Question 1

What actions by the nursing staff would be beneficial for parents who have lost a newborn?

Accepted Answer

Perinatal loss is difficult for all concerned.Some interventions that have been found to be helpful include acknowledging the baby as a person by using his or her name; cleaning the baby and wrapping him or her in a blanket or dressing the child appropriately (so the baby looks warm and tended to); explaining how the baby will look,especially if the child does not have normal features; and giving the parents photographs and other memorabilia of their child.If the child is not in a favorable condition for photographs,a professional photographer is important.The family should always be encouraged to hold,touch,and cuddle the baby after death.

Question 2

The nurse explains to a class of nursing students that which of the following are the main predictors of medically indicated and elective cesarean birth?

Accepted Answer

The main predictors of elective or medically indicated cesarean births are assisted reproductive technology,induced labor prior to 39 weeks' gestation,maternal age older than 35,and multiple-gestation pregnancy (especially higher-order multiples).Native Americans have only a 28% rate of cesarean delivery,the lowest among major ethnic groups.

Question 3

A woman is admitted to the birthing unit in her 42nd week of pregnancy.What interventions does the nurse plan for this patient?

Accepted Answer

This woman is 2 weeks postterm and due to the deterioration of the placenta and subsequent fetal hypoxia,she has been admitted for induction.Emotional support is always necessary,but the nurse needs to be prepared to do more than just offer emotional support.Frequent vaginal checks are not indicated in the nonlaboring patient.This woman may or may not need a cesarean delivery.

Question 4

A woman is asking about a cesarean birth.The nurse explains that which of the following are appropriate indications for this type of birth?

Accepted Answer

Cesarean birth should be reserved for instances where the health of the mother or her fetus is jeopardized.Many conditions can lead to the need for a cesarean birth,but maternal request is not one of them.

Question 5

A nurse is caring for a woman who has an order for a high-dose oxytocin (Pitocin)regimen to stimulate uterine contractions.Which of the following actions are appropriate for the nurse to take?

Accepted Answer

Oxytocin must be administered safely.The high-dose regimen begins with 4 mU/minute and is increased by the same amount every 30 minutes as needed.Uterine tachysystole can occur and the nurse must assess carefully for the development of this situation.The woman is placed sitting upright or in a side-lying position.Oxytocin should always be infused via an electronic infusion device.

Question 6

A woman has experienced a stillbirth and is now nearing term in her current pregnancy.The husband confides to the nurse: "My wife is driving me crazy.She is totally obsessed with this pregnancy." What response by the nurse is best?

Accepted Answer

Recent research by Nowak and Stevens (2010)demonstrates that watchful vigilance is a common and important behavior in couples at risk for adverse perinatal outcomes.The nurse should share this information with the husband.Telling him that the behavior is common and will go away does not really give him information about this issue.The woman does not need counseling unless there are other,more alarming,behaviors occurring.Telling the husband to go fishing or bowling is dismissive.

Question 7

A nursing professor is describing placental abruption to a class of nursing students.What information is included?

Accepted Answer

Placental abruption is a serious condition that can lead to both fetal and maternal death.Other complications include couvelaire uterus and DIC.Bleeding may be so severe that a hysterectomy is needed.To prevent further damage,vaginal and pelvic exams are not performed.Vaginal birth is desirable; cesarean birth is reserved for cases of fetal distress or other obstetric indications and should not be attempted if the woman has severe and uncorrected coagulopathy.

Question 8

The nurse is caring for a woman who is undergoing an induction with oxytocin (Pitocin).The nurse explains to a nursing student that contraindications to labor induction include which of the following?

Accepted Answer

Absolute contraindications for induction of labor include vasa previa or complete placenta previa,transverse fetal lie,umbilical cord prolapse,previous classical cesarean delivery,active genital herpes infection,and previous myomectomy.Breech presentation and severe hypertension are relative contraindications,meaning that induction is possible,but caution should be exercised.

Question 9

A nurse is working with a nulliparous woman diagnosed with placenta previa.What interventions should the nurse plan to implement if necessary?

Accepted Answer

Interventions that are appropriate for women diagnosed with placenta previa include instruction about the need for prenatal iron and folic acid supplementation.Hemorrhage is possible,so a consent form for blood products may be needed.A forceps delivery is not indicated.Women with suspected placenta accreta should be delivered between 34 and 35 weeks; those with placenta previa should be delivered at 36 to 37 weeks.Women diagnosed with a partial or marginal placenta previa who have no bleeding or minimal bleeding may be allowed to attempt a vaginal birth.

Question 10

A woman is G2P1 TPAL1001and pregnant with her second child.Her first child was born via emergent cesarean delivery.She asks the nurse if a vaginal birth is possible.What response by the nurse is most appropriate?

Accepted Answer

There are two types of cesarean delivery: classic (vertical incision)and the lower segment transverse incision.Classic-style incisions are reserved for some cases of shoulder dystocia,placental previa,and when birth must take place emergently.The nurse needs to determine if the woman had a classic cesarean delivery when her first child was delivered emergently.If so,the woman cannot attempt a vaginal delivery.Women with a low transverse incision can safely attempt a trial of labor.

Question 11

The nurse assesses a patient suspected of having disseminated intravascular coagulation (DIC)for which of the following symptoms?

Accepted Answer

DIC includes both bleeding and thrombotic manifestations.Blood in the urine,spontaneous nosebleeds,tachycardia,and widespread bruising are all manifestations that could signal DIC.Slight oozing from an IV site is a common finding,and without bleeding noted at multiple sites,it is probably insignificant.

Question 12

The nurse is explaining dysfunctional labor patterns to a group of nursing students.Which of the following should the nurse include in the list of risk factors for hypotonic labor?

Accepted Answer

Many factors contribute to hypotonic labor,including fetal anomalies,malpresentation,and macrosomia; maternal diabetes and hypertension; multiple gestation; and hydramnios.Anxiety and fear are more likely contributing factors to hypertonic labor.

Question 13

A perinatal nurse is aware that which of the following fetal conditions places a woman at risk for oligohydramnios?

Accepted Answer

Conditions that increase the risk of oligohydramnios include fetal renal abnormalities,poor placental perfusion,and premature rupture of membranes.Maternal diabetes and multiple gestation are risk factors for (poly)hydramnios.

Question 14

The perinatal nurse is explaining to a nursing student that which of the following are problems more frequently associated with twin gestation births?

Accepted Answer

Twins and higher-order multiple-gestation births are associated with more maternal and fetal
complications,including excessive bleeding from adherent placentas,intrauterine growth restriction,long-term fetal disabilities such as cerebral palsy,and multiple fetal presentations.A woman with twins who presents at 38 weeks' gestation or later may be a candidate for a vaginal delivery.

Question 15

A new nurse is struggling to care for a woman whose baby was stillborn.What advice should the nurse preceptor give the novice?

Accepted Answer

A simple "I'm sorry" and a touch of the hand are kind and caring interactions.The novice nurse should not be instructed to avoid saying anything because the woman will want her loss (and baby)recognized.The nurse should not just encourage the woman to think of her other children,as this is dismissive of her loss.Taking over care of the patient will not allow the novice nurse to grow as a professional.

Question 16

A pregnant woman is admitted to the high-risk OB unit and started on an IV of magnesium sulfate (Sulfamag).What assessment by the nurse is most important?

Accepted Answer

Sulfamag can lead to muscle weakness.A critical assessment while using this drug is DTRs.The other assessments are not related to side effects of this drug.

Question 17

The nurse manager of the perinatal services unit wants to improve outcomes associated with perinatal loss.What action by the manager would best help meet this goal?

Accepted Answer

A team approach to perinatal loss and bereavement is best to provide a therapeutic and caring experience for families suffering perinatal loss.The families are best cared for by expert perinatal nurses.Because perinatal loss is not common,developing a unit for this population would not be cost effective.Instead of identifying key nurses to care for these patients and families,the support of an entire team trained to deal with this situation is better.Outcomes should be patient/family oriented,not staff oriented.

Question 18

A woman arrives at the birthing unit for a scheduled cesarean birth.What action by the nurse is most important?

Accepted Answer

Upon arrival to the birthing unit,the priority nursing action is to ensure that a signed maternal consent is on the chart.The nurse will cleanse and shave the abdomen,start an IV,and insert a catheter,but these interventions are not the priority.Laboratory work should have been obtained prior to the day of admission.

Question 19

After a cesarean delivery under general anesthesia,which assessment by the nurse is most critical?

Accepted Answer

Airway always comes first.The other assessments are important,but nothing takes priority over assessment of the airway.

Question 20

The nurse is teaching a childbirth preparation class for women who will have planned cesarean births for medical need.What potential complications of this operation does the nurse describe?

Accepted Answer

There are many possible maternal complications to cesarean birth,including chronic pain,placental problems in subsequent pregnancies,urinary tract injury,wound dehiscence,and adhesions.Sexual dysfunction is not a typical complication.

Quiz 14: Caring for the Woman Experiencing Complications During Labor and Birth