Question 1

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

Accepted Answer

The nurse midwife monitors each fetal heart rate with a separate monitor. Many risks are involved with multiple gestations, such as cord prolapse, uterine dysfunction and premature separation of the placenta. For this reason, each fetus must be closely monitored.

Question 2

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

Accepted Answer

The nurse midwife should monitor the client for signs of water intoxication, such as vomiting. Water intoxication is also manifested by headache and seizures. Oxytocin is an anti-diuretic hormone that causes decreased urine outflow and, consequently, fluid overload. The nurse midwife should closely monitor the client's fluid intake and urine output, test the client's urine specific gravity and limit the intravenous fluid being administered to 150 mL per hour.

Question 3

A nurse 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 nurse 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 nurse suspects that the client is mostly experiencing:

Accepted Answer

The client is demonstrating signs of uterine inversion, a condition in which the uterus completely or partly turns inside out. It usually occurs during delivery or after the delivery. The nurse midwife must monitor the client for signs of hemorrhage and shock.

Question 4

A nurse 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?

Accepted Answer

The fetal presentation of ROA indicates that the fetus is in vertex position. The fetal landmark is the occiput of the fetus. A fetus in a transverse lie would have the scapula or acromion process as the fetal landmark. The other options accurately describe the ROA presentation.

Question 5

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 nurse midwife is the most effective during the labor process?

Accepted Answer

The most effective action during a precipitous labor is to deliver the infant between contractions should an immediate delivery become necessary. The client has to pant in between contractions. The nurse midwife should not attempt to keep the fetus from being delivered. The nurse midwife should apply gentle pressure upward, toward the vagina, to prevent vaginal lacerations and damage to the fetal head.

Question 6

A nurse midwife is monitoring a client who was admitted to the labor and delivery unit about 5 hours ago. The nurse 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?

Accepted Answer

The client is in the active phase of labor. The active phase of labor is the second phase of the first stage of labor. The latent phase is manifested by cervical dilatation from 0 to 3 cm and by contractions lasting 20 to 40 seconds. The active phase of labor is manifested by cervical dilatation from 4 to 7 cm and by contractions occurring every 3 to 5 minutes, each lasting 40 to 60 seconds. The transitional phase is manifested by cervical dilatation from 8 to 10 cm and by contractions lasting 60 to 90 seconds.

Question 7

A client in labor begins to complain of severe abdominal pain and chest pain. On assessment, the nurse 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 nurse midwife?

Accepted Answer

The next action of the nurse midwife is to prepare the client for cesarean delivery. Based on the history and assessment findings, the client has uterine rupture, and this is mainly managed by cesarean delivery. Hysterotomy with hysterectomy may be performed. Intubation and mechanical ventilation may be necessary for clients with amniotic fluid embolism.

Question 8

A nurse 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

Accepted Answer

The nurse midwife may determine the fetal position and presentation through vaginal examination, sonography, combined abdominal inspection and palpation and auscultation of fetal heart tones. It is essential to obtain the fetal position and presentation to determine the possible risks of labor, such as cephalopelvic disproportion, which may require a cesarean birth. CPD may increase the risk of early rupture of the membranes, infection, meconium staining and respiratory distress.

Question 9

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?

Accepted Answer

A low-lying placenta is implanted in the lower uterine segment, but it does not reach the os. A placenta lying low in the uterine segment near or over the internal cervical os indicates placenta previa. Option C refers to marginal placenta. A total placenta previa covers the entire os when the cervix is fully dilated.

Question 10

A nurse 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 nurse 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 nurse midwife is the most appropriate when informing the client about the findings?

Accepted Answer

The nurse midwife should inform the client that her pelvis is too small for the baby's head and that the baby cannot be born vaginally. Learning about the disproportion can be distressing for the client, but it is important to emphasize to the client that the pelvis structure is most likely at fault and not the baby. Informing the client that the baby's head is too large may imply that something is seriously wrong with the baby, which increases the client's anxiety level. In most cases of CPD, especially in cases where fetal well-being is suggested throughout the pregnancy, it is usually the client's pelvis that has problems. Option C does not inform the client why a cesarean birth is necessary and it may further increase the client's anxiety levels. Option D offers false reassurance and does not indicate why the baby cannot be born vaginally.

Question 11

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 nurse midwife is not appropriate during the admission?

Accepted Answer

Bi-manual pelvic examination is not an appropriate nursing action when caring for a client who may have placenta previa. Bi-manual pelvic examination involves the insertion of two fingers inside the vagina and one hand over the abdomen. This action may cause maternal and fetal hemorrhage. Instead, an ultrasound is used to verify the diagnosis. There may be an increased risk of fetal complications due to decreased oxygen supply to the brain, so it is essential to monitor the fetus with an external fetal heart monitor.

Question 12

A nurse midwife is monitoring a client with a cervical dilatation of 3 cm. The nurse 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 nurse midwife?

Accepted Answer

The priority action of the nurse midwife is to administer oxygen by a face mask. The normal fetal heart rate is 120 to 160 beats per minute; a fetal heart rate of 100 beats per minute is not a normal finding. This finding suggests that the fetus may be in distress. Encouraging the client to push with every contraction is not recommended. The client may be placed in side-lying position to promote fetal circulation.

Question 13

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 nurse midwife informs the client that, on the average, the length of labor for primiparous clients is:

Accepted Answer

The average length of labor for primiparous clients is between 13 and 15 hours. For multiparous clients, the average length of labor is between 8 and 9 hours. The length of labor may vary from client to client, but in general, the length of labor is shorter for multiparous clients.

Question 14

A client at 38 weeks' gestation is admitted to the unit after complaining of painful, moderate vaginal bleeding of dark, clotted blood. A series of diagnostic and laboratory tests verify that the client is experiencing abruptio placenta. The fetal heart rate is 180 beats per minute. Which of the following actions is the priority action of the nurse midwife?

Accepted Answer

The priority action of the nurse midwife is to prepare the client for cesarean delivery, order the necessary diagnostic tests and crossmatch about 4 units of packed red blood cells. The main goal when caring for a client with abruptio placenta at term is to deliver the infant, either through vaginal or cesarean birth. Options A and D are more appropriate for clients who are not at term.

Question 15

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

Accepted Answer

The nurse midwife should simultaneously palpate the client's radial pulse and auscultate the fetal heart tone. Simultaneous assessment of the client's radial or carotid pulse and the fetal heart tone makes it easier for the nurse midwife to differentiate the two. The fetal position is LOA, so the nurse midwife should place the Doppler probe on the left side of the client's abdomen, just below the belly button. The fetal heart tone may be assessed by placing the probe over the fetal back. Generous amounts of ultrasound gel should be applied to the client's abdomen and to the face of the probe to help the probe glide more easily and pick up the fetal heart tone.

Question 16

A nurse midwife is assessing a client at 34 weeks' gestation. An external fetal heart monitor is attached. Which of the following assessment findings suggest fetal distress?
I. Fetal heart rate decreases at the onset of contractions and returns to baseline after the contraction
II. Fetal heart rate of 130 beats per minute
III. Greenish amniotic fluid
IV. Continuous decrease in baseline variability

Accepted Answer

Greenish or meconium-stained amniotic fluid and continuous decrease in baseline variability are signs of fetal distress. Early deceleration, which describes a decrease in the fetal heart rate at the onset of contraction and its return to baseline after the contraction, and a fetal heart rate between 120 and 160 beats per minute are not signs of fetal distress. Early deceleration is caused by vagal stimulation from head compression. It is a reassuring pattern. Other signs and symptoms of fetal distress include fetal hyperactivity, severe variable decelerations and late decelerations.

Question 17

A client at 38 weeks' gestation is admitted to the facility after a nurse midwife suspects that she has a case of premature rupture of the amniotic membranes. Which of the following information given by the client supports this diagnosis?

Accepted Answer

Leakage of clear fluid from the vagina without contractions is a classic sign of premature rupture of the membranes. Premature rupture of the membranes occurs in pregnant clients at over 37 weeks' gestation. Vaginal discharge, vaginal bleeding and pelvic pressure without contractions are also signs of premature amniotic membrane rupture.

Question 18

A nurse 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.

Accepted Answer

A uterine intensity of 120 mm Hg and a uterine resting tone of 20 mm Hg both support the diagnosis of hypertonic uterine activity. The uterus usually relaxes between contractions for 60 seconds or longer. The normal uterine contraction intensity is between 50 and 75 mm Hg during labor, and it may increase to 110 mm Hg during pushing in the second stage of labor. The average resting tone is between 5 and 15 mm Hg.

Question 19

A nurse 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 nurse midwife expect when caring for the client?

Accepted Answer

In multiparous women, cervical dilatation usually precedes full effacement. In primiparous women, dilatation occurs rapidly once is full effacement is achieved.

Question 20

A client at 38 weeks' gestation comes to the facility after experiencing leakage of clear fluid from the vagina without contractions. Premature rupture of membranes is suspected. Which of the following actions by the nurse midwife would be inappropriate for a client with this condition?

Accepted Answer

Digital vaginal examinations are not performed to avoid the risk of infection. The nurse midwife may assess the client's cervix and vaginal cavity via sterile speculum vaginal examination. Ampicillin may be administered to prevent infection, a common complication of premature rupture of membranes. An L/S ratio is ordered to assess the maturity of the fetal lung.

Quiz 3: Intrapartum