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233 Cards in this Set
- Front
- Back
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What is the acme component of the contraction?
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The peak of the contraction
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What is the decrement component of the contraction?
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The decrease in the contraction.
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What is the increment component of the contraction?
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The building of the contraction.
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What is a tocodynamometer?
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A pressure sensitive device that is used to externally monitor contractions.
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Where is the tocodynamometer applied?
a) at the level of the umbilicus b) at the level of the symphysis pubis c) at the level of the fundus d) at the level of the occipital prominence of the fetal head |
c) at the level of the fundus
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Which of the following would be a contradiction to application of an internal pressure catheter?
a) preterm labor b) postterm labor c) gestational diabetes d) unruptured membranes |
d) unruptured membranes
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Under which circumstances is internal uterine pressure monitoring indicated?
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High risk pregnancies when accurate measurement of uterine activity is required.
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The process of shortening and thinning of the cervix is termed____.
a) involution b) effacement c) subinvolution d) dilation |
b) effacement
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What period comprises the first state of labor?
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The time period from the onset of true labor to full cervical dilation.
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The anterior fontanel remains open until approximately __ months.
a) 3 b) 6 c) 12 d) 18 |
d) 18
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How long does it take for the posterior fontanel to close?
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6-8 weeks
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When performing an intrapartal vaginal exam on a woman with ruptured membranes, ___ are worn.
a) clean gloves b) sterile gloves c) surgical gloves d) latex free gloves |
b) sterile gloves are worn for ruptured membranes, clean gloves are worn for unruptured membranes
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When the fetus is positioned with is head down, along the long axis of the woman, this is termed ____ lie.
a) longitudinal b) horizontal c) transverse d) oblique |
a) longitudinal
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Describe the position of the fetus in a transverse lie.
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It is lying across the abdomen, with the head on one side of the pelvis, and the butt on the other side of the pelvis.
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What is the oblique lie?
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When the fetus is positioned along the long axis with its head at the top near the breasts; and butt near the pelvis of the woman.
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Describe the Vertex presentation.
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Baby head down, with arms flexed inward, and chin tucked to chest.
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Describe the Military presentation.
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Arms and legs partially flexed, and head straight(not tucked to chest).
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Describe the Brow presentation.
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Legs partially flexed, arms partially extended, chin partially extended.
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Describe the Face presentation.
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Chin extended fully; arms fully extended and back slightly arched.
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In terms of breech presentation, what is Frank?
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legs fully extended by the head, arms fully extended near the butt
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In terms of breech presentation, what is complete/full.
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Baby sitting indian style with arms crossed.
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In terms of breech presentation, what is footling (single or double)?
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When one or two feet sticks through the cervix
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What is a risk with breech deliveries?
a) umbilical cord prolapse b) preterm delivery c) massive hemorrhaging d) increased pain |
a) umbilical cord prolapse; the presenting part may not be covering the cervix to prevent the umbilical cord for prolapsing
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How is cervix dilation affected by breech presentation?
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With breech presentation, the buttocks or feet are not as smooth and hard as the fetal head and are less effective in dilating the cervix
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Breech presentations are usually accompanied by:
a) forceps b) vacuum c) pharmaceutical dilation d) cesarean section |
d) cesarean section
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In the normal female pelvis, what represents the narrowest diameter through which the fetus must pass?
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ischial spines
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What fetal position is the most common and favorable for birth?
a) LOT b) RMA c) LSP d) ROA |
d) ROA
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The presence of bloody show often indicates that labor will begin within ___ hours.
a) 2-3 b) 5-7 c) 10-24 d) 24-48 |
d) 24-48
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The presence of amniotic fluid can be confirmed by:
a) glucose test b) ketone test c) Nitrazine tape test d) Methaline strip test |
c) Nitrazine tape test
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Some women experience ____ as a sign of impending labor.
a) gastrointestinal disturbances b) severe headaches c) labor pain relieves by walking d) labor pains originating in the abdomen |
a) gastrointestinal disturbances( diarrhea, nausea, vomiting or indigestion)
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Where does the pain of true labor usually begin?
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In the lower back, radiating to the abdomen.
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True of False: True labor pains will intensify with rest, and are slightly relieved with walking.
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False: False labor pain is relieved by walking; true labor pain is intensified by walking.
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How far will the cervix dilate with false labor?
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It won't!
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When testing amniotic fluid, Nitrazine tape will turn ___ if positive for amniotic fluid.
a) beige/brown/tan b) gray/blue/green c) orange/red/yellow d) purple/dark blue/teal |
b) gray/blue/green
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When viewing a dried glass slide of amniotic fluid, the slide would reveal a ___ pattern.
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Ferning
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What is a doula?
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A volunteer, or hired woman who is trained in guiding the supporting the woman during child birth.
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During the active stage of labor, the cervix generally dilates at a rate of ___ cm(s) per hour for nulliparous women and ___cm(s) per hour for multiparas women.
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1 cm/hr null
1.5 cm/hr multi |
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What happens during the transition phase in terms of:
1. frequent of contractions 2. length of contractions 3. cervical dilation |
Contractions come every 2-3 minutes lasting 60-90 seconds with cervical dilation of 8-10 cm.
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The latent phase of the first stage of labor is characterized by cervical dilation of __ cm.
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0-3
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Describe the woman in the latent phase.
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She has menstrual like cramps, is excited, talkative, confident, and anxious.
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What time period comprises the second stage of labor?
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Begins with full dilation , and ends with the birth of the fetus.
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True or False: Early in labor, women are encouraged to limit activity, as it will cause worsening labor pains.
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False: Women are encouraged to ambulate to help speed up labor.
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How should the woman on bedrest be encouraged to rest while in labor?
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on her left side to facilitate optimal uteroplacental blood flow
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How is the baseline fetal heart rate determined?
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By averaging the fetal heart rate observed between contractions over a 10 minute period.
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How is tachycardia defined in a fetus?
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A baseline fetal heart rate greater than 160 beats per minute for a duration of 10 minutes or longer.
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Hypoxia, maternal fever, maternal medications, infections, fetal anemia and maternal hyperthyroidism can all result in fetal:
a) bradycardia b) tachycardia c) FHR d) Variability |
b) tachycardia
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Late hypoxia, medications, maternal hypotension, prolonged umbilical cord compression and bradyarrhythmias can all result in:
a) bradycardia b) tachycardia c) FHR d) cyanotic sepsemia |
a) bradycardia
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True of false: The presence of moderate variability is an important indicator of hypoxia.
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False: It is an indicator of fetal well being because it is indicative of an adequately oxygenated neurological pathway in which impulses are transmitted from the fetal brain to the cardiac conduction system: so the fetal heart is properly responding to the lower oxygen environment during contractions
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True of False: The absence of variability indicates a congenital disorder.
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False: It may indicate normal variations such as fetal sleep, a response to certain drugs, general anesthetics or acidemia
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An acceleration is defined as an increase in FHR of ___ beets above the fetal heart baseline that lasts for at least __ to __ seconds.
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15 beats for 15-30 seconds
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Is early or late deceleration commonly observed during active labor and descent of the fetus?
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Early
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Describe the pattern of early decelerations in comparison to contractions when viewing them on a monitor
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They are a mirror image of each other. This means that during the peak of the contraction, the fetal heart rate drops the most in response to the brief hypoxic environment
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____ decelerations are unrelated to the presence of uterine contractions and are thought to be a result of umbilical cord compression.
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Variable
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What is amnioinfusion and what does it treat?
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It is the infusion of warmed normal saline into the uterus via sterile catheter; It is used to treat decelerations caused by cord compression.
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With late decelerations, when does the deceleration begin?
a) at the start of the contraction b) at the peak of the contraction c) at the last third of the contraction d) after the contraction ends |
b) at the peak of the contraction
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Late decelerations indicate the presence of:
a) umbilical cord compression b) uteroplacental insufficiency c) fetal distress d) over sedation |
b) uteroplacental insufficiency
*Remeber the late person is insufficient |
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A woman is receiving an oxytocin infusion and suddenly the monitor shows late decelerations. What should the nurse do?
a) increase IV fluids b) position the woman on her hands and knees c) stop the infusion d) administer narcan |
c) stop the infusion: it is running too fast, and causing contractions to come too soon resulting in uterine hyperstimulation.
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A woman on oxytocin presents with late decelerations. Which of the following steps should be taken. CATA
a) stop the infusion b) administer oxygen by mask c) increase the IV fluid rate d) administer narcan e) call a code Blue |
a,b,c
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What does the Ferguson reflex do?
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Stimulate the urge to push
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True of False: Most practitioners believe that pushing should begin when the woman has reach 10 cm dilation.
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False: Most believe pushing should begin when the woman feels the urge to push, INSTEAD of when full cervical dilation has been reached.
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Describe closed glottis and open glottis pushing.
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Closed glottis: Hold your breath and push for 19 seconds(not popular anymore);
Open glottis: Hold your breath for 5 seconds during pushing and continuously exhale during the pushing. |
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When birth is imminent, and the fetal head is encircled by the vaginal introitus, this is called ___.
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Crowning
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What period of time compromises the third stage of labor?
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Begins with the birth of the infant and ends with the delivery of the placenta
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What makes the placenta detach?
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The change in the interior dimension of the uterus results in a reduction in the size of the placental attachment site.
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Other than the placenta coming out, what else signal the detachment of the placenta from the uterus?
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A gush of blood and/or lengthening of the umbilical cord.
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______ mechanisms occurs when the placenta separates from the inside to the outer margins with the shiny, fetal side of the placenta presenting first.
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Schultz; this is the most common method
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What is the Duncan mechanism of placenta separation?
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When the placenta separates from the outer margins inward, rolls up, and presents sideways. The presenting part of the placenta is rough, not shiny.
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How should the mother be positioned when the baby is placed on her abdomen to facilitate drainage of mucus from the newborn's nasopharynx and trachea?
a) supine b) prone c) trendelenburg d) modified trendelenburg |
d) modified trendelenburg
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What does the nurse do with the placenta after it is delivered?
a) put it in the trash b) put it in a biohazzard disposal container c) send it to pathology d) picks it up and looks at it |
d) Picks it up and looks at it: the nurse needs to make sure all parts of it are fully present, otherwise retained placental parts could cause massive hemorrhaging in the mom.
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The priority assessment of the newborn is the:
a) heart rate b) cry c) respiratory effort d) muscular tone |
a) heart rate (p 393)
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What best indicates the newborn's respiratory effort?
a) grunting b) color c) respiratory rate d) cry |
d) cry; a weak or absent cry is a signal for intervention
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What compromises the fourth stage of labor?
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From the time of the delivery of the placenta through the first 1-2 hours after birth.
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_____ saturated pad(s) within the first hour is considered the normal maximum flow after giving birth.
a) 1/4 b) 1/2 c) 1 d) 2 |
c) 1
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True of False: A steady trickle of blood or blood pooling from the mother's buttocks can be a sign of trauma to the perineum or birth canal.
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True
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What type of pain is described as a slow, deep, poorly localized pain that occurs over the lower abdomen?
a) referred pain b) visceral pain c) somatic pain d) local pain |
b) visceral pain
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What type of pain is described as a faster, well localized intense, sharp, burning, prickling, occurring during the second stage of labor?
a) referred pain b) visceral pain c) somatic pain d) local pain |
c) somatic pain
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Which of the following pregnant women in labor is most likely to respond to painful uterine contractions with crying, loud screams and hysteria?
a) Haitian b) American c) Cambodian d) Vietnamese |
a) Haitian
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Which of the following pregnant women in labor is most likely to respond to painful uterine contractions by being quiet and sedate during labor and birth, and usually attended by a female relative rather than the male partner?
a) Haitian b) American c) Cambodian d) Vietnamese |
c) Cambodian
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What is the gate-control theory of pain?
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Only a certain number of "messages" can be transmitted to the brain at a time; So if you are experiencing pain, if you cause additional messages to flood the brain through massage, music, breathing patterns, imagery or focal points.
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Which of the following positions would help to open the pelvic outlet during labor to facilitate the fetus' downward movement?
a) left-side lying b) right-side lying c) bent-over d) squatting |
d) squatting
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Which of the following positions decreases the patient's back pressure and helps the fetus to rotate into an anterior position?
a) hands and knees b) right-side lying c) bent-over d) squatting |
a) hands and knees
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What should the coach do while the woman sits on the birthing ball to help decrease lower back pain?
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Apply counterpressure and warm compression.
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What is a cleansing breath?
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A long slow deep breath that is taken in through the nose and out through the mouth at the beginning of every contraction.
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What is slow-paced breathing?
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After taking a cleansing breath the woman begins to slowly breathe in and out through her mouth while her coach slowly counts up to four for the inhale and up to four for the exhale.
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What is the expected respiratory rate of a woman practicing slow-paced breathing?
a) 6-8 b) 8-10 c) 10-12 d) 12-20 |
a) 6-8
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What is modified-paced breathing?
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When the woman breaths shallower and approximately twice her normal rate by inhaling slowly but exhaling at a faster pace. She would take a cleansing breath, then breath in to a count of one, two, three, four and breathe out to a count of one, two three. All contractions start and end with a cleansing breath.
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What type of attention focusing strategy utilizes the body's energy field, the "prana"?
a) effleurage b) counterpressure c) therapeutic touch d) healing touch |
c) therapeutic touch
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Which of the following most accurately represents the goal of therapeutic touch?
a) relax the patient through massage b) redirect the energy fields c) help the patient into a hypnotic state d) assess the gate-control theory of pain suppression |
b) redirect the energy fields thought to be associated with pain
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What relieves pain by the delivery of an electric current through electrodes that are applied to the skin over the painful region of a peripheral nerve?
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TENS
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What is intradermal water block?
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Four injections of sterile water into the lower back to relieve back pain.(Keep in mind these are holistic methods)
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What is the most commonly used barbiturate in labor?
a) secobarbital b) flumazenil c) romazicon d) promethazine |
a) secobarbital
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What are side effects on the fetus of administration of secobarbital during labor?
a) tachycardia b) high blood pressure c) respiratory and vasomotor depression d) hyperactive vasomotor responses |
c) respiratory and vasomotor depression
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What type of medications are promethazine (Phenergan), hydroxyzine (Vistaril) and diphendydramine (Benadryl)?
a) histamine agonists b) H1-receptor antagonists c) barbiturates d) sedatives |
b) H1-receptor antagonists
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Which of the following are side effects of phenothiazines on the fetus? CATA
a) heart rate variability b) jaundice c) steven Johnson syndrome d) hypobilirubinemia |
a) heart rate variability
b) jaundice |
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What stage of labor are the following drugs indicated for?
Opioid agonists(Diladid, Demerol, Sublimaze, Sufental) Opioid agonists-antagonists (Stadol, Nubain) and nerve block analgesia such as an epidural or combined spinal-epidural? a) Stage I b) Stage II c) Stage III d) Stage IV |
a) Stage I
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What stage of labor are the following Nerve block analgesia and anesthesia indicated for? Local infiltration, Pudendal block, spinal block, epidural block and combined spinal-epidural block?
a) Stage I b) Stage II c) Stage III d) Stage IV |
b) Stage II
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What medications should be made readily available if your laboring mom has regional anesthesia?
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epinephrine and antihistamines in case of a serious reaction consisting of respiratory depression or hypotension
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What may be added to local perineal infiltration anesthesia given to numb the perineal area during suturing of lacerations or episiotomy to intensify the anesthesia effect, minimize bleeding and prevent systemic absorption?
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epinephrine- it causes vasoconstriction
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True or False: Local perineal infiltration may be used immediately prior to delivery for local anesthesia.
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False: It is a minor numbing agent that is used immediately before birth for episiotomy or after birth for repair of lacerations.
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True or False: Some women have enough natural anesthesia for an episiotomy to be performed without feeling the surgical cut due to the numbing effect caused by pressure of the fetal head against the woman's stretched perineum.
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True!
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Into what area(vertebral area, and spinal cord area) is the spinal anesthesia block injected?
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fourth or fifth lumbar interspace in the subarachnoid space
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What facilitates the migration of anesthetic solution toward the sacral area following administration of spinal anesthesia for a vaginal delivery?
a) injection of 100 mL of saline b) assisting the mother to ambulate a short distance c) injecting enough anesthesia to overcome the hydrostatic pressure of the spinal fluid d) have the mother remain in a sitting position for 1-2 minutes |
d) have the mother remain in a sitting position for 1-2 minutes: This allows gravity to help the fluid migrate down to the sacral area
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True of False: When a patient is anesthetized for a c-section, they are numbed from their nipples to their feet.
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True!
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True or False: A mother received spinal anesthesia. She now needs to be told when to bear down during the vaginal birth since uterine contraction sensation is lost.
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True!
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How is the patient positioned in order to receive a spinal anesthesia block?
a) supine b) lateral/sitting c) semi-fowlers d) prone |
b) lateral/sitting
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Why is lactated Ringer's solution (500-1000 mL) administered prior to receiving an epidural?
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To prevent hypotension resulting from anesthesia administration. It is usually given before the injection to ensure maternal hydration and to confirm the patency of IV tubing(in case rapid infusion of fluids is needed for post-administration hypotension).
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How long after receiving a spinal anesthesia can the patient get a spinal headache?
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Up to 48 hours
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What is an epidural blood patch?
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When 10-20 mL of the patient's blood is slowly injected into the lumbar epidural space so that a clot will form in the tear or hole in the dural mater around the spinal cord, effectively sealing the area from further CSF leakage.
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Which of the following is a side effect of an epidural block?
a) shivering b) loss of consciousness c) mental confusion d) hyperactivity |
a) shivering
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What is a common side effect of opioid use after giving birth?
a) confusion b) hypertension c) hypotension d) itching |
d) itching: Benadryl can be given to treat it
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Which of the following is the best reason why is a side-lying position is maintained after receiving an epidural?
a) to prevent blood pressure changes b) to prevent compression of the vena cava c) to prevent systemic absorption of the anesthetic agent d) to prevent CNS depression |
b) to prevent compression of the vena cava
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How long does it take for an epidural to take effect?
a) 1-2 minutes b) 10-15 minutes c) 20-30 minutes d) it is instantaneous |
c) 20-30 minutes
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How long does it take for a combined spinal-epidural analgesia to kick in?
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Pain relief is immediate
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Does an epidural or combined spinal-epidural have a greater risk infection and postdural puncture headache? Why?
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A combined spinal-epidural since this method is associated with puncture of the dura and placement of a catheter in the epidural space.
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True or False, with an epidural or intrathecal opioid without local anesthetics there is no maternal hypotension or alternation in vital signs.
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True! The patient is aware of contractions but does not feel pain! Wooho!
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What is a priority assessment for a patient with an epidural and opioids on board?
a) blood pressure b) pulse c) respirations d) placental perfusion |
c) respirations: The nurse should monitor and record the patient's respiratory rate every hour for 24 hours after administration of epidural or intrathecal opioids
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Narcan should be administered if the maternal respiratory rate drops below __ breaths per minute or if the maternal oxygen saturation rate decreases to less than ___%.
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10 respirations,
89% |
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If a patient is suffering from respiratory depression from anesthesia what is the first thing you should do?
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Apply a face mask with oxygen while the anesthesiologist is being notified.
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What are some complications of administration of general anesthesia for a complicated c-section?
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hypoxia, inhalation of vomit, respiratory track infection from vomit, and fetal depression
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Which of the following medications are given in order to facilitate passage of the endotracheal tube via muscle relaxation?
a) succinyl choline (Anectine) b) Thiopental sodium (Pentothal) c) metoclopramide(Reglan) d) cimetidine (Hydrochloride) |
a) succinyl choline (Anectine)
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Why would the nurse apply cricoid pressure when preparing to intubate?
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To compress the esophagus to prevent gastric reflux and aspiration before the woman fully loses consciousness.
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What is administered following intubation for the woman undergoing general anesthesia in order to produce rapid uterine relaxation to facilitate intrauterine manipulation and extraction?
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50:50 mixture of oxygen and nitrous oxide
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A client calls the physician's office to schedule an appointment because a home pregnancy test was performed and the results are positive. the nurse determines that the home pregnancy test identified the presence of which in the urine:
a) estrogen b) progesterone c) FSH d) hCG |
d) hCG
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A nurse is caring for a client with gestational hypertension who is in labor. The nurse monitors the client closely for which complication of GH?
a) seizures b) placenta previa c) hallucinations d) altered respiratory status |
a) seizures
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A nurse is reviewing the antenatal history of a client in early labor. The nurse recognizes which of the following factors documented in the history as having the greatest potential for causing neonatal sepsis following delivery?
a) adequate prenatal care b) history of substance abuse during pregnancy c) appropriate maternal nutrition d) spontaneous rupture of membranes |
b) history of substance abuse during pregnancy
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How is the patient positioned for a cesarean delivery?
a) prone b) semi-Fowler's c) trendelenburg d) supine with wedge under right hip |
d) supine with wedge under right hip
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A client in the late, active, first stage of labor has just reported a gush of vaginal fluid. The nurse observes a fetal monitor pattern of variable decelerations during contractions followed by a brief acceleration. After that, there is a return to baseline until the next contraction, when the pattern is repeated. On the basis of this data, the nurse prepares to initially:
a) take the client's vitals b) perform leopold's maneuver c) perform a manual vaginal exam d) test the vaginal fluid with a nitrazine strip |
c) perform a manual vaginal exam as variable decelerations with brief acceleration after a gust of amniotic fluid is a common clinical manifestation of cord compression caused by occult or frank prolapse of the umbilical cord. A manual vaginal exam can detect the presence of the cord in the vagina, which confirms the problem.
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A nurse is assisting with caring for a woman in labor who is receiving IV Pitocin. The nurse monitors the client, knowing that which of the following indicates an adequate contraction pattern?
a) one contraction per minute b) four contractions every 5 minutes c) one contraction every 10 minutes d) three to five contractions every 10 minutes |
d) 3-5 contractions every 10 minutes
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A nurse is monitoring a pregnant woman in labor and notes the presence of variable decelerations on the fetal monitor tracing. Which of the following would the nurse suspect based on this observation?
a) pressure on the fetal head b) umbilical cord compression c) uteroplacental insufficiency d) pacemaker activity of the fetal heart is adequate |
b) umbilical cord compression
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A nurse is monitoring a pregnant woman in labor an notes the presence of accelerations on the fetal monitor tracing. Which action will the nurse take as a result of this observation?
a) document the finding b) take the mother's vital signs c) notify the physician d) reposition the mother |
a) document the finding: Accelerations are transient increases in the fetal heart rate normally caused by fetal movement that often accompany contractions. Accelerations are though to be a sign of fetal well-being and adequate oxygen reserve.
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A nurse is caring for a client in labor. Immediately after delivering a normal healthy infant, the woman suddenly begins to complain of pain, and the nurse notes that the client is bleeding heavily from the vagina. The nurse suspects uterine inversion and takes which immediate action?
a) prepares to administer a tocolytic b) manually replaces the uterus back into the proper location c) pulls strongly on the umbilical cord d) performs fundal massage |
a) prepares to administer a tocolytic: Uterine inversion is a medical emergency requiring immediate recognition, replacement of the uterus into the pelvic cavity, and corrections of associated clinical conditions. Tocolytics or halogenated anesthetics may be given to relax the uterus before attempting replacement.
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A nurse is caring for a term small for gestational age infant immediately after delivery. The nurse's initial care plan in the delivery room to prevent heat loss would include:
a) placing the infant in a pre warmed transport unit b) drying the infant with a warm blanket c) submerging the infant's body in a warm water bath d) allowing the mother to hold the infant immediately after delivery |
b) drying the infant with a warm blanket
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A nurse notes that a client in labor is changing body positions, bearing down, and making expiratory vocalizations. From this info, the nurse knows that the client is likely in what stage of labor?
a) first stage, transition phase b) second stage, descent phase c) second stage, latent phase d) third stage, transition phase |
b) second stage, descent phase
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A nurse performs a vaginal assessment of a pregnant client in labor. On assessment the nurse notes the presence of the umbilical cord protruding from the vagina. The nurse immediately:
a) places a gloved hand in the vagina and hold the presenting part off the umbilical cord b) transports the client to the delivery room c) gently pushes the cord into the vagina d) calls the doctor e) summons help from other staff members |
a) places a gloved hand into the vagina and holds the presenting part off the umbilical cord:When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The mother is also positioned with hips higher than the head to shift the fetal presenting part toward the diaphragm.
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A nurse is caring for a client in labor. The nurse notes the presence of fetal bradycardia on the fetal monitor and suspects that the umbilical cord is compressed. The nurse immediately places the client in what position?
a) high Fowler's b) upright c) with hips elevated d) semi-Fowler's e) standing |
c) with the hips elevated
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A client is brought to the labor unit, and as the nurse is attaching the fetal heart monitor, the client's membranes rupture spontaneously. The nurse immediately:
a) monitors the contraction pattern b) assesses the fetal heart rate c) notes the amount, color, and odor of the amniotic fluid d) prepares the client for immediate delivery |
b) assess the fetal heart rate: When the membranes rupture in the birth setting, the nurse immediately checks the fetal heart rate to detect changes associated with prolapse or compression of the umbilical cord.
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During the intrapartal and immediate postpartum period, which procedure places the newborn infant of an HIV infected mother at risk for exposure to the virus?
a) avoiding the use of forceps b) immediately bathing the newborn c) administering the Vitamin K shot before the bath d) discouraging breast-feeding |
b) immediately administering the Vitamin K shot before the bath, as the infant is covered with blood, mucus and fluid and this could get into the injection site and transmit the HIV infection.
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A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus is at -1 station. The nurse determines that he fetal presenting part is:
a) 1 inch below the iliac crest b) one finger below the symphysis pubis c) 1 inch below the coccyx d) 1 cm above the ischial spines |
1 cm above the ischial spines
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A delivery room nurse performs an assessment on a mother who has just delivered a healthy newborn infant. The nurse assess the uterine fundus, expecting to note that it is positioned:
a) at the level of the umbilicus b) To the left of the abdomen c) Two finger breadths above the symphysis pubis d) To the right of the abdomen |
a) at the level of the umbilicus
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A client was admitted to the maternity unit 12 hours ago and has been experiencing strong contractions every 3 minutes. The client has remained at station 0. The fetal heart rate on admission was 140 beats per minute and regular. The fetal heart rate is decreasing, and a persistent non reassuring fetal heart rate pattern is present. The nurse immediately plans to:
a) prepare to induce labor b) turn the client to the left side c) prepare the client for a cesarean delivery d) continue to monitor the fetal heart rate pattern |
c) prepare the client for a cesarean delivery: Dystocia, failure to progress, and a persistent non reassuring fetal heart rate pattern are indications of the need to perform a cesarean delivery.
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Immediately after the delivery of a newborn infant, the nurse prepares to assist in the delivery of the placenta. The appropriate method to delivery the placenta is to:
a) wait 15 minutes and then pull the cord b) wait for placental separation and then pull gently on the cord while the mother bears down c) never pull on the cord d) press moderately on the uterus/abdomen to facilitate separation |
b) wait for placental separation and then pull gently on the cord while the mother bears down
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Which of the following would be noted if complete uterine rupture has occurred?
a) excessive vaginal bleeding b) maternal bradycardia c) decreasing blood pressure d) increased uterine contractions |
c) decreasing blood pressure: Massive blood is lost, but may not be noted in the vagina since most of the blood is lost into the peritoneal cavity.
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When the fetal occiput is directed toward the maternal back and to the right of the birth passage, the nurse would chart:
a) ROP b) LOP c) ROA d) LOA |
a) ROP
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Which of the following describes the expected pattern of contractions during early labor?
a) every 10-20 minutes b) every 5-7 minutes, lasting 30 seconds c) every 2-3 minutes, lasting 60 seconds d) every 20-30 minutes |
b) every 5-7 minutes, lasting 30 seconds
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During a vaginal examination, the nurse determines that the fetus is at +1 LOP. Which of the following symptoms would the nurse expect to see?
a) fetal heart decelerations b) maternal back pain c) marked fetal movement d) bulging of the maternal perineum |
b) maternal back pain
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What does decreasing variability indicate?
a) fetal distress b) labor is about to being c) the woman is ready to push d) the epidural needs to be slowed |
a) fetal distress
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A nurse is preparing to monitor a client who is to receive an amnioinfusion. Which of the following actions is critical for the nurse to make at this time?
a) Attach the client to an electronic blood pressure cuff b) Insert an internal contraction tacometer c) Attach the client to an oxygen saturation monitor d) perform an amniotic fluid nitrazine test |
b) Insert an internal contraction tocometer: There is a possibility of uterine rupture during an amnioinfusion. An internal pressure transducer, therefore, must be inserted to monitor the client's intrauterine pressures.
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The physician has ordered intravenous oxytocin(Pitocin) for induction for four gravidas. In which of the following situations should the nurse refuse to comply with the order?
a) primigravida with complete placenta previa b) Multigravida with extrinsic asthma c) Primigravida who is 38 years old d) Multigravida who is colonized with group B streptococci |
a) Primigravida with complete placenta previa: This client will have to be delivered via cesarean section.
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A nurse in a maternity unit is reviewing the records of the clients on the unit. Which client would the nurse identify as being at the greatest risk for developing DIC?
a) a primigravida with mild preeclampsia b) a primigravida who delivered a 10 lb baby 3 hours ago c) a gravida II who has just been diagnosed with dead fetus syndrome d) a gravida IV who delivered 8 hours ago and has lost 500 mL of blood |
c) a gravida II who has just been diagnosed with dead baby syndrome: This is a known risk for DIC, as well as severe preeclampsia, massive hemorrhaging
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Lightening involves the descent of the fetal head into the true pelvis ___ days before labor, resulting in more pressure on the bladder and urinary frequency.
a) 2 b) 7 c) 10 d) 14 |
d) 14 days
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When does the rupture of membranes most commonly occur?
a) latent phase of the first stage of labor b) active phase of the first stage of labor c) transition phase of the first stage of labor d) active phase of the second stage of labor |
c) transition phase of the first stage of labor
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Engagement occurs when the presenting part, usually the largest diameter of the fetal head passes the pelvic inlet at the level of the ischial spines. This is referred to station __.
a) -5 b) -1 c) 0 d) 1 e) 5 |
c) 0
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Engagement ranges from ___ to ___.
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-5 to 5
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How long does the first stage of labor last for with the primigravida? How about the Multigravida?
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8-10 hours after reaching the active phase for the primigravida and 2-10 hours after reaching the active phase for the multigravida
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How long does the second stage of labor last for, for the primigravida? How about the multigravida?
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Primigravida: 30 min-3 hrs
Multigravida: 5-30 minutes |
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Ataractics such as phenothizaine medications like promethazine or hydroxyzine are indicated for:
a) nausea and anxiety b) pain and cramping c) dizziness and lightheadedness d) prostaglandin suppression |
a) nausea and anxiety
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What are the adverse effects of ataractics?
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dry mouth and sedation
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A disadvantage of external fetal monitoring is that is cannot measure contraction:
a) frequency b) duration c) intensity d) relaxation |
c) intensity
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What is a normal fetal heart rate?
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110-160
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How long should normal beat to beat variability last for in terms of number of beats and duration?
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They should last for 15 beats and 15 seconds
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Which of the following is the best rationale for utilizing internal fetal heart rate monitoring?
a) internal monitoring can be used through the entire birth process b) external monitoring is more subject to extraneous artifacts c) internal monitoring is more accurate than external monitoring d) external monitoring increases risk of maternal and fetal infection |
c) internal monitoring is more accurate than external monitoring
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A nurse places an external fetal monitor on a client who is in labor. Which of the following instructions is most appropriate for the nurse to give the client?
a) "Lie supine so the tracing shows up the best on the paper" b) "Keep your legs flat so your abdomen is not tense" c) "Lie on your side if that makes you feel comfortable" d) "Avoid moving so there will not be any interferences on the monitor" |
c) "Lie on your side if that makes you feed comfortable" Help with placental perfusion.
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How often should vitals be taken during the latent phase?
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every 30-60 minutes
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How often should vitals be taken during the active phase of labor?
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every 30 minutes
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How often should vitals be taken during the transition phase of labor?
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every 15-30 minutes
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How often is temperature taken for the patient with unruptured membranes?
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every 4 hours
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How often is temperature taken for the patient with ruptured membranes?
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every 1-2 hours
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Which of the following is a sign of complete dilation and fetal descent?
a) urinary frequency b) urinary urgency c) fecal incontinence d) urge to have a bowel movement |
d) urge to have a bowel movement indicates birth is imminent
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After the delivery of the infant, the doctor clamps the cord and allows the partner to cut it. The infant is then placed on the client's abdomen. What should be the nurse's primary responsibility at this point?
a) assess the uterine fundus for tone b) assess for placental separation c) assess the client for signs of hemorrhage d) assess apgar scores at 1 and 5 minutes |
d) assess apgar at 1 and 5 minutes: The nurse's primary responsibility is to stabilize and assess the neonate. The nurse assesses the neonate for any signs of distress. As far as prioritizing: you cannot assume the baby was fine when it came out; assume it was not breathing and assess further
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What is amiotomy?
a) adding sterile saline to the amniotic sac b) inserting an internal pressure monitoring catheter c) breaking the amniotic sac d) removing a sample of amniotic fluid via needle aspiration |
c) breaking the amniotic sac
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Under what conditions is amnioinfusion indicated for?
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Postterm labor, cord compression, meconium-stained amniotic fluid...
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What do the following medication do? Cytotec, Cervidil, Prepidil and other prostaglandin gels.
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They cause the cervix to ripen
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What does the nurse need to confirm prior to administration of oxytocin?
a) fetal engagement at station 0 or below b) dual parental consent c) no administration of oxytocin during previous pregnancies d) uterine fundal height of at least 4 cm above the fundus |
a) fetal engagement at station 0 or below
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Under which of the following conditions should oxytocin be discontinued: CATA
a) contraction frequency more often than every 2 minutes b) contraction duration over 60 seconds c) no relaxation of the uterus between contractions d) contraction duration longer than 90 seconds |
a) contraction frequency more often than every 2 minutes
c) no relaxation of the uterus between contractions d) contraction duration longer than 90 seconds |
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What medication can be given to treat uterine hyperstimulation from oxytocin administration? CATA
a) methergine b) tocolytic c) Brethine d) terbutaline e) atropine |
b) tocolytic
c) Brethine d) terbutaline |
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Which of the following will be preformed in preparation for a Cesarean section?
a) insertion of a A-line b) insertion of a foley catheter c) maintenance of NPO for at least 2 hours d) prepare the woman by positioning her in a prone position |
b) insertion of a foley catheter
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A nurse is providing continuous monitoring throughout a client's amnioinfusion for complication of over distention of the uterus. For which of the following contractions patterns should the nurse observe?
a) hypotonic b) hypertonic c) irregular d) absent |
b) hypertonic
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Which of the following does the nurse need to determine via a pelvic examination prior to an amniotomy?
a) fetal engagement b) fetal lie c) fetal attitude d) fetal position |
a) fetal engagement
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Which of the following contraction patterns indicate that the nurse should discontinue the infusion of oxytocin?
a) frequency of every 2-3 min, duration of 60-90 sec b) frequency of every 2-3 min, duration of 90-120 sec c) frequency of every 1-2 min, duration of 15-30 sec d) frequency of every 1-2 min, duration of 45-60 sec |
b) frequency of every 2-3 minutes and duration of 90-120 seconds
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Which of the following in the multipara's history is a contraindication to VBAC(vaginal birth after c-section)?
a) a low transverse incision b) a horizontal incision c) a classical vertical incision d) a full thickness incision |
c) a classical vertical incision: This places the client at a high risk for uterine rupture.
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What happens to the progesterone, estrogen and oxytocin levels that signal labor to begin?
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progesterone drops,
estrogen increases oxytocin increases |
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What is the relationship between progesterone and prostaglandins?
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They are inversely related: As progesterone drops, prostaglandins increase, causing uterine contraction.
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Explain the fetal adrenal initiation of labor.
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The fetus initiates labor via their adrenal system by producing estriole in the placenta which causes the release of prostaglandins
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What is the term given to the area of the uterus that is most likely to rupture?
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The line of demarcation
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The latent phase of the first stage of labor involves cervical dilation of:
a) 0-3 cm b) 4-6 cm c) 7-8 cm d) 10 cm |
a) 0-3 cm
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The Active phase of Stage I of labor includes cervical dilation of __ to __ cm.
a) 0-3 b) 6-8 c) 4-10 d) 8-10 |
c) 4-10
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The nurse teaches the laboring mother that she must be __ cm(s) dilated in order to receive an epidural.
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at least 4
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The fetus is determined to be in the LOA position. Where would fetal tones be best heard?
a) LLQ b) LUQ c) RLQ d) RUQ |
a) LLQ
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A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate a need to contact the doctor?
a) hemoglobin of 11 b) fetal heart rate of 180 c) maternal pulse of 85 d) WBC of 12,000 |
b) fetal heart rate of 180: A normal fetal heart rate is 110 to 160 beats/min. A count of 180 beats/min could indicate fetal distress and would warrant physician notification. White blood cell counts in a normal pregnancy begin to rise in the second trimester and peak in the third trimester, with a normal range of 11,000 to 15,000/mm3, up to 18,000/mm3.
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A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a Doppler ultrasound device. The nurse accurately determines that the fetal heart sounds are heard by:
a) noting whether the heart rate is greater than 140 b) placing the diaphragm of the doppler on the mothers abdomen c) palpating the maternal radial pulse while listening to the fetal heart rate d) performing leopold's maneuver first to determine the location of the fetal heart rate |
c) palpating the maternal radial pulse while listening to the fetal heart rate: The nurse should simultaneously palpate the maternal radial or carotid pulse and auscultate the fetal heart rate (FHR) to differentiate the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the FHR.
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A nurse is reviewing the record of a client in the labor room and notes that the nurse-midwife has documented that the fetus is at -1 station. The nurse determines that the fetal presenting part is:
a) 1 inch below the coccyx b) 1 inch below the iliac crest c) 1 cm above the ischial spine d) 1 fingerbredth below the symphysis pubis |
c) 1 cm above the ischial spine
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A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of:
a) hematoma b) uterine atony c) placenta previa d) placental separation |
d) placental separation
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Umbilical cord compression is evidenced by:
a) late decelerations b) early decelerations c) short term variability d) variable decelerations |
d) variable decelerations
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Uteroplacental insufficiency is evidenced by:
a) late decelerations b) early decelerations c) short term variability d) variable decelerations |
a) late decelerations
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Fetal head compression is evidenced by:
a) late decelerations b) early decelerations c) short term variability d) variable decelerations |
b) early decelerations during a contraction
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A patient is on Pitocin and starts experiencing hypertonic uterine contractions. The nurse stops the infusion. What is her next step?
a) reposition the client b) perform a vaginal exam c) check the client's blood pressure d) administer oxygen by face mask at 8-10 L/min |
a) reposition the client
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A nurse is reviewing the physician's orders for a client admitted for premature rupture of the membranes. Which doctor order should the nurse question?
a) perform a vaginal examination every shift b) monitor maternal vital signs every 4 hours c) monitor fetal heart rate continuously d) administer ampicillin 1 gm IV piggyback every 6 hours |
a) perform a vaginal examination every shift:Vaginal examinations should not be done routinely on a client with premature rupture of the membranes because of the risk of infection. The nurse would expect to administer an antibiotic, monitor maternal vital signs, and monitor the FHR.
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The nurse notes a prolapsed cord during a vaginal assessment of a laboring woman. What is her initial action?
a) gently push the cord into the vagina b) place the client in trendelenburg's position c) find the closest telephone and page the doctor d) call the delivery room to notify the staff that there will be a c-section |
b) place the client in trendelenburg's position: When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The client should be positioned with the hips higher than the head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff members should call the physician and notify the delivery room. If the cord is protruding from the vagina, no attempt should be made to replace it because to do so could traumatize it and further reduce blood flow. The examiner, however, may place a gloved hand into the vagina and hold the presenting part off the umbilical cord. Oxygen at 8 to 10 L/min by face mask is administered to the client to increase fetal oxygenation.
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A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred?
a) forceps delivery b) schultz presentation c) hypotonic contractions d) weak bearing-down efforts |
a) forceps delivery: Excessive fundal pressure, forceps delivery, violent bearing-down efforts, tumultuous labor, and shoulder dystocia can place a client at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing-down efforts do not add to the risk of rupture because they do not add to the stress on the uterine wall. Schultz presentation is the expulsion of the placenta with the fetal side presenting first and is not associated with uterine rupture.
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A nurse is caring for a client who is experiencing a precipitous birth. The nurse is waiting for the physician to arrive. When the infant's head crowns, the nurse would instruct the client to:
a) bear down b) hold her breath c) breathe rapidly(pant) d) push with each contraction |
c) breathe rapidly(pant): During a precipitous birth, when the infant's head crowns, the nurse instructs the client to breathe rapidly to decrease the urge to push. The client is not instructed to push or bear down. Holding the breath decreases the amount of oxygen to the mother and to the fetus.
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What is a therapeutic serum magnesium level for a laboring patient on magnesium sulfate for the management of preeclampsia?
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4-7.7
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Butorphanol tartrate (Stadol) is prescribed for a woman in labor, and the woman asks the nurse about the purpose of the medication. The appropriate nursing response is which of the following statements?
a) the medication will assist in increasing the contractions b) the medication provides pain relief during labor c) the medication prevents respiratory depression in the newborn infant d) the medication will help prevent any nausea and vomiting |
b) the medication provides pain relief during labor: Butorphanol tartrate is an opioid analgesic that provides systemic pain relief during labor. It does not relieve nausea, increase uterine contractions, or prevent respiratory depression in the newborn infant.
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A pregnant client comes in with vaginal bleeding. The labor nurse suspects a diagnosis of placenta previa if which of the following is noted:
a) painful vaginal bleeding b) abdominal pain c) back pain d) painless vaginal bleeding |
d) painless vaginal bleeding:The classic sign of placenta previa is the sudden onset of painless uterine bleeding. Options 1, 2, and 3 identify signs and symptoms of abruptio placentae.
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A delivery room nurse is caring for a client in labor. The client tells the nurse that she feels that something is coming through the vagina. The nurse performs an assessment and notes the presence of the umbilical cord protruding from the vagina. The nurse immediately places the client in what position?
a) prone b) supine c) reverse trendelenburg d) on the side |
d) on the side: If cord prolapse or compression is suspected, the client is immediately repositioned. Cord compression needs to be relieved so that adequate fetal oxygenation occurs. The client may be turned to the side or the hips can be elevated to shift the fetal presenting part toward her diaphragm, thereby relieving cord compression. A hands-and-knees position may reduce compression on a cord that is entrapped behind the fetus.
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What is the antidote for magnesium sulfate?
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calcium gluconate:Toxic effects of magnesium sulfate may cause loss of deep tendon reflexes, heart block, respiratory paralysis, and cardiac arrest.
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A nurse is administering magnesium sulfate to a client for severe preeclampsia. During administration of the medication, the nurse:
a) assesses for signs and symptoms of labor because the patient will have a decreased level of consciousness b) assesses the client's temp every 2 hours since they will be at a high risk for infection c) schedules a nonstress test every 4 hours to assess fetal well-being d) schedules a daily ultrasound to assess fetal movement |
a) assesses for signs and symptoms of labor because the woman have a decrease in level of consciousness
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A nurse is preparing to administer an analgesic to a client in labor. Which analgesic is contraindicated for a client who has a history of opioid dependency?
a) morphine sulfate b) fentanyl (sublimaze) c) butorphanol tartrate (stadol) d) peperidine hydrochloride (Demerol) |
c) butorphanol tartrate (stadol):Butorphanol tartrate (Stadol) is an opioid analgesic that can precipitate withdrawal symptoms in an opioid-dependent client. It is contraindicated if the client has a history of opioid dependency. Meperidine (Demerol), morphine sulfate, and fentanyl (Sublimaze) are opioid analgesics but do not tend to precipitate withdrawal symptoms in opioid-dependent clients.
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A nurse in a delivery room is assessing a client immediately after delivery of the placenta. Which observation could indicate uterine inversion and require immediate intervention?
a) chest pain b) a rigid abdomen c) a soft and boggy uterus d) maternal complaints of severe pain |
d) maternal complaints of severe pain: Signs of uterine inversion include a depression in the fundal area, visualization of the interior of the uterus through the cervix or vagina, severe pain, hemorrhage, and shock. Chest pain and a rigid abdomen are signs of a ruptured uterus. A soft and boggy uterus would indicate that the muscle is not contracting.
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A pregnant client with anemia is at higher risk for:
a) anxiety b) hemorrhage c) low self-esteem d) postpartum infection |
d) postpartum infection: Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Anemia does not specifically present a risk for hemorrhage. Anxiety and low self-esteem are unrelated to physiological integrity
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A nurse is admitting a client who is at 38 weeks of gestation and states her uterine contractions are every 4 minutes. The nurse notes variable decelerations and a fetal heart rate of 100 to 105/min. Which of the following interventions is highest priority?
a) administer oxygen via face mask at 8 L/min b) reposition the client on her side c) perform a vaginal examination d) initiate IV fluids for the client |
b) reposition the client on her side: Remember that O2 is only useful if it is able to get to the fetus, so repositioning first would allow better perfusion then O2 can follow if needed still
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A client presents to a clinic to confirm a pregnancy. The nurse should explain to the client that human chorionic gonadotropin (hCG) can be detected in the blood as early as
a) 24 hr after conception b) 2 to 5 days after conception c) 6-11 days after conception d) 12-14 days after conception |
c) 6-11 days after conception
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A nurse in the birthing unit is caring for a client following an amniotomy. Which of the following is the highest priority nursing assessment?
a) O2 saturation b) temperature c) blood pressure d) I&O |
b) temperature: Since they are at an increased risk of infection from ruptured membranes
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A client diagnosed with somatoform pain disorder states, "I want to thank the staff for being so understanding when I am in pain." This is an example of a ____ gain.
a) primary b) secondary c) tertiary d) essential |
b) secondary
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Which would the nurse expect to assess in a client with long-term maladaption to stressful events?
a) diarrhea b) pulse 100, blood pressure 150/90 c) profuse diaphoresis d) ulcerative colitis |
d) ulcerative colitis: All the other options are short term side effects to stress
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A client diagnosed with somatization disorder visits multiple physicians because of various, vague symptoms involving many body systems. Which nursing diagnoses takes priority?
a) Risk for injury R/T treatment from multiple physicians b) Anxiety R/T unexplained multiple somatic symptoms c) Ineffective coping R/T psychosocial distress d) Fear R/T multiple physiological complaints |
a) Risk for injury R/T treatment from multiple physicians: This is condusive to multiple medications being prescribed and possible drug interactions
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A client diagnosed with a conversion disorder has a nursing diagnosis of disturbed sensory perception R/T anxiety AEB paralysis. Which short term outcome would be appropriate for this client? The client will:
a) demonstrate recovery of lost function by discharge b) use one effective coping mechanisms to decrease anxiety by day 3 c) express feelings of fear about paralysis by day 1 d) acknowledge underlying anxiety by day 4 |
a) demonstrate recovery of lost function by discharge: This is directly related to the diagnoses of disturbed sensory perception; all others are related to other nursing diagnosis( b:ineffective coping, c:fear d: anxiety)
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A newly admitted client is diagnosed with hypochondriasis. Which short term outcome is appropriate? The client will:
a) rate anxiety as 3/10 by discharge b) recognize a link between anxiety and somatic symptoms by day 2 c) participate in group therapy activities by discharge d) recognize behaviors that generate secondary gains by day 2 |
a) the client will rate anxiety as 3/10 by discharge: Anxiety is this person's main problem. They fear having a major illness. The other options are either unrelated, or do not have realistic time lines.
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During group therapy, a client diagnosed with somatization pain disorder monopolizes the group by discussing the client's back pain. Which nursing statement is an appropriate response?
a) I can tell this is bothering you. Lets briefly discuss this further after group b) Lets see if anyone in the group has ideas on how to deal with pain c) We need to get back to the topic of dealing with anxiety d) Lets check in an d see how others in the group are feeling |
a) I can tell this is bothering you...You have to acknowledge the person's pain, but also focus on other people in the group.
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A client who complains of vague weakness and multisystem symptoms has been diagnoses with a somatoform disorder. Which nursing intervention takes priority?
a) discuss the client's symptoms to provide secondary gains b) discuss the stressor that the client is experiencing c) monitor signs and symptoms, vitals, and lab tests d) teach the client appropriate coping mechanisms to deal with stress |
c) monitor signs and symptoms, vital and labs to make sure this really is a somatoform disorder, and not another medical condition.
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A client has a nursing diagnosis of knowledge deficit R/T relationship of anxiety to hypertension. Which intervention address this client's problem?
a) assess the client for homicidal ideations b) encourage the client to verbalize feelings about anxiety c) role play situations in which anxiety is experienced d) teach the client about the mind body connection |
d) teach the client about the mind body connection: This relates directly to the diagnoses.
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A client has been diagnosed with an exacerbation of tension headaches. Which behavioral intervention would assist the client during active symptoms?
a) help the client to decrease stress by teaching assertiveness skills b) help the client to acknowledge and address the source of anger c) administer medications, such as Inderal d) discuss how personality type may affect exacerbations of tension headaches |
a) help the client to decrease stress by teaching assertiveness skills: This is the only BEHAVIORAL intervention listed
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In which situation is lorazepam (Ativan) used appropriately?
a) long-term treatment of client diagnosed with a conversion disorder caused by anxiety b) long term treatment of clients diagnosed with hypochondriasis c) short term treatment of clients diagnosed with hypertension caused by atherosclerosis d) short term treatment of client diagnosed with body dysmorphic disorder |
d) short term treatment of clients diagnosed with body dysmorphic disorder: Ativan is a benzo used for SHORT TERM treatment of anxiety disorders and alcohol withdrawl
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In which situation is BuSpar used appropriately?
a) long term treatment of client with hypochondriasis b) long term treatment of clients diagnosed with dementia c) short term treatment of clients diagnosed with a conversion disorder d) short term treatment of clients diagnosed with a somatization pain disorder |
a) long term treatment of clients diagnosed with hypochondriasis: BuSpar is an antianxiety medication used for long term treatment; It often takes 3-4 weeks to be effective.
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A client diagnosed with generalized anxiety disorder is placed on Klonapin and BuSpar. Which client statement indicates teaching has been effective? The client verbalizes that:
a) the Klonopin is to be used for long term therapy in conjunction with BuSpar b) BuSpar can cause sedation and should be taken at night c) Klonopin is to be used short term until the BuSpar takes full effect d) tolerance can result with long term use of BuSpar |
c) Klonopin is to be used short term until the buspirone takes full effect
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In which situation would benzodiazapines be prescribed appropriately?
a) long term treatment of PTSD, convulsive disorder, and alcohol withdrawl b) short term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation c) short term treatment of OCD, skeletal muscle spasms, and essential hypertension d) long term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode |
b) short term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation
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A client has been prescribed Klonopin, BuSpar and Celexa for generalized anxiety disorder. What assessment related to the concurrent use of these medications is most important? Monitor for:
a) S&S of worsening depression and suicidal ideation b) changes in mental status, diaphoresis, tachycardia, and tremor c) hyperpyresis, dystonia, and muscle rigidity d) spasms of face, legs, and neck and for bizarre facial movements |
b) Monitor for changes in mental status, diaphoresis, tachycardia, and tremor as the patient is at risk for serotonin syndrome with all these meds being taken together
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Which of the following are examples of anticholinergic side effects from tricyclic antidepressants. CATA
a) urinary hesitancy b) constipation c) blurred vision d) weight gain |
a) urinary hesitancy
b) constipation c) blurred vision As by the words of Liz, anticholinergic effects mean you can Pee, See, Spit, ****! |
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A client has been taking Wellbutrin for more than 1 year. The client has been in a car accident with loss of consciousness and is brought to the ER. For which reason would the nurse question the continued use of this medications? The client:
a) may have a possible injury to the GI system b) is at risk for seizures from a potential closed head injury c) is at an increased risk of bleeding while taking bupropion d) may experience sedation from Wellbutrin, making assessment difficult |
b) the client is at risk for seizures from a potential closed head injury and Wellbutrin specifically can lower seizure threshold, so it should be discontinued since the patient is already at a high risk for seizures with the head injury
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Which antidepressant has a side effect of lowering your seizure threshold?
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Wellbutrin
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Which of the following are symptoms of valium withdrawl?
a) anxiety b) tremors c) vomiting d) dry mouth |
a) anxiety
b) tremors c) vomiting |
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A patient has a paralytic conversion disorder related to the news that he is going to be deployed to Iraq. Which of the following is the priority nursing diagnosis?
a) Anxiety related to recent deployment b) Risk for skin breakdown related to paralytic conversion disorder c) Risk for social isolation related to recent iraq deployment d) Fear related to ineffective coping |
a) Anxiety related to recent deployment
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A patient with a conversion disorder is frequently asking you to get them items that are around the room. What is the best thing to do for them?
a) Tell them to call you whenever they need something so that they can remain safe b) Ask them which items they are going to need for the entire shift, and get them all at once c) Tell them they have to get up and get it themselves d) Move the call bell to just out of reach, and see if they are able to reach it when you leave the room |
b) Ask them which items they are going to need for the entire shift, and get them all at once
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A woman's labor is progressive very slowly and she says "This is taking forever, its never going to happen!". What is the best nursing action?
a) Tell her that dilation occurs faster once effacement has completed b) Say " It must be frustrating for this to be taking longer than you had intended" c) Notify the doctor to plan for a c-section d) Tell the woman that this happens to everyone |
b) Say "It must be frustrating for this to be taking longer than you had intended"
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