Exam 2 Questions Flashcards
Fetal bradycardia is most common during:
A. Maternal hyperthyroidism
B. Fetal anemia
C. Viral infection
D. Tocolytic treatment using ritodrine
C. Viral infection
Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, viral infections such as cytomegalovirus (CMV), maternal hypothermia, and maternal hypothermia.
The nurse providing care for the laboring woman understands that accelerations with fetal movement:
A. Are reassuring
B. Are caused by umbilical cord compression
C. Warrant close observation
D. Are caused by uteroplacental insufficiency
A. Are reassuring
Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being.
The most common cause of decreased variability in the FHR that lasts 30 minutes or less is:
A. Altered cerebral blood flow
B. Fetal hypoxemia
C. Umbilical cord compression
D. Fetal sleep cycles
D. Fetal sleep cycles
A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes.
You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take?
A. Call for help.
B. Insert a Foley catheter.
C. Start oxytocin (Pitocin).
D. Notify the primary health care provider immediately.
D. Notify the primary health care provider immediately.
To relieve an FHR deceleration the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately.
When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that:
A. The examiner’s hand should be placed over the fundus before, during, and after contractions
B. The frequency and duration of contractions are measured in seconds for consistency
C. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together
D. The resting tone between contractions is described as either placid or turbulent
A. The examiner’s hand should be placed over the fundus before, during, and after contractions
The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed.
A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by:
A. Narcotics
B. Barbiturates
C. Methamphetamines
D. Tranquilizers
C. Methamphetamines
The use of illicit drugs such as cocaine or methamphetamines might cause increased variability.
In documenting labor experiences, nurses should know that a uterine contraction is described according to all of these characteristics except:
A. Frequency (how often contractions occur)
B. Intensity (the strength of the contraction at its peak)
C. Resting tone (the tension in the uterine muscle)
D. Appearance (shape and height)
D. Appearance (shape and height)
Uterine contractions are described in terms of frequency, intensity, duration, and resting tone. Appearance is not a term used to describe contractions. Duration is another characteristic of uterine contractions.
The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:
A. Change in position
B. Oxytocin administration
C. Regional anesthesia
D. Intravenous analgesic
A. Change in position
Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman’s heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position.
Fetal well-being during labor is assessed by:
A. The response of the fetal heart rate (FHR) to uterine contractions (UCs)
B. Maternal pain control
C. Accelerations in the FHR
D. An FHR greater than 110 beats/min
A. The response of the fetal heart rate (FHR) to uterine contractions (UCs)
Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement.
A group of fetal monitoring experts (National Institute of Child Health and Human Development, 2008) recommends that fetal heart rate (FHR) tracings demonstrate certain characteristics to be described as reassuring or normal (category I). This includes:
A. Bradycardia not accompanied by baseline variability
B. Early decelerations, either present or absent
C. Sinusoidal pattern
D. Tachycardia
B. Early decelerations, either present or absent
Early decelerations, the absence of late decelerations, and the presence of accelerations indicate a normal category I tracing.
A woman in active labor receives an opioid agonist analgesic. Which medication relieves severe, persistent, or recurrent pain, creates a sense of well-being, overcomes inhibitory factors, and may even relax the cervix but should be used cautiously in women with cardiac disease?
A. Meperidine (Demerol)
B. Promethazine (Phenergan)
C. Butorphanol tartrate (Stadol)
D. Nalbuphine (Nubain)
A. Meperidine (Demerol)
Meperidine is the most commonly used opioid agonist analgesic for women in labor throughout the world. It overcomes inhibitory factors in labor and may even relax the cervix. Because tachycardia is a possible adverse reaction, meperidine is used cautiously in women with cardiac disease.
A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should:
A. Notify the woman’s physician
B. Tell the woman to slow the pace of her breathing
C. Administer oxygen via a mask or nasal cannula
D. Help her breathe into a paper bag
D. Help her breathe into a paper bag
This woman is experiencing the side effects of hyperventilation, which include the symptoms of lightheadedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. The woman can also breathe into her cupped hands if no paper bag is available.
A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure is to use:
A. Counterpressure against the sacrum
B. Pant-blow (breaths and puffs) breathing techniques
C. Effleurage
D. Biofeedback
A. Counterpressure against the sacrum
Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back.
Nurses should be aware of the difference experience can make in labor pain, such as:
A. Sensory pain for nulliparous women often is greater than for multiparous women during early labor
B. Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor
C. Women with a history of substance abuse experience more pain during labor
D. Multiparous women have more fatigue from labor and therefore experience more pain
A. Sensory pain for nulliparous women often is greater than for multiparous women during early labor
Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple.
In the current practice of childbirth preparation, emphasis is placed on:
A. The Dick-Read (natural) childbirth method
B. The Lamaze (psychoprophylactic) method
C. The Bradley (husband-coached) method
D. Encouraging expectant parents to attend childbirth preparation in any or no specific method
D. Encouraging expectant parents to attend childbirth preparation in any or no specific method
Encouraging expectant parents to attend class is most important, because preparation increases a woman’s confidence and thus her ability to cope with labor and birth. Gaining in popularity are Birthing from Within and Hypnobirthing.
With regard to breathing techniques during labor, maternity nurses should be aware that:
A. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction
B. By the time labor has begun, it is too late for instruction in breathing and relaxation
C. Controlled breathing techniques are most difficult near the end of the second stage of labor
D. The patterned-paced breathing technique can help prevent hyperventilation
A. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction
First-stage techniques promote relaxation of abdominal muscles, thereby increasing the size of the abdominal cavity.
With regard to what might be called the tactile approaches to comfort management, nurses should be aware that:
A. Either hot or cold applications may provide relief, but they should never be used together in the same treatment
B. Acupuncture can be performed by a skilled nurse with just a little training
C. Hand and foot massage may be especially relaxing in advanced labor when a woman’s tolerance for touch is limited
D. Therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations
C. Hand and foot massage may be especially relaxing in advanced labor when a woman’s tolerance for touch is limited
The woman and her partner should experiment with massage before labor to see what might work best.
With regard to systemic analgesics administered during labor, nurses should be aware that:
A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier
B. Effects on the fetus and newborn can include decreased alertness and delayed sucking
C. IM administration is preferred over IV administration
D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic
B. Effects on the fetus and newborn can include decreased alertness and delayed sucking
Effects depend on the specific drug given, the dosage, and the timing.
With regard to spinal and epidural (block) anesthesia, nurses should know that:
A. This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births
B. A high incidence of postbirth headache is seen with spinal blocks
C. Epidural blocks allow the woman to move freely
D. Spinal and epidural blocks are never used together
B. A high incidence of postbirth headache is seen with spinal blocks
Headaches may be prevented or mitigated to some degree by a number of methods. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for a spinal headache.
After change of shift report the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is:
A. Visceral
B. Referred
C. Somatic
D. Afterpain
B. Referred
As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions.
The breasts of a bottle-feeding woman are engorged. The nurse should instruct her to:
A. Wear a snug, supportive bra
B. Allow warm water to soothe the breasts during a shower
C. Express milk from breasts occasionally to relieve discomfort
D. Place absorbent pads with plastic liners into her bra to absorb leakage
A. Wear a snug, supportive bra
A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Ice packs, fresh cabbage leaves, and mild analgesics may also relieve discomfort.
A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman’s bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:
A. Urinary tract infection
B. Excessive uterine bleeding
C. A ruptured bladder
D. Bladder wall atony
B. Excessive uterine bleeding
Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly.
What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?
A. “My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter.”
B. “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
C. “I will not have a menstrual cycle for 6 months after childbirth.”
D. “My first menstrual cycle will be heavier than normal and then will be light for several months after.”
B. “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
This is an accurate statement and indicates her understanding of her expected menstrual activity.
With regard to afterbirth pains, nurses should be aware that these pains are:
A. Caused by mild, continual contractions for the duration of the postpartum period
B. More common in first-time mothers
C. More noticeable in births in which the uterus was overdistended
D. Alleviated somewhat when the mother breastfeeds
C. More noticeable in births in which the uterus was overdistended
A large baby or multiple babies overdistend the uterus.
Postbirth uterine/vaginal discharge, called lochia:
A. Is similar to a light menstrual period for the first 6 to 12 hours
B. Is usually greater after cesarean births
C. Will usually decrease with ambulation and breastfeeding
D. Should smell like normal menstrual flow unless an infection is present
D. Should smell like normal menstrual flow unless an infection is present
An offensive odor usually indicates an infection.
Which description of postpartum restoration or healing times is accurate?
A. The cervix shortens, becomes firm, and returns to form within a month postpartum.
B. Rugae reappear within 3 to 4 weeks.
C. Most episiotomies heal within a week.
D. Hemorrhoids usually decrease in size within 2 weeks of childbirth.
B. Rugae reappear within 3 to 4 weeks.
Rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes.
With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:
A. Kidney function returns to normal a few days after birth
B. Diastasis recti abdominis is a common condition that alters the voiding reflex
C. Fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium
D. With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth
C. Fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium
Excess fluid loss through other means occurs as well.
As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding is:
A. Little if any change
B. Leakage of milk at let-down
C. Swollen, warm and tender on palpation
D. A few blisters and a bruise on each areola
A. Little if any change
Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples.
Afterpain
Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.
Somatic Pain
Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor.
Referred Pain
As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions.
Visceral pain
is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen.
When assessing a newborn, a nurse should be aware that the average expected expected apical pulse range of a full-term, quiet, alert newborn is:
A. 120 to 160 beats/ min
B. 150 to 180 beats/min
C. 100 to 120 beats/min
D. 80 to 100 beats/min
A. 120 to 160 beats/ min
The nurse administers vitamin K to the newborn for what reason?
A. Most mothers have a diet deficient in vitamin K, which results in the infant being deficient.
B. Bitamin K prevents the synthesis of prothrombin in the liver and must be given by injection.
C. The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.
D. Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract.
D. Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract.
An African-American woman noticed some bruises on her newborn girl’s buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called”
A. Mongolian spots
B. Nevus flammeus
C. Vascular nevi
D. Lanugo
A. Mongolian spots
An infant boy was born a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed:
A. Once by the obstetrician, just after birth
B. Every 15 minutes during the newborn’s first hour after birth
C. At least twice, 1 minute and 5 minutes after birth
D. Only if the newborn is in obvious distress
C. At least twice, 1 minute and 5 minutes after birth
