1.

A 22-year-old woman tells a clinic nurse that her last menstrual period was 3 months ago, which began on 11/21. She has a positive urine pregnancy test. Using Nageles rule, which date should the nurse calculate to be the womans estimated date of confinement (EDC)? 1. 8/28 2. 1/28 3. 8/15 4. 1/15
ANSWER: 1 To calculate the EDC using Nageles rule, subtract 3 months, and add 7 days. This makes the EDC 8/28.

2. A nurse is caring for a 24-year-old client whose pregnancy history is as follows: elective termination in 1998, spontaneous abortion in 2001, term vaginal de- livery in 2003, and currently pregnant again. Which documentation by the nurse of the clients gravity and parity is correct? 1. G4P1 2. G4P2 3. G3P1 4. G2P1
ANSWER: 1 The woman has been pregnant four times in all (gravity). Each time a woman is pregnant it counts as a pregnancy, regardless of the out- come. Parity is counted once a woman delivers a fetus over 20 weeks old, regardless of whether the fetus survives. This woman has delivered once and is currently pregnant, so the parity is 1.

3. A nurse determines that a gestationally diabetic client in preterm labor has a reactive nonstress test (NST) when which findings are noted? 1. Two fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) above baseline for at least 15 seconds in a 20-minute period 2. A FHR acceleration of 15 bpm above baseline for at least 15 seconds in a 20-minute period 3. Two FHR accelerations of 20 bpm above baseline for at least 20 seconds in a 20-minute period 4. The absence of decelerations in a 20-minute period
ANSWER: 1 The criterion for a reactive NST is the presence of 2 accelerations of 15 bpm above baseline lasting 15 seconds or longer in a 20-minute period.

4. A nurse is performing a vaginal exam on a client who is being evaluated in triage for possible labor. The clients contractions are every 3 to 4 minutes, 60 to 70 seconds in duration, and moderate by palpation. Her cervical exam in the office is illustration 1. Her current exam is illustration 2. What conclusions should the nurse draw from illustration 2?

70 seconds in duration, and moderate by palpation. Her cervical exam in the office is illustration 1. Her current exam is illustration 2. What conclusions should the nurse draw from illustration 2?

or dilated. In illus dilatation.

T est-taking Tip dilatation and c

Content Area: C Intrapartal Manage Assessment; Clien Adaptation/Pathop

Reference: Gabbe and Problem Pregn Livingstone.

ANSWER: 3completely effaced. 4. refers Theto woman completely effaced but not Effacement a thinning is of the cervix, whereas dilatation refers to thedilated. opening of the cervix. In illustration 1, the woman is not effaced or dilated. In illustration 2, she is completely effaced and has some dilatation. A N SWER: 1 3 4 9 . A nurses laboring client has decided to try to get

1. The woman is not dilated or effaced. 1.The The woman is not dilated or not effaced. 2. woman is completely dilated but effaced. 2. The woman is completely dilated but not effaced. 3. The woman has minimal dilatation but is completely effaced. 3. The woman has minimal dilatation but is 4. The woman is completely effaced but not dilated.

5. A nurses laboring client is experiencing decelerations occur through labor without an epidural. The that client is after re- the onsetSystemic medicat tion is present bec of the contraction and do not end until after the contraction is completed. questing intravenous pain medication instead. The The variability is minimal. Which that interventions nurse initiate? SELECT ministered too clo nurse determines which should factorthe would contraindiminute with variab ALL THAT cate APPLY. the administration of nalbuphine hydrochloride present but the FH 1. Reposition the woman. )? administered. (Nubain 2. Provide oxygen via facemask. T est-taking Tip 1. Transition stage (Pitocin). of labor 3. Discontinue oxytocin determ ine w hic 2. Fetal heart rate (FHR) of 110 beats per minute Nubain adm ini 4. Reassess in 30 minutes. 3. Presence of variability 5. Increase oxytocin. Content Area: C 4. Presence of variable decelerations Intrapartal Manage 6. Increase intravenous fluids.
ANSWER: 1, 2, 3, 6 The nurse should reposition the woman, provide oxygen, and discontinue oxytocin in order to decrease the contraction frequency. The woman should be given a bolus of fluid in case the decelerations are related to maternal hypotension. This fetus is experiencing nonreassuring fetal status. The oxytocin should not be increased because this can lead to further nonreassuring fetal status.

Analysis; Client N Parenteral Therapi Level: Analysis

Reference: Davids Maternal-Newborn (8th ed., p. 686). U

6. A nurse is admitting a full-term pregnant client presenting with bright red, vaginal bleeding and intensehas abdominal pain. Her blood pressure on admission is 3 50. A nurse s client been experiencing frequent, contractions for the per last 6 hours. The contrac150/96 painful mm Hg and her pulse is 109 beats minute. Which problem should the tions that arethe of client pooris quality, and there has been no cervinurse suspect likely experiencing? cal change. Which nursing interventions should be 1. Placenta previa initiated? SELECT ALL THAT APPLY. 2. Placenta abruption 3. Bloody show 1. Maintain bedrest 4. Succenturiate placenta 2. Administer a sedative

ANSWER: 3.2Administer pain medications T est-taking Tip Placenta abruption occurs when the placenta separates from the uter- ine wall before the birth of 4. Prepare for amniotomy this type of labo the fetus. It is commonly associated with preeclampsia. Placenta previa is marked by painless 5. Prepare for cesarean delivery vaginal bleeding. Bloody show is a normal physiological sign associated with normal labor Content Area: C

A N SWER: 1 , 2 This woman is ex contractions are f curred. This wom a sedative. Pain m woman relax and continues, augme should be initiate labor pattern unles

6. Administer oxytocin (Pitocin)

Intrapartal Manage Implementation; C Potential/Therapeu

Reference: Davids Maternal-Newborn (8th ed., p. 719). U

progression and is marked by bloody mucous-like consistency. Succenturi- ate placenta is the presence of one or more accessory lobes that develop on the placenta with vascular connections of fetal origin.

7. A nurses laboring client suddenly experiences a dra- matic drop in the fetal heart rate (FHR) from the 150s to the 110s. A vaginal exam reveals the presence of the fetal cord that has protruded through the cervix. What is the initial step the nurse should take? 1. Provide continuous pressure to hold the presenting part off the cord 2. Place the client in Trendelenburgs position 3. Insert and fill a Foley catheter 4. Continue to monitor the FHR
ANSWER: 1 The nurse should first exert continuous pressure on the presenting part to prevent further cord compression. This is continued until birth is achieved, usually by cesarean section birth. The bed should then be placed in Trendelenburgs position to further prevent pressure on the cord. A Foley catheter may be inserted with 500 mL of warmed saline to help float the head and prevent further compression. The fetus is continually monitored throughout until birth is accomplished.

8. A nurse walks into the room of a postpartum client and observes her looking in the mirror at her ab- domen. The client says, My stomach still looks like Im pregnant! The nurse explains that the abdominal muscles, which separate during pregnancy, will do which of the following? 1. Regain tone within the first week after birth 2. Regain prepregnancy tone with exercise 3. Remain permanently separated giving the abdomen a slight bulge 4. Regain tone as the client loses the weight gained during the pregnancy
ANSWER: 2 When the postpartum woman stands during the first days after birth, her abdomen protrudes and gives her a still-pregnant appearance. This is caused by relaxation of the abdominal wall. For the majority of postpartum women, the muscles of the abdominal wall will return to the prepregnancy state within 6 weeks with appropriate exercise. If the woman delivers a very large infant, the abdominal muscles may separate but the separation will become less apparent over time.

9. While assisting with the vaginal delivery of a full- term newborn, a nurse observes that, in spite of the fact that the client did not have an episiotomy or a perineal laceration, her perineum and labia are edematous. To promote comfort and decrease the edema, which intervention is most appropriate? 1. Applying an ice pack to the perineum 2. Teaching the client to relax her buttocks before sitting in a chair 3. Applying a warm pack 4. Providing the client with a plastic donut cushion to be used when sitting
ANSWER: 1 If perineal edema is present, ice packs should be applied for the first 24 hours. Ice reduces edema and vulvar irritation. After 24 hours, heat is recommended to increase circulation to the area. The

client should be taught to tighten her buttocks when sitting because this compresses the buttocks and reduces pressure on the perineum. Donut cushions should be avoided because they promote separation of the buttocks and decrease venous blood flow to the area, thus increasing pain.

10. A woman with oligohydraminos and suspected intrauterine growth restriction gives birth to an infant. The infants 1-minute Apgar score was 6, and the 5-minute Apgar score is 7. Which conclusion should the nurse make from this information? 1. A low Apgar score at 1 minute correlates with infant mortality. 2. A 5-minute Apgar score of 7 to 10 is considered normal. 3. A 5-minute score greater than 9 indicates a decreased risk of neurological impairment. 4. Gestational age, resuscitation measures, and obstetrical medications did not affect the Apgar score.
ANSWER: 2 A 5-minute Apgar score above 7 is considered normal. Whereas a low 1-minute Apgar score does not, a low 5-minute Apgar score is associated with infant mortality. The Apgar score at 5 minutes in full-term infants is a poor predictor of neurological outcome. Variables such as gestational age, resuscitation measures, and medications can all affect the Apgar score.