OB EXAM QUESTIONS WITH ANSWERS GRADED A SUCCESS ASSURED 2023-2024, Exams of Nursing

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OB EXAM QUESTIONS WITH ANSWERS GRADED A

SUCCESS ASSURED 2023-

The nurse is preparing to teach a prenatal class about fetal circulation. Which statements should be included in the teaching plan? Select all that apply.

1. "The ductus arteriosus allows blood to bypass the fetal lungs."

2. "One vein carries oxygenated blood from the placenta to the fetus."

3. "The normal fetal heart tone range is 140 to 160 beats per minute in early

pregnancy."

4. "Two arteries carry deoxygenated blood and waste products away

from the fetus to the placenta."

5. "Two veins carry blood that is high in carbon dioxide and other

waste products away from the fetus to the placenta."

Rationale: The ductus arteriosus is a unique fetal circulation structure that allows the nonfunctioning lungs to receive only a minimal amount of oxygenated blood for tissue maintenance. Oxygenated blood is transported to the fetus by one umbilical vein. The normal fetal heart tone range is considered to be 110 to 160 beats per minute. Arteries carry deoxygenated blood and waste products from the fetus, and the umbilical vein carries oxygenated blood and provides oxygen and nutrients to the fetus. Blood pumped by the embryo's heart leaves the embryo through two umbilical arteries. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement by the student indicates an understanding of the ductus venosus?

1. "It connects the pulmonary artery to the aorta."

2. "It is an opening between the right and left atria."

3. "It connects the umbilical vein to the inferior vena cava."

4. "It connects the umbilical artery to the inferior vena cava."

Rationale: The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery. A pregnant client tells the clinic nurse that she wants to know the sex of her baby as soon as it can be determined. The nurse informs the client that she should be able to find out the sex at 12 weeks' gestation because of which factor?

1. The appearance of the fetal external genitalia

2. The beginning of differentiation in the fetal groin

3. The fetal testes are descended into the scrotal sac

4. The internal differences in males and females become apparent

Rationale: By the end of the twelfth week, the external genitalia of the fetus have developed to such a degree that the sex of the fetus can be determined visually. Differentiation of the external genitalia occurs at the end of the ninth week. Testes descend into the scrotal sac at the end of the thirty-eighth week. Internal differences in the male and female occur at the end of the seventh week. The nurse is performing an assessment on a client who is at 38 weeks' gestation and notes that the fetal heart rate (FHR) is 174 beats/minute. On the basis of this finding, what is the priority nursing action?

1. Document the finding.

2. Check the mother's heart rate.

3. Notify the health care provider (HCP).

4. Tell the client that the fetal heart rate is normal.

Rationale: The FHR depends on gestational age and ranges from 160 to 170 beats/minute in the first trimester, but slows with fetal growth to 110 to 160 beats/minute near or at term. At or near term, if the FHR is less than 110 beats/minute or more than 160 beats/minute with the uterus at rest, the fetus may be in distress. Because the FHR is increased from the reference range, the nurse should notify the HCP. Options 2 and 4 are inappropriate actions based on the information in the question. Although the nurse documents the findings, based on the information in the question, the HCP needs to be notified. The nurse is conducting a prenatal class on the female reproductive system. When a client in the class asks why the fertilized ovum stays in the fallopian tube for 3 days, what is the nurse's best response?

1. "It promotes the fertilized ovum's chances of survival."

2. "It promotes the fertilized ovum's exposure to estrogen and

progesterone."

3. "It promotes the fertilized ovum's normal implantation in the top portion

of the uterus."

4. "It promotes the fertilized ovum's exposure to luteinizing hormone and

follicle-stimulating hormone."

Rationale: The tubal isthmus remains contracted until 3 days after conception to allow the fertilized ovum to develop within the tube. This initial growth of the fertilized ovum promotes its normal implantation in the fundal portion of the uterine corpus. Estrogen is a hormone produced by the ovarian follicles, corpus luteum, adrenal cortex, and placenta during pregnancy. Progesterone is a hormone secreted by the corpus luteum of the ovary, adrenal glands, and placenta during pregnancy. Luteinizing hormone and follicle-stimulating hormone are excreted by

the anterior pituitary gland. The survival of the fertilized ovum does not depend on it staying in the fallopian tube for 3 days. The nursing instructor asks a nursing student to explain the characteristics of the amniotic fluid. The student responds correctly by explaining which as characteristics of amniotic fluid? Select all that apply.

1. Allows for fetal movement

2. Surrounds, cushions, and protects the fetus

3. Maintains the body temperature of the fetus

4. Can be used to measure fetal kidney function

5. Prevents large particles such as bacteria from passing to the fetus

6. Provides an exchange of nutrients and waste products between the

mother and the fetus

Rationale: The amniotic fluid surrounds, cushions, and protects the fetus. It allows the fetus to move freely and maintains the body temperature of the fetus. In addition, the amniotic fluid contains urine from the fetus and can be used to assess fetal kidney function. The placenta prevents large particles such as bacteria from passing to the fetus and provides an exchange of nutrients and waste products between the mother and the fetus. A couple comes to the family planning clinic and asks about sterilization procedures. Which question by the nurse should determine whether this method of family planning would be most appropriate?

1. "Did you ever had surgery?"

2. "Do you plan to have any other children?"

3. "Do either of you have diabetes mellitus?"

4. "Do either of you have problems with high blood pressure?"

Rationale: Sterilization is a method of contraception for couples who have completed their families. It should be considered a permanent end to fertility because reversal surgery is not always successful. The nurse would ask the couple about their plans for having children in the future. Options 1, 3, and 4 are unrelated to this procedure. The nurse should make which statement to a pregnant client found to have a gynecoid pelvis?

1. "Your type of pelvis has a narrow pubic arch."

2. "Your type of pelvis is the most favorable for labor and birth."

3. "Your type of pelvis is a wide pelvis, but it has a short diameter."

4. "You will need a cesarean section because this type of pelvis is

not favorable for a vaginal delivery."

Rationale: A gynecoid pelvis is a normal female pelvis and is the most favorable for successful labor and birth. An android pelvis (resembling a male pelvis) would be unfavorable for labor because of the narrow pelvic planes. An anthropoid pelvis has an outlet that is adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat pelvis) has a wide transverse diameter, but the anteroposterior diameter is short, making the outlet inadequate.

Which purposes of placental functioning should the nurse include in a prenatal class? Select all that apply.

1. It cushions and protects the baby.

2. It maintains the temperature of the baby.

3. It is the way the baby gets food and oxygen.

4. It prevents all antibodies and viruses from passing to the baby.

5. It provides an exchange of nutrients and waste products between the

mother and developing fetus.

Rationale: The placenta provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus. The amniotic fluid surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. Nutrients, medications, antibodies, and viruses can pass through the placenta The nurse is providing instructions to a pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide?

1. Strict bed rest is required after the procedure.

2. Hospitalization is necessary for 24 hours after the procedure.

3. An informed consent needs to be signed before the procedure.

4. A fever is expected after the procedure because of the trauma to the

abdomen.

Rationale: Because amniocentesis is an invasive procedure, informed consent needs to be obtained before the procedure. After the procedure, the client is instructed to rest, but may resume light activity after the cramping subsides. The client is instructed to keep the puncture site clean and to report any complications, such as chills, fever, bleeding, leakage of fluid at the needle insertion site, decreased fetal movement, uterine contractions, or cramping. Amniocentesis is an outpatient procedure and may be done in the health care provider's office or in a special prenatal testing unit. Hospitalization is not necessary after the procedure. A pregnant client in the first trimester calls the nurse at a health care clinic and reports that she has noticed a thin, colorless vaginal drainage. The nurse should make which statement to the client?

1. "Come to the clinic immediately."

2. " The vaginal discharge may be bothersome, but is a normal occurrence."

3. "Report to the emergency department at the maternity

center immediately."

4. "Use tampons if the discharge is bothersome, but be sure to change

the tampons every 2 hours."

Rationale:

Leukorrhea begins during the first trimester. Many clients notice a thin, colorless or

yellow vaginal discharge throughout pregnancy. Some clients become distressed about this condition, but it does not require that the client report to the health care clinic or emergency department immediately. If vaginal discharge is profuse, the client may use panty liners, but she should not wear tampons because of the risk of infection. If the client uses panty liners, she should change them frequently. A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding?

1. A normal test result

2. An abnormal test result

3. A high risk for fetal demise

4. The need for a cesarean section

Rationale: Contraction stress test results may be interpreted as negative (normal), positive (abnormal), or equivocal. A negative test result indicates that no late decelerations occurred in the fetal heart rate, although the fetus was stressed by 3 contractions of at least 40 seconds' duration in a 10-minute period. Options 2, 3, and 4 are incorrect interpretations. The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." Which statement by the client indicates a need for further instruction?

1. "I will record the number of movements or kicks."

2. "I need to lie flat on my back to perform the procedure."

3. "If I count fewer than 10 kicks in a 2-hour period, I should count the

kicks again over the next 2 hours."

4. "I should place my hands on the largest part of my abdomen

and concentrate on the fetal movements to count the kicks."

Rationale: The client should sit or lie quietly on her side to perform kick counts. Lying flat on the back is not necessary to perform this procedure, can cause discomfort, and presents a risk of vena cava (supine hypotensive) syndrome. The client is instructed to place her hands on the largest part of the abdomen and concentrate on the fetal movements. The client records the number of movements felt during a specified time period. The client needs to notify the health care provider (HCP) if she feels fewer than 10 kicks over two consecutive 2-hour intervals or as instructed by the HCP. The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and notes that the fundal height is 30 cm. How should the nurse interpret this finding?

1. The client is measuring large for gestational age.

2. The client is measuring small for gestational age.

3. The client is measuring normal for gestational age.

4. More evidence is needed to determine size for gestational age.

Rationale: During the second and third trimesters (weeks 18 to 30), fundal height in centimeters approximately equals the fetus's age in weeks ± 2 cm. Therefore, if the client is at 28 weeks gestation, a fundal height of 30 cm would indicate that the client is measuring normal for gestational age. At 16 weeks, the fundus can be located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, the fundus is at the umbilicus. At 36 weeks, the fundus is at the xiphoid process. The nurse is performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. The nurse should assess for which probable signs of pregnancy? Select all that apply.

1. Ballottement

2. Chadwick's sign

3. Uterine enlargement

4. Positive pregnancy test

5. Fetal heart rate detected by a nonelectronic device

6. Outline of fetus via radiography or ultrasonography

Rationale: The probable signs of pregnancy include uterine enlargement, Hegar's sign (compressibility and softening of the lower uterine segment that occurs at about week 6), Goodell's sign (softening of the cervix that occurs at the beginning of the second month), Chadwick's sign (violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 4), ballottement (rebounding of the fetus against the examiner's fingers on palpation), Braxton Hicks contractions, and a positive pregnancy test for the presence of human chorionic gonadotropin. Positive signs of pregnancy include fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation, active fetal movements palpable by the examiner, and an outline of the fetus by radiography or ultrasonography. A pregnant client is seen for a regular prenatal visit and tells the nurse that she is experiencing irregular contractions. The nurse determines that she is experiencing Braxton Hicks contractions. On the basis of this finding, which nursing action is appropriate?

1. Contact the health care provider.

2. Instruct the client to maintain bed rest for the remainder of the

pregnancy.

3. Inform the client that these contractions are common and may occur

throughout the pregnancy.

4. Call the maternity unit and inform them that the client will be admitted

in a preterm labor condition.

Rationale: Braxton Hicks contractions are irregular, painless contractions that may occur intermittently throughout pregnancy. Because Braxton Hicks contractions may occur and are normal in some pregnant women during pregnancy, there is no reason to notify the health care provider. This client is not in preterm labor and, therefore, does not need to be placed on bed rest or be admitted to the hospital to be monitored. A client arrives at the clinic for the first prenatal assessment. She tells the nurse that the first day of her last normal menstrual period was October 19,

2018. Using Nägele's rule, which expected date of delivery should the nurse document in the client's chart?

1. July 12, 2019

2. July 26, 2019

3. August 12, 2019

4. August 26, 2019

Rationale: Accurate use of Nägele's rule requires that the woman have a regular 28-day menstrual cycle. Subtract 3 months and add 7 days to the first day of the last menstrual period, and then add 1 year to that date: first day of the last menstrual period, October 19, 2018; subtract 3 months, July 19, 2018; add 7 days, July 26, 2018; add 1 year, July 26,

The nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a healthy 5-year-old child who was delivered at 38 weeks and tells the nurse that she does not have a history of any type of abortion or fetal demise. Using GTPAL, what should the nurse document in the client's chart?

1. G = 3, T = 2, P = 0, A = 0, L = 1

2. G = 2, T = 1, P = 0, A = 0, L = 1

3. G = 1, T = 1, P = 1, A = 0, L = 1

4. G = 2, T = 0, P = 0, A = 0, L = 1

Rationale: Pregnancy outcomes can be described with the acronym GTPAL. G is gravidity, the number of pregnancies; T is term births, the number born at term (longer than 37 weeks); P is preterm births, the number born before 37 weeks of gestation; A is abortions or miscarriages, the number of abortions or miscarriages (included in gravida if before 20 weeks of gestation; included in parity if past 20 weeks of gestation); and L is the number of current living children. A woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of term births is 1, and the number of preterm births is 0. The number of abortions is 0, and the number of living children is 1.

The home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the health care provider (HCP)?

1. Urinary output has increased.

2. Dependent edema has resolved.

3. Blood pressure reading is at the prenatal baseline.

4. The client complains of a headache and blurred vision.

Rationale: If the client complains of a headache and blurred vision, the HCP should be notified, because these are signs of worsening preeclampsia. Options 1, 2, and 3 are normal findings. The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching?

1. "I should stay on the diabetic diet."

2. "I should perform glucose monitoring at home."

3. "I should avoid exercise because of the negative effects on

insulin production."

4. "I should be aware of any infections and report signs of infection

immediately to my health care provider (HCP)."

Rationale: Exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, it is performed at the clinic or HCP's office. Signs of infection need to be reported to the HCP. The nurse is performing an assessment on a pregnant client in the last trimester with a diagnosis of severe preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis?

1. Enlargement of the breasts

2. Complaints of feeling hot when the room is cool

3. Periods of fetal movement followed by quiet periods

4. Evidence of bleeding, such as in the gums, petechiae, and purpura

Rationale: Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy. The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply.

1. A primigravida with mild preeclampsia

2. A primigravida who delivered a 10-lb infant 3 hours ago

3. A gravida II who has just been diagnosed with dead fetus syndrome

4. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood

5. A primigravida at 29 weeks of gestation who was recently diagnosed

with severe preeclampsia

Rationale: In a pregnant client, DIC is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. Dead fetus syndrome is considered a risk factor for DIC. Severe preeclampsia is considered a risk factor for DIC; a mild case is not. Delivering a large newborn is not considered a risk factor for DIC. Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage. The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? Select all that apply.

1. Proteinuria

2. Hypertension

3. Low-grade fever

4. Generalized edema

5. Increased pulse rate

6. Increased respiratory rate

Rationale: The two classic signs of preeclampsia are hypertension and proteinuria. A low- grade fever, increased pulse rate, or increased respiratory rate is not associated with preeclampsia. Generalized edema may occur, but is no longer included as a classic sign of preeclampsia because it can occur in many conditions. The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement?

1. "I will need to increase my insulin dosage during the first 3 months of

pregnancy."

2. "My insulin dose will likely need to be increased during the second and

third trimesters."

3. "Episodes of hypoglycemia are more likely to occur during the first 3

months of pregnancy."

4. "My insulin needs should return to prepregnant levels within 7 to 10

days after birth if I am bottle-feeding."

Rationale: Insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in options 2, 3, and 4 are accurate and signify that the client understands control of her diabetes during pregnancy. A pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss, and fatigue. After assessment of the client, tuberculosis is suspected. A sputum culture is obtained and identifies Mycobacterium tuberculosis. Which instruction should the nurse include in the client's teaching plan?

1. Therapeutic abortion is required.

2. Isoniazid plus rifampin will be required for 9 months.

3. She will have to stay at home until treatment is completed.

4. Medication will not be started until after delivery of the fetus.

Rationale: More than 1 medication may be used to prevent the growth of resistant organisms in a pregnant client with tuberculosis. Treatment must continue for a prolonged period. The preferred treatment for the pregnant client is isoniazid plus rifampin daily for 9 months. Ethambutol is added initially if medication resistance is suspected. Pyridoxine (vitamin B 6 ) often is administered with isoniazid to prevent fetal neurotoxicity. The client does not need to stay at home during treatment, and therapeutic abortion is not required. The nurse is providing instructions to a pregnant client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse?

1. "I should increase my sodium intake during pregnancy."

2. "I should lower my blood volume by limiting my fluids."

3. "I should maintain a low-calorie diet to prevent any weight gain."

4. "I should drink adequate fluids and increase my intake of high-fiber

foods."

Rationale: Constipation can cause the client to use the Valsalva maneuver. The Valsalva maneuver should be avoided in clients with cardiac disease because it can cause blood to rush to the heart and overload the cardiac system. Constipation can be prevented by the addition of fluids and a high-fiber diet. A low-calorie diet is not recommended during pregnancy and could be harmful to the fetus. Sodium should be restricted as prescribed by the health care provider because excess sodium would cause an overload to the circulating blood volume and contribute to cardiac complications. Diets low in fluid can cause a decrease in blood volume, which could deprive the fetus of nutrients.

The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment findings indicate to the nurse that the client is at risk for contracting human immunodeficiency virus (HIV)? Select all that apply.

1. The client has a history of intravenous drug use.

2. The client has a significant other who is heterosexual.

3. The client has a history of sexually transmitted infections.

4. The client has had one sexual partner for the past 10 years.

5. The client has a previous history of gestational diabetes mellitus.

Rationale: HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passage from an infected woman to her fetus. Clients who fall into the high-risk category for HIV infection include individuals who have used intravenous drugs, individuals who experience persistent and recurrent sexually transmitted infections, and individuals who have a history of multiple sexual partners. Gestational diabetes mellitus does not predispose the client to HIV. A client with a heterosexual partner, particularly a client who has had only one sexual partner in 10 years, does not have a high risk for contracting HIV. A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction?

1. "I will watch for the evidence of the passage of tissue."

2. "I will maintain strict bed rest throughout the remainder of

the pregnancy."

3. "I will count the number of perineal pads used on a daily basis and note

the amount and color of blood on the pad."

4. "I will avoid sexual intercourse until the bleeding has stopped, and for 2

weeks following the last evidence of bleeding."

Rationale: Strict bed rest throughout the remainder of the pregnancy is not required for a threatened abortion. The client should watch for the evidence of the passage of tissue. The client is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The client is advised to curtail sexual activities until bleeding has ceased and for 2 weeks after the last evidence of bleeding or as recommended by the health care provider. The nurse is planning to admit a pregnant client who is obese. In planning care for this client, which potential client needs should the nurse anticipate? Select all that apply.

1. Bed rest as a necessary preventive measure may be prescribed.

2. Routine administration of subcutaneous heparin may be prescribed.

3. An overbed lift may be necessary if the client requires a cesarean

section.

4. Less frequent cleansing of a cesarean incision, if present, may be

prescribed.

5. Thromboembolism stockings or sequential compression devices may be

prescribed.

Rationale: The obese pregnant client is at risk for complications such as venous thromboembolism and increased need for cesarean section. Additionally, the obese client requires special considerations pertaining to nursing care. To prevent venous thromboembolism, particularly in the client who required cesarean section, frequent and early ambulation (not bed rest), prior to and after surgery, is recommended. Routine administration of prophylactic pharmacological venous thromboembolism medications such as heparin is also commonly prescribed. An overbed lift may be needed to transfer a client from a bed to an operating table if cesarean section is necessary. Increased monitoring and cleansing of a cesarean incision, if present, will likely be prescribed due to the increased risk for infection secondary to increased abdominal fat. Thromboembolism stockings or sequential compression devices will likely be prescribed because of the client's increased risk of blood clots. The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor? Select all that apply.

1. The contractions are regular.

2. The membranes have ruptured.

3. The cervix is dilated completely.

4. The client begins to expel clear vaginal fluid.

5. The spontaneous urge to push is initiated from perineal pressure.

Rationale: The second stage of labor begins when the cervix is dilated completely and ends with birth of the neonate. The woman has a strong urge to push in stage 2 from perineal pressure. Options 1, 2, and 4 are not specific assessment findings of the second stage of labor and occur in stage 1. The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action?

1. Administer oxygen via face mask.

2. Place the mother in a supine position.

3. Increase the rate of the oxytocin intravenous infusion.

4. Document the findings and continue to monitor the fetal patterns.

Rationale: Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8 to 10 L/minute via face mask is

necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior

vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufficiency resulting from stimulation of contractions by this medication. Although the nurse would document the occurrence, option 4 would delay necessary treatment. The nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. Which assessment finding indicates the need to contact the health care provider (HCP)?

1. Hemoglobin of 11 g/dL (110 mmol/L)

2. Fetal heart rate of 180 beats/minute

3. Maternal pulse rate of 85 beats/minute

4. White blood cell count of 12,000 mm^3 (12.0 × 109 /L)

Rationale: A normal fetal heart rate is 110 to 160 beats/minute. A fetal heart rate of 180 beats/minute could indicate fetal distress and would warrant immediate notification of the HCP. By full term, a normal maternal hemoglobin range is 11– 13 g/dL (110–130 mmol/L) because of the hemodilution caused by an increase in plasma volume during pregnancy. The maternal pulse rate during pregnancy increases 10 to 15 beats/minute over pre-pregnancy readings to facilitate increased cardiac output, oxygen transport, and kidney filtration. White blood cell counts in a normal pregnancy begin to increase in the second trimester and peak in the third trimester, with a normal range of 11,000 to 15,000 mm^3 (11 to 15 x 10 9 /L), up to 18,000 mm^3 (18 x 10^9 /L). During the immediate postpartum period, the white blood cell count may be 25,000 to 30,000 mm^3 (25 to 30 x 109 /L) because of increased leukocytosis that occurs during delivery. The nurse is reviewing the record of a client in the labor room and notes that the health care provider has documented that the fetal presenting part is at the –1 station. This documented finding indicates that the fetal presenting part is located at which area? Click on the image to indicate your answer. Rationale: Station is the measurement of the progress of descent in centimeters above or below the midplane from the presenting part to the ischial spine. It is measured in centimeters, and noted as a negative number above the line and as a positive number below the line. At the negative 1 (–1) station, the fetal presenting part is 1 cm above the ischial spine. Option 1 is at the negative 5 (–

5. station and the fetal presenting part is 5 cm above the ischial spine. Option 2 is at the negative 2 (–2) station and the fetal presenting part is 2 cm above the ischial spine. Option 4 is at the positive 3 (+3) and the fetal presenting part is 3 cm below the ischial spine. A client arrives at a birthing center in active labor. Following examination, it is determined that her membranes are still intact and she is at a –2 station. The health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy?

Select all that apply.

1. Less pressure on her cervix

2. Decreased number of contractions

3. Increased efficiency of contractions

4. The need for increased maternal blood pressure monitoring

5. The need for frequent fetal heart rate monitoring to detect the presence of

a prolapsed cord

Rationale: Amniotomy (artificial rupture of the membranes) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the progress begins to slow. Rupturing of the membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. Increased monitoring of maternal blood pressure is unnecessary following this procedure. The fetal heart rate needs to be monitored frequently, as there is an increased likelihood of a prolapsed cord with ruptured membranes and a high presenting part. The nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction?

1. Variability

2. Accelerations

3. Early decelerations

4. Variable decelerations

Rationale: Variable decelerations occur if the umbilical cord becomes compressed, reducing blood flow between the placenta and the fetus. Variability refers to fluctuations in the baseline fetal heart rate. Accelerations are a reassuring sign and usually occur with fetal movement. Early decelerations result from pressure on the fetal head during a contraction. A client in labor is transported to the delivery room and prepared for a cesarean delivery. After the client is transferred to the delivery room table, the nurse should place the client in which position?

1. Supine position with a wedge under the right hip

2. Trendelenburg's position with the legs in stirrups

3. Prone position with the legs separated and elevated

4. Semi Fowler's position with a pillow under the knees

Rationale: Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and subsequently the fetus. The best position to prevent this would be side-lying, with the uterus displaced off the abdominal vessels. Positioning for abdominal surgery necessitates a supine position, however; a wedge placed under the right hip provides displacement of the uterus. Trendelenburg's position places pressure

from the pregnant uterus on the diaphragm and lungs,