Deck 28: Birth-Related Procedures

Question 1

A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, terbutaline will be administered to:

A) Provide analgesia.
B) Relax the uterus.
C) Induce labor.
D) Prevent hemorrhage.

Answer 1

Relax the uterus.

Question 2

During a visit to the obstetrician, a pregnant patient questions the nurse about the potential need for an amniotomy. The nurse explains that an amniotomy is performed to:

A) Stimulate the beginning of labor.
B) Augment labor progression.
C) Allow application of an internal fetal electrode.
D) Allow application of an external fetal monitor.
E) Allow insertion of an intrauterine pressure catheter.

Answer 2

Stimulate the beginning of labor.
Augment labor progression.
Allow application of an internal fetal electrode.
Allow insertion of an intrauterine pressure catheter.

Question 3

The nurse is completing discharge teaching for a patient who delivered 2 days ago. Which statement by the patient indicates that further information is required?

A) "Because I have a midline episiotomy, I should keep my perineum clean."
B) "Soaking in the tub will help my mediolateral episiotomy to heal."
C) "I can take ibuprofen (Motrin) when my perineum starts to hurt."
D) "The tear I have through my rectum is unrelated to my episiotomy."

Answer 3

"The tear I have through my rectum is unrelated to my episiotomy."

Question 4

The nurse has received an order to rupture a patient's membranes artificially. Which finding in the patient's history would lead the nurse to the order?

A) Group B strep negative yesterday
B) HbsAg negative at 28 weeks
C) HIV-positive X 3 years
D) History of genital herpes

Question 5

Induction of labor is planned for a 31-year-old primip at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important?

A) Administer 100 mcg of misoprostol (Cytotec) vaginally every 2 hours.
B) Place dinoprostone (Prepidil) vaginal gel and ambulate patient for 1 hour.
C) Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec).
D) Prepare to induce labor after administering a tap water enema.

Question 6

In which clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion?

A) Placental abruption
B) Meconium-stained fluid
C) Polyhydramnios
D) Late decelerations
E) Early decelerations

Question 7

The nurse is scheduling a patient for an external cephalic version (ECV). Which finding in the patient's chart requires immediate intervention?

A) Multip, previous birth by cesarean
B) Primip, frank breech ballotable
C) Multip, 37 weeks, complete breech
D) Primip, failed ECV last week

Question 8

The nurse knows that contraindications to the induction of labor include:

A) Placenta previa.
B) Isoimmunization.
C) Diabetes mellitus.
D) Premature rupture of membranes.

Question 9

After inserting prostaglandin gel for cervical ripening, the nurse should:

A) Apply an internal fetal monitor.
B) Insert an indwelling catheter.
C) Withhold oral intake and start intravenous fluids.
D) Place the patient in a supine position with a right hip wedge.

Question 10

A laboring patient's obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed?

A) Maternal temperature, BP, and pulse
B) Estimation of fetal birth weight
C) Fetal presentation, position, and station
D) Biparietal diameter

Question 11

The patient tells the nurse that she has come to the hospital so that her baby's position can be changed. The nurse would begin to organize the supplies needed to perform which procedure?

A) A version
B) An amniotomy
C) Leopold's maneuvers
D) A ballottement

Question 12

The patient is having fetal heart rate decelerations. An amnioinfusion has been ordered for the patient to alleviate the decelerations. The nurse understands that the type of decelerations that will be alleviated by amnioinfusion is:

A) Early decelerations.
B) Moderate decelerations.
C) Late decelerations.
D) Variable decelerations.

Question 13

The nurse is explaining induction of labor to a client. The client asks what the indications for labor induction are. Which of the following should the nurse include when answering the client?

A) Suspected placenta previa
B) Breech presentation
C) Prolapsed umbilical cord
D) Hypertension

Question 14

The patient is undergoing an emergency cesarean birth for fetal bradycardia. The patient's partner has not been allowed into the operating room. What can the nurse do to alleviate the partner's emotional distress?

A) Allow the partner to wheel the baby's crib to the newborn nursery.
B) Take digital pictures of the newborn and show them to the partner.
C) Have the partner wait in the patient's postpartum room.
D) Encourage the partner to be in the nursery for the initial assessment.
E) Teach the partner how to take the patient's blood pressure.

Question 15

Under which circumstances would the nurse remove prostaglandin from the patient's cervix?

A) Contractions every 5 minutes
B) Nausea and vomiting
C) Late decelerations
D) Contractions every 90 seconds
E) Baseline fetal heart rate of 140-148

Question 16

A patient at 40 weeks' gestation is to undergo stripping of the membranes. The nurse provides the patient with information about the procedure. Which information is accurate?

A) Intravenous administration of oxytocin will be used to initiate contractions.
B) The healthcare provider will insert a gloved finger into the cervical os and rotate the finger 360 degrees.
C) The procedure will not cause discomfort, and is usually effective.
D) Labor should begin within 24-48 hours after the procedure.
E) Uterine contractions, cramping, and a bloody discharge can occur after the procedure.

Question 17

A laboring patient's obstetrician has suggested amniotomy as a method for creating stronger contractions and facilitating birth. The patient asks, "What are the advantages of doing this?" What should the nurse cite in response?

A) Contractions elicited are similar to those of spontaneous labor.
B) Amniotomy decreases the chances of a prolapsed cord.
C) Amniotomy reduces the pain of labor and makes it easier to manage.
D) The patient will not need an episiotomy.

Question 18

The client presents for cervical ripening in anticipation of labor induction tomorrow. What should the nurse include in her plan of care for this client?

A) Apply an internal fetal monitor.
B) Allow the client to void prior to insertion of dinoprostone (Cervidil) gel.
C) Withhold oral intake and start intravenous fluids.
D) Place the client in a semi-Fowler's position.

Question 19

The nurse knows that the Bishop scoring system for cervical readiness includes cervical dilatation, consistency, position, and:

A) Fetal station.
B) Fetal lie.
C) Fetal presenting part.
D) Cervical effacement.
E) Cervical softness.

Question 20

The nurse is monitoring a patient who is receiving an amnioinfusion. Which assessments must the nurse perform to prevent a serious complication?

A) Color of amniotic fluid
B) Maternal blood pressure
C) Cervical effacement
D) Uterine resting tone
E) Fluid leaking from the vagina

Question 21

A patient is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (VBAC) with this pregnancy. Which statement indicates that the patient requires more information about VBAC?

A) "I can try a vaginal birth because my uterine incision is a low segment transverse incision."
B) "The vertical scar on my skin doesn't mean that the scar on my uterus goes in the same direction."
C) "There is about a 90% chance of giving birth vaginally after a cesarean."
D) "Because my hospital has a surgery staff on call 24 hours a day, I can try a VBAC there."

Question 22

The nurse is developing a care plan for a newly delivered mother who had a forceps delivery. Which nursing diagnosis is appropriate for a postpartal mother with lacerations from a forceps delivery?

A) Alteration in Body Image related to scar formation
B) High Risk for Infection related to lochia and decreased perineal and birth canal integrity
C) Alteration in Nutrition: more than body requirements related to increased appetite
D) Self-care Deficit related to poor opportunity for independence

Question 23

The nurse is teaching childbirth education classes. Teaching has been successful if the primiparous patient states: "I can reduce the likelihood that I'll tear or need an episiotomy if I:

A) "Push in a semi-sitting position."
B) "Make sure I push long and hard."
C) "Begin regular perineal massage."
D) "Pull back on my legs when pushing."

Question 24

A prenatal patient asks the nurse about conditions that would necessitate a cesarean delivery. The nurse explains that cesarean delivery generally is performed in the presence of:

A) Complete placenta previa.
B) Placental abruption.
C) Umbilical cord prolapse.
D) Precipitous labor.
E) Failure to progress.

Question 25

The physician has determined the need for forceps. The nurse should explain to the patient that the use of forceps is indicated:

A) Because her support person is exhausted.
B) Due to premature placental separation.
C) To shorten the first stage of labor.
D) To prevent fetal distress.

Question 26

The nurse is reviewing charts of clients 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 health care costs in clients 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

Question 27

The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring patient who will have a forceps delivery. Which action or assessment finding requires intervention?

A) Regional anesthesia is administered via pudendal block.
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B) The patient is instructed to push between contractions.
C) Fetal heart tones are consistently between 110 and
D) The patient's bladder is emptied using a straight catheter.

Question 28

After being in labor for several hours with no progress, a patient is diagnosed with CPD (cephalopelvic disproportion), and must have a cesarean section. The patient is worried that she will not be able to have any future children vaginally. After sharing this information with her care provider, the nurse would anticipate that the patient would receive what type of incision?

A) Transverse
B) Suprapubic
C) Classic
D) Vertical

Question 29

The patient is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the patient asks for another. 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."

Question 30

In the operating room, a patient is being prepped for a cesarean delivery. The doctor is present. What is the last assessment the nurse should make just before the patient is draped for surgery?

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

Question 31

The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client 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."

Question 32

A patient attending a prenatal class asks why episiotomies are performed. The nurse explains that risk factors that predispose women to episiotomies include:

A) Large or macrosomic fetus.
B) Use of forceps.
C) Shoulder dystocia.
D) Maternal health.
E) Shorter second stage.

Question 33

The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The provider requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth?

A) Elation, euphoria, and talkativeness
B) A sense of failure and self-disappointment
C) Questions about whether or not to circumcise
D) Uncertainty surrounding the baby's name

Question 34

The patient has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal?

A) The head is delivered after eight pulls during contractions.
B) A bruise is present on the occiput that does not cross the suture line.
C) The location of the vacuum is apparent on the fetal scalp after birth.
D) Positive pressure is applied by the vacuum extraction during contractions.

Question 35

The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed?

A) "Since the scar on my belly goes down from my navel, I am not a candidate for a VBAC."
B) "My first baby was in a breech position, so for this pregnancy, I can try a VBAC if the baby is head-down."
C) "Because my hospital is so small and in a rural area, they won't let me attempt a VBAC."
D) "The rate of complications from VBAC is lower than the rate of complications from a cesarean."

Question 36

The need for forceps has been determined. The patient's cervix is dilated to 10 cm, and the fetus is at +2 station. What category of forceps application would the nurse anticipate?

A) Input
B) Low
C) Mid
D) Outlet

Question 37

The obstetrician opts to use a vacuum extractor for a delivery. The nurse understands that:

A) There is little risk with vacuum extraction devices.
B) There should be further fetal descent with the first two pulls.
C) Traction is applied between contractions.
D) The woman often feels increased discomfort during the procedure.

Question 38

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 the nurse to describe the episiotomy. The nurse responds, "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."

Question 39

The patient demonstrates understanding of the implications for future pregnancies secondary to her classic uterine incision when she 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."