Question 1

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?

Accepted Answer

DIC is a severe complication of placental abruption.Interventions include administration of IV cryoprecipitate or fibrinogen.To avoid further tissue damage,pelvic and vaginal exams are not performed.The woman is critically ill,and vital signs need to be monitored more often than every 4 hours.Vaginal birth is desirable unless fetal distress is present or there are other indications.If a cesarean birth is necessary,the nurse will need to place the signed informed consent form on the chart.

Question 2

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?

Accepted Answer

This woman's labor is progressing precipitously.The nurse should instruct her to breathe through contractions to avoid pushing.Documentation should always be thorough,but further action is needed.The provider should be notified about a possible precipitous birth,but the woman needs assistance to control the bearing-down efforts.The nurse can delegate the notification task to someone else.Patients and their support persons always need information on their progress,but this is not the most important action.

Question 3

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?

Accepted Answer

A forceps-assisted birth is one in which a steel instrument with two curved blades is used to facilitate the birth of the infant's head.Perineal trauma is one of the major complications associated with the use of forceps.Because hemorrhage (bright red bleeding)may result from cervical lacerations and vaginal tearing,the woman requires close observation during the postpartum period.If this occurs,the care provider should be notified regarding a potential vaginal repair.The other actions are not warranted.

Question 4

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?

Accepted Answer

Pregnancy outcome in patients experiencing variable fetal heart rate decelerations caused by cord compression is improved through the use of amnioinfusion,which is the instillation of normal saline or lactated Ringer's solution into the uterine cavity.

Question 5

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?

Accepted Answer

The nurse should review baseline and ongoing laboratory data,including complete blood count,clotting studies,serum electrolytes,and renal function tests.This baseline information is used to alert the care providers to changes in the patient's condition as additional laboratory tests are obtained.
Assessment of vital signs is dependent on the patient's condition.Intake and output may need to be monitored more frequently.Checks for bleeding every 15 minutes are not necessary.

Question 6

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?

Accepted Answer

Maternal problems resulting from abruptio placentae include a couvelaire uterus (the accumulation of blood between the separated placenta and the uterine wall)and disseminated intravascular coagulation.Although a couvelaire uterus is rare,its implications are severe.The uterus takes on a bluish tinge as blood extravasates from the clot into the myometrium.Contractility is lost.The condition is so severe that a hysterectomy may be necessary to control the bleeding.

Question 7

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?

Accepted Answer

Dinoprostone is a prostaglandin E2 preparation for cervical ripening.It should be used cautiously in women with a history of asthma,glaucoma,and renal,hepatic,or cardiovascular disorders.Once the missing information is noticed,the nurse should assess for contraindications to using the medication,then for conditions that make it riskier.The other conditions are not related.

Question 8

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?

Accepted Answer

Rest,hydration,and sedation often are prescribed in hypertonic labor to reduce the irritability of the uterus and help diminish the ineffective contractions.Medications given include hydromorphone (Dilaudid),meperidine (Demerol),and morphine sulfate (Morphine).The other answers are not accurate.

Question 9

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

Accepted Answer

The nurse is the manager of care for the woman with preeclampsia during the intrapartal period.Careful assessments are critical.The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion.Vital signs should be assessed more often than every 6 hours.The patient should be encouraged to maintain a left side-lying position.A urine output of greater than 30 mL/hour is normal.

Question 10

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

Accepted Answer

The birth of the second twin normally occurs within 15 minutes of the first twin.Although there has been concern over complications associated with a longer time period between births,studies have shown that with proper fetal monitoring and maternal surveillance,a safe vaginal birth can take place in an indefinite amount of time.

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?

Accepted Answer

This woman is experiencing hypertonic labor (strong but ineffective contractions).Because maternal anxiety is a major causative factor,the nurse should first assess for anxiety and help to relieve it.A fetal occiput-posterior malposition is also a cause of hypertonic labor,and the nurse should assess for this condition using Leopold maneuvers; however,the health-care provider would perform any attempt at version.Nipple stimulation and oxytocin would be used in hypotonic labor.

Question 12

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?

Accepted Answer

Diabetic women are at risk for having a macrosomic infant,which is a risk factor for hypotonic labor.For this patient,the nurse needs to be especially aware of this and assess for less frequent and less intense labor contractions.The other three conditions are not specifically related to diabetes.

Question 13

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?

Accepted Answer

Precipitous labor contractions produce very rapid,intense contractions.A precipitous labor lasts less than 3 hours from the beginning of contractions to birth.Patients often progress through the first stage of labor with little or no pain and may present to the birth setting already advanced into the second stage.

Question 14

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?

Accepted Answer

Laboratory tests include a complete blood count with platelets,coagulation profile to assess for disseminated intravascular coagulation,metabolic studies for determination of liver enzymes (aspartate aminotransferase,alanine aminotransferase,lactate dehydrogenase),and electrolyte studies to establish renal functioning.The other laboratory values are not as critical in this situation.

Question 15

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?

Accepted Answer

The nurse needs to assess the fetal heart rate immediately before and after the artificial rupture of the membranes.Changes such as transient fetal tachycardia may occur and are common.However,other fetal heart rate patterns,such as bradycardia and variable decelerations,may be indicative of cord compression or prolapse.The nurse should perform a vaginal examination to assess for cord prolapse.Administering oxygen may or may not be needed.Maternal temperature is assessed every 2 hours after artificial rupture of membranes but is not related to this situation.The nurse should not wait 30 minutes prior to doing anything.

Question 16

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?

Accepted Answer

Glucocorticoids such as betamethasone are given prior to 34 weeks' gestation to promote fetal lung maturity if delivery can be delayed for 48 hours.

Question 17

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?

Accepted Answer

Pharmacological pain interventions can slow the progress of labor,especially if the labor pattern was not well established prior to initiating medication.In order to ease pain and discomfort,the nurse should suggest nonpharmacological measures that should help decrease the amount of pain medication the woman requires.The other statements are not accurate,and telling the woman she has to choose between relaxation techniques or amniotomy sounds vaguely threatening.

Question 18

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?

Accepted Answer

Electronic fetal monitoring is applied in the case of a multiple gestation.It is important to identify each of the individual fetal heart rates,and the use of a separate monitor for each fetus is preferable.The other interventions are also appropriate,but do not take priority over fetal monitoring.

Question 19

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?

Accepted Answer

Because nonreassuring fetal heart rate patterns constitute a risk indicator for cesarean birth,the nurse and all members of the health-care team must be ready for this outcome at all times.The nurse should change the woman's position to her side to increase oxygen flow to the fetus.The rate of the IV solution can be increased.Documentation should always be thorough.Fetal scalp electrodes may or may not need to be placed.

Question 20

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?

Accepted Answer

This woman's laboratory values indicate the possible development of HELLP syndrome (hemolysis,elevated liver enzymes,low platelets),which is a factor that may necessitate immediate interventions to facilitate birth.Betamethasone is not given after 34 weeks' gestation.Increasing the IV fluids is not warranted.The patient should be maintained on bedrest,but notifying the provider is a priority.

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

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?