Deck 2: Labor Birthand Immediate Postpartum

Question 1

A client at 20 weeks' gestation asks the midwife if she will be able to breastfeed her baby after birth. The client has a history of type 2 diabetes, which has been well - controlled before and during the pregnancy. The client has a BMI of 34. Which of the following statements by the midwife is the most appropriate?

A)"Whether or not you can breastfeed your baby will depend on your blood glucose levels after birth."
B)"Mothers with type 2 diabetes are encouraged to breastfeed their babies after birth. Breastfeeding may also lower your need for insulin."
C)"You may not breastfeed your baby after birth. Insulin can cross into the breast milk and may cause your baby to develop hypoglycemia. Your baby may be nourished with formula milk."
D)"Breastfeeding is encouraged for clients with type 2 diabetes. However, you may need to increase your insulin when nursing."

Answer 1

"Mothers with type 2 diabetes are encouraged to breastfeed their babies after birth. Breastfeeding may also lower your need for insulin."

Question 2

A midwife is creating a teaching plan for a G1P0 client at 12 weeks' gestation. The midwife focuses on breast care once colostrum secretion begins. Which of the following teachings is not included in the teaching plan?

A)Wash the breasts with clear tap water and mild soap daily.
B)Wear a firm, supportive bra with wide straps.
C)A larger bra may be needed halfway through the pregnancy.
D)If colostrum secretion is excessive, gauze squares may be placed inside the bra.

Answer 2

Wash the breasts with clear tap water and mild soap daily.

Question 3

A midwife is creating a care plan for a client who is in early labor. Which of the following guidelines is least important?

A)Be certain that the outcomes are realistic.
B)Incorporate both the client and her support person.
C)Project a definite time limit for labor to be completed.
D)Address the discomforts of labor.

Answer 3

Project a definite time limit for labor to be completed.

Question 4

A client is admitted to the labor and delivery unit. A midwife is assessing the fetal heart tone monitor tracing and notes late decelerations. Which of the following is the most effective intervention?

A)Administer oxygen through a face mask.
B)Position the client in knee - chest position.
C)Administer oxytocin.
D)Document the findings and continue monitoring the client.

Question 5

A midwife induces labor through amniotomy. The amniotic fluid is assessed and the midwife notes that the amniotic fluid is red in color. This finding most likely suggests:

A)Fetal trauma.
B)Infection.
C)A fetal congenital disorder.
D)Fetal distress.

Question 6

A midwife is reviewing the fetal heart rate monitor tracing obtained from a G2P1 client who is in labor. The midwife notes decelerations at unpredictable times in relation to contractions. The midwife suspects which of the following conditions?

A)Cephalopelvic disproportion
B)Good fetal - well being
C)Uteroplacental insufficiency
D)Cord compression

Question 7

A midwife is caring for a client who is in the first stage of labor. The client's amniotic membranes have not ruptured. Which of the following interventions is the most effective during this stage of labor?

A)Apply distraction techniques during contractions.
B)Instruct the client to lie on her left side and to avoid frequent change of positions.
C)Instruct the client to void at least every two hours.
D)Limit therapeutic touch.

Question 8

A midwife is about to perform an amniotomy on a client who is in the active phase of labor. Before performing the procedure, the midwife informs the client that after the amniotomy, she can expect:

A)Increased efficiency of uterine contractions.
B)Increased number of uterine contractions.
C)Fluttery feeling in the chest.
D)Decreased number of uterine contractions.

Question 9

A midwife is managing the care of a G3P2 client. The birthing room is converted into a birth room when the cervix is dilated to:

A)5 cm
B)5 to 7 cm
C)7 to 9 cm
D)10 cm

Question 10

A client with a multiple pregnancy is scheduled for cesarean delivery and is transported to the delivery operating room. The midwife reminds the staff midwife to position the client in which of the following positions in the operating room?

A)Left side - lying position
B)Semi - Fowler position
C)Supine position, with a wedge placed under the right hip
D)Supine position, with a wedge placed under the left hip.

Question 11

A midwife is managing the care of a G1P0 client who is about to be placed in the lithotomy position. A registered midwife is positioning the client correctly and safely if which of the following nursing actions is observed by the midwife?

A)The strap holding the leg in the stirrups is secured tightly.
B)The top portion of the table is raised to 15 to 20 degrees for effective pushing once the client is in the lithotomy position.
C)The legs are raised one at a time.
D)The registered midwife places the client's legs in the stirrups only when the midwife is scrubbing.

Question 12

A client comes to the facility and tells the midwife that she is in labor and is having some contractions. The client is at 37 weeks' gestation. Which of the following signs indicates that the client is in true labor?

A)Contractions are initially felt in lower back and then sweep around to the abdomen in a wave.
B)The contractions are relieved with ambulation and sleep.
C)The contractions do not achieve cervical dilatation.
D)The contractions remain irregular.

Question 13

After the placental delivery, which of the following is the next action of the midwife?

A)Inspect the placenta.
B)Obtain a baseline blood pressure.
C)Administer oxytocin.
D)Administer an antihypertensive.

Question 14

Which of the following clients is most likely considered for vacuum extraction?

A)A 43 - year - old G1P0 client at 38 weeks' gestation who is in prolonged second stage of labor. The fetal position is LOA
B)A 39 - year - old G5P3 client at 39 weeks' gestation who is expected to have shortening of the second stage of labor. The fetus is in complete breech position. Cervical dilatation is 3 cm.
C)An 18 - year - old G1P0 client at 38 weeks' gestation with a fetal heart tone of 180 beats per minute. The fetus is in transverse lie. Cervical dilatation is 8 cm.
D)A 25 - year - old G1P0 client at 32 weeks' gestation who is in the second stage of labor for 5 hours. An epidural anesthesia is administered. The fetus is in frank breech position. Cervical dilatation is 10 cm.

Question 15

A client gives birth to a baby girl through vaginal birth. After placental delivery, which of the following assessment findings indicates that further evaluation of the client is necessary?

A)Uterine fundus is firm.
B)The fundus is located at the level of the umbilicus.
C)About 300 mL of blood is lost.
D)Specific gravity increases.

Question 16

A client has just given vaginal birth to an eight - pound baby boy. A few minutes after the delivery, the midwife observes lengthening of the umbilical cord and a gush of vaginal blood. The midwife interprets these observations as:

A)Signs of hemorrhage.
B)Signs of placenta previa.
C)Signs of placental separation.
D)Signs of retained placental fragment.

Question 17

A midwife notes that the separation of placenta from the uterus via the Schultze mechanism. This means that:

A)The margin of the placenta separated first; the red, dull and rough surface emerges from the vagina first.
B)The margin of the placenta separated first; the shiny surface emerges from the vagina first.
C)The center portion of the placenta separated first; the maternal surface emerges from the vagina first.
D)The center portion of the placenta separated first; the fetal surface emerges first from the vagina.

Question 18

Which of the following factors contribute(s) to a successful labor?
I. The client's pelvis is of adequate size and contour.
II. The fetus is in an advantageous position and presentation and is of appropriate size.
III. The uterine contractions are adequate.
IV. The client has a strong sense of self - esteem.

A)I and II
B)I and III
C)I, II and III
D)Successful labor depends of all of the above factors.

Question 19

A G3P2 client at 38 weeks' gestation has been in the second stage of labor for more than 3 hours. An epidural anesthesia has not been administered. A vacuum extraction is being considered. Which of the following assessment findings would signal that the extraction can be attempted?

A)Amniotic membranes have already ruptured.
B)Cervical dilatation of 8 cm.
C)Fetal head is 2 cm above the ischial spines.
D)Suspicion of cephalopelvic disproportion.

Question 20

A midwife is reviewing the laboratory tests of a client who is in labor. The laboratory findings include a hemoglobin level of 10 g/dL and a hematocrit concentration of 34%. The midwife is correct if she determines that the client is at risk for which of the following during the postpartum period?

A)Anemia
B)Increased cardiac output
C)Postpartum infection
D)Hemorrhage

Question 21

A midwife may administer meperidine to which of the following clients?

A)A client at 39 weeks' gestation who is expected to give birth in 3 hours.
B)A client at 41 weeks' gestation in the latent phase of labor.
C)A client at 32 weeks' gestation who is expected to give birth in 2 hours.
D)A client at 38 weeks' gestation who is expected to give birth in 1 hour.

Question 22

A client in labor is given oxytocin as an artificial way to induce labor. The midwife reviews the fetal heart monitor tracing and notes that the contractions occur every 3 minutes, lasting about 60 seconds per contraction. Which of the following is the next action of the midwife?

A)Discontinue oxytocin.
B)Increase oxytocin's rate of infusion.
C)Administer oxygen through face mask.
D)Document that the ideal contraction pattern is achieved.

Question 23

Meperidine is administered to a client who is in labor. Which of the following actions by the midwife is the most effective when caring for a client who is administered with meperidine?

A)Closely monitor the client's temperature.
B)Prepare naloxone.
C)Maintain the client in semi - Fowler's position.
D)Closely monitor for hypertension.

Question 24

Which of the following fetal attitudes is the most advantageous for birth?

A)The spine is bowed forward; the head is flexed with the chin touching the sternum; the arms and legs are flexed and folded on the chest; thighs are flexed into the abdomen; calves are pressed against the back of the thighs.
B)The chin is not touching the chest; occipital frontal diameter is the presenting part.
C)The brow of the head is the presenting part; fetus is in partial extension.
D)The back is arched; the neck is extended; occipitomental diameter of the head is the presenting part; fetus is in full extension.

Question 25

A client in labor is administered with an anesthetic through the spinal subarachnoid space. Which of the following actions by the midwife is the least appropriate when managing the client?

A)The midwife maintains the client flat on bed for 8 to 12 hours.
B)Inform the client that headaches may occur.
C)Monitor the client for hypertension.
D)Administer IV fluids.

Question 26

Induction of labor is ordered for a G2P1 client at 43 weeks' gestation. Induction of labor has begun if the following conditions are present except:

A)Cephalic disproportion is not present.
B)The presenting part is engaged.
C)The L/S ratio is 2.5
D)The Bishop score is 7.

Question 27

A client in labor, who is administered with epidural anesthesia, develops hypotension. Which of the following is the immediate action of the midwife?

A)Raise the client's legs.
B)Administer oxygen.
C)Administer IV fluids.
D)Administer ephedrine.

Question 28

A midwife is monitoring a client in labor. Assessment findings determine that the fetus is in cephalic presentation. The descent of _________________ to the level of the ischial spines indicates that engagement has started.

A)Biparietal diameter
B)Intertrochanteric diameter
C)Hips
D)Biacromial diameter

Question 29

An epidural block is ordered for a client in labor. The midwife maintains the client in which of the following positions after the anesthetic is administered?

A)Dorsal recumbent
B)Side - lying position
C)Flat on bed for 12 hours
D)Supine with a rolled blanket beneath left hip

Question 30

Which of the following clients in labor is most likely considered for artificial induction of labor?

A)A client who gave birth to an Rh - positive baby and failed to get a RhoGAM after birth.
B)A client at 43 weeks' gestation who has been in the second stage of labor for one hour.
C)A client who ruptured her membranes 18 hours ago.
D)A client with severe hypertension.

Question 31

A G2P1 client at 39 weeks' gestation is admitted to the labor and delivery unit. A pudendal block is ordered. Which of the following statements about pudendal block is the most accurate?

A)It is administered after labor is established.
B)It blocks uterine and perineal pain and numbs the lower extremities, vagina and perineum.
C)It has no effects on contractions or the fetus.
D)It may cause postpartum headache.

Question 32

A midwife notes that presenting part of the fetus is at the +2 station. This finding indicates that that the fetal presenting part is:

A)At the level of the ischial spine.
B)2 cm below the ischial spine.
C)2 cm above the ischial spine.
D)2 inches above the ischial spine.

Question 33

A nullipara has been in the latent phase of labor for over 20 hours. Prolonged latent phase is diagnosed. Which of the following findings would be expected for this client?

A)Uterine contractions at 12 mm Hg
B)Bishop score - 8
C)Uterine relaxation between contractions is adequate.
D)The uterus is in the hypotonic state.

Question 34

A multiparous client at 38 weeks' gestation has been in the latent phase of labor for over 15 hours. Which of the following are likely causes of the dysfunctional labor?
I.Cephalopelvic disproportion
II.Analgesia is given too early in labor
III.Abnormal fetal head position
IV.Hypertonic contractions

A)I and II
B)I and III
C)I, II and III
D)All of the above are likely causes.

Question 35

A midwife is monitoring a client who is in labor. Assessment findings reveal that the fetus is in LOA position. The midwife notes that the presenting part of the fetus is at 0 station. This finding indicates that:

A)The presenting part is at the perineum, and the fetal head is crowning.
B)The presenting part is at the level of the ischial spines, and the fetal head is engaged.
C)The presenting part is above the level of the ischial spines, and the fetal head is floating.
D)The presenting part has descended to within the pelvic inlet.

Question 36

A midwife is creating a care plan for a client who has been diagnosed with hypertonic uterine dysfunction. Which of the following interventions is included in the plan of care?

A)Encourage the client to ambulate and change positions frequently.
B)Perform amniotomy.
C)Instruct the client to perform breathing exercises.
D)Assess for signs of fluid retention.

Question 37

A midwife is assessing whether or not induction of labor can be initiated for a client at 41 weeks' gestation. The midwife specifically assesses for cervical ripening using the Bishop criteria. Assessment findings include the following: cervical dilatation = 2 cm; effacement = 70%; station = - 2; consistency = medium; position = mid - position. Is the client's cervix ripe enough for induction of labor?

A)Yes. The Bishop score is 8.
B)No. The Bishop score is 7.
C)No. The Bishop score is 6.
D)No. The Bishop score is 5.

Question 38

A client says she has a feeling that something is coming through her vagina. On examination, the midwife notes that the umbilical cord is visible. Which of the following interventions is the least appropriate for the client?

A)Assist the client in knee - chest position.
B)Position the client in Trendelenburg position.
C)Manually elevate the fetal head off the cord.
D)Administer oxygen 2 to 3 L/min

Question 39

A client at 40 weeks' gestation comes to the facility after having a gush of clear of vaginal discharge, which occurs with contractions. The client is admitted to the unit after true labor is determined and the interventions have started. Which of the following is the priority action of the midwife?

A)Order L/S ratio.
B)Perform amniotomy.
C)Attach an external electronic fetal monitor.
D)Determine the frequency of the contractions.

Question 40

A midwife is caring for a client who is scheduled for a cesarean section. The multiparous client is pregnant with twins. The midwife assesses the fetal heart tones through an external fetal monitor. Which of the following actions of the midwife is the most appropriate when assessing the client?

A)Place the monitor over the fetus that is more anterior to the client's abdomen.
B)Monitor each fetal heart rate with a separate fetal monitor.
C)Monitor the twin that is more anterior to the client's abdomen for 15 minutes and then monitor the other in the next 15 minutes.
D)Place the monitor over the umbilical level.

Question 41

A client is given oxytocin for the induction of labor. The midwife should monitor the client for which of the following side effects of oxytocin?

A)Vomiting
B)Increased urine outflow
C)Hypertension
D)Bradycardia

Question 42

A midwife is monitoring a client who is about to deliver the placenta. The client begins to complain of severe pain in the abdominal area. On assessment, the midwife notes that there is a depression in the fundal area of the uterus. Increased flow of vaginal blood is also noted. The client is demonstrating signs of shock. The midwife suspects that the client is mostly experiencing:

A)Rupture of uterus.
B)Uterine inversion.
C)Placenta previa.
D)Abruptio placenta.

Question 43

A midwife performs combined abdominal inspection and palpation on a client who is in labor and determines that the fetal position is ROA. Which of the following statements about the ROA fetal position is false?

A)The fetal landmark is pointing the client's right.
B)The occiput is the fetal landmark.
C)The fetus is in a transverse lie.
D)The back of the fetal head is pointing toward the client's anterior side.

Question 44

A client in labor is expected to give birth less than three hours after the onset of contractions. Which of the following actions by the midwife is the most effective during the labor process?

A)Encourage the client to pant with each contraction.
B)Keep the fetus from being delivered.
C)Deliver the infant between contractions.
D)Apply gentle, downward pressure to the fetal head, toward the rectum.

Question 45

A midwife is monitoring a client who was admitted to the labor and delivery unit about 5 hours ago. The midwife notes a cervical dilatation of 5 cm. The contractions occurring every 5 minutes usually last between 50 and 55 seconds. The client is in which phase of labor?

A)Latent phase
B)Active phase
C)Transition phase
D)Second stage of labor

Question 46

A client in labor begins to complain of severe abdominal pain and chest pain. On assessment, the midwife notes that uterine contractions have stopped and that the abdomen is rigid. Fetal heart tone is not noted. The client's blood pressure decreases, and her heart rate increases to over 100 beats per minute. Which of the following is the next action of the midwife?

A)Maintain bed rest in a side - lying position.
B)Prepare the client for cesarean delivery.
C)Administer oxytocin.
D)Initiate intubation and mechanical ventilation.

Question 47

A midwife is caring for a client in labor and is about to determine the fetal position and presentation. Which of the following methods can be used to obtain the needed assessments?
I.Vaginal examination
II.Sonography
III.Combined abdominal inspection and palpation.
IV.Auscultation of fetal heart tones

A)I, III and IV
B)I, II and IV
C)II, III and IV
D)All of the above can be used to determine fetal position and presentation.

Question 48

After an ultrasound, a client in labor is informed that she has a low - lying placenta. Which of the following statements accurately describes the client's diagnosis?

A)The placenta is improperly implanted in the upper uterine segment.
B)The placenta attaches in the lower uterine segment but it does not reach the cervical os.
C)Only the edge of the placenta extends to the os.
D)The internal os is covered entirely by the placenta.

Question 49

A midwife assesses a client in labor. Combined abdominal inspection and palpation and sonography indicate that the occiput of the fetus is the presenting part. The midwife also finds out that there is a disproportion between the fetus and the client's pelvis. The history of the client's pregnancy is not remarkable. Routine screening tests suggested good fetal well - being. Which of the following statements made by the midwife is the most appropriate when informing the client about the findings?

A)"Your pelvis is too small for the baby's head. Your baby cannot be born vaginally."
B)"Your baby's head is too large for your pelvis. You should consider a cesarean birth."
C)"We're considering a cesarean birth. Tell me how you feel about that."
D)"Your baby cannot be born vaginally. Do not worry much about it. We'll do everything to keep you and your baby safe."

Question 50

A client in her third trimester is admitted to the unit after complaining of painless, bright red vaginal bleeding. Placenta previa is suspected. Which of the following actions of the midwife is not appropriate during the admission?

A)Prepare the patient for an ultrasound.
B)Prepare equipment for bi - manual pelvic examination.
C)Attach an external electronic fetal heart rate monitor.
D)Order blood tests, including hemoglobin and hematocrit counts.

Question 51

A midwife is monitoring a client with a cervical dilatation of 3 cm. The midwife determines that the client has contractions occurring every 3 minutes. Each contraction lasts for 50 seconds. The fetal heart rate is determined at 100 beats per minute. Which of the following is the priority action of the midwife?

A)Encourage the client to push with every contraction and to rest in between contractions.
B)Administer oxygen via face mask.
C)Document the findings as normal.
D)Encourage frequent change of position.

Question 52

A multiparous client whose labor is being conducted with anesthesia is in the second stage of labor. She is unable to deliver 2 hours after reaching the second stage of labor. Forceps delivery is ordered. Which of the following is the priority action of the midwife before the procedure?

A)Attempt the procedure with or without maternal verbal consent
B)Verify the presentation of the fetus.
C)Choose which type of forceps is most appropriate for the client.
D)Administer regional anesthesia before the procedure.

Question 53

A primiparous client at 38 weeks' gestation is admitted to the labor and delivery room after showing signs of true labor. The client asks how long she should expect to be in labor before she gives birth to her baby. The midwife informs the client that, on the average, the length of labor for primiparous clients is:

A)13 to 15 hours.
B)8 to 9 hours.
C)18 to 24 hours.
D)5 to 7 hours.

Question 54

A midwife is assessing a client in labor by auscultating the fetal heart tone using the Doppler ultrasound. The fetal position is LOA. The midwife should not:

A)Place the Doppler probe on the left side of the client's abdomen, just below the belly button.
B)Apply generous amounts of ultrasound gel to the client's abdomen and to the face of the probe.
C)Palpate the client's carotid pulse before auscultating the fetal heart tone.
D)Simultaneously palpate the client's radial pulse and auscultate the fetal heart tone.

Question 55

A midwife suspects that a client at 39 weeks' gestation has hypertonic uterine activity. The client is in the early stages of labor. Which of the following findings support the diagnosis?
I.Uterine intensity is about 120 mm Hg.
II.Uterus relaxes between contractions for 90 seconds.
III.Uterine resting tone is 3 mm Hg.
IV.Uterine resting tone is 20 mm Hg.

A)I and IV
B)III and IV
C)I, II and III
D)All of the findings support a diagnosis of hypertonic uterine activity.

Question 56

A midwife is monitoring a G3P2 client who is in labor. Cervical changes are assessed, and the findings are noted. Which of the following cervical changes would the midwife expect when caring for the client?

A)Cervical effacement is accomplished before dilatation begins.
B)Cervical effacement and dilatation occur at the same time.
C)Cervical dilatation proceeds before full effacement.
D)Cervical dilatation is the only cervical change determined during labor

Question 57

A midwife is monitoring a client at 38 weeks' gestation who is in labor. The most recent findings include full dilatation and cervical effacement. The client says, "I feel this uncontrollable urge to push." The client is in which stage of labor?

A)First
B)Second
C)Third
D)Fourth

Question 58

A G3P2 client at 41 weeks' gestation is in labor. The midwife determines that the client has a cervical dilatation of 10 cm. At this time, the midwife would auscultate for the fetal heart tone:

A)Every 5 to 15 minutes.
B)Every 30 minutes.
C)Every 30 to 60 minutes
D)At the start of each contraction.

Question 59

Each uterine contraction consists of three phases. The contraction is at strongest during which phase?

A)Increment
B)Acme
C)Climax
D)Decrement

Question 60

A client is in the second stage of labor and has been pushing for almost an hour. Which of the following interventions is the most appropriate for the client at this stage?

A)Offer clear fluids in between contractions.
B)Encourage ambulation.
C)Instruct the client to push with each contraction.
D)Encourage frequent changes in position.

Question 61

A client in labor is receiving oxytocin. The midwife assesses the client and notes after uterine palpation that the contractions are uncoordinated and that only a portion of the uterus is involved. Which of the following is the priority action of the midwife?

A)Administer oxygen by face mask at 8 to 10 L/min.
B)Position the client in the side - lying position.
C)Stop the infusion of oxytocin.
D)Check for a prolapsed cord.

Question 62

A midwife reviews a fetal heart rate monitor tracing and notes decelerations occurring until 35 seconds after the onset of each contraction. The midwife further notes that the decelerations are continuous past the end of each contraction. The fetal head is fully descended. The midwife suspects which of the following conditions?

A)Fetal head compression
B)Cephalopelvic disproportion
C)Cord compression
D)Uteroplacental insufficiency

Question 63

A midwife is monitoring a client in labor who is receiving intravenous oxytocin. The fetal heart rate monitor tracing reveals decelerations occurring 35 seconds after the onset of each contraction and continuously past the end of the each contraction. Which of the following is the priority action of the midwife?

A)Change the client's position to side - lying position.
B)Position the client to Trendelenburg position.
C)Stop the administration of oxytocin.
D)Administer oxygen.

Question 64

A midwife is receiving a client who has just delivered a healthy baby girl through vaginal birth. No complications were noted during labor. In the immediate postpartum period, the midwife assesses the client's vital signs:

A)Every 15 minutes during the first hour, every 30 minutes for the next 2 hours, every hour for the next 2 to 6 hours, and then every 4 hours for the next 24 hours.
B)Every 15 minutes during the first 30 minutes, every 30 minutes for the next 2 hours, every hour for the next 4 hours, and then every 4 hours for the next 24 hours.
C)Every 30 minutes for the first hour, every hour for the next 2 hours, every 2 hours for the next 4 hours, and then every 8 hours for the next for the next 24 hours.
D)Every 30 minutes for the first hour, every hour for the next 2 hours, every 4 hours for the next 16 hours, and then every 8 hours for the next 24 hours.

Question 65

A midwife is about to perform a fundal assessment on a client who gave birth to a 7 - pound female newborn. Which of the following nursing interventions is the most appropriate when preparing the client for fundal assessment?

A)Offer 1 to 2 glasses of water.
B)Assist the client in assuming the lithotomy position.
C)Instruct the client to void.
D)Assist the client in assuming a modified Sims position.

Question 66

A midwife is managing the care of a postpartum client who was anemic during labor. The client gave birth to a 7 - pound baby girl 24 hours ago through vaginal birth. On assessment, the midwife suspects that the client has puerperal infection. Which of the following findings supports this diagnosis?

A)Soaked 8 perineal pads within the last 24 hours
B)Heart rate of 80 beats per minute
C)Red lochia with a foul odor
D)A body temperature of 100.4 ºF

Question 67

A midwife is managing the care of a 25 - year - old client who just delivered a set of twins. Which of the following interventions is the priority action of the midwife during the immediate postpartum period?

A)Administer pain medications.
B)Encourage the client to void every 2 hours.
C)Apply warm compress to perineum.
D)Assess fundal tone and height.

Question 68

A midwife is assessing four clients who recently gave birth to healthy newborns through vaginal delivery. All of the clients had uncomplicated labors. Which of the following clients needs further evaluation?

A)A postpartum client who has a temperature of 100.4 °F. The client gave birth 24 hours ago.
B)A postpartum client who soaked 8 perineal pads in the past 24 hours. The client gave birth 24 hours ago.
C)A postpartum client who complains of uterine pain every time she breastfeeds her newborn. The client gave birth 48 hours ago.
D)A postpartum client with clots larger than 1 cm across in the red lochia. The client gave birth 48 hours ago.

Question 69

A midwife is assessing the fundal tone and height of a client who gave birth to a healthy baby boy 24 hours ago. After obtaining the vital signs, the midwife notes that the fundus is at the level of the umbilicus. Which of the following is the next action of the midwife?

A)Document the findings as normal.
B)Obtain the vital signs every 15 to 30 minutes.
C)Initiate fundal massage.
D)Administer oxytocin.

Question 70

A client who gave birth two days ago informs the midwife that she has not had a bowel movement since the delivery of her child. The client had a vaginal birth. Which of the following statements made by the midwife is the most appropriate in this situation?

A)"Bowel elimination usually returns a week after birth. Increase your fluid intake to prevent constipation.
B)"Bowel elimination usually returns 5 to 7 days after birth. Ambulate and increase your fiber intake to prevent constipation."
C)"Bowel elimination usually returns within the first 24 hours. Stay here and I will notify your physician."
D)"Bowel elimination usually occurs within 2 to 3 days after birth. Increase your fiber intake to relieve constipation."

Question 71

A midwife is managing the care of a 25 - year - old postpartum client who gave birth 18 hours ago. No complications were noted during the labor process. The newborn is brought to the client for feeding and to have the mother and child bond for the night. The client says, "I'm too tired. Please get her back to the midwifery, just for tonight. I need to get some sleep." Which of the following is the most appropriate action of the midwife?

A)Create a teaching plan for the mother that focuses on breast feeding.
B)Encourage the client to join a parenting skill class.
C)Accept the client's behavior as an indication that she is in the taking - in phase.
D)Accept the client's behavior as an indication that she is in the taking - hold phase.

Question 72

A midwife is receiving a client who gave birth an hour ago. Which of the following nursing interventions is the priority action of the midwife during the immediate postpartum period?

A)Obtain the client's blood glucose level.
B)Palpate for the height of fundus.
C)Order hemoglobin and hematrocrit tests.
D)Administer oxygen.

Question 73

A 25 - year - old female has just given birth to an eight - pound baby boy. Suctioning of the neonate is required. The first action of the midwife when suctioning a neonate immediately after birth is to:

A)Suction the mouth.
B)Suction the nose.
C)Turn the neonate on his side to drain the secretions.
D)Gently flick the neonate's soles.

Question 74

Which of the following actions by a midwife is the least appropriate when giving respiratory care to a healthy, full - term newborn?

A)Assess the newborn's respiratory rate every 15 minutes during the first hour of life.
B)Suction the newborn's mouth first using a bulb syringe before suctioning the nose.
C)Change the newborn's position frequently.
D)Position the newborn with the head up and on one side.

Question 75

A 38 - week newborn is born to a 30 - year - old through vaginal birth. A minute after birth, a midwife obtains the newborn's APGAR score with the following assessment findings: flexed arms and legs with some active movement, a pulse rate of 110 beats per minute, grimace after inserting a tube through a nostril, pink skin tone except for the hands and feet and regular breathing pattern with a good cry. What is the newborn's APGAR score?

A)6
B)7
C)8
D)9

Question 76

A 37 - week female newborn is born to a 28 - year - old female through cesarean birth. A midwife assesses the newborn a minute after birth for APGAR scoring. The following assessment findings are obtained: flexed arms and legs with limited active movement; a pulse rate of 90 beats per minute; grimacing observed after inserting a tube through one of the nostrils; bluish skin tone, including the extremities; and slow, irregular breaths. Which of the following is the next action of the midwife?

A)Initiate immediate resuscitation.
B)Change the newborn's position and wrap her loosely with a warm blanket.
C)Initiate clearing of the airways and oxygen therapy.
D)Obtain another APGAR score in 5 minutes.

Question 77

A female client at 32 weeks' gestation gives birth to a baby girl. The newborn weighs 1400 grams. When managing the newborn's nutritional needs, which of the following actions by the midwife is the most appropriate?

A)Feed the newborn every 4 to 6 hours.
B)Prepare the newborn for gavage feeding.
C)Prepare the newborn for parenteral hyperalimentation.
D)Bottle feed the newborn with special pre - term formula milk using a preemie nipple.

Question 78

After birth, the midwife immediately dries a male neonate's face and hair with a clean, pre - warmed towel. After drying, the midwife covers the neonate's hair with a cap. The purpose of these actions is to prevent heat loss through:

A)Convection.
B)Conduction.
C)Evaporation.
D)Radiation.

Question 79

A patient was admitted with labor pain. The uterine contraction lasted for about 30 seconds initially, but gradually increased in duration with the progression of labor. In which stage of labor is she now?

A)1st stage
B)2nd stage
C)3rd stage
D)None of the above

Question 80

A 2nd gravida occurred at 40 weeks of pregnancy with abdominal pain. Examination revealed that the uterus was contracting and retracting. On P/V/E, cervix was effaced (OS - 3 cm dilated). After completing the diagnosis, state the complication affecting this woman. (Choose all that apply)

A)Cervical dystocia
B)Retained placenta
C)Hypotonic uterine contraction
D)Pulmonary embolism