OB Questions with Answer IV

81. Twenty-four hours after uncomplicated labor and delivery, the mother’s CBC revels WBC of 17,000/mm3. The nurse would interpret the woman’s WBC count as being indicative of:

1. A bacterial infection of the reproductive system
2. An acute sexually transmitted viral disease

C.    A normal decrease in WBC

4. A normal response to labor process

82. Which of the following statement best describe puerperium?

1. 4-6 hours period after delivery during which the placenta is completely expelled
2. A phase of the fourth stage of labor
3. A term to indicate progressive changes of the breast 4 to 6 weeks after delivery
4. A 6 week period after delivery, during which the reproductive organs return to non-pregnant state

83. A woman G1P1 delivered a 7-lb male infant. She plans to breast feed the baby. On the first day postpartum day, the nurse notes that the woman’s fundus is above the umbilicus and to the left of the midline. What would the nurse initially suspect?   

A.     A full bladder

B.     Retained placental fragments

C.     Uterine atony

D.     Uterine inertia

84. Ellen complains of tenderness and swelling of the breasts. The nurse explains that she is experiencing primary breast engorgement, which lasts for

A.     1 to 2 days

B.     3 to 4 days

C.     5 to 6 days

D.     7 to 8 days

85. Which of the following would the nurse teach the postpartum woman to include in her daily care to keep the nipples in good condition for breastfeeding to prevent potential for infection?

A.     Wash with soap and water before each feeding

B.     Keep the nipples dry and clean

C.     Cover the nipples with a dry and clean plastic pad

D.     Cleanse with antiseptic solution three times a day

86. Which of the following statement best explain why the postpartum mother voids large amount of urine frequently?

A.     A sign of urinary retention and overflow

B.     A normal body’s response to reduce extracellular fluid acquired during pregnancy

C.     A result of decreased bladder tone due to anesthesia during labor

D.     An indication of a bladder infection

87. The period immediately following birth is divided into significant phases. The phase in which the mother’s needs have to be met before she can meet the baby’s needs is called     

A.    Taking-in phase

2. Transition phase
3. Taking-hold phase
4. Bonding phase

88. A woman is discharged on her third postpartum day. What type of lochia should be noted?

A.    Lochia alba

B.    Lochia serosa

3. Lochia rubra
4. Lochia rugae

89. If the fundus of the uterus is felt at the umbilicus immediately after delivery of the placenta,

      the nurse should take which one of the following nursing actions?

1. Catheterize the patient

B.    Massage the fundus to make it firm

3. Administer Methergine
4. Support the mother, because this represents a normal fundus placement

90. Two days after delivery, the nurse assesses a heavy amount of lochia rubra containing

      four blood clots about the size of one-peso coin. This assessment is:

1. Normal for 2 days post-delivery
2. Normal for 4 days post-delivery
3. Abnormal because it is lochia serosa

D.    A sign of complication or hemorrhage

91. Which one of the following conditions would alert the nurse for a possible postpartum hemorrhage?

A.    Delivery of twins after 16 hours of labor

2. Cesarean birth
3. Premature delivery
4. First delivery of 7 lb baby boy 2 hours after rupture of membranes

92. In explaining the pattern of discharge following delivery, the nurse explains that lochia will

 be heavier:

A.    In the morning

2. At night
3. As lochia cessation nears
4. Toward the end of lactation

93. Which hormone works with estrogen and progesterone to stimulate the breast? development and milk production during pregnancy and following pregnancy?

1. FSH
2. Oxytocin

C.    Prolactin

D.    Placental lactogen

94. The first day after delivery, the husband tells the nurse that his wife has been talking constantly about her recent delivery experience. He asks the nurse if this is normal maternal behavior after delivery. The nurse’s best response is:

1. Divert her attention away from the delivery
2. Do you feel uncomfortable talking about the delivery experience?

C.    This is a normal reaction; it allows her to accept the reality of birth

4. It’s a clear sign that your wife needs psychiatric evaluation

95. A mother plans to bottle-feed her son. She asks the nurse when her menstruation will return. The nurse

      correctly states that non-breastfeeding mothers typically resume menstruating in about:

1. 4 to 6 weeks

B.    6-8 weeks

3. 3-6 months
4. 4-8 month

96. The major reason for a 3-week prescription for resumption of sexual intercourse is to prevent

1. Tearing of the episiotomy

B.    Vaginal and cervical infection

3. Bladder infection
4. Dyspareunia

97. After uncomplicated vaginal delivery the mother complains of severe cramping. The nurse knows that such cramping commonly associated with

1. Infection
2. Retained placental fragments

C.    Uterine involution

4. Bladder distension

98. The nurse prepares to help the mother ambulate for the first time after vaginal delivery. Which statement about early ambulation is true?

A.    It may cause hypotensive episodes

2. It facilitates uterine involution
3. It requires no special nursing intervention
4. It should not be attempted for at least 10 hours after delivery

99.  The nurse should assess for a functional let-down reflex. Which sign indicates that the mother’s let-down

 is functioning properly?

A.   The neonate’s vigorous sucking at the breast

B.   Nipple soreness

C.   Leakage of milk from one breast while the neonate nurses at the other breast

D.   A feeling of breast fullness

100.  After 2 breastfeeding sessions, the mother tells the nurse, “when I breastfeed my baby, the cramping gets much worse.” T he nurse’s best response is:

A.   Breastfeeding cause the uterus to contract. I can give you something for pain before you breastfeed

B.   Let me watch while you breastfeed; your technique may be causing this problem

C.   The cramping is normal, but you can not take any medication while you are breastfeeding

D.   The cramping will pass. You just need to continue with the breastfeeding

OB Questions with Answer III

61. After the woman receives epidural block anesthesia, the nurse should immediately:

1. Assess the FHR

B.    Assess the woman’s BP, pulse, and respirations

3. Administer oxygen via face mask
4. Place the woman in semi-Fowler’s position

62. Assessment findings on a woman in labor include cervical dilation of 4 cm, 100% effaced, station 0, contractions every 5 to 6 minutes lasting 50 to 60seconds, membranes intact, FHR 140 to 150 BPM loudest in the upper left quadrant, and hard round mass palpable at the level of the fundus. Assessment findings indicate that the fetus is in

A.    Breech presentation

2. Cephalic presentation
3. Posterior position
4. Transverse lie

63. Assessment findings on a woman in labor include cervical dilation of 4 cm, 100% effaced, station 0, contractions every 5 to 6 minutes lasting 50 to 60seconds, membranes intact, FHR 140 to 150 BPM loudest in the upper left quadrant, and hard round mass palpable at the level of the fundus. While monitoring the FHR membranes rupture spontaneously revealing meconium-stained amniotic fluid. The nurse’s initial action should be to:

1. Prepare the woman for CS delivery because of fetal distress
2. Notify the physician

C.    Determine the FHR

4. Place the woman in left side lying position because amniotic fluid indicates fetal distress

64. 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 woman asks the nurse if it is all right for her to get up and walk around. The nurse’s best response should be

1. “You should stay in bed; walking may interfere with proper uterine contractions”
2. “I can’t make a decision on that, you will have to ask the doctor.”
3. “You will have to stay in bed; otherwise your contractions cannot be timed and no one can listen to the FHR”
4. “It’s quite all right for you to be up and about as long as you feel comfortable and your membranes are intact”

65. A woman in labor progresses to 7 to 8 cm dilated and the vertex is low in the midpelvis. To alleviate discomfort during contractions, the nurse should instruct the woman to

1. Pant during contractions

B.    Abdominal breathe

3. Chest breathe
4. Pant between contractions

66. If labor is progressing satisfactorily, when would it be appropriate to administer medication such as Demerol?

1. 3 cm dilation
2. 4 cm dilation
3. 5 cm dilation

D.    7 cm dilation

67. Demerol 50 mg and Phenergan 50 mg are ordered to be administered IM. This medication would:

1. Induce sleep until the time of delivery

B.    Increase pain threshold, resulting I relaxation

3. Act as amnesic drug
4. Act as a preliminary anesthesia

68. The beginning of the second stage of labor can be recognized by the client’s desire to:

1. Relax during contractions

B.    Push during contractions

3. Pant during contractions
4. Blow during contractions

69. A woman is positioned on the delivery table; both legs should be placed simultaneously in the stirrups to prevent:

1. Excessive pull on the fascia
2. Pressure on the perineum

C.    Trauma to the uterine ligaments

4. Venous stasis in the legs

70. A G3P2 is in labor and is progressing rapidly. When should she be moved into the delivery room?

1. Cervix is dilated 2-4 cm

B.    Cervix is dilated 7-8 cm

3. Cervix is dilated 10 cm
4. At the onset of labor

71. Which of the following is observed first when placenta begins to separate?

1. Lengthening of the cord
2. Sudden gush of blood

C.    Abdomen becomes globular and firm

4. Sudden rise of the fundus

72. The placenta should be delivered within the period of time following delivery?

1. 1-2 minutes

B.    3-10 minutes

3. 15-20 minutes
4. 20-30 minutes

73. Ten minutes after the delivery, the placenta is still intact. What action does the nurse take?

1. Gently pull on the cord to initiate separation
2. Call the physician back to the delivery room
3. Push gently, but firmly on the fundus

D.    Allow the infant to suck the breast

74. About 15 minutes after delivery, the woman begins to complain about chills. The most appropriate action by the nurse would be to:  

A.      Notify the physician of the problem

B.      Cover with a blanket

C.      Administer acetaminophen as ordered

D.     Increase the IV infusion rate

75. The nurse assesses the postpartum mother during the fourth stage of labor for:

1. Level of maternal love

B.    Distention of the bladder

3. Ability to relax
4. Knowledge of the newborn behavior

76. The nurse notes bright red bleeding in a patient who delivered 26 hours ago. What is the probable cause of bleeding?

A.    Uterine atony

2. Normal bleeding
3. Perineal laceration
4. Placental fragments

77. The nurse is aware that the nursing action that would be best promote parent-infant attachment behaviors would be:

1. Encouraging rooming-in, with parental infant care

B.    Keeping the new family together immediately postpartum

3. Restricting visitation on the postpartum unit
4. Supporting the parents’ choice of breastfeeding

78. The nurse is aware that during the taking-in phase of the postpartum period the area of health teaching that the mother will be most responsive to is:

1. Family Planning
2. Infant feeding
3. Infant hygiene

D.    Perineal care

79. A woman’s labor does not progress and a cesarean delivery is performed. Afterwards she tells the nurse

      that she is a “natural childbirth flunkie.” The postpartal phase of adjustment that the statement most closely typifies is:

1. Taking hold
2. Working through

C.    Taking in

4. Letting go

80. A mother chooses to bottle feed her newborn because this will cause the least interference with full resumption of her teaching practice. Before discharge the nurse should teach her that if breast engorgement occurs, she should

1. Take 2 aspirins every 4 hours
2. Apply hot compresses to the breasts

C.    Wear a tightly fitted brassiere

4. Cease drinking milk for 2 weeks

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

OB Questions with Answer I

1. True labor can be differentiated from prodromal or false labor in that in true labor there is a

A.    Strengthening of uterine contractions with walking

2. Failure of presenting part to descend
3. Lack of cervical dilation
4. Cessation of uterine contractions with walking

2. Which of the following statement best describe the characteristic of true contraction?

1. True contractions begin in the lower abdomen
2. True contractions are difficult to determine because they come and go

C.    True contractions have a regularity and become more intense over time

4. True contractions decrease with activity

3. The nurse is assessing between false and true labor. What does she ask the patient to do?

1. Bear down

B.    Walk around

3. Time the contractions
4. Do breathing exercise

4. The birth hazard unassociated with breech delivery is:

1. Intracranial hemorrhage

B.    Cephalhematoma

3. Compression of the cord
4. Separation of placenta prior to delivery of the head

5. Assessment findings indicate that patient is 3 cm dilated, and contractions every 6 minutes lasting 40 seconds. The nurse should monitor the FHT

1. Every 15 minutes
2. Every   30 minutes

C.    Every 60 minutes

4. Every 90 minutes

6. When a patient is admitted to the unit in active labor. What is the initial action the nurse should take?

1. Assess for ruptured membranes

B.    Take V/S and check FHT

3. Perform the Leopold’s maneuvers
4. Catheterize for urine specimen

7. Which of the following statement best describe a normal female pelvis

A.    Sacrum well hollowed, coccyx movable, spines not prominent, wide pubic arch

2. Flat sacrum, movable coccyx, prominent spines, wide pubic arch
3. Sacrum deeply hollowed, immovable coccyx, narrow pubic arch, spines not prominent
4. Flat sacrum, movable coccyx, prominent spines, wide pubic arch

8. The most effective method of determining if the pelvis is adequate to allow the passage of the fetus vaginally is:

1. Pelvimetry

B.    X-ray examination

3. Assessment of characteristics of contractions
4. Duration of labor

9. What does it mean during labor when the nurse assesses the fetal presenting part at “plus one”?

1. One inch above ischial spines
2. One inch below ischial spines

C.    One cm above ischial spines

4. One cm below ischial spine

10.The nurse should be aware that which of the following variations in FHT may be considered normal

1. Decrease in rate during the second stage of labor

B.    Decrease in rate during the midportion of contraction

3. Increase in rate following the rupture of membranes
4. Increase in rate when engagement begins

11. The nursing assessment of a woman in labor reveals contractions lasting 60 seconds and 4 minutes apart; cervix is 6 cm and dilated. The woman is in what phase of the first stage of labor?

1. Latent phase

B.    Active phase

3. Transition phase
4. Early phase I

12. Nursing assessment reveals active labor, breech presentation, ruptured membranes and passage of meconium stained amniotic fluid. The nurse valuates this as:

1. A fetus in distress

B.    A normal assessment

3. A sign of labor is progressing
4. Indicative of CS

13. The bag of water is ruptured artificially when the fetal head is engaged in order to

1. Enable the bag of water to rupture spontaneously if possible, thus avoiding difficult and painful instrumentation
2. Prevent prolapse of the umbilical cord during the forceful expulsion of amniotic fluid from the sac
3. Ensure that small amount of amniotic fluid would be left in the upper portion of the amniotic sac
4. Have the amniotic sac in a dependent position that could be reached without difficulty

14. The cervix is considered completely dilated when the diameter of the os is:

1. 6 cm
2. 8 cm

C.    10 cm

4. 12 cm

15. In timing the contraction the nurse should notify the physician if she detects a contraction lasting longer than

1. 30 seconds

B.    60 seconds

3. 90 seconds
4. 120 seconds

16. The mechanics of the second stage of labor differ from the first stage in that during the second stage

1. The lower uterine segment contracts more than the fundus

B.    The abdominal muscles assist in the expulsion of the fetus

3. The joint of the pelvis are stretched and dislocated
4. All muscles involved in fetal propulsion undergo Tetany

17. The fetal head is engaged when

1. The vertex of the skull is level with the symphysis pubis

B.    The biparietal diameter has passed the pelvic inlet

3. The head rotates from the transverse to the AP position
4. The head has descended beyond the external os

18. To determine the fetal position during labor the nurse should assess which of the following

1. First body part of the fetus felt by the nurse upon vaginal examination

B.    Relationship of a fixed point of the fetus to the quadrants of the maternal pelvis

3. Relationship of the furthermost fetal part to the ischial spines of the maternal pelvis
4. Relationship of the long axis to the mother’s body

19. During the early second stage of labor FHT should be taken at least every

1. 2-4 minutes
2. 5 to 10 minutes

C.    10 to 20 minutes

4. 20 to 30 minutes

20. The changes in shape of the infant’s head that occur owing to pressure from the walls of birth canal are called

A.    Molding

2. Cephalhematoma
3. Microcephaly
4. Caput succedaneum

21. If crowning occurs while the nurse is alone with the patient, the nurse should

1. Place a sterile water over the infant’s head and apply manual pressure until a physician arrives
2. Place a mask over the woman’s face and administer a few drops of ether to delay the delivery
3. Call for help, stay with the patient and guide the slow delivery of the head between contractions
4. Instruct the woman to hold her knees together and leave to obtain help from an experienced nurse

22. The most common position for the fetus at birth is

1. Right occiput anterior

B.    Left occiput anterior

3. Right occiput posterior
4. Left occiput posterior

23. The second stage of labor ends with

1. Complete cervical dilation
2. Bulging of the perineum

C.    Delivery of the baby

4. Removal of the placenta

24. The fetal heart rate variability is not affected by

A.    Maternal sleep

2. The second stage of labor
3. Fetal sleep
4. Maternal drug use

25. The nurse is timing the contractions in a patient who is 7 cm dilated. The nurse should time the contractions

1. From the beginning of a contraction to end

B.    From the beginning of a contraction to the beginning of the next

3. From the end of a contraction to the beginning of the next
4. From the end of a contraction to the end of the next contraction

26. A woman in labor comes to the labor and delivery area with ruptured membranes, contractions that occur every 3 minutes and last 50 to 60 seconds. The fetus is in the LOA position. The nurse’s first action should be to:

A.    Check the FHR

2. Call the physician
3. Check the vaginal fluid with nitrazine paper
4. Admit the patient to the labor and delivery area

27. A woman in labor was admitted with ruptured membranes. Assessment indicates that the FHT is audible in left lower quadrant. When asked to describe the amniotic fluid, the woman states that it was brown-tinged. This indicates that

1. The fetus has an infection

B.    At some point, the fetus experienced oxygen deprivation

3. The fetus is in distress and should be delivered immediately
4. The fetus is not experiencing any undue stress

28. An electronic fetal monitor is attached. The fetal monitoring strip shows an FHR deceleration occurring about 30 seconds after each contraction begins; the FHR return to baseline after the contraction is over. This type of deceleration is caused by:

1. Fetal head compression
2. Umbilical cord compression

C.    Uteroplacental insufficiency

4. Cardiac anomalies

29. The fetal monitoring strip shows an FHR deceleration occurring about 30 seconds after each contraction begins; the FHR return to baseline after the contraction is over. With this type of deceleration, the nurse’s first action should be to:

1. Increase the IV flow rate
2. Call the physician

C.    Position the woman in labor on the left side

4. Continue monitoring the FHR

30. A woman is active labor cries out, “I’m feeling a lot of pressure. I want to push.” The nurse notes that her cervix is dilated 7 cm. How should the nurse respond?

1. Tell the woman to begin to push, then call the physician
2. Tell the woman to breath by blowing air through her mouth when she feels the urge to push
3. Instruct the woman to breath when she gets the urge to push
4. Instruct the woman to hold her breath when she gets the urge to push

Legal Aspects of Nursing Notes III

Writing an Incident Report

-  A tool used as a means of identifying and improving client care. They are usually made

   immediately after its occurrence and validated immediately by co-workers.

-  the real purpose is to provide accurate documentation of occurrences affecting the client as

   to have basis for its intervention.

-  it is usually made as a comprehensive & accurate report on any unexpected or unplanned

   occurrence that affects or potentially affects his family or other members of the health team.

                                   

      The following are common situations that require an incident report:

                             MOST OF THEM ARE NEGLIGENT NURSING ACTS

a.    Falls , Burns & medication error

b.    Break in the aseptic technique

c.    Incorrect sponge count during surgery

d.    Failure to report the clients condition

   Rules in Incident Report

 Don’t use the word error or include lawful judgment or inflammatory words

Legal Rules on Documentation, Charting & MD’s Order

Documentation

- Legally required by accrediting agencies, state licensing laws and state nurse and medical

  practice acts.

-required for insurers reimbursement

- legal documentation that signifies proper communication about the patients condition

Question: What should be written in the nurses notes?

            All facts and information regarding the patients condition, treatment, care, progress and

     response to illness and treatment.

            Document consent or refusal of treatment.

Question:    How should data be recorded? Entries should:

1.    State date and time given.

2.    be written, signed & titled by caregiver or supervisor who observed action

3.    follow chronological sequence

4.    Be accurate, factual, objective, complete , precise and clear

5.    Use universal abbreviations. Example: prn, b.c.

6.    be legible; black pen

7.    Have all spaces filled in, leave no blank spaces.

8.    Avoid judgmental or evaluative statements such as “ uncooperative client”

9.    Do not document for others or change documentation for other individuals

Question: Should I accept verbal phone orders from an MD?

            Generally, NO. Specifically, follow your hospitals by laws, regulations and policies regarding this. Failure to follow the hospital’s rules could be considered NEGLIGENCE.

            In cases when verbal orders are deemed necessary the following outline may find helpful

                                    REGARDING TELEPHONE ORDERS:

1.    date and time entry

2.    repeat the order to the MD & record the order

3.    sign the order, begin with t.o. ( telephone order), write the MD’s name & then signature the order

4.    if another nurse witnesses the order, that signature follows

5.    The physician needs to countersign the order within the time frame according to hospital or agency policy. 

Question: Should I follow an MD’s order if I know it is wrong? ]

            No. If you think a reasonable prudent nurse would not follow it; but first inform the MD and record your decision. Report it to your supervisor.

            Should I follow an MD’s order if I disagree with his or her judgment?

            Yes. Because the law does not allow you to substitute your nursing judgment for a doctors medical judgment. Do record that you questioned the order and that the doctor confirmed it before you carried it out. In order to be safe, check the agency policy manual of your work.

Question: What can I do if the MD delegates a task to me for which I am not prepared?

            Inform the MD of your lack of medication and experience in performing the task. Refuse to do it. If you inform him or her and still carry out the task, both you and the MD could be considered NEGLIGENT if the patient is harmed by it. If you do not tell the MD and carry out the task, you are solely liable.

                                           Liability for Mistakes

Question:  Is the hospital or the nurse liable for the mistakes made by the nurse while following orders?  Both the nurse and hospital can be sued for damage if a mistake made by the nurse injures the patient. The nurse is responsible for his or her own actions. The hospital would be liable, based on the doctrine of Respond eat Superior.

Question: For what would I be liable if I voluntarily stopped to give care at the scene of an accident?  The GOOD SAMARITAN ACT – protects health practitioners against malpractice claims resulting from assistance provided at the scene of an emergency ( UNLESS THERE WAS WILLFUL DOING) as long as the level of care provided is the same way as any other reasonably prudent person would give under similar circumstances. It also encouraged health care professionals to assist in emergency situations without fear of being sued for the care provided. These laws limit liability and offer legal immunity for people helping in an emergency, providing they give reasonable care. 

                                                                                                                                               

                                             Organ Donation

Requirements:

1. Any person 18 years of age or older may become an organ donor by written consent.
2. Informed choice to donate an organ can take place with the use of a written document signed by the client prior to death, a will, or a donor card or an advance directive.
3. In the absence of appropriate documentation, a family member or legal guardian may authorize donation on the descendant’s organs.
4. In case of newborns, they must be full term already ( more than 200 grams)

Laws that Protect potential donors to Expedite acquisition:

1.    National Organ Transplant Act: prohibit selling of organs

2.    Uniform Anatomical Act: guidelines regarding who can donate, how donations are to

Be made, and who can receive donated organs.

3.    Uniform Determination Death Act: Legal determination of brain death ( absence of

       breathing movement, cranial nerve reflex,  response to any painful stimuli and cerebral

       blood flow and flat EEG.

Management of Donor

1.    Maintain body temperature at GREATER than 96.8 F with room temperature at 70 -80 F warming blankets, warmer for IV fluids.

2.    Maintain greater than 100% PaO2 and suction/ turn & use (PEEP) positive End expiratory pressure to prevent hypoxemia caused by airway obstruction & pulmonary edema.

3.    Maintain CVP (Central Venous Pressure) at 8 to 10 mm Hg and systolic blood pressure at greater than 90 mm Hg to prevent Hypotension.

4.    Maintain Fluid & Electrolyte balance due to volume depletion

5.    Prevent infections due to invasive procedures.

Religions that have different views regarding organ donations

1. Russian Orthodox: permits all donations EXCEPT THE HEART.
2. Jehovah’s Witness: DOES NOT ALLOW organ donation and all organ to be

                                         transplanted must be drained of blood first.

3. Judaism: They permit organ donation as long as with RABBINICAL CONSULTATION.
4. Islam: will NOT USE ORGAN STORED IN ORGAN BANKS.

                                                                                                                                                           

                    Do not Resuscitate (DNR)

Factors in giving order of resuscitation:

1. Client’s will and advance directives

2.  Disease Prognosis such as cancer or HIV

3. Client/s ability to cope

4. Whether CPR will be given or not

Reasons for refusing to perform resuscitation

1. Epidemic or widespread disease or debilitating condition & that CPR is not beneficial
2. CPR will aggravate or prolong the agony of the client
3. against cultural & religious suffering
4. Advance directives & Will

                                                                                                                                               

Voluntary Admission versus Involuntary Admissions

Voluntary Admissions:

Requirements & By Laws

1. Lawful or of legal age
2. If the client is too ill, a guardian is possible
3. Client agrees to accept the treatment
4. The client is free  to sign him or herself out of the hospital- Has the right to demand & receive RELEASE.

 Involuntary Admissions

                              Requirements & By Laws

1. Deemed necessary for the following reasons & criteria:
1. Danger to self & others
2. need psychiatric or physical care
3. State laws have been determined legally by the state
2. The client who is involuntarily admitted does not lose his or her right of informed

       consent.

 Question: What is the meaning of Conditional Release?

-          usually requires outpatient treatment for a specified period of time to determine the

      client’s compliance with medication protocol , ability to meet basic needs and ability

      to reintegrate to community.         

        

                                   Other Laws to be Remembered

Tarasoff Act- if there are manifestations that a patient has some suicidal tendencies, it is the duty on the part of the nurse of a threatened suicide or possible harm or threat to others. There must be the proper dissemination of information to other members of the health care team.

Occupational Safety & Health Act- requires that an employer provide a safe work place for employees according to regulations. Employees can confidentially report UNSAFE WORKING CONDITIONS that violate regulations.  A PERSON WHO DOES NOT REPORT UNSAFE WORKING CONDITIONS CAN BE RETALIATED AGAINST BY THE EMPLOYER.

M’Naghten Rule (1832) - a person is guilty if:

a.    person did not know the nature and quality of the act

b.    Person could not distinguish right from wrong, if the person does not know what she / he is doing or a person does not know it was wrong.

Irresistible Impulse Test (used together with M,Naghten Rule) – person knows right from wrong, but:

a.    Driven by impulse to commit criminal acts regardless of consequences.

b.    Lack premeditation in sudden violent behavior.