Deck 22: Birth-Related Procedures

Question 1

A client at 40 weeks' gestation is being considered for cervical ripening. Which criteria should the nurse use to determine the client's success for induction? Select all that apply.
1) Position
2) Effacement
3) Consistency
4) Fetal heart rate
5) Cervical dilatation

Answer 1

1, 2, 3, 5

Question 2

The nurse is completing discharge teaching for a client who delivered 2 days ago. Which statement indicates that further information is required?
1) "I can take ibuprofen (Motrin) when my perineum starts to hurt."
2) "Soaking in the tub will help my mediolateral episiotomy to heal."
3) "The tear I have through my rectum is unrelated to my episiotomy."
4) "Because I have a midline episiotomy, I should keep my perineum clean."

Answer 2

3

Question 3

The nurse manager observes care being provided by a graduate nurse who is caring for a client undergoing a forceps delivery. Which action requires intervention?
1) Bladder is emptied using a straight catheter.
115)
2) The client is instructed to push between contractions.
3) Fetal heart tones are consistently between 110 and
4) Regional anesthesia is administered via pudendal block.

Answer 3

2

Question 4

The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the client's chart requires immediate intervention?
1) "Multipara, transverse lie."
2) "Primipara failed ECV last week."
3) "Primipara, frank breech ballotable."
4) "Multipara, 32 weeks, complete breech."

Question 5

The client is instructing a client recovering from a classic uterine incision for a cesarean birth. Which statement indicates that the client understands implications for future pregnancies that are secondary to this type of incision?
1) "I can only have one more baby."
2) "The next time I have a baby, I can try to deliver vaginally."
3) "Every time I have a baby, I will have to have a cesarean delivery."
4) "The risk of rupturing my uterus is too high for me to have any more babies."

Question 6

A client in the midst of labor and delivery of twins is being considered for a podalic version. What should the nurse assess in order for this version to be considered? Select all that apply.
1) Previous cesarean birth
2) Second fetus does not descend
3) Premature rupture of membranes
4) Presence of third-trimester bleeding
5) Second fetus heart rate nonreassuring

Question 7

A client experiencing a difficult labor is going to have vacuum extraction to facilitate delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance?
1) "The baby's head might have a bruise from the vacuum cup."
2) "The vacuum will be applied for a total of 10 minutes or less."
3) "I can stop pushing and just rest if the vacuum extractor is used."
4) "A small cup will be put onto the baby's head, and a gentle suction will be applied."

Question 8

The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which participant statement indicates that additional information is needed?
1) "Because my hospital is so small and in a rural area, they will not let me attempt a VBAC."
2) "Since the scar on my belly goes down from my navel, I am not a candidate for a VBAC."
3) "The rate of complications from VBAC is lower than the rate of complications from a cesarean."
4) "My first baby was in a breech position, so this pregnancy I can try a VBAC if the baby is head-down."

Question 9

The nurse is instructing a pregnant client scheduled for an elective cesarean birth on the different types of incisions. Where should the nurse identify the location of the Sellheim incision during this teaching?Shape_

Question 10

A client is recovering from general anesthesia after an emergency cesarean birth. What actions should the nurse take when providing care to this client? Select all that apply.
1) Position on the left side.
2) Observe urine for hematuria.
3) Assess level of anesthesia every 15 minutes.
4) Evaluate perineal pad every 15 minutes for 1 hour.
5) Gently palpate the fundus with vital signs assessment.

Question 11

A client recovering from delivery asks for another ice pack to place on the site of a midline episiotomy. How should the nurse respond to this request?
1) "I will get you one right away."
2) "You only need to use one ice pack."
3) "You need to leave it off for at least 20 minutes and then reapply."
4) "I will bring you an extra so that you can change it when you are ready."

Question 12

A client experiencing a difficult labor has a vacuum extraction birth. What is expected with this type of delivery?
1) The head is delivered after eight pulls during contractions.
2) The location of the vacuum is apparent on the fetal scalp after birth.
3) A bruise is present on the occiput that does not cross the suture line.
4) Positive pressure is applied by the vacuum extraction during contractions.

Question 13

A pregnant client receiving oxytocin for labor induction begins demonstrating adverse effects of the medication. In which order should the nurse provide care to this client?
1) Notify the healthcare provider.
2) Discontinue the oxytocin infusion.
3) Position the client onto the left side.
4) Infuse prescribed intravenous fluids.
5) Administer oxygen 8 to 10 L per tight face mask.

Question 14

The risk management nurse is reviewing labor and delivery statistics over the last 2 years in an effort to decrease costs of maternity care. What finding contributes to increased healthcare costs in clients undergoing cesarean birth by request?
1) Prolonged anemia, requiring blood transfusions every few months
2) Increased abnormal placenta implantation in subsequent pregnancies
3) Decreased use of general anesthesia with greater use of epidural anesthesia
4) Coordination of career projects of both partners leading to increased income

Question 15

The nurse is preparing a client with cephalopelvic disproportion (CPD) for an immediate cesarean birth. What is the last assessment that the nurse should make before the client is draped for surgery?
1) Vaginal examination
2) Fetal heart tones
3) Maternal temperature
4) Maternal urine output

Question 16

The clinical nurse coordinator is reviewing the care of clients who undergo artificial rupture of membranes (AROM) by way of amniotomy with a group of nursing students. Which student statement indicates that the teaching has been effective?
1) "Amniotomy is contraindicated for use in labor augmentation."
2) "For women who undergo artificial rupture of membranes, vaginal examinations should be limited."
3) "Women who undergo artificial rupture of membranes should be advised that they will experience a 'dry birth.'"
4) "In most cases, it is appropriate to assess the fetal heart rate (FHR) right after the artificial rupture of membranes is performed."

Question 17

A client at 39 weeks' gestation being prepared for labor induction feels as though the baby has "flipped." What action should the nurse take?
1) Evaluate fetal maturity.
2) Administer dinoprostone (Cervidil) vaginal gel.
3) Implement continuous electronic fetal monitoring (EFM).
4) Notify the healthcare provider that the client feels as though the baby has changed position.

Question 18

A client at 40 weeks' gestation is prescribed dinoprostone (Cervidil) for cervical ripening. What should the nurse include when teaching the client about this medication? Select all that apply.
1) Cramping can occur.
2) Uterine irritability is expected.
3) Membrane rupture is a sign of labor.
4) Leakage of the gel should be reported.
5) Strong regular contractions are expected.

Question 19

The nurse is reviewing the medical history of a pregnant client being considered for cervical ripening. Which data indicate that the order for misoprostol (Cytotec) should be reconsidered? Select all that apply.
1) Current fetal heart rate is tachycardic.
2) Client had one cesarean live birth 3 years ago.
3) Uterine contractions are occurring every 2 minutes.
4) Client has 2+ pedal edema and elevated blood pressure.
5) There is a history of placenta previa with one previous pregnancy.

Question 20

A client who received a mediolateral episiotomy to facilitate vacuum extraction birth asks what kind of episiotomy was performed. How should the nurse explain the location of the episiotomy?
1) "It goes straight back toward your rectum."
2) "It is from your vagina toward the urethra."
3) "It is cut diagonally away from your vagina."
4) "It extends from your vagina into your rectum."