Question 1

A client is in the second stage of labor and has been pushing for almost an hour. Which of the following interventions is the most appropriate for the client at this stage?

Accepted Answer

The most appropriate intervention during the second stage of labor is to instruct the client to push with each contraction. The midwife should also encourage the client to rest in between contractions. Pushing expends energy, and the client should be taught to conserve and regain energy every time she has the opportunity. It is not recommended to offer foods and fluids at this time; however, ice chips may be offered for hydration. Ambulation is recommended during early labor. Frequent position changes are not recommended during the second stage because the client needs to conserve her energy.

Question 2

A client at 38 weeks' gestation comes to the facility after experiencing leakage of clear fluid from the vagina without contractions. Premature rupture of membranes is suspected. Which of the following actions by the midwife would be inappropriate for a client with this condition?

Accepted Answer

Digital vaginal examinations are not performed to avoid the risk of infection. The midwife may assess the client's cervix and vaginal cavity via sterile speculum vaginal examination. Ampicillin may be administered to prevent infection, a common complication of premature rupture of membranes. An L/S ratio is ordered to assess the maturity of the fetal lung.

Question 3

A midwife is monitoring a client in labor who is receiving intravenous oxytocin. The fetal heart rate monitor tracing reveals decelerations occurring 35 seconds after the onset of each contraction and continuously past the end of the each contraction. Which of the following is the priority action of the midwife?

Accepted Answer

The priority action of the midwife is to stop the administration of oxytocin. The client is demonstrating late decelerations, indicating the occurrence of uteroplacental insufficiency. If the client is receiving oxytocin at this time, it is most important to stop the infusion first before starting with the other interventions. The midwife should change the client's position to the side-lying position and administer oxygen after adjusting the rate of oxytocin infusion. The Trendelenburg position is indicated if the client has prolapsed cord.

Question 4

A midwife is assessing a client and her infant one week after delivery. The infant's birth weight was 7.5 pounds. Which of the following findings indicate that the infant is getting enough milk?
I. The mother reports that the infant is wetting 6 to 8 diapers a day.
II. The mother informs the midwife that the infant appears content between feedings.
III. The infant's weight is 6.8 pounds.
IV. The mother reports that the infant quietly swallows during breastfeeds.

Accepted Answer

The signs indicating that an infant is getting enough breast milk include wetting of 6 to 8 diapers a day, appearing content between feedings and losing no more than 10% of birth weight during the first week of life. The mother is effectively breastfeeding the infant if the mother hears a suck-suck-swallow pattern when feeding the infant.

Question 5

On assessment, the midwife notes that a female newborn has pink patches at the nape of the neck. The midwife informs the mother that these patches:

Accepted Answer

Nevus flammeus lesions, also known as stork's beak marks or stork bites, do not fade, but they are usually covered by the hair line. They are more common in females than in males. These lesions are classified as vascular tumors of the skin. They are not caused by an injury during labor. Mongolian spots may disappear by school age without treatment.

Question 6

A client is given oxytocin for the induction of labor. The midwife should monitor the client for which of the following side effects of oxytocin?

Accepted Answer

The midwife should monitor the client for signs of water intoxication, such as vomiting. Water intoxication is also manifested by headache and seizures. Oxytocin is an anti-diuretic hormone that causes decreased urine outflow and, consequently, fluid overload. The midwife should closely monitor the client's fluid intake and urine output, test the client's urine specific gravity and limit the intravenous fluid being administered to 150 mL per hour.

Question 7

A midwife is monitoring a client who is in labor. Assessment findings reveal that the fetus is in LOA position. The midwife notes that the presenting part of the fetus is at 0 station. This finding indicates that:

Accepted Answer

A 0 station indicates that the presenting part, the head of the fetus, is at the level of the ischial spines and that engagement has occurred. Option A indicates a +4 station. Option C indicates a negative station. Option D describes descent, the first cardinal movement of labor. Station refers to the relationship of the presenting part of the fetus to the level of the ischial spines.

Question 8

A midwife is monitoring a client who was admitted to the labor and delivery unit about 5 hours ago. The midwife notes a cervical dilatation of 5 cm. The contractions occurring every 5 minutes usually last between 50 and 55 seconds. The client is in which phase of labor?

Accepted Answer

The client is in the active phase of labor. The active phase of labor is the second phase of the first stage of labor. The latent phase is manifested by cervical dilatation from 0 to 3 cm and by contractions lasting 20 to 40 seconds. The active phase of labor is manifested by cervical dilatation from 4 to 7 cm and by contractions occurring every 3 to 5 minutes, each lasting 40 to 60 seconds. The transitional phase is manifested by cervical dilatation from 8 to 10 cm and by contractions lasting 60 to 90 seconds.

Question 9

A midwife is monitoring a client with a cervical dilatation of 3 cm. The midwife determines that the client has contractions occurring every 3 minutes. Each contraction lasts for 50 seconds. The fetal heart rate is determined at 100 beats per minute. Which of the following is the priority action of the midwife?

Accepted Answer

The priority action of the midwife is to administer oxygen by a face mask. The normal fetal heart rate is 120 to 160 beats per minute; a fetal heart rate of 100 beats per minute is not a normal finding. This finding suggests that the fetus may be in distress. Encouraging the client to push with every contraction is not recommended. The client may be placed in side-lying position to promote fetal circulation.

Question 10

A midwife is reviewing the fetal heart rate monitor tracing obtained from a G2P1 client who is in labor. The midwife notes decelerations at unpredictable times in relation to contractions. The midwife suspects which of the following conditions?

Accepted Answer

The midwife suspects cord compression. Variable deceleration is manifested by decelerations occurring at unpredictable times in relation to contractions. This type of variability usually occurs after rupture of the membranes or in cases of oligohydramnios. Cephalopelvic disproportion is manifested by early decelerations before the head is fully descended. Early decelerations normally occur during the final stages of labor. Uteroplacental insufficiency is manifested by late decelerations.

Question 11

A midwife is teaching a female client how to perform a breast self-examination. On return demonstration, which of the following actions by the client indicates that further teaching is necessary?

Accepted Answer

The client needs further teaching if she uses the tips of her second, third and fourth fingers to press every part of her breast. The client should use the pads of her fingers to palpate her breasts.

Question 12

A midwife is assessing four clients who recently gave birth through vaginal delivery. A part of the examination is measuring the fundal height. Which of the following clients needs further evaluation?

Accepted Answer

A client who gave birth 72 hours ago is expected to have her fundus at 3 cm below the umbilicus. About an hour after birth, the fundus is normally palpated at the level of the umbilicus. The uterus usually descends downward at the rate of 1 fingerbreadth per day. It is usually non-palpable 10 days after the delivery.

Question 13

A female client is admitted to the facility due to alcohol abuse. During the first 24 hours, which of following interventions is the least appropriate?

Accepted Answer

Initiating bleeding precautions is not a priority action during the first 24 hours of treatment for alcohol abuse. Signs of alcohol withdrawal occur during this time period. The nurse has to orient the client frequently to alleviate anxiety and to reinforce reality, as hallucinations and illusions are common. Seizures may occur as the withdrawal progresses, so precautions are initiated on admission. A quiet and non-stimulating environment decreases anxiety and prevents seizures.

Question 14

There are many reasons why nurse midwives should be concerned with professional ethics. Which of the following is the main and critical purpose of applied professional ethics?

Accepted Answer

The main and critical role of applied professional ethics is to maintain internal regulation and avoid external regulation. Self-regulation is preferred because no one knows midwifery better than its members. With self-regulation, external agencies are less likely to interfere with the practice. Ethical codes foster professional identity and encourage nurse midwives to define themselves and communicate who they are in relation to others. Through professional ethics, the consumers and care givers are protected, causing increased confidence in the profession. Ethical codes also signal professional maturity, which stimulates further development of ethical codes and guidelines.

Question 15

A series of laboratory examinations are conducted for a client who is admitted to the facility for an annual checkup. Blood is drawn for serum electrolyte testing. Which of the following assessment findings requires further evaluation?

Accepted Answer

The client's serum chloride level is below the normal range of 98 to 107 mEq/L. Hypochloremia may be caused by excessive sweating or vomiting, or by adrenal and kidney diseases. The other laboratory findings are normal.

Question 16

A midwife is managing the care of a 25-year-old postpartum client who gave birth 18 hours ago. No complications were noted during the labor process. The newborn is brought to the client for feeding and to have the mother and child bond for the night. The client says, "I'm too tired. Please get her back to the nursery, just for tonight. I need to get some sleep." Which of the following is the most appropriate action of the midwife?

Accepted Answer

The most appropriate action of the midwife is to accept the client's behavior as an indication that she is in the taking-in phase. The taking-in phase occurs in the first 24 hours after birth. In this stage, the client is more concerned about her own needs than the baby's. The taking-hold phase is the next phase. A client in this phase demonstrates signs of readiness to learn and face responsibilities. The letting-go phase may begin weeks after the delivery. In this phase, the client incorporates the newborn into the family unit.

Question 17

A midwife is assessing a mature female neonate born to a 21-year-old G3P2 client. Which of the following findings suggests that further evaluation and notification of the physician are necessary?

Accepted Answer

A birth weight of 11 pounds is unusual, which requires further evaluation and notification of the physician. Mature female newborns usually weigh 7.5 pounds, whereas mature male newborns weigh 7.7 pounds on the average. The average birth length for female newborns is 53 cm. In mature newborns, the head circumference is usually 34 to 35 cm. Chest circumference is usually 2 cm less than the head circumference.

Question 18

A client who gave birth to a healthy newborn experiences crying and expresses feelings of sadness and emptiness. The client delivered her baby 3 days ago. The midwife suspects that the client has:

Accepted Answer

The client has postpartum blues. Postpartum blues occurs shortly after childbirth and dissipates quickly. The client may experience crying and express feelings of emptiness. Research shows that postpartum blues occurs in about 70% of postpartum clients. Postpartum depression, on the other hand, occurs in the first few months after childbirth and may last up to a year. Counseling may be recommended. Postpartum psychosis occurs during the first month after childbirth. Clients may have delusions and hallucinations. Drug therapy and psychotherapy are usually recommended.

Question 19

A midwife is receiving a client who gave birth an hour ago. Which of the following nursing interventions is the priority action of the nurse during the immediate postpartum period?

Accepted Answer

The priority action of the nurse during the immediate postpartum period is to palpate for the height of fundus. Hemoglobin and hematocrit may be ordered, but this is not the priority action of the midwife. Oxygen administration is not indicated at this time.

Question 20

A client had a cesarean delivery. The client informs the midwife that she intends to breastfeed her baby. Which of the following instructions is the most effective for a client who wants to breastfeed after a cesarean delivery?

Accepted Answer

The most appropriate action of the midwife is to instruct the client to use the football hold when breastfeeding. This position alleviates or avoids incisional discomfort. Breastfeeding may be started immediately after birth, and the newborn must be breastfed every 2 to 4 hours.

Quiz 8: Midwifery