Deck 19: Nursing Care during Obstetric Procedures

Question 1

Which patient status is an acceptable indication for serial oxytocin induction of labor?

A) Past 42 weeks' gestation
B) Multiple fetuses
C) Polyhydramnios
D) History of long labors

Answer 1

Past 42 weeks' gestation

Question 2

Before the physician performs an external version,the nurse should expect an order for a

A) Tocolytic drug
B) Contraction stress test (CST)
C) Local anesthetic
D) Foley catheter

Answer 2

Tocolytic drug

Question 3

The nurse caring for a woman in labor understands that the primary risk associated with an amniotomy is

A) Maternal infection
B) Maternal hemorrhage
C) Prolapse of the umbilical cord
D) Separation of the placenta

Answer 3

Prolapse of the umbilical cord

Question 4

The greatest risk to the newborn after an elective cesarean birth is

A) Trauma due to manipulation during delivery
B) Tachypnea due to maternal anesthesia
C) Prematurity due to miscalculation of gestation
D) Tachycardia due to maternal narcotics

Question 5

What is an appropriate response to a woman's comment that she is worried about having a cesarean birth?

A) "Don't worry. Everything will be okay."
B) "What are your feelings about having a cesarean birth?"
C) "I know you're worried, but this is a routine procedure."
D) "Patients commonly worry about surgery."

Question 6

To provide safe care for the woman,the nurse understands that which condition is a contraindication for an amniotomy?

A) Dilation less than 3 cm
B) Cephalic presentation
C) -2 station
D) Right occiput posterior position

Question 7

For which patient should the oxytocin (Pitocin)infusion be discontinued immediately?

A) A woman in active labor with contractions every 31 minutes lasting 60 seconds each
B) A woman in transition with contractions every 2 minutes lasting 90 seconds each
C) A woman in active labor with contractions every 2 to 3 minutes lasting 70 to 80 seconds each
D) A woman in early labor with contractions every 5 minutes lasting 40 seconds each

Question 8

Surgical,medical,or mechanical methods may be used for labor induction.Which technique is considered a mechanical method of induction?

A) Amniotomy
B) Intravenous Pitocin
C) Transcervical catheter
D) Vaginal insertion of prostaglandins

Question 9

When preparing a woman for a cesarean birth,the nurse's care should include

A) Injection of narcotic preoperative medications
B) Full perineal shave preparation
C) Straight catheterization to empty the bladder
D) Administration of an oral antacid

Question 10

The nurse practicing in a labor setting knows that the woman most at risk for a uterine rupture is a gravida

A) 3 who has had two low-segment transverse cesarean births
B) 2 who had a low-segment vertical incision for delivery of a 10-pound infant
C) 5 who had two vaginal births and two cesarean births
D) 4 who has had all cesarean births

Question 11

An indication for an episiotomy would be a woman who

A) Has a routine vaginal birth
B) Has fetal shoulder dystocia
C) Is delivering a preterm infant
D) Has a history of rapid deliveries

Question 12

The nurse knows that a urinary catheter is added to the instrument table if a forceps-assisted birth is anticipated.What is the correct rationale for this intervention?

A) Spontaneous release of urine might contaminate the sterile field.
B) An empty bladder provides more room in the pelvis.
C) A sterile urine specimen is needed preoperatively.
D) A Foley catheter prevents the membranes from spontaneously rupturing.

Question 13

The priority nursing care associated with an oxytocin (Pitocin)infusion is

A) Measuring urinary output
B) Increasing infusion rate every 30 minutes
C) Monitoring uterine response
D) Evaluating cervical dilation

Question 14

When positioning the Foley catheter before cesarean birth,the nurse knows that the catheter drainage tube and catheter bag should be

A) Positioned on top of the patient's leg
B) Placed near the head of the table
C) Clamped during the cesarean section
D) Positioned at the foot of the surgeon under the sterile drapes

Question 15

After a forceps-assisted birth,the mother is observed to have continuous bright red lochia but a firm fundus.What other data indicates the presence of a potential vaginal wall hematoma?

A) Mild, intermittent perineal pain
B) Edema and discoloration of the labia and perineum
C) Lack of an episiotomy
D) Lack of pain in the perineal area

Question 16

The standard of care for obstetrics dictates that an internal version might be used to manipulate the

A) Fetus from a breech to a cephalic presentation before labor begins
B) Fetus from a transverse lie to a longitudinal lie before cesarean birth
C) Second twin from an oblique lie to a transverse lie before labor begins
D) Second twin from a transverse lie to a breech presentation during vaginal birth

Question 17

The priority nursing intervention after an amniotomy is to

A) Assess the color of the amniotic fluid.
B) Change the patient's gown.
C) Estimate the amount of amniotic fluid.
D) Assess the fetal heart rate.

Question 18

Which event indicates a complication of an external version?

A) Maternal pulse rate of 100 bpm
B) Fetal bradycardia persisting 10 minutes after the version
C) Fetus returning to the original position
D) Increased maternal anxiety after the version

Question 19

A maternal indication for the use of vacuum extraction is

A) A wide pelvic outlet
B) Maternal exhaustion
C) A history of rapid deliveries
D) Failure to progress past 0 station

Question 20

Immediately after the forceps-assisted birth of an infant,the nurse should

A) Assess the infant for signs of trauma.
B) Give the infant prophylactic antibiotics.
C) Apply a cold pack to the infant's scalp.
D) Measure the circumference of the infant's head.

Question 21

To monitor for potential hemorrhage in the woman who has just had a cesarean birth,the recovery room nurse should

A) Maintain an intravenous infusion at 100 mL/hr.
B) Assess the abdominal dressings for drainage.
C) Assess the uterus for firmness every 15 minutes.
D) Monitor her urinary output.

Question 22

The nurse is caring for a woman in labor at 39 weeks and 5 days of gestation.Her labor progress has slowed due to poor contractions.After discussion with the provider,a decision has been made that she is a good candidate for ___________ of labor.

Question 23

As an adjunct to inductions,a number of procedures to ripen the cervix are employed.One of these methods is the vaginal administration of preparations using prostaglandins.Before administering this medication,the nurse should be aware that this class of drug is an appropriate choice for women who have had a prior cesarean birth.Is this statement true or false?

Question 24

A popular preinduction cervical ripening agent that is Food and Drug Administration (FDA)approved for the treatment of peptic ulcers is __________.

Question 25

While assisting with a vacuum extraction birth,what should the nurse immediately report to the physician?

A) Persistent fetal bradycardia below 100 bpm
B) Maternal pulse rate of 100 bpm
C) Maternal blood pressure of 120/70 mm Hg
D) Decrease in intensity of uterine contractions

Question 26

Induction of labor is considered an acceptable obstetric procedure if it is a safe time to deliver the fetus.The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction,including which of the following? Select all that apply.

A) Rupture of membranes at or near term
B) Convenience of the woman or her physician
C) Chorioamnionitis (inflammation of the amniotic sac)
D) Postterm pregnancy
E) Fetal death

Question 27

Approximately 60% to 80% of women with one low transverse uterine incision from a previous cesarean birth may have a successful vaginal delivery.Recommendations from ACOG related to VBAC risks include (select all that apply)

A) Immediate availability of the obstetric provider
B) Delivery at a tertiary care center
C) Availability of anesthesia personnel
D) Personnel who can assist with the cesarean birth
E) Use of misoprostol for cervical ripening

Question 28

The birth attendant evaluates whether labor and birth are safer for the woman and her fetus than continuing the pregnancy.The Bishop Scoring System remains a popular tool to assist in this task.Is this statement true or false?