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:

Accepted Answer

Terbutaline is a beta-adrenergic agonist that is administered to relax the uterine muscles, making it easier to perform an external version. It is not used for analgesia or to induce labor, and it does not prevent hemorrhage.

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:

Accepted Answer

A,B,C,E

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?

Accepted Answer

The statement "The tear I have through my rectum is unrelated to my episiotomy." indicates a misunderstanding. A tear through the rectum (a third or fourth-degree laceration) can be directly related to an episiotomy, especially if it was a mediolateral episiotomy, which can increase the risk of more severe tearing.

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?

Accepted Answer

Artificial rupture of membranes in a patient with HIV poses a risk of vertical transmission of the virus to the fetus. Therefore, a history of HIV is a significant consideration when planning to artificially rupture membranes.

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?

Accepted Answer

Using misoprostol (Cytotec) for cervical ripening carries a risk of uterine hyperstimulation, which can lead to fetal distress and uterine rupture in women with insulin-dependent diabetes. Dinoprostone (Prepidil) may also carry similar risks. Administering a tap water enema is no longer considered necessary or beneficial prior to labor induction. The most appropriate method of induction for this patient is starting with a low dose of misoprostol (50 mcg) and waiting 4 hours before initiating Pitocin (oxytocin), with careful monitoring of the patient's response to avoid uterine hyperstimulation.

Question 6

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

Accepted Answer

The answer of In which clinical situations would it be...

Question 7

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

Accepted Answer

A patient with a history of a previous cesarean birth (multip, previous birth by cesarean) is at increased risk for uterine rupture during an external cephalic version (ECV), necessitating immediate intervention to reassess the appropriateness of attempting an ECV.

Question 8

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

Accepted Answer

Placenta previa is a contraindication to the induction of labor because it can lead to severe bleeding due to the placenta covering the cervix.

Question 9

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

Accepted Answer

Placing the patient in a supine position with a right hip wedge helps maintain uterine perfusion and prevents supine hypotension syndrome by displacing the uterus off the inferior vena cava.

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?

Accepted Answer

Before performing an amniotomy, it's crucial to assess the fetal presentation, position, and station to ensure the safety and appropriateness of the procedure. This helps in determining if the fetus is in a favorable position for a vaginal delivery following the amniotomy.

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?

Accepted Answer

A version is a procedure done to change the position of the fetus inside the uterus. The nurse would need to organize supplies such as ultrasound machine, to locate the baby, and medications to help relax the uterus. An amniotomy is the breaking of the amniotic sac, which is not related to changing the position of the baby. Leopold's maneuvers and ballottement are ways to assess the position of the baby, not change it.

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:

Accepted Answer

Amnioinfusion is used to alleviate variable decelerations, which are caused by umbilical cord compression. Early and moderate decelerations are generally not concerning, and late decelerations are a sign of fetal distress that may require more immediate interventions.

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?

Accepted Answer

Induction of labor may be indicated in cases of hypertension, as the risk of complications such as preeclampsia and eclampsia increase with continuing pregnancy beyond 40 weeks. Suspected placenta previa and prolapsed umbilical cord are contraindications for induction of labor, while breech presentation may require a cesarean delivery.

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?

Accepted Answer

The answer of The patient is undergoing an emergency cesarean...

Question 15

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

Accepted Answer

The answer of Under which circumstances would the nurse remove...

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?

Accepted Answer

The answer of A patient at 40 weeks' gestation is...

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?

Accepted Answer

Amniotomy can create stronger contractions that are similar to those that occur during spontaneous labor, which can help progress the labor and facilitate birth. It does not necessarily reduce pain or make it easier to manage, nor does it eliminate the need for an episiotomy. While it may decrease the chances of a prolapsed cord, this is not typically one of the primary advantages cited for amniotomy.

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?

Accepted Answer

Allowing the client to void prior to insertion of dinoprostone gel helps prevent bladder discomfort and decreases the risk of infection, since the cervix and urethra are in close proximity. The other options are not necessary for cervical ripening. An internal fetal monitor may be used later in the induction process to assess fetal well-being. Withholding oral intake and starting intravenous fluids may be necessary for induction, but are not needed for cervical ripening alone. Placing the client in a semi-Fowler's position is not specifically indicated for cervical ripening.

Question 19

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

Accepted Answer

The answer of The nurse knows that the Bishop scoring...

Question 20

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

Accepted Answer

The answer of The nurse is monitoring a patient who...

Quiz 28: Birth-Related Procedures