Question 1

The pregnant client expresses a desire to schedule birth during the baby's father's furlough from the Army. The nurse explains that prior to induction of labor, it is essential to determine which condition?

Accepted Answer

Reassurance of fetal lung maturity is essential before elective procedures such as induction or cesarean. The cervix must be favorable for dilation but need not be dilated prior to induction. Prior rupture of membranes is not necessary for induction. Uterine hypertonia is a risk factor associated with induction of labor.

Question 2

When the client receiving an oxytocin (Pitocin) drip at 16 mU/min develops hypertonic stimulation, FHR 138 bpm with accelerations, and no decelerations, the nurse's best response would be to:

Accepted Answer

In the absence of any adverse fetal response, hypertonic stimulation can be managed by reducing the infusion rate by 1 to 2 mU/min until uterine hyperstimulation is resolved. Stopping the drip immediately is not necessary unless hyperstimulation continues and adverse fetal responses occur. Reassessing and repositioning are of no benefit in this situation.

Question 3

A pregnant woman develops hypertension. The nurse monitors the client's blood pressure closely at subsequent visits because the nurse is aware that hypertension is associated with what complication?

Accepted Answer

Hypertension associated with pregnancy is associated with reduced placental blood flow. Abruptio placentae, cardiac abnormalities in the neonate, and neonatal jaundice are not directly related to maternal hypertension.

Question 4

Which assessment would be important for a 6-hour-old infant who has bruising over the cheeks from a forceps birth?

Accepted Answer

Following a forceps birth, the infant may have ecchymoses and facial nerve injury. Facial asymmetry suggests facial nerve damage. Changes in newborn reflexes, presence of caput and molding, and changes in the anterior and posterior fontanels are not risks associated with trauma to the infant's face.

Question 5

In which client situation could an amniotomy be safely performed?

Accepted Answer

The cervix must be partially open to allow the membranes to be ruptured. An amniotomy cannot be performed when the cervix is closed. Breech presentation would be delivered by cesarean section and membranes would be ruptured at birth. Rupturing the membranes in a client with hydramnios can result in abruptio placentae.

Question 6

On vaginal exam, the client's cervix is anterior, soft, 70% effaced, dilated 2 cm, and the presenting part is at 0 station. The Bishop's score for this client is:

Accepted Answer

On the Bishop's scoring system, an anterior cervix = 2 points, soft cervix = 2 points, 70% effaced = 2 points, 2 cm dilated = 1 point, and 0 station = 2 points, for a total score of 9.

Question 7

The pregnant client is admitted to the labor and birth unit for induction of labor. Which finding would allow the induction to continue as planned?

Accepted Answer

Procedures to ripen (soften) the cervix and make it more likely to dilate with the forces of labor are a common adjunct to induction. Most are done the day before the scheduled induction. Contraindications associated with induction may include cephalopelvic disproportion and umbilical cord prolapse. A cesarean section is indicated for abruptio placentae.

Question 8

Which aspect of newborn assessment may be limited by the application of a vacuum extractor at birth?

Accepted Answer

The vacuum extractor is applied on the occipital bone and may create scalp edema at the application site. The posterior fontanel connects the occipital bone to the parietal bones. The anterior fontanel, coronal suture lines, and parietal bones are not part of the application area for a vacuum extractor.

Question 9

A vaginal exam for a laboring multipara client who is 42 weeks' gestation reveals the following information: 4 cm, minimal effacement, -2 station. Which clinical factors would affect the clinical management decision not to rupture membranes with an AmniHook?

Accepted Answer

The fact that the presenting part is not engaged causes concern because there is increased risk of a prolapsed cord on artificial rupture of membranes (AROM). Vaginal dilation is adequate for attempt to rupture membranes. The fact that a client is a multipara is not a significant reason to affect clinical decision making with regard to AROM. Postdates of pregnancy may warrant a more aggressive approach to speed the labor and birth process.

Question 10

A client who is receiving oxytocin (Pitocin) infusion for the augmentation of labor is experiencing a contraction pattern of more than eight contractions in a 10-minute period. Which intervention would be a priority?

Accepted Answer

The client is exhibiting uterine tachysystole (uterine tetany). Priority intervention is to stop the infusion. The next course of action is to place oxygen on the client and reposition and increase the flow rate of the primary infusion. If the condition does not improve, the physician may be called for additional orders.

Question 11

Which breech presentation should the nurse recognize as being favorable for an external cephalic version?

Accepted Answer

An external cephalic version (changing the fetal presentation from breech to cephalic) is more successful when the pregnancy is at least 37 weeks and there is still adequate room and fluid to manipulate the fetus but prior to term or onset of labor. A low-lying placenta, previous cesarean birth, and uterine fibroids are contraindications for version.

Question 12

When a laboring client receiving 12 mU of pitocin for induction develops a contraction pattern of every 2 minutes lasting 80 seconds and recurring late decelerations, the nurse should immediately:

Accepted Answer

Uterine hyperstimulation can reduce placental blood flow and decrease fetal oxygenation. Late decelerations are caused by uteroplacental insufficiency. Stopping the oxytocin infusion will reduce uterine activity and increase fetal oxygenation. Administering O₂, repositioning the client, and increasing the rate of the primary nonadditive infusion will not be effective until hyperstimulation is resolved.

Question 13

Which clinical finding indicates the use of vacuum extraction as a birth method?

Accepted Answer

Vacuum extraction is used in place of forceps as an assistive method to help with the birth of the fetus. It is not used in nonvertex presentations. Mentum presentation is where the chin is the presenting part. Vacuum extraction should not be used in the presence of caput succedaneum (swelling) or in the presence of excessive molding.

Question 14

Select the situation that describes the safest administration of oxytocin induction and cervical ripening agents.

Accepted Answer

Dinoprostone (Cervidil) in a 10-mg, time-release insert may be left in place for up to 12 hours and oxytocin induction can be safely started 1 hour after insert is removed. Oxytocin and cervical ripening agents cannot be administered at the same time. Misoprostol (Cytotec) is contraindicated in a women with previous cesarean. The maximum dose of dinoprostone (Prepidil) 1.5 mg/24 hr.

Question 15

A client is being sent into the labor and birth unit for a serial induction of labor. The Bishop's score is 7. What would the nurse anticipate as the sequence of treatment planned for this client?

Accepted Answer

A serial induction looks at a progressive treatment plan that is based on the best outcome, that of a successful birth. Because the Bishop's score is 7, this indicates that certain conditions are not favorable for an induction. Therefore, the use of mechanical methods for cervical ripening maybe warranted. A serial induction is typically done over a 3-day period in which cervical ripening is followed by 2 days of Pitocin infusion, and on the last day an amniotomy is performed in conjunction with the infusion.

Question 16

Which assessment finding is indicative of a major complication 1 hour following a forceps birth?

Accepted Answer

Trauma to the vaginal area from a forceps birth may result in significant blood loss from hematomas or lacerations. Tachycardia is an early sign of compensation for excessive blood loss. A displaced uterine fundus is mostly likely indicative of a full bladder. Vaginal pain may be present even when the vaginal mucosa is intact. Moderate lochia rubra is a common finding early in the postpartum period.

Question 17

In which of these situations should the nurse anticipate the use of forceps or vacuum extraction?

Accepted Answer

Forceps or vacuum extraction is considered if the second stage should be shortened for the well-being of the woman or fetus. Onset of late decelerations is an indication for an operative birth. With the fetus at +3 station, an outlet operative birth can be performed. Complete dilation for 2 hours at +2 station, complete dilation for 1 hour with a transverse arrest at station +1, and complete dilation for 1 hour with fetal descent from 0 station to +1 in 1 hour are situations in which client pushing and position changes would be used before operative intervention is indicated.

Question 18

Which of the following factors would lead to an increased risk for a prolapsed cord to occur during an amniotomy?

Accepted Answer

Prolapsed cord is more likely to occur when the presenting part is not engaged and the pregnancy is preterm because the fetus would be smaller and there would potentially be more amniotic fluid. If the presenting part is engaged and the pregnancy is at term or postdated, it is less likely that a prolapsed cord would occur.

Question 19

The nurse is preparing to administer a vaginal prostaglandin preparation to ripen the cervix of a client. With which client should the nurse question the use of vaginal prostaglandin as a cervical ripening agent?

Accepted Answer

Prostaglandins are contraindicated in clients who have had a previous surgery in the upper uterus, such as a previous classic cesarean incision or extensive surgery for uterine fibroids. A side effect of prostaglandin administration is hyperstimulation of the uterus. A Bishop's score of 5, 42 weeks of gestation, or a previous low transverse cesarean birth are not contraindications for cervical ripening.

Question 20

Following an external cephalic version, which assessment finding indicates a complication?

Accepted Answer

A serious risk of external cephalic version is that the fetus may become entangled in the umbilical cord, compressing its vessels and resulting in hypoxia. The onset of irregular contractions, maternal blood pressure of 110/70 mm Hg, and maternal pulse rate of 100 bpm are normal findings.

Quiz 16: Nursing Care During Obstetric Procedures