78.
A client is admitted with a suspected abrup- tio placentae. The nurse should assess the client for which of the following signs and symptoms? Select all that apply.■ 1. Bleeding that is concealed or apparent.
■ 2. Abdominal rigidity.
■ 3. Painful abdomen.
■ 4. Painless bleeding.
■ 5. Large placenta.
■ 6. Bleeding that stops spontaneously.
79.
A multigravid client is in active labor with twins at 38 weeks’ gestation. The nurse should monitor the client closely for symptoms of which of the following?■ 1. Pregnancy-induced hypertension.
■ 2. Urinary tract infection.
■ 3. Chorioamnionitis.
■ 4. Precipitous delivery.
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80.
A 39-year-old multigravid client at 39 weeks’gestation admitted to the hospital in active labor has been diagnosed with class II heart disease. To ensure cardiac emptying and adequate oxygenation during labor, the nurse plans to encourage the client to do which of the following?
■ 1. Breathe slowly after each contraction.
■ 2. Avoid the use of analgesics for the labor pain.
■ 3. Remain in a side-lying position with the head elevated.
■ 4. Request local anesthesia for vaginal delivery.
81.
When developing the plan of care for a mul- tigravid client with class III heart disease, which of the following areas should the nurse expect to assess frequently?■ 1. Dehydration.
■ 2. Nausea and vomiting.
■ 3. Iron-defi ciency anemia.
■ 4. Tachycardia.
82.
A multigravid client in active labor has been diagnosed with class II heart disease and has had a prosthetic valve replacement. When developing the plan of care for this client, the nurse should antici- pate that the physician most likely will order which of the following medications?■ 1. Anticoagulants.
■ 2. Antibiotics.
■ 3. Diuretics.
■ 4. Folic acid supplements.
83.
A primigravid client at 39 weeks’ gestation is admitted to the hospital for induction of labor. The physician has ordered prostaglandin E2 gel (Dino- prostone) for the client. Before administering pros- taglandin E2 gel to the client, which of the following should the nurse do fi rst?■ 1. Assess the frequency of uterine contractions.
■ 2. Place the client in a side-lying position.
■ 3. Determine whether the membranes have rup- tured.
■ 4. Prepare the client for an amniotomy.
84.
A multigravid client at 39 weeks’ gestation diagnosed with insulin-dependent diabetes is admit- ted for induction of labor with oxytocin (Pitocin).Which of the following should the nurse include in the teaching plan as a possible disadvantage of this procedure?
■ 1. Urinary frequency.
■ 2. Maternal hypoglycemia.
■ 3. Preterm birth.
■ 4. Neonatal jaundice.
85.
Which of the following nursing diagnoses would be the priority for a multigravid diabetic client at 38 weeks’ gestation who is scheduled for labor induction with oxytocin (Pitocin)?■ 1. Risk for defi cient fl uid volume related to oxy- tocin infusion.
■ 2. Pain related to prolonged labor and uterine ischemia.
■ 3. Fear related to possible need for cesarean delivery.
■ 4. Risk for injury, maternal or fetal, related to potential uterine hyperstimulation.
86.
A multigravid client is receiving oxytocin (Pitocin) augmentation. When the client’s cervix is dilated to 6 cm, her membranes rupture spontane- ously with meconium-stained amniotic fl uid. Which of the following actions should the nurse do fi rst?■ 1. Increase the rate of the oxytocin infusion.
■ 2. Turn the client to a knee-to-chest position.
■ 3. Assess cervical dilation and effacement.
■ 4. Monitor the fetal heart rate continuously.
87.
A multigravid client in active labor at 39 weeks’ gestation has a history of smoking one to two packs of cigarettes daily. For which of the following should the nurse be alert when assessing the client’s neonate?■ 1. Hyperirritability.
■ 2. Hyperbilirubinemia.
■ 3. Low birth weight.
■ 4. Hypocalcemia.
88.
A primigravid client who has had a pro- longed labor but now is completely dilated has received epidural anesthesia. Which of the follow- ing should the nurse include in the teaching plan about pushing?■ 1. The client needs to push for at least 1 to 3 minutes.
■ 2. Pushing is most effective when the client holds her breath.
■ 3. The client should be urged to push with an open glottis.
■ 4. Pushing is limited to times when she feels the urge.
89.
The physician determines that outlet forceps are needed to assist in the delivery of a primigravid client in active labor with a large-for-gestational-size fetus. The nurse reinforces the physician’s explana- tion for using forceps based on the understanding about which of the following concerning the loca- tion of the fetal skull?■ 1. It is engaged past the inlet.
■ 2. It is at +1 station.
■ 3. It is visible at the perineal fl oor.
■ 4. It has reached the level of the ischial spines.
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90.
The physician orders an amnioinfusion for a primigravid client at term who is diagnosed with oligohydramnios. Which of the following should the nurse include in the client’s teaching plan about the purpose of this procedure?■ 1. To decrease the frequency and severity of variable decelerations.
■ 2. To minimize the possibility of fetal metabolic alkalosis.
■ 3. To increase the fetal heart rate accelerations during a contraction.
■ 4. To raise the amniotic fl uid index to more than 15 cm.
91.
The nurse is admitting a primigravid client at 37 weeks’ gestation who has been diagnosed with pregnancy-induced hypertension to the labor and delivery area. Which of the following client care rooms is most appropriate for this client?■ 1. A brightly lit private room at the end of the hall from the nurses’ station.
■ 2. A semiprivate room midway down the hall from the nurses’ station.
■ 3. A private room with many windows that is near the operating room.
■ 4. A darkened private room as close to the nurses’ station as possible.
92.
A multigravid client is admitted to the labor area from the emergency room. At the time of admis- sion, the fetal head is crowning, and the client yells,“The baby’s coming!” To help the client remain calm and cooperative during the imminent delivery, which of the following responses by the nurse is most appropriate?
■ 1. “You’re right, the baby is coming, so just relax.”
■ 2. “Please don’t push because you’ll tear your cervix.”
■ 3. “Your doctor will be here as soon as pos- sible.”
■ 4. “I’ll explain what’s happening to guide you as we go along.”
93.
The nurse is caring for a multigravid client who speaks little English. As the nurse enters the client’s room, the nurse observes the client squatting on the bed and the fetal head crowning. After call- ing for assistance and helping the client lie down, which of the following actions should the nurse do next?■ 1. Tell the client to push between contractions.
■ 2. Provide gentle support to the fetal head.
■ 3. Apply gentle upward traction on the neo- nate’s anterior shoulder.
■ 4. Massage the perineum to stretch the perineal tissues.
94.
During the fi rst hour after a precipitous deliv- ery, the nurse should monitor a multiparous client for signs and symptoms of which of the following?■ 1. Postpartum “blues.”
■ 2. Uterine atony.
■ 3. Intrauterine infection.
■ 4. Urinary tract infection.
95.
A multigravid client in labor at 38 weeks’gestation has been diagnosed with Rh sensitization and probable fetal hydrops and anemia. When the nurse observes the fetal heart rate pattern on the monitor, which of the following patterns is most likely?
■ 1. Early deceleration pattern.
■ 2. Sinusoidal pattern.
■ 3. Variable deceleration pattern.
■ 4. Late deceleration pattern.
96.
The physician orders oxytocin to be added to the intravenous fl uids of a 30-year-old multigravid client at 37 weeks’ gestation with twins after vaginal delivery. The nurse should administer the oxytocin after delivery of which of the following?■ 1. First placenta.
■ 2. First twin.
■ 3. Second placenta.
■ 4. Second twin.
97.
The nurse in the labor and delivery area receives a telephone call from the emergency room announcing that a multigravid client in active labor is being transferred to the labor area. The client has had no prenatal care. When the client arrives by stretcher, she says, “I think the baby’s coming … Help!” The fetal skull is crowning. The nurse should obtain which of the following infor- mation fi rst?■ 1. Estimated date of delivery.
■ 2. Amniotic fl uid status.
■ 3. Gravida and parity.
■ 4. Prenatal history.
98.
A multiparous client delivers dizygotic twins at 37 weeks’ gestation. The twin neonates require additional hospitalization after the client is dis- charged. In planning the family’s care, an appropri- ate goal for the nurse to formulate is that, while the twins are hospitalized, the parents will do which of the following?■ 1. Discuss how they will cope with twin infants at home.
■ 2. Participate in care of the twins as much as possible.
■ 3. Take turns providing 24-hour observation of the twins.
■ 4. Identify complications that may occur as the twins develop.
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99.
A primigravid client at 41 weeks’ gestation is admitted to the hospital’s labor and delivery unit in active labor. After 25 hours of labor with membranes ruptured for 24 hours, the client delivers a healthy neonate vaginally with a midline episiotomy. Which of the following nursing diagnoses should the nurse identify as the priority for the client?■ 1. Activity intolerance related to diffi cult labor process.
■ 2. Sleep deprivation related to prolonged labor.
■ 3. Situational low self-esteem related to lengthy labor process.
■ 4. Risk for infection related to birth trauma and prolonged ruptured membranes.
100.
The nurse is caring for a primiparous client and her neonate immediately after delivery. The neonate was born at 41 weeks’ gestation and weighs 4,082 g (9 lb). Assessing for signs and symptoms of which of the following conditions should be a prior- ity in this neonate?■ 1. Anemia.
■ 2. Hypoglycemia.
■ 3. Delayed meconium.
■ 4. Elevated bilirubin.
101.
A multigravid client in active labor at term is diagnosed with polyhydramnios. The physician has instructed the client about possible neonatal complications related to the polyhydramnios. The nurse determines that the client has understood the instructions when the client states that polyhydram- nios is associated with which of the following in the fetus or neonate?■ 1. Renal dysfunction.
■ 2. Intrauterine growth retardation.
■ 3. Pulmonary hypoplasia.
■ 4. Gastrointestinal disorders.
102.
A primigravid client at 39 weeks’ gesta- tion is admitted to the hospital in active labor. On admission, the client’s cervix is 6 cm dilated. After 2 hours of active labor, the client’s cervix is still dilated at 6 cm with 100% effacement at 21 sta- tion. Contractions are 3 to 5 minutes apart, lasting 45 seconds, and of moderate intensity. The nurse determines that the client is most likely experienc- ing which of the following?■ 1. Cephalopelvic disproportion.
■ 2. Prolonged latent phase.
■ 3. Prolonged transitional phase.
■ 4. Hypotonic contraction pattern.
103.
The physician who elects to perform a cesar- ean delivery on a primigravid client for fetal distress has informed the client of possible risks during the procedure. When the nurse asks the client to sign the consent form, the client’s husband says, “I’ll sign it for her. She’s too upset by what is happening to make this decision.” The nurse should:■ 1. Ask the client if this is acceptable to her.
■ 2. Have the client and her husband both sign the consent form.
■ 3. Ask the client to sign the consent form.
■ 4. Ask the doctor to witness the consent form.
104.
A multigravid client at term is admitted to the hospital for a trial labor and possible vaginal birth. She has a history of previous cesarean deliv- ery because of fetal distress. When the client is 4 cm dilated, she receives nalbuphine (Nubain) intrave- nously. While monitoring the fetal heart rate, the nurse observes minimal variability and a rate of 120 bpm. The nurse should explain to the client that the decreased variability is most likely caused by which of the following?■ 1. Maternal fatigue.
■ 2. Fetal malposition.
■ 3. Small-for-gestational-age fetus.
■ 4. Effects of analgesic medication.
105.
The nurse is caring for a primipara in active labor when the fetus develops severe bradycardia with late decelerations, and an emergency cesarean delivery is performed with the client under general anesthesia. After the delivery, the client tells the nurse, “I feel terrible. This is exactly what I didn’t want to happen!” Which of the following is a prior- ity nursing diagnosis for this client?■ 1. Interrupted family processes related to cesar- ean delivery.
■ 2. Anxiety related to incisional scar and neona- tal outcome.
■ 3. Pain related to surgical incision and uterine cramping.
■ 4. Situational low self-esteem related to inability to deliver vaginally.
106.
During a scheduled cesarean delivery of a primigravid client with a fetus at 39 weeks’ gesta- tion in a breech presentation, a neonatologist is present in the operating room. The nurse explains to the client that the neonatologist is present because neonates born by cesarean delivery tend to have an increased incidence of which of the following?■ 1. Congenital anomalies.
■ 2. Pulmonary hypertension.
■ 3. Meconium aspiration syndrome.
■ 4. Respiratory distress syndrome.
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107.
A 28-year-old multigravid client at 28 weeks’gestation diagnosed with acute pyelonephritis is receiving intravenous fl uids and antibiotics. After teaching the client about the rationale for the aggres- sive therapy, the nurse determines that the client needs further instruction when she says that acute pyelonephritis can lead to which of the following?
■ 1. Preterm labor.
■ 2. Maternal sepsis.
■ 3. Intrauterine growth retardation.
■ 4. Congenital fetal anomalies.
108.
A primigravid client at 38 weeks’ gestation is admitted to the labor suite in active labor. The client’s physical assessment reveals a chlamydial infection. The nurse explains that if the infection is left untreated, the neonate may develop which of the following?■ 1. Conjunctivitis.
■ 2. Heart disease.
■ 3. Harlequin sign.
■ 4. Brain damage.
109.
A 34-year-old primigravid client at 39 weeks’gestation admitted to the hospital in active labor has type B Rh-negative blood. The nurse should instruct the client that if the neonate is Rh positive, the client will receive an Rh immune globulin (RHIG) injection for which of the following reasons?
■ 1. To prevent Rh-positive sensitization with the next pregnancy.
■ 2. To provide active antibody protection for this pregnancy.
■ 3. To decrease the amount of Rh-negative sensi- tization for the next pregnancy.
■ 4. To destroy fetal Rh-positive cells during the next pregnancy.
110.
A 16-year-old primigravid client admitted at 38 weeks’ gestation with severe pregnancy-induced hypertension is given intravenous magnesium sul- fate and lactated Ringer’s solution. The nurse should obtain which of the following information?■ 1. Urinary output every 8 hours.
■ 2. Deep tendon refl exes every 4 hours.
■ 3. Respiratory rate every hour.
■ 4. Blood pressure every 6 hours.
111.
The labor and delivery room nurse has received a telephone call from the emergency room indicating that a multigravid client in early labor and diagnosed with probable placenta previa will be arriving soon. In preparation for the client’s arrival, the nurse anticipates that the physician will order which of the following?■ 1. Whole blood replacement.
■ 2. Continuous blood pressure monitoring.
■ 3. Internal fetal heart rate monitoring.
■ 4. An immediate cesarean delivery.
112.
During admission, a multigravida in early active labor acts somewhat euphoric and tells the nurse that she smoked some crack cocaine before coming to the hospital. In addition to fetal heart rate assessment, the nurse should monitor the client for symptoms of which of the following?■ 1. Placenta previa.
■ 2. Ruptured uterus.
■ 3. Maternal hypotension.
■ 4. Abruptio placentae.
113.
A primigravid client in early labor tells the nurse that she was exposed to rubella at about 14 weeks’ gestation. After delivery, the nurse should assess the neonate for which of the following?■ 1. Hydrocephaly.
■ 2. Cardiac disorders.
■ 3. Renal disorders.
■ 4. Bulging fontanels.
114.
A primigravid client in early labor with abruptio placentae develops disseminated intra- vascular coagulation (DIC). Which of the following should the nurse expect the physician to order?■ 1. Magnesium sulfate.
■ 2. Warfarin sodium (Coumadin).
■ 3. Fresh-frozen platelets.
■ 4. Meperidine hydrochloride (Demerol).
115.
A multigravid client diagnosed with chronic hypertension is now in preterm labor at 34 weeks’gestation. The physician has ordered magnesium sulfate at 3 g/hour. Which assessment fi nding indicates that the intended therapeutic effect has occurred?
■ 1. Decrease in fetal heart rate accelerations.
■ 2. Decrease in the frequency and number of contractions.
■ 3. Decrease in maternal blood pressure rate.
■ 4. Decrease in maternal respiratory rate.
116.
A primigravid client who was successfully treated for preterm labor at 30 weeks’ gestation had a history of mild hyperthyroidism before becoming pregnant. The nurse should instruct the client to do which of the following?■ 1. Continue taking low-dose oral propylthioura- cil (PTU) as ordered.
■ 2. Discontinue taking the methimazole (Tapa- zole) until after delivery.
■ 3. Consider breast-feeding the neonate after the delivery.
■ 4. Contact the physician if bradycardia occurs.
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117.
A primigravid client at 37 weeks’ gestation has been hospitalized for several days with severe pregnancy-induced hypertension. While caring for the client, the nurse observes that the client is beginning to have a seizure. Which of the following actions should the nurse do fi rst?■ 1. Pad the side rails of the client’s bed.
■ 2. Turn the client to the right side.
■ 3. Insert a padded tongue blade into the client’s mouth.
■ 4. Call for immediate assistance in the client’s room.
118.
While assessing a primigravid client admitted at 36 weeks’ gestation, the nurse observes multiple bruises on the client’s face, neck, and abdomen.When asked about the bruises, the client admits that her boyfriend beats her now and then and says, “I want to leave him because I’m afraid he will hurt the baby.” Which of the following actions is the nurse’s most appropriate response?
■ 1. Tell the client to leave the boyfriend immediately.
■ 2. Ask the client when she last felt the baby move.
■ 3. Refer the client to a social worker for possible options.
■ 4. Report the incident to the unit nursing supervisor.
119.
A multigravid client in active labor at term suddenly sits up and says, “I can’t breathe! My chest hurts really bad!” The client’s skin begins to turn a dusky gray color. After calling for assistance, which of the following should the nurse do next?■ 1. Administer oxygen by face mask.
■ 2. Begin cardiopulmonary resuscitation.
■ 3. Administer intravenous oxytocin.
■ 4. Obtain an order for intravenous fi brinogen.
Managing Care Quality and Safety
120.
The nurse is working on a busy labor and delivery unit with other nurses and a licensed practical nurse. Which of the following labor clients would the nurse assign to the licensed practical nurse?■ 1. A G 4, P 3 client with a history of gestational diabetes.
■ 2. A G 3, P 1, Ab 1 client at 35 weeks’ gestation.
■ 3. A G 1, P 0 client with leaking green amniotic fl uid.
■ 4. A G 2, P 1 client with a history of hyperem- esis gravidarum.
121.
A newly delivered client is asking to go to the bathroom 45 minutes after delivery. She had an epidural for labor & delivery, has an IV infusing, and every 15 minutes assessments are in progress.To provide the safest care for this client the nurse should:
■ 1. Ask her to remain in bed until the 15-minute assessments are complete.
■ 2. Assess client’s ability to stand and bear weight before going to the bathroom.
■ 3. Encourage the client to sit at the side of the bed before ambulating to the bathroom.
■ 4. Ask the client to ambulate the fi rst time with a staff member at her side.
122.
The charge nurse is preparing for the day shift on the Labor and Delivery unit. Which of the following would be included in the responsibilities for this position? Select all that apply.■ 1. Review the current status of each labor client with the primary nurse.
■ 2. Admit the new labor client sent from the triage area.
■ 3. Complete the work of the nurse who had to leave 30 minutes early.
■ 4. Follow up with the primary nurse after a delivery.
■ 5. Complete report of unit with the oncoming charge nurse.
123.
The labor and delivery nurse is assigned to triage for the day. There are four clients already in rooms and the following reports have been received about each of these clients. To provide the safest care and best manage time, the nurse should plan to see which client fi rst?■ 1. A primipara in active labor at 5 cm asking to be admitted and wanting an epidural.
■ 2. A primipara who is 100% effaced, 8 cm dilated, + 2 station complaining of nausea.
■ 3. A client with no prenatal care, occasional contractions, BP 148/90, c/o and swollen feet.
■ 4. A client who is at 42 weeks’ gestation with bloody show, no contractions, ROM 1 hour ago leaking green fl uid.
124.
The triage nurse is giving a telephone report to the receiving nurse in the labor and delivery unit.The client is a G4 P3 who is 8 cm dilated and is being transferred to the labor and delivery unit. How should the labor and delivery nurse manage the next ten minutes with the client? Select all that apply.
■ 1. Place client on the fetal and contraction monitor.
■ 2. Call other staff to set up the delivery table.
■ 3. Assess comfort needs of client.
■ 4. Determine support systems for client.
■ 5. Prepare to give an early report to the nurse arriving on the next shift.
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