Question 1

When caring for a laboring patient,the nurse notes the onset of sudden vaginal bleeding at the beginning of cervical dilation.The patient denies any pain.What action by the nurse is best?

Accepted Answer

This woman has the classic sign of vasa previa,in which the unprotected fetal vessels cover the cervical os and precede the fetus.This condition is usually seen with a velamentous insertion of the umbilical cord.The nurse should conduct a careful vaginal exam,assessing for exposed fetal blood vessels.The patient may need an emergent cesarean delivery.This assessment should come prior to interventions such as positioning.

Question 2

A nurse is assisting with a forceps delivery.After the forceps are applied,the nurse notes fetal bradycardia.What action by the nurse takes priority?

Accepted Answer

When the forceps are applied,umbilical cord compression can occur.Compression of the cord causes a decrease in the fetal heart rate.The nurse should immediately inform the provider so that the pressure can be released.The nurse is responsible for documenting the fetal heart rate before and immediately after forceps application,but relieving the pressure on the umbilical cord takes priority.The nurse should not wait 5 minutes for another assessment,nor should the nurse turn the patient on her side as a first action.

Question 3

A nulliparous woman has been admitted to the labor and birth unit.Her Bishop score is 4.What medication does the nurse plan to administer?

Accepted Answer

The Bishop score is a rating system used to determine the level of cervical inducibility.Labor induction is more likely to be successful with a higher score (9 or more for nulliparous women; 5 for multiparous women).This woman's cervix is not favorable for induction,so a cervical ripening agent should be used.Cytotec is one such agent.Betamethasone is used to improve fetal lung maturity.Hydromorphone is a pain medication.Oxytocin would be used to augment labor once the cervix is favorable.

Question 4

A nurse is caring for a patient who had a laminaria tent inserted 6 hours ago.What action by the nurse is most appropriate?

Accepted Answer

A laminaria tent is a hydroscopic cervical dilator made of seaweed,which swells as it absorbs moisture.Hydroscopic dilators remain in place for 6 to 12 hours,after which time they are removed and the woman is assessed for cervical dilation.The other interventions are not specific to this type of dilator.

Question 5

A nurse is caring for a woman who gave birth to a term infant an hour ago.The chart notes that the baby was born after demonstrating a positive turtle sign.What assessment finding by the nurse warrants immediate action?

Accepted Answer

A turtle sign describes a situation where the fetal head retracts during contractions after crowning.This is a clinical indicator of possible shoulder dystocia.Maternal complications of shoulder dystocia include hemorrhage and soft tissue trauma.A blood pressure as low as this woman's blood pressure measurement could be an indicator of hemorrhage,and the nurse needs to assess the woman further.The finding of lochia rubra 1 hour after birth is normal,as is a maternal heart rate of 68 beats/ minute.The finding of one saturated perineal pad within 2 hours is also normal.

Question 6

A woman has just given birth to an infant whose 1-minute Apgar score was 9.Meconium-stained amniotic fluid was noted upon rupture of the membranes.What action by the nurse is most appropriate?

Accepted Answer

Vigorous infants born in the presence of meconium-stained amniotic fluid do not need routine tracheal suctioning after birth.An Apgar score of 9 indicates that this baby is not depressed,so the nurse should continue to provide routine care for the infant and assess the 5-minute Apgar score.The other interventions are not warranted.

Question 7

A woman had an amniotomy 1 hour ago.Now she is complaining of uterine tenderness.What action by the nurse is most appropriate?

Accepted Answer

An amniotomy is an invasive procedure that carries the risk of infection.Maternal temperature should be assessed at least every 2 hours afterward.Other signs of infection include uterine tenderness,chills,foul-smelling vaginal discharge,and fetal tachycardia.The nurse should first assess the woman's temperature (and assess for other signs of infection)and then notify the health-care provider.The other two options would not be indicated at this time.

Question 8

A woman at 30 weeks' gestation is 80% effaced and 5 cm dilated.Which action by the nurse takes priority?

Accepted Answer

In preterm labor,if the woman's membranes have ruptured or if her cervix is more than 50% effaced and 3-4 cm dilated,it is not likely that the labor can be stopped.A cesarean birth is preferable to a vaginal delivery because it diminishes pressure on the fetal head and decreases the risk of intracranial hemorrhage.Because there is a high likelihood of cesarean birth,the nurse should ensure that consent for cesarean delivery is on the chart,in the event that the labor cannot be halted.Tocolytic medications are administered to halt contractions; if unsuccessful,the birth will occur.

Question 9

A woman's membranes have just ruptured and she states "I feel something in my vagina." The nurse assesses the woman and sees part of the umbilical cord protruding from the vagina.What action by the nurse is best?

Accepted Answer

Exposure to room air will cause the umbilical cord to dry out,leading to atrophy of the umbilical vessels.The nurse should not attempt to replace the cord but should cover it with a warm,saline-soaked sterile compress.The nurse should also exert upward pressure on the presenting part to relieve cord compression and prevent fetal hypoxia.The woman should be positioned in extreme Trendelenburg,modified Sims,or knee-chest position to take pressure off the cord.Assessing maternal and fetal signs is important,but first the nurse needs to preserve the cord.

Question 10

A woman is receiving oxytocin (Pitocin)via infusion.The nurse assesses the following: uterine contractions lasting 100 seconds every 1.5 minutes,uterine resting tone 36 mm Hg,baseline fetal heart rate (FHR)108 beats/minute with absent variability.What action by the nurse takes priority?

Accepted Answer

Oxytocin can cause uterine tachysystole,and the nurse's assessments are consistent with this condition.The priority action by the nurse is to stop the infusion.The nurse should notify the provider.Documentation should be thorough.Reassessment should be driven by a written protocol.

Question 11

A woman is about to undergo an external version.What action by the nurse takes priority?

Accepted Answer

Because the version can cause feto-maternal bleeding,women who are Rh-negative should receive Rh immune globulin (RhoGAM).Offering emotional support is always important,but does not take priority over keeping the patient safe.The physician is responsible for explaining the procedure.Because uterine relaxation is important for a successful version,tocolytic medications may be given (not medications that increase uterine tone).

Question 12

A nurse is caring for a pregnant woman with diabetes mellitus.What assessment finding demonstrates that the patient has successfully met an important goal during pregnancy?

Accepted Answer

Women with diabetes should strive to maintain their blood glucose readings within normal parameters during pregnancy.Poor glycemic control contributes to fetal macrosomia (fetal weight > 500 g)and other complications.Weight gain should not be restricted to 20 lb,and electrolyte readings are not related to a major goal for this woman.

Question 13

A laboring woman complains of sudden,sharp,severe pain during a contraction,and when the contraction ceases,the pain is gone.What assessment by the nurse takes priority?

Accepted Answer

A ruptured uterus is an obstetrical emergency.A classic sign is sudden pain during a contraction that ceases abruptly.Uterine rupture may be incomplete and the woman may be asymptomatic.Changes in fetal heart tracings (e.g.,sudden bradycardia,prolonged late or variable decelerations)are the most common signs and symptoms and frequently precede the onset of maternal symptoms (i.e.,pain,bleeding).Although all assessments are appropriate,the first thing the nurse should do is assess the fetal heart tracings.

Question 14

A nurse assisting in a birth observes the patient suddenly fall back against the bed and become unresponsive.What action by the nurse takes priority?

Accepted Answer

In any emergency situation,such as an unresponsive patient,the nurse needs to assess airway,breathing,and circulation and begin providing CPR if needed.The patient may or may not need an emergency cesarean delivery.Inserting a urinary catheter is not the priority.

Question 15

A nurse has administered dinoprostone gel (Prepidil)to a nulliparous woman whose Bishop score is 5.Fifteen minutes later the patient complains of intense itching,vaginal burning,and shortness of breath.What medication does the nurse anticipate giving?

Accepted Answer

In case of adverse reactions to dinoprostone,the nurse will administer terbutaline,0.25 mg intravenously or subcutaneously.The other medications are not indicated.

Question 16

A new nurse is working with a patient undergoing an induction of labor.What action by the new nurse would prompt the preceptor to intervene?

Accepted Answer

During an induction of labor,the IV fluid intake should not exceed 1,000 mL in 8 hours to prevent fluid overload after the placenta is delivered.If the new nurse has documented a larger amount,the preceptor needs to intervene.The other options show proper care of this patient.

Question 17

A nurse is caring for a patient with abruptio placentae.What assessment findings would indicate that the woman is hemodynamically stable?

Accepted Answer

Hemorrhage is a significant possibility with placental abruption.A hematocrit less than 30% is indicative of maternal hemodynamic stability; the presence of fetal bradycardia,maternal hypoxia,and urine output less than 30 mL/hour are indicative of an unstable state.

Question 18

A nurse is caring for a woman who will be induced,but her cervix is not yet favorable for this intervention.The provider leaves an order for dinoprostone vaginal insert (Cervidil),which the nurse administers at 9:00 a.m.At what time does the nurse anticipate induction with oxytocin (Pitocin)?

Accepted Answer

After Cervidil administration,contractions usually begin within 5 to 7 hours.If further augmentation is needed with oxytocin,it can be administered 30 to 60 minutes after the dinoprostone vaginal insert is removed.

Question 19

A nurse has instructed a woman on the procedure for nipple rolling.What action by the patient demonstrates good understanding of the teaching?

Accepted Answer

Nipple rolling can stimulate uterine contractions after labor has begun.The technique is used when labor is not progressing satisfactorily.The nurse instructs the patient to roll one nipple at a time for 10 minutes through her clothing.Then she should switch to the other side.The woman should rest during contractions.

Question 20

The perinatal nurse explains to a nursing student that perinatal loss occurs when a woman's baby is lost during what time period?

Accepted Answer

Perinatal loss is defined as the death of a fetus or infant from the time of conception through the end of the newborn period,28 days after birth.

Quiz 14: Caring for the Woman Experiencing Complications During Labor and Birth