) A sterile urine specimen is needed preoperatively.
D) A Foley catheter prevents the membranes from spontaneously rupturing.

Answer 3

An empty bladder provides more room in the pelvis.

Question 4

When preparing a woman for a cesarean birth,the nurse's care should include

A) injection of narcotic preoperative medications.
B) full perineal shave preparation.
C) straight catheterization to empty the bladder.
D) administration of an oral antacid.

Question 5

For which patient should the oxytocin (Pitocin)infusion be discontinued immediately?

A) A woman in active labor with contractions every 31 minutes lasting 60 seconds each
B) A woman in transition with contractions every 2 minutes lasting 90 seconds each
C) A woman in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each
D) A woman in early labor with contractions every 5 minutes lasting 40 seconds each

Question 6

After an amniotomy,which action by the nurse takes priority?

A) Assess the color of the amniotic fluid.
B) Change the patient's gown.
C) Estimate the amount of amniotic fluid.
D) Assess the fetal heart rate.

Question 7

The nurse caring for a woman in labor understands that the primary risk associated with an amniotomy is

A) maternal infection.
B) maternal hemorrhage.
C) prolapse of the umbilical cord.
D) separation of the placenta.

Question 8

After a forceps-assisted birth,the mother is observed to have continuous bright red lochia but a firm fundus.What other finding is important to correlate with these data?

A) Mild, intermittent perineal pain
B) Edema and discoloration of the labia and perineum
C) Lack of an episiotomy
D) Lack of pain in the perineal area

Question 9

A nursing faculty member explains to students that which patient status is an acceptable indication for serial oxytocin induction of labor?

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

Question 10

The greatest risk to the newborn after an elective cesarean birth is

A) trauma due to manipulation during delivery.
B) tachypnea due to maternal anesthesia.
C) prematurity due to miscalculation of gestation.
D) tachycardia due to maternal narcotics.

Question 11

Prior to cesarean birth,the nurse places the indwelling catheter and tubing in which manner?

A) Placed on the floor on a sterile drape
B) Placed near the head of the table
C) Clamped during the cesarean section
D) Positioned at the foot of the bed

Question 12

Surgical,medical,or mechanical methods may be used for labor induction.Which technique is considered a mechanical method of induction?

A) Amniotomy
B) Intravenous Pitocin
C) Transcervical catheter
D) Vaginal insertion of prostaglandins

Question 13

Before the physician performs an external version,the nurse should expect an order for a

A) tocolytic drug.
B) contraction stress test (CST).
C) local anesthetic.
D) indwelling catheter.

Question 14

Which event indicates a complication of an external version?

A) Maternal pulse rate of 100 bpm
B) Fetal bradycardia persisting 10 minutes after the version
C) Fetus returning to the original position
D) Increased maternal anxiety after the version

Question 15

The nurse understands that which condition is a contraindication for an amniotomy?

A) Dilation less than 3 cm
B) Cephalic presentation
C) -2 station
D) Right occiput posterior position

Question 16

The nurse practicing in a labor setting knows that the woman most at risk for a uterine rupture is a gravida

A) 3 who has had two low-segment transverse cesarean births.
B) 2 who has had a low-segment vertical incision for delivery of a 10-pound infant.
C) 5 who has had two vaginal births and two cesarean births.
D) 4 who has had four cesarean births.

Question 17

A maternal indication for the use of vacuum extraction is

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

Question 18

The priority nursing care associated with an oxytocin (Pitocin)infusion is

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

Question 19

Immediately after the forceps-assisted birth of an infant,which action by the nurse is next?

A) Assess the infant for signs of trauma.
B) Give the infant prophylactic antibiotics.
C) Apply a cold pack to the infant's scalp.
D) Measure the circumference of the infant's head.

Question 20

The standard of care for obstetrics dictates that an internal version might be used to manipulate the

A) fetus from a breech to a cephalic presentation before labor begins.
B) fetus from a transverse lie to a longitudinal lie before cesarean birth.
C) second twin from an oblique lie to a transverse lie before labor begins.
D) second twin from a transverse lie to a breech presentation during vaginal birth.

Question 21

A woman is receiving oxytocin to augment labor.The nurse notes that the Montevideo units are measured at 560 and the fetus is showing late decelerations.What action by the nurse takes priority?

A) Notify the charge nurse of the situation.
B) Document the findings in the chart.
C) Increase the rate of oxytocin slowly.
D) Stop the oxytocin infusion.

Question 22

To monitor for potential hemorrhage in the woman who has just had a cesarean birth,what action by the recovery room nurse is most appropriate?

A) Maintain an intravenous infusion at 100 mL/hr.
B) Assess the abdominal dressings for drainage.
C) Assess the uterus for firmness every 15 minutes.
D) Monitor her urinary output.

Question 23

The labor and delivery nurse learns that recommendations from ACOG related to VBAC risks include which of the following? (Select all that apply.)

A) Immediate availability of the obstetric provider
B) Delivery at a tertiary care center
C) Availability of anesthesia personnel
D) Personnel who can assist with the cesarean birth
E) Use of misoprostol for cervical ripening

Question 24

The labor and delivery nurse must be cognizant of the specific conditions appropriate for labor induction,including which of the following? (Select all that apply.)

A) Rupture of membranes at or near term
B) Convenience of the woman or her physician
C) Chorioamnionitis
D) Postterm pregnancy
E) Fetal death

Question 25

A nurse assesses a woman and gathers the following data:
Dilation: 4 cm
Effacement: 60%
Fetal station: 0
Cervical consistency: medium
Cervical position: middle
Calculate this woman's Bishop score ____________

Question 26

While assisting with a vacuum extraction birth,what should the nurse immediately report to the provider?

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

Question 27

A woman is going to have a vaccum extraction delivery.What nursing intervention is most important to prevent complications?

A) Empty the woman's bladder.
B) Apply cold packs to the perineum.
C) Assess vital signs after the procedure.
D) Monitor the woman's temperature.

Question 28

A new graduate nurse is preparing to hang oxytocin for a woman to augment her labor.What action by the new nurse warrants intervention from the preceptor?

A) Adds oxytocin to the IV as a piggyback
B) Programs the IV pump for a primary infusion
C) Assesses FHR and uterine activity prior to starting the infusion
D) Attaches the infusion line to the proximal port