Question 1

A patient is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (VBAC) with this pregnancy. Which statement indicates that the patient requires more information about VBAC?

Accepted Answer

While the other statements demonstrate some knowledge about VBAC, option C is incorrect. The current success rate for VBAC is around 60-80%, so stating a 90% success rate indicates a need for more information.

Question 2

The nurse is developing a care plan for a newly delivered mother who had a forceps delivery. Which nursing diagnosis is appropriate for a postpartal mother with lacerations from a forceps delivery?

Accepted Answer

A forceps delivery can cause tissue trauma and lacerations in the perineum and birth canal, increasing the risk of infection. Therefore, the appropriate nursing diagnosis would be High Risk for Infection related to lochia and decreased perineal and birth canal integrity. Choice A may also be appropriate, but it is not the top priority in this situation. Choice C and D are not relevant to the patient's current condition.

Question 3

The nurse is teaching childbirth education classes. Teaching has been successful if the primiparous patient states: "I can reduce the likelihood that I'll tear or need an episiotomy if I:

Accepted Answer

Beginning regular perineal massage can help to increase elasticity and reduce the likelihood of tearing or needing an episiotomy during childbirth. Pushing in a semi-sitting position, pushing for a long time, and pulling back on the legs are not recommended techniques and may increase the risk of tearing or needing an episiotomy.

Question 4

A prenatal patient asks the nurse about conditions that would necessitate a cesarean delivery. The nurse explains that cesarean delivery generally is performed in the presence of:

Accepted Answer

Complete placenta previa, placental abruption, umbilical cord prolapse, and failure to progress are conditions that can necessitate a cesarean delivery due to risks to the mother or baby. Precipitous labor, while rapid, does not typically require a cesarean unless complications arise.

Question 5

The physician has determined the need for forceps. The nurse should explain to the patient that the use of forceps is indicated:

Accepted Answer

The answer of The physician has determined the need for...

Question 6

The nurse is reviewing charts of clients who underwent cesarean births by request in the last two years. The hospital is attempting to decrease costs of maternity care. What findings contribute to increased health care costs in clients undergoing cesarean birth by request?

Accepted Answer

Increased abnormal placenta implantation in subsequent pregnancies is a potential complication of cesarean births by request, which can result in increased health care costs due to the need for more frequent monitoring and interventions in subsequent pregnancies.

Answer: C 
 Prolonged anemia requiring blood transfusions every few months can be a complication of cesarean births by request, which can result in increased health care costs due to the need for ongoing medical management and interventions.

Answer: B and D are incorrect choices as they do not contribute to increased health care costs related to cesarean births by request.

Question 7

The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring patient who will have a forceps delivery. Which action or assessment finding requires intervention?

Accepted Answer

Instructing the patient to push between contractions is incorrect and requires intervention. During labor, the patient should be instructed to push during contractions, not between them, to effectively aid in the delivery process.

Question 8

After being in labor for several hours with no progress, a patient is diagnosed with CPD (cephalopelvic disproportion), and must have a cesarean section. The patient is worried that she will not be able to have any future children vaginally. After sharing this information with her care provider, the nurse would anticipate that the patient would receive what type of incision?

Accepted Answer

A transverse incision (also called a low transverse or Pfannenstiel incision) is preferred for cesarean sections when future vaginal deliveries are desired. This type of incision has a lower risk of complications, such as uterine rupture, during subsequent pregnancies. Suprapubic and classic incisions are rarely used, and vertical incisions are associated with a higher risk of complications and are usually reserved for emergencies.

Question 9

The patient is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the patient asks for another. The best response from the nurse is:

Accepted Answer

Applying ice packs for swelling after a delivery with a midline episiotomy is a common practice. However, it's important to allow the skin to return to its normal temperature between applications to prevent tissue damage. A typical recommendation is to apply the ice pack for 10 minutes and then leave it off for 20 minutes before reapplying. This cycle helps reduce swelling while minimizing the risk of cold injury to the skin.

Question 10

In the operating room, a patient is being prepped for a cesarean delivery. The doctor is present. What is the last assessment the nurse should make just before the patient is draped for surgery?

Accepted Answer

The last assessment the nurse should make just before the patient is draped for surgery is the fetal heart tones. This ensures that the baby is doing well and there are no signs of distress before the surgery begins. Maternal temperature and urine output may have been assessed earlier, and a vaginal exam is not needed at this point in the process.

Question 11

The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance?

Accepted Answer

The client's statement of being able to stop pushing and just rest if a vacuum extractor is used indicates a lack of understanding of the procedure. In fact, the client will still need to push during contractions while the vacuum is being used to assist in the delivery.

Question 12

A patient attending a prenatal class asks why episiotomies are performed. The nurse explains that risk factors that predispose women to episiotomies include:

Accepted Answer

Episiotomies may be performed for several reasons, including to facilitate childbirth in the case of a large or macrosomic fetus (A), to assist with the delivery when forceps are used (B), and to resolve shoulder dystocia, where the baby's shoulder gets stuck after the head has been delivered (C). These interventions can help prevent severe perineal tears and facilitate the delivery process.

Question 13

The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The provider requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth?

Accepted Answer

The client initially expressed a desire for a "normal" birth without intervention, but ultimately gave in to the use of a vacuum extractor. It is possible that the client may feel a sense of disappointment or failure that the birth did not go as planned. The nurse should assess the client for any negative emotions or feelings and provide support and reassurance. Option A is unlikely as exhaustion and the use of medical intervention do not typically lead to feelings of elation and talkativeness. Options C and D are unrelated to the situation and not relevant to assess for after the birth.

Question 14

The patient has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal?

Accepted Answer

The location of the vacuum on the fetal scalp after birth is an expected and normal finding following vacuum extraction. This is due to the suction applied to assist in delivering the baby, which can leave a temporary mark or swelling on the scalp where the vacuum was attached.

Question 15

The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed?

Accepted Answer

The statement that the scar on the belly goes down from the navel indicates a lack of understanding about the location of the cesarean scar and its impact on VBAC candidacy. Further education is needed to correct this misconception. The other statements demonstrate an understanding of VBAC candidacy criteria and hospital policies.

Question 16

The need for forceps has been determined. The patient's cervix is dilated to 10 cm, and the fetus is at +2 station. What category of forceps application would the nurse anticipate?

Accepted Answer

Low forceps application is anticipated when the fetus is at +2 station, indicating that the head is low in the pelvis but not yet at the pelvic floor.

Question 17

The obstetrician opts to use a vacuum extractor for a delivery. The nurse understands that:

Accepted Answer

It is expected that there should be further fetal descent with the first two pulls when using a vacuum extractor for delivery. This can be confirmed by assessing the station of the fetal head between pulls. The other options are incorrect as vacuum extraction devices have some risks, traction should be applied during contractions, and the woman may feel increased discomfort during the procedure.

Question 18

The patient requires vacuum extraction assistance. To provide easier access to the fetal head, the physician cuts a mediolateral episiotomy. After delivery, the patient asks the nurse to describe the episiotomy. The nurse responds, "The episiotomy:

Accepted Answer

A mediolateral episiotomy is cut diagonally away from the vagina towards one of the patient's thighs. It is done to provide more room for the baby's head during delivery. Option A is incorrect because an episiotomy is not cut straight back towards the rectum. Option B is incorrect because an episiotomy is not cut from the vagina towards the urethra. Option D is incorrect because a episiotomy should not extend into the rectum.

Question 19

The patient demonstrates understanding of the implications for future pregnancies secondary to her classic uterine incision when she states:

Accepted Answer

A classic uterine incision increases the risk of uterine rupture in future pregnancies, often necessitating cesarean deliveries for any subsequent births to minimize this risk.

Quiz 28: Birth-Related Procedures