Deck 8: Nursing Care of Women With Complications During Labor and Birth

Question 1

A pulsating structure is felt during a vaginal examination of a woman in labor. To prevent compression of a prolapsed cord, the nurse would position the woman:

A) On her hands and knees
B) On her left side with a pillow placed between her legs
C) On her back with her head lower than the rest of her body
D) Supine with her legs elevated and bent at the knee

Answer 1

On her back with her head lower than the rest of her body

Question 2

Several hours after delivery the nurse finds a woman crying. The woman says repeatedly, "My baby is beautiful, but I was planning on a vaginal delivery. Instead I needed an emergency C-section." The most appropriate nursing diagnosis is:

A) Anxiety related to the development of postpartum complications
B) Ineffective individual coping related to unfamiliarity with procedures
C) Risk for ineffective parenting related to emergency cesarean section
D) Grieving related to loss of expected birth experience

Answer 2

Grieving related to loss of expected birth experience

Question 3

The frustrated patient in hypotonic labor complains "My doctor won't induce my labor because of some silly Bishop score. He said I was a 4. What kind of magic number do I need?" The nurse explains that prior to induction the patient should be a Bishop score of at least:

A) 6
B) 8
C) 10
D) 12

Answer 3

6

Question 4

The initial vaginal examination of a woman admitted to the labor unit reveals that the cervix is dilated 9 cm. The panicked woman asks the nurse, "Please give me something." The most appropriate pain relief intervention for a woman in precipitate labor is to:

A) Get an order for an intravenous narcotic
B) Notify the anesthesiologist for an epidural block
C) Stay and breathe with her during contractions
D) Tell her to bear with it because she is close to delivery

Question 5

When a woman is admitted to the labor and delivery unit, she tells the nurse that she is anxious about delivery, anxious about the welfare of her baby, anxious about how quickly she will recover…in short, anxious about everything. The nurse is aware that anxiety can affect labor by:

A) Decreasing a woman's pain sensitivity
B) Reducing blood flow to the uterus
C) Increasing the ability to tolerate pain
D) Enhancing maternal pushing through greater muscle tension

Question 6

The nurse is administering terbutaline (Brethine) to a pregnant woman to prevent preterm labor. The nurse would assess for which adverse effect?

A) Maternal tachycardia
B) Maternal hypertension
C) Fetal bradycardia
D) Fetal hypokalemia

Question 7

The statement that indicates a woman understands activity limitations for the management of preterm labor is:

A) "After my shower in the morning, I do the laundry and straighten up the house, then I rest."
B) "I pack a picnic basket and put it next to the sofa so I do not have to get up for food during the day."
C) "I have a 2-year-old to care for, but I try to rest as much as I can."
D) "I get really bored at home, so I go to the shopping mall for just a little while."

Question 8

A woman who is 33 weeks pregnant is admitted to the obstetrical unit because her membranes ruptured spontaneously. She must be closely observed for signs of:

A) Chorioamnionitis
B) Hemorrhage
C) Hypotension
D) Amniotic fluid embolism

Question 9

When a hypotonic labor dysfunction occurs in a patient who is dilated to 5 cm with membranes intact, the nurse informs the patient that the physician most likely will:

A) Perform an amniotomy
B) Initiate tocolytic drugs
C) Order a sedative for the patient
D) Plan to do an emergency cesarean section

Question 10

A woman 2 weeks past her expected delivery date who is receiving an oxytocin infusion to induce labor begins to have contractions every 90 seconds. The nurse's initial action should be to:

A) Stop the oxytocin infusion
B) Continue the infusion and report the findings to the physician
C) Turn her on her left side and reassess the contractions
D) Administer oxygen by mask

Question 11

Following an amniotomy, the nursing assessment that should be reported immediately is:

A) Fetal heart rate is regular at 154 beats/min
B) Amniotic fluid is clear with flecks of vernix
C) Amniotic fluid is watery and pale green
D) Maternal temperature is 37.8°C

Question 12

A woman who is 24 weeks pregnant is placed on an IV infusion of magnesium sulfate. The nurse should inform the patient that she might experience the side effect of this drug which is:

A) Nausea and vomiting
B) Headache
C) Warm flush
D) Urinary frequency

Question 13

The new mother is distressed and tearful about the elevated dome over her baby's posterior fontanelle. The nurse's best response is, "This condition will resolve itself in a few days. It is caused by:

A) Prolonged pressure against the partially dilated cervix."
B) Small leak of fluid through the posterior fontanel."
C) Pressure of the forceps during delivery."
D) The effect of the vacuum extractor."

Question 14

A woman is having a difficult labor because the fetus is presenting in the right occipital position (ROP). To encourage fetal rotation and pain relief the nurse would position the patient:

A) Prone with legs supported and give her a back massage
B) Supine with legs bent at the knee
C) Standing with support
D) Sitting up and leaning forward on the over-bed table

Question 15

After several hours of labor, a nursing assessment reveals that a woman's cervix is 5 cm dilated but contractions are becoming shorter and less frequent. The nurse knows that this labor pattern is described as:

A) Normal
B) Hypotonic
C) Hypertonic
D) False

Question 16

The nursing care of a woman with a third-degree laceration immediately after delivery would include:

A) Warm compresses to the perineum
B) Cold pack to the perineum
C) Warm sitz bath
D) Elevation of hips to prevent edema

Question 17

The nurse would assess an infant delivered with the use of forceps for:

A) Loss of hair from contact with forceps
B) Sacral hematoma
C) Facial asymmetry
D) Shoulder dislocation

Question 18

A pregnant woman's membranes ruptured prematurely at 34 weeks. She will be discharged to her home for the next few weeks. The nurse planning discharge instructions would teach the woman to:

A) Report any increase in fetal activity
B) Notify her obstetrician for a temperature above 37.8°C
C) Massage her breasts to promote uterine relaxation
D) Rest in a side-lying Trendelenburg position with hips elevated

Question 19

During a strenuous labor, the woman asks for some pain remedy for the sudden pain between her scapulae which seems to occur with every breath she takes. The nurse should:

A) Give the pain remedy
B) Notify the charge nurse immediately
C) Turn patient to her back and flex her knees
D) Suggest that the coach give her a back rub

Question 20

A student nurse questions the instructor as to what alteration should be made for the assessment of the fundus of a new postoperative cesarean section patient. The best response is that the fundus of a patient with a cesarean section is:

A) Not assessed until the second postoperative day
B) Gently assessed as usual
C) Assessed only if large clots appear in lochia
D) Only once every shift

Question 21

Following an amniotomy, the umbilical cord becomes depressed. The nurse prepares the client for an installation of a bolus of warm sterile saline into the uterus, which is called ____________________.

Question 22

The nurse explains to a client that a minimum score of ____________________ on the Bishop scale is predictive of successful labor induction.

Question 23

The nurse reviews for the childbirth preparation class the rationales for labor induction, which are: Select all that apply.

A) Placenta previa
B) Prolapse of cord
C) High station of fetus
D) Maternal diabetes
E) Placental insufficiency

Question 24

After an amniotomy, the nurse is alert for signs of infection which would include: Select all that apply.

A) Oral temperature of 99.8°F
B) Increase in FHR to 172 beats/min
C) Flecks of vernix in the amniotic fluid
D) Low back pain
E) Edematous labia

Question 25

The client has been declared to be in hypotonic labor. Among the interventions a nurse could apply to help the labor progress are: Select all that apply.

A) Encouraging the client to sit upright
B) Assisting client to ambulate
C) Stimulating the nipples
D) Offering emotional support
E) Allowing client to vent frustration