The Multigravid Client in Labor

36.

The nurse is caring for a primigravid client in active labor who has had two fetal blood samplings to check for fetal hypoxia. The nurse determines that the fetus is showing signs of acidosis when the scalp blood pH is below which of the following?

■ 1. 7.5.

■ 2. 7.4.

■ 3. 7.3.

■ 4. 7.2.

37.

Assessment of a primigravid client reveals cervical dilation at 8 cm and complete effacement. The client complains of severe back pain during this phase of labor. The nurse explains that the client’s severe back pain is most likely caused by the fetal occiput being in a position that is identifi ed as which of the following?

■ 1. Breech.

■ 2. Transverse.

■ 3. Posterior.

■ 4. Anterior.

38.

The nurse assesses a primiparous client in labor for 20 hours. The nurse identifi es late decel- erations on the monitor and initiates standard pro- cedures for the labor client with this wave pattern.

Which interventions should the nurse perform?

Select all that apply.

■ 1. Administering oxygen via mask to the client.

■ 2. Questioning the client about the effectiveness of pain relief.

■ 3. Placing the client on her side.

■ 4. Readjusting the monitor to a more comfort- able position.

■ 5. Applying an internal fetal monitor to help identify the cause of the decelerations.

39.

When performing Leopold’s maneuvers on a primigravid client, the nurse is palpating the uterus as shown below. Which of the following maneuvers is the nurse performing?

■ 1. First maneuver.

■ 2. Second maneuver.

■ 3. Third maneuver.

■ 4. Fourth maneuver.

40.

Before placing the fetal monitoring device on a primigravid client’s fundus, the nurse performs Leopold’s maneuvers. When performing the third maneuver, the nurse explains that this maneuver is done for which of the following reasons?

■ 1. To determine whether the fetal presenting part is engaged.

■ 2. To locate the fetal cephalic prominence.

■ 3. To distinguish between a breech and a cephalic presentation.

■ 4. To locate the position of the fetal arms and legs.

41.

A primigravid client in active labor with a fetus in LOP position complains of severe back pres- sure. Which of the following would be the priority nursing diagnosis for this client?

■ 1. Anxiety related to fear of maternal-fetal out- comes.

■ 2. Ineffective coping related to lack of experi- ence in labor.

■ 3. Urinary retention related to prolonged labor process.

■ 4. Pain related to occipitoposterior position and prolonged fetal descent.

42.

One-half hour after vaginal delivery of a term neonate, the nurse palpates the fundus of a primi- gravid client, noting several large clots and a small trickle of bright red vaginal bleeding. The client’s blood pressure is 136/92 mm Hg. Which of the fol- lowing would the nurse do fi rst?

■ 1. Continue to monitor the client’s fundus every 15 minutes.

■ 2. Ask the physician for an order for methyler- gonovine (Methergine).

■ 3. Immediately notify the physician of the cli- ent’s symptoms.

■ 4. Change the client’s perineal pads every 15 minutes.

44.

A nurse is preparing a change-of-shift report and has been caring for a multigravid client with a normally progressing labor. Which of the following information should be part of this report? Select all that apply.

■ 1. Interpretation of the fetal monitor strip.

■ 2. Analgesia or anesthesia being used.

■ 3. Anticipated method of birth control.

■ 4. Amount of vaginal bleeding or discharge.

■ 5. Support persons with the client.

■ 6. Prior delivery history.

45.

A multigravid client is admitted at 4-cm dilation and requesting pain medication. The nurse gives the client Nubain 15 mg and Phenergan 25 mg slow I.V. push. Within 5 minutes, the client tells the nurse she feels like she needs to have a bowel move- ment. The nurse should fi rst:

■ 1. Have naloxone hydrochloride (Narcan) avail- able in the delivery room.

■ 2. Complete a vaginal examination to determine dilation, effacement, and station.

■ 3. Prepare for delivery.

■ 4. Document the client’s relief due to pain medication.

46.

A multigravid laboring client has an exten- sive documented history of drug addiction. Her last reported usage was 5 hours ago. She is 2 cm dilated with contractions every 3 minutes of moderate intensity. The physician orders nalbuphine (Nubain) 15 mg slow I.V. push for pain relief followed by an epidural when the client is 4 cm dilated. Within 10 minutes of receiving the nalbuphine, the client states she thinks she is going to have her baby now.

Of the following drugs available at the time of the delivery, which should the nurse avoid using with this client in this situation?

■ 1. 1% lidocaine (Xylocaine).

■ 2. Naloxone hydrochloride (Narcan).

■ 3. Local anesthetic.

■ 4. Pudendal block.

47.

A 31-year-old multigravid client at 39 weeks’

gestation admitted to the hospital in active labor is receiving intravenous lactated Ringer’s solution and a continuous epidural anesthetic. During the fi rst hour after administration of the anesthetic, the nurse should monitor the client for:

■ 1. Hypotension.

■ 2. Diaphoresis.

■ 3. Headache.

■ 4. Tremors.

48.

A 30-year-old G 3, P 2 is being monitored internally. She is being induced with I.V. oxytocin (Pitocin) because she is overdue. The nurse notes the pattern below. The client is wedged to her side while lying in bed and is approximately 6 cm dilated and 100% effaced. The nurse should fi rst:

bpm 240 210 160 150 120 90 60 30 INDEX OF FHR

VARIABILITY 21 18

15 12

9 5

3 0

100 75

50 25

0 mm Hg 500

375 250 125

INDEX OF0 UTERINE ACTIVITY

bpm 240 210 160 150 120 90 60 30 INDEX OF FHR

VARIABILITY 21 18

15 12

9 5

3 0

100 75

50 25

0 mm Hg 500

375 250 125

INDEX OF0 UTERINE ACTIVITY

■ 1. Continue to observe the fetal monitor.

■ 2. Anticipate rupture of the membranes.

■ 3. Prepare for fetal oximetry.

■ 4. Discontinue the Pitocin infusion.

49.

The nurse, while shopping in a local department store, hears a multiparous woman say loudly, “I think the baby’s coming.” After asking someone to call 911, the nurse assists the client to deliver a term neonate. While waiting for the ambulance, the nurse suggests that the mother initiate breast-feeding, primarily for which of the following reasons?

■ 1. To begin the parental-infant bonding process.

■ 2. To prevent neonatal hypothermia.

■ 3. To provide glucose to the neonate.

■ 4. To contract the mother’s uterus.

50.

Approximately 15 minutes after delivery of a viable term neonate, a multiparous client complains of a chill. Which of the following should the nurse do next?

■ 1. Assess the client’s pulse rate.

■ 2. Decrease the rate of intravenous fl uids.

■ 3. Provide the client with a warm blanket.

■ 4. Assess the amount of blood loss.

51.

The physician plans to perform an

amniotomy on a multiparous client admitted to the labor area at 41 weeks’ gestation for labor induction.

After the amniotomy, the nurse should fi rst:

■ 1. Monitor the client’s contraction pattern.

■ 2. Assess the fetal heart rate (FHR) for 1 full minute.

■ 3. Assess the client’s temperature and pulse.

■ 4. Document the color of the amniotic fl uid.

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52.

Which of the following nursing diagnoses is the priority after delivery for a multiparous client who received an epidural anesthetic?

■ 1. Pain related to episiotomy and exhaustive pushing efforts.

■ 2. Anxiety related to inability to move legs and toes.

■ 3. Risk for injury related to epidural anesthesia.

■ 4. Excess fl uid volume overload related to labor process and intravenous fl uids.

53.

Which of the following would the nurse expect as a common fi nding for a multiparous client delivering a viable neonate at 41 weeks’ gestation with the aid of a vacuum extractor?

■ 1. Caput succedaneum.

■ 2. Cephalohematoma.

■ 3. Maternal lacerations.

■ 4. Neonatal intracranial hemorrhage.

54.

The nurse is assessing fetal presentation in a multiparous client. The illustration below indicates which of the following types of presentation?

■ 1. Frank breech.

■ 2. Complete breech.

■ 3. Footling breech.

■ 4. Vertex.

55.

Two hours ago, a multigravid client was admitted in active labor with her cervix dilated at 5 cm and completely effaced and the fetus at 0 sta- tion. Currently, the client is experiencing nausea and vomiting, a slight chill with perspiration beads on her lip, and extreme irritability. The nurse should fi rst:

■ 1. Warm the temperature of the room by a few degrees.

■ 2. Increase the rate of intravenous fl uid adminis- tration.

■ 3. Obtain an order for an intramuscular anti- emetic medication.

■ 4. Assess the client’s cervical dilation and station.

56.

When assessing the frequency of contractions of a multiparous client in active labor admitted to the birthing area, the nurse should assess the inter- val between which of the following?

■ 1. Acme of one contraction to the beginning of the next contraction.

■ 2. Beginning of one contraction to the end of the next contraction.

■ 3. End of one contraction to the end of the next contraction.

■ 4. Beginning of one contraction to the beginning of the next contraction.

57.

While a client is being admitted to the birth- ing unit she states, “My water broke last night, but my labor started two hours ago.” Which of the fol- lowing is a concern? Select all that apply.

■ 1. Maternal vital signs: T. 99.5, HR 80, R 24, BP 130/80 mm Hg.

■ 2. Blood and mucus on perineal pad.

■ 3. Baseline fetal heart rate of 140 with a range between 110 and 160 with contractions.

■ 4. Peripad stained with green fl uid.

■ 5. The client states, “This baby wants out—he keeps kicking me.”

58.

While the nurse is caring for a multiparous client in active labor at 36 weeks’ gestation, the client tells the nurse, “I think my water just broke.”

Which of the following should the nurse do fi rst?

■ 1. Turn the client to the right side.

■ 2. Assess the color, amount, and odor of the fl uid.

■ 3. Assess the fetal heart rate pattern.

■ 4. Check the client’s cervical dilation.

59.

The nurse has obtained a urine specimen from a G 6, P 5 client admitted to the labor unit. The woman asks to go to the bathroom and reports that she feels she has to move her bowels. Which actions would be appropriate? Select all that apply.

■ 1. Assisting her to the bathroom.

■ 2. Applying an external fetal monitor to obtain fetal heart rate.

■ 3. Assessing her stage of labor.

■ 4. Asking if she had back labor pains like this with any of her other deliveries.

■ 5. Allowing her support person to take her to the bathroom to maintain privacy.

■ 6. Checking the degree of fetal descent.

60.

A multigravid client admitted to the labor area is scheduled for a cesarean delivery under spinal anes- thesia. After instructions by the anesthesiologist, the nurse determines that the client has understood the instructions when she says which of the following?

■ 1. “The medication will be administered while I am in a side-lying position.”

■ 2. “The anesthetic may cause a severe headache which is treatable.”

■ 3. “My blood pressure may increase if I lie down too soon after the injection.”

■ 4. “I can expect immediate anesthesia that can be reversed very easily.”

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61.

When developing the plan of care for a multiparous client in active labor who receives an epidural anesthetic, which of the following would the nurse anticipate that the physician will order if the client develops moderate hypotension?

■ 1. Ephedrine sulfate.

■ 2. Epinephrine (Adrenalin Chloride).

■ 3. Methylergonovine (Methergine).

■ 4. Atropine sulfate.

62.

The physician determines that the fetus of a multiparous client in active labor is in distress, necessitating a cesarean delivery with general anes- thesia. Before the cesarean delivery, the anesthesiol- ogist orders cimetidine (Tagamet) 300 mg PO. After administering the drug, the nurse should assess the client for reduction in which of the following?

■ 1. Incidence of bronchospasm.

■ 2. Oral and respiratory secretions.

■ 3. Acid level of the stomach contents.

■ 4. Incidence of postoperative gastric ulcer.

63.

The nurse prepares a client for lumbar epi- dural anesthesia. Before anesthesia administration, the nurse instructs the client to assume which of the following positions?

■ 1. Lithotomy.

■ 2. Side-lying.

■ 3. Knee-to-chest.

■ 4. Prone.

64.

The nurse is assessing the perineal changes of a multigravid client in the second stage of labor.

The illustration below represents which of the fol- lowing perineal changes?

■ 1. Anterior-posterior slit.

■ 2. Oval opening.

■ 3. Circular shape.

■ 4. Crowning.

65.

After suctioning to clear the airway of a term neonate who appears in good condition after spon- taneous vaginal delivery, which of the following would the nurse do next?

■ 1. Place the infant in a radiant warmer.

■ 2. Instill erythromycin in the eyes.

■ 3. Obtain the neonate’s weight.

■ 4. Put identifi cation bracelets on each wrist.