Labor And Delivery Questions

Front 1

A Primagravida at 35 weeks gestation is diagnosed with hydraminos. After birth, the nurse should assess the newborn for
1. Cardiac Defect
2. Kidney disorders
3. Diabetes mellitus
4. Esophageal atresia

Back 1

4. Rational Both esophageal atresia and anencephaly are associated with hydramnios

Front 2

A laboring client begins to experience contractions 2-3 minutes apart that last 45 seconds. Between contractions, the nurse records a fetal heart rate (FHR) of 100 Beats per min. The nurse should
1. Notify the MD immediatly
2. Continue to monitor FHR
3. monitor maternal VS
4. Chart HR as expected

Back 2

1. Rational: Bradycardia (bseline below 120 beats per min) indicates the fetus is stressed and requires medical intervention

Front 3

A Pregnant woman asks a nurse how will smoking affect her baby. The nurse's best response is:
1. The placenta is permable to some smoke
2. Smoking relieves tension and the fetus responds according
3. Vasoconstriction will affect both fetal and maternal blood vessels
4. Fetal and maternal circulation are seperated by the placental barrier.

Back 3

3. Rational: Cigarette smoking or continued exposure to secondary smoke cuses both maternal and fetal vasoconstriction, resulting in fetal growth retardation, and increased fetal and infant mortality

Front 4

Contraindications for an oxytocin challenge test would include:
1. Preeclampsia
2. Placenta Previa
3. Imminent preterm delivery
4. Uteroplacental insufficiency

Back 4

4. Rational: A positive contraction stress test indicates compromised fetal heart rate during contractions, which is associated with uteroplacental insufficiency

Front 5

A client who is 38 weeks' pregnant arrives at the hospital complaining of painless vaginal bleeding. She is documented as G2 T1 P0 A0 and L1. The most likely cause of the bleeding is
1. Placenta previa
2. Ruptured uterus
3. placental accreta
4 concealed abruptio

Back 5

1. Rational Placenta previa is classically painless bleeding; the placenta partially or completly covers the cervical os and, therefore, as the cervix diliates the placenta seperates and bleeds

Front 6

A client comes to the clinis for a sonography at 36 weeks gestation. Before the test begins, the client complains of severe abdominal pain. Heave vaginal bleeding is noted, and her HR increases while her BP drops. The nurse should suspect that the client has a:
1. Hydatidiform mole
2. Vena Caval syndrome
3. Marginal placenta previa
4. Complete abruptio placenta

Back 6

4. Rational Severe pain accompained by bleeding at term or close to it is symptomatic of complete premature detachment or the placenta. (abrupto placenta)

Front 7

The nurse realizes that the abdominal pain associated with abruptio placenta initially may be caused by:
1. Hemorrhage shock
2. Inflammatory reactions
3. Concealed hemorrhage
4. Blood in the uterine muscle

Back 7

3 rational: the blood cannot escape from behind the placenta, thus the abdomen becomes boardlike and painful because of the entrapment

Front 8

The nurse is aware tht the bleeding following severe abruptio placentae is usually caused by:
1. Polycythemia
2. Thrombocytopenia
3. Hyperglobulinemia
4. Hypofibrinogenemia

Back 8

4 rational: Clotting defects are common in moderate and severe abruptio placenta because of the loss of fibrogen from severe internal bleeding

Front 9

The care of a client whith placenta previa includes:
1 Vital signs once q chift
2. Tap water enma before delivery
3. Observation and recording the bleeding.
4, Limited ambluation until the bleeding stops

Back 9

3 rational: Observation and documtation of bleeding are independant nursing functions and necessary fro implementing safe care, becuse hemorrhage and shock can be life threating

Front 10

The nurse should explain to a client who is experiencing preterm contractions in the 35th week of gestation with her cervix 2cm dilated that sexual intercourse:
1. Does not need any restriction
2. Is prohibited because it might stimulate labor
3. Should be resticted to the side lying position
4. Is permitted as long as penile penetration is shallow

Back 10

2. Rational: Prostoglandins in semen may stimulate labor, and penile contact with the cervix may increase myometrial contractility

Front 11

A client who in the third trimester comes to the hospital with a complaint of vaginal bleeding. She states that she snorted cocaine 2 hours ago. Which complication is most likely causing the client's vaginal bleeding?
1. Placenta previa
2. Abruptio placenta
3. Ectopic pregnacy
4. Spontaneous abortion

Back 11

2 rational: abrupto placental is accociated with cocaine use and seen in the third trimester

Front 12

After delivery of twins, a client may be predisposed to experiencing a postpartum hemorrhage. Which of the following is most likely to cause hemorrhage in the client
1. Atony of the uterus
2. Secondary infection
3. Laceration of the cervix
4. Retained placental fragments

Back 12

1. ratioonal atony often results from an overdistended uterus; uterine contraction does not occur readily

Front 13

A client is 39 weeks' pregnant and in labor. Her physician has informed her that she will have to have a cesarean birth because she has
1. Gonorrhea
2. Chlamydia
3. Chronic hepatitis
4. Active genital herpes

Back 13

4 Rational: once the membranes have ruptured, the active herpes infection ascends and can infect the fetus; since herpes does not cross the placenta, a cesarean birth can decrease transfer or the virus to the fetus

Front 14

When assessing clients who have given birth, the nurse should be aware that postpartum hemorrhage rarely occurs as a complication of:
1. delivery of twins
2. Retained placenta
3. Overdistended bladder
4. Uncompromised gestational hypertension

Back 14

4. Rational: uncomplicated gestational hypertension with uterine involution, return of the uterine tone, or constriction of vessels at the placental site

Front 15

during the postpartum period it is not uncommon for a new mother to have increased cardiac output with tacycardia. Because of this, the nurse should carefully observe the postpartum client with known cardiac problems for signs of:
1. irregular pulses
2. hypovolemic shock
3. respiratory distress
4. increased vaginal bleeding

Back 15

3. Rational: as the heart fails; the respiratory rate and effort increases in an attempt to maintain oxygen to all body cells

Front 16

the nurse in the birthing suite has just admitted the following four clients. Which one of these clients should the nurse prepare for a cesarean birth?
1. Multipara with a shoulder presentation
2. Multipara with a documentated station of "floating"
3. Primigravida with a fetus presenting occiput posterior
4. Primigravida with twins gestation with lowermose twin in the vertex presentation

Back 16

1. Rational: Multipara with a shoulder presentation is indicative of a transverse lie; This indicates the need for a cesarean birth

Front 17

During the first hour after a cesarean birth the nurse notes that the client's locia has saturated one peripad. Based on the knowledge of expected lochial flow, the nurse concludes that this indicates:
1. Scant locial flow
2. Postpartum hemmorhage
3. Retained placental fragments
4. Locial flow within normal limits

Back 17

4. Rational: It is expected that up to two peripads can be saturated in the first hour

Front 18

When a client is admitted to the labor unit with a BP 130/90 2+ protienuria, and edema of the hands and face, the nurse should ask the client about the presence of:
1. constipation, edema, visual problems, headache
2. Visual disturbances, H/A constipation and bleeding
3. Leakage of fluid, bleeding, edema, pain in the ABD
4. H/A, visual disturbances, edema, pain in the ABD

Back 18

4 Rational: To ascertain the severity of the preeclampsia these are the signs that must be accessed

Front 19

The first assessable objective sign of a seziure in a client with eclampsia is frequently:
1. Epigastric pain, N/V
2. Presistent H/A and blurred vision
3. Spots or flashes of light before the eyes
4. Rolling of the eyes to one side with a fixed stare

Back 19

4. Rational This is a sign of CNS invlovement that the nurse can observe without obtaining subjective data from the client

Front 20

during an emergency delivery, the nurse notes the baby's head crowning on the perineum, the nurse's priority action to support the head by:
1. Applying suprapubic pressure over it
2. Distributing the fingers evenly accross it
3. Placing a hand frimly against the perineum.
4. Maintaining firm pressure against the anterior fontanel

Back 20

2. Rational: Distribution of the fingers around the head will prevent a rapid change in intracranial pressure while the head is being delivered

Front 21

a cardiac client goes into labor. To prevent the client from developing cardiac decomposition during labor the nurse should:
1. Admin IV of isotonic saline
2. Maintain IV infusion of isotonic saline
3. Admin oxytocin to accelerate contractions
3. Position her on her sides with shoulders elevated

Back 21

4. Rational: The side lying position, takes the weight off large blood vessels, and blood flow to the heart in increased; elevating the shoulders relieves pressure on the diaphram

Front 23

APA Reference:
Nugent, P. Pelican, P. Saxton, D. Mosby's Comprehensive Review of Nursing for the NCLEX-RN examination 8th edition. 2006

Back 23

Jeremy Sherwin wednesday october 7, 2009