Question 1

A client in labor is receiving oxytocin. The midwife assesses the client and notes after uterine palpation that the contractions are uncoordinated and that only a portion of the uterus is involved. Which of the following is the priority action of the midwife?

Accepted Answer

The priority action of the midwife is to stop the infusion of oxytocin. The immediate goal is to reduce the uterine activity. After stopping the infusion, the client is positioned in the side - lying position, and oxygen is administered. After these initial interventions, the midwife should examine the vagina for prolapsed cord.

Question 2

A midwife reviews a fetal heart rate monitor tracing and notes decelerations occurring until 35 seconds after the onset of each contraction. The midwife further notes that the decelerations are continuous past the end of each contraction. The fetal head is fully descended. The midwife suspects which of the following conditions?

Accepted Answer

The fetal heart rate monitor tracing reveals that the client is demonstrating late decelerations. Late decelerations occur due to uteroplacental insufficiency or decreased blood flow through the intervillous spaces of the uterus during contractions. Fetal head compression is manifested by early decelerations. Cephalopelvic disproportion is manifested by early decelerations before the head is fully descended. Cord compression is manifested by variable decelerations.

Question 3

A midwife is monitoring a client in labor who is receiving intravenous oxytocin. The fetal heart rate monitor tracing reveals decelerations occurring 35 seconds after the onset of each contraction and continuously past the end of the each contraction. Which of the following is the priority action of the midwife?

Accepted Answer

The priority action of the midwife is to stop the administration of oxytocin. The client is demonstrating late decelerations, indicating the occurrence of uteroplacental insufficiency. If the client is receiving oxytocin at this time, it is most important to stop the infusion first before starting with the other interventions. The midwife should change the client's position to the side - lying position and administer oxygen after adjusting the rate of oxytocin infusion. The Trendelenburg position is indicated if the client has prolapsed cord.

Question 4

A midwife is receiving a client who has just delivered a healthy baby girl through vaginal birth. No complications were noted during labor. In the immediate postpartum period, the midwife assesses the client's vital signs:

Accepted Answer

The midwife should assess the client every 15 minutes during the first hour, every 30 minutes for the next 2 hours, every hour for the next 2 to 6 hours, and then every 4 hours for the next 24 hours. Urine output, amount of vaginal bleeding and uterine tone are also assessed during the postpartum period.

Question 5

A midwife is about to perform a fundal assessment on a client who gave birth to a 7 - pound female newborn. Which of the following nursing interventions is the most appropriate when preparing the client for fundal assessment?

Accepted Answer

Before fundal assessment, the midwife should instruct the client to void. Emptying the bladder before the examination increases the accuracy of the results. The client should lie on her back with the knees bent.

Question 6

A midwife is managing the care of a postpartum client who was anemic during labor. The client gave birth to a 7 - pound baby girl 24 hours ago through vaginal birth. On assessment, the midwife suspects that the client has puerperal infection. Which of the following findings supports this diagnosis?

Accepted Answer

Vaginal bleeding with red and foul - smelling lochia indicates that the client is most likely experiencing puerperal infection. Hemorrhage is defined as losing more than 500 mL of blood within 24 hours. It is estimated that each perineal pad can hold as much as 50 mL of blood. A slight increase in body temperature is expected within the first 24 hours after birth because of dehydration.

Question 7

A midwife is managing the care of a 25 - year - old client who just delivered a set of twins. Which of the following interventions is the priority action of the midwife during the immediate postpartum period?

Accepted Answer

Clients who give birth to twins are at risk for postpartum hemorrhage. Multiple pregnancies can distend the uterus, which may result in uterine atony. A uterus with ineffective contractions is most likely to develop hemorrhage. To evaluate the client's risk, the midwife should closely monitor for the fundal height and tone. Administration of pain medication and encouraging the client to void are appropriate interventions, but they are not the priority actions of the midwife. A cold compress is applied to the perineum to relieve or control pain. Warm compresses may increase the client's risk for bleeding and may aggravate the inflammation process.

Question 8

A midwife is assessing four clients who recently gave birth to healthy newborns through vaginal delivery. All of the clients had uncomplicated labors. Which of the following clients needs further evaluation?

Accepted Answer

The postpartum client with clots larger than 1 cm across in the red lochia needs further evaluation. Clots in the red lochia are usually observed in the initial period after labor, but they are normally smaller than 1 cm. This finding could suggest the occurrence of uterine atony or retained placental fragments. The other clients are exhibiting normal postpartum symptoms. A slight increase in body temperature is expected during the first 24 hours. A client who soaked more than 10 perineal pads in the last 24 hours is most likely diagnosed with hemorrhage, but 8 is within an expected range. Uterine pain during breastfeeding is expected. Suckling stimulates the secretion of oxytocin, which may stimulate the uterus.

Question 9

A midwife is assessing the fundal tone and height of a client who gave birth to a healthy baby boy 24 hours ago. After obtaining the vital signs, the midwife notes that the fundus is at the level of the umbilicus. Which of the following is the next action of the midwife?

Accepted Answer

An hour after the delivery, the fundus is expected to be one fingerbreadth below the umbilicus. This client is experiencing uterine atony. The first step in managing uterine atony is fundal massage. If the uterus cannot maintain its contractions, oxytocin is administered. The client's vital signs should be closely monitored, but the first action of the midwife should be to initiate fundal massage.

Question 10

A client who gave birth two days ago informs the midwife that she has not had a bowel movement since the delivery of her child. The client had a vaginal birth. Which of the following statements made by the midwife is the most appropriate in this situation?

Accepted Answer

Bowel elimination usually occurs within 2 to 3 days after vaginal birth. For postpartum clients who had a cesarean section, bowel elimination may not occur until 3 or 4 days after birth. The client should be encouraged to increase her intake of fiber and fluids and to engage in safe physical activities to relieve constipation. Constipation commonly occurs after birth due to many factors, such as reduced intake of food, anesthesia and use of narcotics or pain medications.

Question 11

A midwife is managing the care of a 25 - year - old postpartum client who gave birth 18 hours ago. No complications were noted during the labor process. The newborn is brought to the client for feeding and to have the mother and child bond for the night. The client says, "I'm too tired. Please get her back to the midwifery, just for tonight. I need to get some sleep." Which of the following is the most appropriate action of the midwife?

Accepted Answer

The most appropriate action of the midwife is to accept the client's behavior as an indication that she is in the taking - in phase. The taking - in phase occurs in the first 24 hours after birth. In this stage, the client is more concerned about her own needs than the baby's. The taking - hold phase is the next phase. A client in this phase demonstrates signs of readiness to learn and face responsibilities. The letting - go phase may begin weeks after the delivery. In this phase, the client incorporates the newborn into the family unit.

Question 12

A midwife is receiving a client who gave birth an hour ago. Which of the following nursing interventions is the priority action of the midwife during the immediate postpartum period?

Accepted Answer

The priority action of the midwife during the immediate postpartum period is to palpate for the height of fundus. Hemoglobin and hematocrit may be ordered, but this is not the priority action of the midwife. Oxygen administration is not indicated at this time.

Question 13

A 25 - year - old female has just given birth to an eight - pound baby boy. Suctioning of the neonate is required. The first action of the midwife when suctioning a neonate immediately after birth is to:

Accepted Answer

After birth, neonates require assistance in clearing their airways of the mucus and amniotic fluids from their lungs. The first action of the midwife is to suction the neonate's mouth immediately after birth. The nose is suctioned after the mouth. Suctioning the neonate's nose first may stimulate the receptors in the nose, resulting in aspiration of secretions from the mouth.

Question 14

Which of the following actions by a midwife is the least appropriate when giving respiratory care to a healthy, full - term newborn?

Accepted Answer

A newborn should be placed on one side with the head down, not up, to facilitate drainage of secretions from the respiratory tract. A newborn's respiratory rate should be assessed every 15 minutes during the first hour of life, taking note of alterations in respiratory effort and rate. The mouth should be suctioned before the nose to prevent aspiration. The newborn should be re - positioned frequently to further encourage the drainage of secretions.

Question 15

A 38 - week newborn is born to a 30 - year - old through vaginal birth. A minute after birth, a midwife obtains the newborn's APGAR score with the following assessment findings: flexed arms and legs with some active movement, a pulse rate of 110 beats per minute, grimace after inserting a tube through a nostril, pink skin tone except for the hands and feet and regular breathing pattern with a good cry. What is the newborn's APGAR score?

Accepted Answer

The newborn's APGAR score is 7. APGAR scoring is performed 1 minute and 5 minutes after birth. This scoring system assesses five components:
§Activity, or muscle tone
§Pulse
§Grimace, or reflex irritability
§Appearance, or skin color
§Respiration
The newborn's APGAR score is calculated as follows: flexed arms and legs with some movement = 1; pulse rate above 100 = 2; grimacing = 1; pink skin tone except for the hands and feet = 1; a good cry and regular breathing pattern = 2. 1+2+1+1+2 = 7.

Question 16

A 37 - week female newborn is born to a 28 - year - old female through cesarean birth. A midwife assesses the newborn a minute after birth for APGAR scoring. The following assessment findings are obtained: flexed arms and legs with limited active movement; a pulse rate of 90 beats per minute; grimacing observed after inserting a tube through one of the nostrils; bluish skin tone, including the extremities; and slow, irregular breaths. Which of the following is the next action of the midwife?

Accepted Answer

The next action of the midwife is to initiate clearing of the airways and oxygen therapy. The newborn has an APGAR of 4, calculated as follows: flexed arms and legs with limited active movement = 1; pulse rate below 100 beats per minute = 1; grimacing after inserting a tube through one of the nostrils = 1; bluish skin tone, including the extremities = 0; slow, irregular breaths = 1. An APGAR score of 4 to 6 indicates that the newborn requires oxygen therapy. An APGAR score of less than 4 indicates that the newborn needs immediate resuscitation. An APGAR score greater than 6 indicates well - being of the newborn. Options B and D are most appropriate for a newborn who has an APGAR score between 7 and 10.

Question 17

A female client at 32 weeks' gestation gives birth to a baby girl. The newborn weighs 1400 grams. When managing the newborn's nutritional needs, which of the following actions by the midwife is the most appropriate?

Accepted Answer

The most appropriate action is to prepare the newborn for parenteral hyperalimentation. Premature babies born sooner than 34 weeks' gestation find it hard to feed from a breast or bottle because they have difficulty coordinating sucking, breathing and swallowing. Newborns weighing less than 1500 grams are considered very low - birth weight infants. These newborns are nourished intravenously. As they get older and stronger, gavage feeding may be initiated. If the newborn is born at 35 weeks' gestation and is able to tolerate oral feedings, breast milk may be given through a bottle using a preemie nipple. To prevent dehydration, it is recommended that mothers of premature babies, unlike mothers of full - term babies, not wait four hours between feedings.

Question 18

After birth, the midwife immediately dries a male neonate's face and hair with a clean, pre - warmed towel. After drying, the midwife covers the neonate's hair with a cap. The purpose of these actions is to prevent heat loss through:

Accepted Answer

The actions of the midwife help prevent heat loss through the process of evaporation. Evaporation is the loss of heat when a liquid is converted to vapor. Drying the neonate with a clean, pre - warmed towel and covering the neonate's hair with a cap are some of the interventions that prevent evaporation. Convection is the flow of heat from the surface of the body to cooler surrounding air. Conduction is the transfer of body heat to a cooler object that is in contact with the baby. Radiation is the transfer of body heat to a cooler solid object not in contact with the body.

Question 19

A patient was admitted with labor pain. The uterine contraction lasted for about 30 seconds initially, but gradually increased in duration with the progression of labor. In which stage of labor is she now?

Accepted Answer

1st stage
The first stage starts with the onset of true labor pain, and ends with full dilation of the cervix. Contractions usually last much longer in the second stage than in the first stage. The second stage commences at full dilation of the cervix, and ends with expulsion of the fetus. The third stage begins after expulsion of the fetus.

Question 20

A 2nd gravida occurred at 40 weeks of pregnancy with abdominal pain. Examination revealed that the uterus was contracting and retracting. On P/V/E, cervix was effaced (OS - 3 cm dilated). After completing the diagnosis, state the complication affecting this woman. (Choose all that apply)

Accepted Answer

Cervical dystocia and C. Hypotonic uterine contraction
This is a case of a full - term pregnancy (2nd gravida) with a first stage normal labor. The first stage starts from the onset of true labor pain and ends with full dilatation of cervix. The complications of the first stage of labor include early rupture of membrane, hypotonic uterine contraction, cervical dystocia, and fetal distress. Retained placenta and pulmonary embolism are complications of the third stage of labor.

Quiz 2: Labor Birthand Immediate Postpartum