Deck 50: Labor, Delivery, and Postpartum

Question 1

The nurse is caring for a postpartal woman and reviews the following lab results in her medical record: HBsAg-negative, rubella titer less than 1:8/1:10, Rh-negative with Rh-positive infant. Which injections will the nurse expect to be ordered?

A) Hepatitis B immune globulin and MMR today
B) MMR and Rh_o(D) immune globulin (RhoGAM) today
C) Rh_o(D) immune globulin (RhoGAM) and hepatitis B immune globulin today
D) Rh_o(D) immune globulin (RhoGAM) today and MMR in 3 months

Answer 1

Rh_o(D) immune globulin (RhoGAM) today and MMR in 3 months

Question 2

The nurse is assisting with placement of epidural anesthesia for a woman who is in labor. To help prevent maternal hypotension, which is the nurse's initial action?

A) Administer 40-80 mcg of intravenous phenylephrine.
B) Infuse a bolus of 500-1000 mL of an isotonic solution before the procedure.
C) Monitor the patient's blood pressure closely during epidural placement.
D) Turn the patient onto her left side and give a rapid bolus of IV fluids.

Answer 2

Infuse a bolus of 500-1000 mL of an isotonic solution before the procedure.

Question 3

The nurse has just administered Rh_o(D) immune globulin (RhoGAM) to a postpartal woman. What information will the nurse include when teaching this patient?

A) "Avoid live vaccines for 3 months."
B) "There are no adverse reactions to this injection."
C) "The immune globulin does not cross into breast milk."
D) "You will not need to have the injection with future deliveries."

Answer 3

"Avoid live vaccines for 3 months."

Question 4

The nurse provides teaching for a postpartal woman who will take bisacodyl tablets to help with constipation. What information will the nurse include when teaching this patient about this medication?

A) "Crush the tablet if it is difficult to swallow."
B) "Store this medication in a cool, dry place."
C) "Take the tablet with a carbonated beverage."
D) "Take with milk if gastrointestinal upset occurs."

Question 5

The nurse is caring for a woman who is in early labor. The woman wants to avoid pain medications as long as possible. What will the nurse tell her?

A) "I can give you a sedative-hypnotic now to help you relax."
B) "I can teach you some simple breathing exercises to help lessen discomfort."
C) "If you take fentanyl (Sublimaze) now, it will be more effective than if you wait."
D) "You may take ibuprofen, which won't cause drowsiness."

Question 6

The nurse is preparing a woman who is in labor for a lumbar epidural and explains that she will receive a continuous infusion of epidural anesthesia. She asks what will happen if that isn't effective. What response by the nurse is correct?

A) "Increasing the amount of anesthesia will increase the risk of postdural headache."
B) "You should tell the provider, and you may receive rescue doses of anesthesia if needed."
C) "Epidural anesthesia cannot be combined with oral anesthesia."
D) "The consistent level provided by the continuous anesthesia will be sufficient."

Question 7

The nurse is caring for a woman who is in labor. The woman is anxious and reports increasing nausea after receiving an opioid analgesic medication. The nurse will contact the provider and request an order for which intravenous medication?

A) Hydroxyzine HCl (Vistaril)
B) Pentobarbital sodium (Nembutal)
C) Promethazine (Phenergan)
D) Pentobarbital (Nembutal)

Question 8

A woman who is 2 months pregnant tells the nurse that she has never received the MMR vaccine and has not had these diseases. She has 3-year-old and 5-year-old children who have not been immunized. The nurse will recommend which of the following?

A) Delay obtaining the vaccines for her children and herself until after her baby is born.
B) Have her children vaccinated now and obtain the vaccine for herself after the baby is born.
C) Obtain the MMR vaccine for her children and herself when she is in her third trimester of pregnancy.
D) Obtain the MMR vaccine for her children and herself within the next few weeks.

Question 9

The nurse is caring for a patient after the third stage of labor, and the provider orders 20 units of oxytocin to be given intramuscularly. The nurse will explain to the patient that this drug is being used for which purpose?

A) To allow the cervix to close
B) To enhance milk letdown
C) To prevent uterine atony
D) To suppress lactation

Question 10

The nurse is caring for a postpartal patient who has just delivered her first baby by caesarean section. The mother's blood type is Rh-negative, and the infant's blood type is Rh-positive. The provider has ordered human D immune globulin (RhoGAM). The nurse understands that this patient may need:

A) less than the usual RhoGAM dose.
B) more than the usual RhoGAM dose.
C) no RhoGAM.
D) the usual RhoGAM dose.

Question 11

Constipation is common during the postpartum period. Which of the following OTC products can be used to help manage constipation postpartum?

A) Hydrocodone
B) Promethazine
C) Docusate sodium and sennosides
D) Dinoprostone

Question 12

The nurse examines a woman who has received an epidural block. The woman's cervix has been dilated at 5 cm for an hour after having shown steady progression earlier. The nurse will notify the provider and anticipate a need for:

A) caesarean section.
B) forceps delivery.
C) intravenous oxytocin.
D) vacuum extraction.

Question 13

The nurse is caring for an infant who is 2 days postpartum and notes that the infant has a poor sucking response. Which of the following medications can contribute to delayed breastfeeding with a poor sucking response for up to 4 days if used during labor?

A) Butorphanol tartrate (Stadol)
B) Fentanyl (Sublimaze)
C) Nalbuphine (Nubain)
D) Pentobarbital (Nembutal)