MATERNAL AND CHILD NURSING

(INTRAPARTUM PERIOD)

Prepared by: Dennis N. Muoz, PT, RN, RM, MANc

1) After delivery of a full-term newborn, the nurse is assessing for evidence of bonding behaviors between the mother in the infant. Which of the following observation would indicate a positive bonding experience: a. The mother asks the nurse to keep the baby in the room b. The mother turns her face toward the baby to initiate eye-to-eye contact. c. The mother states the shes going to name the baby after her labor nurse. d. The mother requests the nurse to take a picture of the baby in the open warmee.

2) The nurse palpates a multiparas fundus immediately after delivery of placenta and assesses that its boggy. The nurse massages the patients uterus until its firm. Which medication would the nurse anticipates might need to be administered if the uterus becomes boggy again? a. b. c. d. Oxytocin (Pitocin) Ibuprofen Rh0(D) immune globulin (RhoGam) Magnesium sulfate

3) An intrapartum patient ask the nurse, why cant have anything to eat during labor? which of the following statements would the nurse include in her responcse.
a. You dont need food during labor because you have an I.V. infusion. b. the gastrointestinal system stops during labor so the food would remain in your stomach, c. The risk of aspiration great during labor so all food in withheld d. Eating food during labor would cause the contractile pattern to slow down

4) The nurse is caring for the patient receiving terbutaline. The nurse observes the medication is having a therapeutic effect when the patient: a. No longer perceives pain in her perineal area. b. Dilates 1.5 cm every our during labor c. Has constructions that decrease in frequency and duration d. Has a pulse rate that increases from 90 to 120 beats/minute

5) Four different intrapartum patients present to the labor unit. Which of these patients would require a cesarean delivery: a. Primigravida with the lowermost twin a vertex presentation b. Multipara with a traverse lie confirmed by ultrasound c. Multipara with the fetal station documented as floating d. Primigravida with the fetus in an occiput posterior position

6) The nurse is providing postamniocentesis care for a patient at 34 weeks gestation. Which of the following nursing actions is essential? a. Ambulating the patient to initiate contractions b. Observing the puncture site for any licking fluid c. Cleaning the abdomen with antiseptic solution d. Informing the patient that a cesarean delivery is planned

7) Which of the following patients would have the highest priority for being monitored with internal fetal monitoring? a. Patient with ruptured membranes b. Patient at complete dilation and +2 station c. Patient in latent phase with intact membranes d. Patient with fetus in vertex presentation and meconium-stained fluid

8) Which of the following patients would the nurse consider a priority for being place at high risk for fetal distress during labor a. Patient with a 20-to 25-pound weight gain during pregnancy b. An Rh-negative patient with a negative indirect Coombs test c. A gestational diabetic whose glucose level was 90 mg/dl on admission d. A patient at 43 weeks gestation admitted for induction of labor

9) The nurse is providing care for a patient with a twin pregnancy. Which of the following fetal factors would enhance the possibility of a vaginal birth?

a. Twin A is in a vertex presentation b. Twin A is in a breech presentation c. Evidence exist of fetal distress in one fetus d. Gestation is less than 32 weeks, and the fetal size is less than 2,000 g.

10) Upon palpitation of an intrapartum patients abdomen, the nurse assess the fetus is in a breech presentation. Where would the nurse auscultae for the fetal hearth tone? a. b. c. d. Above the umbilicus Left lower abdomen Below the umbilicus Right lateral abdomen

11) Immediately after a spontaneous rupture of the membranes, the nurse observes a loop of umbilical cord protruding from the vagina. The first nursing action would be to:

a. b. c. d.

Administer oxygen Notify the doctor Document the deceleration Elevate the hips on two pillows

SITUATION: The nurse is teaching a group of couples in childbirth class. Question 12 to 16 refers to this SITUATION.

12) After the nurse describes normal labor, including the premonitory signs of labor, the patients attending the class comment. Which of the following marks would indicate that further teaching is necessary? a. My membranes wont rapture until Im ready to deliver b. I may feel Braxton Hicks contractions as my pregnancy progress. c. lightening usually occurs 2 weeks before labor begins in a first pregnancy d. Ill begin to see a bloody mucous vaginal discharge as my cervix begins to dilate.

13) Which statement by a class member indicates a need for further teaching about breathing techniques during labor and delivery? a. Ill continue to use slow. Deep breathing throughout the labor. b. Ill use blowing techniques if I have an urge to push and Im not completely dilated. c. Ill take in a deep breath and hold it into the count of 10 when Im pushing. d. Ill request an epidural anesthetic when my constructions begin and wont need to use breathing techniques

14) The nurse reviews the contractile patterns seen during the latest phase of labor. Which of the following statements made by the patients indicates that she understood the teaching?
a. My contractions should be every 2 to 3 minutes, lasting for 60 to 90 seconds, and will be strong. b. I should expect not to be able to feel my contractions during the early talent phase of labor. c. My contractions will be mild, lasting for approximately 30 seconds, and occurring about every 10 minutes. d. I expect to be in the talent phase of labor for only a short time.

15) One class member is a primigravida who intends to breast-feed. She asks the nurse when shell be able to breast-feed her infant. Which of the following statements would the nurse include in her response? a. Immediately after birth b. During the second period of reactivity c. After the newborns bath when the temperature is stable d. After assessing the babys gag reflex with a sterile water feeding

16) The nurse is teaching the class about painrelief measures available during the second stage of labor. Which of the following painrelief measures would the nurse include? a. b. c. d. Narcotic analgesics Spinal block Pudendal block Sedative hypnotics

SITUATION: A new nurse on the labor and delivery unit id receiving departmental policies regarding high-risk pregnancy. Questions 17 to 20 refer to this SITUATION

17) What type of precautions would the nurse use in providing care for a human immunodeficiency virus (HIV)-positive intrapartum patient? a. Strict isolation b. Enteric isolation c. Standard precaution d. Respiratory precautions only

18) When a patient who is HIV-positive is admitted to the unit in labor at term, which of the following interventions would the nurse question as posing a particular risk to the fetus? a. b. c. d. Nonstress test Sonogram Sterile vaginal examination Application of the fetal scalp electrode

19) The nurse receives a report from the laboratory that a patients rapid plasma reagin test is positive. Which of the following would the nurse expect to see in the newborn?

a. Tremors b. Snuffles c. Ruddy coloring d. Seizure activity

20) The nurse is assessing the complete blood count report of a patient labor. Which of the following results would the nurse report to the doctor? a. b. c. d. White blood cell count of 12,000/pl Hemoglobin level of 6.6 g/dl Platelet count of 255,000/pl Red Blood Cell count of 4.5 million/pl

SITUATION: Maria Ramirez is a gravid 3 para 2 who presents to the hospital with a report that she has noticed decreased fetal movement over the last 2 days. Questions 21 to 25 refer to this SITUATION.

21) The nurse performs Leopolds maneuvers on Mrs. Ramirez and notes the following findings: a soft, firm mass in the fundus: several knots and protrusions on the mothers left side and hard, round, movable object in the pubic area. The cephalic prominence is on the left side. Base on this findings, the nurse determines that the fetal position is:

a. b. c. d.

Left accipitoanterior (LOA) Right accipitoanterior (ROA) Left sacroposterior (LSP) Right sacroposterior (RSP)

22) The nurse is places an external fetal monitor on Mrs. Ramirez. Which of the following instructions would the nurse give to Mrs. Ramirez is regarding the fetal monitor? a. The monitor requires that you lay on your back so the tracing records accurately. b. Youll need to use the bedpan because the tracing must be recorded continuously. c. The monitor records your contractile pattern in the fetal response to the contractions. d. The monitor will records your dilation and effacement and fetal decent in th pelvis.

23) As Mrs. Ramirez enters the second stage of labor, the nurse observes what appears to be Mrs. Ramirezs membranes rupture spontaneously. Which of the following would be the nurses priority action?

a. Have the patient turn on her left side. b. Coach the patient to bear down with next contraction c. Assess the fetal heart rate d. Clean the perennial area with a warm washcloths

the

24) Which assessment would the nurse perform to validate that the membranes are ruptured? a. Observed for a think, mucous vaginal discharge. b. Test the leaking fluid with nitrazine paper. c. Assess the patients temperature, pulse, and blood pressure. d. Send a urine specimen from the patient to be cultured

25) The nurse observes that the amniotic fluid is me conium- stained. Which of the observation on the fetal heart tracing would indicate signs of fetal distress? a. Early deceleration with average variability b. Changes in the baseline variability from 6 to 10 beats/ minute c. An increase in the fetal heart rate from 135 to 150 with fetal activity d. A variable deceleration lasting 60 seconds return to a baseline tachycardia

SITUATION: Beth Moore is a primigravida who has just been admitted to the labor unit. After Mrs. Moores orientation t the labor unit, the nurse applies the external fetal monitor and conducts a vaginal examination.

Questions 26 to 30 refer to this SITUATION

26) The vaginal examination reveals that the fetus is in a vertex presentation and at a- 1 station. The nurse would interpret these findings to indicate that the fetal:

a. b. c. d.

Head is engaged Buttocks is crowning Head is above the ischial spines Buttocks are below the ischial spines

27) The nurse is teaching Mrs. Moores husband brad how to time the duration of his wifes contractions. Which of the following statements would the nurse use in her teaching? a. Duration is timed from the beginning of one contraction to the beginning of the next contraction b. duration is timed from the beginning of contraction to the end of the same contraction c. duration can be determined only with an internal pressure catheter, which will be inserted after the membranes are ruptured d. duration is measured by timing the interval between the end of one contraction and of the beginning of the next contraction

28) The nurse continues monitor Mrs. Moores progress in labor. Which of the following statements would require the nurse to collect additional data? a. Me conium-stained amniotic fluid b. Left occipitoanterior (LOA) fetal presentation c. Blood-tinged vaginal discharge at complete dilation d. Maternal pulse between 90 and 95 beets/minute

29) Mrs. Moores husband has gone to phone the family to report on the progress of labor. As the nurse enters the room, she observed Mrs. Moore focusing on Brads picture and breathing deeply with her contraction. The nurse would interpret this behavior as characteristics of which phase of labor? a. Active b. Latent c. Third d. Fourth

30) When Mrs. Moore has reached transition, which og the following behavior would the nurse expect Mrs. Moore to display? a. Explaining in detail her birth plan b. Slowly breathing with her contractions c. Panting rapidly at the peak of each contraction d. Pushing the nurses hand off their abdomen

SITUATION: The labor room nurse is admitting Suzanne Russel, who has gestational diabetes, to the triage area of the unit at 32 weeks gestation. Her doctor has sent Mrs. Russel to the hospital because she reported occasional irregular contractions over the last 2 days.

31) Mrs. Russel states, I have twin sons who are delivered at term, and I have one miscarriage at 12 weeks. the nurse determines that Mrs. Russels obstetric history is:

a. 32012 b. 43012 c. 41012 d. 31012

32) Mrs. Russel doctor orders amniocentesis. At this gestational age, which of the following fetal outcomes will the amniocentesis determine? a. Lung maturity b. Growth patterns c. Placental exchange d. Chromosomal abnormalities

33) The nurse receives a report of a lecithinsphingomyelin ratio of 1:1 for a patient with gestational diabetes who is at the 32nd week of gestation and in pattern labor. Which of the following actions should be included on this patients plan of care? a. Perform contraction stress test. b. Notify the doctor that the fetal lungs immature c. Prepare the patient for an immediate cesarean section d. Inform the patient that the fetal lungs mature

are

are

34) Mrs. Russels doctor has ordered terbutaline to stop preterm labor contractions. Which of the following assessments would be most important to determine before administration of the medication? a. Urinary output b. Respiratory rate c. Apical pulse rate d. Deep tendon reflexes

35) An additional order id written for bethemethesone, 12 mg I.M. every 12 hours for two doses, for Mrs. Russel. The expected therapeutic effect of this medication is to?

a. b. c. d.

Inhibit labor contractions Accelerate fetal lung maturity Decrease blood loss during labor Prevent development of chorioamnionitis

SITUATION: Claire Logan is admitted to the labor unit for induction of labor at 38 weeks gestation. Her health history indicates that she has had two previous pregnancies delivered at term. During this pregnancy she has been diagnosed with gestational diabetes. Questions 36 to 40 refer to this SITUATION.

36) Which of the following interventions would the nurse expect to perform on admission? a. Test Mrs. Logans urine for protein with a dipstick b. Measure Mrs. Logans fundal height with a tape measure c. Administer Mrs. Logans oral hypoglycemic d. Assess Mrs. Logans glucose level with a finger stick.

37) Which nursing diagnosis would the nurse anticipate as having highest priority for the patient with gestational diabetes in labor? a. Risk for infection related to invasive procedures during labor b. Risk for injury to fetus related to the effects of diabetes on uteroplacental functioning c. Knowledge deficit related to lack of information about care during labor d. Altered family processes related to diabetes increasing the patients risk of complications

38) Mrs. Logan tells the nurse that she has had weekly nonstress test shows that, after 30 minutes, three periods of fetal activity were noted with acceleration of 15 beat/minute last for 15 seconds. The nurse would interpret the nonstress test results as: a. Reactive b. Positive c. Nonreactive d. Unsatisfactory

39) Mrs. Logan tells the nurse, My previous labors stated on their own. How will this induction of labor be different from my last labor? upon which theory would the nurse base her response?
a. An induction causes the inductions to be more intense during the first stage of labor b. The risk of the uterine rupture is less because the oxytocin (Pitocin) is controlled with an infusion pump c. The goal of induction is to produce a contractile pattern similar to that observed in spontaneous labor d. During an induction, fetal monitoring begins as soon as the oxytocin is started, whereas in a spontenoues labor monitoring begins when signs of distress occur

40) Which of the following patient assessments would indicate the therapeutic response to administration of prostaglandin gel? a. Contraction lasting more than two minutes b. Softening of the vertex c. Nausea and vomiting d. Decrease in the blood pressure

SITUATION: Janet Wilson is a 17-year-old primigravida admitted to the labor unit at 39 weeks gestation. She tells the nurse that her doctor said that she needed to be treated for high blood pressure.

Question 41 to 45 refer to this SITUATION

41) Which assessment finding would support the diagnosis of pregnancy-in-duced hypertension (PIH)?

a. Dependent ankle edema b. Weight loss of 2 pounds c. Protein in the urine d. Pink, frothy sputum

42) Which labor room assignment would the nurse give to the patient diagnosed with pregnancy-induced hypertension? a. Near the elevator so that she can be transported quickly b. Across from the nurses station so that she can be observe closely c. In a back hallway where there is a quite, private room d. Close to the nursery so shell maintain hope of the positive outcome

43) The doctor has ordered magnesium sulfate for Ms. Wilson. Performing which of the following assessment would be most important to evaluate whether the patient experiencing toxic effects of magnesium sulfate? a. Blood pressure b. Patellar reflex c. Pulse rate d. Anxiety level

44) Which of the following nursing action is considered a priority when providing care for a patient receiving magnesium sulfate? a. Monitor fluid intake and output because this medication has a antidiuretic effect b. Place the patient in Trendelenbrgs position to increase venous return c. Assess the respiratory rate because a side effect of this medication is respiratory depression d. Administer this medication so that contractions are strong, occur at least 3 minutes apart, and last 50 to 60 seconds apart

45) Which of the following interventions would assist in minimizing further progression of Ms. Wilsons induced-hypertension? a. Maintaining a salt-free diet b. Restricting fluids to 500 ml per day c. Raising the blinds to allow sunlight into the room d. Encouraging bed rest in the side-lying position

SITUATION: Holly Pratt is a primigravida who has come who has come to the hospital at term stating that her baby hasnt been moving very much during the last 24 hours and that shes leaking fluid. The nurse applies the fetal monitor and determines that Ms. Pratts membranes have ruptured. Questions 46 to 50 refer to this SITUATION

46) The fetal monitor indicates that Ms. Pratts fetus is experiencing cord compression. Which of the following is an accurate description of the fetal heart rate pattern? a. A smooth, flat baseline of 140 beats/minute b. An abrupt decrease in fetal heart rate unrelated to the contraction c. An acceleration of the fetal heart rate of 15 beats/minute above the baseline d. A deceleration that occurs at the beginning of the contraction and resolves by the end of the contraction

47) The doctor indicates that Ms. Pratt needs an amnioinfussion. The priority nursing action would be to monitor: a. b. c. d. Fetal heart rate changes. The amount of normal saline infused Maternal temperature every 2 hours The height of the maternal fundus

48) The nurse assess that Ms. Pratts fetus has a baseline hearth rate of 186beat/minute. Which of the following is an accurate interpretation of this fetal heart rate? a. The fetal heart rate is within normal range b. The fetal heart rate indicates mild hypoxia c. The fetal heart rate documents a fetal response to activity d. The fetal heart rate confirms that the fetus is descending rapidly

49) The nurse observes that Ms. Pratts fetus is showing decreased variability on the monitor strip. The nurse performs scalp stimulation expecting which of the following outcomes?

a. b. c. d.

Fetal heart rate acceleration Early deceleration Continued decreased variability Fetal movement with an acceleration

50) Ms. Pratt hesitates to have epidural anesthesia for relief of labor pain because she doesnt want to have a spinal headache. Which of the following nursing diagnosis is appropriate for Ms. Pratt? a. Potential for injury related to toxic systemic reaction b. Altered urinary elimination related to effects of epidural anesthesia c. Impaired gas exchange in fetus related to anesthetic agent d. Knowledge deficit related to lack of information about epidural anesthesia

SITUATION: Sandy Helm is scheduled for induction of labor because shes now in the 42nd week of gestation. Her health history indicates that she had a normal pregnancy, and recent nonstress test have been reactive.

Questions 51 to 56 refer to this SITUATION:

51) The nurse starts an I.V infusion of 1,000 ml Lactated Rangers solution to which 10 units of oxytocin (Pitocin) has been added. Which of the following assessments would require that the nurse immediately discontinue the oxytocin infusion? a. Spontaneous rapture of the membranes containing a few shreds of blood and mucus b. An increase in a blood pressure from 120/70 to 130/84 over the last 30 minutes c. Contractions with a frequency of 3 minutes and duration of 60 seconds d. Fetal heart rate deceleration at the peak of the contraction decreasing from 140/ 100 beats/minute and lasting for 60 seconds

52) During Mrs. Helms induction of labor, which of the following must the nurse assess to determine whether the oxytocin is having a therapeutic or an adverse effect?
a. Blood glucose level b. Urine output c. Contractive pattern d. Deep tendon reflexes

53) After 2 hours of receiving I.V. oxytocin, Mrs. Helms contractions are 90 to 110 seconds in duration. The nurses first action would be to: a. Notify the doctor b. Discontinue the oxytocin infusion c. Decrease the oxytocin to 10U/minute d. Increase the infusion rate of the mainline I.V. fluids

54) Mrs. Helm received an epidural anesthetic when her dilation reached 5 cm. Which of the following nursing diagnoses would have the highest priority for her at this time? a. Risk of altered urinary elimination related to the effects of the epidural b. Knowledge deficit related to lack of information about regional anesthesia c. Risk of injury related to hypotension secondary to vasodilation and pooling in extremities d. Impaired skin integrity related to an inability to move lower extremities

55) Immediately after administration of the epidural anesthesia, the nurse palpates Mrs. Helms blood pressure, which suddenly falls to 90/40. The nurses first action would be to: a. b. c. d. Raise her head off the bed Administer oxygen by face mask Turn her to a side-lying position Assist her to a knee-chest position

56) Which of the following would be a favorable fetal outcome after Mrs. Helm received epidural anesthesia?
a. The fetal heart rate decreases to 90 beats/minutes b. The fetal heart pattern shows consistent late deceleration c. The fetal heart tracing exhibits a smooth baseline of 140 beats/minute d. The fetal heart tracing shows accelerations with fetal movement

SITUATION: Tammy George is a 15year-old primigravida who arrives at the triage age saying that the school nurse told her that her blood pressure was too high. She hasnt received any prenatal care but thinks shes at 36 weeks gestation. The nurse applies the fetal monitor and conducts her nursing admission. Questions 57 to 61 refer to this SITUATION.

57) The nurse takes Ms. Georges blood pressure, which is 160/110. In support of a possible diagnosis of pregnancy-induced hypertension, what additional data should the nurse collect?

a. Urine dipstick indicating trace of glucose b. Complaints of a frontal headache for the last week c. Increase of lb since she last weighed herself d. Complaints of dependent edema in the late afternoon that resolves after sleeping

58) Which monitor pattern would the nurse expect to observe if Ms. George is experiencing uteroplacental insufficiency? a. Late deceleration b. Early deceleration c. Variable deceleration d. Fetal acceleration

59) The nurse observes that Ms. Georges fetus has a fetal heart pattern indicating uteroplacental insufficiency. The nurses first intervention would be to:
a. Assist the patient to semi-Fowlers position b. Assist the patient to turn to a sidelying position c. Administer oxygen by nasal cannula at 3 L/minute d. Coach the patient to pant with her next contraction

60) The doctor plans cesarean delivery for Ms. Georges fetus as soon as possible. Which of the following preoperative instructions would the nurse give Ms. George? a. Youll have a nasogastric tube b. Youll have to remain in one position during your recovery c. Youll be separated from your baby for the first 24 hours d. Youll be encouraged to turn, cough, and take deep breaths after the delivery

61) Which of the following medications would the nurse expect to give Ms. George before the cesarean birth?

a. Secobarbital (Seconal) b. Morphine sulfate c. Sodium citrate (Bicitra) d. Oxytocin (Pitocin)

SITUATION: Margie Sullivan at 40 weeks gestation. She and her husband Dan come to the labor unit. Mrs. Sullivan has four other children and is in active labor. This is Dans first child. Hes eager to support his partner even though they havent attended childbirth class.

Questions 62 to 67 refer to this SITUATION.

62) Mr. Sullivan asks the nurse what his role should be because Mrs. Sullivan seems so uncomfortable. The nurse explains that the coachs primary role is to be: a. An active support person throughout the labor b. An observer who primarily participates during delivery c. A witness to the labor and delivery experience d. An information giver to all other family members not present at the birth

63) The nurse is teaching Mrs. Sullivan how to use effleurage during labor. Which of the following statements would the nurse include in her teaching?
a. Hold your breath and push with each contraction b. Massage your uterus at the peak of each contraction c. Ambulate during the latent and active phases of labor d. Lightly trace a pattern on your abdomen with your fingertips

64) The nurse performs Leopolds maneuvers and determines that Mrs. Sullivans fetus is in the right occipitoanterior (ROA) position. The nurse interprets this to mean that the fetus is: a. b. c. d. In a transverse lie In a frank breech presentation Facing toward the maternal left pelvis In a face presentation

65) Mr. Sullivan asks the nurse, Why are you doing that?As the nurse pal. Pates Mrs. Sullivans abdomen. The nurses response should include which of the following statements? a. So I can determine how large your baby is and whether hell be able to fit into your wifes pelvis. b. It tells me what your babys station is and how far dilated and effaced your wife is. c. I cant tell much, but it allows me to feel if your baby is moving. d. So I can tell what position your baby is in and where to listen to your babys heart beat.

66) Mrs. Sullivan is examined by the nurse, who documents the following data: cervix. 9 cm; position, +2. The nurse determines that Mrs. Sullivan is in which stage of labor.

a. First b. Second c. Third d. Fourth

67) Mrs. Sullivan calls out, My Babys coming! to ensure the patients safety, the nurses initial action would be to:

a. b. c. d.

Observe the perineum Notify the obstetrician on call Encourage the patient to deep breathe Initiate I.V fluids

SITUATION: Jeanne ONeill has come to the triage area at 37 weeks gestation concerned about some occasional contractions. Shes 40 years old. This is her second pregnancy, and her clinic chart indicates that, despite several health problems, her prenatal care has been sporadic. Questions 68 to 73 refer to this SITUATION

68) Mrs. ONeill tells the nurse that she a thick, while, cheesy discharge; itching; and burning in urinations. The nurse assesses these symptoms to be indicative of which of the following vaginal infection: a. Cervicitis b. Candidiasis c. Gonorrhea d. Trichomoniasis

69) Which of the following maternal high-risk factor places Mrs. ONeill at risk for delivering
a newborn with congenital anomalies? a. Diabetes mellitus b. Pregnancy-induced hypertension c. Hemoglobin hypertension d. Preterm labor treated with terbutaline

70) The nurse determines that Mrs. ONeill is having Braxton Hicks contractions can be discharge from the triage area. Which statements made by Mrs. ONeill would indicate that she needs additional teaching about when to come to the hospital?
a. if my membranes rupture, Ill wait until my contractions begins b. if my contractions increase in frequency and duration, Ill come to the hospital c. If I experience vaginal bleeding, Ill come to the hospital. d. If my baby stops moving, Ill come to the hospital.

71) Mrs. ONeill returns to the hospital the next day with a complaint of vaginal bleeding. She states that she snorted cocaine approximately 1 hour earlier. Which of the following complications is most likely causing the patients of vaginal bleeding? a. Placenta previa b. Abruption placentae c. Ectopic pregnancy d. Spontaneous abortion

72) Which of the following assessments would indicate that Mrs. ONeill has developed abruption placentae? a. Increased blood pressure and periodical edema b. Pain in the lumbar sacral area radiating to the area above the symptysis pubis c. Sharp fundal pain without relaxation between contraction d. Painless vaginal bleeding and an increased pulse rate

73) The nurse suspects that Mrs. ONeill has experienced an intrauterine fetal demise. Which of the following nursing actions is most appropriate in caring for Mrs. ONeill at this time? a. Administer pain medication b. Provide privacy by leaving her in the labor room alone until the doctor arrives c. Request that the father of the baby remain in the waiting room until the assessment is performed d. Have the most experienced labor nurse ausculate for the fetal heart tones

SITUATION: Kim Knight is a 33-year-old primigravida who has come to the hospital because she experienced bright red vaginal bleeding. Shes at 35 weeks gestation. Her clinic chart indicates that she was diagnosed with placenta previda 3 weeks earlier. Questions 74 to 77 refer to this SITUATION

74) Which of the following would the nurse implement initially in caring for Ms. Knight? a. Maintain the patient in a side-lying position b. Perform a vaginal examination to assess labor progress c. Assess fetal heart tones using an internal scalp electrode d. Ambulate the patient to facilities labor contractions

75) Ms. Knight requires an emergency cesarean delivery under general anesthesia. Which of the following questions must the nurse to ask Ms. Knight before surgery? a. Would you like anyone to be with you during the delivery? b. When was the last time you ate solid food? c. Are you sure you want general anesthesia for the delivery d. Would you like to receive a sedative before the delivery to help you relax?

76) Ms. Knight delivers a healthy newborn. During the initial assessment after the birth the nurse expects to observe which of the following in the newborns umbilical cord? a. b. c. d. Two veins and one artery One vein and one artery One vein and two arteries Two vein and two arteries

77) Immediately after delivery the nurse would expect to assess Ms. Knights fundus to be: a. Deviated to the right b. One fingerbreadth above the level of the umbilicus c. Firm and contracted at the umbilicus d. Four fingerbreadth above the umbilicus and slightly deviated to the left