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

Question 1

The perinatal nurse providing care to a laboring woman recognizes a non-reassuring fetal heart rate tracing.Which of the following is the most appropriate initial action by the nurse?

A)Assist the woman to a left lateral position.
B)Decrease the rate of the intravenous solution.
C)Document the fetal heart rate and variability.
D)Request that the provider apply a fetal scalp electrode.

Answer 1

Assist the woman to a left lateral position.

Question 2

The perinatal nurse provides information to a laboring woman with twins that the second twin will normally be born within what time frame?

A)Within 5 minutes of the first twin
B)Within 15 minutes of the first twin
C)Within 30 minutes of the first twin
D)Within 60 minutes of the first twin

Answer 2

Within 15 minutes of the first twin

Question 3

The perinatal nurse is asked to assess a 35-year-old woman who is a G1 TPAL 0000 at 34 weeks' gestation with a twin gestation.The patient complains of regular contractions with low abdominal pain that moves into the lumbar section of her back.The perinatal nurse's most appropriate initial nursing action is to do which of the following?

A)Assess the patient's contractions.
B)Initiate continuous fetal monitoring.
C)Reassure the patient and her partner.
D)Review the patient's birth plan.

Answer 3

Initiate continuous fetal monitoring.

Question 4

The perinatal nurse is providing care to a 17-year-old G2 TPAL 0010 patient at 32 weeks' gestation.An ultrasound examination confirms that she is experiencing an abruptio placentae.The patient's vital signs are as follows: BP: 110/66 mm Hg,P: 92 beats/minute,R: 18 breaths/minute,fetal heart rate: 156 beats/minute.What assessment should the nurse include in this patient's plan of care as a priority?

A)Hourly vital signs
B)Intake and output every 8 hours
C)Blood draw for complete blood count (CBC),prothrombin time (PT),and electrolytes
D)Checks for perineal bleeding every 15 minutes

Question 5

The perinatal nurse explains to a nursing student that the most appropriate patient for an amnioinfusion is a woman who has a fetal heart rate tracing that exhibits which pattern?

A)Absent variability
B)Early decelerations
C)Late decelerations
D)Variable decelerations

Question 6

A woman has been diagnosed with hypertonic labor.She has an order for hydromorphone (Dilaudid).The student is preparing the medication and asks the labor nurse the rationale for using it.What response by the nurse is best?

A)"It is to induce prescribed rest and relax the uterus."
B)"It's for the pain associated with those strong contractions."
C)"The patient must be allergic to other pain meds."
D)"This is the best medication for labor and birth."

Question 7

The perinatal nurse notes a rapid decrease in the fetal heart rate (FHR)that does not recover immediately following an amniotomy.What action should the nurse perform first?

A)Administer oxygen at 100%.
B)Assess the maternal temperature.
C)Perform a vaginal examination.
D)Recheck the FHR in 30 minutes.

Question 8

The perinatal nurse knows that one of the most severe complications for a patient with a diagnosis of abruptio placentae is which of the following?

A)Couvelaire uterus
B)Hydrops fetalis
C)Hypertension
D)Increased blood volume

Question 9

The nurse is preparing to admit a diabetic woman who is in labor.The nurse plans care to assess carefully for which of the following conditions in this patient?

A)Diminishing uterine contractions
B)Need for an epidural block
C)Onset of intrapartum hypertension
D)Overly strong,painful contractions

Question 10

The perinatal nurse is providing care to a 25-year-old G1 TPAL 0000 woman hospitalized with severe hypertension at 33 weeks' gestation.The nurse is preparing to administer the second dose of betamethasone (Celestone),prescribed by the physician.The patient asks,"What is this injection for again?" Which of the following is the best response by the nurse?

A)Helps your baby grow and develop
B)Helps your baby's lungs to mature
C)Prepares your body to begin labor
D)Stabilizes your blood pressure

Question 11

A woman reports feeling uterine contractions that are strong,but on subsequent cervical checks,the nurse does not note any changes.What action by the nurse is most appropriate?

A)Assess the woman for causes of anxiety.
B)Attempt an external version of the fetus.
C)Instruct the woman on nipple stimulation.
D)Prepare to administer oxytoxin (Pitocin).

Question 12

The perinatal nurse has administered a dose of dinoprostone (Cervidil)to a woman prior to a labor induction with oxytocin (Pitocin).The nurse then notices that the admission database is incomplete.What conditions should the nurse quickly question the patient about?

A)Asthma
B)Gallbladder disease
C)IV drug use
D)Penicillin allergy

Question 13

A woman is experiencing a long and painful labor and is becoming increasingly intolerant of the pain.She has been receiving frequent,small doses of IV hydromorphone (Dilaudid).The nurse suggests that she switch from medication to massage and water treatments.The patient is reluctant.What explanation by the nurse is best?

A)"It's either this or you'll need an amniotomy."
B)"Pain medicine sometimes slows labor down."
C)"You are getting too much pain medication."
D)"Your anxiety can cause labor to be slow."

Question 14

The perinatal nurse is caring for a patient with preeclampsia.What intervention does the nurse include on this patient's care plan?

A)Administer magnesium sulfate per agency policy.
B)Assess the patient's blood pressure every 6 hours.
C)Encourage the patient to rest on her back.
D)Notify the physician of urine output greater than 30 mL/hr.

Question 15

The perinatal nurse is providing care to a 32-year-old G1 TPAL 0000 at 34 weeks' gestation.Her blood pressure is 170/100 mm Hg,reflexes are +3,urine is 2+ for protein,and the patient is complaining of a headache.An intravenous solution of magnesium sulfate is begun with an hourly dose of 2 g.Which laboratory value would be assessed most carefully by the nurse?

A)Aspartate aminotransferase (AST)
B)Gamma-glutamyl transpeptidase
C)Hematocrit
D)Neutrophil count

Question 16

The nurse is caring for a woman with a placental abruption and suspects the patient has developed disseminated intravascular coagulation (DIC).What interventions does the nurse anticipate?

A)Administering IV fibrinogen
B)Performing hourly vaginal exams to assess for cervical dilation
C)Performing blood pressure assessments every 4 hours
D)Obtaining consent for a cesarean birth

Question 17

The perinatal nurse is caring for a preeclamptic patient at 35 weeks' gestation.The patient's newest laboratory results include the following: platelet count 98,000/mm³ and RBC 3.1 million/µL.What action by the nurse is most appropriate?

A)Administer betamethasone (Celestone).
B)Increase the patient's IV fluids.
C)Maintain the patient on bedrest.
D)Notify the health-care provider immediately.

Question 18

The perinatal nurse determines by vaginal examination that a patient's cervix is fully dilated and the fetal presenting part is descending rapidly with the patient's pushing efforts.The most appropriate nursing intervention at this time would be to do which of the following?

A)Assist the patient with breathing patterns to slow down her pushing.
B)Document the patient's progress and coping abilities in labor.
C)Notify the health-care provider to come now for the birth.
D)Provide information to the patient's partner about her stage of labor.

Question 19

The perinatal nurse is providing care to a multiparous woman in labor.Upon arrival to the birthing suite,the cervix is 5 cm dilated and the patient is experiencing contractions every 1 to 2 minutes that she describes as "strong." The patient states that she labored for 1 hour at home and is feeling some rectal pressure.The patient is most likely experiencing what condition?

A)Hypertonic contractions
B)Hypotonic contractions
C)Precipitous labor
D)Uterine hyperstimulation

Question 20

During the postpartum assessment,the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large amount of bright red vaginal bleeding.Her uterine fundus is firm.The most appropriate action by the nurse is to collaborate with the health-care provider in which activity?

A)Bladder assessment and catheterization
B)Preparing the woman for a hysterectomy
C)Uterine massage and oxytocin infusion
D)Vaginal assessment and repair

Question 21

The perinatal nurse explains to a nursing student that perinatal loss occurs when a woman's baby is lost during what time period?

A)Any time during the first year of life
B)From conception through birth
C)From conception through the first 28 days after birth
D)During labor or delivery

Question 22

A nurse is caring for a pregnant woman with diabetes mellitus.What assessment finding demonstrates that the patient has successfully met an important goal during pregnancy?

A)Blood glucose consistently < 130 mg/dL
B)Electrolyte levels remaining within normal limits
C)Fetal weight > 4,500 g at birth
D)Pregnancy weight gain of no more than 20 lb

Question 23

A new nurse is working with a patient undergoing an induction of labor.What action by the new nurse would prompt the preceptor to intervene?

A)Assesses contractions every 5 minutes in the second stage of labor
B)Calculates and charts the maternal total urine output every 4 hours
C)Documents an IV intake of 1,500 mL in 8 hours
D)Records the maternal vital signs a minimum of every 60 minutes

Question 24

A woman at 30 weeks' gestation is 80% effaced and 5 cm dilated.Which action by the nurse takes priority?

A)Arrange a palliative care consult for probable fetal demise.
B)Encourage the woman to attempt a trial of labor before undergoing a cesarean section.
C)Ensure that informed consent for a cesarean birth is on the chart.
D)Inform the woman that if the tocolytic therapy is successful,she will deliver.

Question 25

A nurse is assisting with a forceps delivery.After the forceps are applied,the nurse notes fetal bradycardia.What action by the nurse takes priority?

A)Assess the fetal heart rate in 5 minutes.
B)Document the findings in the chart.
C)Inform the health-care provider immediately.
D)Turn the woman on her left side.

Question 26

A nurse is caring for a woman who will be induced,but her cervix is not yet favorable for this intervention.The provider leaves an order for dinoprostone vaginal insert (Cervidil),which the nurse administers at 9:00 a.m.At what time does the nurse anticipate induction with oxytocin (Pitocin)?

A)In 30 to 60 minutes after the last dose of dinoprostone
B)In 30 to 60 minutes after the dinoprostone insert is removed
C)In 5 to 7 hours or when contractions begin
D)In 6 to 12 hours after the dinoprostone insert is removed

Question 27

A nurse is caring for a patient with abruptio placentae.What assessment findings would indicate that the woman is hemodynamically stable?

A)Fetal heart rate: 108 beats/minute
B)Hematocrit: 33%
C)Oxygen saturation: 90%
D)Urine output: 20 mL/hour

Question 28

A woman's membranes have just ruptured and she states "I feel something in my vagina." The nurse assesses the woman and sees part of the umbilical cord protruding from the vagina.What action by the nurse is best?

A)Cover the cord with warm sterile saline-soaked compresses.
B)Push the cord segment back into the vagina.
C)Position the woman in reverse Trendelenburg.
D)Take the maternal and fetal vital signs.

Question 29

A nurse is caring for a patient who had a laminaria tent inserted 6 hours ago.What action by the nurse is most appropriate?

A)Assess and record maternal temperature.
B)Document fetal and maternal heart rate.
C)Perform an amniotic membrane stripping.
D)Remove the laminaria tent and assess cervical dilation.

Question 30

A nurse assisting in a birth observes the patient suddenly fall back against the bed and become unresponsive.What action by the nurse takes priority?

A)Assess airway,breathing,and circulation.
B)Begin immediate cardiopulmonary resuscitation.
C)Insert an indwelling urinary catheter.
D)Prepare for an emergency cesarean delivery.

Question 31

A nulliparous woman has been admitted to the labor and birth unit.Her Bishop score is 4.What medication does the nurse plan to administer?

A)Betamethasone (Celestone)
B)Hydromorphone (Dilaudid)
C)Misoprostol (Cytotec)
D)Oxytocin (Pitocin)

Question 32

A nurse has administered dinoprostone gel (Prepidil)to a nulliparous woman whose Bishop score is 5.Fifteen minutes later the patient complains of intense itching,vaginal burning,and shortness of breath.What medication does the nurse anticipate giving?

A)Epinephrine (Adrenalin)
B)Hydromorphone (Dilaudid)
C)Misoprostol (Cytotec)
D)Terbutaline (no brand name)

Question 33

A woman is about to undergo an external version.What action by the nurse takes priority?

A)Determine Rh status;give Rh immune globulin if needed.
B)Explain the procedure to the woman and obtain consent.
C)Offer emotional support to both the woman and her partner.
D)Prepare to administer oxytocin (Pitocin)as per protocol.

Question 34

A nurse has instructed a woman on the procedure for nipple rolling.What action by the patient demonstrates good understanding of the teaching?

A)Pinches and pulls the nipples on alternating sides
B)Rolls both nipples together for 10 minutes
C)Rolls one nipple at a time during a contraction
D)Rolls one nipple at a time through her clothing

Question 35

A laboring woman complains of sudden,sharp,severe pain during a contraction,and when the contraction ceases,the pain is gone.What assessment by the nurse takes priority?

A)Abdominal palpation
B)Fetal heart tracing
C)Maternal vital signs
D)Intrauterine pressure

Question 36

A woman had an amniotomy 1 hour ago.Now she is complaining of uterine tenderness.What action by the nurse is most appropriate?

A)Increase the IV infusion rate.
B)Notify the health-care provider.
C)Perform a vaginal examination.
D)Take the woman's temperature.

Question 37

A nurse is caring for a woman who gave birth to a term infant an hour ago.The chart notes that the baby was born after demonstrating a positive turtle sign.What assessment finding by the nurse warrants immediate action?

A)Lochia rubra is noted an hour after birth.
B)Maternal blood pressure is 90/42 mm Hg.
C)Maternal heart rate is 68 beats/minute.
D)Patient saturates one perineal pad in 2 hours.

Question 38

A woman has just given birth to an infant whose 1-minute Apgar score was 9.Meconium-stained amniotic fluid was noted upon rupture of the membranes.What action by the nurse is most appropriate?

A)Apply oxygen at 0.5 L/minute via face mask.
B)Assess and document the infant's 5-minute Apgar score.
C)Transfer the neonate to the intensive care unit.
D)Vigorously suction the infant's trachea.

Question 39

When caring for a laboring patient,the nurse notes the onset of sudden vaginal bleeding at the beginning of cervical dilation.The patient denies any pain.What action by the nurse is best?

A)Document the findings in the woman's chart.
B)Place the woman in a knee-chest position.
C)Prepare the woman for an immediate cesarean birth.
D)Perform a careful vaginal exam to assess for exposed umbilical cord vessels.

Question 40

A woman is receiving oxytocin (Pitocin)via infusion.The nurse assesses the following: uterine contractions lasting 100 seconds every 1.5 minutes,uterine resting tone 36 mm Hg,baseline fetal heart rate (FHR)108 beats/minute with absent variability.What action by the nurse takes priority?

A)Document the findings.
B)Notify the provider.
C)Reassess the FHR in 10 minutes
D)Stop the infusion.

Question 41

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?

A)Chronic pain
B)Sexual dysfunction
C)Subsequent placental problems
D)Urinary tract injury
E)Wound dehiscence

Question 42

A perinatal nurse is aware that which of the following fetal conditions places a woman at risk for oligohydramnios? (Select all that apply.)

A)Fetal renal abnormalities
B)Maternal diabetes
C)Multiple gestations
D)Poor placental perfusion
E)Premature rupture of membranes

Question 43

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

A)Active genital herpes
B)Certain fetal malpresentations
C)Maternal request
D)Some multiple gestations
E)Umbilical cord prolapse

Question 44

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

A)Frequent vaginal checks
B)Care for the patient undergoing a labor induction
C)Emotional support while awaiting delivery
D)Preparation for cesarean delivery

Question 45

What actions by the nursing staff would be beneficial for parents who have lost a newborn? (Select all that apply.)

A)Ask the baby's name and use it.
B)Clean the infant and wrap in a blanket.
C)Encourage them not to see their baby.
D)Explain how the infant will look.
E)Take photographs to give the parents.

Question 46

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?

A)"Do you think your wife could benefit from some counseling?"
B)"Recent research has shown that this is a common behavior."
C)"This is a totally normal response and will be over soon."
D)"You can always go out fishing or bowling when it is too much."

Question 47

A nurse is working with a nulliparous woman diagnosed with placenta previa.What interventions should the nurse plan to implement if necessary? (Select all that apply.)

A)Educate the woman about prenatal iron supplements.
B)Facilitate informed consent for blood.
C)Educate the woman about the need for a forceps delivery.
D)Explain that she will undergo a planned delivery at 34-35 weeks.
E)Advise the woman that a vaginal birth may be possible.

Question 48

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

A)Cleanse and shave the woman's abdomen.
B)Ensure that signed informed consent is on the chart.
C)Facilitate a blood draw for type and cross match.
D)Initiate a large-bore IV and insert a catheter.

Question 49

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? (Select all that apply.)

A)Use of assisted reproductive technology
B)Induced labor before 39 weeks of gestation
C)Maternal age greater than 35
D)Multiple-gestation pregnancy
E)Native American ethnicity

Question 50

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

A)Blood in the Foley catheter bag
B)Slight oozing from an IV site
C)Spontaneous nosebleed
D)Tachycardia
E)Widespread bruising

Question 51

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?

A)Deep tendon reflexes (DTRs)
B)Fetal heart tones
C)Serum calcium level
D)Temperature

Question 52

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

A)Airway
B)Circulation
C)Lochia
D)Vital signs

Question 53

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? (Select all that apply.)

A)Anxiety and fear
B)Fetal malpresentation
C)Maternal obesity
D)Multiple gestation
E)Pain medication

Question 54

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? (Select all that apply.)

A)Assess frequently for uterine tachysystole.
B)Increase the infusion every 30 minutes as needed.
C)Place to woman prone to prevent dizziness.
D)Start the infusion at 2 mU/minute.
E)Use an electronic infusion device.

Question 55

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?

A)Develop a unit specifically for this population.
B)Establish a multidisciplinary perinatal loss team.
C)Identify key nurses to care for these patients.
D)Provide debriefing services for the nursing staff.

Question 56

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

A)"Don't say anything;that's better than upsetting her."
B)"Encourage the mother to think of her other children."
C)"Why don't you let me take care of this patient?"
D)"You can simply say 'I am so sorry for your loss.'"

Question 57

A nursing professor is describing placental abruption to a class of nursing students.What information is included? (Select all that apply.)

A)Cesarean delivery is almost always needed.
B)Complications include couvelaire uterus and DIC.
C)Fetal and maternal death may occur.
D)Hysterectomy may be necessary to control bleeding.
E)Pelvic and vaginal exams are not performed.

Question 58

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? (Select all that apply.)

A)Active genital herpes infection
B)Breech presentation
C)History of a myomectomy
D)Severe hypertension
E)Vasa previa or complete placenta previa

Question 59

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

A)Adherent placentas and bleeding
B)Intrauterine growth restriction
C)Long-term fetal disabilities
D)Abnormal fetal presentations
E)Requirement for cesarean delivery

Question 60

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?

A)"No,after cesarean birth you cannot delivery vaginally."
B)"Not if your cesarean delivery was the classic-style operation."
C)"Yes,you can always at least have a trial of labor."
D)"Yes,vaginal birth is usually successful after cesarean deliveries."

Question 61

A G2P1 woman wishes to have a trial of labor after a previous low-transverse cesarean delivery.What factors would permit the woman to be allowed this trial of labor? (Select all that apply.)

A)Adequate pelvis size related to fetal size
B)Desire to use epidural analgesia
C)Patient free of any chronic illnesses
D)No history of uterine abnormalities
E)Physician available throughout the trial who is capable of performing a cesarean delivery