Question 1

The clinical nurse coordinator is meeting with a group of nursing students in post conference to teach about caring for women who undergo artificial rupture of membranes (AROM) by way of amniotomy. Which nursing student's statement indicates that the teaching has been effective?

A)"For women who undergo artificial rupture of membranes, vaginal examinations should be limited."
B)"In most cases, it is appropriate to assess the fetal heart rate (FHR) right after the artificial rupture of membranes is performed."
C)"Amniotomy is contraindicated for use in labor augmentation."
D)"Women who undergo artificial rupture of membranes should be advised that they will experience a 'dry birth.'"

Accepted Answer

Vaginal examinations should be limited for women who undergo artificial rupture of membranes (AROM) to reduce the risk of infection.

Question 2

The patient had a classical uterine incision for her cesarean birth. The nurse knows that the patient understands implications for future pregnancies that are secondary to her classical uterine incision when the patient states:

A)"The next time I have a baby, I can try to deliver vaginally."
B)"The risk of rupturing my uterus is too high for me to have any more babies."
C)"Every time I have a baby, I will have to have a cesarean delivery."
D)"I can only have one more baby."

"Every time I have a baby, I will have to have a cesarean delivery."

Accepted Answer

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

Question 3

The patient is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. The patient is asking for her ice pack to be refreshed. The best response from the nurse is:

A)"I'll get you one right away."
B)"You only need to use one ice pack."
C)"You need to leave it off for at least 20 minutes and then reapply."
D)"I'll bring you an extra so that you can change it when you are ready."

"You need to leave it off for at least 20 minutes and then reapply."

Accepted Answer

Ice packs should be used intermittently to reduce swelling and pain. Leaving the area without an ice pack for intervals (such as 20 minutes) helps prevent tissue damage from prolonged cold exposure.

Question 4

The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring patient who is undergoing a forceps delivery. Which action requires intervention?&#10;A)Regional anesthesia is administered via pudendal block.&#10;B)The patient is instructed to push between contractions.&#10;C)Fetal heart tones are consistently between 110 and 115.&#10;D)Bladder is emptied using a straight catheter.

Accepted Answer

The patient should not be instructed to push between contractions during a forceps delivery, as this can cause additional trauma to the maternal tissues and fetal head. Instead, the provider should guide the patient to push during contractions while they apply forceps to assist delivery. A, C, and D are appropriate actions during a forceps delivery.

Question 5

The nurse is reviewing charts of patients 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 healthcare costs in patients undergoing cesarean birth by request?

A)Increased abnormal placenta implantation in subsequent pregnancies
B)Decreased use of general anesthesia with greater use of epidural anesthesia
C)Prolonged anemia, requiring blood transfusions every few months
D)Coordination of career projects of both partners leading to increased income

Accepted Answer

Increased abnormal placenta implantation in subsequent pregnancies can lead to increased healthcare costs due to the need for additional testing and monitoring during pregnancy, as well as a higher likelihood of needing a repeat cesarean delivery. The other options do not directly relate to increased healthcare costs associated with cesarean birth by request.

Question 6

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 what kind of episiotomy was performed. What is the best response for the nurse to make? "The episiotomy":

A)"Goes straight back toward your rectum."
B)"Is from your vagina toward the urethra."
C)"Is cut diagonally away from your vagina."
D)"Extends from your vagina into your rectum."

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Accepted Answer

A mediolateral episiotomy is cut diagonally away from the vagina towards the patient's thigh.

Question 7

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

A)"A small cup will be put onto the baby's head, and a gentle suction will be applied."
B)"I can stop pushing and just rest if the vacuum extractor is used."
C)"The baby's head might have a bruise from the vacuum cup."
D)"The vacuum will be applied for a total of ten minutes or less."

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Accepted Answer

While the use of a vacuum extractor can help facilitate delivery, it is important for the patient to understand that they will still need to push and actively participate in the delivery process. The vacuum extractor simply provides some assistance in pulling the baby out. Resting and not pushing during the use of a vacuum extractor is not recommended.

Question 8

Induction of labor is planned for a 31-year-old primip due to insulin-dependent diabetes. The patient is 39 weeks' gestation. She reports that she feels as though her baby has "flipped" in her abdomen. Which nursing action is most important?

A)Evaluate fetal maturity.
B)Administer dinoprostone (Prepidil ) vaginal gel.
C)Implement continuous electronic fetal monitoring (EFM).
D)Notify the patient's physician that the patient feels as though her baby has changed position.

Accepted Answer

The most important nursing action is to notify the physician because the patient feels the baby has changed position, which could indicate a breech or other abnormal presentation that may affect the induction plan and delivery method.

Question 9

The nurse is scheduling a patient for an external cephalic version (ECV). Which finding in the patient's chart requires immediate intervention?&#10;A)&#34;Multip, transverse lie.&#34;&#10;B)&#34;Primip, frank breech ballotable.&#34;&#10;C)&#34;Multip, 32 weeks, complete breech.&#34;&#10;D)&#34;Primip, failed ECV last week.&#34;

Accepted Answer

The presence of a "Multip, 32 weeks, complete breech" situation requires immediate intervention before scheduling an external cephalic version (ECV) because the procedure is typically performed after 37 weeks of gestation to reduce the risk of preterm labor. At 32 weeks, the fetus is considered preterm, and attempting an ECV could increase the risk of complications.

Question 10

The nurse is completing discharge teaching for a patient who delivered two days ago. Which statement indicates that further information is required?&#10;A)&#34;Because I have a midline episiotomy, I should keep my perineum clean.&#34;&#10;B)&#34;Soaking in the tub will help my mediolateral episiotomy to heal.&#34;&#10;C)&#34;I can take ibuprofen (Motrin) when my perineum starts to hurt.&#34;&#10;D)&#34;The tear I have through my rectum is unrelated to my episiotomy.&#34;

Accepted Answer

The statement "The tear I have through my rectum is unrelated to my episiotomy." indicates a misunderstanding. A tear through the rectum, known as a third or fourth-degree tear, can be directly related to an episiotomy, especially if it extends or if the episiotomy was mediolateral. This misunderstanding suggests the patient requires further information about the nature of her injury and its relation to the episiotomy.

Question 11

After being in labor for several hours with no progress, the patient is diagnosed with cephalopelvic disproportion (CPD) and must have a cesarean section. The patient is being prepared for a cesarean delivery in the operating room. The doctor is present. The nurse knows that the last assessment the nurse should make just prior to the patient's being draped for surgery is:

A)Maternal temperature.
B)Maternal urine output.
C)Vaginal exam.
D)Fetal heart tones.

Accepted Answer

The answer of After being in labor for several hours...

Question 12

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

A)"A small cup will be put onto the baby's head, and a gentle suction will be applied."
B)"I can stop pushing and just rest if the vacuum extractor is used."
C)"The baby's head might have a bruise from the vacuum cup."
D)"The vacuum will be applied for a total of ten minutes or less."

Accepted Answer

The answer of The patient has been pushing for two...

Question 13

The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed?&#10;A)&#34;Since the scar on my belly goes down from my navel, I am not a candidate for a VBAC.&#34;&#10;B)&#34;My first baby was in a breech position, so this pregnancy I can try a VBAC if the baby is head-down.&#34;&#10;C)&#34;Because my hospital is so small and in a rural area, they won't let me attempt a VBAC.&#34;&#10;D)&#34;The rate of complications from VBAC is lower than the rate of complications from a cesarean.&#34;

Accepted Answer

The answer of The nurse is teaching a class on...

Deck 23: Birth-Related Procedures