OB Questions with Answer II

31. A woman is in labor for 6 hours. Her contractions are occurring every 2 minutes and lasting 70 seconds. She is diaphoretic, restless, and irritable, moaning that she “can’t take it anymore.” According to this assessment findings, which phase of labor she is in?

1. Latent phase
2. Second stage
3. Third stage

D.    Transitional phase

32. Which procedure would be best to determine if the woman has spontaneously ruptured amniotic membranes?

1. A CBC

B.    A fern test

3. Urinalysis
4. A vaginal exam

33. A woman is experiencing true labor when her contraction pattern shows

1. Occasional irregular contractions
2. Irregular contractions that increase in intensity
3. Regular contractions that remain the same

D.    Regular contractions that increase in frequency and duration over time

34.The nurse is to perform Leopold’s maneuvers on a pregnant woman. What instructions does the nurse give the patient just before the assessment?

1. Take slow, deep breaths to relieve pain
2. Do not eat the night before the procedure
3. Remain on strict bedrest prior to procedure

D.    Urinate before the procedure

35. The nurse performs Leopold’s maneuvers to assess

A.    Fetal position

2. Cervical dilation
3. Fetal well-being
4. Stage of labor

36. During the active phase of labor the woman reports severe back pain that becomes increasingly intense during contractions. The nurse should place the woman in which position

1. Supine position
2. Semi-Fowler’s

C.    Squatting

4. Side lying on the side of the fetal back

37. The nurse should encourage the woman to void frequently during labor primarily to

A.    Enhance fetal descent

2. Prevent UTI  
3. Strengthen the perineal and vaginal muscles
4. Assess the urine specimen for albumin

38. Assessment indicates that the woman’s membranes rupture several hours ago before admission. Which action would be the nurse’s priority in caring for her?

1. Monitor BP
2. Monitoring her I and O
3. Providing frequent perineal care

D.    Measuring her temperature every 2 hours

39. A woman in labor with complete cervical dilation begins pushing during contractions, the FHR drops to approximately 90 BPM and then quickly returns to the baseline when she stops pushing. This sudden change is probably the result of

1. Maternal position
2. Maternal drug use
3. Fetal abnormality

D.    Umbilical cord compression

40. Assessment reveals cervical dilation of 5 cm cervical effacement 80%, station -3 frequency of contractions 5 to 8 minutes, duration of contractions 40-50 seconds, membranes ruptured spontaneously 1 hour prior to admission, vertex presentation, LOA position. Based on assessment, the fetal presenting part is:

A.    At the level of the pelvic inlet

2. At the level of the ischial spines
3. 1 cm below the ischial spines
4. At the perineum

41. Assessment reveals cervical dilation of 5 cm cervical effacement 80%, station -3 frequency of contractions 5 to 8 minutes, duration of contractions 40-50 seconds, membranes ruptured spontaneously 1 hour prior to admission, vertex presentation, LOA position. The FHR should be most audible in which quadrant of the woman’s abdomen?

1. Left upper quadrant

B.    Left lower quadrant

3. Right upper quadrant
4. Right lower quadrant

42. The LOA position means that

1. Lie is longitudinal and the fetal occiput is directed toward the left posterior portion of the maternal pelvis
2. Lie is transverse and fetal mentum is directed toward the left posterior portion of the maternal pelvis
3. Lie is longitudinal and the fetal occiput is directed toward the left anterior portion of the maternal pelvis
4. Lie is oblique and fetal anterior fontanel is directed toward the left posterior portion of the maternal pelvis

43. Assessment reveals cervical dilation of 5 cm cervical effacement 80%, station -3 frequency of contractions 5 to 8 minutes, duration of contractions 40-50 seconds, membranes ruptured spontaneously 1 hour prior to admission, vertex presentation, LOA position. The physician places the woman on bed rest. Which assessment finding necessitates this action?

1. 5 cm cervical dilation
2. 80% cervical effacement
3. Contractions every 5 to 8 minutes

D.    Station –3

44. The fetal monitor strips shows an FHR deceleration occurring during the increment of a contraction, reaching its lowest point at the acme of the contraction, and returning to baseline during the decrement of the contraction. This type of deceleration indicates

1. Fetal distress
2. Uteropalcental insufficiency

C.    Fetal vagal nerve stimulation

4. Umbilical cord compression

45. During labor, the nurse assesses the woman’s BP

1. During the increment of a contraction

B.    Between contractions

3. During the decrement of a contraction
4. During the acme of contraction

46. The fetal monitor strips shows an FHR deceleration occurring during the increment of a contraction, reaching its lowest point at the acme of the contraction, and returning to baseline during the decrement of the contraction. This type of deceleration indicates

1. Maternal hypoxia
2. Fetal lung maturity
3. Fetal movement

D.    Fetal well-being

47. Which factor would be most helpful in assessing the adequacy of the woman’s placental perfusion?

1. The duration and intensity of her contraction
2.  Her ability to cope with discomfort of labor

C.    The duration of the rest phases between contractions

4. The effectiveness of her breathing techniques during a contraction

48. If a laboring woman breathes improperly when using of childbirth preparation, the result could be which of the following?

1. Increased pulse

B.    Hyperventilation

3. Hypertension
4. FHR deceleration

49. A woman in labor complains of tingling sensation and numbness of her hands and feet and she uses her breathing techniques. These symptoms indicate:

A.    Respiratory alkalosis

2. Metabolic alkalosis
3. Respiratory acidosis
4. Metabolic acidosis

50. A woman in labor complains of tingling sensation and numbness of her hands and feet. She breathes deeply and rapidly. Which nursing action would best alleviate the woman’s complaints?

1. Administering 4L of oxygen by face mask
2. Increasing her IVF of dextrose 5% in LR solution

C.    Telling her to exhale into her cupped hands and then reinhale

4. Having her exhale into a paper bag

51. A woman progresses through labor until cervical dilation is 10 cm. Which breathing technique, besides cleansing breaths, should the woman use during contractions at this time?

1. Modified paced breathing at no more than twice her normal respiratory rate
2. Patterned paced breathing at no more than 4 times her normal respiratory rate

C.    Breath holding 5 to 6 seconds while pushing with open glottis

4. Breath holding for 10 to 15 seconds with a closed glottis during long, sustained pushes

52. A woman in labor experiences cramps in her right leg. These cramps probably are the result of:

1. A low serum calcium level

B.    Pressure on the lumbo-sacral nerve plexus

3. Pressure on the pudendal nerve
4. A calcium-potassium imbalance

53. Which of the following statements best explain the purpose of effleurage during labor?

1. This is massage of the legs to remove cramps that occur during labor

B.    This is gentle massage of the abdomen to facilitate relaxation

3. This is application of pressure over the sacral area to relieve backache
4. This is a form of biofeedback for relaxation

54. Shortly before delivery the woman receives pudendal block anesthesia. After receiving the pudendal block, which reactions the woman is likely to experience?

1. Delayed voiding after delivery because the nerves supplying the bladder are numb
2. Complete relief from the discomfort of uterine contractions during labor
3. Numbness of the legs after delivery

D.    Numbness of the birth canal and the perineum to allow pushing during delivery

55. The physician performs midline episiotomy. This procedure is performed for all of the following reasons EXCEPT to:

1. Prevent perineal laceration
2. Avoid stretching and tearing of the perineum

C.    Shorten the third stage of labor

4. Reduce the incidence of subsequent perineal relaxation with cystocele or rectocele

56. How should the nurse prepare the prescribed oxytocin to be administered with 1L of dextrose 5% in water?

1. Add 10U of oxytocin to main IV line
2. Add 10U of oxytocin to 1L of prescribed solution, then piggyback the solution to main IV line
3. Add 10U of oxytocin to 1L of prescribed solution using an infusion control device, and then piggyback the solution to the main IV line.
4. Add 10U of oxytocin to 500 ml of prescribed solution using an infusion control device, then piggyback the solution to the main IV line

57. Which factor is a contraindication for using oxytocin to augment labor?

A.    Fetal distress

2. Prolonged labor
3. An extended period since rupture of membranes
4. Postmaturity

58. Assessment reveals cervical dilation of 5 cm cervical effacement 65%, station -1 frequency of contractions 5 to 8 minutes, duration of contractions 30-50 seconds, membranes ruptured spontaneously 12 hour prior to admission, FHR 130 to 140 BPM. The physician prescribed oxytocin to augment labor. Which nursing diagnosis on the woman’s care plan has the HIGHEST PRIORITY during oxytocin administration?

1. Pain R/T uterine contraction
2. Fear R/T unknown outcome
3. Knowledge deficit R/T use of oxytocin during labor

D.    Potential for altered uterine tissue perfusion R/T uterine contractions

59. A woman in labor is admitted. Assessment reveals cervical dilation of 5 cm cervical effacement 65%, station -1 frequency of contractions 5 to 8 minutes, duration of contractions 30-50 seconds, membranes ruptured spontaneously 12 hour prior to admission, FHR 130 to 140 BPM. The physician prescribed oxytocin to augment labor. Which nursing intervention is NOT appropriate for her?

1. Piggybacking the oxytocin into the Y-site closest to the IV insertion site
2. Explaining oxytocin administration and what to expect

C.    Placing her in high Fowler’s position

4. Assessing the FHR and contraction pattern every 15 minutes

60. A woman in labor is connected to fetal monitoring device. The nurse notes contractions every 1-minute, last 60 seconds, and result in uterine pressure of 90 mmHg. The FHR is 160 to 170 BPM with normal variability. The nurse’s initial action should be to:

1. Record the time the contractions increased in intensity
2. Continue monitoring the contractions and FHR

C.    Discontinue oxytocin administration

4. Notify the physician